bluuebunny/crossref_metadata_2025 huggingface dataset:
Urban green infrastructure size, quality and proximity and health outcomes in older populations
Authors: Cook P A , Dennis M , Wheater C P , James P , Lindley S
Published: October 2020

Background

A city's multi-functional network of green and blue spaces has an important role underpinning the health and wellbeing of its residents. Although evidence of positive links between nature and health is plentiful, little is known about which particular aspects of green and blue spaces are most influential, and how benefits might vary between social groups and age.

Methods

We used a green infrastructure (GI) approach combining a high-resolution spatial dataset of land-cover and function with area-level demographic and socio-economic data. A comprehensive characterisation of the Greater Manchester UK city region was generated. The GI attributes were used in step-wise multi-level regression analyses to test for associations between population chronic morbidity and the functional, physical and spatial components of GI across an urban socio-demographic gradient.

Results

Individual GI attributes were significantly associated with health in all socio-demographic contexts; even when associations between health and overall green cover were non-significant. For areas with having higher proportions of older people ('older neighbourhoods'), associations were found between health and land-cover diversity, informal greenery and patch size in high income areas. In lower income areas, health was predicted by proximity to public parks and recreation land.

Conclusions

A nuanced description of greenspace in terms of quality, cover type, diversity explains more variation in population health than a single metric such as percentage green cover. People in urban neighbourhoods that have older age populations and lower income are disproportionately healthy if their neighbourhoods contain accessible, good quality public greenspace. This has implications for strategies to decrease health inequalities and inform international initiatives, such as the World Health Organisation's Age-Friendly Cities programme.

Key messages

A nuanced description of green and blue space in terms of quality, cover type, diversity explains more variation in population health than a single metric such as percentage green cover. People in urban neighbourhoods that have older age populations and lower income are disproportionately healthy if their neighbourhoods contain accessible, good quality public greenspace.
Crowdfunding for medical expenses in the United Kingdom
Authors: Pifarré Coutrot I , Cornelsen L , Smith R
Published: October 2020

Background

Medical crowdfunding is a rapidly growing phenomenon worldwide and a new means for patients to finance health related expenses. It raises many ethical concerns such as increasing inequities. In the UK, which operates a state-funded universal health care system, the phenomenon is unexpected and hasn't yet been studied. Our study aims at answering basic questions as who is using crowdfunding to fund health-related expenses, for what and why.

Methods

We have drawn the first 400 medical campaigns amongst 1,000 available on GoFundMe UK website. We used a content analysis method to extract data from narratives on age, sex, health condition and funds' purposes.

Results

Among the 400 campaigns, 1/2 requested funds for cancer care for both common and rare cancers, from which 1/3 disclosed a stage 4. A third of the sample sought funds to get treatment abroad, mostly in Germany and the US, for most part cancer therapies such as immunotherapy but also alternative therapies. A quarter of the sample sought support to alleviate financial burden associated with ill-health. Other purposes included getting private care in the UK (19%) and getting medical equipment (18%).

Conclusions

Our findings may put forward some gaps within the National Health Service (NHS) and social care such as issues to access therapies or equipment, lack of holistic care and inadequate welfare patient support. However, it does not explain fully the rise of crowdfunding that may also be a counterpart of patients' empowerment. For instance, patients can shift to the private sector, in the UK or abroad, when a treatment is not available within the NHS, such as high cost last-resort treatments for those with poor prognosis. We recommend policy makers to: use medical crowdfunding to inform policy,support patients to make empowered decisions,protect patients from commercial traps.

Key messages

Studying medical crowdfunding allows better understanding of patients’ perceived or actual unmet need for health and social care to inform policy development. This threat to equity should be addressed globally by providing patients with support to be empowered, with universal health coverage and by regulating better private facilities and health tourism.
Left behind: the state of universal health coverage in Europe
Authors: Burns R , Graversen P , Miller A , Bader C , Offe J , Fille F , Aldridge R W
Published: October 2020

Background

Barriers to access healthcare and lack of data undermine Universal Health Coverage (UHC) in Europe, despite the region's clear commitment to the Sustainable Development Goals and UHC. Current indicators measuring unmet healthcare needs in the European Union (EU) often exclude more marginalised groups, further rendering their health needs invisible and the data to inform policy flawed. For effective evaluation of UHC, comprehensive data on the health of these groups is needed.

Methods

We conducted an evaluation of humanitarian healthcare provision of people attending Médecins du Monde (MdM) programmes in seven countries in Europe (Belgium, France, Germany, Luxembourg, Sweden, Switzerland, and the United Kingdom). MdM is a humanitarian organisation, providing care to those excluded from mainstream healthcare services. We describe the characteristics of MdM service users, their determinants of health and healthcare access.

Results

A total of 29,359 people were seen between January 2017 and December 2018. Nearly all were migrants (97.2%, 21,591/22,136), with 66.3% (11,690/17,629) of people reported not having a right or permission to reside in the country they presented in. A majority were living below the poverty line (92.6%, 7,660/8,268), residing in insecure housing (44.3%, 8,895/20,097) or living as street homeless or in emergency shelters (20.4%, 4,107/20,097). Most people reported having no healthcare coverage (81.7%, 14,848/18,164). When asked about barriers to accessing healthcare, 20.8% of responses reported economic barriers (3,960/19,020) and 14.3% reported a lack of knowledge of health system/entitlements (2,718/19,020).

Conclusions

This humanitarian service evaluation highlights the intersecting vulnerabilities and barriers to access healthcare for people excluded from mainstream healthcare systems across Europe. Our findings provide a unique insight into the extent of unmet healthcare needs of migrants and other marginalised populations.

Key messages

UHC requires comprehensive data on the population groups who are many times left without access to health services and who are often excluded from national data collection and research. A majority of MdM service users do not have healthcare coverage and experience multiple and intersecting barriers to access healthcare across Europe.
5.I. Skills building seminar: National burden of disease studies: inspirational experiences from across the globe
Authors:   Organised by: COST Action CA18218,   Chair persons: Brecht Devleesschauwer - Belgium, Henk Hilderink - Netherlands
Published: October 2020

What are the most relevant diseases in a country? Which risk factors are the strongest contributors to disease and death? How is the impact of different diseases evolving over time, and how does it compare to other countries or across sub-national units? With a constantly growing need to rationalize the allocation of available resources, a timely, sound and comprehensive answer to these fundamental questions is more than ever needed to inform public health decision making.

Driven by the impact of the Global Burden of Disease study, several countries have decided to establish a national burden of disease study to address these questions. Central to any national burden of disease study is the establishment of a coherent framework for routinely quantifying the impact of diseases and risk factors in terms of Disability-Adjusted Life Years (DALYs). National burden of disease studies further allow to valorise existing health information, foster collaborations with national stakeholders, and support capacity building. Implementing a national burden of disease study is however highly resource demanding, and many researchers struggle to effectively translate their findings to decision makers.

This skills building seminar gathers five inspirational examples of national burden of disease studies from across the globe. They reflect the diversity in approaches that currently exist. Indeed, while some countries have implemented their national burden of disease framework themselves, an increasing number of countries is collaborating with the Institute for Health Metrics and Evaluation (IHME) to conduct national and sub-national burden of disease studies. Both approaches have their own specific advantages, which will be outlined during the seminar. The selected examples further document the iterative, step-wise processes behind the implementation of a national burden of disease study, as well as the challenges, but also success stories, in translating data to policies. Overall, the aim is to demonstrate the added value of national burden of disease studies, and to share realistic, hands-on experiences on the steps needed to initiate, implement and maintain a national burden of disease study.

Key messages

National burden of disease studies are increasingly established across the world to support public health decision making. Different international initiatives are emerging to support countries initiate, implement and maintain a national burden of disease study.
The French national Global Burden of Disease (GBD) evaluation project
Authors: Gallay A , Rachas A , Gastaldi-Ménager C , Desenclos J C , Constantinou P , Tajahmady A , Le Strat Y
Published: October 2020

As in many countries, there is an urgent need to prioritize the issues in public health care and prevention in France. The French GBD project aims to offer a unique set of combined morbidity and mortality estimates to inform health policy makers in France, at the national level. However, because of the variability in health status and risk factors across geographical areas, policy makers need comparable estimates at the regional and local levels to target specific populations and to implement actions to improve health. Besides, although the accuracy of the indicators provided by the GBD has not been evaluated in the French context, it would be likely improved by enhancing and enriching the French data used as input.

The French national health data system is one of the largest healthcare claims database in Europe. Based on these data, the French National Health Insurance (Cnam) and Santé publique France (SpFrance), in collaboration with clinicians and researchers, have developed a set of algorithms to identify diseases based on health care reimbursements, which could improve GBD estimates.

Cnam and SpFrance both contribute to the definition, prioritization and evaluation of health policies in France and have therefore decided to pool their strengths and mutualize their resources to build a common rationale and provide consistent French Burden of Diseases estimates. A collaboration with the Institute of Health Metrics and Evaluation (IHME) has also been initiated, to allow Cnam and SpFrance benefiting from IHME's infrastructure and expertise and together seek to improve the estimates of the indicators using comparable methods at local and national levels, and consistent with the overall Global Burden of Disease project.

Finally, beyond the ongoing production of the GBD metrics, another objective is the knowledge transfer to Cnam and SpFrance as learning organizations.

The project has started with a framework between the three parties and the expression of interest.
5.K. Workshop: Innovative methods for population health research: lessons from the European Joint Action InfAct
Authors:   Organised by: Sciensano (Belgium),   Chair persons: Anne Gallay - France, Isabel Noguer Zambrano - Spain
Published: October 2020

Health information is essential to inform decision-makers, researchers and the public. The availability of health and non-health information generated from different sources is increasing. The possibility to link administrative data sources with other databases offers unique opportunity to answer research questions which, for example, require a large sample size or detailed data on hard-to-reach population. However, the linking of information from multiple data sources for population health surveillance and research can be complex and may require advanced expertise and skills in analyzing big data. Therefore, more efficient ways of linking and analyzing health information using big data across European countries are required. Nevertheless, the use of data linkage and the new technology such as artificial intelligence for data analysis across national public health institutes and health information and statistics offices across European countries varies.

The Joint Action on Health Information (InfAct) aims to establish a solid infrastructure on EU health information through improving the availability of comparable, robust and policy-relevant health status data and health system performance information. In the area of innovation in health information, InfAct focuses on developing guidance and recommendations based on case studies in data linkage and analysis for population health research.

The main objectives of this workshop are to share the experiences gained in using new methodological approaches for population health research, to highlight the underlying limitations and lessons learnt, and their implications for the facilitation of health policy processes. The workshop will begin with the latest developments in new methods for data analysis using artificial intelligence, followed by the presentation of potential uses of the hospital admissions/mortality ratio to assess the variability of non-communicable diseases within a country. Then, a java interactive tool to analyze industrial pollution for public health surveillance will be introduced, followed by an update on the development of a federated architecture for population health research that provides solutions to interoperability challenges. Finally, a new business model for health information in the age of digitalization will be presented.

Interactive exchange with the delegates will facilitate knowledge and opinion exchange regarding new approaches in population health research, and support learning from the experiences of the Joint Action. A commentary will summarize the main discussion points, and be submitted to the European Journal of Public Health.

Key messages

The main outputs of the Joint Action InfAct will contribute to the development of new methods for population health research. The results will support knowledge exchange among EU Member States, and facilitate the adoption of good practices considering country context.
Hospital admissions/mortality ratio: a composite health indicator for monitoring NCD
Authors: Ortiz-Pinto M , Pérez-Gómez B , Galán I , Sarmiento-Suárez R , Gómez-García T , Fernández-Navarro P , Padrón-Monedero A , Noguer I
Published: October 2020

Background

Our aim was to test the usefulness of a new tool to monitor NCD. We evaluated a composite indicator, the ratio of hospitalizations vs mortality rates (HMR), by assessing its capacity of identifying additional variability among regions. In this communication, we present the analysis corresponding to ischemic heart disease as an example.

Methods

We used the Hospital Morbidity Survey and the Death Statistics for Spain in 2016, both provided by the National Institute of Statistics, to calculate age-adjusted hospitalisation and mortality rates for ischemic heart disease for men and women in all 52 provinces of Spain. Subsequently, we computed HMR, the ratio of the age-adjusted of hospital morbidity and mortality rates. The correlation and linear adjustment between provincial mortality and morbidity rates, as well as mortality and HMR, were also estimated by sex.

Results

The rate of hospital admissions for ischemic heart disease in Spain was 407 per 100,000 in men and 129.4 in women. The mortality rate was 93.1 per 100,000 in men and 40.3 in women. In both sexes, the highest morbidity and mortality rates were observed in the south of Spain. Pearson correlation between morbidity and mortality rates were 0.53 (p < 0.01) in men and 0.75 (p < 0.05) in women. HMR showed a different spatial pattern with important variability. In men the average ratio was 4.3, with a range of 2.8 (Tenerife) to 7.1 (Melilla); in women the average was 3.2 with a range between1.7 (Zamora and Tenerife) and 4.7 (Barcelona), and in both sexes very high ratios were found in Catalonia's provinces. Association between mortality rate and HMR showed a negative correlation in both men (-0.39; p < 0.01) and women (-0.24; p < 0.05).

Conclusions

HMR is a composite indicator that provides complementary information regarding the individual analysis of hospital morbidity and mortality rates. HMR of ischemic heart disease shows an important geographical variability and an inverse association with mortality.
Assessing and piloting interoperability for population health research
Authors: Estupiñán-Romero F , Gonzalez-García J , Bernal-Delgado E
Published: October 2020

Issue/problem

Interoperability is paramount when reusing health data from multiple data sources and becomes vital when the scope is cross-national. We aimed at piloting interoperability solutions building on three case studies relevant to population health research.

Interoperability lies on four pillars; so: a) Legal frame (i.e., compliance with the GDPR, privacy- and security-by-design, and ethical standards); b) Organizational structure (e.g., availability and access to digital health data and governance of health information systems); c) Semantic developments (e.g., existence of metadata, availability of standards, data quality issues, coherence between data models and research purposes); and, d) Technical environment (e.g., how well documented are data processes, which are the dependencies linked to software components or alignment to standards).

Results

We have developed a federated research network architecture with 10 hubs each from a different country. This architecture has implied: a) the design of the data model that address the research questions; b) developing, distributing and deploying scripts for data extraction, transformation and analysis; and, c) retrieving the shared results for comparison or pooled meta-analysis.

Lessons

The development of a federated architecture for population health research is a technical solution that allows full compliance with interoperability pillars.

The deployment of this type of solution where data remain in house under the governance and legal requirements of the data owners, and scripts for data extraction and analysis are shared across hubs, requires the implementation of capacity building measures.

Key messages

Population health research will benefit from the development of federated architectures that provide solutions to interoperability challenges. Case studies conducted within InfAct are providing valuable lessons to advance the design of a future pan-European research infrastructure.
Research on High School Students’ and Teachers’ Mental Health Literacy Levels in Istanbul, Turkey
Authors: Karabey S , Arslan S
Published: October 2020

Background

Mental health literacy (MHL) is critical to reduce health inequality and for raising awareness and early recognition of mental illnesses. This study among students and teachers in Istanbul, Turkey, aimed to (1) determine the knowledge levels towards mental illnesses, (2) identify barriers to help-seeking behaviors and (3) assess stigmatizing attitudes towards mental illnesses.

Methodology

A cross-sectional, descriptive study design was used, and 810 high school students and 241 teachers were included in our study between Mar-Jul 2019. Data was collected through the Mental Health Literacy Questionnaire and the Beliefs towards Mental Illness Scale.

Results

Students' recognition percentages of depression, schizophrenia and social phobia vignettes were found to be 27.5%, 47.7% and 6.2%, respectively. Teachers' were found to be 46.5%, 42.7% and 26.1%, respectively. A statistically significant relationship was found between students' correct recognition of vignettes and gender, age group, mother education levels, and father education levels (p < 0,005). Female sex, older age, and having a parent with higher level of education were more likely to correct identify the vignettes. Among teachers, a significant relationship was found between correct recognition of vignettes and gender (p < 0,005). Females were more likely to correct identify the vignettes. Regarding the BMI subscales, students' average score was 21,6±9,8 for “poor social and interpersonal skills and incurability”, 19,9±6,9 for “dangerousness”, 1,5±2,3 for “shame” and 42,9±16,2 for total scale and the teachers' average scores were 23,6±10,1, 21,3±6,6, 1,2±1,7 and 46,2±16,6 in the same order.

Conclusions

The findings show that efforts are needed among both pupils and teachers in order to encourage help seeking behavior and to increase the belief that the solution of mental health problems is possible. Strengthening accessible mental health services and reducing stigma towards mental illnesses are also crucial.
Ten recommendations to foster mental health in children - Systematic development of information materials for parents and pediatricians
Authors: Zysset A , Winogradow D , Passalacqua S , Crameri A , von Wyl A , Wieber F
Published: October 2020

Introduction

Many mental disorders develop during childhood, with an estimated 10-20% of children affected, and they often persist into adulthood. As mental disorders are often recognized delayed or not at all, mental health promotion and the early detection of mental illness in childhood are relevant public health tasks. Pediatric practices are a particularly suitable setting for such efforts are as they do have regular and direct contact with most children. This project therefore aimed to develop materials to raise parents' awareness of children's mental health and provide specific suggestions for mental health promotion and screening for mental health problems.

Methods

A systematic literature review in the field of mental health promotion, clinical psychology and positive psychology on life skills and resilience revealed several effective concepts. In a participatory process with psychiatrists and pediatricians, ten concepts were selected: self-esteem, self-efficacy, problem solving skills, optimism, emotion regulation, recreation, family climate, nature, offline-activities, and peer support. In a preliminary evaluation of parents' perspective on a parent-brochure, 74 parents of 6-12-year-old kids filled in two online-questionnaires on the perceived relevance and usefulness of the ten concepts and the respective behavioral suggestions; one right after learning about the recommendations and one four weeks later.

Results

First analysis show that parents perceive the recommendations as highly relevant and useful at both measurement time points and that they integrated many of them in their everyday family life.

Conclusions

Resource-oriented suggestions on the promotion of mental health in children seem to offer a non-stigmatizing way to address mental health topics in the pediatric practice. In a next step, we plan to field-test the evaluation and uptake of the accompanying information brochure by pediatricians.
6.C. Workshop: Digitalizing maternal and child public health
Authors:   Organised by: EUPHA Child and adolescent public health section,   Chair persons: Julia Dratva - Switzerland, Danielle Jansen – EUPHA-CAPH
Published: October 2020

Digital Technologies have transformed many sectors in societies, and, increasingly, is changing the health care sector and health research. In comparison the potential of digital technologies in public health has been less explored. The workshop aims to address both the challenges and potentials of digital public health with focus on maternal and child public health. Presenters will provide examples of how digital technologies and digital health innovations can sustain and improve maternal and child health.

The workshop presents three perspectives on digital maternal and child public health from different continents. This is a deliberate choice to highlight the universal and global relevance of digitalization in maternal and child public health. After the presentations, time is foreseen for a discussion on potential and limitations, as well as the generalizability of methods and results for maternal and child health globally, as well as on the question of governance in digital public health.

The workshop topics will span from digital health information seeking to monitoring and the use of artificial intelligence for policy development. Each presentation covers a different technology or digital approach to public health. The presentations will critically explore how these technologies and approaches can improve public health from a local and global perspective, and will raise central issues, such as acceptance and availability of novel technologies, generalizability of results, governance and participatory approaches in the digital transformation in maternal and child health globally.

Key messages

Digital technologies can provide different impact for maternal and child public health depending on area of implementation, e.g. health promotion, policy development. Challenges and potentials range from specifically local and health-system related to globally generalizable factors.
Use of artificial intelligence based models for learning better policy for maternal and child health
Authors: Sethi T , Awasthi R
Published: October 2020

More than 640,000 babies died of sepsis before they reach the age of one month in India in 2016. Despite a large number of government schemes aimed at reducing this rate, this number still remains high because of the complexity and interplay of factors involved. Finding an optimum policy and solutions to this problem needs learning from data. We integrated diverse sources of data and applied Bayesian Artificial Intelligence methods for learning to mitigate sepsis and adverse pregnancy outcomes in India. In this project, we created models that combine the robustness of ensemble averaged Baeysian Networks with decision learning and impact evaluation by using simulations and counterfactual reasoning respectively. We will demonstrate the process of learning these models and how these led us to infer the pivotal role of Water, Sanitation and Hygiene for reducing Adverse Pregnancy Outcome and neonatal sepsis in the population studied. We will also demonstrate the creation of explainable AI models for complex public health challenges and their deployment with wiseR, our in-house, open source platform for doing end-to-end Bayesian Decision Network learning.
Energy and Climate Change Scenarios in the Mediterranean: An opportunity for cooperation
Authors: Velez Lapão L
Published: October 2020

Background

Climate change is modifying weather patterns, producing far-reaching effects on the environment, the economy and society as a whole, endangering global livelihoods, health, food and energy security, and water resources. Europe, and the Mediterranean will not escape the effects of climate change, which will aggravate risks and threats to human security (mainly public health) and regional stability. Actual cooperation and appropriate instruments are needed to address these threats. In this context, higher temperatures and extreme weather phenomena, such as severe droughts and heat waves will inevitably cause water scarcity in these regions and significant health issues. The degradation of the environment will foreseeably create security and health crisis scenarios, arising from energy shortages, air quality, water stress and food supply problems.

Methods

A scenario analysis was designed to address the relation between security, healthcare, energy and climate change, which contains multiple dimensions. We did a review of the literature and use it to feed the scenario analysis development, to better describe a phenomenon that is complex, with many possible paths and outcomes.

Results

Among the possible scenarios, two were considered: one based on collaboration and the other, on conflict. Several dimensions were examined to address both cooperation instruments and the consequences of non-cooperation: Energy production (e.g., conventional versus renewable) and use; water resources and food security; the environment (air quality) and the impact on health; Population and migration flow.

Conclusions

Climate change is a serious threat. To achieve and implement cooperation, there must be multilateral collaboration between the EU and the other Mediterranean countries, including stronger investment flows from north to south, in conjunction with the promotion of both energy efficiency policies and better healthcare system in the south.
6.E. Workshop: Health promotion: An integrative paradigm for sustainable health, wellbeing and development
Authors:   Organised by: IUHPE,   Chair persons: Margaret Barry - Ireland, Margaret Barry - Greece
Published: October 2020

This workshop addresses the importance of health promotion for enabling all human beings to have healthy lives, to maximise their health potential and ensure that no one is left behind. Health promotion is a critical component of modern health systems and a vital strategy for sustainable health development and human flourishing. Effective health promotion strategies are essential in addressing the broader determinants of health, reducing health inequities, and tackling current and emerging health challenges to human development.

Achieving the UN Sustainable Development Goals (SDGs) and universal health coverage calls for concerted action on health promotion as an integral component of modern health systems and future development. While successive global health policies have endorsed the need to invest in health promotion, political commitment to implementing health promotion is lacking and health policies and budgets remain focused on curative approaches. Health promotion is often poorly understood, both within the health sector and society more widely, and there is a limited appreciation of what is required to translate health promotion into effective action. Transformative health promotion actions are needed to deliver on improved population health and wellbeing and the creation of a healthy society where human wellbeing can flourish.

Objectives

This workshop will engage participants in an interactive discussion on how health promotion policy, research and practice can be strengthened in order to advance human health and wellbeing. Critical insights will be exchanged on how to bring a renewed focus on health promotion as a key transformative and disruptive strategy for advancing human wellbeing development. The workshop will critically consider what mechanisms are needed for strengthening health promoting policies, implementation processes and structures, capacities and research, to advance population health and wellbeing and a healthier future for all.

Key messages

Health promotion actions are critical to the delivery of improved population health and health equity, transforming health systems and enhancing human wellbeing and sustainable development. Strengthening health promoting polices, practices and research is essential to achieve the UN Sustainable Development Goals and enable the conditions for a healthier world.
Experiences of healthcare workers displaced by conflict: lessons from past conflicts and implications
Authors: Moqeem U , Mukhtar O , Abbara A , Jabbour S , Abouzeid M
Published: October 2020

Background

Conflicts cause mass displacement, including of healthcare workers (HCWs). Understanding experiences of HCWs over the displacement trajectory, from push factors out of conflict zones, to barriers and facilitators in transit and host countries, is key to developing support mechanisms and informing policy discussions regarding return and reintegration.

Methodology

We systematically reviewed 6 academic databases and grey literature using combined search terms for HCWs, displacement, conflict, and experiences to identify English-language literature documenting personal or professional experiences of HCWs displaced by conflict, published between 1945 to 2020. Open coding and thematic analysis were used to identify emerging themes. Quality appraisal was conducted.

Results

25 publications from academic journals, snowballed references, and grey literature from 10 geographical contexts and various types of HCW met inclusion criteria, many from conflicts in the Middle-East. 5 themes emerged: Conflict drives displacement: HCWs fled due to direct violence and deteriorating working conditions caused by increased workload, depleting resources, workforce attrition and attacks on healthcare. Giving back: Refugee HCWs were determined to continue working but had to do so informally or by working with humanitarian agencies. Personal and professional integration in host countries: refugee HCWs overcame barriers to relicense after which they reported disadvantage in job applications due to professional gaps and discrimination; many ended up working under-qualified jobs. Psychological toll on HCWs was pronounced. Prospects on return: HCWs desired to return to their home countries but feared political instability and violence.

Conclusions

Policies which support HCW retention during conflict, integration into host health systems, and encourage return post-conflict must be implemented. Further research is required to understand the individual and systemic support mechanisms required.

Key messages

Displaced HCWs experience many personal and professional challenges. Policies that support HCWs across the displacement trajectory and support return and post-conflict system rebuilding are required.
Team Climate in Primary Health Care in a region of São Paulo countryside, Brazil
Authors: Silva J A M , Mininel V A , Ogata M N , Machado M L T , Feliciano A B , Sampaio S F , Pedro W J A , Souza G C , Agreli H F , Meirelles E
Published: October 2020

Background

Interprofessional teams are responsible for Primary Care at Brazilian HealthCare System. Teamwork climate is considered a key for quality of healthcare services and care perceived; it results in perceptions about a team, considering aspects that influence their relationship and effectiveness. The study aims to analyse the teamwork climate of Primary Care workers.

Methods

Survey cross-sectional carried out in a region of São Paulo countryside with 419 Primary Care professionals from 60 teams of public health services. We collect data through the Team Climate Inventory with 38 items and 4 factors. We analysed the data using a psychometric, factorial confirmatory analysis. This research is part of the Universal CNPq Project, process 431461/20163, and all ethical concerns were observed.

Results

In the sample 47 (11.2%) were nurses, 143 (34.1%) community health workers, 87 (20.7%) nursing assistants and 27 (6.4%) physicians and 115 (27,6%) other health professionals. Cronbach was >0,90 in all factors of Team Climate Inventory and the correlation was confirmed with p < 0,05. In the factor 1 - Team Participation M = 3,79, DP = 0,66; factor 2 - Support to new ideas M = 3,66, DP = 0,68; factor 3 - Team objectives M = 5,04, DP = 0,98; factor 4 - Tasks orientation M = 4,92, DP = 1,30 with p-value 0,001 to all factors. Tukey's post hoc analysis indicated that the group with less than one year in the teams (M = 5.31) had a significantly higher average when compared to groups with 6 to 10 years in the team (M = 4.91) and 11 years old or more (M = 5.04).

Conclusions

Results showed a good team climate in the sample, the potential to strengthen the teams and the relevance of working time together to get better results for patient health care. The magnitude of the public health impact by reporting on the team climate indicators of the 60 Brazilian teams are local and international relevance.

Key messages

The time of work together in a team can be a predictor of clear objectives in teamwork. The team climate recognizing can promote reinforce of the teamwork and the results to Public Health. Policy makers and managers can apply these results to build workforce management actions.
Nurse density matters: a 30-country observational study of antimicrobial resistance priority type
Authors: Kaba H , Kuhlmann E , Scheithauer S
Published: October 2020

Background

Although the warming climate and antimicrobial use were associated with antimicrobial resistance (AMR), they showed poorer explanatory strength in southern and eastern European countries, characterized with higher levels of nurse emigration. The present study investigated the contribution of nurse density to AMR variance explanation in the EU/EEA region for “Priority 1” AMR types (WHO).

Methods

A 30-country observational study was conducted. Combined species six-year prevalence of carbapenem resistant gram-negative bacteria (Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Acinetobacter spp.; CRGN) were determined using public ECDC data of clinical isolates, which were subjected to statistical analysis.

Results

Countries with low nurse density (< median) displayed a 10-fold higher median CRGN prevalence compared to those with high density (p < 0.001). Furthermore, proportions of reported isolates for all species (standardized by the total number of reported isolates per country) negatively correlated with nurse density with the exception of Ecoli, which showed a positive correlation (rs = 0.73, p < 0.001). In multivariate analysis, nurse but not physician density significantly explained total log_CRGN variance (R2=83%). Notably, nurse density had a higher contribution to variance explanation than outpatient antimicrobial use. However, this observation could be retained only for countries without a gate-keeping role of GPs.

Conclusions

This study contributes novel data by identifying a potential association between nurse density and CRGN. Statistical observation might be supported by survey data on health workers' attitudes, which identified nurses and associates as the professionals most likely to perform hand hygiene.

Key messages

Including nurses in future AMR policies may help to tackle the spread of critical AMR types, such as CRGN. Strengthening the role of nurses in fighting AMR may be most beneficial in countries without a gatekeeping system.
Knowledge, attitude and practice on antibiotic use and resistance among the Italian population, 2019
Authors: Vaccaro C , Fortunato F , Iannazzo S , Furiozzi F , Martinelli D , Prato R
Published: October 2020

Background

Public knowledge, awareness and behaviors related to antibiotic use and antimicrobial-resistance (AMR) are vital to ensure the prudent use of these drugs. In this work, we present the top-line results of the first national survey of AMR among the Italian general population aged ≥18 years.

Methods

From August to September 2019, we conducted a population-based cross-sectional random survey through mixed CATI/CAMI/CAWI methodologies among representative samples of the general population, parents of children aged 0-11 years, adults ≥65 years and pet's owners. Results were summarized using relative frequencies.

Results

Of 1,400 persons interviewed, 47% and 68% respectively correctly said that it is false that antibiotics kill viruses and are effective at treating colds and flu. More than 80% of respondents considered themselves to be well-informed about antibiotics but only one in two people knew what is meant by AMR. While the vast majority (96%) of respondents said that they obtained the last course of antibiotics that they used from a medical prescription, 11% incorrectly said that they stopped taking antibiotics when they felt better or that they used those left over from a previous course. In addition, 55% of pet's owners said they obtained antibiotics without a prescription from a pharmacy or elsewhere. Almost all respondents (97%) believed that it's everyone's responsibility to use antibiotics wisely, with the 80% who expressed concerns about the potential of AMR to affect themselves and their families; however, 40% did not think that action at an individual level is the most effective way of tackling resistance to antibiotics.

Conclusions

Our findings show some improvement in Italians' knowledge, awareness and behaviors related to antibiotic use and AMR but there are needs to be a greater sense of responsibility to take charge of the AMR problem. These results may be drivers of structured national awareness campaigns.

Key messages

In 2019, we conducted the first national survey of AMR among the Italian population: >80% of respondents felt themselves well-informed about antibiotics but only 1/2 people knew what is meant by AMR. Almost all Italian sample believed that it's everyone's responsibility to use antibiotics wisely, but 40% did not think that action at an individual level is effective to tackle AMR.
Key indicators for harmonized European population health surveillance: an iterative approach
Authors: Do S D , Murrin C M , Hebestreit A H
Published: October 2020

Introduction

A pan-European approach to evaluate policy impact on health behaviours requires the employment of a consensus set of established, relevant indicators. This set includes indicators for policy and action, behavioural aspects, determinants and health outcomes.

Methods

Following an iterative selection process, we prioritised an agreed set of health indicators of high priority for policy makers. During this process, over 30 European experts were invited to attend a workshop and consult on inclusion and prioritisation of indicators. These experts were representatives of surveillance systems and informants of similar initiatives, e.g. STOP, Co-Create, HBSC, WHO COSI as well as representatives of organisations providing monitoring data such as OECD, EC DG SANTE, WHO and Eurostat. The consultation process was initiated prior to the workshop via email and continued with facilitated group discussions during the workshop.

Results

Lists with indicators relevant for policy evaluation and monitoring of 1) dietary behaviour (N = 76), 2) physical activity/sedentary behaviour (N = 86) as well as 3) socio-demographic indicators (N = 9) have been composed; examples will be presented. This suite of key indicators was agreed and then mapped against data in existing pan-European monitoring systems in order to provide an open-access catalogue suitable for the design and evaluation of new and existing policies.

Conclusions

The presentation will offer an opportunity for researchers and stakeholders to learn more about this catalogue, the indicators and how they could be applied and integrated into their activities.

Key messages

We provide a set of health indicators relevant for pan-European policy impact evaluation. These indicators - ideally measured using harmonized instruments - may facilitate collection of comparable data across EU surveillance and monitoring systems.
Spatial patterns in regional life expectancy trends in the European Union between 1990 and 2018
Authors: Hrzic R , Vogt T , Brand H
Published: October 2020

Background

A substantial life expectancy gap exists at the regional level in the European Union (EU). It has consistently followed an east-west pattern since 1990. The spatial pattern in the rate of change of regional life expectancy is less well established. Understanding both patterns is necessary to guide regional cohesion and health inequalities policy in the EU. Our aim was to investigate whether there are distinct spatial patterns in regional life expectancy trends in the EU since 1990.

Methods

Using Eurostat's regional life expectancy database, we constructed a panel of sex-specific period life expectancy at birth (PLE) for 201 EU NUTS2 regions between 1990 and 2018. Regions with populations less than a hundred thousand and with more than ten years of missing data were excluded. We clustered the regions based on the similarity of the shapes in PLE trends for each sex using a bootstrap version of the K-means algorithm. The optimal numbers of clusters were determined based on a majority of five empirical criteria. Finally, we used a bootstrap version of the join count test to assess the degree of the spatial association of the identified clusters.

Results

Preliminary results of clustering on PLE trends support a two-cluster model for women (high and moderate rate of PLE improvement) and a three-cluster model for men (very high, high, and moderate rate of PLE improvement). The clusters do not correspond to EU macro-regions or the year of EU accession. The female high rate and male very high rate of PLE improvement clusters overlap in northern Portugal, northern Italy, Finland, Poland, Czechia, Austria, the Budapest region, and Slovenia. The join count tests reject a random spatial patterning of clusters.

Conclusions

EU regional life expectancy trends since 1990 exhibit a spatial pattern that does not correspond to EU macro-regions or recent EU accession. Analysing spatial patterns in regional lifespan disparity trends would be an interesting next step.

Key messages

Subnational EU life expectancy trends exhibit a spatial pattern that undermines the prevailing east-west divide narrative as eastern European regions are among the best performing since 1990. National differences in health may not reflect the experience of European citizens in their regions. Subnational and dynamic perspectives are key for future health disparities research in the EU.