bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey of risk factors in coronary heart disease: novel recruitment strategy and preliminary results
Authors: Marza Florensa A , Vaartjes I , Klipstein-Grobusch K , Zhao M , Cooney MT , Graham I , Grobbee D
Published: October 2021

Introduction

SURF CHD (Survey of Risk Factors in Coronary Heart Disease) is a clinical audit on secondary prevention among CHD patients aiming to simplify recording and assessment of risk factors and medication. The second wave of the study (SURF CHD II) uses a novel recruitment strategy that provides a wider and more representative picture of CHD secondary prevention.

Methods

The survey is conducted during outpatient visits and collects data on demographics, risk factor history and measurements, and medications. The novel recruitment strategy is based on the network of European Association of Preventive Cardiology (EAPC). National Cardiovascular disease Prevention Coordinators (NCPC) appointed by the EAPC were invited; national cardiac societies (NCS) were invited in countries without NCPCs; and interested clinicians may also participate. SURF researchers discussed tailor-made approaches to implement the audit with national representatives.

Results

48 NCPCs, 11 NCS and 9 individual contacts were invited. 95 centres in 31 countries are participating and have enrolled 6966 participants in 5 regions: 109 in Eastern Mediterranean, 5170 in Europe, 108 in Americas, 1563 in South East Asia and 16 in Western Pacific. 24.4% of participants were female and mean age was 63.8±18 years. 75.3% of the study population had BMI≥25kg/m2 and 20.0% were smokers. Blood pressure <140/90mmHg was recorded in 61.8% of participants, 26.4% had LDL <1.8 mmol/l and 40,1% had HbA1c<7%. South East Asia recorded the lowest prevalence of BMI≥25kg/m2 and LDL levels. Lowest use of statins was recorded in Europe and of angiotensin-converting enzyme inhibitors in Americas.

Conclusions

The novel recruitment strategy proved to be practicable. Preliminary results indicate regional variations in risk factors and secondary prevention. SURF will continue to collaborate with NCPCs and NCS to achieve a broader insight on CHD secondary prevention with a simplified tool.

Key messages

Cardiovascular risk factor prevalence in coronary patients is high and presents regional variations. SURF is a simplified clinical auditing tool useful to assess risk factor recording and management. Centre enrolment for the study based on the network of a renowned association of cardiology is practicable and helps to provide a wide picture of secondary prevention of coronary heart disease.
Substance use behaviours and the UK furlough scheme: evidence from eight longitudinal population surveys
Authors: Green M , Di Gessa G , Maddock J , Parsons S , Wielgoszewska B , Stevenson AJ , Griffith GJ , Booth C , Croft J , Ploubidis GB
Published: October 2021

Disruptions to economic activity such as job loss can impact substance use behaviours. During the COVID-19 pandemic many countries implemented a furlough scheme to prevent job loss. We examine how furlough was associated with respondents' substance use behaviours in the initial stages of the pandemic in the UK. Data were from over 27,000 participants in eight adult longitudinal surveys. Participants self-reported economic activity (furlough or job loss vs stable employment) and smoking (any current), vaping (any current) and drinking alcohol (>4 days/week or 5+ drinks per typical occasion) both before and during the initial stages of the pandemic. Changes in frequency/quantity of substance use were also examined. Risk ratios were estimated within each study using modified Poisson regression, adjusting for a range of potential confounders, including pre-pandemic behaviour (though this was excluded in analyses of behaviour change). Findings were synthesised using a random effects meta-analysis. Compared to stable employment, participation in the furlough scheme was associated with smoking (risk ratio: 1.24 [95% CI: 1.08-1.42]; I2=0%) while job loss was associated with vaping (1.72 [1.10-2.71]; I2=25%) and heavier drinking (1.21 [1.02-1.43]; I2=2%), but these associations were largely accounted for by confounders (adjusted risk ratios: smoking: 1.06 [0.96-1.16]; I2=8%; vaping: 1.55 [0.93-2.56]; I2=42%; and drinking: 1.03 [0.89-1.20]; I2=35%). Furlough was associated with drinking more than before the pandemic (adjusted risk ratio: 1.15 [1.00-1.33]; I2=70%), and with increases in vaping behaviour (1.54 [1.14-2.07]; I2=0%). Increased drinking associated with furlough is concerning, while increased vaping likely represents moves to reduce smoking and may be positive.
Generic health literacy of adolescents in Germany: Results of a nationwide cross-sectional survey
Authors: Jordan S , Domanska OM , Loer AK
Published: October 2021

Background

For developing effective interventions to promote health literacy in adolescence, differentiated data on the distribution of health literacy levels is required, but still lacking for this age group in many countries. The study aims to measure the distribution of generic health literacy (GHL) among adolescents addressing cognitive, behavioural, communicative and motivational dimensions of GHL.

Methods

We conducted a representative nationwide cross-sectional online survey among 14-17-year-olds living in Germany (n = 1,235). Data on GHL were collected from 09.2019-12.2019 using the “Measurement of Health Literacy Among Adolescents”-Questionnaire (MOHLAA-Q). It was specially developed for this age-group and consists of a total of 29 items in four subscales: A: “Difficulties in Dealing with Health-Related Information”, B: “Health-Related Communication Skills”, C: “Attitudes toward One's Own Health & Health Information” and D: “Health-Related Knowledge”. We also collected data on socio-demographic factors. Bivariate and multiple logistic regression analyses were carried out.

Results

About half of the 14-17-year-olds reported many (8.4%) or some difficulties (42.2%) in dealing with health information. We observed low communication-related skills in 28.1% of adolescents. Regarding the attitude towards their own health and health information, 56.8% of respondents had a rather “partly passive/partly active” attitude and 8.8% had a “passive” attitude. 22.7% of the adolescents had a low level of health-related knowledge. All socio-demographic factors apart from age showed significant differences in each of the scales: by family affluence in all scales, by gender and by educational level in 3 scales and by migration background in 1 scale.

Conclusions

The results indicate a need for promoting GHL among adolescents. The differences in the four scales suggest that all dimensions of GHL should be addressed, but also considering socio-demographic factors at the same time.
Cost-effective and promising interventions relative to mental health of the health workforce and their delivery conditions
Authors: Petelos Elena
Published: October 2021

EXPH members and Opinion collaborators

Effective interventions to protect mental health of the health workforceare likely to be complex and multi-faceted, addressing modifiable risk factors to be implemented across multiple levels. In the context of the Opinion development, evidence from multiple sources, encompassing best practices, guidelines, toolkits, among others, was reviewed. This allowed for the identification of coordinated integrated approaches. Due to potential stigma and discrimination, efforts in the workplace to support mental health should be accompanied by due consideration of legal and ethical responsibilities. The excess burden of mental health issues in the health workforce is well-described, however assessing cost-effectiveness of interventions to address them remains complex given the challenges in quantifying the impacts to assess (economic, societal, ethical, etc.). Organisational delivery conditions are conceptualized in this Opinion using an implementation science framework, which posits that the success of implementation depends on how its delivery is organised and is context dependent. Contextual factors such workplace culture and leadership can largely influence implementation outcomes, whereas resource constraints and barriers, as well as facilitators are also examined. Specifically, we identified several core conditions for the delivery of mental health services. With respect to the intervention, meeting and adapting to evolving user needs is important, as well as assessing the role of stigma, whilst ensuring those with a history of mental health and/or pre-disposing factors are not targeted. Many delivery conditions focused on the workplace and included ensuring safe space and processes (e.g., for help-seeking) and fostering an environment of trust; training in mental health assessment and key delivery conditions for occupational health practitioners and managers while emphasising that there should be no adverse consequences for help-seeking behaviour; and driving transformation in organisational culture towards one of acceptance of the continuum of mental health issues. To support workplace interventions, a clear and comprehensive regulatory and financial structure and mechanisms of support are required. Attention to public and private sector organisations, including multinational corporations (MCNs) and small- and medium-sized enterprises (SMEs) is needed. These enabling structures should encompass sustainable support for long-term prevention and treatment programs, and research and development of innovative approaches, such as de-stigmatization, care re-organization, regulatory frameworks, and data collection and harmonization.
Available prevention and management interventions for fetal alcohol spectrum disorder (2007 to 2017)
Authors: Adebiyi B , Mukumbang F
Published: October 2021

Background

The global prevalence of Fetal Alcohol Spectrum Disorder (FASD) remains high despite the various preventive and management interventions that have been designed and implemented to tackle the issue in various settings. The scoping review aims to identify and classify prevention and management interventions of FASD reported globally across the life span and to map the concentration of these interventions across the globe.

Methods

We conducted a scoping review searching databases such as Ebsco Host (Academic Search Complete, ERIC, SoINDEX, Health Source: Nursing/Academic Edition, CINAHL, Medline and Psych-ARTICLES), SAGE Journals, Sabinet and PubMed. Two reviewers independently screened studies for eligibility and used the Effective Public Health Project assessment tool to assess the methodological rigour of the included studies. A framework approach to data analysis was done and a narrative approach was used to synthesise and report on the findings.

Results

Thirty-two prevention intervention studies and 41 management intervention studies were identified. All the interventions were reported to be effective or showed promising outcomes for the prevention and management of FASD, except four. Although Europe and Africa have a relatively higher prevalence of FASD, the lowest number of interventions to address FASD were identified in these regions. Most of the interventions for FASD were reported in North America with comparatively lower FASD prevalence.

Conclusions

The uneven distribution of interventions designed for FASD vis-à-vis the burden of FASD in the different regions calls for a concerted effort for knowledge and intervention sharing to enhance the design of contextually sensitive preventive and management policy in the different regions.

Key messages

There are effective interventions for the prevention and management of FASD, however, the interventions were not distributed according to the burden of FASD in different regions. There is a great need to share and implement context/culturally appropriate interventions for the prevention and management of FASD among regions.
3.A. Workshop: Integrating the use of genomic data in personalised healthcare: implications across the board
Authors:   Organised by: EUPHA-PHG, EUPHA-ETH, EUPHA-EPI, EUPHA-CHR,   Chair persons: Roberta Pastorino (EUPHA-PHG), Roza Adany (Hungary)
Published: October 2021

Genomics has the potential to benefit overall health by ensuring that citizens and patients receive timely and effective diagnosis, information, and treatment. Much progress has been made in genetic risk assessment for a wide variety of conditions, with implications for implementation of personalized medicine (PM). PM strategies include the use of decision-making processes based on biomarker-driven approaches that may have the desired discriminatory accuracy to distinguish between high-risk and low-risk subjects and may guide prevention strategies, prophylactic and therapeutic decisions. Many countries in Europe have nascent PM programmes, and human genomics is undergoing a step change from being a predominantly research-driven activity to one driven through healthcare. However, for any healthcare system, the integration of genomic data for PM requires extensive adjustments. These adjustments include, the development of technical infrastructure, competences and ethical legal social implications frameworks, for acquiring, storing, sharing, interpreting and delivering genomic information. This workshop will discuss how the access to genomic and linked phenotypic data at population-scale has tremendous potential to effectively advance PM in healthcare systems, but to fully realise this ambition, it is crucial that a genome and health data-sharing framework is developed and can effectively reach healthcare systems in European Member States and beyond.

Key messages

The adoption of genomics by European healthcare systems is crucial to fulfill the potential of Personalised Medicine for patients and citizens. Effective data sharing agreements are needed, because without them the personalised healthcare approach will not work.
Research use cases measuring the impact of COVID-19 on population health
Authors: Thißen M , Bernal-Delgado E , Rodriguez-Blazquez C , Estupiñán-Romero F , Forjaz J , Gonzalez-García J , Lyons R , Schmidt A , Seeling S , Zeitlin J
Published: October 2021

Background

Wide variations in COVID-19 infection and outcomes exist across Europe and within countries. PHIRI will look at COVID-19 impacts in specific subgroups by conducting research through use cases of immediate relevance for public health policies focusing on indirect effects of the pandemic related to healthcare and other policies to contain the pandemic. Furthermore, the use cases represent pilot activities for the benefits and added value of a research infrastructure by bringing together data from different European countries.

Methods

Four research use cases will focus on selected aspects of vulnerable population groups and risk factors, delayed medical care in cancer, perinatal health outcomes, as well as mental health outcomes and are selected based on public health importance, geographic coverage, feasibility of producing actionable insights and relevance for the PHIRI infrastructure. The use cases will demonstrate how a broad variety of secondary data (e.g. administrative and survey data) can be pooled and/or reused in a distributed way across Europe.

Results

The outputs of the use cases will be processed by formalizing data models, data management processes and analytical pipelines in an interoperable way to feed in the federated research infrastructure. The use cases facilitate research by making scalable, reproducible methods available within PHIRI and by publishing the FAIRified use cases analysis results on the Health Information Portal. They will provide outcomes to guide policy makers in preparedness and response scenarios and will ensure the development of a format for the timely dissemination of use case results to the targeted groups.

Conclusions

PHIRI will provide insights in real life use cases to generate immediate results on key health impacts of COVID-19 on population health to underpin decision making and will drive the development of the federated research infrastructure that allows rapid cycle analysis.
The COVID-19 International Student Well-being Study
Authors: Van De Velde S , Buffel V , Bracke P , Van Hal G , Wouters E
Published: October 2021

Background

We will present the COVID-19 International Student Well-being Study (C19 ISWS). The C19 ISWS is a cross-sectional multi-country study that collected data on higher education students during the first wave of the COVID-19 outbreak (spring 2020).

Methods

The dataset allows to describe (1) the living conditions, financial conditions and academic workload before and during the COVID-19 outbreak, (2) the current level of mental well-being and changes in healthy lifestyles, (3) perceived stressors, (4) resources (e.g., social support and economic capital), (5) COVID-19 related knowledge, and (6) attitudes towards COVID-19 measures implemented by the government and higher education institution (HEI). The dataset additionally includes information about COVID-19 measures taken by the government and HEI that were in place during the period of data collection.

Results

As a large international consortium of 26 countries and 110 higher education institutions (HEIs), we successfully developed and executed an online student survey during or directly after the initial peak of the Covid-19 pandemic.

Conclusions

The collected data provide a comprehensive and comparative dataset on student well-being. In this article, we present the rationale for this study, the development and content of the survey, the methodology of data collection and sampling, and the limitations of the study. In addition, we highlight the opportunities that the dataset provides for advancing social science research on student well-being during the COVID-19 pandemic in varying policy contexts. Thus far, this is the first cross-country student well-being survey during the COVID-19 pandemic, resulting in a unique dataset that enables high priority and socially relevant research.
Using GIS maps for measuring equitable community health and nutrition programs
Authors: Kim H , Ackerson J
Published: October 2021

Background

The University of Minnesota (UMN) Extension Supplemental Nutrition Assistance Program Education (SNAP-Ed) documents the geographic data of statewide community health and nutrition policy, systems, and environmental change (PSE) programs for low-income communities. SNAP-Ed collaborates with communities to organize food security efforts, offer direct nutrition education, and consult with organizations about promoting healthy foods and physical activities. UMN Extension's SNAP-Ed implemented 972 PSE programs with 1,077 community partners and reached 624,129 people between 2017 and 2020.

Methods

SNAP-Ed's support of population-level health and nutrition initiatives is intended to increase access to healthy foods for SNAP-Ed eligible individuals. Geospatial analysis can identify if program efforts reach target populations. Low-income and low-food access census tracts were identified by using the U.S Treasury and USDA, respectively. In this study, buffer boundaries were set around SNAP-Ed designated PSE programs, paralleling USDA's access boundaries of 10 miles for rural areas and one mile for urban areas. Low-program access tracts were identified by their weighted population centroid or geographic boundary's intersection with the food security program buffers.

Results

Results show that 78.5% of low-food access and low-income areas have moderate to high-program access. Furthermore, moderate to high-program access communities tend to have higher percentages of BIPOC population and higher poverty rates when compared to low-program access communities among low-income and low-food access communities.

Conclusions

UMN Extension will continue to use GIS analysis for understanding where to promote, support, and organize around the implementation of food security programs and therefore better reach eligible audiences.

Key messages

Using geospatial analysis allows us to measure community health and nutrition PSE program access and program access equity. Minnesota's low-income and low-food access population has higher community health and nutrition programs access.
Implementation of The Daily Mile™: survey of primary schools in Greater London
Authors: Ram B , Chalkley A , van Sluijs E , Hargreaves D , Viner R , Saxena S
Published: October 2021

Background

The Daily Mile™ is a free school-based active mile intervention. Its main features include that children run or jog for 15 minutes at least 3 times a week (3x/wk) during school hours. The Daily Mile Foundation recommends 10 principles for successful implementation. These are it is (1) quick (15 minutes), (2) fun, (3) whole school participates, (4) it takes place in all weathers, (5) 3x/wk in addition to curricular lessons (not during PE, breaks, before/after school), (6) ideally in the school playground, (7) safe, (8) simple (no equipment), (9) children go at their own pace and (10) no change of clothes or shoes is needed. The aim of this study was to identify how many Greater London primary schools adopting The Daily Mile implement its 10 principles.

Methods

In September 2020, we sent all state-funded primary schools (n = 1721) in every Greater London borough (n = 32) a survey to find out if and how they implemented The Daily Mile.

Results

By June 2021, 368 (21%) schools responded to our survey (at least one from every London borough). Of these, 195 (53%) schools adopted The Daily Mile of which only 7 (4%) reported implementing all 10 principles; a median 7 (IQR: 6,8) principles were reported implemented. Whole school participation was reported by 93 (48%) Daily Mile schools, 104 (53%) reported implementing The Daily Mile for 15 minutes, 127 (65%) implemented it at least 3x/wk, and 149 (76%) schools reported that the children ran or jogged during The Daily Mile. A large proportion of schools reported implementing The Daily Mile in the school playground and that it was done simply (both n = 171, 88%), but only 85 (44%) schools reported implementing it during lessons.

Conclusions

Daily Mile schools in Greater London implement 7/10 principles on average. Whether implementing all the principles limits the success of its desired effect is unclear. Studies assessing effects of The Daily Mile should consider its implementation when reporting results.

Key messages

Of The Daily Mile’s 10 principles, an average of 7 are implemented in London schools. Studies examining The Daily Mile should consider implementation which may impact its desired effect.
Food and nutrition literacy: an education booklet and video on ultra-processed food
Authors: Pereira de Araújo T , Moraes M de , Afonso C , Rodrigues S
Published: October 2021

Background

The COVID-19 pandemic appears to have contributed to change in eating habits for a significant part of the Portuguese population. The increase in the snacks consumption during the confinement period was reported by almost a third of the population. Often the snacks chosen are ultra-processed foods: industrial formulations that include excess of sugar, oils, fats, salt, and additives, antioxidant, stabilizers and preservatives substances in their ingredients. Excessive ultra-processed food consumption has been associated with worse health indicators.

Objectives

To develop informative educational material about ultra-processed foods and their health risks to be available to the general Portuguese population, and thus to promote food and nutrition literacy.

Results

The development of this new tool started in September 2020 and in April 2021 the booklet was approved by the UPPER Project team to be made available through digital media (cell phone, computer, laptop and tablet) or print. The booklet contains 33 pages with illustrative images and simple and didactic language. It is focused in seven main topics: “What are ultra-processed foods?”, “Which are they?”, “How to recognize them when purchasing?”, “What are worth for?”, “What is the relationship with health?”, and “What foods to choose?”. A short video with 2 minutes duration, summarizing and explaining the booklet, was also produced. The booklet impact will be piloted in a school intervention project that has been designed and submitted for ethical approval.

Conclusions

The developed booklet and explanatory video are didactic materials in simple language to achieve all general Portuguese population.

Key messages

The booklet is an instrument intending to improve literacy in ultra-processed foods. The booklet is a tool that can be used in health promotion programs and public policies in food and nutrition.
Transferring and piloting the Belgian best practice of community-based mental health networks in participating countries to the JA ImpleMENTAL
Authors: Bélorgey N , Di Fiandra T , Lora A
Published: October 2021

Community-based mental health services are key to improving mental health systems and health outcomes. Across Europe, mental health systems still stand at different levels of a change process that involves elaborating, testing and refining diverse models of interorganisational collaboration for mental health service delivery in local settings. Central to these endeavours are the principles that community-based mental health service delivery is patient-centred, integrates medical, psychological and social interventions, including prevention, health promotion and rehabilitation, and contributes to improving continuity of care. The transfer and piloting of the Belgian practice of community-based service networks is the focus of a specific work package which involves 14 countries working together under the leadership of the German Federal Centre for Health Education and the Italian Lombardy Region. The presentation gives an overview of main features and lessons learned from the Belgian practice and presents the work package activities conducted within a four-step approach entailing a preparatory, analysis, piloting and evaluation phase. The whole process is supported by a training action and the use of indicators for assessing networks and services. The six-months preparatory phase involves mobilising relevant stakeholders at various levels and elaborating a conceptual framework for transfer and piloting of selected elements of the Belgian practice in a wide variety of countries and regions in terms of socio-economic, cultural and political context and stages of transition towards deinstitutionalisation of mental health service delivery. This will help identifying challenges and facilitators of network development and collaboration across sectors and framing a tailored approach that allows for flexibility in addressing the heterogeneity of pre-existing practices, implementation scale and field preparation. Early findings of this phase will be shared with the audience.
The impact of the COVID-19 epidemic and anti-epidemic measures in the Roma neighborhood in Bulgaria
Authors: Kamburova M , Georgieva S
Published: October 2021

Introduction

COVID-19 is becoming an indicator of inequality in societies. Due to the difficult socio-economic situation, Roma in Bulgaria face a higher risk of suffering and death due to COVID-19 than general population. The aim of the report is to analyze the impact of the epidemic of COVID-19 and the anti-epidemic measures applied among the Roma community in Sliven district, Bulgaria.

Material and methods

An exploratory qualitative study design was adopted, combining focus group discussion and qualitative interviews. One focus group with 8 representatives of the Roma ethnic group, and 7 in-depth interviews with specialists working with the Roma community were conducted in November 2020. Data were subjected to thematic analysis. 6 priority topics have been formulated and a hierarchical framework of codes has been built through free software. The experts, assessment of 13 university professors of public health was applied. The COREQ - checklist for reporting quality research was used.

Results

A segregated Roma community of about 20 000 people lives in the Nadezhda neighborhood in the town of Sliven. The impressions of the author from the in-depth conducted interviews with the specialists were compared with the summarized view of the experts, reflecting the information received from the Roma population in focus group. Matching the codes of the author and the experts in relation to 5 of the topics such as: work - work; fear - insecurity; healthcare - doctor; ‘closing the neighborhood' - police; despair, pessimistic views, deterioration of the epidemic situation - disease, misery, famine was found. No coincidences were found regarding future measures to reduce the negative effects of the COVID-19 crisis.

Conclusions

The measures taken against the spread of the pandemic further worsen the medical and social situation of the Roma ethnic group in Bulgaria. Our findings pointed to the importance of a multi-sectoral strategy to improve Roma health during and after a COVID-19.

Key messages

Due to the socio-economic situation, Roma in Bulgaria face a higher risk of suffering and death due to COVID-19 than general population and multi-sectoral strategy to improve Roma health is needed. According Roma ethnic group in Bulgaria the measures taken against the spread of the COVID-19 pandemic further worsen their medical and social situation and lead to disease, misery and famine.
Quantifying the burden of disease in Scotland in 2018: a Scottish Burden of Disease study
Authors: Fletcher E , Wyper GMA , Grant I , de Haro Moro MT , McCartney G , Stockton DL
Published: October 2021

Background

The Scottish Burden of Disease (SBoD) Study monitors the contribution of over 100 diseases and injuries to the population health in Scotland. Providing robust estimates of the burden is important as recent evidence has highlighted stalling life expectancy and worsening trends in self-assessed general health and understanding the burden of disease is the first step in identifying areas of prevention which could have the biggest impact on health. Our aim was to estimate disability-adjusted life years (DALYs) for 2018, for all causes of disease and injury.

Methods

The SBoD 2016 study estimated the burden for 132 causes of injury and disease using routine data and patient-level record linkage. For this update, years lived with disability were estimated using 2016 age-sex-deprivation specific rates, assuming no change in disease prevalence from 2016, but taking account of changes to the population structure. Years of life lost were calculated from 2018 observed deaths and the application of the Global Burden of Disease aspirational life table.

Results

In 2018 the leading causes of burden were ischaemic heart disease, Alzheimer's/other dementias, lung cancer, drug-use disorders and cerebrovascular disease, representing over a quarter (27%) of the total DALYs in Scotland. Of the 10 leading causes of disease burden, four are wholly attributable to ill-health, demonstrating the added-value of considering DALYs in conjunction with traditional measures of mortality and morbidity.

Conclusions

Ischaemic heart disease continues to be the leading cause of burden of disease in Scotland, however recent years show an increase in burden of social causes and diseases primarily affecting the ageing population. These changes in leading causes demonstrate the importance of continuing to monitor the burden of disease in Scotland, to provide robust evidence for planning of local and national services.

Key messages

The study demonstrates the added-value of considering the burden of disease, in conjunction with traditional measures of morbidity and mortality. Ischaemic heart disease continues to be the leading cause of burden of disease in Scotland.
Mobilizing human resources
Authors: Williams G , Karanikolos M
Published: October 2021

The COVID-19 pandemic has confronted health systems with extraordinary changes in demand for health services, which magnified underlying disparities in the health workforce. Initial health workforce capacities were critical, as health systems only have two options to increase workforce level: increasing capacity among the existing workforce or mobilising/recruiting additional personnel. Workforce capacity became a limiting factor in an effective pandemic response, particularly in countries with acute workforce shortages. Countries in Europe have pursued various strategies to rapidly surge the numbers of health workers and using their existing human resources differently, including by introducing or expanding on alternative and flexible approaches such as task shifting and other skill-mix changes. The pressure to provide services across the continuum of care, from prevention and vaccination to specialist and inpatient care, led several countries to re-evaluate the distribution of tasks among the health workforce. In the best cases, multidisciplinary team-based staffing models combined the skills of multiple health professionals, enabling provision of the right care at the right time. This presentation will provide an overview of strategies to increase capacity for surges in human resources requirements, as well as supporting measures that help recognise the key role of health workers in the pandemic response. A brief overview of key metrics to assess resilience in the area of human resources will also be provided.
Delivering public health interventions
Authors: Karanikolos M
Published: October 2021

Public health has faced unprecedented pressures from the dual demands of responding to the COVID-19 pandemic while maintaining delivery of essential public health services such as screening and vaccinations. At the beginning of the pandemic, public health efforts turned towards implementing appropriate preventative health measures to control or mitigate transmission, while the rollout of COVID-19 vaccines has started since late 2020. Preventative public health measures to control or mitigate transmission include observing hygiene guidelines; using personal protective equipment (such as masks); limiting contact through physical distancing measures, curfews, bans on non-essential persons' movement and closing schools, businesses, as well as regional and national borders. All these measures have been supported, with Find, Test, Trace, Isolate, and Support (FTTIS) services, but many countries have struggled to implement these successfully, even months into the pandemic. While organisations such as the ECDC have issued guidance on implementing such interventions depending on the epidemiological situation, national strategies have ultimately depended on the countries' priorities, political realities and weighing the benefits against the potential adverse effects (such as mental health, economic and social impacts) and there has been little coordination among the countries. International coordination in the area of vaccines has also not always worked effectively. This presentation will provide an overview of strategies on implementing effective public health measures, including FTTIS systems and COVID-19 vaccinations. A brief overview of key metrics to assess resilience in the area of public health delivery will also be provided.
The role of the teacher in identifying (non-Western) children in need for psychosocial care
Authors: Eijgermans DGM , Raat H , Jansen PW , Blok E , Hillegers MHJ , Jansen W
Published: October 2021

Background

The prevalence of mental health problems in Europe is higher among children with a non-Western than a Western background. Nevertheless, non-Western children use less psychosocial care. A possible explanation is the differences in parents' perceived need for care. Non-Western parents generally have a lower perceived need, which calls for other significant adults in the children's life to identify this need. This study investigates whether teachers could fulfil a role in identifying mental problems, especially in non-Western children, to improve the access to care.

Methods

The study sample of 9-year-old children was retrieved from the Generation R Study (N = 3,084), a population-based cohort of children born in Rotterdam, the Netherlands. Teacher- and mother-reported problems were measured at 6 years via questionnaires. Psychosocial care use was mother-reported at the research centre at 9 years (8.1% used care).

Results

Our findings showed that, among children who used care, elevated problem levels at 6 years were reported for 10% by mothers and teachers, for 16% by mothers only and for 22% by teachers only. Hierarchical logistic regressions showed that having teacher-reported problems was associated with psychosocial care use (OR:3.06, p<.05), also after adjusting for mother-reported problems (OR:2.83, p<.05). Ethnic background did not moderate this association. Nonetheless, non-Western children did use significantly less care than Western children (OR:.58, p<.05), irrespective of their problem level.

Conclusions

The association between teacher-reported problems and psychosocial care use suggests that teachers can play a role in identifying mental problems in children, in addition to parents. The role of the teacher might be particularly important for non-Western children in Western countries as their parents report on average a lower need for care, irrespective of the actual need. This calls for prevention strategies that focus on the teacher's unique position.

Key messages

Teachers have an important role in the identification of mental health problems and access to psychosocial care for children. The signalling function of teachers is extra important for children with a non-Western migrant background as this group uses less care, irrespective of their problem level.
Developing an Ethical Model of Care for People with a Variation of Sex Development in Switzerland
Authors: Kraus C , Meyrat BL
Published: October 2021

Background

What constitutes best practice in the area of intersex, renamed Disorders/differences of sex development (DSD/dsd) or even variations of sex development (VDS) after the “Chicago consensus”? What kind of model of care would meet the requirements of an ethical management of intersex/dsd/VDS?

Methods

In 2005, we launched an interdisciplinary SHS and gender medicine project to improve the standards of care for persons with intersex/dsd/VDS. Abroad, this project, initiated in Lausanne, has sometimes been called the “Swiss Model”. It includes the development of an interdisciplinary team, based at the University hospital CHUV, who takes care of persons born with intersex/dsd/VDS and also teaches an ethical model of care to students at the Medical School of the University of Lausanne. The “Swiss Model” is centered on the children's fundamental rights to bodily integrity, self-determination and genital autonomy. We describe our 10 years' experience, the reasons, goals and development modalities of our team and model of care.

Results

We have developed a medical ethics “from below” to overcome the lack of ethical recommendations, as it was the case until 2012 in Switzerland. During this period of time, genital surgeries and other non-vital medical treatments have been postponed until the child could fully participate in the medical decisions and give one's informed assent or consent. Only one family did not follow our recommendations.

Conclusions

The Lausanne experience testifies to the possibility of changing the so-called Johns Hopkins paradigm in actual practice. The model of care we have implemented can define best practice as it is scientifically grounded, medically reasonable, and ethically consistent.
5.C. Workshop: COVID-19 response in Europe one year on: a tale of five countries
Authors:   Organised by: EUPHA-IDC,   Chair persons: Michael Edelstein (EUPHA-IDC), Aura Timen (Netherlands)
Published: October 2021

In November 2021 it will have been almost two years since the emergence of the COVID19 outbreak. The scale, duration and impact of the pandemic was unforeseen and unprecedented, with Europe being among the hardest hit regions. Within the region, individual countries have taken very different approaches to pandemic management and have achieved very different results. There are therefore wide variation in terms of diseases incidence and mortality within the region. The availability of vaccination has again widened differences with large differences between countries in term of vaccine access, and vaccination behaviour and coverage. At the World Congress of Public Health in November 2020, we compared and contrasted the situation and response in five countries in the European region: The UK, Italy, Poland, Portugal and Sweden. These countries were selected based on their very different approaches to managing the crisis and wide differences in terms of the epidemiology of COVID19 in country. Since then the pandemic has expanded more than 60 times in terms of number of cases, most countries experience serial lockdowns, and vaccines became available, which countries adopted at very different rates. In this interactive workshop we will invite representatives from those same five countries to discuss how and why their countries' situation evolved the way it did, and how policy choices in the last year have impacted on their national epidemiological situation. The session will go beyond simple description and will enable each country to reflect on different components of their management approach such as case identification, contact tracing, testing, social distancing, mask use, communication, travel restrictions, and vaccination, and contrast it with others. We plan to have short and effective 5 min presentations followed by a longer and constructive thought-provoking moderated discussion. Importantly, the five European case studies will offer ground to discuss issues such as balancing public health with other imperatives such as economic ones, equity and the pros and cons of a national vs a regional approach to pandemic management. The audience will be engaged through a Q&A session.

Key messages

Balancing public health with other imperatives is a challenge to which no universally agreed approach exists. The lack of a unified approach to pandemic management has led to wide inequalities within the region.

A Tale of 5 countries- the UK perspective

Jamie Lopez Bernal Public Health England, London, UK

A Tale of 5 countries- the Sweden perspective

Sara Byfors Public Health Agency of Sweden, Stockholm, Sweden

A Tale of 5 countries- the Portugal perspective

Ricardo Mexia Ministry of Health, Lisbon, Portugal

A Tale of 5 countries- the Poland perspective

Maria Ganczak University of Zielona Gora, Zielona Gora, Poland

A Tale of 5 countries- the Italy perspective

Anna Odone University of Pavia, Pavia, Italy
Anthropometric indicators and diabetes incidence: results from a national cohort study, Turkey
Authors: Emli Alpay E , Unal B , Ergor G , Dinc Horasan G , Sozmen K , Ekinci B , Sakarya S
Published: October 2021

Background

Anthropometric indicators such as Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and Body Shape Index (ABSI) are used globally to evaluate the risk of type 2 diabetes (T2DM). Our study aimed to investigate associations between different anthropometric indicators and the risk of T2DM using data from a national cohort.

Methods

The data on anthropometric measures and other risk factors of diabetes were obtained from Turkey Chronic Diseases and Risk Factors Survey in 2011 (n = 18,477). Disease information for the years 2012-2017 of the cohort has been reached through electronic health records and DM was ascertained by standard ICD-10 Codes. Four logistic regression models were generated based on different groups of confounders: unmodifiable risk factors, behavioral risk factors, comorbidities and socioeconomic variables. Categorical BMI, WC, WHR, WHtR, and ABSI values were used and adjusted RRs (95% CIs) of measurements were computed for men and women separately.

Results

Median follow-up year (IQR) was 6,46 (0,06). Between 2012 and 2017, 540 people were diagnosed with new diabetes. All anthropometric measurements except ABSI were associated with T2DM risk in all models. Among the anthropometric measures, BMI showed the strongest effect on incident diabetes, both in men (BMI ≥30; RRadj: 3.06, 95% CI 1.93-4.86) and women (BMI ≥30; RRadj: 2.58; 95%CI 1.73-3.85) in model 4 (adjusting for all confounding factors). WHtR provided the second strongest association with a RRadj of 2.57 in men (95% CI 1.78-3.71) and 2.55 in women (95%CI 1.87-3.47).

Conclusions

Independent of other risk factors, individuals with high BMI, WHR, WHtR and WC are at higher risk of developing T2DM. Public health strategies aimed at prevention of weight gain and obesity will probably be the most effective way to struggle with diabetes.

Key messages

There is a strong association between anthropometric measurements and type 2 diabetes incidence. Anthropometric indicators can be used to predict the risk of type 2 diabetes in males and females by clinicians and public health practitioners.
Adaptation and learning processes of stroke survivors and family carers: a scoping review
Authors: Moura A , Castanheira Pais S , Magalhães P , Alves E
Published: October 2021

Background

Knowledge on the processes of adaptation and learning after stroke are scarce, hindering the development of evidence-based public health strategies to promote survivors and family carers' health and wellbeing, across the post stroke trajectory. This study aims to assess the available evidence on the processes of adaptation and learning after stroke, by mapping the main barriers and enablers according to the perspectives of stroke survivors and family carers.

Methods

A scoping review was performed, following PRISMA-ScR guidelines. The electronic databases PubMed, ISI Web of Science, PsycINFO and SciELO were searched for empirical, peer-reviewed, original, and full-length studies on the processes of adaptation and learning of stroke survivors and family carers, in March 2021. Eligibility and data extraction were conducted by two independent researchers. The main qualitative data were explored by thematic content analysis and quantitative findings were synthesized.

Results

The included studies, 29 qualitative and 1 quantitative, were published between 1994 and 2019. Most of the studies were carried out with small samples and without a specific focus on the adaptation and learning processes after stroke. Barriers and enablers to stroke adaptation and learning processes were influenced by physical, psychological and social characteristics. The poor physical and functional status of survivors, the inability to maintaining the Activities of Daily Living, emotional disturbances, lack of support and information, and changes in roles, were identify as main barriers to stroke adaptation. Using coping strategies and having psychological, educational, and financial support were described as enablers.

Conclusions

Public health policies and practices should consider the physical, psychological and social barriers and enablers to the stroke adaptation and learning processes to ensure a high-quality long-term care centred on survivors and family carers.

Key messages

Robust theoretical and methodological studies, specifically designed to deeply explore and describe the post stroke adaptation and learning processes, are needed. Understand the main barriers and enablers to adaptation and learning after stroke may be useful for developing health education interventions centred on survivors and carers preferences and needs.