bluuebunny/crossref_metadata_2025 huggingface dataset:
Are children at schools registered to The Daily Mile™ more physically active?
Authors: Venkatraman T , Honeyford K , van Sluijs EMF , Costelloe C , Saxena S
Published: October 2021

Background

The Daily Mile (TDM) is among the most popular school-based running programmes recommended globally by governments and the WHO to meet the shortfalls in children's physical activity. In England, it has been adopted by 1 in 5 primary schools. However, its impact on children's physical activity has not been assessed at scale. We aimed to compare a)minutes (mins) of moderate to vigorous physical activity (MVPA) in and outside school hours and b)meeting physical activity guidelines in primary school children in England, comparing those in schools registered with TDM with those that were not.

Methods

This was a cross-sectional study. We used self-reported data of 49,561 English primary school children(5-11 years) from the Active Lives Children and Young People Survey and TDM registration data of their school. We compared mins of MVPA in and outside school hours between children in TDM-registered and non-registered schools using a multilevel zero-inflated negative binomial model; and the differences in the likelihood of meeting physical activity guidelines based on TDM registration with a multilevel logistic regression model. All models included a random effect for school and adjusted for potential confounders.

Results

Children attending TDM-registered schools reported an extra 36 mins of MVPA a week overall, including 10 additional mins (95%CI:3,16) MVPA/week during school hours and 26 additional (95%CI:4,44) mins MVPA/week outside school hours. Children in TDM-registered schools were 6% more likely to meet physical activity guidelines compared to those who were not(RR:1.06 (95%CI:1.02,1.11)).

Conclusions

Children in primary schools registered to TDM report more physical activity that is not compensated for outside school hours. However, the absolute differences fall considerably short of international guidelines across the whole child population. Therefore, a whole school and systems-based approach is required, embedding school-based running programmes.

Key messages

Children in schools registered to TDM report more MVPA overall, inside, and outside school hours; suggesting no compensation of activity in those who are registered. TDM is a potential solution to increase children’s physical activity during the school day.
Global health from home - results from a German student-led online lecture series during COVID-19
Authors: Gepp S , Gök S , Jung L , Kreitlow A , Machleid F , Nordmann K , Weber L
Published: October 2021

Background

The COVID-19 pandemic calls for a skilled health workforce, yet global health is largely missing in the medical curriculum in Germany. The interdisciplinary national student “Global Health Network” therefore initiated an online lecture series. “Global Health - perspectives, opportunities and challenges” included 14 lectures on a range of topics held by German and international academics from October 2020 to January 2021.

Methods

Evaluations were performed prior to, at midterm and after the series, including 5-point likert scales and open questions. Using quantitative and qualitative approaches, participants' motivation and learning outcomes of global health education were analysed.

Results

A total of 1393 students registered for the series. Individual lectures attracted on average 400 participants, mainly female medical students between 20-25 years, but also a variety of ages, genders and disciplines. Main reasons for participation included interest in COVID-19-related developments, learning about global health-specific topics, and professional development. More than 40% of participants reported to know little about global health before attending; after the lecture series, only 10% made this statement. In addition, 90% of participants perceived an increase of motivation to learn more about the topics, while about 40% gained motivation to become practically involved in the field. The lecture series was accredited in the curriculum at some universities, thus innovating the curriculum and enabling formal credits.

Conclusions

The new model of student-led online teaching proved to be feasible and demonstrated students' interest and positive impact on global health knowledge. Further institutional change and inclusion of global health in the curricula have to follow.

Key messages

Students need global health education to respond to global health-related challenges. Volunteer student-led initiatives can increase knowledge and interest and be an important driver for change towards improving global health education.
Evaluation of the impact of the European Code against Cancer on awareness and attitudes towards cancer prevention at the population and health promoters’ levels
Authors: Ritchie D
Published: October 2021

Introduction

The European Code against Cancer (ECAC) informs the public on steps to take to reduce their cancer risk. Despite over three decades of promotion, no systematic evaluation of its impact has yet been carried out. This study aimed to address the gap in knowledge regarding the impact of the ECAC.

Methods

An online survey targeting adults in the general population was conducted and analysed by age, gender, and country, both descriptive and mutually adjusted in logistic regression analyses. Additionally, semi-structured interviews with health promotion professionals from not-for-profit organisations in Europe were conducted and a qualitative thematic analysis was carried out for each interview.

Results

8171 people from eight European countries responded to the survey. Although 70 % of respondents were aware of cancer prevention guidance, a low percentage of participants had previously heard about the ECAC (2% in UK to 21 % in Hungary and Poland). Females were more likely to make lifestyle changes to reduce their risk of cancer (odds ratio = 1.17; 95 % confidence interval: 1.05-1.29). Twenty-eight online semi-structured interviews with professionals were conducted covering 25 countries. Regional variation in the methods and target groups of the promotion and dissemination of the ECAC was reported.

Conclusions

Whilst familiarity with the ECAC in the general public is low, professionals frequently use it as a basis for informing population-level actions. Future editions should be accompanied by a systematic evaluation of the ECAC investigating the impact upon society.
Better communication with migrant communities during COVID-19 pandemic:a portuguese experience
Authors: Neto J , Carvalho C , Letras S
Published: October 2021

Odemira, in the southeast litoral of Portugal, has 33% of migrant citizens, mostly from Southeast Asia, going up to 50% counting transient citizens. Most of them do not speak English, making communication with health services difficult. They tend to live in overcrowded houses with unsanitary conditions. With the emergence of the COVID-19 pandemic, all the above resulted in high incidence and ineffective contact tracing (CT), testing and isolation by the public health teams. It was essential to develop strategies to manage and control outbreaks, and also to achieve health equity. Our experience can be useful for other countries in dealing with their multicultural communities. This intervention started in march 2020 and is still ongoing. The aims were to improve the accuracy of epidemiological surveys (ES) and CT, to more easily stop transmission, to develop the communication skills of health professionals and to improve migrant's healthcare access. For this, the focus was on digital written communication tools (Whatsapp, translation apps). It was created a toolkit to guide ES and CT tailored to the migrant population, with tips and best practices, and used translated information materials about preventive COVID-19 measures. Workshops were led with health professionals. It was stablished work with local NGOs, creating social media campaigns during crucial events (Holi holliday). As results. it was achieved a better ES output, more accurate CT and better transmission control, with noticeable differences between march 2020 and now. The relationship with this community improved, having better access to services and their needs met. Health professionals reported being more at ease dealing with these patients. Our experience shows it's possible to communicate effectively despite language and cultural barriers, that cultural knowledge is important in advancing public health goals and that multidisciplinary and intersectoral work is essential to effective interventions.

Key messages

This intervention allowed us to achieve a better output of epidemiological surveys, more accurate contact tracing and were more effective in breaking transmission chains and controlling outbreaks. It was achieved a better understanding and relationship with this community, with better ability to respond to their needs and promoting their access to healthcare.
The Impact of Covid-19 on the population-based cancer screening programmes. Basque Country (Spain)
Authors: Portillo Villares MI , Altzibar Arotzena JM , Arenaza Lamo E , Otegi Ariztondo A , Santos Zorrozua B , idigoras Rubio I , Davila Exposito T , Muñoz Santos C , Bilbao Iturribarria I
Published: October 2021

Background

The Breast Cancer (BCS) and Colorectal Cancer (CRCS) screening programmes are consolidated in the Basque Country with coverage and participation rates according to EU recommendations. The Cervical Cancer Screening (CCS) carried out in 2018 achieved an appropriate migration from an opportunistic programme an coverage in 2019. The pandemic disrupted the invitations and participation because of the lockdown and procedures offered because of Covid-19 safety measures since then. Objective: Analysis of the expected impact of the pandemic on early detection of advanced lesions and cancer.

Methods

Retrospective cohort study including all invitations 2016-2020 and results estimated (E) and observed (O) in 2020 without and with pandemic. Analysis R v 4.0. Description of measures taken into account to minimize the decrease of activity.

Results

Eligible population in BCS O/E were 54.4% (CI 95%: 41.0-41.6; p < 0.05) (85,574 vs 150,534), estimating 202 BC (35 in situ and 167 advanced) not detected. In CRCS eligible population O/E were 39.2% (CI 95%: 44.9-45.3; p < 0.05) (119,851 vs 257,889), estimating 1,695 advanced neoplasias (1,540 advanced adenomas and 154 invasive cancer) not detected. The CCS invitation had an important delay, with a 30% of target population invited (42,654 vs 142,180 women). Participation rate showed a slight decrease in the three programmes. The main measures implemented to minimize the disruption effects were: prioritization of confirmed diagnosis, increased activity to recover from the delays in 2020-2021 and the establishment of protocols to decrease intensive surveillance in case of post-colonoscopy.

Conclusions

The Pandemic has significantly affected the three population-based programmes, showing a reduction of its benefits in incidence and mortality at medium-long term as the COVID-19 and Cancer Global Modelling Consortium (CCGMC) appointed and published. Stakeholders should take into consideration the quick recovery of them.

Key messages

The benefits of the cancer screning programmes are seriously affected. It is needed to measure the COVID-19 consecuencies in cancer screening programmes.
Progress in lung and colorectal cancer survival, in Cyprus (2004-2017): a population-based study
Authors: Quattrocchi A , Demetriou CA , Cory OA , Saad B , Constantinou C , Papamichael D , Charalambous H , Demetriou A , Scoutellas V , Kolokotroni O
Published: October 2021

Background

Lung and colorectal cancer are the leading causes of cancer deaths in Cyprus. We describe preliminary analysis of (overall and by stage of diagnosis) age-standardised 5-year net survival (hereafter reported as NS) trends, for these two cancers.

Methods

We analysed data from the national population-based Cyprus Cancer Registry on adults (age 15+) diagnosed between 2004-17 with lung or colorectal cancer with follow-up until December 2019. We used cohort approach for 2004-08 (time 1-T1), 2009-13 (T2) and period approach for 2014-17 (T3) to estimate NS and 95% confidence interval (CI). Stage at diagnosis was categorised as localised, regional and distant, based on the Surveillance Epidemiology and End Results. The International Cancer Survival Standard age-specific weights were used for standardisation.

Results

Between 2004-17, all-stages NS increased from 16% (CI:15-17; T1) to 22% (CI:21-23; T3) and from 57% (CI:56-59; T1) to 61% (CI:60-62; T3) for lung and colorectal cancer, respectively. For lung cancer, NS increased from 37% (CI:29-47; T1) to 55% (CI:47-65; T2) and 65% (CI:57-74; T3) for diagnosis at localised stage, from 28% (CI:23-35; T1 and CI:22-35; T2) to 39% (CI:33-46; T3) for regional stage and from 4% (CI:3-6; T1) to 6% (CI:4-8; T2) and 7% (CI:6-10; T3) for distant stage. For colorectal cancer, NS increased from 75% (CI:71-80; T1) to 76% (CI:72-79; T2) and 84% (CI:80-87; T3) for diagnosis at localised stage, from 65% (CI:62-68; T1) to 69% (CI:66-72; T2) and 72% (CI:69-74; T3) for regional stage and from 11% (CI:9-16; T1) to 12% (CI:9-16; T2) and 15% (CI:12-19; T3) for distant stage.

Conclusions

Over the study period, survival improvements were observed. Late stage at diagnosis seems to be a contributing factor to decreased survival of lung or colorectal cancer patients in Cyprus. Increasing public awareness of cancer risk factors and symptoms and investment in early detection is vital to reduce delay in diagnosis and treatment and to improve survival.

Key messages

Lung and Colorectal cancer survival continues to improve although at different pace by stage at diagnosis. Any shift to earlier stages at diagnosis brings substantial survival improvements. Survival trends can help both in the formulation of strategies for cancer prevention, screening, and treatment and in the assessment of their effectiveness.
The Association between GDP and non-communicable disease mortality in the WHO European Region
Authors: Khanzada A , Mousa A , Thompson R , Rawaf D , Ikpeme M , Watt H , Mechili EA
Published: October 2021

Background

The WHO Europe Region consists of 53 countries, each of which has differences in mortality from cardiovascular (CVD), neurological, and chronic respiratory diseases. Such diverse metrics result from political, social, and economic events that have influenced the health performance of each European sub-region. From a public health perspective, an updated analysis of such metrics is required for policymakers and health system organisations to improve the overall population health outcomes.

Methods

This study utilised data between 1990-2017 from the Global Burden of Disease study 2017 to explore the association between GDP and NCD mortality in Western, Central, and Eastern Europe and Central Asia. The mortality data was already stratified by age and sex, and a fixed effected regression analysis was run to observe associations between both variables using STATA. Data completeness was 80-100% for GDP and 100% for mortality across the European region. The final results were reported as a rate per 100,000, with confidence intervals. The rate changes were calculated using an equation from the GBD.

Results

The most significant decrease per 100,000 of the population across all three NCDs as GDP increased was in Central Asia and Eastern Europe among both sexes. For every 1000 unit increase in GDP, we expect -12.13 [-13.60, -10.66] and -14.49 [-16.89, -12.29] less deaths in CVD in females and males per 100,000 of population, respectively. Western Europe had the lowest decrease per 100,000 of the population, as with every 1000 unit increase in GDP, we expect -2.42 [-2.59, -2.25] and -4.09 [-4.33, -3.84] fewer deaths in CVD in females and males, respectively.

Conclusions

The overall differential rate of mortality from the three NCDs is decreasing across all regions. However, there is a large disparity between the sexes. Males have a higher mortality rate across CVD and chronic respiratory diseases, whilst neurological disorders were highest among females.

Key messages

This study’s analysis has added to existing knowledge on chronic health patterns in the WHO European region. Governments in Eastern Europe and Central Asia should introduce health policies targeting unhealthy consumption of alcohol, smoking and diets, as seen in Western Europe.
Digital health technologies: a systematic review of their cost-effectiveness
Authors: Puleo V , Gentili A , Failla G , Melnyk A , Di Tanna G , Ricciardi W , Cascini F
Published: October 2021

Background

Digital health interventions have a potential to improve safety, efficacy and quality of care, reducing waste in healthcare costs. Despite premises, the evidence regarding cost and effectiveness of digital tools in health is scarce and limited.

Objectives: The aim of this systematic review is to summarize the evidence on cost-effectiveness of digital health interventions and to assess whether the studies meet the established quality criteria.

Methods

We queried PubMed, Scopus and Web of Science databases for articles in English published from 1 January 2016 to 31 December 2020 that performed economic evaluations of digital health technologies. The methodological rigorousness of studies was assessed with a well-established checklist (CHEERS). The incremental cost-effectiveness ratio (ICER)was calculated when the reviewed study reported related data but did not express the ICER.

Results

Searches identified 1476 results, 552 of which were selected for abstract and 35 were included in this review. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The qualitative analysis identified the economic and effectiveness evaluation of seven different types of interventions: fourteen studies on a new telemedicine service; five on telecounseling; five on teletherapy; two on telemonitoring; five on new mobile applications; two on m-health programs; one on digital platforms and one on electronic health records.

Conclusions

Findings on cost-effectiveness of digital interventions showed a growing body of evidence and suggested a generally favorable effect in terms of costs and health outcomes. However, due to the heterogeneity across study methods, the comparison between interventions still remains difficult. Further research based on a standardized approach is needed in order to methodically analyze incremental cost-effectiveness ratios, costs, and health benefits.

Key messages

Digital interventions suggested a favorable effect in terms of costs and health outcomes. Digital health interventions have a potential to improve safety, efficacy and quality of care.
Intergenerational inequalities in COVID-19
Authors: Gabrijelčič Blenkus M , Costongs C
Published: October 2021

COVID-19 as a disease mainly affects older people. However, the measures that governments have introduced to prevent the spread of the pandemic will mainly impact on the younger ones. The key challenges for countries are to respond to both: (1) reducing the spread of the pandemic and (2) managing its syndemic, psycho-social dimension. Governments should design cross-cutting measures to address both these dimensions, be sensitive to and targeting different groups to enable, on one hand, a new normal life with the virus for individuals, and on the other hand, to enable society to function normally. For that aim, countries have to establish effective monitoring and measuring of the situation in order to ensure appropriate, effective and targeted responses. PANDA is an example of a good practice in Slovenia. The PANDA findings indicate that there are differences between generations in perceptions of the pandemic, in vaccine acceptance and in pandemic experiences. Mental health for example is one of the most affected components of health status in individuals, with worse results for younger generations. For the age group 65 - 74 years, 9 % are reporting depression symptoms and 13.5% reporting problems in mental health, while for the 18 - 29 years group, 17.8% are reporting depression symptoms and 28.5% mental health problems. Even more serious are the differences we could observe in assessing the financial situation, with 34.4% of the surveyed participants aged 18-29 years assessing their financial situation as worse in the last three months, compared to only 9.9% of those in the age group 65-74. Observed intergenerational inequalities are bringing along the responsibility of the older members of the population to get vaccinated, not only to protect themselves and prevent the collapse of the health system, but also to enable younger generations to get their lives back to normal and allow them to live and eat, attend education and socialise normally.
Colleagues affect healthy eating and exercise behavior
Authors: van der Put A , Ellwardt L
Published: October 2021

Exercising and eating healthy are not just an individual choice, but influenced by the social environment. Family members, friends or neighbors influence (un)healthy choices individuals make, yet little is known about other important contacts: colleagues. Many people spend at least 8 hours a day at work, mostly surrounded by the same colleagues. As a third of daily calories are consumed in the workplace and a lot of time is spent sitting there, colleagues could be important in shaping the (un)healthy choices employees make. We study to what extent colleagues influence each other's eating and exercise behavior. We focus on two pathways: colleagues can encourage a healthy lifestyle or act as role models whose behavior can be observed and copied. We use the European Sustainable Workforce Survey, with data on 4345 employees in 402 teams in 113 organizations. We measured healthy eating as how often employees eat fruit and vegetables. We measured exercise by the number of days in the past week employees did sports/physical activity for more than 30 minutes. Colleague encouragement was assessed by the extent to which employees said their colleagues encourage them to eat healthy food or exercise frequently. We computed colleague behavior by taking the average fruit and vegetable consumption, and exercise, of all colleagues in a team. We fitted multilevel models with employees nested in teams and controlled for gender, age, education, working hours, job physical demands, self-rated health, sector and country. Preliminary results show colleague encouragement for healthy eating positively affected fruit consumption (p<.01), colleague fruit consumption did not(p=.62). Both colleague encouragement (p<.01) and colleague vegetable consumption (p=.04) positively relate to vegetable consumption. Colleague encouragement positively (p=.03), and colleague exercise behavior (p<.01) negatively, affected exercise. Worksite health interventions should emphasize the role colleagues may play.

Key messages

Next to family, friends and neighbors, also colleagues influence each other’s eating and exercise behavior. Worksite health interventions should the role colleagues may play into account when attempting to improve employee health.
School stress and health complaints: Testing the Adolescent Stress Questionnaire in Spain and Sweden
Authors: García-Moya I , Corell M , Paniagua C , Vaez M , Löfstedt P
Published: October 2021

Background

According to the Health Behaviour in School-aged Children (HBSC) study, over a third of adolescents feel pressured by schoolwork in European countries, with increases associated to age and in girls. School pressure has been linked with increased health complaints, which illustrates the importance of schools from a public health perspective. To get a better understanding of school stress in adolescence, there is a need to test measures that reflect a broader array of potential school-related stressors. The aims of this cross-national study were: (1) to analyze the functioning of a specific measure to assess school stress in adolescence and (2) to examine the links between school stress and health complaints.

Methods

The sample consisted of students aged 13 and 15 years: 1,249 students (54.6% girls) who had participated in project EASE in Spain, and 576 students (50.6% girls) in Sweden. The measure tested was the Adolescent Stress Questionnaire (ASQ-S), specifically the 9 items on school stress from the subscales school performance, future uncertainty, and school-leisure conflict. For the assessment of health complaints, the HBSC health complaints checklist was used.

Results

CFA supported a three-correlated factor structure and a high reliability of the three subscales of the ASQ-S in both countries. In regression analyses, the association between school stress and health complaints was significant when controlling age and sex, with the increase in the level of explained variability due to several stress dimensions being 18.8% in Spain and 25.2% in Sweden.

Conclusions

Different facets of school life can contribute to stress during adolescence, with more public health attention needed when it comes to school stress and its links with increased health complaints.

Key messages

The instrument used for school stress may be useful in cross-national studies in adolescent samples. More public health attention should be paid to school stress and its links with increased health complaints in adolescence.
Stakeholders’ involvement in identification of research and policy needs for children’s mental health
Authors: Ristovska G , van den Hazel P , Weber M , Jansen S , Benz S , White M , Arat A , Spiroski I , Schreckenberg D , van Kamp I
Published: October 2021

Background

The overarching aim of the Horizon 2020 Equal-Life project is to develop evidence-based guidance for policy-and decision-makers concerning child environment and long-term effects on mental health and cognitive development. Stakeholders at national and local level are crucial in improving the physical and social environments children grow up in. In this paper, we present preliminary results of a repeated survey on stakeholders' needs concerning environmental determinants of mental health and cognitive development of children and adolescents.

Methods

We invited potential stakeholders from relevant fields of expertise. Two of three rounds of the Delphi survey were performed by means of an on-line survey between November 2020 and February 2021.The questionnaire was aimed at identifying research questions, knowledge gaps and raised issues about data collection and analysis regarding improving mental health and cognitive development, policy needs related to environment and its role in children's mental health and the potential effectiveness of policy interventions.

Results and Conclusions

In the 1st survey round 34 stakeholders participated and in the 2nd survey round 51 stakeholders participated from 26 different countries and continents. Across both rounds of the survey most participants were from research institutes (21), public health organisations (8), civil society (6), national stakeholders (5) with only little involvement of local or regional authorities or child care organisations. Stakeholders identified several research priorities such as: instruments to improve children's mental health, preventive programs addressing mental health, integrated mental health care services, programs aimed at parenting skills and child care. Early life exposure to adverse social events and psychosocial stressors in the family and socioeconomic disadvantage were recognized as main factors for child development.

Key messages

The guidance from Equal-Life aims to include stakeholders in creation of intervention strategies and preventive measures for mental health and the cognitive development of children. Evidence-based policies and programmes can buffer the negative effects of adverse environments and create restorative ones, and by doing so improve mental health and cognitive development.
A European Partnership on Transforming health and care systems – state of play and future plans
Authors: Montante Sabrina
Published: October 2021

Horizon Europe will foresee the establishment of a number of European Partnerships. One proposed Partnerships is targeted towards Transforming health and care systems, which is presented in the opening presentation. Research and Innovation activities (R&I) in such a EU Partnership should accelerate the transformation towards sustainable health and care systems. It builds on the experience and outcomes of some closely related European initiatives, including the Active & Assisted Living Programme (AAL Programme), the Joint Programme Initiative “More Years, Better Lives', the European Innovation Partnership on Active & Healthy Ageing and the To-Reach Coordination and Support Action (CSA). The four initiatives share a common vision to improve the European citizens' health by reaching high quality, fairly accessible, sustainable, efficient, health promoting and resilient health and care systems for all EU citizens. The Partnership aims to achieve this objective by 2030 by means of providing multidisciplinary research with a particular focus on improving the ability of relevant health and care actors to take up innovative solutions, including organisational, service and policy innovations. The process is to develop a Strategic Research and Innovation Agenda (SRIA), building on work on already conducted by previous projects and initiatives, including the ones listed above. The workshop at the EPH Conference can be seen as part of a series of workshops to advance the Strategic Research and Innovation Agenda based on countries priorities and wide stakeholders' consultations, To provide cumulitative learning, the presentation will share the outcomes of a consultation process among European stakeholders so far, among others involving decision makers and research funding bodies to identify common goals and priorities, providing opportunity to workshop participants to reflect and add missing elements crucial for such a Strategic Research and Innovation Agenda.
The organisation of resilient health and social care following the COVID-19 pandemic – A critical review
Authors: Rogers Heather L.
Published: October 2021

As second presentation, a recent Opinion by the Expert Panel on effective ways of investing in Health (EXPH) will be shared and used as point of reference to assess what the key components are of a future Partnership. This Opinion on the organisation of health and social care following the COVID-19 pandemic (1) identifies the building blocks of resilient health and social care systems, (2) explores the elements and conditions for capacity building to strengthen health system resilience, (3) addresses healthcare provision for vulnerable patient groups and how to sustain such provision in a system under stress, and (4) sets out an approach to develop and implement “resilience tests” of Member State's health systems. The recommendations target a number of key areas, including: enhancing workforce training and resilience, identifying and reducing disinformation, fostering interprofessional and inter-sectoral collaboration with community health workers and informal care givers for example, strengthening primary and mental health care, and a number of other priorities. An overarching recommendation is to enhance investment from the European Commission in the development and implementation of (a) comprehensive resilience testing of health systems that use qualitative and quantitative data collection methodologies to generate meaningful, actionable results for health system transformation, and (b) corresponding learning communities within and across Member States to share lessons learned through this process. Based on this work, what are the priorities for a Partnership, and how can it add value to existing initatives?
Tingbjerg Changing Diabetes: Dynamic intersectoral collaboration in community health promotion
Authors: Bloch P
Published: October 2021

Background

Intersectoral collaborative action is a beneficial and cost-effective strategy in health promotion and multilevel, comprehensive interventions are increasingly used to prevent chronic diseases. Yet, more knowledge is needed on processes of sustainable intersectoral partnership building. Tingbjerg Changing Diabetes (TCD) is a long-term (2014-2032) initiative to promote health and prevent type 2 diabetes in the socially disadvantaged neighbourhood Tingbjerg, Copenhagen, Denmark. TCD applies the Supersetting approach to mobilise community resources and to attain synergistic effects through coordinated engagement of multiple stakeholders in multiple settings in local community. The Supersetting approach constitute five core principles: integration, participation, empowerment, context-sensitivity, knowledge. Activities draw on Community Action Research.

Methods

The paper analyses partnership building processes in TCD. Data includes contextual analyses, log data, notes from partner meetings/workshops, partner interviews and activity process evaluations. Partners include educational, private and public institutions (incl. Copenhagen Municipality), a local political committee, social housing associations and research institutions.

Results

Drivers of sustainability of TCD related partnerships included trusting, dynamic and flexible relations established at multiple levels of involvement. Local resource identification and co-creation processes ensured feasibility of activities by involving most relevant partners. The evolvement of interrelated project activities based on shared goals, structures and principles fostered cohesion of TCD's intersectoral partner collaboration.

Conclusions

The intersectoral partner collaboration in TCD was established, maintained and expanded through iterative processes of activity and project development. Thus, TCD has been effective in mobilizing and integrating multiple intersectoral partners in community health promotion.

Key messages

The sustainability of TCD intersectoral partner engagement and collaboration is driven by dynamic relations at multiple levels ensuring consistent, yet flexible engagement. The iterative project development building on community interests and shared goals, structures and principles maintain the dynamic partnerships of TCD.
Alcohol packaging as a promotional tool: A focus group study with young adult drinkers in Scotland
Authors: Jones D , Moodie C , Purves RI , Fitzgerald N , Crockett R
Published: October 2021

Background

Given the dearth of research on consumer perceptions of alcohol packaging as a marketing tool, with existing studies focused on children and adolescents, our aim was to explore how young adults view and engage with alcohol packaging.

Methods

Eight focus groups were conducted in Glasgow (Scotland) in September 2019 with young adult drinkers (n = 50), segmented by age (18-24, 25-35), gender (female, male) and social grade (ABC1, C2DE). Participants were shown, allowed to handle, and asked about, a range of alcoholic products. Data were analysed thematically using an inductive approach.

Results

Five main themes emerged from the data. The first was the ubiquity of alcohol packaging, with frequent exposure reported in different settings, such as shops and drinking venues, and via marketing. The second was appeal, with pack graphics (e.g. colour), structure (e.g. shape, size) and promotions (e.g. gifts, limited-editions) allowing alcohol packs to capture attention, enable products to stand out on shelves, and help create product and brand liking, interest and choice. Third, alcohol packaging was frequently associated with specific occasions and activities. Fourth, alcohol packaging informed perceptions of product-consumer targeting, suitability, and intended drinker profiles. Fifth, alcohol packaging also engaged non-visual senses, guiding expectations of product taste and palatability.

Conclusions

For young adult drinkers in Scotland, alcohol packaging can capture attention, create appeal, and help shape perceptions of the product, drinker and drinking experience.

Key messages

Alcohol packaging is a key marketing communications vehicle, which can attract attention, create product and brand liking, interest and choice, guide expectations, and influence purchasing decisions. Alcohol packaging conveys messages of consumer-product suitability and acceptability, helping to reinforce perceptions that alcohol is a desirable product via pack structure, graphics, and promotions.
Co-designing a training package to promote health/oral health for people experiencing homelessness
Authors: Rodriguez A , Biazus Dalcin C , McGoldrick N , van Blerk L , Murray C , Freeman R
Published: October 2021

Background

In Scotland, 31,333 households were assessed as experiencing homelessness in 2019/20. This population present high morbidity and mortality which is a public health issue. Their health needs have been identified within Scottish policy as part of the broad goal of reducing inequalities and poverty. Those experiencing homelessness face multiple exclusions that must be addressed by practitioners from all health and social care sectors. Frontline staff have identified they often do not have adequate information and/or training on wider health issues linked with their client's needs. The aim of this research is to co-produce training resources to support front-line staff to discuss and to promote health and oral health.

Methods

Community-based participatory research that used online workshops to listen to the views of people with lived experience, practitioners and students from health and third sector, and policy makers regarding accessibility of services and practitioner approach towards those experiencing homelessness. Content analysis will be used to identified recurrent themes.

Results

The preliminary findings shown that lack of empathy from practitioners, continuity of care and stigma are barriers to access services. This is informing a co-designed knowledge exchange training packaged to help practitioners to improve knowledge and ability to promote health/oral health and to engage with people experiencing homelessness or at risk of becoming homeless. Educational materials (e-book on health promotion, comics books on barriers to access services, and a guide to promote oral health) compose this training package.

Conclusions

The training package allows adaptations to different settings and contexts and will be an important resource to be used by practitioners from different fields to prevent and tackle homelessness. Participants are sharing important views related to the need of a human rights and social justice-based approach to health promotion.

Key messages

Development of a co-designed knowledge exchange training package to improve practitioners' knowledge and ability to communicate and to engage with people experiencing homelessness. To empower people experiencing homelessness regarding positive health/oral health behavior change.
Two interventions to help smokers quit - when less is more
Authors: Kovačević J , Kosic Bibic N , Sovic S , Musil V , Zombori D , Juresa V
Published: October 2021

Smoking cessation has known individual health benefits and significant positive economic effect at the population level. Interventions aiming to help smokers quit are available in most EU countries, involving individual or group-work and pharmacotherapy. Public health resources are limited and insufficient. Research, comparing different approaches taking into account necessary resources, is needed to select the most effective interventions. Since 2008 in Pozega-Slavonia County, Croatia, there have been two organized programs, without pharmacotherapy, for smokers. Namely: “Non-smoking school” as an intensive group-work and the “Quit and win” based contest combined with individual support. We compared the two approaches, measured as costs for human and material resources. The aim was to determine which approach costs less for the same outcome defined as one long term (6 months) successful ex-smoker.

There were 63 smokers in the group program. The 30 day abstinence rate was 77.8% (49/63), and out of those 38.8% (19/49) abstained long term. Follow up rate was 100%. Group-work cost was €10,702/63 smokers; €170 per smoker, €218 for a short term and €563 for a long term ex-smoker. Human resources cost were 96.5% of the resources. There were 153 smokers in the contest. Short term abstinence rate was 73.9% (113/153) and out of those 34.1% (31/91) abstained long term. Follow up rate was 80.5%. Contest cost was €11,292/153 smokers; €74 per smoker, €100 for a short term and €364 for a long term ex-smoker. Human resources cost were 45.2% of the resources. In the contest, equivalent long term abstinence rates were achieved for only 64.7% of resources and 50% less human resources (96.5% vs. 45.2% human resources in all resources) compared to group therapy program. Novel combination of evidence-based approaches “Quit and win” with individual support shows promising results using less human and material resources delivering results comparable to costlier intensive group-work.

Key messages

We have shown that an extra financial spending significantly reduces work-load resulting in lower cost per ex-smoker. Contests could be used as a successful method to help smokers quit, using the same limited resources available.
Government political ideology and COVID-19 public health policy responses
Authors: Vasco Santos João
Published: October 2021

The global spread of COVID-19 has led to a wide range of pandemic response measures, heterogeneous between countries, varying mostly in time and duration of implementation. Common measures include social distancing, travel restrictions, school closings, bans on public gatherings, investment in healthcare, contact tracing and other public health interventions. Although response measures to COVID-19 in European countries were quite similar in the first moments of the pandemic, different types of measures, with various strictness levels, have been applied in subsequent months, with great diversity among countries, even in the European Union (EU) or European Economic Area (EEA). Governments have played a key role in these decisions. Therefore, it is of particular interest to understand the association between governments' political ideology and the public health policy responses to the COVID-19 pandemic. In this workshop, we will reflect on electoral outcomes in the past year in Europe, and discuss how governments' political ideology, including on a left-right axis, affected the strictness, or stringency, of restrictive measures applied in response to the pandemic progression, in conjunction with key variables such as incidence, hospital occupancy rate or test positivity rate. This might have implications for understanding how political ideology might influence public health policies in response to pandemics.
Experiences from one year Rapid Exchange Forum
Authors: Habl Claudia
Published: October 2021

The Rapid Exchange Forum (https://www.phiri.eu/wp8 ) within the PHIRI project offers policy advisors, commission services, knowledge-brokers, researchers and stakeholders working in the pandemic response a low-threshold exchange format. The delegates work on a technical level and complement the high-level Health Security Committee meetings. Since November 2020 meetings take place in a structured and efficient online format on a bi-weekly basis and are usually attended by 30 delegates from most European countries. The topics discussed (e.g., national vaccination strategies discussed in early January; planned studies on the long term effects of Covid-19 in April, etc.) are pre-selected based on a initial need's assessment in the PHIRI project (www.phiri.eu). The topics are put into voting one week before the meeting and the selected topic is answered by countries latest until one day after each meeting. Results are collected in a systematic, concise format and will be soon regularly published in the planned EU Health Information Portal. Concrete results for instance were, that Austria legally stopped the sole use of plastic mouth shields (visors) and replaced them by the FFP2-masks.
Building a federated research infrastructure for a policy-rapid response
Authors: Bernal-Delgado E , Estupiñán-Romero F , González-García J , Telleria-Orriols C , Thißen M
Published: October 2021

Background

Mobilizing real world data from multiple data hubs in multiple countries to carry out policy-oriented research, requires orchestrating the governance of workflows, being compliant with legal and ethical requirements, and semantic harmonization and technological interoperability. In the context of PHIRI, policy-oriented research has to provide insight to policy-makers to cope with pandemics.

Methods

PHIRI builds this concept on the deployment of four use cases throughout a federated research infrastructure. A central hub orchestrates all the elements encompassing the development of such an infrastructure; so, a common governance model, common methodology pursuing semantic interoperability, and the development and deployment of technological solution containing ETL processes, data quality assessment solutions and data analyses, all packaged to be rolled out in the different data hubs composing the federation.

Results

A prototype orchestrating those workflows is being followed in four use cases: indirect effects of the pandemic on vulnerable populations, delayed breast cancer treatments due to the pandemic, perinatal health affections along the COVID19 crisis, effects of the pandemic on mental health care. A prototype of the technological platform supporting interoperable federated analyses has been prepared.

Conclusions

It is pertinent, feasible and reliable using a federated research infrastructure leveraging real world data from many data hubs in many countries to answer research queries on the COVID19 pandemic.
How the population worldwide is reacting to the COVID-19 vaccines: a systematic review on hesitancy
Authors: Failla G , Pantovic A , Al-Ajlouni Y , Ricciardi W , Cascini F
Published: October 2021

Background

High rates of vaccination are worldwide required to establish a herd immunity stopping the current COVID-19 pandemic evolution. Vaccine hesitancy is a major barrier in achieving herd immunity across different populations. This study sought to conduct a systematic review of the current literature regarding attitudes and hesitancy to receiving COVID-19 vaccination worldwide.

Methods

A systematic literature search was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Multiple databases were searched, namely PubMed and Web of Science, on February 24th, 2021 using a set of developed keywords. Inclusion criteria included the study to be 1) conducted in English; 2) investigated attitudes, hesitancy, and/or barriers to COVID-19 vaccine acceptability among a given population; 3) utilized validated measurements techniques; 4) have the full text paper available and 5) be peer-reviewed prior to final publication. The Newcastle Ottawa (NOS) scale for cross sectional studies was used to assess the quality of the studies.

Results

73 studies were included in qualitative synthesis. Overall, vaccine acceptance rates ranged from 23.6% in Kuwait to 94.3% in Malaysia and Nepal. A variety of different factors contributed to increased hesitancy, some of which included having negative perception of vaccine efficacy, safety, convenience and price. Some of the consistent socio-demographic groups that were identified to be associated with increased hesitancy included: women, younger participants, less educated, with lower income, with no insurance, living in the rural area and self-identified as a racial/ethnic minority.

Conclusions

Vaccine hesitancy rates against COVID-19 vaccine ranged widely among across different populations. Identifying the factors that interplay and result in high hesitancy rates among a population can allow formulating a directed intervention to increase their vaccination uptake rates.

Key messages

It is necessary to understand the factors that contribute to the COVID-19 vaccine hesitancy. It is important to inform policy-makers and formulate direct intervention measures that will successfully handle the pandemic.