bluuebunny/crossref_metadata_2025 huggingface dataset:
2.L. Workshop: Public Health Institution and Academia’s role in building capacity for Health Impact Assessment
Authors:   Organised by: EUPHA-HIA, EUPHA-HWR, ASPHER,   Chair persons: Piedad Martin-Olmedo (EUPHA-HIA), Ellen Kuhlmann (EUPHA-HWR)
Published: October 2022

Health impact assessment (HIA) is a process, which systematically judges the potential, and sometimes unintended effects of any new proposal (policy, project, program or strategy) on the population health, and the distribution of those effects within the population. It was conceived in 1999 as the supporting tool for the implementation of Health in All Policies (HiAP), but its practical use remains quite partial worldwide, with exceptional regions and countries (e.g. Wales (UK), Australia). Several surveys conducted nationally, but also across Europe by the World Health Organization-Regional Office for Europe identified several barriers that hinder a broader and more extensive practical application of HIA. One of these limitations lies in the lack of understanding and knowledge of professionals from non-health sectors about the benefits that addressing health considerations in the planning process of their projects, strategies or programs may have. In this sense, the HIA is frequently seen as an additional bureaucratic burden. Other common constraints reported refer to inadequate resources (guidelines, tools, evidence) and lack of qualified staff experienced in conducting HIA. Respondents from those surveys also deplored a history of unsatisfactory experiences involving intersectoral collaboration with health professionals, decision makers and other public sector stakeholders. Health agencies, such as national and regional Public Health Institutes (PHIs) can play a critical role in overcoming these limitations. They can act by providing independent advice and support based on the best available evidence to governments and proposal developers (projects, programs, strategies). However, they need to have knowledge, resources and capacity to do so. On the other hand, these basic concepts and procedures related to HiAP or HIA are rarely addressed in depth in the university curricular training of health sectors or other sectors such as environmental science or urbanism. Present workshop intends to analyse different experiences in Europe regarding the role of PHIs and also the academia in overcoming those reported exiting barriers, and reach a more sustainable and healthy societies. The fundamentals of what could be a training program on HIA principles across Europe will be also discussed.

Key messages

• PHIs can demonstrate leadership for HIA and HiAP by providing support to decision makers in better understand the wider health impacts and how they will manifest themselves across the population.

• HIA practice requires of the design of proper training programs and of certain validation process, which avoids conflicts regarding consultants’ impartiality and independence in conducting a HIA.
Old and new challenges of HIA Capacity building in Portugal
Authors: Costa L , Costa A , Dias Ferreira AC , Martín-Olmedo P , Green L
Published: October 2022

Within the European framework on health, adopted in 2012 by the Member States in the World Health Organization European Region, Health Impact Assessment (HIA) plays a crucial role in achieving the Sustainable Development Goals by supporting decision-makers to address health impacts and inequalities and ensure health gains. In Portugal, the integration of HIA in the Public Health Services (PHS) is still lacking despite of several attempts to implement HIA. In the pandemic and post-pandemic context, Public Health Authorities are busy with a lot of mandatory tasks, and the absence of a national policy framework for HIA that puts into practice the legal obligations arising from the Environment Impact Assessment Directive 2014/52/EU inhibits its sustainable implementation. The National Institute of Health Doutor Ricardo Jorge (INSA) has been involved in capacity building initiatives designed to further support the institutionalization of HIA in Portugal. This presentation outlines the lessons learned from this experience and will identify key facilitators and barriers elements for HIA implementation in specific contexts. The role of PHS in HIA development and execution will be discussed taking into consideration policy dialogue conclusions, and data collected from a survey aim to address the use and perception of this methodology in Public Health Units at the local level. The more recent Portuguese Fundamental Law on Health (Law nº95/2019) provides an important policy support ensuring Health in All Policies (HiAP) and it also opens a new pathway to enable HIA implementation at the national, regional, and local levels. In this respect, the PHS could play a crucial role taking leadership for HIA in Portugal. Novel and old approaches are still withstanding challenges.
The Empowering Example of High Vaccine Uptake among the Arab Minority in Israel
Authors: Essa-Hadad J
Published: October 2022

Introduction

Over 1.9 million Arabs live in Israel and constitute 21% of the total population. Despite being a disadvantaged minority population with wide gaps in health indicators, Arabs have higher Human Papillomavirus (HPV) and Measles, Mumps, and Rubella (MMR) vaccination rates compared with the general Jewish population.

Methods

In-depth interviews with 20 health care providers and 30-40 Arab mothers and teens will be conducted to collect information about health system enablers to HPV and MMR vaccination. All interviews are conducted in Arabic by an Arab researcher, audio-recorded, transcribed, and analysed using thematic analysis of the transcripts. Themes will be mapped on the theoretical Social-Ecological Model.

Results and discussion

Preliminary results indicate several health system enablers, such as accessible vaccination services through the school system and mother child clinics, vaccination provided at no cost, and high levels of trust towards healthcare professionals, who are Arab and understand the social and cultural norms of the community. Despite high vaccine uptakes, parents and teens had limited knowledge regarding vaccination, particularly HPV.

Conclusions

This research provides important insights into health system enablers regarding HPV and MMR vaccination among the Arab minority in Israel. Such evidence can serve as a basis for interventions and guidance to improve vaccine uptake among other underserved minority communities in Europe.
Continuous perinatal health monitoring and analysis in Europe based on a federated analytic approach: a proof of concept study
Authors: Philibert M , Amyx M , Durox M , Dimnjakovic J , Thissen M , Estupiñán-Romero F , Berna E , Zeitlin J
Published: October 2022

Background

International comparisons of population indicators of maternal and newborn health are valuable for guiding health policy and practice. The Covid-19 pandemic revealed the difficulties of compiling comparable, timely data in Europe. As part of the PHIRI (Population Health Information Research Infrastructure) project, we developed a protocol to facilitate the exchange and analysis of population birth data in Europe.

Methods

The Euro-Peristat network, which includes experts from 31 European countries, developed a common data model and R scripts to facilitate rapid exchange of anonymised aggregate tables (https://zenodo.org/record/5148032#.YmlUttpBxPY). These tables were used to compile comparable perinatal health indicators from routine population-based sources for the years 2015 to 2020. We assessed the feasibility of this approach and the availability, quality and comparability of the data.

Results

Building on previous Euro-Peristat recommendations and a structured consensus process, the network defined a common data model including 22 variables for the testing phase. 17 additional variables were considered important and feasible for a second phase. 25 countries created patient-level data files. Most countries had 20 or more of the data items, whereas 1 had 18, 3 had 16 and 2 had 15 variables. Limiting factors included not having all data in a single database, most often the case for neonatal and infant mortality or vital statistics versus healthcare data, and the diversity or absence of data on socioeconomic status. Setting up the model was time consuming, but once established, running the R scripts was easy and quick (<15 min). The protocol requires the active participation of each country to ensure it is correctly applied.

Conclusions

We illustrated the feasibility of using a common data model with open source scripts to facilitate rapid production of data and analysis on key perinatal health indicators in European countries
Socioeconomic differences in perinatal health outcomes: perinatal health surveillance through a health-equity prism
Authors: Smith L , Farr A , Zurriaga O , Cuttini M , Verdenik I , Vidal Benedé MJ , Kearns K , Sakkeus L , Kyprianou T , Barros H
Published: October 2022

Background

Socioeconomic status (SES) is strongly associated with perinatal health outcomes, perpetuating intergenerational health inequalities. Our aim was to assess the utility of population data in Europe to monitor social inequalities in key perinatal health indicators.

Methods

Using the PHIRI federated analysis protocol to aggregate routine birth data from across Europe, we collected data on selected perinatal health indicators by SES from 2015 to 2020. Mothers’ education level (primary/lower secondary; upper secondary; postsecondary) was the preferred SES indicator; if unavailable, parents’ occupation or area-based deprivation scores were provided. The International Standard Classification of Occupations was used to group parents’ occupations into 4 categories, while area-based deprivation scores were measured in quintiles. For each country, we calculated risk ratios (RR) for preterm birth, stillbirth, neonatal death and caesarean delivery (CD) comparing the most with the least disadvantaged group

Results

17 countries provided data on maternal education, 5 on area-based deprivation, 1 on parents’ occupation and 2 could not provide data. For preterm birth, stillbirth and neonatal death, lower SES was associated with worse outcomes with most RR between lowest and highest groups in the range of 1.5 to 3.0. In contrast, in some countries, such as Croatia, Latvia, Lithuania and Spain, CD rates were higher for socially advantaged groups whereas the gradient was reversed in others (Denmark, Luxembourg, the Netherlands and Italy).

Conclusions

European countries can provide perinatal health indicators by SES, revealing marked socioeconomic inequalities in perinatal health. The differing SES gradient between countries for CD raise questions about care organization and clinical practice. Further exploration of the harmonization of differing SES measure across countries is required, while countries that do not monitor SES data should aim to improve existing systems.
Achieving more with less: lessons from country-level analyses of caesarean delivery and perinatal outcomes in Europe
Authors: Zeitlin J , Mortensen L , Nijhuis JG , Recio Alcaide A , Velebil P , Tica V , Mierzejewska E , Klungsoyr K , Donati S , Macfarlane A
Published: October 2022

Background

There is consensus that caesarean delivery (CD) is a lifesaving procedure for both mother and child in emergency situations and that CD without medical indication should be avoided. However, the rate that optimally balances the risks and benefits of CD is unresolved. In 1985, the World Health Organization concluded that the CD rate should be no more than 10-15%; subsequent reviews relating CD rates to infant mortality show no benefits at the country-level for rates higher than 15-19%. However, stillbirth has not been investigated because comparable international stillbirth data are not readily available.

Methods

We conducted an ecological study in 25 European countries from 2015 to 2019 utilizing data from routine birth data sources aggregated using the Euro-Peristat PHIRI federated data analysis protocol. We assessed country-level associations between CD rates and perinatal outcomes (singleton preterm birth, stillbirth at ≤ 24 weeks’ gestational age, neonatal death) for all years using Pearson correlations, adjusted for clustering of years within country. Correlations were also estimated between linear trends over time in the indicators.

Results

The median [range] of CD rates was 23.1% [16.2 to 56.9] in 21 participating countries, while these were 6.9% [5.3 to 11.9] for preterm birth, 3.3 per 1000 total births [1.8 to 7.6] for stillbirth and 1.9 per 1000 live births [0.7 to 6.1] for neonatal mortality. The CD rate was not associated with the stillbirth rate (cluster-adjusted rho: -.01, P=.94) or with the neonatal mortality rate (rho:.27, P=.27). However, there was a strong positive correlation with the preterm birth rate (rho:.81, P<.001). Results were similar in time trend analyses.

Conclusions

Higher CD rates were not associated with lower stillbirth or neonatal mortality rates, but were strongly correlated with higher preterm birth rates. This study suggests no benefits and indicates potential harms for higher CD rates in Europe.
Meeting the health needs of forcibly displaced populations: translating evidence into implementation via the WHO global research agenda on migration and health
Authors: Orcutt M
Published: October 2022

In this presentation, Dr Orcutt, will outline the health system responses needed to respond effectively to the health needs of forcibly displaced populations - from initial health assessments to the longer term - and the role that research can play in ensuring evidence-informed policies and practice. She will present the main areas of the WHO's new global research agenda on migration and health and outline how translating evidence into implementation is essential to improve the health of migrants.
Strengthening implementation of catch-up vaccination and multi-disease screening for new migrants
Authors: Hargreaves S
Published: October 2022

Dr Hargreaves will discuss the current guidance for EU/EEA countries on public health considerations for newly arrived migrants, with a specific focus on catch-up vaccination delivery across the life course in mobile populations. She will explore current initiatives and best practices to ensure child, adolescent and adult refugees and migrants are included in catch-up planning and delivery for missed vaccines and missed doses and to align them with the host country vaccine schedule.
Health care provision to migrants: what did we learn from the Ukraine, Afghan, and Syrian crises?
Authors: Veizis A
Published: October 2022

Dr Veizis was involved in the immediate health care provision to Ukrainian people fleeing to neighbouring countries including Poland and Moldova, as well as health care provision to Syrian people residing in Greece, working for the non-governmental organisation INTERSOS and previously MSF. He will discuss his experiences to date in terms of immediate and long-term provision to these groups and the role of both NGOs and mainstream health services in meeting the needs of forcibly displaced migrants to Europe.
2.P. Round table: Covid-19 pandemic: the rise or downfall of public health
Authors:   Organised by: EUPHA,   Chair persons: Iveta Nagyova (EUPHA), Marieke Verschuuren (EUPHA)
Published: October 2022

This year, we are celebrating 30 years of the European Public Health Association. But celebrating this after over two years of COVID-19 and the Russian reinvasion of Ukraine, invites us all to reflect on the use, misuse and non-use of public health. Over the years, our approach to public health has evolved. At the start of the 20th century, public health emphasized the inequalities created by the environments in which people lived, including housing, sanitation, and nutrition. By the end of the century, this extended to the political and commercial determinants of health and the concept of planetary health, which would later be encapsulated by the 2016 Vienna Declaration on Public Health. Given this comprehensive approach, supported by a much greater body of knowledge produced by many disciplines, public health should have been in the driver's seat when the world was hit with COVID-19. But it was not. Its expertise was often absent from COVID-19 response teams. Policies were often driven by panic in the face of visions of overwhelmed hospitals. Restrictions on mixing were essential until more was known about this new virus but there were failures to appreciate the impact that these measures would have on those already disadvantaged, many in precarious employment in public-facing jobs and overcrowded accommodation. As a consequence, existing health inequalities deepened. It seemed that much that had been learned over the preceding decades had been forgotten. In this roundtable, we seek to explain why, and what needs to change in order to refocus the centrality of public health on supporting and creating fair societies as a prerequisite for health for all.

So, is COVID-19 the downfall or the new rise of public health? In this Round Table, we will discuss the questions as follows.

1. Where was public health during COVID-19?

2. Why were social factors ignored during COVID-19?

3. Why has public health not used/is not using the momentum created by COVID-19?

4. And the main question: How can we create a fair society?

Key messages

• Public health needs to strengthen its core activities.

• Advocacy is a key role for public health.

Speakers/Panellists

Martin McKee

LSHTM, London, UK

Natasha Azzopardi Muscat

WHO, Msida, Malta

Dineke Zeegers Paget

EUPHA

Klaus D Pluemer

Independent Public Health & Health Promotion Consultant, Duesseldorf, Germany

Caroline Costongs

EuroHealthNet, Brussels, Belgium
FRESHER: Challenges and opportunities for building Health/Healthy futures
Authors: Giuffrè G , Giesecke S
Published: October 2022

Background

FRESHER (2016-2018) Foresight and modelling for European health policy and regulation - is a H2020 project that aimed at representing alternative health Scenarios to test future policies for tacking Non-Communicable Diseases (NCDs). The key added-value consists in the combination of qualitative foresight and quantitative forecast approaches: a micro-simulation model, specifically developed by the project, computed the health outcomes of the four FRESHER Scenarios.

Methods

The Scenarios building activities involved overall more than four-hundred experts and stakeholders, with different backgrounds within and beyond health fields, throughout all the steps of the process, in two surveys and nine workshops. The horizon scanning phase led to identify a wide range of societal trends that impact health and NCDs. Considering a long-term horizon at 2050, eight trends were then selected and ranked according to their importance and uncertainty.

Results

In the Scenario Building phase, the combination of different evolutions of the selected trends resulted in four alternative futures: a Business as Usual Scenario, “The rich get healthier”, two response Scenarios, “We will Health you” and “Healthy together”, and a worst case Scenario “Desolation Health”. The scenarios imagine different futures and depict how health would subsequently change in such worlds.

Conclusions

Given the increasing need to put health at the centre of all policies, it is necessary to make more evident the relationship between societal trends and their impact on health, specifically for NCDs. The translation of trends, and their evolutions, into changes of risk factors is a viable option to assess the impact of public health policy. FRESHER aimed to trigger a dialogue across different scientific and policy communities outside the health sector in order to define innovative strategies and identify disruptive innovations.
Sources of bias in COVID-19 infection fatality rate estimation
Authors: Pezzullo AM
Published: October 2022

Since the beginning of the devastating COVID-19 pandemic, there has been a great debate about various public health relevant parameters such as the number of people infected with SARS-CoV-2, the number of deaths from COVID-19, and the resulting infection fatality rate (IFR), calculated as a ratio of the number of deaths from COVID-19 and the number of people infected with SARS-CoV-2. Among people dying from COVID-19, the largest burden is carried by the elderly, and locations with an older population will have a higher average IFR. Drawing from a project on the estimation of age-stratified IFR at an international level, in this methodological presentation, I will review the considered sources of bias for COVID-19 IFR calculation and interpretation. Both numerator and denominator can be overestimated or underestimated leading to biased estimates, while different locations can present sources of true variability. The estimation of the number of people infected with SARS-CoV-2 (the denominator of the IFR) presents several challenges. Relying on testing is inadequate due to a substantial undiagnosed proportion, and seroprevalence studies have been used to estimate the number of people infected with COVID-19, but selection bias can arise when the examined population might have a lower or higher risk than the target population. This can be the case when factors such as ethnicity, working status, and comorbidity are not considered in the recruitment. Information bias can result from suboptimal test performance and seroreversion. The number of deaths can be underestimated in situations where testing is not widely available and overestimated by the attribution of COVID-19 deaths to patients that have died with COVID-19 but not from it. Sources of true variability between locations are the population age distribution, protection of the vulnerable populations, as well as the presence of a prepared and efficient healthcare system.
Public Health Ethics and ‘the Science’ in Public Decision-Making
Authors: Coggon J
Published: October 2022

In this presentation, I aim to complement the ideas presented by the other speakers by raising questions about ethics and (different senses of) integrity. In particular, against the pressures of providing evidence bases for governmental decision-making during the COVID-19 pandemic, I ask critically whether, or to what extent, we find harmony between the integrity of science, scientists, and democratic decision-makers. The potential for tensions is explained through consideration of public communication, pluralism in scientific knowledge bases, basic uncertainty, and fundamental principles such as transparency in political decisions. The reality of the tensions is found by considering some limits of ‘the science’ as it has been used in political turns of phrases such as ‘we are following the science’. The tensions are particularly evident where there are gaps given expedited methodologies, when we explore how ‘the science’ actually represents a plural concept, and where we acknowledge that science even broadly conceived is not able to be all that leads decision-making. And they are compounded by factors that might motivate silence or simplification in public communication, such as the apparent appeal of making ‘the science’ seem clearer or more uniformly agreed than may be the case, or by using ‘the science’ to avoid or obfuscate discussion of value judgments. The complexities of these ethical points provide their own important context for evaluating evidence-based policy within and beyond the pandemic.
Current gaps in data and health information system in the European Region
Authors: Davia S
Published: October 2022

When the SDGs were adopted in 2015, it was already clear that major issues regarding data availability would need to be tackled to enable comprehensive and policy-relevant monitoring and reporting. The SDG Report 2019 found that most MS were still not regularly collecting data for more than half of the global indicators. The measurement framework (MF) of the EPW builds on the SDGs. Also here, important data gaps for the included health-related SDG indicators exist. These gaps relate, e.g., to coverage of treatment for substance use disorders and the proportion of women with satisfied family planning needs. In addition, the MF exposed data gaps for several other areas that are highly relevant for the WHO European Region, such as health inequalities, intersectoral action for health, ageing populations and mental health. To help overcome these gaps, the EPW MF includes a development list. This list contains 20 indicator areas for which either no well-defined measures have yet been included in Region-wide international data collections or where data are available only for a limited number of MS. It will serve as a priority list for developmental work on indicators in the European Region in the coming years. Data gaps as described above are not stand-alone problems but are linked to wider issues with the functioning of HISs. In the European Region, the main HIS challenges relate to limited resources and capacity; insufficient coordination and collaboration, leading to fragmentation and problems with interoperability; lack of central governance; and limited use of health information for decision-making. In this presentation, we will give an overview of the main gaps in data and HISs in the European Region and explain the roadmap for the implementation of the EPW MF, which will be an important tool to achieve sustainable improvement of data availability and quality for key indicators. Tools to improve HIS performance overall will be addressed in the next presentation.
Highlighting the ‘public ‘in digital public health – a critical reflection
Authors: Zeeb H , Schüz B , Pigeot I
Published: October 2022

What is the appropriate differentiation of digital public health versus digital health - or is there none? This is an essential question when pondering digitalisation and public health, especially with a view to the potential development of the field. Digital health seems to be a general term related to information and communication technology in health care. Putting a public health lens on this general descriptive term can be done by simply expanding it towards public health as a population science and practice field, rather than the narrow medical and health care arena. However, a more specific approach towards outlining similarities and differences will also focus on digital technologies and their challenges in the core areas of prevention and health promotion. Considering the leading public health functions, their relationship with digitalisation and their specific requirements towards digitalisation can be a valuable path to describe and discuss what digital public health is all about. We will also highlight where interfaces and interrelations with digital health need to be considered for research and practice. This contribution will aim to provide such a perspective.
A framework for developing and evaluating digital and public health tools
Authors: Schüz B , Müllmann S , Pan C-C , Jahnel T , Forberger S , Jürgens D , Pedros Barnils N , Gerhardus A
Published: October 2022

To paraphrase a classic, evaluating digital technologies in health is a bit like eating spinach - no one is against it in principle because it is good for you. However, no one would do it unless being asked to. In recent years, the sheer number of digital health technologies that potentially fulfil public health purposes has increased tremendously. The basis for evaluating such tools for public health purposes however has not met this pace, and in particular frameworks for the systematic development and evaluation of digital technologies in public health are rare. Existing frameworks for digital technologies focus on clinical aspects of digital health applications (e.g., NICE Evidence standards framework for digital health technologies), thus lacking both a population and prevention focus. Generic frameworks such as the Health Technology Assessment (HTA) methodology do not contain items specific to digital technologies and public health purposes. Here, we describe the process of developing a framework specific for the development and evaluation of digital public health technologies based on the core HTA model. We conduct a scoping review of frameworks for the development and the evaluation of technologies in public health and digital health, following PRISMA-SCR guidelines. The identified frameworks are then mapped onto the core HTA model to develop additional items specific for the development and the evaluation of digital technologies in public health. These additional items can be used to integrate the development and evaluation of digital technologies for public health purposes within the wider HTA context, making this process both transferable and scalable.
Implementing a digital public health project - lessons learned?
Authors: Buttigieg S , Agius Muscat H , Ebejer J-P
Published: October 2022

The demand for the digitalisation of public health has been ongoing for more than a decade. The COVID-19 pandemic was the tipping point that accelerated the ideation, implementation, and scale-up of such public health projects. Despite the well-needed push, the same challenges that face every similar implementation will nonetheless be the same if not accentuated. The scope of the presentation is to highlight the difficulties and facilitators that such implementations and evaluations bring forward. We will also see what we can learn as public health professionals to ensure that present and future information systems are well-planned. We have to ensure that they do not succumb to the pressure of well-intended stakeholders who are yearning for such solutions to help their business workflows. This presentation will be enhanced with the lessons learned from implementing, monitoring, and following up on Malta's national contact tracing app and Customer Relationship Management systems based on Microsoft Dynamics 365 technologies that tackled the Test, Track and Trace workflows that were integral to the COVID response in Malta.
Association of hospital/ICU characteristics with HAIs: findings from the SPIN-UTI project
Authors: Barchitta M , Maugeri A , Favara G , Magnano San Lio R , La Mastra C , La Rosa MC , Campisi E , Mura I , Agodi A ,   SPIN-UTI network
Published: October 2022

Background

Preventing the spread of healthcare-associated infections (HAIs) in Intensive Care Units (ICUs) constitutes a priority for Public Health. In a country with decentralized healthcare system, the comparison between and within regions might represent a useful approach to identify what hospital and ICU indicators are associated with HAIs.

Methods

Using data from the SPIN-UTI (”Sorveglianza attiva Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva”) network, the present analyses aimed to identify the main hospital and ICU indicators associated with HAI incidence at national level, and to stratify the analyses between Italian regions.

Results

No associations between hospital/ICU characteristics and HAIs were evident at national level. However, ICUs in Southern Italy showed the highest incidence density of HAIs if compared with those in Central and Northern Italy (p < 0.001). Stratified analyses found a positive association of incidence density of HAIs and total days in ICU in Northern Italy (β = 0.3; SE = 0.1; p = 0.002); a positive associations with ICU size (β = 1.8; SE = 0.7; p = 0.020), total days in hospital (β = 0.06; SE = 0.02; p = 0.037) and total days in ICU (β = 0.5; SE = 0.1; p = 0.006) in Center Italy; a positive association with hospital size in Southern Italy (β = 20.3; SE = 9.4; p = 0.033).

Conclusions

Although our study confirms that HAIs still represent an important issue in Italian ICUs, there is some variation between regions from Northern, Central and Southern Italy. In general, we found that HAI incidence increased with increasing number of beds in hospital and in ICU, as well as with the the increasing number of patient-days. However, further research is necessary to better understand if additional hospital and ICU characteristics could motivate the observed regional differences.

Key messages

• There is a large regional variation in the incidence of HAIs in Italian ICUs and hospitals.

• This difference that could be motivated by specific hospital and ICU characteristics.
Factors influencing general practitioners’ decisions in migrant patients with mental health disorder
Authors: Duveau C , Wets C , Delaruelle K , Demoulin S , Dauvrin M , Lepièce B , Ceuterick M , De Maesschalck S , Bracke P , Lorant V
Published: October 2022

Background

Patients with a migration background (MB) have more mental health disorders than those without migration background. Yet, those patients are still underrepresented in mental healthcare services and have more unmet medical needs. Although providers’ bias has been well studied, up to date, little is still known about the factors explaining those biases. We assessed the effect of general practitioners’ (GPs') individual and organizational factors on their decision-making regarding diagnosis, treatment and referral recommendations for patient with MB with symptoms of major depression.

Methods

An experimental study staged a video-vignette of a depressed patient with or without MB. GPs had to make decision about diagnosis, treatment and referral. We then assessed the influence of several factors on their decisions such as age, ethnicity, workload and patient confidence. ANOVA and MANOVA were used for analyses.

Results

Overall, we found more unfavourable decisions in GPs diagnosis and treatment recommendations regarding the patient with a MB (F = 3.56, p < 0.001). In addition, they considered the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and would prescribe less often a medical treatment to these patients (F = 4.09, p < 0.05). Nevertheless, few factors explained these differences, except the age, the workload and the patient trustworthiness.

Conclusions

This paper highlighted GPs biases based on apparent migration background of a patient with major depression that perpetuates ethnic inequalities in mental health care. Further research into the origins of discrimination in primary mental health care are needed to explain how and when those discriminations arise.

Key messages

• This paper shed light on pervasive unintentional discrimination still persist in mental health care among migrants in Europe.

• These findings may help us to further understand the role of general practitioner behaviour in primary mental health care discrimination.
How do countries plan, purchase and use imaging technologies to prevent over-purchase and overuse?
Authors: Waitzberg R
Published: October 2022

Background

The adoption of new and expensive technologies is one of the main causes of the growing expenditure on health. Regulators are concerned that health care providers purchase (and use) imaging technologies in quantities that exceed the need, increasing expenditure with little value. We review how countries regulate the purchase and use of imaging technologies.

Methods

Qualitative. We collected data using a questionnaire completed by researchers from 17 high-income countries purposefully selected based on variation of policies. We built and compared case studies.

Results

Eleven of the 17 countries analyzed have clear criteria for planning and purchasing imaging technologies. Countries plan different areas, such as supply of specialist care, hospitals by level and type of services, quantity or type of equipment, as well as expenditure on health services and resource allocation. Most countries combine three mechanisms that manage the purchase or use of imaging technologies: (1) seven countries regulate by requiring certificates of need, licenses, or purchase approvals; others regulate by directly limiting the amounts, types and quality of technologies. (2) All countries use financial tools such as activity-based payment, limited and conditional budgets, and caps on income or volume of services. (3) Nine countries centralize purchase by a government agency. The literature provides inconclusive evidence regarding the impact of these mechanisms on expenditure on health and access to imaging services.

Conclusions

Planning the imaging technologies market with clear criteria is essential to avoid abuse. Most countries combine the three mechanisms (regulation, financial tools, centralized purchase). Financial tools are more common and effective. Countries with single payers implement more regulation than countries with multiple, competing, payers. In the later, regulated competition seems to replace regulation. There is a trend of adopting centralized procurement.

Key messages

• Planning the imaging technology market is a precondition to avoid abuse.

• Regulation, financial tools, and centralized purchase can be combined to manage the use of imaging technologies.
Barriers for using amoxycillin dispersible tablet in pediatric pneumonia treatment in Bangladesh
Authors: Shah M , Ahmed S , Rana S , Mothabbir G , Islam J , Islam S
Published: October 2022

World Health Organization recommends guideline for integrated management of childhood illnesses (IMCI) where Amoxicillin Dispersible Tablet (DT) appears as the first drug of choice for treating childhood pneumonia. The Government of Bangladesh adopted the IMCI strategy in 1998, and scaled it up nationwide by 2014. But, even today, the use of Amoxicillin DT, either in public or private sector, for managing childhood pneumonia is a rare event in Bangladesh. We conducted this exploratory study to understand the existing barriers, both in public and private sector, those have influences on reduced availability of Amoxicillin DT and non-compliance of health service providers to follow IMCI guideline by using Amoxicillin DT for treating a child with pneumonia, in Bangladesh. We conducted desk review of relevant strategy and policy documents, key informant interviews with 19 key individuals from Ministry of Health and national / international NGOs. Collected information were analyzed and interpreted using thematic analysis method. Identified barriers through this study pointed to inadequate policy level focus on IMCI implementation, non-inclusion of Amoxicillin DT in the national essential drug list, single source of Amoxicillin DT producing pharmaceutical in the country coupled with bureaucracy and procurement procedural complexity, lack of training of health service providers and abundant availability of antibiotic over the counter. Study respondents recommended for policy level strengthening of IMCI program, increasing coverage of training for health care provider, including practicing pediatricians both at public and private sectors, facilitating production and procurement procedures and prohibiting antibiotic sell over the counter.

Key messages

• Facilitation of production and procurement procedure coupled with enforcement of law prohibiting antibiotics availability over the counter are urgent needs.

• Policy level support emphasizing full compliance of service providers for quality of implementation of IMCI program in Bangladesh (and similar other settings) is also important.
Food choices characterized by the Nutri-Score nutrient profile and risk of cardiovascular diseases
Authors: Deschasaux-Tanguy M , Huybrechts I , Julia C , Hercberg S , Srour B , Danesh J , Riboli E , Gunter MJ , Touvier M
Published: October 2022

Background

Nutrition is a well-established risk factor for cardiovascular diseases (CVD) that can be leveraged by public health prevention strategies. In addition to dietary guidelines, front-of-pack nutrition labels (FoPNL) can help consumers make healthier food choices. Nutri-Score, a scientifically validated 5-color FopNL based on the nutrient profile FSAm-NPS has been adopted by several European countries but remains optional under current EU labeling regulation, which is to be revised end of 2022. Scientific evidence is therefore needed on the relevance of the Nutri-Score at the European level. Our objective was to study the association between the consumption of food as graded by the FSAm-NPS and CVD risk in a large European population.

Methods

This prospective analysis was conducted on a case-cohort comprising 13,308 participants without CVD risk factors at baseline, among which 5,326 first incident cases of CVD from the EPIC-CVD study (8 European countries). Food intakes were assessed using country-specific dietary questionnaires. The FSAm-NPS was calculated for each food based on its 100g content in energy, sugar, saturated fatty acid, sodium, fibre, protein, and fruits/vegetables/legumes/nuts. Multi-adjusted Cox models were computed.

Results

Overall, associations were observed between the consumption of foods with a higher FSAm-NPS score (lower nutritional value) and a higher risk of myocardial infarction (MI; HR1-SD=1.12 [1.05,1.21]; HRQ5/Q1=1.23 [1.00,1.52]). Associations with stroke were not significant. Overall, associations were more particularly observed in men.

Conclusions

In this large European population, a higher risk of MI was observed in individuals consuming on average a diet with higher FSAm-NPS foods (reflecting consumption of foods with a lower nutritional value/less favourable Nutri-Score). This adds to the evidence on the relevance of Nutri-Score as a public health tool to help consumers choose healthier food products.

Key messages

• The consumption of foods with a lower nutritional quality as graded by the Nutri-Score was associated with a higher risk of myocardial infarction in the large European EPIC-CVD case-cohort study.

• This adds to the evidence supporting the relevance of the Nutri-Score as a complementary tool to dietary guidelines to help consumers make healthier food choices.
Mental health of healthcare workers during the first year of the COVID-19 pandemic in the Netherlands
Authors: van der Noordt M , Proper KI , Loef B , Boot CRL , Kroese FM , de Bruin M , van Oostrom SH
Published: October 2022

Purpose

In March 2020, the WHO declared COVID-19 a pandemic. Previous virus outbreaks, such as the SARS outbreak in 2003, appeared to have a great impact on the mental health of healthcare workers. The aim of this paper is to study to what extent mental health of healthcare workers differed from non-healthcare workers during the first year of the COVID-19 pandemic.

Methods

We used data from a large-scale longitudinal online survey conducted by the Corona Behavioral Unit in the Netherlands. Eleven measurement rounds were analyzed, from April 2020 to March 2021 (N = 16,657; number of observations=64,316). Mental health, as measured by the 5-item Mental Health Inventory, was compared between healthcare workers and non-healthcare workers over time, by performing linear GEE-analyses.

Results

Mental health scores were higher among healthcare workers compared to non-healthcare workers during the first year of the pandemic (1.29 on a 0-100 scale; 95%-CI=0.75-1.84). During peak periods of the pandemic, with over 100 hospital admissions or over 25 ICU admissions per day and subsequently more restrictive measures, mental health scores were observed to be lower in both healthcare workers and non-healthcare workers.

Conclusions

During the first year of the COVID-19 pandemic, we observed no relevant difference in mental health between healthcare workers and non-healthcare workers in the Netherlands. To be better prepared for another pandemic, future research should investigate which factors hinder and which factors support healthcare workers to maintain a good mental health.

Key messages

• During the first year of the COVID-19 pandemic, we observed no relevant difference in mental health between healthcare workers and non-healthcare workers in the Netherlands.

• During peak periods of the pandemic, mental health was observed to be poorer in both healthcare workers and non-healthcare workers.
Health workers’ perception vs medically approved COVID-19 infection risk: the risk communication gap
Authors: Kuhlmann E , Behrens GMN , Cossmann A , Homann S , Happle C , Dopfer-Jablonka A
Published: October 2022

Background

This study analyses how healthcare workers (HCWs) perceived risks, protection and preventive measures during the COVID-19 pandemic in relation to medically approved risks and organisational measures. We aim to explore ‘blind spots’ of pandemic protection and identify mental health needs.

Methods

A German multi-method hospital study at Hannover Medical School serves as an ‘optimal-case’ scenario of a high-income country, well-resourced hospital sector and an organisation with low HCW infection rate serves to explore governance gaps in HCW protection. Document analysis, expert information and survey data (n = 1163) were collected as part of a clinical study into SARS-CoV-2 serology testing during the second wave of the pandemic (November 2020-February 2021). Selected survey items included perceptions of risks, protection and preventive measures. Descriptive statistical analysis and regression were undertaken for gender, profession and COVID-19 patient care.

Results

Our study reveals a low risk of 1% medically approved infections among participants, but a much higher mean personal risk estimate of 15%. The majority (68.4%) expressed ‘some’ to ‘very strong’ fear of acquiring infection at the workplace. Individual protective behaviour and compliance with protective workplace measures were estimated as very high. Yet only about half of the respondents felt strongly protected by the employer; 12% even perceived ‘no’ or ‘little’ protection. Gender and contact with COVID-19 patients had no significant effect on the estimations of infection risks and protective workplace behaviour, but nursing was correlated with higher levels of personal risk estimations and fear of infection.

Conclusions

A strong mismatch between low medically approved risk and personal risk perceptions of HCWs brings stressors and threats into view, that may be preventable through improved information, risk communication and inclusion of mental health support in pandemic preparedness.

Key messages

• Healthcare workers’ perceptions of COVID-19 infection risks are much higher than medically approved infection risk.

• Pandemic preparedness and protection plans must pay greater attention to information, risk communication and mental health needs.