bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring ethical issues arising from a problem-solving intervention in the Swedish Primary Care
Authors: Karlsson I , Sandman L , Axén I , Bergström G , Kwak L , Sernbo E , Brämberg E Björk
Published: October 2022

Background

Common mental disorders count for a large percentage of sick leave cases in Europe and in Sweden. Problem-solving with workplace involvement have shown promising results in reducing the number of sick leave days for employees on sick leave for these conditions. Engaging the workplace by for example including the first-line manager in the return-to-work process changes the usual role of the primary care. Hence, this study aims to explore ethical issues that potentially arise when introducing workplace involvement as part of a problem-solving intervention.

Methods

A qualitative study in the Swedish Primary Care using data from semi-structured interviews with rehabilitation coordinators (n = 6), employees on sick leave for common mental disorders (n = 13), and their first-line managers (n = 8). A theoretical framework for systematic identification of ethical aspects of healthcare technologies was used to guide the interviews and reporting of results. Content analysis was used to code the data, searching for latent content. Ethical issues related to the ethical values privacy, identity, autonomy, professional values, third party, equality and justice were identified and described. The analysis was concluded by a normative discussion.

Results

Ethical issues were identified such as difficulties for the employees to control personal information. A need to create an integrated role of a patient and an employee and for coordinators to act neutral instead of as a patient advocate. Managers needed to balance the needs of the organization with the needs of the employee. A pre-requisite for participation was agreeing to manager involvement which may affect the equality of the intervention.

Conclusions

A conversation about sharing of information, roles, responsibilities and expectations during the rehabilitation should be initiated early and be continuous. Managers need support in learning the “how to” when having an employee on sick leave due to a common mental disorder.

Key messages
Effect, economic and process evaluation of a mental health return to work intervention: study design
Authors: Starke F , de Rijk A , Wegewitz U
Published: October 2022

Background

In Germany, the sickness absence duration for mental disorders lasts on average more than twice as long as for all other diseases. Interventions that link medical-therapeutic approaches with organisation-directed methods to improve a sustainable return to work (RTW) have hardly been evaluated. The aim is to present the study design, which evaluates the (cost-)effectiveness and feasibility of an 18-month intensified RTW aftercare delivered by German psychiatric outpatient clinics to employees with mental disorders.

Methods

A two-arm multicentre randomised controlled study is carried out. Sick-listed employees with mental disorders are recruited within psychiatric hospitals (n = 506). Besides care as usual, the intervention group receives a multimodal treatment consisting of individual RTW-support, RTW-aftercare groups, and web-based aftercare. At five time points over a 24-month observation period, quantitative effectiveness and health economic evaluation data from a societal perspective will be obtained. Intervention fidelity, reach, context, satisfaction and dose delivered will be examined in a multi-method process evaluation. A qualitative evaluation using pre-and post-interviews from a sub-sample (n = 30) will complement the effectiveness and process evaluation findings.

Results

Recruitment is currently ongoing. The intervention is expected to improve the employeés achievement of a sustainable RTW, defined as the 12-month remain and participation at work without having sickness absence periods of > 6 weeks (after RTW). It is hypothesized that the intervention is preferable in terms of costs compared to care as usual. The interviews allow for a better understanding of subjective experiences with the intervention.

Discussion

This study evaluates the (cost-)effectiveness and implementation process of an intensified RTW aftercare. If successfully implemented and evaluated, it might be adopted as standard care for employees with mental disorders in Germany.

Key messages
Co-locating public mental health services in communities: a realist evaluation
Authors: Baskin C , Duncan F , Oliver E , Samuel G , Adams A , Gnani S
Published: October 2022

Background

Public mental health (PMH) services address social determinants of mental health, such as poverty, poor housing, and job insecurity. Austerity and welfare reform in the UK has led to cuts to social and welfare support, increasing poor mental health and widening inequalities, exacerbated by COVID-19. State health services lack capacity to tackle social issues that contribute to a large proportion of expressed mental health need. Co-locating PMH services within community spaces is a potential solution to increase early access and improve quality of services. Using a realist evaluation, we sought to develop the theory on how community co-location affects PMH outcomes, who this works best for, and how this is impacted by the context of delivery.

Methods

We collected data from service-users and service-providers at six case study sites across England, UK, using interviews (n = 62), four focus groups (n = 40) and two stakeholder workshops (n = 19).

Results

We identified four overarching theories. First, community providers do not operate under the same limits as state services allowing them the flexibility and time to build trust and ongoing relationships with service users. Second, the ethos and culture of services is to empower users to access help and be independent. Third, accessing support from a shared local space allows a coordinated and holistic response reducing barriers such as distance, cost, and anxiety. Four, as they are recreational services and spaces for access by all with no predefined/required level of need they are better at promoting wellbeing and primary prevention.

Conclusions

Community co-location of PMH services can strengthen the overall mental health system by widening reach to people vulnerable to poor mental health and enabling earlier intervention on associated social determinants. This has potential to reduce mental health inequalities and demand on the state health system.

Key messages
Public perceptions uncovered: engaging in decision-making regarding non-pharmaceutical interventions
Authors: Kemper S , Bongers MEJ , Kupper JFH , De Vries M , Timen A
Published: October 2022

Background

To control the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) were implemented worldwide, that heavily impacted the daily lives of citizens. Occasionally, the public expressed discontent about NPIs, as NPIs did not always corresponded with their preferences. The question is if and how public engagement (PE) could aid in development and implementation of NPIs, in order to improve legitimacy, quality and compliance.

Methods

An online survey was conducted from 27 October to 9 November 2021, with a representative sample of the public in the Netherlands on gender, age, education, place of residency and migration background. In total 4981 respondents participated. Perceptions and preferences about PE in decision-making on NPIs to control COVID-19 was collected. Four NPIs were used: Nightly curfew (NC); Digital Covid Certificate (DCC); Closure of schools and daycares (CSD); and 1.5meter social distance.

Results

Around 25% of respondents expressed a desire to engage in decision-making, as it would increase understanding and quality of NPIs, and their trust in the government. Especially for the NPIs DCC and NC, respondents found it valuable to engage, by providing their perspective on certain trade-offs in values in decision-making (e.g. opening up society vs division in society by vaccination status). The public could play a role by giving feedback on bottlenecks during decision-making, however overall responsibility should stay with experts and policy-makers. Desire for engagement was lowest for CSD. Around 50% of the respondents did not want to engage, as they felt they were not knowledgeable enough to do so and did not perceive a need to engage. The other 25% had a neutral disposition.

Conclusions

Engagement was not self-evident for most respondents, yet the ones willing to engage revealed important possibilities for future outbreaks. Next, a deliberative process for PE in decision-making could be executed, in order to implement our findings in practice.

Key messages
Impact of the kidney transplantation moratorium in France because of the COVID-19 pandemic
Authors: Bonnemains V , Le Borgne F , Savoye E , Legeai C , Pastural M , Bayat-Maokei S , Lenain R , Leffondré K , Couchoud C , Foucher Y
Published: October 2022

Background

The COVID-19 pandemic has resulted in worldwide kidney transplantation (KT) moratoriums. The impacts of these moratoriums on the life expectancy of KT candidates remain unclear.

Methods

We simulated the evolution of several French candidate populations for KT using a multistate semi-Markovian approach and according to moratorium durations ranging from 0 to 24 months. The transition rates were modeled from the 63,927 French patients who began dialysis or were registered on the waiting list for KT between 2011 and 2019.

Results

Among the 8,350 patients active on the waiting list at the time of the French KT moratorium decided on March 16, 2020, for 2.5-months, we predicted 4.0 additional months [CI: 2.8, 5.0] on the waiting list and 42 additional deaths [CI: -70, 150] up to March 16, 2030. In this population, we reported a significant impact for a 9-month moratorium duration: 135 attributable deaths [CI: 31, 257] up to March 16, 2030. Patients who became active on the list after March 2020 were less impacted.

Interpretation

The temporary moratorium of KT during a COVID-19 peak in order to free up hospitals’ resources doesn't impact patients’ 10-year survival if the moratorium does not exceed a prolonged period.

Funding. French National Research Agency (ANR-20-COV8-0002-01).

Key messages
Immune Response After Vaccination against SARS-CoV-2 in the Elderly in the Czech Republic
Authors: Tomaskova H , Martinek J , Janosek J , Zelena H , Kloudova A , Jezo E , Kral V , Sturcova H , Pohorska J , Madar R
Published: October 2022

Background and Aims

Elderly, especially those with chronic diseases, are a population at high risk of a severe course of the SARS-CoV-2 infection. The study aimed to investigate the complex immune response after vaccination in nursing home residents older than 65 years depending on the previous COVID-19 status and vaccine brand.

Methods

375 participants participated in the study in September-October 2021. IgG antibodies against spike protein and nucleocapsid protein, the titer of virus neutralization antibodies, and cellular immunity (interferon-gamma release assay) were tested in elderly nursing home residents vaccinated with Pfizer, Moderna 30-31 weeks after the completion of vaccination and in those vaccinated with AstraZeneca 23 weeks before sampling. The prevalence with 95% confidence intervals (CI) was evaluated in Stata version 17.

Results

In total, 95.2% (95% CI: 92.5%-97.1%) of samples had positive results of anti-S IgG, 92.8% (95% CI: 89.7%-95.2%) were positive in virus neutralization assay and 89.0% (95% CI: 84.5%-92.5%) in the interferon-gamma-releasing assay (indicator of cellular immunity). Even though the immune response to the Pfizer and Moderna vaccines were evaluated after a longer period than AstraZeneca, the immune response in residents vaccinated with these vaccines were superior. All immune parameters in vaccinated individuals were significantly higher in convalescent residents than in those who had not been infected with COVID. No case of COVID-19 occurred during the vaccination-to-test period.

Conclusions

High immune response was found in elderly nursing homes residents (65 years and older) after 5-7 months after vaccination against SARS-CoV-2. In particular, vaccinated convalescents showed high immune responses. It appears that such residents are much better protected from COVID-19 than those who are only vaccinated.

Key messages
Vaccination policy strategies before and during the COVID-19 pandemic: an overview
Authors: Garlasco J , Charrier L , Thomas R , Gardois P , Bo M , Zotti CM
Published: October 2022

Background

The debate on vaccination strategies has been periodically involving researchers, policymakers, and also the population. Interest waves have occurred both after a revival of childhood infectious diseases in 2016-2017, due to low vaccine coverages, and during the recent Coronavirus outbreak. This study aimed at overviewing vaccination strategies (and corresponding vaccine coverages) for childhood vaccinations and SARS-CoV-2.

Methods

Measles was chosen as a childhood vaccination indicator. Policy data were retrieved from health institutions (either European or national/regional) and, for COVID-19, also from press agencies and newspaper websites. Vaccine coverage data were retrieved from the World Bank, World Health Organisation, and UNICEF databases (for childhood vaccines), and from the “Our World in Data” platform for SARS-CoV-2. A qualitative comparison was performed between the two contexts.

Results

Unlike childhood vaccinations, few countries (and only Austria in Europe) imposed generalised COVID-19 mandates, most countries preferring targeted mandates for higher-risk groups. Many countries confirmed their traditional voluntary vaccination approach also for COVID-19, while countries historically relying on compulsory vaccination strategies, such as Slovenia and Hungary, surprisingly opted for voluntary SARS-CoV-2 vaccination, with unsatisfactory results. However, no tangible crude association was generally found between vaccination policies and achieved coverages, although factors such as cultural background, education, and religion appeared to influence the impact of vaccination policies.

Conclusions

The COVID-19 experience has enriched pre-existent vaccination strategy debates by adding interesting elements concerning attitudes toward vaccines in a novel context. Reading the available results in the frame of vaccine hesitancy determinants can help to understand the relationship between policies and actual coverages.

Key messages
Interaction between MTNR1B polymorphisms and lifestyle intervention on pregnancy outcomes
Authors: van Poppel M , Corcoy R , Simmons D , Desoye G , Mendizabal L , Zulueta M
Published: October 2022

Background

Interactions between polymorphisms of the melatonin receptor 1B gene (MTNR1B) and lifestyle intervention for gestational diabetes have been described. Whether these are specific for physical activity or healthy eating intervention is unknown.

Objectives

To assess the interaction between MTNR1B rs10830962 and rs10830963 polymorphisms and lifestyle interventions during pregnancy.

Methods

Women with a BMI of ≥ 29 kg/m2 (n = 436) received counseling on healthy eating (HE), physical activity (PA) or both. The control group received usual care. The analysis had a factorial design with comparison of HE versus no HE and PA versus no PA. Maternal outcomes at 24-28 weeks were gestational weight gain (GWG), maternal fasting glucose, insulin, insulin resistance (HOMA-IR), and development of GDM. Interaction between receiving either HE or PA intervention and genotypes of both rs10830962 and rs10830963 was assessed using multilevel regression analysis.

Results

GDM risk was increased in women homozygous for the G allele of rs10830962 or rs10830963 (OR 2.60 [95% CI 1.34, 5.06] and 2.83 [1.24, 6.47], respectively). Significant interactions between rs10830962 and interventions were found: In women homozygous for the G allele, but not in the other genotypes, the PA intervention reduced maternal fasting insulin (beta -0.16 [95%CI -0.33, 0.02], p = 0.08) and HOMA-IR (-0.17 [-0.35, 0.01], p = 0.06). In heterozygous women, HE intervention had no effect, whereas in women homozygous for the C allele, HE intervention reduced GWG (-1.6 kg [-2.4, -0.8]).

Discussion

In women homozygous for the risk allele of MTNR1B rs10830962, GDM risk was increased and PA intervention might be more beneficial than HE intervention for reducing maternal insulin resistance.

Key messages
Impact of COVID-19 on maternal and neonatal outcomes: a population-based cohort study in Latvia
Authors: Zile-Velika I , Gavare I , Veisa V , Rezeberga D
Published: October 2022

Introduction

Coronavirus disease (COVID-19) has affected many pregnant women worldwide. Pregnant women with COVID-19 infection belong to a vulnerable group with concerns about the effect of the disease on maternal and neonatal health.

Objectives

To assess association of COVID-19 on maternal and neonatal outcomes in Latvia.

Methods

Data source was Medical Birth Register. A total of 17206 birth data for 2021 were included in the data analysis.

Results

2.1% (n = 358) women with COVID-19 (U07.1; U07.2) during pregnancy or delivery. COVID-19 infection was related to the following conditions during pregnancy - gestation diabetes (10.6% to 4.6%; p < 0.001); placental abruption (1.7% to 0.6%; p < 0.05). Birth outcomes for COVID-19 infected women showed that infection has led to the increased caesarean section (27.7% to 22.0%; p < 0.01), preterm birth (12.8% to 5.3%; p < 0.001); low birth weight ≤2499g rate (10.1% to 3.9%; p < 0.001); stillbirths (2.8% to 0.4%; p < 0.001) and newborn infections specific to the perinatal period (P35-P39) (9.5% to 5.2%; p < 0.05). Increased BMI (8.9% to 6.8%), fetal distress (3.9% to 2.4%); preeclampsia, eclampsia (3.2% to 2.1%), hypertension (2.8% to 2.0%), gestational hypertension (5.0% to 3.8%) more frequently were observed among COVID-19 infected patients but the difference was not statistically significant. COVID-19 associated with higher odds (adjusted by mother age, multiple births, gestational age, mode of delivery) of gestational diabetes (ORadj 2.3; 95%CI 1.7-3.4; p < 0.001), newborn infections specific to the perinatal period (ORadj 1.7; 95%CI 1.2-2.4; p < 0.01) and stillbirth (ORadj 4.0; 95%CI 1.9-8.2; p < 0.001).

Conclusions

COVID- 19 during pregnancy is associated with higher risk of adverse maternal and perinatal outcomes. The study results of short-term pregnancy outcomes show importance of implementation of all recommended COVID-19 prophylactic measures by public health specialists and clinicians during antenatal care.

Key messages
Knowledge, beliefs and experience of adopting healthy habits in pregnancy: a mixed methods study
Authors: Kolokotroni O , Economou M , Koutrouba A , Prokou M , Derlagen A , Zadeh P Enayati , Philippou E , Hileti D , Quattrocchi A , Mosquera MC
Published: October 2022

Background

Early life exposures affect a child's obesity risk. The EARLY START uses participatory action research to develop an intervention for reducing early life obesogenic exposures. The initial phase uses a mixed methods approach to investigate pregnant mothers’ knowledge, beliefs, and experience of adopting healthy dietary and physical activity (PA) habits.

Methods

Cypriot pregnant women in 2021 completed a web-based questionnaire on: a) Adherence to Mediterranean diet (MD) (MEDAS tool); b) knowledge, beliefs on diet and PA. A subgroup participated in a structured focus group discussion of their experience/needs in adopting healthy habits. Data were analyzed using Descriptive and Thematic Content methods.

Results

Ninety-seven women participated, 73% <35 y.o., 49% primigravida, 92% with tertiary education. Adherence to MD was moderate (median 6/14, IQR 2.5), 90% were eating <3 portions of fruit/vegetables daily, 50% believed their diet was healthy and did not change habits in pregnancy. Most had access to information (94%), internet was the commonest source (74%), and the doctor the most trusted (47%). Mild and moderate-intensity PA were considered appropriate by many (60%) for the first and second half of pregnancy, respectively. Most (90%) were aware of the risks of excessive weight gain in pregnancy. Qualitative analysis showed that women value diet as “the main driver to holistically achieving a healthy pregnancy”. The main barrier was the “struggle between the will and ability”. PA was considered a “therapy” but the challenge was “to achieve the right balance”. Internet was described as “accessible but unreliable information source”. Women believed that needs can be met by “early, holistic recommendation-based interventions run by professionals”.

Conclusions

A huge gap exists between knowledge, beliefs, and practice of healthy behaviours in pregnancy. New interventions should meet gaps and needs using contextualized, timely, holistic, and reliable approaches.

Key messages
International Horizon Scanning the impact of Covid-19 on increasing the health gap and vulnerability
Authors: Instone A , Stielke A , Allen J , Cotter-Roberts A , Bainham B , Couzens L , Beynon C , Dyakova M , Green L
Published: October 2022

The COVID-19 pandemic has caused unprecedented challenges for populations, health systems and governments worldwide, which have resulted in lasting economic, social and health impacts. The results of such have been felt disproportionately throughout society and existing vulnerabilities have been highlighted and heightened. A clear understanding of the extent of these vulnerabilities is needed in order to fully address the problem. The World Health Organization Collaborating Centre on Investment for Health and Well-being (WHOCC), Public Health Wales has developed a summary report focusing on the existing and emerging inequalities resulting from the pandemic, as identified through international evidence and learning from the International Horizon Scanning Reports. These reports, undertaken between May 2020 - August 2021, are based upon rapid evidence synthesis reviews of international literature. The summary report focuses on global learning and best practices in order to better understand and address the unequal impacts of the pandemic. The information has been categorised according to the five essential conditions required to enable a healthy life as presented within the WHO health equity conditions framework. The report provides evidence on groups most vulnerable to both direct and indirect impacts of the pandemic as well as promising practice to address the resulting inequity. Inequalities and related factors explored within the report include but are not limited to, level of deprivation and education. Taking a global perspective, this report summarises international evidence to support inclusive, sustainable, and equitable solutions, such as protecting economic well-being and taking an intergenerational lens in both response and recovery. To address and mitigate the impact of the pandemic upon vulnerable groups, collating and sharing international evidence and best practice has proven to support equitable long-term socio-economic and environmental recovery.

Key messages

• International learning provides vital insights to support recovery in Wales and beyond.

• Responses to the pandemic should address the needs of the vulnerable to reduce existing health gaps.
Healthy ageing: Herpes zoster infection and the role of the adjuvanted recombinant zoster vaccine
Authors: Curran D , Doherty TM , Lecrenier N , Breuer T
Published: October 2022

Background

Increases in life expectancy over the last 50 years has been matched by an increase in the burden of diseases (e.g. herpes zoster (HZ)) in adults ≥50 years of age (YOA). Without intervention, around 30% of individuals can expect to develop HZ in their lifetime, which would impact their daily activities and healthy ageing.

Methods

We conducted a narrative review on published literature on the impact of developing HZ on healthy ageing and the ability of vaccination to prevent the burden of disease due to HZ. Specifically, we describe HZ impact on quality of life (QoL), and impact of the adjuvanted recombinant zoster vaccine (RZV) on reducing the burden of HZ in adults ≥50 YOA.

Results

In adults ≥50 YOA with HZ, 65.1% and 15.8% reported severe pain and worst imaginable pain, respectively. Pain persisted for up to 90 days (defined as post-herpetic neuralgia) in 10-20% of HZ patients, and occasionally for years after initial symptoms. Pain due to HZ impacted all domains of QoL (psychological, physical and social). Evidence suggested that RZV reduced HZ burden of illness and burden of interference on daily activities by > 90%. Reports also suggested that RZV retained vaccine efficacy of > 90% in all frailty subgroups, who typically respond poorly to other vaccinations. Long-term follow-up data reported vaccine efficacy against HZ of 84.1% (95% confidence interval, 64.4% - 94.0%), 8 years post-vaccination. Modelling studies demonstrated that vaccination resulted in reduced hospitalization and other healthcare visits related to HZ.

Conclusions

Vaccination with RZV can protect older adults from HZ, thus maintaining QoL and promoting active and healthy ageing.

Key messages

• There is significant burden of disease due to HZ among adults ≥50 YOA due to ageing and immunosenescence.

• Vaccination can reduce burden of disease among the elderly and frail individuals and maintain QoL.
Stylish UV-C lamp for disinfecting household objects
Authors: Iannaccone R , Nante N , De Palma I , Amodeo D , Messina G
Published: October 2022

Background

Considering the current pandemic situation, the growing problem of antibiotic resistance and the increase in healthcare costs, attention to daily disinfection is becoming increasingly important. This study aimed to evaluate the bactericidal efficacy of a modern and stylish UV-C device designed for the home environment.

Methods

The experimental study was conducted between July-August 2020 on four bacterial strains: Staphylococcus aureus, Salmonella typhymurium, Klebsiella pneumoniae and Escherichia coli. The UV-C device consist of a protective dome with a reflective coating, a UV-C lamp (placed in the device base) and three reflective holders. Different positions and exposure times were tested using two different carriers holder for the bacterial inoculum (plastic and stainless steel) to estimate the germicidal efficency related to UV-C lamp exposure, with direct and reflected (from the dome coating) light.

Results

The experiment showed that the higher bacterial inactivation effect (3.5 to 7 log10) was achieved for all four strains at 3 minutes, but even at 1 minute, there is a marked reduction in the bacterial load with the only exception of Klebsiella pneumoniae. After 45 and 30 seconds, steel carriers contaminated by Escherichia coli and Staphylococcus aureus on the opposite side of the UV-C source showed significant reductions in the range between 99 and 99,9%.

Conclusions

The device has proven to be effective for the disinfection of various everyday objects placed into the lamp and introduces beauty to the household environment.

Key messages

• In this study, UV-C device proved to be a valuable tool for disinfecting household items and enhancing safety for everyday health.

• UV-C device proved to be a valuable tool for disinfecting household items and enhancing safety for everyday health.
Promoting positive masculinities among young people in Stockholm, Sweden. A mixed-methods study
Authors: Salazar M , Cerdán-Torregrosa A
Published: October 2022

Background

Despite policies aiming to curtail men’s violence against women (VAW) in Sweden, one in three women have experience physical/sexual VAW. Promoting anti-VAW masculinities among young men is a key intervention to reduce VAW; yet little is known about what actions could be used to effectively do so in Sweden. This study aims to: 1. Identify actions that young people (men and women), and stakeholders believe can be used to promote anti-VAW masculinities and 2. Quantify the relationship, coherence and patterns of importance and applicability between the different identified actions.

Methods

A mixed-methods study was conducted in Stockholm in 2019. In-depth interviews with young people aged 18-24 years (men= 16, women=12) and stakeholders (n = 12) were used to identify actions to promote anti-VAW masculinities. Then, an online survey with 83 people (77 young people) was conducted asking participants to sort the actions and rate them in terms of importance and applicability. Multidimensional scaling and hierarchical cluster analysis were used to create clusters maps. Each cluster was rated in terms of importance and applicability.

Results

Six clusters were identified: 1.own self-reflection and change, 2. actions in leisure-cultural spaces, 3. mandatory education on gender-VAW, 4. positive role models in public arenas, 5. support civil society and 6. strengthen government, police, and legal response. The clusters of mandatory education on gender-VAW and own self-reflection and change were rated higher in importance (mean 5.1 and 4.8 respectively). Mandatory education on gender-VAW and actions in leisure-cultural spaces were rated higher in applicability (mean 4.6 and 4.7 respectively). Correlation between importance and applicability was low (rho=0.16).

Conclusions

Promoting anti-VAW masculinities to tackle VAW should be done in multiple arenas. Mandatory education on gender-VAW in schools and leisure spaces are key strategies to promote anti-VAW masculinities.

Key messages

• Preventing VAW by focusing on masculinities requires the involvement of various social spheres.

• Mandatory education on gender and VAW is considered key in curtailing men’s VAW in Sweden.
Complete coverage by examinations: relationship to colorectal cancer burden and the COVID-19
Authors: Ngo O , Kouril J , Suchanek S , Dusek L , Seifert B , Zavoral M , Majek O
Published: October 2022

Background

Colorectal cancer (CRC) is among the most common cancers and cancer causes of death worldwide. CRC screening and early detection is essential to reduce CRC incidence and mortality. CRC screening has been initiated in the Czech Republic in 2000 for persons over 50 and currently offers a faecal occult blood test (FOBT) or screening colonoscopy (CS). The aim of our study was to present complete coverage by examinations in relation to the trends in CRC burden and impact of COVID-19.

Methods

We defined the complete coverage by examinations as the proportion of persons aged over 50 undergoing examination with CRC early detection potential (FOBT or CS for any indication) during past 3 years. Standardized incidence and mortality rates were used to assess epidemiological trends. The impact of COVID-19 was assessed for 2020 and 2021 by comparing the volume of examinations with 2019. We used national health registries (National Registry of Reimbursed Health Services, Czech National Cancer Registry) as the source of data.

Results

Complete coverage was increasing over time and reached around 50% in recent years (target population is more than 4 million persons, most of the performed examinations were screening FOBT). However, coverage has decreased to 47.9% in 2020. In 2020 and 2021, the number of tests performed decreased by 16.9% and 5.5%, respectively, compared to 2019. CRC incidence and mortality rates have decreased by more than 20% and almost 30%, respectively, in the last decade.

Conclusions

Complete coverage has reached a satisfactory level and has likely a positive impact on the epidemiological trends. However, further action is needed to increase coverage, recently affected by COVID-19 pandemic, when non-acute health care may have been neglected.

Key messages

• The long-term high level of coverage by examinations likely has a positive impact on CRC burden.

• The observed decrease in coverage caused by COVID-19 needs to be appropriately compensated.
Digital transformation of public health systems: strengthening to take rights seriously
Authors: Macedo Silva A , Ventura M
Published: October 2022

The expansion of digital public health, with the use of data in digital systems for planning and operation of public health policy, presents itself as strategic for the public and digital future of Public Health Systems, such as Brazilian Sistema Único de Saúde/SUS, as well as for the effectiveness of the right to healthcare and expansion of the access to public health services (with the experience of COVID-19 highlighting the importance of digital health, as well as fostering its accelerated expansion). Such digital expansion will increasingly stress the fundamental right to the protection of personal data, and it is therefore important to strengthen the regulatory and care response of SUS in the field of digital public health, both for the preservation of its regulatory capacity in digital public health (facing market private interests of Big Tech for example), but also to guarantee the protection of fundamental rights, such as the protection of personal data. The theory of fundamental rights and the dogmatics on personal data protection offer support to solve the tensions to the right to data protection arising from the expansion of digital health, with consideration between the rights of patients-data subjects and the needs of managing and planning public health policy

Key messages

• The intense use of data and digital systems in public health policy is strategic to strengthen public health systems.

• The enhancement of Public Health Systems’ regulatory capacity in digital transformation is important to protect right to health and data protection.
Socio-demographic and socio-economic disparities in medical rehabilitation in Germany in 2019
Authors: Kniffert S , Stamm O , Heimann- Steinert A
Published: October 2022

Medical rehabilitation is a valuable component to restore physical and mental health, to prevent social isolation and to ensure a return to work. Due to the demographic change and the still increasing number of Post-Covid-19 patients, the demand for rehabilitation is still increasing. Latest, the COVID-19 pandemic elucidated that especially people from lower socio-economic backgrounds are disproportionally affected by health crisis. The aim of this study was to determine the influence of socio-demographic and socio-economic factors on quantitative exercise therapy in medical rehabilitation and to clarify the divergence of existing research findings. In our study we used data from 824.606 rehabilitation cases (German Federal Pension Insurance) and investigated the role of age and gender, marital status, social status and location towards inequalities in access to medical rehabilitation. Multiple linear regression and effect size calculation were used to show associations and to discuss the relation to clinical relevance. We were able to show a highly significant difference (P < 0.001) in access to exercise therapy in our study group. Patients aged 65+, women, single or widowed people, rehabilitants of low socioeconomic status or people located in the new federal states in Germany received shorter and less frequent exercise therapy. There are differences of up to 3.5 hours of treatment duration and 4.25 treatments per week, when disadvantaged social factors accumulate. However, despite the presented differences, the received treatments for the disadvantaged groups are still in the range of suggested minimum therapeutic requirements by the German Federal Pension Insurance. We could show a significant difference in rehabilitative therapy, which is solely based on social factors. There is an urgent need to draw special attention to the here discussed inequalities in access to medical rehabilitation for socially disadvantaged population and the overarching impact on society.

Key messages

• The social inequality in medical rehabilitation to the detriment of the socially disadvantaged population that we have identified must give rise to clear changes in order to establish social justice.

• Equal opportunities and health quality assurance that address the individual needs of each patient should be the focus of socio-medical, policy development.
Vocational training of health mediators of primary care teams improves their sense of coherence
Authors: Kósa K , Katona C , Bíró É , Vincze S
Published: October 2022

Background

A Primary Care Model Programme had been implemented in Hungary between 2013-2017 in which group practices were established that employed - among others - nonprofessional health workers (health mediators, similar to community health workers) to facilitate access for the most disadvantaged population groups. The health of mediators, themselves mostly disadvantaged ethnic Roma, was monitored every odd year of the Programme.

Methods

A repeated cross-sectional health interview survey had been implemented inviting all health mediators who were employed at the time of the survey. The same questionnaire was used in all 3 surveys with items from the European Health Interview Survey 2009 and validated versions of other scales.

Results

Positive changes occurred in the health status of mediators during 5 years of follow-up. Significant improvement in mental health occurred among those who completed on-the-job vocational training. By 2017, significant increase in sense of coherence was observed among those who obtained vocational qualification as opposed to those who did not. The proportion of highly stressed mediators showed a significant increase among those with no vocational training. Improvement was detected in all mediators in health awareness, dysfunctional attitudes, psychological stress and smoking prevalence.

Conclusions

Significant improvement in mental status among those who obtained on-the-job vocational qualification were observed during follow-up of ethnic Roma health mediators in the programme in which they were equal members of the primary health care team. Employment of health mediators in primary care teams not only contributed to improving access to care for disadvantaged groups but also improved the mental health of mediators themselves.

Key messages

• Nonprofessional health mediators are important members of primary care teams servicing disadvantaged populations.

• Significant improvement in mental status during 5 years of follow-up occurred among Roma health mediators who received vocational training and were equal members of primary health care teams.
The EU response to NCDs: a content analysis on building resilient post-COVID health systems
Authors: Paric M , Orhan R , Czabanowska K
Published: October 2022

Background

Non-communicable diseases (NCDs) impose a heavy burden on healthcare systems of countries in the European Union (EU). An estimated 91.3% of all deaths and 86.6% of DALYs in the EU-28 were attributable to NCDs. It is imperative that the EU act on mitigating this challenging health issue and help create trajectories for building resilient health systems. Using qualitative analysis, this study examines the question of how the European Commission 2019-2024 is planning to mitigate the impact of NCDs on health systems, while taking into account the COVID-19 pandemic.

Methods

Content analysis was applied to understand how NCDs are framed and how an EU narrative is constructed to mitigate the impact of NCDs on health systems by the European Commission. A total of 44 documents were analysed, including speeches, press releases, newsletters, statements and policy documents. In vivo coding was performed using the software package ATLAS.ti 9. Unique codes were simplified and clustered into descriptive themes with a high level of abstraction.

Results

This study identified five main themes: ‘health plan', ‘COVID-19', ‘future direction', ‘collaboration and solidarity', and ‘persuasion'. Themes show that the Commission is emphasising the impact of the pandemic and the relevance of policies tackling NCDs for developing EU-wide resilient health systems. By calling for more cross- and multi-sectoral collaboration, like creating a European Health Union, the Commission hopes to create the right climate for a European framework for cooperation, which can help develop harmonised and resilient EU health systems.

Conclusions

Although increasing health systems resilience is high on the Commission’s agenda, it seems that there are no actionable points for Member States in terms of addressing national health policy. We recommend the Commission looks towards eliminating this observed disconnect and creating actionable points in line with Member States’ health systems’ capabilities.

Key messages

• Our findings show emphasis is placed on EU-wide health policies, more robust health systems, and the collective power of the EU. However, there are no concrete actions coupled with these concepts.

• COVID-19 highlighted the limitations of national policy for protecting health systems against cross-border health threats. It tested the Commission’s resolve in pushing for more European cooperation.
Public Health benefits by implementing digital symptom diaries for COVID patients from Cologne
Authors: Gruene B , Kugler S , Kuefer-Weiß A , Wolff A , Kossow A , Nießen J , Neuhann F , Ginzel S , Buess M
Published: October 2022

Background

High rate of people infected with SARS-CoV-2 and their contacts in Cologne, Germany required innovative tools for notification, monitoring and reporting. The digital tool for COVID19 (DiKoMa) provides self-service symptom diaries allowing (a) the stratification for prioritized telephone contact by the health authority and (b) training a machine learning (ML) model that predicts infections with prevailing dominant variant (PDV) from early symptom profiles (SP).

Methods

Pseudononymized SP covering the first week of diary recordings were included for training (16646 index, 11582 contacts). A balanced random forest (BRF) model was trained to differentiate early predictive symptom patterns of different PDV and contact persons. Model evaluation was performed using sex and age stratified cross validation (CV), the model was validated on SP recorded from days 1 and 6.

Results

From 03/20 to 02/22, 90478 indeces and 75444 contact persons reported symptoms and health status, covering 46% and 42% of all reported cases, respectively. Diaries contained between 1-52 entries (566791, median 2). Daily analysis of entries, prioritized according to age, prevalent co-morbidities and detoriation of symptoms allowed risk adjusted follow up even during phases with high case notification rates. The top 5 predictive factors of the BRF were immunization, cough, dysgeusia and dysnosmia, fatigue, and sniffles to differentiate infection between wildtype, three PDV and contact persons (CV AUC 80.6%, Validation AUC 77.1%).

Conclusions

The use of digital symptom diary surveillance helps to provide appropriate medical support for patients on a large scale. Machine learning shows potential for symptom based risk assessment to differentiate PDV for future outbreaks and can thus become a valuable tool alongside specific laboratory diagnostics.

Key messages

• Digital symptom diaries are a powerful and widely accepted tool to attend COVID19 patients in isolation. They allow risk stratification for follow up and are a low-threshold service.

• Machine learning supports index case identification by symptom analysis and can thus become a valuable tool alongside specific laboratory diagnostics.
Analysis of a test system for the detection of SARS-CoV-2 in children attending school
Authors: Boietti E , Bert F , Lo Moro G , Barbaro S , Barbero S , Minutiello E , Sinigaglia T , Fagioli F , Siliquini R
Published: October 2022

Background

During the COVID-19 pandemic, in order to keep schools open and reduce SARS-CoV spreading, SARS-CoV-2 positive paediatric patients (PP) need to be isolated early. The aim of this study was to describe the appropriateness of school hot spot (HS) for SARS-CoV 2 testing based on open access of PP in a paediatric hospital in Turin, Italy.

Methods

A cross-sectional study was performed between September 2020 and March 2021. The data collected included: date of swab execution, type of swab, execution setting of the swab, result of the swab, sex, age of PP and the mean value of the Rt (reproductive number) of pandemic in the Piedmont region. We collected data about PP from four different hospital settings (HS, Emergency department, day hospital and hospital wards) of Regina Margherita Children’s Hospital (Turin, Italy). We analyzed a sample of 13,283 PP (aged 0-19 years) testing for SARS-CoV-2. The main outcome was the likelihood of testing positive in different settings and in different age groups.

Results

In Our sample, females were 45.8%. The median age was 6.8 years (IQR 3.0-11.2). The swabs executed in all the hospital settings had a lower likelihood of resulting positive compared with the school HS setting. Newborns below 3 months (adj OR 1.85, 95%CI 1.14 - 3) and patients aged between 11 and 13 years old (adj OR 1.32, 95%CI 1.07 - 1.63) reported a higher probability of a swab tested positive compared to adolescents. Instead, children aged between 3 months and 2 years (adj OR 0.77, 95%CI 0.61 - 0.96) and aged between 3 years and 5 years (adj OR 0.66, 95%CI 0.53 - 0.83) were less likely to result positive.

Conclusions

We found a high prevalence of PP positive to the test for the detection of SARS-CoV-2 at the school hot spot compared with other settings. The open access modality to the nasopharyngeal swab was effective in identifying PP with COVID-19. Public health authorities should implement this testing modality in order to reduce SARS-CoV-2 infections in PP.

Key messages

• Open access testing system to detect SARS-CoV-2 is important to do as many tests as possible to identify COVID-19 patients and isolate them in the pediatric population.

• The open access testing modality to detect COVID-19 patients saves time for doctors who, instead of carrying out the patient history, can devote themselves to other clinical activities.
First year of the pandemic: Years of Life Lost due to COVID-19 in Serbia
Authors: Stevanović A , Todorović J , Rosić N , Bjelobrk G , Mandić-Rajčević S , Šantrić-Milićević M , Bjegović-Mikanović V
Published: October 2022

Background

The first case of COVID-19 in Serbia was reported on 6th March 2020. Since then, Serbia has registered several epidemic peaks, which have led to a considerable increase in premature mortality. Basic evaluation of COVID-19 premature mortality burden needs to include frequency of COVID-19 deaths among different age-groups.

Methods

All-cause mortality data disaggregated by age and sex, population estimates and remaining life expectancy for different age-groups were acquired from the Statistical Office of the Republic of Serbia. Years of Life Lost (YLL) due to COVID-19 were calculated for the period from March to December 2020. European Standard Population was used for calculating age-standardized mortality rates. We acknowledge the support from the BoCO-19 - The Burden of Disease due to COVID-19 project coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe.

Results

In 2020, there were 127,572 YLLs due to COVID-19, with 81,147 of YLLs (63.6%) attributable to men and 46,425 (36.4%) to women. Contribution of COVID-19 to the total all-cause YLL was also higher in men comparing to women: 11.39% and 7.80%, respectively. Three epidemic peaks were observed in 2020, together composing two thirds (65.6%) of total YLLs due to COVID-19. December was the month with the greatest burden, accounting for 45.8% of all YLLs due to COVID-19. Crude YLL rate for COVID-19 was 1849.1 per 100,000, or 1733.5 per 100,000 after standardization.

Conclusions

Registered COVID-19 deaths accounted for one tenth of total YLLs in Serbia in 2020, with men contributing almost twice as much to that number compared to women. On average, 12.32 YLLs originated from each registered COVID-19 death. Further studies need to assess the impact of the COVID-19 epidemic on avoidable mortality trends in Serbia.

Key messages

• COVID-19 deaths comprised one tenth of all-cause YLLs, with two-thirds of COVID-19 YLLs attributable to men.

• To reduce premature mortality burden, epidemic peaks need to be prevented.