bluuebunny/crossref_metadata_2025 huggingface dataset:
An overview of burden of disease studies in Europe
Authors: Charalampous P , Gorasso V , Plass D , Monteiro Pires S , Von der Lippe E , Pallari E , Mereke A , Devleesschauwer B , Haagsma J
Published: October 2021

Facing the considerable variation in the computation of disability-adjusted life years (DALY) in the numerous updates of the Global Burden of Disease (GBD) study and many independent studies, the European burden of disease network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key assumptions used in the European burden of disease (BoD) studies. The SLR will provide an overview of the existing BoD studies and the computational variations used and will also help identifying ways to harmonize the approaches enhancing the comparability of BoD estimates. The SLR was split in four parallel reviews: non-communicable diseases (NCDs), communicable diseases (CDs), injuries and risk factors. For the first three, the search strategy included terms describing the population (GBD area “European region”) and the BoD measures (years lived with disability, years of life lost, and DALYs). We included studies published between January 1990 and April 2020, without language restrictions. The search strategy was run in PubMed, Web of Science, Cochrane, and Embase. OpenGrey, OAIster, CABDirect, WHO and targeted public health agency websites were screened for grey literature. In addition, burden-eu members were asked to supplement the list of publications with any material available within their national public health institutes. Data extraction focused on methodological information. The title, abstract and full-text screening resulted in the final inclusion of 165 papers regarding NCDs, 189 with CDs, and 124 papers regarding injuries. The final list includes peer-reviewed articles and reports showing a variability in data sources used (e.g. patient medical records, disease registries, insurance claims sources) and model assumptions (e.g. use of multi-morbidity adjustments, use of disability weights). Further data extraction and analysis is in process, and will be presented during the workshop.
A systematic literature review of burden of disease studies in Europe: next steps and implications for researchers
Authors: Devleesschauwer B , Charalampous P , Gorasso V , Plass D , Monteiro Pires S , Von der Lippe E , Haagsma J
Published: October 2021

Facing the considerable variation in the computation of disability-adjusted life years (DALY), the European Burden of Disease Network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key variations in the assumptions used in the European burden of disease (BoD) assessments. The studies were evaluated in terms of pre-defined criteria, focusing on data sources used and on specific methodological and normative choices to assess BoD. Preliminary results show a wide variety in methodological assumptions used to quantify DALYs, but also important inconsistencies in the reporting of methods and particular assumptions. For instance, the quantification of uncertainties is not a common practice, even though most authors seem to be aware of the uncertainty in their DALY estimates and discuss uncertainties as an important study limitation. When uncertainties were quantified, different approaches were used, and described using inconsistent nomenclature. The results of the SLR show that there is a clear need for standardized reporting guidelines for DALY estimates. Such a tool could be based on quality assessment checklists already in place for clinical trials and observational studies (PRISMA, STROBE, CRD), and would require inclusion of the DALY's key methodological and normative choices. Standardized DALY reporting guidelines could serve multiple purposes. First and foremost, they would allow to increase the quality of reporting, thereby increasing the transparency and comparability of BoD studies. As a reference document, such guidelines would also help to harmonize nomenclature, which would further increase transparency and comparability. Last but not least, it would also serve as a capacity building tool, supporting researchers in understanding which methods and assumptions underlie the DALY metric. To address this need, the burden-eu network aims to play a driving role in the development of standardized DALY reporting guidelines.
Relationship between clinical record completeness and occurrence of adverse events within hospitals
Authors: Mellace F , Scarpis E , Brunelli L , Tullio A , Cautero P , Londero C , Farneti F , Valent F , Cocconi R
Published: October 2021

Introduction

Clinical record (CR) is an appropriate source for adverse events (AEs) detection and Italian law requires its compilation. Its completeness is used as an indicator of the quality of care provided and offers guidance on system changes to improve professional practice. This study aimed at assessing the completeness of CRs, describing AEs' rate and triggers, and investigating the relationship between CR completeness and the occurrence of AEs.

Methods

A retrospective review of CRs was conducted, randomly selecting patients discharged from Internal Medicine (IM), General Surgery (GS) and Obstetrics (O) between June and September 2020 at the Academic Hospital of Udine (Italy). The completeness of CRs was assessed using a 65-items checklist developed by the hospital Quality Unit. Triggers and rate of AEs were detected by using Global Trigger Tool. Relationship between AEs and completeness of CR was analyzed using nonparametric tests.

Results

Among 93 reviewed CRs, 91.4% were from the GS, 5.4% from IM and 3.2% from O. Patient mean age was 64.6±18, women were 51.6%. The average completeness of CRs was 50.4% [30.4%-83.5%]. Identified triggers and AEs were 125 and 29 respectively, with at least one AE every 23.7% admissions, 31.2 AEs per 100 admissions and 40 AEs per 1000 patient-days. The most frequent AEs were surgical damage (51.7%; 15) and hospital-acquired infection (24.1%; 7). Hospitalization length for patients with at least one AE was 12.6 days, whereas it was 6.3 days without AEs. A significant positive correlation (R = 0.36; p < 0.001) was found between length of hospitalization and number of AEs. The increase in CR completeness is associated with the decrease of the total number of AEs (R=-0.18; p = 0.083).

Conclusions

These findings suggest a direct association between the number of AEs and the length of hospital stay. The correlation between CR completeness and AEs suggest that patient safety could benefit from the improvement of clinical record compilation.

Key messages

More studies are needed to understand if the occurrence of AEs to patients may cause a prolonged length of hospitalization. A better compilation of CRs should allow to reach a more effective communication between healthcare workers, creating a work environment less prone to errors and AEs.
Audit and feedback strategies: study protocol and preliminary results from the EASY-NET project
Authors: Agabiti N , Grilli R , Valent F , Ciccone G , Marchesini Reggiani G , Marenzi G , Di Carlo C , Bramanti P , Davoli M
Published: October 2021

Background

In Italy there is evidence of a large variability in health care services and health outcomes. This multi-regional project is funded on Ministry of Health and Health Regional Authorities (code NET-2016-02364191). The aims are: 1) To test the effectiveness of Audit and Feedback (A&F) interventions in improving health professional practices and patients' outcomes in different settings using both a quantitative and a qualitative approach. 2) To examine factors that may explain variations in the effectiveness of A&F. 3) To evaluate the impact of A&F in reducing avoidable differences in access to effective health care interventions in socioeconomically disadvantaged populations.

Methods

In the 7 participating Regions (about 33 million inhabitants) experimental study designs have been implemented in different clinical areas (e.g. before-after controlled study, cluster randomized trial): in Lazio emergency care and chronic diseases care, in Friuli Venezia Giulia emergency care, in Piemonte oncology care, in Emilia Romagna chronic disease care, in Lombardia cardiovascular care, in Calabria deliveries and maternal health, in Sicilia emergency care. The effectiveness of different types of A&F are compared in term of outcomes using health information system databases.

Results

Preliminary results show large heterogeneity in developing and conducting A&F, in term of team project composition, type of intervention, clinicians' behavior to be changed, outcomes indicators, professionals involved, structure and timing of data reporting, actions to be implemented after the intervention. Limited awareness and interest of clinicians in A&F interventions was found.

Conclusions

The project represents a unique opportunity to explore how A&F interventions could be better designed. Different A&F strategies will be compared in term of clinical outcomes. The identification of barriers/facilitating factors will supply knowledge on mechanisms and tools to enhance A&F effectiveness.

Key messages

The project supports providers in reducing gap between knowledge and practice. The project promotes culture of interprofessional collaboration as a key point for high quality care.
Hospital hand hygiene monitoring: internal audits and the role of public health residents
Authors: Moro M , Vigezzi GP , Chiappa F , Salvati S , Cocciolo G , Oradini Alacreu A , Capraro M , Nizzero P , Odone A , Signorelli C
Published: October 2021

Background

Healthcare workers (HCW) adherence to hand hygiene (HH) is the most effective infection prevention and control (IPC) measure to fight healthcare-associated infections (HAI) and is a crucial component for standard precautions, especially in a pandemic context. As suggested by the WHO and Joint Commission Network Project, evaluating adherence to HH is essential to identify deficiencies and promote improvement interventions.

Methods

San Raffaele Hospital in Milan, Italy, adopted internal audits to measure HCWs' adherence to HH according to WHO Guidelines. Public health (PH) residents were enrolled as auditors. They were trained with WHO technical manual for observers and handovers among residents. WHO observation form was used for collection. Process index was HH adherence, stratified by profession, unit, opportunity and indication.

Results

8 PH medical residents carried out observations from January 2018 to December 2019. 434 HCWs were observed in 26 hospital units (191 nurses, 148 physicians, 83 healthcare assistants and 11 other professionals). Global adherence was 53%, calculated on 1,969 opportunities, and 2,221 indications observed, followed by 932 hands rubbing and 110 handwashing. Most observations involved nurses (adherence of 53%) and physicians (54%). Global adherence was generally higher in medicine, specialist surgery and intensive-care units while lower in general surgery and rehabilitation units. Indications with the highest adherence were “after body fluid exposure risk” (69%) and “after touching a patient” (64%). The lowest adherence (44%) was observed for “before clean/aseptic procedure” indication. The belief that gloves use may replace HH might partially explain the data.

Conclusions

Global HH adherence was in line with significant published data and was far better than 2016 data but slightly lower than observations in 2018 when the program started. We believe 2020 HH compliance could have changed due to HCW involvement in IPC against COVID-19.

Key messages

Hand hygiene (HH) audits represent a crucial tool of clinical governance and risk management: auditors’ training, monthly and annual reports, and feedbacks allowed to structure a virtuous process. If HH audits aim to improve practice we should understand when HH is most beneficial, assessing quality, improving performances through achievable targets using reproducible methods and technologies.
The impact of smoking on mortality in the face of population ageing: the example of Germany
Authors: Mons U
Published: October 2021

Background

Despite weak tobacco control, smoking in Germany has steadily declined over the last 25 years. As policymakers often expect that this trend will also reflect in a declining associated public health burden, I sought to quantify trends in smoking-attributable mortality (SAM) and to explore the impact of population ageing.

Methods

Smoking and mortality statistics from 1992 to 2018 were obtained from the German Statistical Office, from which SAM was calculated separately for each cause of death causally associated with smoking using Levin's formula for population-attributable fractions. The impact of population ageing was explored by comparing crude and age-standardized SAM, respectively. To estimate the impact of population ageing on future SAM, a forward projection until 2040 was modelled assuming continuation of smoking trends and constant mortality rates.

Results

About 126.900 deaths were attributable to smoking in Germany in 2018. Since 1992, total SAM declined only slightly, while stronger decreases were seen in age-adjusted SAM. Differences between crude and age-standardized SAM seem to be particularly striking in men. The forward projection of SAM suggests that recent increases in smoking in the middle aged as well as population ageing dynamics will lead to further steady increases within the next two decades in both sexes to about 138.250.

Conclusions

Results indicate that past decreases in SAM due to declines in smoking were largely compensated by population ageing. In the next two decades, current smoking trends and population ageing will lead to a steady increase in SAM. Only by taking determined immediate policy action could significant inroads into reducing the smoking-associated disease burden be achieved. Also, given still significant smoking rates in middle and old age, there is tremendous potential to curb the associated public health burden by intensifying cessation programs.

Key messages

Contrary to common expectations among policymakers, the smoking-attributable public health burden will strongly increase in the next decades in Germany. Determined immediate policy action is required to halt or attenuate these trends.
Health literacy needs among unemployed adults: Triangulating interview and scoping review data
Authors: Samkange-Zeeb F , Singh H , Lakeberg M , Kolschen J , Schüz B , Zeeb H , Christianson L , De Santis K , Brand T
Published: October 2021

Disadvantaged populations, including unemployed adults, often exhibit low levels of health literacy. Exploring subjectively perceived health literacy needs in these populations can serve as an entry point for participatory intervention development. We aimed to assess health literacy needs of unemployed adults by triangulating qualitative interviews data and a scoping review. Using a parallel approach, we combined results of an interview study with 10 participants of a job-reintegration program in Germany and a scoping review. The interviews, conducted in early 2021, focused on health topics of interest to the participants and their sources of health-related information. Data were analysed using thematic analysis. For the scoping review, we searched MEDLINE, CINAHL, PsycInfo and SCOPUS up to January 2021 for studies containing “unemployed” AND “health literacy” in titles/abstracts. Study selection and data extraction were done independently by two researchers. Nutrition and physical activity emerged as core themes during the interviews, with some participants referring to the importance of both for mental health. Doctors and the institution running the job-reintegration program were the sources of health-related information often mentioned. The Corona pandemic was reported to have limited physical activity and affected psycho-social well-being. Five out of 2696 studies were included in the review. Four focused on mental health literacy, the fifth assessed information seeking practices in unemployed adults. The qualitative analysis revealed that health literacy needs of unemployed adults go beyond mental health literacy. As nutrition and physical activity impact mental health, interventions targeting such topics might also improve mental health literacy in unemployed adults. Study findings will be discussed with unemployed persons and social workers in co-production workshops that aim to identify and prioritize health literacy needs for intervention development.

Key messages

Health literacy programs for unemployed adults should target nutrition and physical activity. Workforce re-integration programs play a pivotal role in improving health literacy of unemployed adults.
Socioeconomic inequalities in health: the role of daily hassles and the importance of health
Authors: Verra SE , Poelman MP , Mudd AL , de Vet E , de Wit J , Kamphuis CBM
Published: October 2021

A low socioeconomic position (SEP) adversely affects health outcomes and is associated with a lower perceived importance of health. It has been suggested that people with a low SEP disproportionately face daily hassles, as a result of which health may be perceived as less important for those with a low SEP compared to those with a high SEP. A lower perceived importance of health likely influences health-related behaviours that affect health outcomes. This study examines whether socioeconomic inequalities in self-assessed health are mediated by daily hassles and/or the perceived importance of health, and whether there is sequential mediation of daily hassles and perceived importance of health. A cross-sectional survey was conducted in 2019 among N = 1,334 Dutch adults. Participants rated the extent of eleven commonly experienced daily hassles (e.g., financial hassles, legal issues), and indicated the perceived importance of two health-related domains (not being ill, living a long life). Inequalities in self-assessed health according to SEP (indicated by income and education) were examined using structural equation modelling, with daily hassles and perceived importance of not being ill or living long a life either as single or sequential mediators. Daily hassles and perceived importance of health individually mediated the relationship between SEP and self-assessed health, but importance of health did not mediate the association between by daily hassles self-assessed health. Socioeconomic inequalities in self-assessed health were explained by the experience of daily hassles, and by differences in the perceived importance of health individually, but the perceived importance of health did not explain the influence of the experience of daily hassles. Addressing the challenging circumstances (e.g., financial or housing hassles) associated with a low SEP, may contribute to improving self-assessed health. Further research should examine how daily hassles affect health.

Key messages

Daily hassles and the perceived importance of health mediated the relationship between socioeconomic position and health. There was no association between daily hassles and the perceived importance of health.
Policy interactions during the Dutch ‘Public Health Foresight, in the light of COVID-19'
Authors: Hilderink Henk
Published: October 2021

When the sense of urgency of the COVID pandemic increased, in March 2020, the Dutch Ministry of Health commissioned RIVM to do the study “Public Health Foresight, in the light of COVID-19”. The aim of this study was to analyze Impact of the corona pandemic on current and future health and health care, to support broader consideration of measures and to be better prepared in the future. This was done by addressing not only the direct impacts, e.g. the disease burden of COVID-19, but also the indirect impacts of the measures, e.g. mental health, health impacts of changed life styles and delayed health care provision. During this 8 months trajectory, interaction with policy makers was frequent and intensive. In the context of Parliamentary elections there were constant pressures on policymakers from the virologists and hospital and ICU ward managers; as well as non-health Ministers in the government cabinet and the general public questioning decisions on whether to act or not. In the presentation we draw implications for public health experts on do's and don'ts in interaction with policymakers.
Racial implicit bias among obstetricians and midwives, and information on Down syndrome screening
Authors: Azria E , Rousseau A , Anselem O , Bonnet MP , Deneux C , Sauvegrain P , Richetin J
Published: October 2021

Background and objectives

Previous studies showed disparities in prenatal screening for Down syndrome according to the maternal place of birth. Among the factors that might be involved in these differences, social cognition offers the concept of implicit bias (IB) used to describe the fact of having attitudes towards people or associating stereotypes with them without necessarily conscious knowledge. In line with theoretical and empirical contributions in social psychology that postulate and demonstrate the role of automatic processes in determining behavior, IBs often predict how individuals behave more accurately than conscious values. The existence of IB among health professionals has been demonstrated in emergency care or pain management. To our knowledge, no study of IB has been conducted in Europe, nor in the field of perinatal care. Thus, our objectives were to test for IBs towards African women in terms of evaluation (negative bias) and strength (positive bias) among perinatal health professionals and test whether these IBs predicted treatment recommendations toward African vs. French patients.

Methods

Through online data collection, 887 perinatal care practicians (obstetrician-gynecologists, midwives) answered a series of case vignettes depicting African vs. French patients, with one specific to a Down syndrome screening situation. Then, participants completed two Implicit Association Tests to assess valence and strength IBs toward African vs. French women.

Results

81.3% of the sample showed an implicit evaluative preference for French over African women, and 60.2% had an implicit perception of African women as stronger than French. However, decision toward Down syndrome screening were not influenced by the patient's origin nor by the healthcare professional implicit bias.

Conclusions

Perinatal practicians seem to have implicit biases toward African women, but the way they provide information regarding Down Syndrome screening is not affected.
“Life in the camps makes you sick.” Results of a photovoice project with refugees in Munich, Germany
Authors: Namutebi L , Nakyazze OC , Bamuwayira A , Huber A , Krasniqi S
Published: October 2021

Background

Refugees newly arriving in Germany are housed in large accommodation centers. Living in such camps make it difficult to stay healthy due to the psychological stresses associated with the loss of privacy, the hygienic conditions and the bad nutrition. While these conditions are known, few studies exist that capture the lived experiences of refugees in such shelters.

Methods

The project ‘Vulnerability and empowerment: Participatory approaches to health promotion with refugees' (EMPOW), funded by the German Research Foundation (2019-2022) applies a participatory design involving three study sites. In Munich, the Photovoice method was used to identify health challenges in the camps. Examples are shown and discussed.

Results

Being forced to live in camps constitutes a specific hazard to the health of refugees. Often, they are not allowed to cook or to bring their own food. Canteens, bedrooms and sanitary facilities are shared with many people, which poses a major hygiene problems (especially during the Corona pandemic). Particularly for pregnant women this situation is harmful to their health. The COVID-19-pandemic worsens these problems significantly e.g. via quarantine measures that are imposed on shelters and its inhabitants for long periods.

Conclusions

The photovoice stories document the serious deficits of the shelter system from a community perspective showing how these are detrimental to the inhabitants' health. Suggestions are made for improving the situation so that persons seeking asylum in Germany have better chances to stay healthy. The perspective of refugees themselves on these challenges must be taken seriously in order to improve their health.

Main messages

Photovoice provides a tool for refugees to express and interpret their lived experiences. The shelter system in Germany is detrimental to the health of refugees.
Engaging communities through community mapping
Authors: Gangarova T , Freiwald G
Published: October 2021

Background

Evidence shows that migrants and refugees in Germany don`t have equal access to drug prevention programs and harm reduction services, nor are they meaningfully engaged in their development. Participatory practice provides valuable tools for building capacity and enabling migrants, refugees and service providers to co-create knowledge and develop appropriate educational media and services.

Methods

For the project, ‘Harm reduction services for and with migrants in Germany” (PaSuMi), funded by the German Ministry of Health (2017-2020), a study design following the principles of Community-based participatory research was applied. We introduce the PaSuMi case study in Dortmund where community mapping was implemented with injecting drug users. Community mapping is a participatory process which enables the visual expression of characteristics, resources and needs of a community: a map of a community is drawn, analyzed in the group and used to determine steps for action. After outlining the theoretical framework and the steps for applying the method we discuss its advantages and limitations.

Results

Two community partners in Dortmund were trained as peers and supported to implement the method with their community. As a result a map of “places of trust and care” was created. This was made into a flyer which was distributed to new-comers for orientation, and to service providers to optimise their streetwork.

Conclusions

Community Mapping enables the participation of disadvantaged communities (e.g. people with low literacy skills) and work in multilingual groups. It works in various settings with low financial and time expenditure. The method can pose ethical challenges - especially when working with highly stigmatized communities.

Main messages

Community Mapping provides a tool for engagement of disadvantaged communities. It enables service providers to tailor their services better to community needs.
European School on Health Information: Strengthening Public Health Information Workforce in Europe
Authors: Lapao L , Peyroteo M , Paulo M
Published: October 2021

Background

The globalisation of the world economies has increased the need for more global health approaches requiring sophisticated and sustainable Health Information (HI) systems, and the development of new technologies. These new technologies require skilled professionals to manage public health information in most efficient ways. New challenges in Public Health, such as Pandemics, are demanding more skillful people to respond to these challenges. However, currently large inequalities on availability and training of qualified Public Health Information professionals exist in Europe.

Methods

In order to set up a sustainable European Union HI training program, the 1st European School on Health Information (ESHI2020) was developed, an HI capacity building programme with European Experts. Based on this, PHIRI established Capacity Building as a fundamental arm for the development of health information, from which a set of training, courses and webinars have emerged.

Results

The ESHI2020 took place online from Oct 1 to Nov 5 2020, and was focused on Health Examination Survey, from data collection to policy-making. The course consisted of 5 sessions, including theoretical and practical classes, group work among trainees and discussion of practical cases and projects on HIS involving trainees and trainers. 20 participants from Europe, and 15 lecturers from European most important public health institutes and Universities contributed to this training.

Conclusions

There is a need for qualified skilled professionals in HI taking into account a changing global environment. Most of HI capacity building programmes are yet to reach maturity, and the results from the first ESHI2020 led to a new strategy on Health Information in Europe, that with the support of the PHIRI project will give rise to an European and annual program on Health Information.
Comparison of metabolic syndrome prevalence using four definitions – a case study from Finland
Authors: Haverinen E , Paalanen L , Palmieri L , Padron-Monedero A , Noguer-Zambrano I , Sarmiento Suárez R , Tolonen H
Published: October 2021

Background

Metabolic syndrome (MetS) is an increasing population health threat in Europe. Several MetS definitions are available. Our aim was to compare four different MetS definitions among Finnish adults, to assess their agreement and to evaluate the impact of the choice of the definition on the prevalence of MetS.

Methods

Data from FinHealth 2017, a cross-sectional population health survey, focusing on adults over 25 years were applied in the analysis (n = 5667). Measured data on anthropometrics, blood pressure, biomarkers and questionnaire data were used to classify the participants according to the definitions. The definitions chosen for the comparison were those by the World Health Organization (1998), National Cholesterol Education Program Adult Treatment Panel III (2004), International Diabetes Federation (2005) and Joint Interim Statement (2009).

Results

The four MetS definitions resulted in substantially different MetS prevalences among the Finnish adult population: 18% by WHO, 32% by NCEP-ATP III, 43% by IDF and 46% by JIS. Among all participants, only 13.5% were identified to have MetS according to all four definitions. The component of the definitions with highest prevalence was elevated blood pressure among men and central obesity among women. Prevalence of Mets increased with age; especially steeply among the youngest age groups. Due to varying cut-off points the prevalence of different components varied between the definitions. The agreement, estimated with kappa coefficients, ranged from 0.38 (WHO vs. IDF and WHO vs. JIS) to 0.95 (IDF vs. JIS).

Conclusions

The differences between observed MetS prevalences using the four different definitions were large. For cross-country comparisons as well as for trend analyses within a country, it is essential to use the same definition of MetS to avoid possible bias due to differences in used definitions as well as to use standardized measurement protocols in measuring different components of MetS.

Key messages

It is important to use standardized measurement protocols during data collection to achieve comparable data. For cross-country comparisons as well as for trend analyses within countries, it is essential to use identical MetS definitions to avoid possible biases.
Developing Recommendations on a Consent Model for Health Information in Ireland using a Public Engagement Approach
Authors: Flaherty SJ
Published: October 2021

A major challenge for healthcare in Ireland today is achieving an appropriate balance between the protection of personal health information, and the use and sharing of such information, to improve care and to provide a more seamless experience for patients receiving care across multiple healthcare settings. Ireland is at an early stage of eHealth adoption. There is a lack of clarity in relation to an appropriate model for the collection, use and sharing of personal health information. As we start to introduce new digital technologies, it is essential that a robust consent model is in place to protect people's rights in relation to health information. Drawing on international evidence, it is important to engage with the public around the introduction of new technologies, such as a national electronic health record. Engagement will ensure that new technologies are implemented in a way that is acceptable to the public; involving people in important decisions about their health information and ensuring that their rights are upheld. To advance this, HIQA, in partnership with the Department of Health and the HSE, conducted the first National Public Engagement on Health Information in Ireland to ask the public their views on how their health information should be collected, used and shared in Ireland. People were asked to share their views through a national survey and focus groups. Building on the findings from the National Public Engagement, HIQA has worked collaboratively with key stakeholders to develop recommendations on a consent model for health and social care. Guidance is also being developed to define the consent model for the various uses of health information. There is an additional need for comprehensive national policy and legislation in relation to health information in Ireland.
Engaging the public on health information – the importance of being inclusive, authentic and collaborative
Authors: Darlington A
Published: October 2021

Successful implementation of eHealth solutions will only be realised with the support, confidence and trust of the public. An important step in this process is engagement with the public to understand their expectations and attitudes in relation to the use of their health information. Involving people in important decisions about their health information and ensuring that their rights in relation to health information are upheld is crucial and will ensure that new technologies and initiatives are implemented in a way that is acceptable. Public engagement must be undertaken in a meaningful and authentic way to build trust and confidence. Three core principles must guide public engagement: ensuring each activity is inclusive and reflects a diverse range of views; there must be an openness about the boundaries of influence and intended outcomes; and a focus must be placed on partnership and collaboration, for engaging with the public and sharing learnings with relevant organisations. Public engagement undertaken as part of the ‘OneLondon' programme, one of the UK's most progressive large-scale public deliberation events on health information, highlighted that people expect greater clarity in the intended use of health information. This appeared to be of importance for both healthcare professionals and members of the public. Despite the complexity of particular technologies, people believe there should be transparency about why, by whom, and how health information is collected, used and shared. Transparency is the foundation of building a trusted system. Additional examples of public engagement activities include the establishment of a Citizen's Advisory Group, who explore, discuss and deliberate specific issues to inform future decision-making and policy development. Continued and alternative means of engagement will be necessary to meet future challenges and take advantage of potential opportunities.
The Country Assessment Tool - process of development and use
Authors: Kumar B
Published: October 2021

The objective of the Country Assessment (CA) is to give an overview of the migration and health field in the partners' countries. Having an overview of the complex migration and health field enables partners to identify entry points for implementing actions to reduce inequities in migrant's health. The Country Assessment (CA) was based on findings from the projects first deliverable “Policy Framework for Action” (PFA). The PFA mapped key international policy documents between 2007 and 2018. We reviewed and extracted a coherent synthesis we called the ‘Road Map'. The synthesis identified six main areas that is covered in the CA tool: 1) Data and research 2) Governance and leadership 3) Intersectoral action 4) Health Service Responsiveness 5) Migrants access to health services 6) vulnerable groups. The Country Assessment template was piloted by two partner countries, Norway and Italy. The template was revised until all partners were satisfied with the range of questions. Partners then filled in readily available information and examples of available data and policy in their country.
Social prescribing, evidence and progress; the view from England
Authors: Bertotti M , Husk K
Published: October 2021

Social prescribing enables primary care to refer individuals with health and/or social issues to a ‘link worker' whom provides ‘holistic' support to patients and refers them to further agreed non-clinical activities (e.g. walking group) and/or social services (e.g. housing). Social prescribing has the potential to help managing or addressing a wide range of health and social issues, particularly pertinent in a pandemic and post pandemic world, centred around individual choice, and based on maximising the asset offered by the voluntary sector. Yet, evidence and policy development have gone hand in hand, and sometimes in reverse in England. The NHS made a good case and rationale for implementing social prescribing before the concomitant evidence base had rigorously proven its impact. Researchers are now in a position of trying to evidence (and communicate what good evidence might be) whether what has been rolled out works, in what ways, and for whom. In contributing to the development of the evaluation of social prescribing, the main challenge experienced was that what counts as good evidence depends entirely on ‘what is meant' by social prescribing. Social prescribing was found to be a pathway consisting of a set of relationships and set of activities/complex interventions as part of that pathway, therefore asking ‘what works' is not trivial. So, for the patient pathway there is a need for robust, well conducted evidence syntheses from different parts of the pathway, good qualitative work around the experiences of referrers and individuals, secondary data analysis of the health service use, effectiveness work on the activities themselves, all crucially underpinned by strong data monitoring and capture. Working with a very broad range of stakeholders (commissioners, healthcare providers, activity providers, link workers, and individuals with lived experience) goes some way to communicating this complexity and helping base decisions on the most appropriate evidence.
Developing a social prescribing research school using translational research: Learning from Wales
Authors: Wallace C , Elliott M
Published: October 2021

The Wales School for Social Prescribing Research (WSSPR) was launched in April 2020. Central to its functioning, WSSPR uses a translational research model (Cooksey, 2007; Weeks et al 2013) to describe, order and organise a multi-phase programme of applied research, development and evaluation. It promotes an equal and mutually supporting relationship between theory-building, knowledge acquisition and practice, without privileging any one activity. Within WSSPR sits the Wales Social Prescribing Research Network. The network has a membership of over 300 individuals interested in social prescribing research across Wales, this includes academics, social prescribers, policy makers, health and social care professionals and commissioners. The school is also linked to three communities of practice in the North, West & Mid, and South East of Wales, which collectively reach over 1000 social prescribing practitioners. Through the translational research model, issues and questions are raised by practice or members of the public through the network to WSSPR. These inform thinking and development of research projects and proposals. The network is then used to disseminate findings, receive feedback on findings and implement evidence-based changes in practice. This presentation will discuss the development of WSSPR and our networks & communities of practice using a translational model of research to develop programmes of research for Wales. It will discuss the challenges and provide step by step developmental guidance about setting up a research organisation for SP. It will demonstrate the impact of the social prescribing research and its contribution to the evidence base to date.
Developing evidence on social prescribing initiative in Lisbon: Challenges and insights for improving
Authors: Dias S , Figueiredo C , Hoffmeister L , Gama A
Published: October 2021

Social prescribing is recent in Portugal and evidence is needed on the potential of this complex intervention to improve health and wellbeing outcomes but also to inform the commissioning of these programmes. In a collaborative approach, an evaluation protocol of the social prescribing in two primary healthcare units in Lisbon was developed, aiming to assess its implementation and impact at three levels: patients, health system and health-social sector intersection, within a mixed-methods approach. Exploring the social prescribing contribution to enhance patients' quality of life, well-being and activation involves assessing these outcomes throughout a longitudinal perspective. In an exploratory, prospective study, baseline data collection and three follow-ups are included. Secondary data comprise health status indicators collected from patients' medical records as well as referral and social responses elaborated within the intervention. Patients' experiences on the social prescribing activities performed, perceived changes in lifestyle, and perspectives about positive and negative aspects are assessed in semi-structured interviews. The need for further understanding the impact at the health system' level calls for an attentive look at the processes of change in patients' patterns of healthcare services use (appointments in primary healthcare units, hospital admissions and emergency episodes), but also changes in the services' reorganization to better integrative health care. At a broader level, insights will be obtained on the effects on the intersection between the health and social sectors and the experiences of networking, through focus group discussions with all the stakeholders involved. The social prescribing implementation process, barriers, facilitators and suggestions for improvement will also be explored. In this presentation, challenges will be debated, as well as insights for reflection about opportunities for improving evidence development.
Opportunities and barriers of creating healthy living environments – a Delphi Study
Authors: Leimann J , Kuchler M , Plantz C , Quilling E
Published: October 2021

Comprehensive intersectoral and participatory strategies are required for successful implementation and functioning of local health promotion governance across Europe. 12 experts from 7 European countries took part in the two-stage online Delphi survey. 22 theses on key topics of municipal health promotion, prepared in a participatory process through interviews and a workshop with experts, were rated on a 10-point Likert scale (strongly disagree - strongly agree), and the confidence in answering and comments was queried. This procedure was repeated in the 2nd round. The response behaviour of the participants from the 1st round was made transparent to enable changes in opinion. In the quantitative analysis, the distribution of thesis rating was determined. The extent of consensus building was determined by comparing standard deviations. The comments were evaluated and summarized by content analysis. The outcome of the Delphi survey represents consensus-generated recommendations for the creation of healthy living environments in the municipal context. Consensus was reached on most of the theses. The experts agree on the need for an open structure of networks (mean 9.2; SD 0.6), a common vision in these networks (mean 8.3; SD 0.8), the resources required for organizing participatory processes (mean 9.5; SD 0.9) and the responsibility of all political areas for implementing an overall municipal strategy (mean 9.1; SD 0.8). The qualitative analysis provides indications that certain theses are assessed differently due to country-specific experiences and conditions. The results of the Delphi study provide a clear direction for generating recommendations. Depending on context and country, some contents are evaluated differently, which should be taken into account for the recommendations. In total, the study identified recommendations with cross-national validity that are beneficial for the creation of health promoting structures at local level.
Did You Ever Imagine Yourself?
Authors: Kaade H
Published: October 2021

Moral injuries during wars and crises are likely to happen, especially in the health system. In 2016, the United Nations and Arab League Envoy to Syria put out an estimation that 400,000 that had died in the Syrian conflict, in which many medical personnel were also targeted. By 2016, more than 50% of the Syrian doctors have left the country. These circumstances are reflected in the amount of needs and gaps in the system. In addition the huge increase in the number of injuries has, unfortunately, in the end led to moral injuries. The aim of this talk is to share some of the scenarios that I passed through while working as a medical doctor during the Syrian war, in order to highlight the amount of pressure and the unexpected situations while being under moral pressures. Based on the personal experiences I endured during my clinical work in Aleppo, Syria, as a medical doctor during the war between 2013-2016, I will mention some scenarios that I have faced during my work there. Neither I nor other colleagues would have ever imagined to be in such hard situations or being forced to pass through such cases as a medical doctor. Based on the personal experiences I will identify the impact of wars on health care systems and workers, focusing on Syria as an example.
6.N. Workshop: The politics of credit and blame: centralizing/decentralizing governance in the COVID-19 pandemic
Authors:   Organised by: European Observatory,   Chair persons: Matthias Wismar (European Observatory)
Published: October 2021

Objective

The overarching aim of this workshop is to use the theory of credit and blame politics to explain significant and dynamic shifts in power relations through centralization/decentralization within and between governments during the pandemic. Centralization is not just territorial but can also apply within government and change the extend of autonomy and influence ministers, departments and agencies have. To this end we will have a total of five presentations:

Introduction into the theory of politics of blame and credit as a driver for centralization/decentralization; three country case studies including Austria, the Czech Republic and France and a concluding presentation on Credit-taking, blame-avoidance as drivers for power shifts: implications for effective emergency responses

Background

Centralization between governments means an increase in the power of the central government vis-a-vis other ‘subnational' governments such as regions, states, provinces, or municipalities. ‘Command and control' is a common recommendation in public health emergencies (3) and central governments do often take powers over or away from subnational governments in crises. This is most politically contentious in federal states such Spain, Canada, or Germany, but can happen even in countries where there is a history of only local government (such as Ireland, Portugal, or the Nordic states).

This workshop is built on a forthcoming publication. To ensure interactivity, the chair will feed back comments to the speakers between presentations and before the end of the session.

Key messages

In COVID-19 responses credit-taking and blame-avoidance leads to major powershifts within and between governments. Emergency response planning, knowledge broker, media and civil society need to help mitigate the negative effects of credit-taking and blame avoidance for a better pandemic response.