bluuebunny/crossref_metadata_2025 huggingface dataset:
Population wellbeing and psychosocial burden during the COVID-19 Pandemic in Germany – results from (bi-)weekly monitoring data and the resulting health promoting activities on the national level
Authors: De Bock F
Published: October 2021

Since march 2020, data on risk perception, behavior and psychosocial wellbeing of the population with regard to the COVID-19 pandemic have been collected regularly (biweekly to weekly) in Germany as part of the COVID-19 Snapshot Monitoring (COSMO). The data i.e. show that the psychosocial burden is higher in specific population subgroups, such as younger adults and families.

Based on these data, the Federal Centre for Health Education as part of the federal government developed health promoting activities on the national level to maintain wellbeing and buffer the burden. Over the course of the pandemic, these activities changed dynamically according to the differing situation (lock-down, incidence). With the second wave, as incidences increased dramatically without vaccination available, the activities were expanded from a web-based platform ‘Psychisch stabil bleiben' (Mind your mental health), supported by a nationwide telephone counseling service, to a nationwide mail distribution of postcards in five different languages, with links to the virtual platform and various telephone counselling services. The website offers information on coping strategies and psychotherapeutic services, edited for specific population groups (e.g. parents, people with preexisting mental illness, health professionals) in five different languages. The postcards were distributed through primary care providers, pharmacies and social services in socially disadvantaged geographical areas, trying to increase reach in vulnerable populations.
Mind the gap: population ageing and health financing sustainability
Authors: Cylus J , Williams G , Barber S , Roubal T
Published: October 2021

Background

Models used to forecast the effects of population ageing on health financing usually only explore effects on health spending, while neglecting effects on health revenues.

Methods

Using publicly available data, we construct simulation models to project how changes in the population age mix affect both public sector health revenues and expenditures across a range of countries representing a diverse mix of health financing systems in Europe as well as the Western Pacific (Australia, Bulgaria, Japan, Slovenia, United Kingdom and Vietnam).

Results

By 2100, the largest gap between health revenues and expenditures due to population ageing under current health financing arrangements is expected in Vietnam; the majority of that health financing gap (87.1%) is attributable to expected growth in health expenditures. In Slovenia and Japan, the financing gaps are forecast to reach less than half that of Vietnam by 2100; however, the reasons for the increases in gaps vary. In Slovenia, nearly half of the increase in the gap (44.2%) is due to reductions in health revenues compared with just under one-third (28.7%) in Japan.

Conclusions

There is a perception that population ageing will have deleterious effects on the sustainability of public sector health financing. However, this is highly dependent on how financing systems are designed. Our simulation models demonstrate that comparative analyses that give equal attention to both health expenditures and revenues provide decision makers a balanced set of policy options for addressing the challenges of population ageing. The options range from targeting expenditures and utilization of services to diversifying revenue generation.
A Scoping Review on the Role of Access toward achieving Universal Health Coverage in Oral Health
Authors: Ghanbarzadegan A , Balasubramanian M , Luzzi L , Brennan D , Bastani P
Published: October 2021

Background

Improving access to health services is a way towards achieving Universal Health Coverage (UHC) in oral health. The purpose of this review was to map the determinants of access to dental services within a UHC framework.

Methods

Scoping review methods were adopted for the review. PUBMED, Scopus, ISI Web of Science and ProQuest were searched for academic literature on determinants of access to dental services in OCED countries. Articles published in the last 10 years were included. No restriction was placed on study methods; only articles in the English language were included. Qualitative synthesis was conducted, also including trend analysis and mapping exercise

Results

A total of 4320 articles were identified in the initial search; 60 articles were included in the qualitative synthesis. The results indicate 7 main themes as the determinants of access to dental services: family level, culture, health status, affordability of services, Social environment, geographic and transportation. Defined determinants of access to dental services, family-level factors, culture and geographical access to dental services, can fill the population axis of the UHC cube. Social environment determinants and affordability of services fill the gap of financial protection as another axis of the UHC cube and finally, availability of dental services and the individual's health status are aligned with the appropriateness of services, the third axis of the UHC cube.

Conclusions

This scoping review has identified family-level and cultural, health status, affordability, and availability of services, social environment, and geographic factors contributing towards the inequality in access towards dental services. In addition to considering these main determinants, it is important for policymakers to pay more attention to social and cultural access determinants.

Key messages

An exact definition of access to services should be defined and implemented in the dental literature. Health Policymakers besides considering the derived themes of access into dental services should pay attention to social and cultural access determinants.
Self-reported sick leave following a brief preventive intervention on work-related stress
Authors: Hultén A-M , Bjerkeli P , Holmgren K
Published: October 2021

Background

General practitioners (GPs) play an important role for early identification and prevention of sick leave among patients perceiving ill health due to work-relates stress. In order to fulfil the role, they need adequate methodologies and tools. This study aimed to evaluate the effectiveness of a brief intervention in primary health care including early identification of work-related stress combined with feedback at consultation on the number of self-reported sick leave days.

Methods

A randomised controlled trial was performed at seven primary health care centres in western Sweden. Self-reported sick leave data collected between November 2015 and January 2017 were analysed prospectively. The study included 271 employed, non-sick-listed patients aged 18-64 years seeking care for mental and/or physical health complaints. The intervention group received a brief intervention about work-related stress, including training for GPs, screening of patients' work-related stress, feedback to patients on screening results and discussion of measures at GP consultation. The control group received treatment as usual.

Results

At 6-month follow-up 59/105 (56%) in the intervention group and 61/115 (53%) in the control group reported no sick leave. At 12-month follow-up the corresponding numbers were 61/119 (51%) and 57/122 (47%) respectively. There were no statistically significant differences between the intervention group and the control group in the median number of self-reported sick leave days.

Conclusions

The brief intervention showed no effect on the numbers of self-reported sick leave days. However, using sick leave as an outcome measure was difficult, as sick leave is multifactorial and the data has a non-normal distribution. In addition, sick leave might be used as an indicator as well as a possible treatment of ill health. Other actions and interventions to address patients perceiving ill health due to work-related stress should be explored.

Key messages

Sick leave is used as an indicator and as a treatment of ill health, which can complicate the evaluation of studies. The complexity of primary health care trials calls for other evaluation methods.
Referral to treatment of absent employees diagnosed with burnout in the Netherlands
Authors: de Rijk AE , De Witte J , van Steenderen S , Schaufeli WB
Published: October 2021

Background

Despite large amounts of research on determinants of burnout, research on its treatment is scarce. In the Netherlands, occupational physicians (OPs) can officially diagnose burnout and have to offer return-to-work (RTW) guidance to employees on sick leave, which includes referral to treatment. This research aimed to explore 1) characteristics of treatment for burnout and 2) how employee-, complaint- and employer characteristics relate to referral to treatment by the OP and to employee RTW expectation.

Methods

All 212 employees (45% male, 42.5 years of age, 35% high educated) diagnosed with burnout at one occupational health service during February-June 2020 were included. Register data (gender, age (years), education, organization size) and self-reported data collected online (living situation; Burnout Assessment Tool (BAT) score; cause of absence mainly work-related (0/1); treatment (0/1); on waiting list (0/1); type of treatment; treatment focused on RTW (0/1); employee RTW expectation high (0/1)) were tested with Chi2, ANOVA and logistic regression analyses.

Results

Of all employees, 75.9% (n = 161) were referred to treatment by their OP, of which 25.5% (n = 41) were currently on a waiting list. The majority received treatment from a nurse practitioner (51.7%) or psychologist (23.3%) These practitioners focused on RTW less often (51.6%-60.7%) than the other practitioners (81.5-100%) (p = 0.042). Multivariate tests showed age to relate to referral to treatment (OR 0.956; 95% CI 0.928-0.986) and BAT score to employee RTW expectation (OR 0.635; 95% CI 0.407-0.991).

Conclusions

OPs referred three quarters of the employees on sick leave with burnout to treatment. Referral by OPs related only to younger age and employee RTW expectation only to BAT score. The practitioners that were referred to most often, focused less on RTW. As burnout is a work-related syndrome, these findings suggest room for improving the treatment's focus on (returning to) work.

Key messages

OPs referred 75.9% of the burned out employees on sick leave to treatment, particularly younger employees. The practitioners that were referred to most often, focused less on RTW.
Socioeconomic differences in major depressive disorder onset and the role of lifestyle factors
Authors: Hoveling LA , Liefbroer AC , Schweren LJS , Bültmann U , Smidt N
Published: October 2021

Background

Major depressive disorder (MDD) onset strongly varies by socioeconomic position (SEP). One of the pathways that could explain the SEP-MDD onset relationship is via lifestyle factors, but little is known about this pathway. This study aims to disentangle the complex interplay between SEP measures, education, income and occupational prestige, and MDD development and to what extent the associations are mediated by lifestyle (related) factors, occupational and leisure time physical activity, smoking, alcohol intake, diet quality, sleep and central adiposity.

Methods

An adult subsample (n = 76,045) of the Lifelines Cohort Study without MDD at baseline was used. MDD onset was measured after a median follow-up time of 3.8 years with the Mini International Neuropsychiatric Interview (MINI). Direct associations between the SEP measures, the lifestyle factors and MDD onset were estimated, independent of age, sex, depression history and time between baseline and second assessment, using logistic regression analyses. Mediating percentages were estimated using the Karlson-Holm-Breen method.

Results

A total of 1,864 participants (2.5%) developed MDD during follow-up. Education, income and occupational prestige were inversely associated with MDD onset. Educational differences in MDD onset were for 18.7% explained by lifestyle factors, with smoking (9.1%) and central adiposity (6.7%) being the strongest mediating factors. Income differences in MDD onset were for 5.9% explained by lifestyle factors, with alcohol intake (4.0%) and central adiposity (2.6%) being the strongest mediating factors. Occupational prestige differences in MDD onset were not explained by lifestyle factors.

Conclusions

Individuals with a higher education, income or occupational prestige had a lower risk of MDD onset compared to their lower SEP counterparts. This was mainly due to a healthier lifestyle, with smoking, alcohol intake and central adiposity being the most important factors.

Key messages

Education, income and occupational prestige were inversely associated with MDD onset. Educational and income differences were mainly explained by smoking, alcohol intake and central adiposity.
Urban health guidelines implementation: evidence and practice
Authors: Vigezzi GP , Barchiesi AT , Alquati M , Voltini E , Gianfredi V , Odone A , Signorelli C
Published: October 2021

Issue

Urban planning plays a crucial role in healthy lifestyle promotion, impacting physical activity and non-communicable diseases prevalence. National and regional strategies rely on an integrated approach. Under the chapter of collective prevention and public health, the new LEA (Assistance Essential Levels) include evaluating land-use plans (PGT in Italy) with a preventive assessment on the relationship between health and urban environment.

Description of the problem

The Italian Ministry of Health and the Lombardy Region with Polytechnic University of Milan proposed good practices for health impact evaluation of urban and environmental interventions of regeneration and redevelopment. After bibliographic research, on-site and on-field training, community practice and experts' evaluation, a multicriterial tool was built. A set of indicators (7 macro-areas) was selected to measure the propensity of urban plans to promote health. In 2020 the new guidelines were introduced in the administrative process of health impact assessment for receptors and of quinquennial PGT re-evaluation.

Results

The Health Protection Agency of the Po Valley (provinces of Cremona and Mantova, in Northern Italy) was asked to produce 344 judgements on civil buildings during 2020. Among them, 12 opinions referred to partial variations of PGT in 12 different municipalities. No comprehensive urban plan evaluation was requested in 2020.

Lessons

PGT evaluation through the proposed tool allows estimating the capacity to control population risk factors and promote a context organized to satisfy social needs and improve quality of life. In the rural context of small municipalities of Cremona and Mantova, an encountered limitation was the small size of urban centres. Thus, applying strategies conceived for metropolitan areas was challenging. A contextual evaluation of bordering municipalities urban plans would be desirable to promote bigger-scale interventions about transports, soil use and emission sources.

Key messages

Applying urban health good practices to land-use plan evaluation in rural areas with small municipalities poses some issues due to reduced interventions scale. It would be helpful to promote the simultaneous evaluation of bordering municipalities' urban plans so as to suggest integrated health interventions on a larger scale.
Prevention of breast&ovarian cancer in women with BRCA-1/2 mutations - A decision-analytic evaluation
Authors: Hallsson LR , Sroczynski G , Engel J , Siebert U
Published: October 2021

Background

Women who have inherited BRCA-1/2 mutations have substantially elevated lifetime risks for developing breast and/or ovarian cancer and may develop these cancers around age 30. Therefore, breast and ovarian cancer prevention should be administered relatively early in life for those women. We systematically evaluate the long-term effectiveness and cost-effectiveness of different breast and ovarian cancer prevention strategies in women with BRCA-1/2 mutations in Germany.

Methods

A decision-analytic Markov model simulating lifetime breast and ovarian cancer development in BRCA-1/2 carriers was developed to evaluate different strategies including intensified surveillance (IS), prophylactic bilateral mastectomy (PBM), and prophylactic bilateral oophorectomy (PBSO) alone or in combination at different ages. German clinical, epidemiological and cost (in 2018 Euro) data were used. Outcomes included cancer incidences, mortality, life years (LYs), quality-adjusted life years (QALYs), and discounted incremental cost-effectiveness ratios (ICER).

Results

All intervention strategies are more effective and less costly than IS alone. Prevention with PBM plus PBSO at age 30 maximizes life expectancy with 6.3 LYs gained, whereas PBM at age 30 with delayed PBSO at age 35 improves quality of life with 11.1 QALYs gained, when compared to IS alone. Both strategies are cost effective with ICER significantly below 10,000 EUR/LY or QALY gained.

Conclusions

Based on our results, PBM at age 30 plus PBSO between age 30 and 40 prolongs life and is cost effective in women with BRCA-1/2 mutations in Germany. Serial preventive surgeries with delayed PBSO potentially improve quality of life for women. We therefore suggest that efforts should be directed to carefully and thoroughly inform women with BRCA-1/2 mutations about their options to prevent breast and ovarian cancer.

Key messages

Prophylactic mastectomy at age 30 combined with prophylactic oophorectomy between age 30 and 40 may prolong lives and be cost effective in German women with BRCA- 1/2 mutations. Women’s quality of life might be improved by a delayed prophylactic oophorectomy after a prophylactic mastectomy.
Mortality in residential care services for people with disabilities in Ireland
Authors: McMahon M , Dunbar P , O’Connor A , Grogan C , Dunnion M , O’Connor L
Published: October 2021

Background

All-cause mortality is higher in people with disability than in people without disability. There is a need for descriptive epidemiological studies of deaths in people with disability to inform the development of public health interventions. All deaths in residential disability services in Ireland are notified to the Chief Inspector in the Health Information and Quality Authority (HIQA). These include notification of unexpected and expected deaths. The herein aim was to describe total, unexpected and expected deaths, and identify leading causes of death in residential disability services in Ireland.

Methods

Data on deaths in residential disability services in 2019 and 2020 were extracted from the Database of Statutory Notifications from Social Care in Ireland. The number of total deaths was calculated along with the percent and number of unexpected and expected deaths. The primary cause of death notified by services was coded using ICD-11 chapter headings.

Results

During 2019 and 2020, on average 9,115 people resided in residential disability services. Of these, 395 died, of which 45% (n = 178) were notified as unexpected. The leading causes of unexpected deaths were respiratory system diseases (35%, n = 62) and circulatory system diseases (18%, n = 32). The leading causes of expected death were respiratory system diseases (41%, n = 89) and cancers (31%, n = 67).

Conclusions

Almost half of deaths in residential disability services were notified as unexpected. Respiratory disease was the leading cause of both expected and unexpected death in people with disability residing in residential services in Ireland; three-fold the general Irish population (10.7%). Public health interventions aimed at reducing respiratory disease may reduce deaths in this group.

Key messages

In 2019 and 2020, nearly half of deaths of people with a disability residing in residential services were notified as unexpected. Death from respiratory diseases was substantially higher in people with disability living in residential services in Ireland than in the general population and warrants public health intervention.
How would the HSPA framework play out in practice? ‘Effectiveness (Service Delivery)'
Authors: Karanikolos Marina
Published: October 2021

In this presentation we examine the role of effectiveness for the HSPA framework. Effectiveness is considered a final health system goal. Additionally, it is an assessment area of the service delivery function and its sub-functions and is therefore also considered as well as an intermediate goal of the health system.
Sharing of public health information in response to maritime outbreaks – report from an exercise conducted at a European level
Authors: Kourentis L , Kostara E , Christoforidou E , Mouchtouri V , Hadjichristodoulou C , Militzer K , von Münster T , Ehlers L , Dirksen-Fischer M , Heidrich J
Published: October 2021

Background

Inter-country communication and structured information flow is of major importance in outbreak management potentially affecting more than one country, particularly in case of a public health event of international concern. Though there are established communication systems in European Member States (MS), public health events in the maritime sector challenge authorities and stakeholders.

Methods

Guidelines for inter-country communication developed by the joint action were tested via a 1-day web-based multi-sectorial, discussion-based table-top exercise (TTE) for ports at European level. Two outbreak scenarios (gastroenteritis and COVID-19) on passenger ships in separate regions (Mediterranean, North Sea) were acted out consecutively.

Results

Thirty participants and 63 observers from 20 MS, cruise ships, international and European institutions took part in the TTE. The TTE identified two different information flows: (1) authorities at local level implementing public health measures on ships share information with the next and previous ports of call, either directly or via national level authorities using different platforms depending on the event without clearly predefined criteria and (2) the ship captain sends health information to the next port of call (via the National Single Window or Email or Telephone or other means). Relying on communication via emails and telephones however, has limitations: a) limited access, b) no central data storage, c) historical data unavailable. Lack of communication channels for feedback to the ship and of coordinating and closing an event was evident.

Conclusions

A successfully conducted European TTE in maritime outbreak scenarios identified lack of clear international communication as communication channels were not always clear and depend on local/national conditions. There is potential for improving international communication. Guidelines for inter-country communication in this setting may help enhance communication practice.
What is next? Vision statement and reflections for sustaining project outcomes in a possibly post-pandemic era
Authors: Heidrich J , Militzer K , Mouchtouri V , Dionisio M , Janiec J , Kairiene B , Otorepec P , Timen A , Dirksen-Fischer M , Hadjichristodoulou C
Published: October 2021

Introduction

The ongoing COVID-19 pandemic has demonstrated the importance in strengthening cooperation and coordinated action of Member States (MS) to improve preparedness and response capacities at points of entry (PoE). This emphasizes the need for perpetuating the work of EU HEALTHY GATEWAYS (EU HG) and the availability of this cross-European network to transfer lessons learned for future public health threats.

Methods

An interdisciplinary sustainability working group identified options for continuity of activities at EU level and provided a template national sustainability plan to be adapted by MS based on national needs and priorities.

Results

Since the beginning of the pandemic EU HG provided 37 consultations to MS, developed 15 advice documents, delivered training courses, produced a study on preparedness and response at PoE and developed the EU digital Passenger Locator Form (EUdPLF) system. A European web-based network for PoE was developed including discussion forums, e-learning platform, searchable network of professionals' at PoE registry, bibliographies, web-based training resources and best practice catalogues. Overall, the 533 inspectors in the EU SHIPSAN INFORMATION SYSTEM (EU SIS) recorded 29268 IHR (International Health Regulations) certificates, followed up 69 public health events via the communication network for EU ports, and recorded >4600 hygienic deficiencies.

Conclusions

EU HG has a holistic approach, supporting operations on local, regional, national and European level and by taking into account all transport sectors. The web-based systems and capacity building activities support EU Decision 1082/2013/EU for serious cross-border health threats and the EUdPLF supports implementing Decision (EU) 2017/253 for the contact tracing of passengers identified through PLFs. Adoption of components of EU SIS will support implementation of Regulation (EU) 2019/1239 which includes the provision of a common ship sanitation database.
The influence of the COVID-19 pandemic on the prevalence of severe injuries in The Netherlands
Authors: Blatter B , Krul IM
Published: October 2021

Our goal was to study the influence of COVID-19 measures and coinciding changes in activities on the prevalence of severe injuries treated at the Emergency Departments (EDs) in The Netherlands. We performed a retrospective observational study with data from the Dutch Injury Surveillance System (DISS) and compared prevalences of ED-visits during lockdown period (March 16 - May 10 2020) with prevalences in the same period in 2019. We also compared a period from May 11 to July 5 2020, in which the measures were relaxed, with the same period in 2019. To exclude a possible effect of avoiding hospitals and EDs duet o COVID-19, we included only treatments for severe injuries. The prevalence of ED-visits due to severe injuries was 27% lower during lockdown than during the same period in 2019 (6755 vs. 4902, p < 0,05). This decrease was seen among all types of injuries and all age categories, but was largest within sports injuries and among 10-19 year old persons (-55%). Opposite to those decreases we saw increases in specific types of injuries such as doing home maintenace work (+31%), and skeelering or skating. (+233%). Among 0-11 year olds, the prevalence of injuries due to trampoline use increased by 68%. During the relaxation period regarding COVID-19 measures, the prevalence of severe injuries increased by 19% compared to lockdown, but was still 11% lower than compared with the same period in 2019. We concluded that changes in activities due to COVID-19 measures during lockdown have led to changes in the number of severe injuries treated at the ED. Variations in prevalence primarily seem to relate to variations in sports and traffic participation, and stay in and around the home.
The European Union Confronts COVID-19
Authors: Greer S , Brooks E
Published: October 2021

Issue

The politics of European Union (EU) health policy are also the politics of European integration. Debate about EU policies always entails debate about the appropriate role and powers granted to the EU.

Description

From some angles, the EU looks more like a federation (ex EUA), deeply entrenched in its citizens' lives. It has a powerful shared culture among leaders and strong, entrepreneurial, and statelike political institutions. Its legal system is entwined with member state law to such an extent that member state courts have driven legal integration and change as much as EU institutions, both in general and in health. From another angle, it still looks like an international organization (ex WHO) or a regional trade block (ex Mercosur). We ask what policy a member state might make, but, in the case of the EU, many ask if the EU should have a policy at all. Should it respond, and, if so, how and to whose benefit?

Results

Like international organizations or confederations, though, the EU responds primarily to and is shaped by the demands of its member states. They have actively maintained this dichotomous structure so as to prevent transfer of power and loss of sovereignty. Member states ultimately determine the direction of the EU, and they have supported EU expansion only when they require a “European rescue of the nation state”.

Lessons

The EU's weak public health and social policy responses to the crisis reflect this effort on the part of member states to limit its role over the decades, whereas the major expansion in its role over the summer of 2020 reflects the perceived interests of member states, which now seek another European rescue of the nation state.

Main messages

This crisis of COVID-19 leave behind a different EU. Between the redefinition in salience, resource, and law of public health, shared European actions and the development of EU debt for member states, it is likely that a step forward promoted integration in health and beyond.
Three Approaches to Handling the COVID-19 Crisis in Federal Countries
Authors: Czypionka T , Reiss M
Published: October 2021

Issue

Despite their geographical and cultural proximity, Germany, Austria, and Switzerland can teach very different lessons on how to handle the COVID-19 pandemic. Timing and severity of outbreaks during the first wave were fairly similar in Germany and Austria, whereas Switzerland faced a higher infection rate at the peak of the crisis (although far from rates in France or Italy).

Description

The aim of this presentation is to examine the outbreak responses of the three countries in the spring of 2020 and give insight into the dynamics and rationales behind these responses.

Results

Although the three countries are all prime examples of federalism, Austria and Switzerland showed a decisive, uniform public health response resulting from epidemic laws granting the central level precedence under such circumstances. In Germany, by contrast, individual state governments played a central role. Response measures eventually taken by the three countries were not too different but how decisions were made and subsequently communicated to the public varied considerably. The three countries fared well in reducing transmission rates and never came close to reaching capacity limits in their health systems during the first wave. However, while all of them experienced a resurgence of infections in fall, the epidemiological development took a diverging course across the three countries in the following months.

Lessons

While all countries were successful in the first wave, differences in the paths chosen are likely to impact adherence to measures and may help explain divergent developments in the subsequent waves.

Main messages

Swift and decisive actions seem to have been successful answers to the first wave of the pandemic, but approaches to implementation and communication of these approaches to the public may make the difference in the further course of the pandemic.
COVID-19 in Central and Eastern Europe
Authors: King E , Loblova O
Published: October 2021

Issue

Countries of central and eastern Europe (CEE) are rarely accustomed to praise when compared to their western European neighbors. During the early months of the COVID-19 pandemic, however, as core European countries such as Italy, Spain, or the United Kingdom reported hundreds of confirmed cases and even deaths per day, all CEE countries managed to contain the disease with considerably lower rates of infection and deaths.

Description

This changed in late summer and fall of 2020, when many CEE countries overtook western Europe in the number of new COVID-19 cases, as well as deaths, per population, but for a few months the region could enjoy its unusual accomplishment. A number of hypotheses have been suggested to explain the surprising containment success in the spring, including the widespread prevalence of the bacille Calmette-Guérin tuberculosis vaccine, lower population density and exposure to tourism, lack of trust in the healthcare system and government in general, low testing numbers (which may have led to underreporting of cases), and an autocratic advantage leaders of imperfect democracies, such as in CEE, enjoy when imposing lockdowns and other restrictive policies.

Results

In the spring, CEE governments implemented strict measures to protect public health at a time when their countries had few COVID-19 cases and deaths at most in the single digits.

Lessons

The Russian approach to addressing COVID-19 reflects the messiness of classifying “regime type.” Some of the responses used were more authoritarian in their approach. A greater flow of information and more transparency in the data would allow a more complete assessment of Russia's response to COVID-19.

Main messages

Creating a “virus of silence,” short- cutting global standards for vaccine clinical trials, and not providing disaggregated and timely data make it difficult to evaluate the reasons for Russia's relatively low case count and low fatality rate.
How to deal with sickness absence among primary school pupils?
Authors: Pijl EK , Vanneste YTM , Mathijssen JJP , Feron FJM , de Rijk AE
Published: October 2021

Background

Missing school can lead to lower educational achievement, early school dropout and health problems. To address sickness absence in secondary schools the intervention Medical Advice for sick reported students (MASS) has been developed. Because of fundamental differences in relation to the children's age and in the schools' organisational structure, the original MASS is not suited to primary schools. The aim of this study was to adapt MASS to primary education.

Methods

The intervention mapping approach steps 1 through 4 were used to adapt MASS to primary schools (MASS-PS), including a literature search, stakeholder interviews and pre-testing.

Results

In step 1, a planning group was formed and a logic model of the problem was created based on a literature search and interviews with stakeholders. In step 2, a logic model of change was created to determine the behavioural and environmental factors that need to change to achieve the goals of the intervention. In step 3, a theoretical basis and practical strategies to adjust MASS to primary education were determined. In step 4, practical support materials were developed and two pre-tests of the materials were performed with stakeholders and end-users.

Conclusions

Intervention mapping was successfully used to adapt MASS to primary schools. The main changes were the lowering of the threshold for extensive sickness, consultations between teacher and absenteeism coordinator and the addition of a social worker and remedial educationalist as experts next to the child and youth healthcare physician. The second pre-test did not yield any adaptations, indicating good acceptance in practice. With MASS, extensive sickness absence among primary school pupils can be addressed as a ‘red flag' for underlying problems.

Key messages

Intervention mapping steps one through four were sucessfully used to adapt a secondary school intervention to adress sickness absence among students (MASS) to primary schools. With the adapted MASS intervention, extensive sickness absence among primary school pupils can be addressed as a ‘red flag’ for underlying problems.
Mental health, integration, and voting in municipal elections among foreign-born population
Authors: Seppänen A , Lilja E , Sipinen J , Kazi V , Kuusio H
Published: October 2021

Background

Social inclusion measures are essentially related with health among foreign-born population (FBP). Municipal elections provide a way to participate in societal decision making even for those without Finnish citizenship. However, the voter turnout in municipal elections among FBP has remained low. The aim of this study is to explore mental health, migration and integration related factors' associations with voting in municipal elections among FBP.

Methods

Associations between self-reported municipal voter turnout and language skills, main reason for migration, psychological strain and sense of belonging (SB) to locals, country of origin and other groups were studied by using nationally representative data from the cross-sectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6836). Weights were used to correct the sample. Age and sex were used as control variables.

Results

Voter turnout was higher among those with: at least intermediate local language skills (39% vs. 25%, p < 0.001); those who moved because of family (42%), studies (39%) or refugee status (39%) versus those who moved because of work (23%, p < 0.001); no psychological strain (38% vs. 27%, p < 0.001); SB to locals and country of origin (45%) and SB to locals but no country of origin (43%) versus those with SB to country of origin but no SB to locals, or those with no SB to any of the groups presented (both 25% p < 0.001).

Conclusions

Lack of language skills can be a barrier to participate in municipal elections. Migrating for family reasons might reflect commitment to stay in current country and therefore increase motivation to influence by voting. Moreover, lack of sense of belonging to locals and psychological strain might demotivate participation.

Key messages

Factors hindering political participation can be manifold and need more studies to enhance participation across all groups. Attention should be paid to provide clear and sufficient information regarding municipal elections and candidates in several languages.
Health literacy and e-health literacy among Arabic speaking migrants in Sweden
Authors: Wångdahl J , Nilsson U , Dahlberg K , Jaensson M , Bergman L
Published: October 2021

Background

Health inequities arise when the public cannot access and understand health information in an easy, accessible, and understandable way, which may be partly due to limited health literacy (HL). Migrants may have limited HL. A subgroup that may have limited HL is migrants. This study explored comprehensive health literacy (CHL) and electronic health literacy (eHL) among Arabic-speaking migrants in Sweden.

Methods

A cross-sectional observational study conducted in Sweden year 2019. Data was collected among Swedish and Arabic speakers through the Health Literacy Survey European Questionnaire (HLS-EU-Q16), the eHealth Literacy Scale (eHEALS), and questions about self-perceived health and Internet use. Arabic speakers CHL and eHL was compared with native Swedish speakers. Various statistical analyses were performed to determine the associations and predictors for limited CHL and eHL.

Results

A total of 681 respondents were included in the analysis. CHL and eHL differed between the native Arabic-speaking migrants and the native Swedish speakers. The Arabic speaking migrants had significantly lower CHL and eHL mean sum scores. Predictors for limited CHL and eHL were being Arabic speaking, less Internet use, and not finding the Internet to be important or useful. Time spent in Sweden was associated with higher levels of both CHL and eHL.

Conclusions

CHL and eHL differ between Arabic-speaking migrants and native Swedish speakers, but difference in eHL was smaller than difference in CHL and there was a difference in both CHL and eHL related to time spent in Sweden. Internet can therefore be seen as an appropriate channel for disseminating health information to Arabic-speaking migrants in Sweden.

Key messages

Internet can be considered an appropriate channel to distribute health information to Arabic-speaking migrants in Sweden. Time spent in Sweden is associated with higher eHL and CHL levels among Arabic-Speaking migrants.
10.B. Workshop: The COVID-19 Health Systems Response Monitor: what can we learn for the future
Authors:   Organised by: European Observatory,   Chair persons: Erin Webb (Germany), Ewout Van Ginneken (Germany)
Published: October 2021

The Health Systems Response Monitor (HSRM) was established in March 2020 at the beginning of the COVID-19 pandemic to collect and organize up-to-date information on how 50 countries in the WHO European Region and Canada are responding to the crisis. The HSRM uses a structured template, focusing primarily on the responses of health systems but also capturing wider public health initiatives. The HSRM is a joint undertaking of the WHO Regional Office for Europe, the European Observatory on Health Systems and Policies, and the European Commission. The HSRM builds on the Health Systems and Policy Network of the European Observatory, which brings together an international group of high-profile institutions from Europe and beyond with high academic standing in health systems and policy analysis. The content collected on the HSRM platform has been used to enhance cross country learnings through topical snapshots, papers, webinars and more. At the end of 2020, the European Observatory initiated a Health Policy Special Issue (SI) based on the work of the HSRM containing both thematic policy papers and full comparative descriptions and analysis of country responses. Overall, work from the HSRM aims to provide coherent and comprehensive insight on lessons learned from the COVID-19 response so far to support policymakers for future waves or in case of future pandemics.

This workshop aims to provide the audience with an overview of the COVID-19 HSRM and the insights gleaned from the SI. An introductory overview will briefly introduce the COVID-19 HSRM and the SI. The first presentation will compare provider payment adjustments across 20 countries. The second presentation will focus on how countries planned services for potential surge capacity, managed care provision, and maintained routine services in both hospital and outpatient settings during the first wave of the pandemic. The third presentation will zoom in on experiences in primary health care. The last presentation will feature one of the country comparison papers from social health insurance countries.

The workshop will conclude with an audience discussion about the lessons learned from the COVID-19 HSRM, and future opportunities for research using the HSRM.

Key messages

The COVID-19 Health System Response Monitor has tracked the progression of health policies throughout the pandemic and captures particularly policy relevant aspects. Both thematic and cross-country comparisons can illuminate how health systems have responded to the COVID-19 pandemic and provide lessons for future waves and pandemics.
Work-related support in clinical care for patients with chronic diseases: intervention development
Authors: Butink M , Boonen A , Dona D , Peters M , Senden T , Baadjou V , de Rijk A
Published: October 2021

Background

Labor participation among patients with chronic diseases is lagging behind, particularly in the Netherlands. Most workers with a chronic disease might be able to deal with their disease and work participation, but a specific group needs support preferably. This study focuses on the development of a work-related support intervention in clinical care to promote sustainable work participation of patients with chronic diseases who regularly visit the outpatient clinic.

Methods

The first four steps of the Intervention Mapping (IM) approach were used to develop the intervention for a Dutch university hospital. A needs assessment based on a literature review, expert opinions and experiences, a qualitative study with healthcare professionals (n = 9) and consultation with financial staff (Step 1) was used to formulate objectives of the intervention (Step 2). Guided by theory-based methods and practical applications (Step 3), an intervention program, including training and tools for healthcare professionals (medical specialists and nurse specialists), was developed (Step 4).

Results

The needs assessment revealed the importance of stepped care comprising: screening; risk stratification; and if targeted, a problem assessment and providing tailored work-related support, including follow-up. In order to provide work-related support in clinical care, behavioral change of healthcare professionals is necessary. To change their behavior, a program, two training sessions for healthcare professionals and practical tools (screening list, conversation cards and a map with work-related support options) were developed.

Conclusions

To provide work-related support in clinical care for patients with chronic diseases, healthcare professionals need information, skill building training and tools. Despite providing support in care-as-usual, additional time is needed and must be financed. Cost effectiveness evaluation of the intervention is a necessary next step.

Key messages

Healthcare professionals should discuss ‘work’ with targeted patients. To provide work-related support in clinical care, healthcare professionals need knowledge, skills, tools and time.
The effects of long-term physical activity interventions: Scoping review in the Nordic countries
Authors: Haverinen E , Elonheimo H , Tolonen H , Jousilahti P , Wennman H
Published: October 2021

Background

Physical activity (PA) is an important part of maintaining good overall health. Currently, the number of insufficiently physically active adults and children is alarmingly high worldwide. To tackle the challenge, several interventions have been conducted, however the current knowledge on the intervention effectiveness is still inconclusive. This scoping review aims to summarize the effects of long-term PA interventions across all age groups in the Nordic countries.

Methods

A scoping review was conducted by including all age groups and interventions lasting more than 12 months. The aims of the interventions had to focus on increasing PA and/or fitness. A framework of Behaviour Change Wheel (BCW) was used to describe components of the intervention functions.

Results

Initially 1937 studies were identified. 12 intervention studies fulfilled inclusion criteria and were included in the analysis. From the included studies seven focused on children and/or their parents and five on working-age adult populations. Most of the studies built upon theoretical backgrounds and included several Behaviour Change Functions. Hindering factors for synthesis were variations in measurement methods; both subjective and objective outcome measures were reported. Among all age groups, PA interventions had modest effects.

Conclusions

There was no clear evidence on the effects of the interventions in increasing PA or fitness in long-term interventions in communities. However, even small improvements in PA are important in increasing PA at population level and in enhancing public health. More research is required for evidence-based community and public health planning.

Key messages

Although intervention effects were modest, theoretical backgrounds were widely adapted in the PA interventions. Variations in the measurement methods hindered comparison of the study effects. Decreased PA is a current public health concern, which requires novel approaches to conduct health interventions.