bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare spaces for autism spectrum disorder - removing barriers for mental disability
Authors: Morganti A
Published: October 2020

Mental impairments diagnoses are increasing, due to changes in incidence and prevalence and increased changes in diagnostic methods. Among them, Autism Spectrum Disorder (ASD) is now diagnosed in one child on fifty- nine during scholar and pre-scholar age: this will make them frequently visitors of healthcare and therapeutic structures since childhood.

Sensorial hypo- or hyper-activation is one of the principal features that can affect the wellbeing of people with ASD, causing discomfort. Sounds, lights, colours, smells, shapes and surfaces should be carefully chosen in order to design as much as possible an “Autism-friendly space”, that could be also a healing space that helps handling sensorial stimuli inside stressful healthcare environments.

At the moment, among literature there are just few contributions that analyse the impact of built environment on ASD users, and there are no insights about healthcare spaces. Despite these gaps, there are still no guidelines provided by institutions to set design standards and guide designers, architects or caregivers in the project phase.

The goal of the research is to provide a specific evaluation tool for healthcare spaces and best practices formulation, validated in collaboration with stakeholders and ASD users through a co-design approach. These design strategies will be subsequently applied, improving two study-case environments, in order to compare the different outcomes on user's wellbeing and compliance.
Optimizing a stroke caregiver support programme in practice with Participatory Action Research
Authors: Krieger T , Feron F , Dorant E
Published: October 2020

Family caregivers (FCG) play a key role in the day-to-day care of stroke survivors. Most FCG support programmes are complex public health interventions. Often, they are designed top-down without key stakeholder participation. Hence, when implementing these programmes in real world settings, they may experience “teething problems”. Optimization in practice and actively engaging its stakeholders to accurately fit the programme to the needs in practice may enhance the programmés chance of success.

The Participatory Action Research (PAR) strategy was chosen for the optimization of a German primary prevention programme for stroke FCGs. Immediately after the development of the preliminary support concept (5 Conceptual Building Blocks - CBB), conducted top-down by the academic research team, iterative PAR-cycles (observe - reflect - plan - act) were applied. Together with the stakeholders (service providers and FCG), three steps were taken: (1) verifying and fitting the preliminary CBBs, (2) detecting, developing, verifying and fitting new blocks, and (3) prioritizing all blocks. For data collection a multi-methodological design was chosen.

Through PAR, a matured FCG support concept was obtained, containing eight CBBs. The five preliminary CBBs: ‘Content’, ‘Human resources’, ‘Personalized approach’, ‘Timing’, and ‘Setting’, were optimized and prioritized as core blocks, providing the base for individual caregiver support. Three new CBBs: ‘Network building’, ‘Communication’, and ‘Social safety-net’ were assigned as facilitating blocks, interlinking and securing the programme within the existing support system.

PAR was found to be essential for both systematically detecting conceptual weaknesses of the preliminary concept and adjusting its components to the needs of the key stakeholders, before full-scale implementation. Involvement of stakeholders, with high levels of participation, will enhance the acceptance of the matured concept and its feasibility in practice.
31.F. Workshop: Health system (performance) assessment: working towards a common approach
Authors:   Organised by: European Observatory on Health Systems and Policies, WHO,   Chair persons: Jonathan Cylus - UK
Published: October 2020

Since the publication of the World Health Report 2000, which aimed at assessing health systems performance globally, a number of health systems performance assessment (HSPA) frameworks and tools, designed for various purposes, have emerged. In 2017, the joint Universal Health Coverage 2030 Technical Working Group on Health Systems Assessment (TWG), consisting of health policy makers and global actors, such as the WHO, World Bank, USAID, Unicef, European Commission, OECD, etc., was formed with the aim to align the existing tools and develop a common approach to understanding and measuring health systems performance globally.

As part of this work, the European Observatory on Health Systems and Policies (OBS) has developed a Health Systems Performance Assessment framework for Universal Health Coverage (HSPA Framework for UHC), that allows to evaluate health system performance, largely by drawing on the information available in the existing tools or through global data collection initiatives. Suggested approach is based on the detailed assessment of the four health system functions (governance, financing, resource generation and service delivery) and their sub-functions, the interaction of which jointly leads to the successes and failures in the achievement of health system goals. We propose distinct assessment areas for specific functions and sub-functions as a way to identify potential strengths and weaknesses, which can then be related to actions or responsibilities of specific actors within a health system, or linkages to other sectors.

The objective of the workshop is to introduce the background, rationale, methods and process of developing of the HSPA framework for UHC; present a systematic approach to assessing various functions of health system and their interactions; relate the assessment areas of specific functions and sub-functions to the final health system goals; and, finally, to test the use of the framework in practice.

The workshop is structured as follows: the workshop will start from the four 10-minute presentations (outlined below), followed by an interactive session with the audience to discuss the content of the framework and elaborate on its potential use for HSPA and applications globally.

Key messages

The HSPA framework for UHC is an approach that allows to bring together existing HSPA efforts and moves towards a more systematic and universally applicable health system performance assessment. The approach assesses performance through attribution of various health system outcomes to specific functions and sub-functions, allowing to identify strengths and weaknesses that affect performance.
Trends in mortality and heart failure after acute myocardial infarction in Italy from 2007 to 2017
Authors: Rosato S , D'Errigo P , Manno V , Maraschini A , Cerza F , Cicala S D , Forti M , Mureddu G F , Badoni G , Sferrazza A
Published: October 2020

Background

Uncertainties on long-term outcomes after acute myocardial infarction (AMI) still exist, despite the ongoing progresses in the management of patients with AMI. This study aims to appraise early and 1-year outcome of patients hospitalized due to AMI and to describe the role of heart failure (HF) as complication affecting prognoses.

Methods

Retrospective nationwide cohort study based on administrative data on patients with AMI admitted in all Italian hospitals from 2007 to 2017. Index admission mortality rate (I-MR), 30-day and 1-year post-discharge mortality rate (PD-MR), and 30-day and 1-year total mortality rate (T-MR) were analysed; mortality average annual changes (AC) and their 95% CI were calculated; the Cox model, adjusting for age, sex, comorbidities and length of stay, was used to analyse 1-year PD-MR

Results

1,148,820 patients were considered. From 2007 to 2017, both I-MR and T-MR up to 1 year decreased significantly (from 10.9 to 8.4%; AC: -0.28%; CI: -0.31 to -0.25 and from 20.2% to 17.1%: AC: -0.33%; CI: -0.39 to -0.28, respectively). From 2010, also the rate of PD-MR decreased significantly from 11.7% to 10.4%, with such favourable trend confirmed at multivariable analyses. The HF diagnosis at the index admission is always associated with a significant increase in the risk of death (1-year T-MR average: 43% and 12% in patients with or without HF, respectively; both patients with and without HF show a constant improvement in I-MR, T-MR and PD-MR over time.

Conclusions

In the last decade, the remarkable improvements in the in-hospital treatment of patients with AMI and in the overall prognosis up to 1 year are confirmed by a constant decrease in both early and long-term mortality. Since complication from HF remains a dangerous condition that significantly worsens the prognosis of the AMI patient, appropriate management strategies must be identified and implemented to guarantee best results from both clinic and public health perspective.

Key messages

Remarkable improvements achieved in overall prognosis after AMI over the past 10 years. HF confirms to be a condition able to worsen AMI patients’ prognosis.
Comparing European guidelines for medical student education focusing on emergency preparedness
Authors: Holm S , Ghazal Asswad A , Fundano N , Khan H , Petráková A
Published: October 2020

A review of a variety of European guidelines for the assessment of medical students and their education, progression and preparedness for practise post-medical school. The various approaches were compared and contrasted with the advantages and disadvantages of each being evaluated. Their approaches towards emergency situation preparedness, or lack thereof, were also assessed.
Bridging the implementation and information gap on cancer prevention and survivorship in Europe: results from the iPAAC Joint Action
Authors: De Angelis R , Lipponen S
Published: October 2020

Background

About 40% of cancers are preventable and of those cancers about 50% are due to tobacco. Cancer prevention and early detection can reduce remarkably cancer burden and inequalities with effective strategies from the European Code Against Cancer. A better use of registries data can help to bridge the existing information gaps on cancer survivors, a dramatically growing population challenging the sustainability of public health systems in Europe.

Methods

Policy implementation through collaborative efforts based on cancer registry data, comprehensive policies and innovations. Promotion of standards and methods to facilitate systematic delivery of comparable indicators on cancer survivors by country in Europe.

Results

In cancer prevention known effective measures require European-wide comprehensive action. Population-based cancer screening programmes need continuous quality assurance and follow-up. Prevalence of short- and long-term survivors derived from a joint European dataset (EUROCARE-6, 29 countries) show that differences in survivorship are wide, consistently with demography, incidence and survival patterns. Breast, colorectal and prostatic cancers are the most frequent among all cancer survivors.

Conclusions

Collaboration across fields of science and policy sectors is needed to boost cancer prevention. Cancer survivors are a growing heterogeneous population to be monitored in public health to support Health Technology Assessment and survivors' care planning.

Key messages

Priority actions are developed within iPAAC Joint Action to encourage effective policies and implementation. Joint analysis of standardised European datasets strengthens the impact of cancer registries information. Indicators on cancer prevalence should be systematically integrated in the European Cancer Information System (ECIS).
Implementing precision genomics and innovative immunotherapies in oncology at healthcare level
Authors: Van den Bulcke M , Negellen S
Published: October 2020

Background

Precision genomics through integrating broad information on the genome has proven to be very promising in some tumors and the advent of specific immunotherapies looks to even strengthen this new paradigm. WP6 and WP9 of Joint Action on cancer control have the role of supporting the development of a Roadmap to facilitate the implementation of innovative cancer control actions in EU Member States.

Results

The following actions have been identified: to cover ethical, legal and privacy issues on the use of genome information, the societal debate must be organized,stratified screening by genetic testing of high-risk cancer patients may replace population-wide screening,implementing precision genomics requires careful HCS planning,we need jointly to deal with 'Direct to Consumer',education and training on genomics of health professionals, policy makers and citizens,identification of solutions and remaining challenges to optimize the integration of innovative immunotherapies into clinical practice guidelines,description of early access programs and innovative reimbursement modelsdescription of Horizon scanning systems, to anticipate emerging drugs and address specificities for anticancer drugs and biomarkersdefine the needs and describe optimal programs of real-life monitoring of patients treated with CAR-T cells

Conclusions

Many countries face similar challenges but a number among them developed innovative approaches to overcome these barriers. There is need for capacity building, training and harmonization on the application of genomics and immunotherapies in many countries.

Key message

Providing examples on how to approach implementation of these innovations into the healthcare system through a 'mutual learning' initiative could be a very useful initiative.
The impact of end-userś participation (cancer patients) during the optimization process
Authors: Houwaart S
Published: October 2020

End-user (e.g. patients or the public) testing of information material is becoming more common in the German public health care system. However, including the end-user (in this case patients) in an optimisation process and thus enabling a close collaboration while developing PIMs is still rare. This is surprising, given the fact that patients provide the exact perspective one is trying to address.

Within the isPO project, a patient organization is included as a legal project partner to act as the patient representative and provide the patient's perspective. As such, the patient organization was included in the PHR approach as part of the PIM-optimisation team. During the optimisation process, the patients gave practical insights into the procedures of diagnosing and treating different types of cancer as well as into the patient's changing priorities and challenges at different time points. This was crucial information for the envisioned application of the individual PIMs and their hierarchical overview. Moreover, the developed PIM-checklist enabled the patients to give detailed feedback to the PIMs. With their experience of being in the exact situation in which the PIMs will be applied, their recommendations, especially on the wording and layout of the materials, have been a valuable contribution to the PIM optimisation process.

In this part of the seminar, we will take a closer look at the following skill building aspects: What is gained from including patients as end-users in the development and optimization of PIM?How can we reach patients to contribute to a PIM optimization process? Which requirements and prerequisites do patients have to provide to successfully work on an optimisation team?How to compromise and weigh opinions when different ideas occur?

Altogether, this part will construct a structured path of productive patient involvement and help to overcome uncertainties regarding a collaboration with patient organizations.
Guiding the development of community-based services for vulnerable migrants and refugees in Europe
Authors: Karnaki P , Zota K , Riza E , Gil-Salmerón A , Garcés-Ferrer J , Linos A
Published: October 2020

The Mig-HealthCare roadmap & toolbox emphasize an approach that can be implemented at a local community level by local health professionals. The roadmap and toolbox were the main outcome of the project which combines evidence from original research and other information to present concrete steps in the provision of care to migrants and refugees at a community level. The vision of Mig-HealthCare for this roadmap & toolbox is to (1) Help the health professionals working primarily at the community health care level to familiarize themselves with the key areas of importance in refugee/migrant health (2) Provide health professionals with a valuable set of best practices and handy tools to facilitate their work and to increase their efficiency in delivering appropriate care to migrants/refugees (3) Create a network of professionals experienced in refugee/migrant health who through using this roadmap & toolbox will improve their related knowledge and experience. The roadmap & toolbox is a user-friendly online application which focuses on the key steps for optimal health care delivery to migrants & refugees. It comprises: (1) The necessary actions a health professional needs to engage in during delivery of care to migrants & refugees namely issues related to continuity of information and language, culture & communication issues (2) Health issues of particular importance for migrants & refugees that will pose challenges to health care services especially at the community level including Mental Health, Vaccinations, Maternal/ child health, Health promotion, Oral Health/ Dental Care, Non-Communicable Diseases (NCDs) & chronic conditions (3) an algorithm. Both the roadmap and the toolbox are connected to a toolbox comprising tools in various languages for health professionals or migrants/refugees.
Pilot action within the framework of the Mig-HealthCare project - implementation of community-based pilot studies addressing health inequalities of migrants and refugees
Authors: Zota K , Karnaki P , Gil-Salmerón A , Riza E , Garcés-Ferrer J , Linos A
Published: October 2020

In the framework of the Mig-HealthCare project, a roadmap to community-based health care was developed including a toolbox and an algorithm. The Mig-HealthCare partners piloted parts of the roadmap in 8 EU countries. Piloting included actions on health promotion issues for migrants/refugees, mental health issues, non-communicable diseases, screening for breast and cervical cancer and vaccination issues. Two recommended practices were also piloted among migrants/refugees namely the 'circle of health' and health mentors while the Greek partner tested the developed algorithm in various health settings. All pilots were evaluated using common and pilot specific indicators for (a) appropriateness: the extent to which the piloted interventions were suitable for the target groups (service providers and/or migrants/refugees) (b) effectiveness: the extent to which the pilots' objectives were achieved, or are expected to be achieved, taking into account their relative importance (c) satisfaction: the extent to which pilots meet or surpass target groups and stakeholders (refugee/migrants, service providers and local population) expectation and needs (d) sustainability: the continuation of benefits from the pilot. Sustainability in the pilot implementation context is the ability of key target groups to sustain pilot benefits. Moreover, the impact of the interventions and their results should be sustainable in time. The impact of the pilots on the study population as well as implications for community-level health services are discussed.
Community-based intervention to prevent the incidence of Non-Communicable Diseases in the migrant population: Pilot study in Valencia (Spain)
Authors: Gil-Salmerón A
Published: October 2020

Non-Communicable Diseases (NCDs) are prevalent in the migrant population with increased years of residency in the host country. In this regard, health education and lifestyle interventions have proven to be cost-effective modifying risk factors. The Spanish pilot of the Mig-HealthCare project directly aims to reduce the prevalence of NCDs reducing the well-known “healthy migrant effect” by increasing the levels of health literacy and also turning the lifestyles of the participants into healthier habits in the host country.

The Mig-HealthCare pilot in Spain is a one-month group-based Health Education and Lifestyle Intervention to prevent the incidence of non-communicable diseases in Migrant and refugee populations addressing their Acculturation Process (HELP-MAP). Consequently, the pilot intervention addressing 4 topics: health literacy, physical activity, dietary patterns and strategies for coping with stress.

The implementation of the pilot will be carried out in two different community services (i) one NGO providing care and accommodation for asylum seekers and (ii) three social care units within primary health care centres. Furthermore, following the Mig-Healthcare study protocol evaluation will focus on acculturation strategies, level of health literacy, physical exercise, change in diet, use of health care access and Quality-Adjusted life-years (QALY)
WHO European Health Literacy Action Plan
Authors: Sørensen K , Koylyu A , Mikkelsen B
Published: October 2020

Background

Grounded in the last decade's health literacy developments; the work of the European health literacy action networks on measurement and NCDs as well as the newly adopted European Health Literacy Roadmap and resolution agreed upon by their 53 Member States in 2019, the WHO European Region continues its investment in health literacy. A WHO European health literacy action plan is under development to be launched in 2021. The action plan implies concrete actions for Member States on how to develop health literate populations and societies.

Methods

Based on co-creation principles, the development of the action plan is conducted by stakeholders from a wide range of fields and disciplines. Lead by the WHO European Regional Office, the process includes an initial stakeholder meeting, iterative technical consultations with experts and the wider stakeholder community and Member State consultations. The analytical methods integrate a SWOT-analysis, future scenario thinking and long-sight action planning approaches as well as application of health literacy analytics.

Results

The results of the initial analytical steps will be presented such as the SWOT analysis, the future scenarios and associated recommendations on how to create health literate populations and societies in Europe. Additionally, the outline of the draft of the European health literacy action plan will be open for discussion and input.

Conclusions

Through an iterative process, the European health literacy action plan is co-produced by multiple actors through a series of consultations facilitating ownership and accountability. The European health literacy action plan can be an inspiration and a model for other world regions.
From value-based pricing to fair pricing: the role of HTA for UHC
Authors: Garner S
Published: October 2020

The UHC key concepts and relevant UN resolutions recommending transparency, including in relation to HTA and pricing. The role of innovation and intellectual property frameworks will be discussed, including financing and co-ordination of R&D for health technologies. Examples on the importance information exchange can play to improve negotiations will also be discussed, along with key considerations, commonalities and differences for for developed and developing countries.
Use of evidence-informed deliberative processes in HTA
Authors: Oortwijn W
Published: October 2020

The second speaker will provide an overview of different types and contexts of deliberative processes in relation to HTA, and exploration of ethical frameworks to ensure legitimate decision-making for the attainment of fair processes and UHC.
Patient participation and representativeness in HTA processes
Authors: Apostolidis K
Published: October 2020

The final speaker will discuss the participation of patients in deliberative processes and HTA, along with what patients, their carers, but also survivors, envision in terms what constitutes a fair process, equitable access and fair pricing, at a time when out-of-pocket catastrophic payments are on the rise across developed nations, whereas access to innovative treatments is seriously hindered by the forbidding price they carry.
Tuning a UV-C device to challenge new threats in the sanitization setting of healthcare facilities
Authors: Amodeo D , Pallecchi L , Nagaia C , Spataro G , Cardaci R , Messina G
Published: October 2020

Background

Environmental hospital hygiene plays a role in healthcare-associated infections emergency caused by resistant multi-drug organisms. The implementation of new and effective disinfection procedures is now more than ever important to prevent the cross-transmission of pathogens in the hospital facilities. In combination with common chemicals biocides, UV technology is a realistic option for environmental disinfection. In this study, we evaluate a UV device for its effectiveness on an emerging pathogen.

Methods

A laboratory cross section experiment was performed between August and October 2019. Two different strains of Candida auris (CBS 10913 and CBS 12372) were tested on 20 cm2 stainless steel carriers inoculated with 10 µl of bacterial culture at a concentration of 1x105 CFU/mL. The inoculum was spread until dry in aseptic condition. Carriers were placed parallel to the UV device, having 4 UV-C lamps that emit 325 W, at a fixed distance of 2.44 m. Biocidal tests were carried out in triple at three different light exposure times (5, 10 and 20 minutes). After treatment, laboratories procedures were used to detach and transfer the remaining microorganisms from the carriers to plates and compared them to controls after incubation at 37 °C for 48 h.

Results

A significant inactivation of C. auris already occurred at 5 minutes, reaching 3-4 log10 reduction at 20 minutes of UV-C exposure. No substantial differences were identified by analyzing the results between the two strains.

Conclusions

The chosen distance of 2.44 m from the target allows to ideally sanitize an entire hospital room. However, to avoid the limit of shaded areas due to the presence of non-movable objects, a couple of positions are recommended, so that shorter distances can reduce the exposure time or increase the average irradiance level of exposed surfaces.

Key messages

In sanitation of hospital environments, the use of viable alternatives as UV-C can contribute to the reduction of infections caused by multidrug-resistant microorganisms. Accurate testing of different space-time irradiation configurations allows to achieve important results related to the biocidal effects of UV devices.
A new dedicated clinic for HCWs’ counseling and vaccination: experience of an academic hospital
Authors: Malacarne F , Brunelli L , Miceli S , Gallo T , Petrin G , Rosa I , Gubian F , Cocconi R , Brusaferro S
Published: October 2020

Issue

Despite low healthcare workers (HCWs) vaccination coverage being a risk for hospital outbreaks, vaccine hesitancy is not unusual among HCWs. In Italy vaccinations are strongly recommended for HCWs, but there are few occasions for a dedicated counseling. Aim of the study is to evaluate the effectiveness of a new vaccination service in the academic hospital of Udine (northern Italy) in tackling vaccine hesitancy among HCWs.

Description of the problem

Available data on HCWs specific antibody titers revealed that in high-risk units, 25% of HCWs were certainly unprotected for at least 1/6 of the vaccine preventable diseases (VPDs): measles, rubella, mumps, varicella, pertussis, hepatitis B; only varicella coverage reached the herd immunity target. Periodic occupational health visit was the only moment to screen for VPDs protection and suggest vaccination, but the following inconvenient procedure of HCWs contacting the vaccination office outside the hospital, often lead to delays or loss. In order to improve vaccination adherence, since June 2019 a dedicated clinic has been set up inside the hospital, making vaccination counseling and administration available every two weeks, with appointments directly given by the occupational doctor.

Results

From June 2019 to February 2020, a total of 362 appointments were booked for the dedicated vaccination clinic, 69.7% of which actually took place as 252 HCWs actually accessed the service. Hours dedicated to the service activity were 76 hours, distributed over 19 days. Administered vaccination were 322, including 107 MMR (measles, rubella, mumps), 4 MMRV (MMR+varicella), 20 varicella, 64 hepatitis B, 127 DTPa (diphtheria, tetanus, pertussis).

Lessons

Making the access to vaccination more convenient in term of service location within the hospital and giving the appointment when performing the occupational health visit seems to be helpful in filling the VPDs protection among HCWs gap.

Key messages

Monitoring immunological status of HCWs and promoting vaccination at occupational health visit would sustain herd immunity protection for susceptible individuals in healthcare settings. The dedicated hospital vaccination clinic and the effective procedure of giving the appointment during the occupational health visit could be helpful in improving HCWs vaccine adherence.
Stakeholder analysis in a policy game process in Tunisia
Authors: Oltean O , Coman M A , Sandu P , Essafi Kallel K , Ben Rejeb M , Ghorbel F , Eklund Karlsson L , Chereches R M , Zrig A , Plančíková D
Published: October 2020

This paper discusses the policy game methodology and design that will be used in a simulation that aims to assess and understand the public health policy making in Tunisia. The policy game aims to analyzes the interactions, alliances and networks formed by the institutions and stakeholders during a policy game intervention that will be organized in Tunis, in which policy makers, civil servants, researchers and practitioners will simulate the use of evidence in real life policy making. The simulation has been realized within the Erasmus+ CONFIDE project focused on enhancing transnational partnerships and building capacity to inform evidence-based policies in Tunisia. This capacity building project and policy game is built on the collaboration of four Tunisian universities, from Tunis, Sfax, Sousse and Monastir, and three universities from the European Union, from Romania, Denmark and Slovakia. The policy game will focus on the drafting and implementation of a national strategy for fighting the increase of drug consumption among the Tunisian youth, a phenomenon which is rather new in Tunisia and spreading rapidly. The policy game will be followed by an analysis aiming to explore the impact of the intervention in enhancing cross-sector collaboration and the use of local stakeholder network regarding drug policy making. The preliminary results showed that the stakeholders approached this problem in a collaborative way and were willing to up-take evidence-based measures in the creation of a national strategy to fight drug consumption. This exercise has also shown that the policy game can be an effective tool in enhancing the use of scientific arguments in policy making and encourage stakeholders to approach policy making in a cross-sector way.

Key messages

Policy game can be an effective tool in enhancing the use of scientific arguments in policy making and encourage stakeholders to approach policy making in an interdisciplinary way. Stakeholders approached this problem in a collaborative way and were willing to up-take evidence-based measures in the creation of a national strategy to fight drug consumption.
The NCCMT’s dynamic model for evidence-informed public health
Authors: Clark E , Neil-Sztramko S , Dobbins M
Published: October 2020

Issue

It is well accepted that public health decision makers should use the best available research evidence in their decision-making process. However, research evidence alone is insufficient to inform public health decision making.

Description of the problem

As new challenges to public health emerge, there can be a paucity of high quality research evidence to inform decisions on new topics. Public health decision makers must combine various sources of evidence with their public health expertise to make evidence-informed decisions. The National Collaborating Centre for Methods and Tools (NCCMT) has developed a model which combines research evidence with other critical sources of evidence that can help guide decision makers in evidence-informed decision making.

Results

The NCCMT's model for evidence-informed public health combines findings from research evidence with local data and context, community and political preferences and actions and evidence on available resources. The model has been widely used across Canada and worldwide, and has been integrated into many public health organizations' decision-making processes. The model is also used for teaching an evidence-informed public health approach in Masters of Public Health programs around the globe. The model provides a structured approach to integrating evidence from several critical sources into public health decision making. Use of the model helps ensure that important research, contextual and preference information is sought and incorporated.

Lessons

Next steps for the model include development of a tool to facilitate synthesis of evidence across all four domains. Although Indigenous knowledges are relevant for public health decision making and should be considered as part of a complete assessment the current model does not capture Indigenous knowledges.

Key messages

Decision making in public health requires integrating the best available evidence, including research findings, local data and context, community and political preferences and available resources. The NCCMT’s model for evidence-informed public health provides a structured approach to integrating evidence from several critical sources into public health decision making.
A training program to qualify people with intellectual disabilities for inclusive research
Authors: Grebe C , Voß M , Heitland L , Nadolny S , Latteck ÄD
Published: October 2020

Background

Inclusive research aims to involve people with intellectual disabilities (ID) with their views and values in all steps of the research process. But there is a lack of published training programs that address the qualification of people with ID for their roles as co-researchers.

Objectives

The aim was to develop a training program, based on constructivist didactics, in order to empower people with ID to act as initiators of health-related research, interviewers, data analysts and authors. In addition, the program aims to promote social self-organization and health literacy. The program consists of four steps: 1) Recruiting, relationship and team building; 2) Analysis of communication skills; 3) Choice of topic and formulation of a research question relevant to the lifeworld of the co- researchers 4) Exercises, carried out with an open, flexible approach, taking into account the individual biographies, knowledge, skills and interests of the team. Professional researchers moderate this process and promote the activation of knowledge and experiences. The whole process comprised weekly team meetings over a period of 7 months.

Results

The co-researchers were successfully empowered to deal with new kinds of demands and tasks. As of March 2020, the co- researchers selected pain as their topic and successfully formulated research questions, developed a guideline for semi-structured interviews and acquired essential interviewing skills. Data collection and analysis are still pending.

Conclusions

The implemented inclusive research approach pursued here, offers opportunities for generating research findings that are more relevant for the target group and their lifeworld. Consequently, professionals can better address the needs of their clients and develop tailored interventions. For the involved co-researchers with ID the training program seems to be successful in empowering them in decision-making and in reflecting on their own and other's health-related needs.

Key messages

People with intellectual disabilities can successfully be qualified as co-researchers with a 7-months weekly training program. The training program helps the co-researchers in reflecting on their own and other’s health-related needs.
Social network characteristics are associated with depressive symptoms: The Maastricht Study
Authors: Gianfredi V , Schaper N C , Eussen S J P M , Odone A , Signorelli C , Dukers N , Koster A , Stehouwer C D A , Wasselius A , Schram M T
Published: October 2020

Background

Previous studies suggested that social network characteristics are associated with depression. However, most of the previous studies investigated social network characteristics in isolation. We assessed the association of both structural and functional social network characteristics with prevalent and incident depressive symptoms over 5 years of follow-up.

Methods

We used data from 2,465 participants (49.1% women, mean age 59.8± 8.1 years) of The Maastricht Study, a population-based prospective cohort study. Social network characteristics were assessed through a name generator questionnaire. Depressive symptoms (9-item Patient Health Questionnaire score ≥10) were assessed at baseline and annually over 5 years. We used multivariate logistic regression and Cox regression analyses adjusted for socio-demographic characteristics, lifestyle and cardiovascular risk factors.

Results

Less emotional (odds ratio (OR) (95% confidence interval (CI)):1.19; 1.01-1.40) and informational support (OR (95%CI): 1.20 (1.04-1.39), and every fewer 10% of family members (OR(95%CI) 1.11 (1.01-1.23) were associated with prevalent clinically relevant depressive symptoms. Less emotional support (hazard ratio: 1.13; 95%CI: 1.03-1.25) was associated with incident clinically relevant depressive symptoms.

Conclusions

This study observed associations between poor social network characteristics with higher odds of depressive symptoms. In particular, less emotional support was associated with both prevalent and incident depressive symptoms.

Key messages

Poor social network characteristics were associated prevalent depressive symptoms. Less social support was associated with a higher risk of depressive symptoms.
Developing the health examination protocol for asylum seekers in Finland: project results
Authors: Skogberg N , Garoff F , Ahmed Haji Omar A , Koponen P , Klemettilä K-L , Castaneda A E
Published: October 2020

Issue

Initial health assessment is crucial for identification of healthcare needs and screening of acute health problems among new asylum seekers. As in other countries, practices across reception centres in Finland varied and health data was inconsistently recorded, making systematic monitoring through the electronic health record system (EHR) challenging.

Description of the issue

The main objectives of the national Developing the health examination protocol for asylum seekers in Finland project (TERTTU, 2017-2019) were to unify practices across reception centres through development of health assessment content and the quality of EHR recordings. The project consisted of three phases: 1) baseline evaluation; 2) conduct of a population-based health examination survey among asylum seeking adults and children; 3) development work guided by findings of stages 1 and 2, supplemented with thematic qualitative interviews with end-users (reception centre nurses, asylum seekers and authorities supervising services).

Results

The project exceeded expectations. Altogether 1087 adults and children participated in the survey (participation rate 76 %). Survey findings were published in a national report, providing the main evidence-base for development work. This was complemented by thematic interviews with 15 reception centre nurses, 19 asylum seekers and 3 authority representatives. Health assessment protocol was piloted and further developed based on feedback from end-users and transferred into the reception centres EHR. A handbook for the health assessment was published, supported with educational short videos.

Lessons

Successful implementation required close collaboration with authorities responsible for providing services for asylum seekers and involvement of end users at all stages. Results of this project benefit all other countries receiving asylum seekers. The study protocol is available in English, Somali, Kurdish (Sorani), Dari, Arabic, Russian, French and Finnish.

Key messages

The initial health assessment protocol for asylum seekers and supporting materials developed in the TERTTU project benefits all receiving countries. Systematic recording of health data was also developed, which will be used for planning health system response according to the health care needs of new asylum seekers.
Strengthening Child-centred Health Systems response: what happens with migrant children?
Authors: Gil-Salmerón A , Garcés-Ferrer J
Published: October 2020

Migrant children are especially vulnerable to the challenges experienced during the migratory process and its integration in the host country, even more, if they are unaccompanied. Child-centred Health Systems responses are needed, for that reason, the Erasmsus+ project EUVETCARE aims to strengthen the capacity of the professionals and systems to meet the specific needs of this population.

A qualitative study allowed a needs assessment of the health and social care professionals in 5 EU countries (Cyprus, Germany, Greece, Italy and Spain). A total of 15 focus groups were carried out (99 participants). Focus groups discussions were transcribed verbatim in local languages and transcripts were analyzed using thematic analysis. Moreover, a literature review informed about the current learning opportunities for professionals in the European context regarding migrant children.

Focus groups discussions highlighted some general needs for all professionals such as communicative skills with migrant children and their families as well as cultural competence to deal with these cases. Moreover, participants stressed the need to deal with this population with low levels of health literacy too. Finally, strategies to provide integrated care and meet the major needs of these children were needed. Unaccompanied minors were highlighted as a vulnerable group by participants. In addition, the literature review revealed some gaps in the learning guidelines offer across Europe.

Future training for professionals should stress the specific gaps in order to don't replicate existing materials. Furthermore, professionals' voices should be taken into account in the design of these new training to directly answer to their professional needs. Additionally, the needs of migrant children have to be differentiated and appropriated culturally-competent care delivered in order to minimize health inequalities for this group.

Key messages

Training of healthcare professionals should target culturally-competent case management strategies for minor migrants. The delivery of health care for minor migrants requires major intensity from the health care services.
Contextual housing environment and mental health of asylum seekers – a multi-level analysis
Authors: Mohsenpour A , Biddle L , Bozorgmehr K
Published: October 2020

Background

Housing is an important determinant of health among asylum seekers and refugees (ASR). Little is known about the effects of contextual housing environment. We used state-wide reliable and valid data to examine these effects on ASR mental health.

Methods

We drew a balanced random sample of 58 shared refugee accommodation centers (SRA) from 1938 centres with 70,634 ASR in Germany's 3rd largest federal state. We measured depression (PHQ2) and anxiety (GAD2) using established instruments in nine languages. We assessed physical housing environment with a validated multi-dimensional Small-area Housing Environment Deterioration index (SHED). Linking survey- and SHED-data to GIS- and secondary data sources on accommodation size and remoteness, district urbanity and deprivation, we used multi-level logistic regression to calculate exposure effects and 95 % confidence intervals (CI), while adjusting for age, sex, relocations and chronic illness.

Results

Of 412 ASR living in 58 SRA, 45.0% of inhabitants and 35.7% of SRA were rated as having a high/very high degree of deterioration. The odds for reporting symptoms of generalized anxiety increased for the highest degree of deterioration (1.30; 0.37-4.55), large accommodation size (1.01; 1.00-1.03), remoteness (1.63; 0.61 - 4.36), district urbanity (1.67; 0.66-4.20) and deprivation (1.33; 0.60-2.92). The odds of depression symptoms increased in SRA with highest deterioration (1.98; 0.74-5.33) and accommodation remoteness (1.10; 0.48-2.52), decreased in SRA with district urbanity (0.63; 0.31-1.28) and district deprivation (0.66; 0.36-1.23) but not large accommodation size (1.00; 0.99-1.02).

Conclusions

Almost half of ASR are living in SRA with high/very high degree of deterioration. There is a general tendency of higher odds for mental illness symptoms conditional on housing environment. Future analyses with sample size calculations are needed to better understand these health associations for shared refugee accommodation.

Key messages

We described contextual housing environment, i.e. degree of deterioration, accommodation size, remoteness, urbanity and deprivation, of a balanced random sample of 58 shared refugee accommodations. In multi-level logistic regression, contextual housing environment tends to be associated with higher odds for reporting symptoms of mental illness.
Enhancing partnerships and collaboration in times of change
Authors: Clark E , Neil-Sztramko S , Dobbins M
Published: October 2020

Issue

In 2019, the government of the Canadian province of Ontario announced major changes to the structure, governance and funding of public health services. Throughout these changes, publicly funded local and regional public health organizations are still expected to provide effective, evidence-informed programming to their communities. The National Collaborating Centre for Methods and Tools (NCCMT) has facilitated collaborations to support Ontario public health through this transition.

Description of the problem

In order to support evidence-informed public health in Ontario during this transition, the NCCMT reached out to current and potential partners, within and beyond the public health sector for a multidisciplinary approach. We conducted a needs assessment for an evidence review repository, which would allow public health practitioners to share and build upon each other's work. Finally, demonstrating the value of public health to policymakers can be inherently challenging as the return on investment in public health is often very long term. We partnered with health units in varying capacities to find and synthesize evidence to advocate for continued investment in public health.

Results

This initiative has provided important lessons in developing and maintaining strong partnerships. Looking beyond the public health sector can establish mutually beneficial partners and allies in other disciplines. A key finding was the need to establish infrastructure to support collaboration and resource sharing. Finally, we learned that big picture questions like demonstrating the value of public health require many different perspectives, inputs and areas of expertise.

Lessons

Through this initiative, we have developed a multidisciplinary, collaborative approach to supporting evidence-informed public health through times of major restructuring. This approach can be applied to future changes to public health on smaller or larger scales, or within other geographic regions.

Key messages

Multidisciplinary approaches can support collaboration, unity and advocacy in times of change. Establishing infrastructure to support collaboration and sharing of resources is valuable.