bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing resilience though a health system performance lens
Authors: Zimmermann J , Karanikolos M , Haywood P , Levy N , Cylus J
Published: October 2023

Health system resilience testing has generated keen interest since the COVID-19 pandemic but so far no methodology for this complex exercise exists. Our concept of resilience testing is inspired by the experience of stress tests in the banking sector. The novel approach is a mixed-method country-led exercise, which applies a health system lens to a particular shock scenario, and identifies vulnerabilities using the Health System Performance Assessment Framework for Universal Health and the Shock Cycle. In the first part of the presentation we describe the resilience testing methodology, based on the two conceptual frameworks. We share lessons from the required preparatory work: shock scenario selection, scope of background research, formation of a resilience testing group, resilience test day structure and process, and the facilitator's role. We also discuss the outcomes of the resilience testing process, which includes a formal assessment of the resilience of the health system. This will provide workshop participants with an overview of key concepts to conduct a country-led resilience testing exercise. The second part of the presentation focuses on the overarching results from the country-led pilots. These show that the resilience testing method can identify specific health system weaknesses at different stages of the shock cycle. Given the appropriate selection of resilience test facilitator and participants, the method can also detect system-wide challenges, shock implications and spill-overs. The participant interaction on the test day may identify key priorities for action and strengthen relevant national multiprofessional networks. Overall, the resilience testing approach is an important new tool to identify strengths and weaknesses of the current health system and in scenario-specific preparedness planning.
Strengthening health system resilience at the European level
Authors: de La Mata I
Published: October 2023

The resilience testing project builds on the work carried out by the ‘Expert Panel on effective ways of investing in health’ in its ‘opinion on the organisation of resilient health and social care following the COVID-19 pandemic’, adopted on 25 November 2020 as well as the December 2020 report by the EU Expert Group on Health Systems Performance Assessment (HSPA) titled ‘Assessing the resilience of health systems in Europe: an overview of the theory, current practice and strategies for improvement’. Resilience testing may contribute to the European Semester, which addresses health system effectiveness, accessibility and resilience. The encompassing resilience assessment framework (‘the testing framework’) will serve to detect critical health system weaknesses against specific shocks as well as long-term structural challenges. This will help to develop recommendations for remedial action. The heath system resilience testing methodology will support the implementation of the Regulation on serious cross-border threats to health which envisages stress tests and simulation exercises to help the development of health system functions and preparation of prevention, preparedness and response plans. It could also support the European Centre for Disease Prevention and Control (ECDC) in their assessment activities of the prevention, preparedness and response plans. By establishing a resilience testing methodology, Member States will be able to regularly and independently review their preparedness for health crisis and check their healthcare systems’ resilience against specific high-pressure scenarios and long-term structural challenges. This action will generate insight and evidence through resilience tests and will reinforce the ability of Member States and regions to become more resilient to future shocks.
Self-perceived barriers to healthcare access for patients with post COVID-19 condition
Authors: Brus I , Spronk I , Heemskerk SCM , Biere-Rafi S , Tieleman P , Polinder S , Haagsma J A
Published: October 2023

Background

Many patients with post COVID-19 condition (PCC) require healthcare services. However, qualitative studies indicate that patients with PCC encounter many barriers to healthcare access. This cross-sectional study aimed to identify which barriers to healthcare access patients report, and to determine differences between subgroups based on sociodemographic characteristics, medical characteristics, and PCC symptoms (fatigue, dyspnoea, cognitive problems, anxiety and depression).

Methods

Data were collected via an online survey from 10,462 adult patients with a confirmed or suspected COVID-19 infection in the Netherlands, who experienced persisting symptoms ≥3 months after the initial infection. To measure self-perceived barriers, a list of eleven possible barriers was used, covering multiple aspects of healthcare access.

Results

Respondents reported a median of 2.0 (IQR=3.0) barriers; “I didn’t know who to turn to for help” (50.9%) and “No one with the right knowledge/skills was available” (36.8%) were most frequently reported. Multivariate logistic regression analyses showed that those with lower age, higher educational level, longer disease duration, not hospitalized, and who had more severe PCC symptoms, had significantly higher odds of reporting ≥1 barrier to healthcare access. Analyses per barrier showed that women had higher odds of reporting financial barriers as well as feeling uncomfortable asking for help, while men had higher odds of reporting barriers related to availability of care. Hospitalized respondents had lower odds of reporting barriers related to availability of care, but not financial barriers.

Conclusions

This study shows that the majority of patients with PCC experiences barriers to healthcare access and that the type of barriers patients experience differs depending on sociodemographic and medical characteristics. Differences by educational level might be due to underrepresentation of low educated patients who experience barriers.

Key messages

• Many patients with post COVID-19 condition experience barriers to healthcare access, including barriers related to availability of care, finances, and feeling uncomfortable asking for help.

• The number and type of barriers patients with post COVID-19 condition report differs depending on sociodemographic characteristics, medical characteristics and the presence of core symptoms.
Socioeconomic inequalities in smoking and drinking in adolescence: social network dynamics
Authors: Rado M K , Kisfalusi D , Laverty A A , van Lenthe F J , Been J V , Takács K
Published: October 2023

Background

Network-based interventions have the potential to prevent socioeconomic inequalities in health behaviors but require a good understanding of the underlying social network mechanisms. We investigated whether (1) adolescents selected friends with a similar socioeconomic status (SES), (2) smoking and alcohol consumption spread in networks, and (3) the exclusion of non-smokers or non-drinkers differed between SES groups.

Methods

We applied Stochastic Actor Oriented Models to the complete social network data (“Wired into Each Other” data) of 253 adolescents in eight Hungarian secondary school classes over three waves between 2010 and 2013. SES was measured based on entitlement to an income-tested regular child protection benefit.

Results

High SES adolescents were most likely to form friendships with peers from their own SES group (odds ratio [OR] = 1.1, 95% Confidence Interval [CI] = 1.0-1.1). Adolescents adjusted their smoking behavior (OR = 24.0, 95% CI 1.3-454.9) but not their alcohol consumption (OR = 1.6, 95% CI 0.6-4.4) to emulate the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 1.0, 95% CI 0.9-1.1), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.2, 95% CI 1.0-1.3), but this association was not significantly different according to SES.

Conclusions

Socioeconomic inequalities in health behaviors were driven by preferences to form friendships within their own SES group and the spread of smoking and alcohol consumption in the network. These inequalities were not amplified by SES differences in encouraging smoking or drinking.

Main messages: In three waves of observations in a Hungarian adolescent cohort, the study found social network effects for inequalities in smoking and alcohol consumption.

Key messages

• Inequalities in health behaviors arise because adolescents with high socioeconomic backgrounds selected each other as friends and smoking/alcohol consumption spread in networks.

• Inequalities were not due to socioeconomic differences in encouraging harmful behaviors.
6.M. Workshop: Private equity investment in Europe’s primary care sector
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Bernd Rechel (European Observatory)
Published: October 2023

This workshop explores the growing role of private equity funds in Europe's primary care sector. Based on a rapid response report of the European Observatory on Health Systems to the French National Health Insurance Fund (Caisse nationale de l’assurance maladie, CNAM), it offers a platform for sharing examples from across Europe, facilitating cross-country learning through country presentations and audience participation. Private equity investments in Europe’ health sector have increased exponentially in recent years, including in primary care, but this trend has so far received very little attention. This is surprising, as this development has the potential to change the healthcare landscape in Europe dramatically. The short investment and resale horizon of private equity funds and the emergence of practice chains and monopolistic structures are of particular concern. Ultimately, the growing private equity involvement in Europe's primary care sector could undermine equitable access to health care, reduce physicians’ autonomy, affect local or regional cooperation, erode data protection and raise health care costs. However, private equity investments may also be associated with benefits, such as providing needed capital or enabling employment for young physicians who want to work part-time or do not want to run a practice as entrepreneur. So far, there is little transparent information on ownership structures and very little research on the impact of private equity investments on outcomes, such as equity, access and quality of care. This workshop aims to provide a snapshot of trends in Europe and to inform current debates on how regulators should best respond. It provides an overview of the situation in four European countries (Germany, the Netherlands, Ireland and Sweden) and of policy responses so far. The workshop will provide opportunity for the audience to comment on and discuss the country presentations, share experience in their own countries, and consider policy options in Europe to improve transparency on ownership structures and ensure the interests of patients, the public, and health workers are protected. The workshop will be of interest to researchers, practitioners and policy-makers working on primary care in Europe.

Key messages

• The workshop provides a forum for discussing the growing role of private equity investment in Europe's primary care sector.

• It explores regulatory options to safeguard the interests of patients, health workers and the public.
Private equity investment in Germany's primary care sector
Authors: Tille F
Published: October 2023

Background

A major reform of the primary care sector in Germany that included a new law on health system financing in 2004 introduced new tools to be used by “entrepreneurial doctors”. These new tools provided opportunities for corporate investments into primary care, including through private equity funds (PEFs). Since then, there has been a stark increase of private investments.

Methods

A review of academic and grey literature, media reports and relevant organizational websites.

Results

Investments by PEFs in Ambulatory Health Care Centres (in German: Medizinische Versorgungszentren, MVZs) have increased continuously in recent years, and latest estimates suggest that in 2020 about 750 of overall 3800 MVZs were owned by PEFs. However, exact and robust data on how many MVZs are owned by PEFs do not exist, as there are no (legal) requirements for disclosures of these investment and ownership structures in Germany. Often, investors are located in tax havens, making the identification of ownership difficult. In addition, a PEF investing into an MVZ may include one health care facility, several dozens or over 100, depending on how well developed the network is (sometimes including long-term care facilities), further complicating an understanding of ownership status. The public debate on private equity investments in Germany's health system has been intensifying in recent years and a number of concerns have been raised, leading to calls by medical chambers for stricter regulation. Federal Minister of Health, Karl Lauterbach, announced in late 2022 that a law prohibiting private equity acquisitions of MVZs would be forthcoming in 2023.

Conclusions

The involvement of PEFs in Germany's ambulatory health care centres has increased substantially in recent years, leading to increasing public concerns and calls for stricter regulation.
Commercial general practice chains in the Netherlands
Authors: Groenwegen P , Timans R
Published: October 2023

Background

Traditionally, Dutch GPs are self-employed professionals who run a general practice either alone or in cooperation with other GPs. This traditional governance model of general practices has recently been supplemented with new models that involve private investors and general practice chains, with different ownership conditions, different relationships with health workers, and different earnings models.

Methods

We conducted a review of academic and grey literature and of media reports. We also analysed the dataset on general practitioners and general practices held by the Netherlands Institute for Health Services Research (Nivel) where we are based.

Results

The number of practices that are part of a commercial provider is highly uncertain. Our analysis of the Nivel dataset on general practitioners and general practices found 120 practices that were staffed with locums only. These could potentially be part of for-profit chains. However, it is likely that this also includes different forms of not-for-profit cooperations between GPs. Moreover, we found 108 practices which employed practice holders as salaried employees and were not registered as (non-profit) foundations. We estimate that the number of commercially run practices in the Netherlands is somewhere between 45 and 230 practices (out of the 4,874 practices registered in 2022). No research has so far been undertaken in the Netherlands on the consequences of the emergence of practice chains for service provision, but both positive and negative consequences are possible. The risks of decreased accessibility and continuity of care have resulted in ongoing investigations by the Inspectorate for Health Care and Youth and the Dutch Health Care Authority.

Conclusions

Several general practice chains have emerged in the Netherlands and some of these are commercial, but precise data on numbers are not available. Concerns have been raised on the impact of this development on service provision.
Large investors’ involvement in Ireland's primary care centres
Authors: Mercille J
Published: October 2023

Background

In 2001, Ireland announced a Primary Care Strategy that has led to the implementation of primary care centres (PCCs) throughout the country. This presentation examines the nature and extent of private sector involvement in establishing the PCC network since 2001, focusing on large global investors.

Methods

A dataset on all primary care centres in Ireland was constructed, comprising information on geographical location, the year that it became operational, and its delivery mode (public procurement, lease, or public-private partnership). A survey of large investment patterns was also conducted through the grey literature and news reports.

Results

By 2023, 172 PCCs are planned to be operational, developed through public, leased or public-private partnerships arrangements. Before 2009, PCCs were delivered by traditional public procurement, but since 2009, private delivery methods have been prioritized. Leased primary care centres have been attractive for large institutional investors attracted by stable rental income. This paper surveys the patterns and trends involved.

Conclusions

Trends in large multinational and domestic investments in the primary care market should be documented systematically because they have the potential to transform the existing PCC network and primary care system.
Hepatitis C virus screening in Piemonte: an effective strategy to eliminate HCV chronic infections
Authors: Thomas R , Castella A , Audisio L , Fasano P , Maina P , Massobrio G , Simoncini M , Zanella D , Minniti D , Dall’Occo F
Published: October 2023

In 2016, WHO set the goal of elimination of Hepatitis C Virus (HCV) by 2030. Globally, about 58 million people have chronic HCV, which causes cirrhosis, hepatocellular carcinoma and death (around 300000 in 2019), representing a heavy burden for public health. In Italy, the incidence of HCV acute infection is around 0.11 per 100000, and the estimated number of non-diagnosed chronic infections is 280000. In order to reach WHO's goal, the Istituto Superiore di Sanità (ISS) and the Ministry of Health implemented a strategy based on the detection of silent chronic infections and their treatment with direct-acting antivirals (DAAs), which cure around 95% of HCV infections. Therefore, in 2022, Regione Piemonte started a screening program contacting all residents born between 1969 and 1989. The screening was performed with rapid blood tests (antibodies detection, sensibility and specificity ca. 99%), and in case of a positive result, a HCV-RNA test was offered to confirm chronic infection and the need for treatment with DAAs. The Local Health Authority TO3, invited 36120 out of 158017 eligible residents (temporary and permanent), in the period March 2022 - April 2023 with invitation letters or catch-up strategies on other occasions; 6000 rapid blood tests were used (16.6% of invited population), and 11 (0.19%) tested positive. The RNA test confirmed 5 (0.08%) results. All the positive subjects were referred to 2 hospitals for DAAs treatment. As demonstrated by ISS, HCV screening could represent an effective mean to meet WHO's goal of HCV elimination by 2030 and also allow us to reduce HCV's burden on public health; although, with the current low adhesion rate, these results may not be reachable. Therefore, it is necessary to implement health promotion campaigns, to involve more stakeholders, including social and healthcare associations, General Practitioners and policy-makers, as the entire population's health would benefit from a successful HCV elimination program.

Key messages

• HCV and viral hepatitis represent a heavy burden for public health, high costs for Health Systems and severely affect the quality of life of subjects with un-diagnosed chronic infections.

• The availability of reliable, non-invasive, tests and of extremely effective treatments should move policy-makers to allocate more resources in the implementation of HCV eradication strategies.
Comparison of predictors for long-term survival and healthcare costs of cancer patients in Scotland
Authors: Haining K , Lone N , Lemmon E , Hall P
Published: October 2023

Background

New cancer treatments can improve prognosis, but may impact on the sustainability of health systems due to additional healthcare use by survivors of cancer. This study compared predictors of long-term healthcare costs with predictors of survival in a national cohort of people with cancer, with an aim of identifying factors associated with both improved survival and reduced costs.

Methods

This was a retrospective cohort study using linked administrative healthcare data from NHS Scotland. Participants were people diagnosed with a first malignant cancer (1st Jan 2009 to 31st Dec 2010). The outcomes were incident healthcare costs derived from inpatient episodes, outpatient visits and prescription costs. Univariable and multivariable Cox and GLM regressions were used to evaluate the predictors (age, sex, area deprivation, method of detection, pre-diagnosis costs, rurality, region, stage of detection, comorbidities).

Results

55,807 individuals with cancer were followed over eight years after diagnosis and found to incur substantial healthcare costs (mean £29,460 at 2017 GBP, 95% CI £29,199 to £29,720). Variables negatively associated with costs tended to be positively associated with hazard of death, e.g., age > =80 (adjusted cost ratio 0.55, p < 0.001; adjusted hazard ratio 5.94, p < 0.001), stage IV (adjusted CR 0.69, p < 0.001; adjusted HR 3.14, p < 0.001), history of dementia (adjusted CR 0.51, p < 0.001; adjusted HR 1.69, p < 0.001). Only screening as a method of first detection was significantly associated with both lower costs (adjusted CR 0.85, p < 0.001) and lower hazard of death (adjusted HR 0.30, p < 0.001).

Conclusions

Screening was associated with both improved survival and reduced healthcare costs. These results support the current priorities of national public health agencies and research funders to focus investment on improving early diagnosis.

Key messages

• Factors associated with reduced post-diagnosis healthcare costs tended to be associated with poorer survival.

• Screening was associated with reduced healthcare costs and better survival.
Snapshot of CSE landscape in Eastern European and Central Asian countries and introduction to SERAT tool
Authors: Yepoyan T
Published: October 2023

Comprehensive sexuality education when delivered in schools by well-trained teachers consistently over several years following an evidence-based informed curriculum can empower learners to realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives. However, too many young people globally including in Eastern Europe and Central Asia are deprived of the right to such education. Some countries like Ukraine, Republic of Moldova, Armenia and Kyrgyzstan have made elements of sexuality education part of the school curriculum. Other countries have integrated into the curriculum topics related to physical, mental and reproductive health but find it challenging to discuss in the classroom gender, sexuality and relationships because of resistance coming from political and religious circles as well as from parents. To support countries to collect data and analyze the strengths and gaps in their health education programmes, UNESCO has devised an excel-based tool called SERAT (Sexuality Education Review and Assessment Tool). Once data is entered into SERAT, results are presented in bar charts, which are automatically created, to enable immediate analysis of the strengths and weaknesses of a programme. The tool also helps to assess the relevance of a sexuality education programme in relation to the national context and SRH priorities. SERAT is based on the International Technical Guidance on Sexuality Education (UNESCO, 2018).
Translation of SERAT findings into concrete steps to advance CSE in Georgia
Authors: Bandzeladze M
Published: October 2023

The 2018 revision of the National Educational Curriculum in Georgia made the first attempts to integrate selected CSE topics into two school subject standards - biology and civic education. The Ministry of Education and Science recognizes that the changes introduced in the National Curriculum and school subject standards in 2018 are not sufficient and is therefore committed to gradually expanding the coverage of topics in the formal education system and strengthening the process through informal education. To support this initiative and assess the current quality of school-based sexuality education in the country, an analysis was conducted using SERAT. Overall, the legal and policy context in relation to many CSE components is quite well developed in Georgia. The curriculum development process is very participatory, with the involvement of teachers, parents, students and experts. While the general curriculum for CSE focuses on equity and equal rights for all, gender-specific topics, especially on sexuality, are not covered. Using SERAT, the Ministry of Education and Science of Georgia clearly identified the gaps within the National Curriculum and started the process of revising the two subject standards (Biology and Civic Education) to ensure the coverage of more topics within the framework of the formal education system per UNESCO standards. The Ministry initiated a project School Doctor's Hours with the technical assistance of UNFPA CO Georgia. The project envisages conducting informational sessions with the children enrolled in the elementary education. Finally, Civil Society representatives started actively using the findings of SERAT either in their advocacy efforts or while designing projects on CSE. SERAT findings greatly informed the process of designing the comprehensive communication campaign entailing work on the policy, community and individual levels, while simultaneously working with the traditional and new media for changing public discourse on CSE.
How should we monitor marketing foods to children for their better eating habits?
Authors: Gregorio M J
Published: October 2023

There is unequivocal evidence that childhood obesity is influenced by marketing of foods and non-alcoholic beverages high in saturated fat, salt and/or free sugars (HFSS). Furthermore, there is convincing evidence that HFSS marketing in traditional media has detrimental effects on children's eating and eating-related behaviour, and HFSS marketing in digital media has similar effects with stronger effect in vulnerable groups. According to the WHO Commission on ending childhood obesity, efforts must be made to ensure that children everywhere are protected against the impact of marketing and given the opportunity to grow and develop in an enabling food environment - one that fosters and encourages healthy dietary choices and promotes the maintenance of healthy weight. Children are being continuously exposed to powerful food marketing, increasingly in the digital environment. Best-ReMaP partners were exploring how to better monitor food marketing and advertising activities, in particular of promotional activities targeted to and/or impacting children at one hand, and how could marketing activities could be better regulated. Main actions of Best-ReMaP consortium in this field were as following, among others: (1) to identify, develop and share best policy practices to reduce exposure of children to the (digital) marketing of unhealthy foods, (2) develop coordinated and comprehensive protocols and tools to monitor the extent and nature of (digital) marketing exposure of children, including the upgraded WHO nutrient profile model, and to (3) support Member States with the implementation of the new EU rules on audiovisual media services.
Using Causal Loop Diagrams (CLDs) to inform the development of Directed Acyclic Graphs (DAGs)
Authors: Avila-Palencia I
Published: October 2023

Complex systems-based approaches, like causal loop diagrams (CLDs), are increasingly being used in population health studies. Traditionally, directed acyclic graphs (DAGs) have been frequently used in causal inference methods in population health studies to define analysis plans and identify potential biases. The use of those two methodologies has been suggested to be incompatible due to DAGs being apparently unsuitable for modelling systems containing feedback loops, a common feature of complex systems. In this presentation we will detail the steps and decisions that a research team could follow to translate a CLD into a series of DAGs.
Framework for federated causal inference based on real-world observational data sources (BY-COVID)
Authors: Meurisse M , Estupiñán-Romero F , Van Goethem N , González-Galindo J , Bernal-Delgado E
Published: October 2023

Background

Causal inference techniques help researchers and policy-makers to evaluate public health interventions. Approaching causal inference by re-using routinely collected observational data across different regions is challenging and guidance is currently lacking. With the aim of filling this gap and allowing a rapid response in the case of a next pandemic, a methodological framework to estimate causal effects in a federated research infrastructure is showcased in the baseline use case of the European BY-COVID project.

Methods

A framework, implementing existing methodologies and expertise, is proposed, enabling federated research based on routinely collected sensitive individual-level data. The framework includes step-by-step guidelines, from defining a research question, to establishing a causal model, identifying and specifying data requirements in a data model, and developing an interoperable and reproducible analytical pipeline for distributed deployment. Using open-source software, a complete workflow implementing federated causal inference was prototyped to assess the real-world effectiveness of SARS-CoV-2 primary vaccination in preventing infection in populations spanning different countries, integrating a data quality assessment, imputation of missing values, matching of exposed to unexposed based on identified confounders and a survival analysis within the matched population.

Results

The proposed methodological framework was successfully demonstrated within the BY-COVID use case, illustrating its feasibility and value. Different Findable, Accessible, Interoperable and Reusable (FAIR) research objects were produced, such as a study protocol, a data management plan, data model and interoperable analytical pipeline.

Conclusions

The framework provides a systematic approach to address policy-relevant causal research questions in a privacy-preserving way. The methodology and derived research objects can be re-used and contribute to pandemic preparedness.

Key messages

• Estimating causal effects using observational data in a privacy-preserving way was demonstrated to be achievable and can help policy-makers to evaluate public health interventions.

• The methodology, constituted of Findable, Accessible, Interoperable and Reusable (FAIR) research objects, is generalizable to other research questions and contributes to pandemic preparedness.
What Works overviews: Opportunities and Challenges
Authors: Van Dale D , Leenaars K
Published: October 2023

In the Netherlands in 2007 the RIVM established a good practice portal for Health promotion and Disease prevention. In this portal we present the effectiveness, quality and feasibility of programmes or interventions with all the material needed for implementation. However, evaluation and usability studies showed that health promotion practitioners and decision makers needed not only practices but also overviews of options for evidence based actions for health topics and specific target groups in diverse settings for their policy plans.

In 2016 we started to develop What works overviews for several topics The What works overviews consist of:

• A report of a systematic review for a specific topic, target group and setting, e.g., Alcohol prevention for children aged from 12-18 years.

• Overview of the results on the website of Healthy Living website (loketgezondleven.nl) with

- An overview of recommendations: what works, what doesn’t work and what is still uncertain?

- Overview of integrated policy actions

- Good practices or examples of municipalities and schools preferable from our portal

In this workshop we will show how we develop the What Works overview, the results of a usability study and the challenges we have with the dissemination, keeping up the data and funding.
Access Game
Authors: Paiva Neto F
Published: October 2023

This activity will last 40 minutes. The Access game and easy to play and aims to discuss and trigger reflections about the path of people with mental care needs seeking access and integrality of care in health system. Histories of three characters who represent people seeking access to mental health care in Primary health care (PHC) will be presented. The board game will be set up on the floor, allowing participants to walk around the board, which will represent the path do access PHC. During the game, participants will find figures that illustrate and trigger discussions about the barriers of access to mental health care, as well as PHC's strengths and strategies to overcome these barriers and guarantee integrality of care. Figures that illustrate PHC strengths and strategies (ex: community health worker, collaborative care, and intersectionality) make the player move forward, while those that represent characters’ access barriers to the service [eg: stigma, low professionals’ skills and supply-based management (and not on the population needs)] make the player return some squares. Also, players will be invited to share examples of their professional experiences, pointing out what barriers were identified and strategies that contributed to overcome it. By sharing their experiences, participants will advance a few more spaces. Game's components are: 1 board, 1 dice, 3 characters that represent people who use the health service, and cards with illustrations and explanatory texts. The winner will be the one with the character that manages to overcome the barriers and improve access based on the strengths PHC elements, arriving first at the end of the journey, which is represented by access to integrality of care. Participants will have the opportunity to recognize which strategies contribute to overcome mental health care access barriers. Thus, even if there is only a winner, everyone wins, taking the knowledge acquired in the discussions to their professional practices.
8.B. Workshop: Fit for purpose surveillance - strategies to implement effective surveillance systems in EU/EEA countries under the new Serious Cross Border Health Threats Regulation (2022/2371)
Authors:   Organised by: HaDEA, European Commission,   Chair persons: Isabel de la Mata (European Commission - DG Sante)
Published: October 2023

Background

As part of the European Health Union package, the EU Regulation 2022/2371 on serious cross-border threats to health has entered into force on 26 December 2022. Chapter III (Articles 13-17) of this Regulation provide new provisions for Epidemiological surveillance, the Digital platform for surveillance, and EU reference laboratories.

Methods

Several Implementing Acts are currently in preparation, which will define in more detail the concrete implementation of these provisions, such as the list of communicable diseases, case definitions, procedures for the operation of the epidemiological network for epidemiological surveillance, the specifications of the digital platform for surveillance and its specific rules for functioning, as well as to designate EU reference laboratories. Via the EU4Health Programme, the European Commission is furthermore providing funding for Integrated Surveillance, Surveillance capacity building

Results

The workshop will inform on the current state of implementation, on the results of the preparatory works carried out so far as well as on an outlook to the short and longer term plans for the implementation of the regulation on serious cross-border threats to health. Furthermore, it will inform on a funding mechanism for the improvement of EU Surveillance Systems as one of the central lessons learnt from the COVID-19 pandemic and showcase a good national practice.

Conclusions

The COVID-19 pandemic has clearly illustrated that the creation and further development of sound, reliable, integrated and real-time digital surveillance systems are a very crucial component for preparedness against serious cross border health threats. The current work under the new regulation is a valuable opportunity for public health practitioners to improve surveillance at EU, national and regional level.

The workshop will host panel presentations followed by a round-table discussion.
What's Next and the Quest for 2030 SDG Attainment
Authors: Lyshol Heidi
Published: October 2023

Time is running out to achieve the 2030 SDGs. Data are lacking for many SDG indicators, and data are often outdated or presented with a time lag. The WHO European Region is comprised of 53 countries whose health systems and priorities differ; devising a perfect common indicator framework is difficult. The European Programme of Work Measurement Framework is a set of 26 indicators chosen for data availability. The EPWMF reports on the SDG indicators most relevant to the Region. All indicators can be sourced from existing data collections, presenting no extra burden to Member States (MS). WHO proposes two key processes: 1) develop a European Region Health Information Network with membership from all MS and WHO collaborating centers, research institutions, and international organizations. This will improve the quality of health information through international cooperation and knowledge exchange. As the three country stories have shown, we have much to learn from each other. 2) develop a list of SDG indicator areas for which limited data exist across the Region. Main principles: (1) Organize development work as a long-term, institutionalized activity embedded in regular structures and processes of WHO/Europe; (2) Ensure strong involvement of MS so indicators reflect their priorities and any adaptations to data collections are feasible and agreed upon; (3) Ensure strong involvement of international organizations to prevent duplication of work and increased reporting burden; (4) Align development with policy processes to ensure coherence between WHO policy, monitoring and evaluation frameworks and (5) Create flexible structures bringing together relevant experience through working in topic-specific expert groups, utilizing lessons learned from HIS assessments to create realistic indicators that can measure progress. Thus, we will move towards 2030 with a clear plan for developing concrete indicators to ensure all MS can report on the SDGs.

Speakers/Panelists

Heidi Lyshol

Norwegian Institute of Public Health, Oslo, Norway
“The worst has already happened”: communicating sensitively with bereaved survey participants
Authors: O'Ceallaigh D , Verling A M , Marley E , Mason T , Tuohy E , Rohde D
Published: October 2023

Issue

The National Care Experience Programme asks people about their experiences of health and social care services, including maternity bereavement and end-of-life care. The surveys aim to identify areas of good experience, as well as areas requiring improvement. Implementing surveys on sensitive topics involves a duty of care to participants to ensure the highest ethical standards and sensitive communication with bereaved parents and relatives.

Description of the problem

Under General Data Protection Regulation, there is an obligation to be transparent with people in the event that they are invited to participate in a survey. This must be balanced with sensitive and respectful communication with those who have experienced a loss. The mode of contact and timing of surveys requires careful consideration.

Results

Bereaved parents and relatives, support organisations and subject matter experts were engaged with extensively to inform the National End of Life Survey and National Maternity Bereavement Experience Survey, including the mode of contact with eligible parents and relatives and the timing of surveys. A detailed communications plan was developed to share information across social media platforms, radio and relevant websites. Communication about the survey balanced key messages on the aims, methods and eligibility criteria with a sensitive and time-appropriate delivery.

Lessons

Both surveys asked about the lived experiences of significant, traumatic life events. Participation had the potential to place an emotional burden on participants, who had to relive their experiences of loss. In order to limit the potential harm, bereaved parents and relatives were involved in all stages of the survey development process. Information on support services was included with all survey invitations and documentation. Strong response rates highlight a willingness amongst bereaved parents and families to share their experiences to inform improvements to care.
Generating actionable evidence from free-text feedback to improve maternity and acute hospital experiences: A computational text analytics & predictive modelling approach
Authors: Ojo A , Rizun N , Isazad Mashinchi M , Walsh G S , Gruda D , Narayana Rao M , Venosa M , Foley C , Rohde D , Flynn R
Published: October 2023

Background

Patient experience surveys are a key source of evidence for supporting decision-making and quality improvement in healthcare services. These surveys contain two main types of questions: closed and open-ended, asking about patients’ care experiences. Apart from the knowledge obtained from analysing closed-ended questions, invaluable insights can be gleaned from free-text data. Advanced analytics techniques are increasingly used to harness free-text data, yet existing approaches do not offer the rigour required to support formal decision-making through free-text.

Methods

This study addresses the challenge of effectively and rigorously analysing patients’ free-text feedback to improve maternity and acute hospital services in Ireland. Aspects of healthcare services (i.e. themes) that could be improved were determined using computational text analytics and predictive modelling. Themes extracted from comments were prioritised based on volume, the intensity of negative affect expressed in the texts, and the estimated influence of the themes on overall patient satisfaction.

Results

Results demonstrate the viability of producing rigorous evidence for prioritising interventions to improve healthcare services based on free-text feedback. Specifically, consistency in advice and support in breastfeeding were among the most important issues for maternity services. For acute hospital services, meals quality and access, A&E waiting time, ward hygiene and communication at discharge were among the most important issues. Women also wanted more emphasis on prior birth experience and complications in future maternity care surveys.

Conclusions

Advances in computational text modelling enable the extraction of concrete and actionable insights from the analysis of free-text data. This approach also allows decision-makers to prioritise emergent themes and inform actions that will positively impact overall patient satisfaction.
Subtle industry interference in public health: the case of the alcohol industry
Authors: Ghandour L
Published: October 2023

Upstream drivers of alcohol consumption forcing people to consume alcohol frequently and excessively and experience alcohol-related harms are in fact all industry-related factors: easy physical access to alcohol, cheap alcohol beverage pricing, and heavy alcohol advertising and promotion. Unequivocal evidence exists on how these visible industry tactics effectively allow the infiltration of alcohol products into the market, targeting specific subgroups (women, youth), increase total per capita consumption and subsequently alcohol-related morbidity and mortality. This presentation will highlight using country cases and various examples the more subtle mechanisms in which the industry has successfully been interfering with nations’ progress in alcohol policy (e.g., NoLo beverages, interfering with WHO definitions, using SDGs to foster partnerships). Using the whole-of-government whole-of-society approaches, the presentation will also present evidence-based multi-sectoral actions (their facilitators and barriers) for more effective national alcohol policy. Given that alcohol is no ordinary commodity, the presentation will end with implications for policy to counterbalance global alcohol industry interference and support national actions.
Cancer risk according to fasting blood glucose trajectories: a population-based cohort study
Authors: Khong T , Oh J-K , Bui T , Kang H-Y , Park E
Published: October 2023

Background

Diabetes mellitus is known to increase the risk of cancer. Fasting blood glucose (FBG) levels can be changed over time. However, the association between FBG trajectory and cancer risk has been insufficiently studied. This research aims to examine the relationship between FBG trajectories and cancer risk in the Korean population.

Methods

We analyzed data from National Health Insurance Service-National Health Screening Cohort collected between 2002 and 2015. Group-based trajectory modeling was performed on 256,271 Koreans aged 40 to 79 who had participated in national health examinations at least three times from 2002 to 2007. After excluding patients with cancer history before 2008, we constructed a cancer-free cohort. The Cox proportional hazards model was applied to examine the association between FBG trajectories and cancer incidence, after adjusting covariates. Cancer case was defined as a person who was an outpatient thrice or was hospitalized once or more with a cancer diagnosis code within the first year of the claim.

Results

During the follow-up time (2008-2015), 18,991 cancer cases were identified. Four glucose trajectories were found: low-stable (mean of FBG at each wave <100 mg/dL), elevated-stable (113-124mg/dL), elevated-high (104-166mg/dL), and high-stable (>177mg/dL). The high-stable group had elevated risks in multiple myeloma, liver and gastrointestinal cancer, with hazard ratio (HR): 4.09 (95% confidence interval (CI): 1.40-11.95), HR: 1.68 (95%CI: 1.25-2.26) and HR: 1.27 (95%CI: 1.11-1.45) respectively. In elevated-stable group, the risk increased for all cancer (HR: 1.08, 95%CI: 1.02-1.16) and stomach cancer (HR: 1.24, 95%CI: 1.07-1.43). Significant associations were also found in the elevated-high group with oral (HR: 2.13, 95%CI: 1.01-4.47), liver (HR:1.50, 95%CI: 1.08-2.08) and pancreatic cancer (HR:1.99, 95%CI: 1.20-3.30).

Conclusions

Our study highlights that the uncontrolled high glucose level for many years may increase cancer risk.

Key messages

• Individuals in the prediabetes stage may be at an increased risk of developing cancer.

• Fasting blood glucose trajectories may be a predictive factor for the development of digestive cancer.