bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional inequalities in waiting times: analysis of orthopedic appointments in Slovenia
Authors: Poldrugovac M , Kuhar M , Kasapinov B
Published: October 2024

Background

Long waiting times for healthcare services are a priority issue in the Slovenian healthcare system. Over the past decade the system for monitoring waiting times has evolved and is currently linked to the eReferral system, which allows detailed monitoring of data in particular related to secondary care services, such as outpatient specialist visits. Our aim was to explore the differences in waiting times between Slovenian regions in the case of first orthopedic outpatient visits in order to identify potential causes or contributing factors.

Methods

The analysis was based on the data from the waiting list database on 1 January 2024. The database includes information on region of residence of the patient and the region where the provider is located. Data were available on the number of persons on the waiting list and on the average expected waiting time for them. Waiting times relate to each of three urgency levels, which are indicated on the referral (very fast, fast and ordinary).

Results

Average expected waiting times for first orthopedic outpatient visits differed considerably among residents of different regions, ranging from 159 day to 265 days (60% more). The regional differences were even larger if only “very fast” and “ordinary” referrals were considered. The share of appointments in each urgency referral level also varied considerably, for example the share of patients with a “very fast” referral ranged between 15,7% and 37,6%, depending on the patient region of residence. The Pearson correlation coefficient between the region of residence of patients and the region where the provider is located was 0,78.

Conclusions

Waiting times and referral patterns for first orthopedic outpatient visits for patients from different regions vary considerably. Despite a free choice of provider and public data on expected waiting times, the differences correlate closely with the geographic distribution of providers.

Key messages

• Waiting times for outpatient visits in orthopedics differ by Slovenian region, despite free choice of provider.

• The assessment of inequalities is made more difficult by varying share of different urgency levels of referrals.
Rapid increase of multi-drug resistant Pseudomonas aeruginosa in Greece - WHONET-Greece (2020-2023)
Authors: Polemis M , Theofili E , Tryfinopoulou K
Published: October 2024

Background

Multidrug-resistant (MDR) Pseudomonas aeruginosa has been documented as a significant threat associated with adverse patient outcomes. We aimed to describe the rapid increase in the prevalence of an MDR P.aeruginosa phenotype at the national level, as detected through the Greek Electronic System for the Surveillance of Antimicrobial Resistance (WHONET-Greece).

Methods

Routine susceptibility data of 22,236 P.aeruginosa isolates of hospitalized patients in forty-five hospitals, isolated over the past four years (2020-2023) were analyzed using ‘Resistance profiles’ analysis of WHONET software(ver.2023), considering five antimicrobial groups/agents.

Results

We confirmed the rapid increase in the prevalence of a carbapenem-resistant P.aeruginosa (CRPA) phenotype resistant to all five antimicrobial groups/agents tested (carbapenems, piperacillin-tazobactam, cephalosporins, fluoroquinolones and aminoglycosides). The prevalence increased by 63.8% in 2023 (from 15.2% to 24.9%, 1.64-fold increase), whereas in the last 24 months of the study period a 2.13-fold increase was observed (from 11.7% to 24.9%). In parallel, the prevalence of all other CRPA profiles decreased in 2023 from 22.5% to 17%. We also examined the prevalence of this MDR phenotype in the different NUTS-1 regions of the country, which revealed that the rapid increase is mainly observed in Attika (EL3, 19/45 hospitals) and Central Greece (EL6, 8/45 hospitals) where prevalence reached 25.4% and 26.2% in the second half of 2023 respectively. Northern Greece (EL5, 15/45 hospitals) showed a steady increase over the four years (12% to 19.3%), while in the Aegean Islands/Crete region (EL4, 3/45 hospitals) the prevalence levels were stable.

Conclusions

There is an emerging multi-drug CRPA phenotype in Greece. Only with systematic, nationwide surveillance could we identify and verify such threats. The findings of this study should be used for targeted interventions and further analysis through molecular techniques.

Key messages

• The early detection of such emerging multi-drug CRPA phenotype in Greece allows for for targeted interventions and further analysis through molecular techniques.

• Systematic surveillance of antimicrobial resistance based on routine susceptibility data is a great way to identify and verify emerging public health threats.
What characterizes the eldercare debut? A registry-based study of pre-entry health care use
Authors: Alencar Siljehag P , von Berens Å , Meinow B , Lennartsson C , Agerholm J
Published: October 2024

Introduction

Timely identification of needs due to functional loss in old age is important. Policy guidelines requires local collaborative care action. Eldercare debut circumstances are poorly investigated from a collaborative perspective. This study explored the socio-demographic characteristics, functional status and patterns of health care use leading up to the first application for eldercare, and how older people’s intensity of primary care use was associated with their intensity of granted eldercare at debut.

Methods

Data on socio-demographics, functional status, and informal care in people ≥65 years (July ‘21 to June ‘22; n = 3,649) were combined with data on inpatient and outpatient care six months preceding debut in Stockholm, Sweden. Descriptive and regression statistics were used.

Results

Every second person debuted following a hospital stay and one in four had extensive functional limitations. The majority made one or two visits in primary care, but 13% had a high intensity of use and 20% made no visits at all. More than half received informal care weekly or daily. Non-use and high use of primary care were both significantly associated with increased probability of receiving high intensity of eldercare.

Conclusions and implications

The intensity of primary care use can provide an indication of people’s intensity of eldercare at debut, which is important for resource allocation. Deeper collaboration between eldercare and primary care actors can facilitate early identification of people in need of support, thereby alleviating individual suffering, enabling secondary and tertiary prevention, and optimizing the management of welfare resources.

Key messages

• The intensity of primary care use can provide an indication of people’s intensity of eldercare at debut.

• Deeper collaboration between eldercare and primary care actors can facilitate early identification of older people with social support needs.
Boosting influenza vaccination rates through policy gamification: the ‘Let’s Control Flu’ project
Authors: Lopes H , Hermenegildo C , Franco D
Published: October 2024

Background

Influenza remains a public health challenge globally, leading to substantial morbidity and mortality, particularly among vulnerable groups. Despite the benefits of vaccination, achieving the desired vaccination coverage rates (VCR) proves challenging across Europe. The ‘Let’s Control Flu’ (LCF) tool emerges as a new contribution, merging gamification with epidemiological data and public health policies to help increase influenza VCR.

Methods

The LCF tool, developed from an extensive literature review and validated by a National Advisory Board, initially showcased its capabilities in Sweden. Offering an interactive simulation, it allows stakeholders to explore the outcomes of implementing 13 targeted public health policies (PHP) on influenza VCR and health outcomes such as infection rates, hospitalizations, and mortality. This approach simplifies epidemiological complexities, paving the way for informed decision-making.

Results

Following its success in Sweden, the LCF tool was extended to Germany and Czechia, underlining the value of gamified tools in public health decision-making. The application across these new countries not only resulted in paths to improve VCR but also provided insights into the tool’s scalability and adaptability different landscapes.

Conclusions

The LCF project underscores the efficacy of integrating gamification into health policy decision-making, offering a replicable model for enhancing influenza vaccination uptake across Europe. With the tool now successfully applied in multiple countries, its potential for broader European and global application is evident. This initiative aligns with WHO’s objectives, spotlighting gamification as a relevant component in improving vaccination strategies and readiness for influenza and other preventable diseases, thereby reinforcing the importance of innovative approaches in public health policy development.

Key messages

• The LCF tool integrates gamification with public health strategies to help effectively raise influenza vaccination coverage.

• By merging gamification and epidemiological insights, the LCF tool also serves as a scalable model for Europe, supporting WHO’s goals to improve vaccine strategies and preparedness.
What’s pension got to do with it? Mortality inequality at older ages
Authors: Fritzell J , Forslund M , Östergren O
Published: October 2024

Background

The potential role of social protection systems and welfare states for population health and mortality has attracted increased interest in recent decades but mostly focused on overall characteristics or clusters of countries. Moreover, often neglecting older people even though the great majority of all deaths in high-income countries occur at later ages. We focus on the key social protection scheme for old adults: the generosity of the level of pensions. We compare pensions based on previous work history to basic minimum pensions. Our study is novel both by linking pension system to remaining life expectancy at age 65(LE65+), but also by studying the association to variation in LE65+, since that gives a measure of inequality. We do so across countries and over time.

Methods and Materials

Our sources of data are from the Human Mortality Database and the Social Policy Indicator Database. Data for OECD countries are matched over a long period of time and analysed by pooled time-series regression analyses with fixed effects.

Results

Although the results indicate that the generosity of pensions based on both pervious work history and basic minimum income our results primarily show the importance of basic minimum income. Here the effect sizes are larger and especially for women than for men (0.149*** vs. 0,.0715***). Concerning the variation in LE (65+) we find that more generous basic pensions are associated with reduced variation for women -4.64e-05**.

Conclusions

We provide new insights in how pension policies potentially influence mortality among older persons especially by extending our analyses also to inequality in mortality. Our results points to the importance of basic pensions. The gendered division of labour is a plausible explanation for the findings and to have an adequate pension for all should be of primary concern for public health.

Key messages

• Adequate basic pension for all of importance for remaining life expectancy among older people.

• Adequate basic pension for all of importance for reducing mortality inequality among women.
Setting targets for antibiotic use in general practice in Europe: a scoping review
Authors: Garzon-Orjuela N , Roche K , Vornhagen V , Moran A , Walkin S , Cullen W , Blake C , Vellinga A
Published: October 2024

Background

National Action Plans (NAPs) aim to address antimicrobial resistance (AMR) understanding and awareness but struggle to translate targets into clinically relevant guidance for general practice. This scoping review aims to identify and map antibiotic use targets in European general practice and explore if and how these targets are linked to NAPs.

Methods

A systematic search strategy was carried out in MEDLINE (OVID), EMBASE and SCOPUS, with additional manual searches. Two research questions were addressed: ‘What are existing targets for antibiotic use in general practice in the 31 European countries?’ and ‘How are these targets linked to the NAPs on AMR?’. The results are presented narratively.

Results

77 reports were included, of which 33 focused on national targets and general practice or linking national targets to local areas. Reports describe local strategies or initiatives to achieve targets, such as feedback to prescribers, systems with benchmarks (at local, regional, and national levels) and financial incentives. However, these reports provide aggregated targets for general practice, such as a percentage reduction of antibiotics prescribed. These targets are set in general, for a specific type of antibiotic, for an amount per number of patients, in defined daily doses (DDD) or in items. None of the reports translate national targets into clinically relevant or practical targets for general practitioners (GPs).

Conclusions

Most European countries have a NAP with national targets. The type of targets and their implementation at the national and local level vary between countries. Translating national targets into daily clinical practice is challenging and often lacks the involvement and input of prescribers (GPs).

Key messages

• Translating targets into daily clinical practice is challenging and often lacks the involvement and input of prescribers (GPs).

• Local strategies, feedback to prescribers, benchmark systems (local, regional, national), and financial incentives drive successful target achievement.
Study on access to social protection policies by homeless people during the COVID-19 pandemic
Authors: Andrade de Souza A , Jorge Martins A L , Drummond Marques da Silva G , de Moraes Teixeira Vilela Dantas A C , Alves Marinho R , da Matta Machado Fernandes L , Miranda Magalhães Júnior H , Debortoli W , Paes-Sousa R
Published: October 2024

The study analyzed the access of homeless people (HP) to health and social protection policies, including emergency measures, during the COVID-19 pandemic in Belo Horizonte (BH), capital of the state of Minas Gerais, Brazil. Its main objective was to provide data on the profile of HP in the municipality, in addition to evaluating existing public policies focused on HP, based on the time frame of the health emergency. Study with mixed methods design with triangulation of quantitative and qualitative data. It used official databases in parallel with document analysis, interviews and focus groups. As a result, the cartography showed that in the first months of the pandemic the municipality had difficulty reorganizing the health system, which underwent constant protocol updates, consolidating, however, over the months. Important emergency interventions in the municipality of BH involved activities that facilitated HP’s access to the provision of services, including intersectorality between health services, social assistance and the third sector. The temporary offer of various intersectoral services, simultaneously with the offer of daytime shelters by organized civil society, was considered a key factor for the expansion and intensification of care networks for HP during the emergency phase. Itinerant services were among those with the greatest positive evidence of service to HP, with emphasis on the ‘Consultório na Rua’. The study concluded that understanding the profile of homeless people in BH and the intersectoral variables that impact HP contributes to better directing investments in interventions for these individuals and increasing the effectiveness of health and social protection systems, in line with with the work carried out by the third sector.

Key messages

• Understanding the inter-sector variables that impact Homeless People contributes to better targeting of investments in interventions in protection social.

• Knowing the profile of the homeless population makes it possible to organize more effective health care and social assistance.
Agenda 2030 for sustainable development in Portuguese Speaking Countries, indicators inequalities
Authors: Carvalho Malta D , Santos Magalhães Cardoso L , Gomes da Silva A , Augusto Veloso G , Malta dos Santos F , Ferrinho P , Ferreira A , Passos Cupertino de Barros F , Luiz Pinho Ribeiro A , Naghavi M
Published: October 2024

Background

Achieving the SDG Sustainable Development goals represents a major global challenge. The Community of Portuguese Speaking Countries (CPLP) is made up of countries: Angola, Cape Verde, Guinea-Bissau, Equatorial Guinea, Mozambique, São Tomé and Príncipe, Brazil, Portugal, and East Timor. Studies on SDG indicators are little studied among these countries. The study analyzes SDG health indicators in the Community of Portuguese Speaking Countries (CPLP) and their projections for 2030, and investigates the correlation between the countries’ level of development and the performance of these indicators.

Methods

Ecological epidemiological study. Estimates from the Global Burden of Disease (GBD) study between 1990 and 2021 were analyzed, referring to fifteen indicators: universal health coverage, sanitation, smoking, maternal and child health, vaccination coverage and communicable diseases. The GBD study generated projections by calculating the annual change since 1990 for each country and year and then calculating the weighted annualized rate of change. The correlation between the Sociodemographic Index (SDI) and the SDG indicators was investigated using the Spearman test, at a significance level of 5%.

Results

The best performances of the analyzed indicators were seen for Portugal, followed by Brazil, Cape Verde and São Tomé and Príncipe. In other countries, high rates of infectious diseases, maternal and childhood mortality, malnutrition, low vaccination coverage and sanitation were observed. There was a negative correlation between the SDI and the indicators of childhood mortality rate (R=-0.82; p < 0.05), malnutrition (R=-0.7; p < 0.05), incidence of tuberculosis (R =-0.73; p < 0.05) and positive between SDI and sewage coverage (R=-0.83; p < 0.05).

Conclusions

The CPLP presents internal differences regarding the health indicators analyzed, making it essential to advance cooperation between countries to achieve the SDG targets in 2030.

Key messages

• There are great inequalities between SDG indicators in Portuguese-speaking countries.

• It is important to advance technical cooperation between countries to formulate solutions and leave no one behind.
Exploring UK adult and policy stakeholder perspectives on obesity prevention policy and inequalities
Authors: Brown O , Langley T , Murray R , Bogdanovica I , Bains M
Published: October 2024

In England, 14 obesity strategies have been published, including 689 proposed policies, while rates of obesity persist, and inequalities worsen. This study explores adults’ attitudes in relation to food-related obesity policy and how socioeconomic inequalities in obesity are considered throughout the policy process through the perspective of policy stakeholders (PSH). 31 semi-structured interviews with UK-based adults (GPP) (18+) and 14 interviews with PSH categorised as government officials, academics, and advocacy group representatives were conducted and analysed using Braun and Clarke’s thematic analysis. Both PSH and GPP attributed obesity causation primarily to the food environment rather than to individual behaviour. The PSH identified the food industry’s role in shaping the environment. Level of deprivation was believed to exacerbate the barriers to healthy weight in both samples. All participants agreed that, in the UK, there was an unequal opportunity to attain a healthy diet. A disconnect was found between the GPP perspectives towards the barriers to healthy weight and their attitudes towards policy action. The GPP described mistrust in the government’s motives and willingness, fuelling the perspective that policy lacked impact and was disconnected from their lived experiences, particularly among participants of lower socioeconomic status and higher weight classifications. The PSH raised concerns regarding barriers to policy implementation, including inconsistent government commitment, competing priorities, and resistance to state intervention. PSH suggested that it was unfeasible to prioritise inequalities while population rates remain high, and the failure of implement proposed policies continue. This study shows the necessity of incorporating a health equity lens, breaking down policy silos, and amplifying community voices in the policy process to challenge assumptions regarding lived experiences and ensure healthier equitable policy outcomes.

Key messages

• The study shows the importance of integrating a health equity lens, breaking policy silos, and amplifying community voices to challenge assumptions and achieve more equitable policy outcomes.

• Obesity policy requires greater consideration to inequalities to strengthen policy impact as demonstrated by all participants recalling the unequal opportunity to sustain a healthy weight in the UK.
Proficiency in Personalized Medicine and Health Data Sharing in the EU
Authors: Causio F A , Beccia F , Kreeftenberg Ll , Calabrò G E , Pastorino R , van El C , Boccia S
Published: October 2024

Personalized medicine, leveraging genetic, environmental, and lifestyle data, has already transformed healthcare by tailoring prevention, diagnosis, and treatment to individual patients. The successful development and implementation of personalized approaches rely on the public’s proficiency and awareness of personalized medicine, enabling access to innovative techniques and fostering a willingness to share health-related data. We distributed a survey to 6,581 respondents from 8 EU countries: France, Germany, the Netherlands, Italy, Spain, Poland, Hungary, and Romania. 52.5% of respondents were female (n = 3,458), with a mean age of 48.5 years (range 18-89 years, median = 49 years, SD = 15.96), and 37.91% of the participants reported achieving tertiary education. Our survey investigates the general public’s knowledge of personalized medicine, support for genetic testing, and willingness to share health data among EU citizens while assessing their perception and acceptance of these medical paradigms. Knowledge levels vary among different EU countries. Only 12.11% of respondents had a high knowledge of the topics presented in this survey. Support for implementing genetic testing in healthcare was high, with 81.52% supporting the implementation of genetic testing in their healthcare systems, and nuanced differences in acceptance were observed based on testing purposes. 52.35% reported willingness to share health data. Both support for implementing genetic testing and the willingness to share health data correlated positively with knowledge and education levels. Geographical differences within the EU highlighted variations in attitudes toward personalized medicine and data sharing, with respondents from Southern Europe displaying higher odds than their peers in Central and Eastern Europe. The results emphasize the need for targeted communication and education strategies to enhance public understanding and trust in personalized medicine and health data sharing.

Key messages

• High support for genetic testing across the EU highlights the need for enhanced public education on personalized medicine to boost understanding and data sharing willingness.

• Geographical differences in attitudes toward personalized medicine in the EU suggest targeted strategies to build trust and knowledge, particularly in Central Europe.
Mapping the Policy Alternatives for Rare Cancer
Authors: Kostadinov K , Hristova-Atanasova E , Musurlieva N , Iskrov G , Stefanov R
Published: October 2024

Issue

This policy research addresses the issue of rare cancers in the European Union (EU). Rare cancers have an annual incidence rate of less than 6/100 000 and face challenges in diagnosis, clinical care, and research investment. Survival rates for rare cancers are lower compared to common cancer types, with significant variations among EU Member States.

Description of the problem

Policy frameworks for rare cancers are often fragmented and greatly vary across the EU. This study aims to develop a tool for assessing policy alternatives by reviewing existing national rare cancer policies, conducting interviews with experts, and analysing core stakeholders at the EU level.

Results

The main policy alternatives covered five domains: definition, registration, organisation of care, access to innovative therapies, and funding. Interviews revealed four policy options for each domain. Six core stakeholders were determined: patient organisations, healthcare professionals, researchers, industry, health legislators, and health authorities. A pilot policy assessment tool was developed on this basis.

Lessons

The pilot study coherently explored policy alternatives for rare cancers in the EU. Using these findings, policymakers and researchers can assess the impact of different policy options at a national level and contribute to the development of a unified EU policy framework for rare cancers. The pilot survey was also useful to collect input from the core stakeholders.

Key messages

• This study identifies key policy domains and feasible alternatives. A pilot preference assessment study based on these options can aid in EU policy development.

• Navigating rare cancer policy complexities demands collaboration and innovation. Engaging stakeholders and exploring alternatives can forge a more effective EU framework for addressing rare cancers.
An overview and comparison of approaches used for health policy analysis: What to use and when?
Authors: Berghuis-Mutubuki E , Hilderink H
Published: October 2024

Background

Public health challenges are complex and analyzing them requires advanced approaches such as, societal cost-benefit analysis (SCBA), health impact assessment (HIA), and strategic foresight. Analyzing health policy is a multifaceted process, and depends on, among others, the scope, approach, and policy goals. Given this complex and multifaceted nature, it is not always clear which approach to use, and how the approaches can complement each other. Therefore, health policy analysis could benefit from practical and explicit guidance regarding clear identification of cases and types of analysis. Hence in this paper we aim to develop a framework that can provide this guidance.

Methods

In this paper we describe the differences and similarities of three distinct health policy assessment approaches, SCBA (an economic evaluation approach that takes into account the impact on society as a whole), HIA (is a combination of tools that focus on evaluating the potential health effects of a given policy) and strategic foresight (a systematic and participatory approach used to anticipate and plan for future trends and uncertainties that may impact policy), their application, and how they can complement each other within the field of public health. A framework that can be used when deciding which health policy approach to use for a given case will be developed, based on existing literature, frameworks, and a case study.

Discussion

This paper contributes to knowledge on health policy analysis and towards efficiency and clarity in analyses conducted in this field.

Key messages

• There is little guidance regarding how to conduct health policy analysis.

• Clear guidance on which approaches to use and how they complement each other will contribute towards efficiency and clarity in health policy analysis.
The meta-governance of quality registries for public health
Authors: Kuhrn M M , Laschkolnig A , Degelsegger-Márquez A
Published: October 2024

Issue/problem

Healthcare-related planning and policy requires evidence, which in turn requires data. Generating sensitive, high-quality data is expensive. Given the constraints of routine or study-related data for quality monitoring, quality registries are commonly used. But when is it adequate, from a public health meta-governance point of view, to establish dedicated quality registries?

Description of the problem

Many countries have established public patient registries over time. The lack of a meta-governance framework complicates decision-making for establishing and funding dedicated quality registries. Simultaneously, legal advancements like the European Health Data Space may enhance the use of routine data in healthcare policy, potentially transforming both registry and meta-governance practices.

Results

We identified key meta-governance challenges, such as setting criteria for the creation, modification, or closure of registries, deciding on public funding and choosing between routine and specially collected data. We argue against using absolute thresholds like disease prevalence, advocating for a scorecard approach that evaluates epidemiologic reasoning, policy relevance, healthcare impact and factors like data availability and registry synergies.

Lessons

The EHDS will enable enhanced secondary data use, necessitating decisions on when to use routine versus specifically collected data. Decision-makers must consider sustainability, ethics, practicability and data linkability, while recognizing risks such as data quality limitations and potential bias from original data collection purposes.

Key messages

• The necessity for quality registries varies by case, serving specific policy questions. Optimizing funds and avoiding arbitrary decisions require a strategy based on a meta-governance framework.

• With the introduction of EHDS, the focus may shift more toward data curation and quality control, making it critical to align registry efforts with the broader health information system.
An Irish public health policy research team: impact and lessons learned, one year on
Authors: Norris M , McDowell C , Power V , Spillane S , Ryan M , O’Neill M
Published: October 2024

Issue

In 2023, in Ireland, a public health policy research team was established in the Health Information and Quality Authority to conduct evidence syntheses and provide evidence-based advice to inform national decision-making, at the request of the Department of Health. One year on, we reflect on the impact of this team and outline lessons learned. These findings may support other countries in creating and developing public health policy research teams.

Description of the problem

We aim to answer the following questions: What impact can a public health policy research team have and what are the lessons learned, one year on? Projects completed by the team in 2023 were reviewed for stakeholder engagement (such as expert and public and patient involvement) and impact (feedback from policymakers, resulting public health actions or policies and online report downloads).

Results

Seven public health projects were completed in 2023, in areas including: Long COVID, public health reform, rapid multiplex testing, and medical countermeasure stockpiling. National and international stakeholders were engaged with via expert advisory group membership, document review and project presentations. Patient representatives were included from Long COVID Advocacy Ireland and Rare Diseases Ireland. Project reports were downloaded a total of 281 times. Positive feedback was received from all stakeholders. Project findings were presented to policymakers to inform national public health and rare disease strategy development, and the Long COVID model of care in Ireland.

Lessons

Early and ongoing stakeholder engagement is key when translating research to practice, via policy. Innovative methods of engagement, including public and patient involvement, can ensure meaningful collaboration. Adapting methodologies to meet stakeholder needs, such as rapid evidence synthesis, enhances impact. Lastly, research impact on policy takes time, and an understanding of national policy development is required.

Key messages

• A public health policy research team provides impactful evidence synthesis to advise national policymakers.

• Stakeholder engagement is key to developing impactful policy advice.
Proton-pump inhibitor use in older adults: Public vs. Private Prescribing in Portugal
Authors: Romano S , Teixeira Rodrigues A , Torre C , Perelman J
Published: October 2024

Background

Proton pump inhibitors (PPI) are frequently overprescribed, posing challenges to patients and healthcare systems. In Portugal, the publicly funded National Health Service (NHS) provides universal coverage and reimburses the cost of medications regardless of the prescription origin. If private practices may benefit from longer consultation times allowing better prescription, they do not face any incentive to avoid over-prescription. We aimed to compare outpatient prescription trends, patterns, and costs of PPI among older adults in private and public sectors.

Methods

Nationwide retrospective ecological study on PPI prescribed for older adults in Portugal 2020-2022. Data on defined daily doses (DDD) and costs were obtained from a national public database by healthcare sector, sex (female/male), and age group (65-74, ≥75). We analysed trends, market share of DDD per 1000 older adults per day (DID), and mean cost per DDD (€/DDD) for all PPI substances.

Results

We observed a decrease in prescribed PPI from 349.0 DID in 2020 to 341.9 DID in 2022. Omeprazole (reference and cheaper substance) was the most prescribed drug for females and pantoprazole for males in the public sector. Similar pattern was observed among those aged ≥75 in the private sector while for those aged 65-74, esomeprazole was the most prescribed drug. Overall, the private sector prescribed PPI with a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances (rabeprazole +0.032 €/DDD; lansoprazole +0.029 €/DDD; esomeprazole +0.021 €/DDD).

Conclusions

PPI prescription followed similar trends in both sectors, but private practitioners tend to prescribe more expensive drugs, because their patients can afford them and because there is no incentive for more rational prescription. Since the NHS financially supports drugs prescribed in private practices, financial incentives towards rationale prescription should also fall in this sector.

Key messages

• Overall, the private sector prescribed PPI with a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances.

• Since the National Health Service financially supports drugs prescribed in private practices, financial incentives towards rationale prescription should also fall in this sector.
Can more CVD prevention increase life expectancy in Germany? Analysis with European data 2000-2019
Authors: Stolpe S , Kowall B
Published: October 2024

Background

Life expectancy (LE) in Europe is increasing since long - while mortality from cardiovascular diseases (CVD) declines, attributed to advances in therapy and prevention. Whether this is still applies the last 20 years is unclear. Recently, Germany’s low LE compared to other Western European countries (2019: 81.3 yrs; Spain: 84, Italy 83.6) was seen as result of high CVD mortality due to insufficient prevention. This led to the establishment of the German Federal Institute for Prevention and Education in Medicine, aimed at reducing CVD and -in the long term - narrowing the gap in LE. We explore whether data on CVD mortality and morbidity support this idea.

Methods

With data from OECD, WHO and IHME (GBD 2021), we calculated the mean annual change in LE and in age-standardised mortality (ASM) for CVD for 2000-2019 for European countries by sex. We estimated the linear association (adj R²) between the mean annual change in LE and ASM for CVD for West- and East-Europe, and -country-specific- between incidence and ASM from CVD.

Results

For 2000-2019, mean annual change in LE was lower in West- than in East-Europe: 0.25 yrs vs. 0.30 in men and 0.17 vs 0.22 in women; for ASM in CVD, it was about half as large: -6.6/100.000 vs. -11.1 for men and -4.1 vs. -8.0 for women. Similarly, the adj R² for the association between mean annual change in LE and in ASM for CVD was lower in West- compared to East-Europe: 0.43 vs. 0.24 in men and 0.21 vs. no association (adj R² -0.01) in women. Courses of CVD incidence were heterogeneous (linearly or wave-shaped in- or decreasing, stable or u-shaped). In Germany, it decreased wave-shaped, with an adj R² for linear association with ASM for CVD of 0.79 in women and 0.63 in men. The association between LE and ASM for CVD is low in West-European countries. Even if amplified prevention lowers CVD mortality, a positive effect on LE is questionable. Differences in LE are stable since long. Non-morbidity related factors might decisively effect LE.

Key messages

• Life expectancy in Europe-and it’s mean annual change since 2000 is not associated with age-standardised CVD mortality in women, and only moderate in men in West-Europe, in contrast to East-Europe.

• Course of CVD incidence is country-specific and very heterogeneous and reveals no overall association with CVD mortality rates.
The adoption of a place-based framework to inform municipal health strategies
Authors: Freitas A , Almendra R , Santana P
Published: October 2024

Background

Health is a place-based issue. Research shows that inequalities in health are significantly influenced by social, economic, and environmental factors, making local policies related to these domains critical determinants. Yet, place-based health planning remains underutilized by local practitioners, not receiving adequate attention from policy-makers. Departing from the Municipal Health Strategy of Coimbra, this presentation aims to showcase the framework used for guiding municipal health planning, addressing multidimensional factors, geographic analysis, intersectoral collaboration and participatory approaches.

Methods

The conceptual and methodological framework followed a population health approach with a geographic lens, looking at how the health outcomes and health determinants were geographically distributed across the municipality (data disaggregated at sub-municipal level), as well as the extent to which policies from multiple sectors can address them. The planning cycle followed an iterative seven-stage process based in five key actions: 1 - Assess (Health Profile), 2 - Prioritize (Priorities), 3 - Plan (Objectives and Strategies), 4 - Implement (Action Plan) and 5 - Monitor (Targets and Measures, Monitoring Plan). Participatory processes were conducted involving local stakeholders and citizens to identify needs, establish priorities and actions.

Results

The framework for action integrates 14 goals and 94 actions across six policy domains: Sustainable Mobility and Public Places, Safe and Adequate Housing, Accessible Healthcare, Social Cohesion and Participation, Education and Health Literacy and Intersectoral and Collaborative Leadership.

Conclusions

Adopting a place-based framework to health planning, involving a geographical and multidimensional health assessment as well as the participation of local stakeholders and citizens, was considered effective in turning evidence into practice.

Key messages

• Municipal health strategies should be developed with a place-based perspective, prioritizing health as the focal point across various intersectoral municipal policies.

• The integrated framework shed light on the experience of co-creation to inform health-oriented planning, ensuring that actions address specific needs of localities.
Analyzing Public Discourse on the Affordable Care Act through YouTube Comments
Authors: McKelvy T , Garman J , Green K , Mongeaux J , Ivanitskaya L , Bizri-Baryak R
Published: October 2024

Introduction

Social media’s pervasive role in daily life provides a unique avenue for understanding public sentiments. This study utilizes YouTube comments on an MSNBC video about the Affordable Care Act (ACA) to explore public opinions on the policy and its political implications.

Methods

A qualitative analysis of YouTube comments on an MSNBC video was conducted. Netlytic, a scraping tool, gathered 1,949 comments. Thematic analysis, based on a coding framework derived from Semetko and Valkenburg’s frames, identified three predominant frames: Responsibility, Human Interest, and Economic Consequences.

Results

Of the 1949 comments posted in response to the ACA video on YouTube, 488 were analyzed. Three media frames were used to categorize the comments. Among the analyzed comments, 42% fell within the Responsibility Frame, indicating that 205 comments attributed responsibility for ACA-related issues, healthcare access, and costs to political parties, individual politicians, and government entities. The Human-Interest Frame accounted for 11% of the comments, with 53 remarks reflecting individual experiences related to healthcare access and costs. Additionally, 26% of the comments fell within the Economic Consequences Frame, signifying those 125 comments included remarks concerning the economic impacts of the ACA, such as increased healthcare access, taxes, and penalties. The remaining 21% of comments did not align with the three frames.

Conclusions

This study embarked on a comprehensive exploration of public discourse surrounding the Affordable Care Act (ACA) within the context of the 2024 presidential election, utilizing YouTube comments as a rich source of qualitative data. Through a meticulous methodological approach, which included thematic framing analysis and intercoder reliability assessments, valuable insights into the diverse perspectives and sentiments expressed by social media users regarding this critical healthcare legislation were gained.

Key messages

• Social media allows for real-time understanding of people’s thoughts, beliefs, opinions, and ideas, as well as serves as a useful tool that fosters broad, unfiltered data/content.

• Researchers conducted a qualitative analysis of public discourse on YouTube to explore the range of sentiments regarding the ACA.
Body composition trajectories before the diagnosis of type 2 diabetes mellitus in Whitehall II study
Authors: Major D , Fazekas-Pongor V , Hung W Y , Singh-Manoux A , Brunner E J , Kivimaki M , Tabak A G
Published: October 2024

Background

The trajectories of anthropometric and body composition measures (important predictors of diabetes) are rarely explored before diabetes diagnosis. Our study aimed to compare trajectories of fat mass (FM), fat-free mass (FFM), body mass index (BMI), and waist circumference (WC) preceding type 2 diabetes mellitus (T2DM) to aging trajectories of individuals without diabetes during follow-up.

Methods

We used data from the Whitehall II study, a prospective cohort of British civil servants. 5-yearly BMI and WC were available for up to 20 years, while 5-yearly FM and FFM measures were available for up to 10 years. Linear mixed models with a backward timescale (from diabetes diagnosis or end of follow-up) were performed stratified by sex and adjusted for age, occupational grade, ethnicity, and lifestyle factors.

Results

A total of 1674/990 (anthropometric/body composition analysis) women (233/81 incident diabetes) and 3917/2710 men (479/217 incident diabetes) 49.81 [0.08]/60.91 [0.9] (mean [SE]) years of age at baseline were included. All outcomes were higher in cases compared to controls. Women’s FM, BMI, and WC followed a quadratic increase in both groups with a faster increase among incident diabetes cases (dBMI 0.04 [0.01] kg/m2/year, dFM 0.19 [0.09] kg/year, dWC 0.2 cm/year [0.05]). FFM decreased linearly with similar slopes in cases and controls. Men’s FM, BMI, and WC also showed a quadratic increase with faster increase in incident cases compared to controls (dBMI 0.03 [0.01] kg/m2/year, dFM 0.23 [0.04] kg/year, dWC 0.08 [0.02] cm/year). FFM followed a quadratic decrease in both groups with a slower rate (0.06 [0.03] kg/year) in incident cases.

Conclusions

Incident diabetes cases have higher anthropometric and body composition measures 10-20 years before diabetes diagnosis compared to controls. Furthermore, incident cases showed faster increases in these measures except for FFM that decreased during follow-up with similar or lower speeds in cases than controls.

Key messages

• Traditional anthropometric measures do not capture the underlying changes in body composition.

• The inclusion of body composition in risk calculators may result in more precise diabetes prediction.
Adolescent well-being in time of crisis: The role of social and residential contexts
Authors: Bitar S , Minary L , Lalloué B , Kestens Y , Manneville F , O’Loughlin J , Ligier F , Agrinier N
Published: October 2024

Background

It is unknown whether social or residential context during the COVID-19 lockdowns may impact mental well-being. We identified classes of each of social and residential context during the lockdown and examined their associations with mental well-being among French adolescents one-year after the first lockdown.

Methods

We used data collected in a cross-sectional study design in 2021 from 387 adolescents ages 12 to 15 years enrolled in the school-based pilot study for EXIST. Participants reported social and residential characteristics during the lockdown retrospectively, and current mental well-being in self-report questionnaires. We used latent class analysis to identify classes of social and residential contexts, and linear regression models to study their association with mental well-being.

Results

Four social context classes were identified: class 1 ‘Low opportunities for social contacts at home’, class 2 ‘Moderate opportunities for social contact at home”, class 3 ‘High opportunities for social contact at home’, and class 4 ‘Very high opportunities for social contact at home’. Compared to class 4, lower levels of mental well-being were observed among adolescents in class 1 (b= -4.08, 95% CI [-8.06; -0.10]) one year after the lockdown. We identified four residential context classes, with differences across classes in proximity to nature, type of residence (e.g., apartment, house), and level of neighborhood deprivation. No association was found between residential context during the lockdown and adolescent mental well-being one year later.

Conclusions

An unsupportive social environment during the lockdown may have long-term effects on mental well-being among adolescents. Given the observed disparities in social support, future intervention should aim to strengthen social support for adolescents living in unsupportive environments (e.g., remote homework assistance, support for isolated parents, provision of virtual chat rooms for adolescents).

Key messages

• Mental well-being was challenged among youth with lower levels of social connectedness and support during lockdown, residential context was not associated with adolescent well-being after one year.

• During crisis, a critical need among adolescents does not pertain to the physical attributes of their living environment, but rather to social support from friends or family within and outside home.