bluuebunny/crossref_metadata_2025 huggingface dataset:
Telemedicine: first steps in a north-eastern Italian region during first year of pandemic
Authors: Antinolfi F , Deroma L , Moccia A , Lesa L , Grillone L , Virgili G , Lattuada L
Published: October 2021

Background

Covid-19 pandemic imposed searching for innovative solutions to ensure safety access to outpatient services. In March 2020 first cases were reported in Friuli Venezia Giulia (FVG) region, in Italy; in April 2020 FVG included teleconsultation in the healthcare offer. This study evaluated in-presence medical consultations (IPCs) delivered in FVG before and after first cases reported in region and correlation between IPCs, teleconsultations and new admissions to Covid-19 wards during pandemic.

Methods

IPCs were analysed dividing in pre (February 1st, 2019-February 29th, 2020) and post (March 1st, 2020-March 31st, 2021) Covid-19 emergency period and comparing mean months values with t-test. IPCs and teleconsultations delivered during emergency (March 1st, 2020-March 31st, 2021) were divided in months and correlated with new admissions to Covid-19 wards in the same period with Pearson test.

Results

IPCs delivered in pre-Covid-19 period compared with post were 1,105,823 vs 973,350 (-12%), peaking in October (98,980 vs 86,821; -12.3%) and minimum in April (82,061 vs 61,523; -25.1%). Pre-Covid-19 mean IPCs were significantly different compared to post (85,063 vs 74,873; p=.003). Focusing on emergency period, IPCs were negatively related to teleconsultations (973,350 vs 2140; r=-.43; p=.13). The negative correlation found between new admissions to Covid-19 wards (9154) and IPCs was weak and not significant (r=-.12; p=.69), while a positive and significant correlation was found between teleconsultations and new admissions to Covid-19 wards (r=.59; p=.03).

Conclusions

Results showed a significant reduction of post-Covid-19 IPCs compared to pre and a significant correlation between teleconsultations and new admissions to Covid-19 wards in FVG during first year of Covid-19 emergency. Contagion containment measures and fear probably influenced access to outpatient services while teleconsultation should be considered as an alternative to face-to-face during pandemic period.

Key messages

A reduction of in-presence medical consultations was found in a north-eastern Italian region during first year of pandemic. Teleconsultation could be a valid solution in case of increasing Covid-19 hospitalizations.
The concept of Knowledge Translation in relation to Burden of Disease
Authors: Pallari E , Hilderink HBM
Published: October 2021

The importance to bridge the gap between research and policy making has been widely recognised. Also, in the field of Burden of Disease, this gap exists. There are various terms used to define the dynamic process of synthesising, exchanging and applying generated knowledge into policy making. These are among other interchangeably used terms: knowledge translation, research utilization, implementation science, knowledge transfer or knowledge exchange, here referred to as knowledge translation (KT). The driver behind the systematic effort of KT is to bridge the gap between the generation of that knowledge and its application such as to improve public health. Among communication strategies to achieve KT include the engagement with policy and decision-makers for effective use of the findings into potential benefits for the health and wellbeing of the population. Other strategies, include the development of patient-public-involvement partnerships to communicate the findings with the public and create an open dialogue for further use of research results into practice. The focus of KT by researchers to date has mainly been on the ‘translation' of biomedical research, including findings from clinical trials, evidence from clinical practice guidelines, mixed-methods data on the development of implementation tools and other. However, similar findings on the translation of such evidence from burden of disease studies (BoD) have been non-existent. Potential reasons for this may have been challenges such as creating effective engagement strategies with appropriate stakeholders for the use of BoD findings, establishing a common methodological framework, difficulties in interpreting the findings for health-policy purposes, or miscommunication practices on the value and impact of BoD. Further, BoD methodological tools require specialist knowledge and interpretation of results into practice, hence, making KT even more challenging. Therefore, the prospect of developing a KT framework specifically for BoD remains an opportunity but also a pressing challenge.
Scottish Burden of Disease (SBOD) study: a population health surveillance system for meaningful action
Authors: Wyper G , Grant I , Fletcher E , De Haro Moro MT , McCartney G , Stockton DL
Published: October 2021

In 2012, planning began to launch the Scottish Burden of Disease (SBOD) study. The aim was to create a population health surveillance system to assess the impact of over 100 causes of disease and injury, and risks, measured by disability-adjusted life years (DALYs). The study has become a mainstay over the last five years as a tool to aid strategic and proportionate decision-making. In 2017, its scope expanded to highlight the extent of inequalities in DALYs by socioeconomic status. Additionally, it now provides comprehensive estimates for 14 regional Health Boards, which are responsible for protecting and improving the health of their local populations. It also provides estimates for 32 local government regions, which provide services related to the broader determinants of health, such as: education, social care and housing. To help turn findings from the SBOD study into action, push, pull and integrated efforts are used. Push efforts involve working together with publishing and communications leads to share key findings. These are commonly in the form of plain English and academic reports, summary briefings, social media messages and infographics. Key messages are also shared through television, radio and newsprint. Pull efforts have recently been improved to house estimates within interactive R Shiny dashboards, which contain user-friendly charts and easy to download data. Integrated approaches involve working with relevant national and local stakeholders, to help shape national and local priority setting. Findings from the study are being used by national and local government and health institutions. Third sector organisations are also key users of SBOD findings, particularly for health conditions that generate high-levels of ill-health, rather than mortality. In 2021, the study will publish an update, and increase capacity on integrated efforts to further embed the SBOD in national and local strategic planning.
Documenting experiential knowledge to enhance breast and cervical cancers screening uptake in France
Authors: Gaspard S , Georgelin B , Soudier B , Halfen S ,   IPCSP Project Steering Committee, Bouhier F , Berdougo F , Rush E
Published: October 2021

Issue

Improving uptake of Cancer Screening programs (CS) remains a public health priority in France, as stated in the latest national cancer control strategy. The French Society for Public Health designed in 2020 a project to document Interventions Promoting CS Participation (IPCSP) for vulnerable groups, for both breast and cervical cancers. This project provides experiential and practical evidence built up from IPCSP and offers relevant insights for the new strategy.

Methods

The project aims at capitalizing, i.e. collecting, documenting and circulating, experiential knowledge from practitioners who implement IPCSP locally (health professionals, social workers, grassroots organizations, etc.). The project consists in 3 main steps: 1/identify promising IPCSP through a nationwide call for applications; 2/ document the key mechanisms impacting how IPCSP unfold (context, partnerships, barriers and levers, ethics), 3/ publish a summary for each IPCSP, available online. The goal is to build up original knowledge from field actions, documenting how IPCSP tackle several factors that can hinder uptake, in various contexts.

Results

20 IPCSP were selected. IPCSP targets included: women of low-income neighborhoods, allophone women, inhabitants of healthcare deserts, handicapped persons, etc. Most IPCSP (16 out of 20) featured reaching out strategies, such as: peer education, on-site screenings, etc. All promoted informed choice. A cross-case analysis of IPCSP highlighted key, recurring implementation levers. One is co-constructing IPCSP throughout within local, multi-professional, long-standing partnerships, in which partners bring complementary skills: medical expertise, proximity with target populations, project management skills, community engagement skills, etc.

Lessons

20 detailed summaries will offer concrete data on how to put insights to enhance CS uptake into action. Other stakeholders and policymakers alike can benefit from experiential knowledge built up from IPCSP.

Key messages

Documenting interventions promoting uptake of breast and cervical cancer screening programs and detailing how they work is crucial to building knowledge and to helping enhance participation for all. Partnerships can provide effective, population-specific and context-specific levers to promote uptake of cancer screening programs in France. Co-constructing the intervention throughout is key.
Effect of peer-education on the willingness to vaccinate against COVID-19 among high school students
Authors: Pasek O , Michalska J , Piechowicz M , Stoliński M , Ganczak M
Published: October 2021

Introduction

The willingness to vaccinate against COVID-19 among adolescents remains low. Peer-education about SARS-CoV-2 may positively influence attitudes to vaccinate among this group.

Objective

To assess the influence of peer-based educational intervention on the willingness to vaccinate against COVID-19 among Polish high school students.

Methods

In the Polish Lubuskie province, a peer education campaign was introduced among final year high school students from 24 randomly selected schools. Before and after the 45-minute lecture, conducted online by 13 medical students in 51 classes with science and other programs, the willingness to vaccinate was checked using an anonymous questionnaire. The p-value was calculated with the use of chi-square and Wilcoxon signed rank tests.

Results

Out of 883 students, 638 responded (72%); 268 males (42%), mean age: 18.4±0.6 years, 69% lived in cities with <100,000 inhabitants, 32% were in the science program. The willingness to vaccinate improved from 31.8% to 35.2% after education (p < 0.001); in females from 29.7% to 33.1%; in males from 34% to 37.7% (p < 0.002; p < 0.01 respectively). Before intervention 43.5% students living in the large cities and 26.5% in small cities wanted to be vaccinated, this increased to 48.0% and 29.5% respectively (p < 0.003; p < 0.005) after intervention. There were significant between-locations and between-programs differences in the willingness to vaccinate before and after intervention (p < 0.001; p < 0.001 and p < 0.001; p < 0.001 respectively). The improvement in the science program was from 44.3% to 47.8%; in the other programs from 26.1% to 29.5% (p < 0.01; p < 0.002 respectively).

Conclusions

Adolescents' willingness to vaccinate against COVID-19 was alarmingly low, especially among females, students from small cities and attending the non-science program. Concise integrated teaching designed to address mistrust and knowledge deficiencies can be effective in improving the uptake.

Key messages

Research provide data about students’ attitudes towards COVID-19 vaccination and indicate the need for universal educational campaigns. Online education is an effective method which may substantially increase COVID-19 vaccination rate in Poland.
Mental health promotion in France during the Covid19 pandemic
Authors: Arwidson P
Published: October 2021

Public Health France have put in place a psychobehavioural surveillance system quickly after the beginning of the first lockdown in March 2020. Aside questions about people's perceptions about the pandemic (worry, perceived level of risk...), and their protective behaviours (social distancing, hand washing...), a module of questions on mental health (anxiety, depression and life satisfaction) was introduced. 22 rounds of this survey called CoviPrev have now been undertaken. This survey has been instrumental in raising the awareness by the government on the negative impacts of the pandemic on the mental health of the French population. We have designed, scientifically tested a media campaign to support the population's mental health. This campaign is now on air. This is the first national mental health media campaign since 2007. We hope it will initiate a long-term communication strategy aimed at promoting the mental health of the population.
Othering of Forced Migrant Women in Maternal Care. Becoming a Mother – Being constructed as Other: Results of a qualitative study in Germany
Authors: Engelhardt M , Gaudion M , Kamhiye J , Borde T
Published: October 2021

Refugee women are legally entitled to all necessary medical services related to pregnancy - including medical check-ups, childbirth costs, and midwifery assistance. However, studies indicate that they face structural barriers to maternal care access and are at greater risk of having poor pregnancy outcomes. This study aimed to explore the role of attributions of Otherness and practices of Othering in maternal care and the consequences for the quality of maternal care for forced migrant women in Germany. Qualitative semi-structured problem-centered interviews were conducted in three regions. The study sample includes 64 health care professionals (social workers, midwives, gynecologists) as well as 15 forced migrant women who recently gave birth to a child. Interviews were analyzed via framework analysis to identify perceptions, attitudes, and contextual conditions of providing maternal care to female refugees and to examine their experiences in the German maternity health care system. Most professionals showed an implicit, rarely questioned notion of an ostensible center of motherhood and parenthood. The qualitative results show how forced migrant women are constructed as other to this presupposed center of mothers. The practice of Othering occurs individually by health care professionals as well as structurally by the German asylum system and health care system. Both exclusionary and benevolent processes of Othering come into play. The effects of those attributions of Otherness are described from the perception of refugee new mothers concerning their pathways, resources, and obstacles in maternal care. Opportunities to achieve adequate maternal care for mothers and parents constructed as others from an ostensible and rarely questioned center of motherhood and parenthood are presented and discussed. To face diversity in maternal care, the notion of the center needs to be critically discussed as well as different aspects of consequences of Othering.
Excess all-cause mortality from January to August 2020: a temporal analysis in 20 countries
Authors: Demetriou CA , Achilleos S , Quattrocchi A , Gabel J , Heraclides A , Kolokotroni O , Constantinou C , Pagola Ugarte M , Nicolaou N , Rodriguez-Llanes JM
Published: October 2021

Analysis of all-cause mortality is an important tool to investigate the impact of the COVID-19 pandemic. This study aims to investigate the magnitude and potential determinants of excess all-cause mortality, from January until August 2020, using national mortality databases from 20 countries part of the C-MOR consortium. Excess weekly mortality for 2020 was calculated by comparing observed against expected weekly number of deaths for 2020. Expected 2020 weekly mortality was estimated using 2015-19 data based on a time series model adjusting for time trend and seasonality. The excess mortality was visualized against a stringency index (SI), based on nine government response indicators, downloaded from the Oxford COVID-19 Government Response Tracker. Brazil, Cyprus, France, Ireland, Italy, countries of the UK, Spain and the USA showed a substantial increase in the observed mortality during 2020, which lasted from 1 (Cyprus) to 7 (England and Wales, Scotland) weeks. Australia, Denmark and Georgia observed fewer than expected deaths, whereas in Austria, Estonia, Israel, Norway, Slovenia and Ukraine 2020 mortality was as expected. Italy, Spain, UK and Brazil enforced high SI measures at least after 3 weeks from the first COVID-19 death. Sweden and the USA did not apply high SI measures for the duration of this study. In Austria, Estonia, Israel, Norway, Cyprus, Georgia, Slovenia and Ukraine, measures of high SI were implemented within 2 weeks of the first COVID-19 death. The decreased mortality in Australia is probably attributed to different seasonality patterns coupled with strict control measures. Several but not all countries showed excess all-cause mortality. Excess mortality was shown to be influenced by the seasonality patterns of each country, as well as the promptness of governments to apply high SI control measures. As the pandemic continues, the lessons learned from the first months of the pandemic can prove useful to minimize increases in all-cause mortality.

Key messages

Some countries showed excess all-cause mortality between January and August 2020, whereas others displayed either negligible excess mortality or even a decrease in all-cause mortality. Excess mortality may be partly attributed to delayed application of strict control measures whereas lack of excess mortality may be due to seasonality and/or strict control measures.
One Health in Urban environment- public health challenge for the future
Authors: Jevtic M , Savic S
Published: October 2021

Urban environment is a specific one in which are citizens and also their pets and other animals looking for a mutual place for a qualitative life. Humans are trying to make their life as good as possible, bringing the “nature” inside urban environment, but not always thinking through if urban environment will have effect on that “nature” - pets and plants in houses. The availability of data on number of pets in urban environments is being studied. It is estimated that in a city of 500.000 inhabitants, there are around 17.000 dogs, but number of cats is even more challenging to find. Which towns are the highlighted ones with developed culture of cohabitation? The ones with equally developed conditions for the life “of all. WHO (1990) suggests that dog ecology and related anthropological aspects can serve to establish background information for the planning and implementation of dog population management schemes and for the control of zoonotic diseases. Dog population density is related to different habitats, cultures, and social conditions of human populations (Fielding and Plumridge 2005). For example, Albert and Bulcroft (2015) in their study underline the important social and emotional roles that pets play in the urban household. People in cities demonstrate high levels of attachment, caring, and intimacy towards their pets. Pets are viewed as important members of households and owners are willing to spend high budget of money on needed medical or preventive care for their pets. One health concept in an urban environment has a specific significance from overcoming common risks for humans and animals point of view. The risk of infectious diseases is probably the most common one, including zoonotic diseases. This risk can even be a life threating one. There is also the risk of non-infectious diseases and influence of the mental health of owners to pet's life. Also, the influence of owner's life style to the life of pets - eating, walking and other habits.
Ghana: health system review 2021
Authors: Opoku D , Edusei AK , Agyei-Baffour P , Teddy G , Polin K , Quentin W
Published: October 2021

A health system review provides a detailed description of a health care system and of reform and policy initiatives in progress or under development. The health system review of Ghana serves as an effort to also assess the system's performance towards the attainment of universal health coverage (UHC). A workshop was organized in 2018 to develop a template for writing the health system review of Ghana. This serves as a pilot study to test the feasibility of using a template somewhat like that of the WHO European Observatory on Health Systems and Policies for writing health system reviews of African countries. The health system review of Ghana is the first to be written for an African country modelled after the HiT reviews by the European Observatory. One key characteristics of the health system of Ghana is the introduction and reform of the national health insurance scheme (NHIS) in 2003 and 2012 respectively. About 40% of the population are enrolled and 60% enrolled are exempted from premium payments. Ghana has since 2010 scaled-up a national telemedicine programme, becoming one of the first adopters and innovators in Africa to integrate digital health technologies into mainstream health care system. Since 2018, Ghana has implemented the NHIS mobile renewal service, which allows payment of health insurance coverage using mobile money technologies. Ghana is one of the first countries to introduce a nationwide health insurance in Africa. The NHIS is one significant effort towards health systems strengthening and achieving UHC. Enrolment in in the NHIS contributes to better access to health care and improved financial protection. However, not only is population coverage low, but there is a serious concern about the system's financial sustainability. A promising approach is to improve the mobile-money based intervention through the high mobile-phone penetration rates in Ghana to enable more effective household saving arrangements towards UHC.

Key messages

Ghana presents important lessons, including the introduction of a national health insurance. This contributes to better access to health care and improved financial protection. Ghana is exploiting the use of mobile phone technologies and has become one of the first adopters and innovators in Africa to integrate digital health technologies into mainstream health care system.
Associations of university student life challenges with mental health and self-rated health
Authors: Porru F , Schuring S , Bültmann U , Portoghese I , Burdorf A , Robroek S
Published: October 2021

Background

Mental health problems are highly prevalent among university students. Stress due to student life challenges may be a risk factor for poorer health. This study investigates to what extent student life challenges and changes therein are associated with mental health and self-rated health.

Methods

In a longitudinal study with 568 Italian university students mental health was assessed using the Mental Health Inventory-5 (MHI-5) and self-rated health with a single item from the Short Form 36 Health Survey (SF36) (score ranges: 0-100) at baseline and at six months follow-up. Student life challenges were investigated using six subscales (score ranges: 1-4) of the Higher Education Stress Inventory (HESI). A between-within linear regression model was used to investigate whether a higher exposure to life challenges was associated with poorer health (between individuals) and whether changes in student life challenges were associated with changes in health (within individuals).

Results

Higher exposure to student life challenges was associated with poorer mental health (b ranging from -5.3 to -10.3) and self-rated health (b ranging from -3.1 to -9.6). An increase in student life challenges within individuals was associated with poorer mental health and self-rated health, in particular for high workload (b up to -5.9), faculty shortcomings (b up to -5.7), and unsupportive climate (b up to -5.6).

Discussion

Exposure to student life challenges and changes therein are associated with university students' health. Our findings suggest that student life challenges may be a target for interventions to improve mental health and self-rated health among university students.

Key messages

Mental health and self-rated health differ between students and change within-them. Higher exposure to student life challenges is associated with poorer health, and an increase in student life challenges is associated with a decrease in health.
Heatwave-related morbidity in Australia: Effect modification by Individual and Area-level factors
Authors: Varghese B , Beaty M , Bi P , Nairn J
Published: October 2021

Background

Heatwaves are associated with increases in mortality, emergency department visits, and hospital admissions. However, evidence regarding heatwave impacts on general practice (GP) visits is limited. The objectives of this study were to quantify the impact of heatwaves on GP visits in Australia and identify the individual and area-level factors that modify the heatwave-GP visits association.

Methods

Warm-season (October-March) GP visits data (2011-2016) were obtained from the Australian Bureau of Statistics. Using a case-crossover approach we assessed the effect of heatwaves (defined using Excess Heat Factor) on GP visits at the Statistical Area Level 2 (SA2) spatial unit (reflecting suburbs), as well as effect modification by individual and area-level factors. Results are reported as percent increase in GP visits during severe/extreme heatwaves compared with non-heatwaves.

Results

Nationally, GP visits increased by 4% (95%CI: 3-4%) during severe/extreme heatwaves. But impacts varied with the highest effect observed in Canberra (16.4%; 95%CI:15.4-17.4%), Adelaide (14.9%; 95%CI: 14.3-15.4%), and regional Victoria (13.5%; 95%CI: 13-14%). A gradient of impact was found within locations, for example, vulnerable SA2s nationally were featured by a higher proportion of populations with no air-conditioning, low income, limited English proficiency, living alone, and a prevalence of diabetes and circulatory diseases. Individual-level factors included those: living alone, with limited English proficiency, with diabetes, hypertension and using anti-coagulants and diuretic medications.

Conclusions

Heatwaves increase GP visits in Australia, with impacts varied between locations and populations, affecting certain areas and individuals disproportionately. Our results using an individual and area-level linked data suggest that local area and individual vulnerabilities should be incorporated when developing place-based interventions combating heatwave-health impacts.

Key messages

Heatwaves increase GP visits in Australia, but with spatial variability across and within locations. Individual and area-level factors contribute to heatwave-vulnerability.
Climate change and the city: analysis of the urban heat island effect on mortality in Valencia, Spain
Authors: Boned Fustel P , Cuesta Peredo C , Boned-Ombuena A , Carreiro G , Fustel Rodríguez M
Published: October 2021

Background

Heatwaves are increasing due to climate change and they are responsible for more fatalities than any other extreme meteorological phenomenon. An excess of mortality can occur during heatwaves, and it is usually higher in cities than in rural areas. This can be partly explained by the urban heat island effect, a human-induced modification of the local temperatures. This study assessed the effects of the July 2017 heatwave -one of the highest in recent years according to Heat Index available data- in Valencia (Spain).

Methods

Analytic, observational, and retrospective study on the effects of the 27-31 July 2017 heatwave in the city and province of Valencia on population mortality. Observed and expected number of deaths in our population were compared, using the same period of 2013 as a reference, and Standardized Mortality Ratio (SMR) was calculated for the capital city (urban area) and the province (suburban and rural areas) of the Valencian Region (Spain).

Results

The analysis showed a significant excess of mortality in the city of Valencia (787,808 pop) during the July 2017 heatwave, with an SMR of 1.634 (95% CI 1.356-1.952). In that period 116 deaths occurred, mean age 79.7 years, 50,7% women. By age groups, the population above 65 years was identified as the most vulnerable, with an SMR of 1.607 (95% CI 1.311-1.949). The mortality excess was 8% higher among men compared to women, although the difference was not significant. No significant increase in mortality was found in the province of Valencia (1,752,899 pop).

Conclusions

The July 2017 heatwave in the Region of Valencia brought an excess of mortality in its capital city, which did not take place in rural areas. Elderly are especially vulnerable to these extreme temperature events. Our findings raise awareness on the importance of climate change mitigation and adaptation measures, especially as regards its effects in urban areas. The regional heatwave protocol for nursing homes was enhanced.

Key messages

Adverse climate events are increasing due to global warming. The July 2017 heatwave in the Region of Valencia brought an excess of mortality in its capital city, especially among elderly. This study raises awareness on the need for climate change mitigation and adaptation measures, especially as regards the urban heat island effect.
Effects of high temperatures on poor mental health outcomes: a systematic review and meta-analysis
Authors: Liu J , Varghese B , Hansen A , Bi P
Published: October 2021

Background

In the context of warming temperature and increased prevalence of mental disorders, a growing body of literature suggests the adverse effects of high temperatures on mental health. However, no study has quantitatively summarised the evidence. This study therefore systematically reviews the epidemiological evidence and summarises the quantitative effects of high temperatures on mental health outcomes, including mortality and morbidity.

Methods

A systematic search of peer-reviewed epidemiological studies in five databases that linked high temperatures and mental health was conducted on literature published till November 2020. A range of mental health conditions were defined using ICD-10 classifications. We included studies that examined the quantitative association between temperatures and mental health mortality or morbidity (i.e. hospital admissions, emergency presentations) in the general population. Random-effects models were used to summarise the percentage changes in mental health outcomes per 1 °C temperature increase.

Results

The keyword search yielded 4560 citations from which 34 studies were included in the meta-analysis. For 1 °C increase in temperature, the risk of mental health-related mortality and morbidity increased by 2.2% (95%CI: 1.5-2.9%) and 0.9% (95%CI: 0.7-1.5%). The greatest risk was associated with mortality attributed to substance-related mental disorders (4.6%; 95%CI: 0-10.1%), and organic mental disorders (3.3%; 95%CI: 2-4.6%). A 1 °C temperature rise was also associated with a statistically significant increase in morbidity such as mood disorders, organic mental disorders, and schizophrenia. Higher risk was evident for elderly and populations living in tropical and subtropical climate zones.

Conclusions

Our results suggest that exposure to high temperatures increases the risk of poor mental health outcomes. These risks will likely increase with a warming climate.

Key messages

High temperatures are associated with poor mental health outcomes, including mortality and morbidity. The findings reinforce the need for preventive intervention to protect vulnerable populations.
Global comparison of mitigation and vaccine behaviours, motivators, and communication
Authors: Lavoie KL , Stojanovic J , Bacon SL ,   for the iCARE study team
Published: October 2021

Issue/problem

In an unprecedented effort to end the pandemic, national mitigations strategies have been implemented and highly effective vaccines have been developed and rolled out in record time. Success of many of these public health endeavors is contingent upon people being willing to engage in proposed behaviours.

Description of the problem

The key to slowing the spread of COVID-19 and ending the pandemic, is public adherence to the rapidly evolving behaviour-based government policies. However, adherence to these policies involves implementing behaviour changes that may come with significant personal, social and economic costs. In addition, public health vaccination campaigns are widely available, and the success of these initiatives is dependent on the behaviour of people getting the vaccine. Understanding the determinants of adherence at each phase of the infection curve around the world is critical for effective policy planning and communication.

Results

The results of the global iCARE study demonstrated a substantial level of national variations, when it comes to engaging in preventive behaviours (social distancing, mask-wearing, hand-washing, self-isolating). Moreover, we observed increasing levels of COVID-19 vaccine hesitancy across several countries. Adherence to these behaviours seems to be driven by socio-demographic (e.g., age, sex, gender, ethnicity, parental status, employment/ student status, built environment, healthcare system factors), psychological (e.g., COVID-19 attitudes, beliefs and concerns), behavioural, physical/mental health, and economic factors.

Lessons

iCARE study offers deeper understanding and continuous assessment of the predictors of behavioural adherence globally. To this end, the study identified possible communication targets, and proposes tailoring the format and the content of the communication, which should be consistent, prioritize equity, foster transparency and trust-building in different communities.
A Tale of Two Pandemics in Three Countries
Authors: Saboga-Nunes L , Peralta-Santos A , Magalhães PC
Published: October 2021

Issue

Italy, Spain, and Portugal's health systems are financed through general taxation, are generally free at the point of care, and provide universal health coverage. The three national health systems emerged in the late 1970s, in Italy as the result of the collapse of the previous social health insurance system and in Spain and Portugal as part of their democratization. They share some standard organizational and performance features that constitute potential strengths and vulnerabilities when facing a pandemic event.

Description

One of the most salient of these features is the impact of a decade of fiscal austerity. During the Great Recession and the Eurozone crisis, the governments of Italy, Spain, and Portugal decreased the budget available for health care, leading to cuts in long-term infrastructure investments and making it even more difficult to deal with the problem of workforce.

Results

Compared with northern European countries, these countries have very efficient healthcare systems. In other words, the return in terms of population health is very good for every Euro invested.

Lessons

However, in what is only apparently a paradox, efficiency is not an advantage during a pandemic. If all the resources are fully optimized, any significant surges in demand, such as those experienced during early March 2020 in Italy and Spain, this favors a collapse of the health system. Portugal seemed especially vulnerable, as it had the lowest number of intensive care unit beds per inhabitant in Europe and one of the lowest levels of investment in public health services in Europe.

Main messages

In 2015, on average, the countries of the Organization for Economic Co-operation and Development (OECD) allocated 2.8 percent of their total healthcare budget to health promotion and disease prevention. More investment in health promotion is a need strategy to drive countries over critical conditions.
Machine learning and COVID-19: a tool for healthcare setting choice by primary care physicians
Authors: Vetrugno G , Foti F , Di Pumpo M , Cicconi M , D'Ambrosio F , La Milia DI , Pastorino R , Boccia S , Damiani G , Laurenti P
Published: October 2021

Background

Primary care physicians have a crucial role in determining the appropriate healthcare setting for their confirmed or suspect COVID-19 patients. Machine learning provides science-based tools that can be used for clinical decision-making which have already been applied to the fight against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) both in the therapeutic and the prevention area. The aim of this study was to develop a machine learning-based tool to support primary care physicians to decide between home monitoring and hospitalization for their patients before diagnostic test results are available.

Methods

A retrospective cohort study with data from a hospital setting was performed. Patients' medical history and clinical, laboratory and radiological findings were collected and the dataset was used to train a predictive model for COVID-19 severity. The patients were divided between confirmed and suspect cases on the basis of the positivity of the nasopharyngeal RT-PCR test results. A splitting algorithm was recursively used to choose the predictor. A decision tree was built.

Results

A total of 198 subjects were enrolled for the study. Out of them, 28 cases were classified as mild disease, 62 as moderate disease, 64 as severe disease, and 44 as critical disease, according to WHO guidelines. The G2 value was used to determine the contribution of each obtained value to build the decision tree. The tree was, therefore, built choosing values that maximized G2 and LogWorth. SpO2 (cut point = 92%) was chosen for the optimal first split. The correspondence between inputs and outcomes was validated.

Conclusions

Our tool provides accurate clinical severity prediction for both confirmed and suspect COVID-19 patients. We, therefore, propose its implementation in the everyday life challenges of primary care physicians to support their clinical decision-making in providing appropriate and timely care for their patients.

Key messages

Primary care physicians have a crucial role in determining the appropriate healthcare setting for their confirmed or suspect COVID-19 patients. We propose a tool that provides an accurate clinical severity prediction for both confirmed and suspect COVID-19 patients to help choosing the appropriate healthcare setting for them.
Poverty and energy issues as environmental and health challenges in SDGs
Authors: Jevtic M , Matkovic V , Bouland C
Published: October 2021

In 2019, 21.1 % of the EU-27 population were at risk of poverty or social exclusion. Energy poverty is one of many poverty forms and it is a widespread problem across Europe, as between 50 and 125 million people are unable to afford proper indoor thermal comfort. Energy poverty is linked to low household income, high energy costs and energy inefficient homes. These challenges are deeply connected with SDG7 and SDG1, and also produce environmental pollution. The roots of energy poverty are in polluting fuels that are the cheapest and at hand to the population in (risk of) poverty. Biomass heating is the inefficient use in old stoves and the lack of wood drying before use (the loss of up to 50% of the energy and higher energy costs of heating). Biomass and coal is also a major contributor to poor air quality in many European regions, especially in eastern part of the EU and Western Balkans. Biomass smoke contains health-damaging substances (particulate matter, PAHs etc). Studies on indoor air pollution show concentrations of PM10 may extremely exceed standards for ambient air pollution levels and put the people (mostly women and children), at increased risk of health impacts. Biomass burning also leads to the release of black carbon, which is not only a concern for health, but also as short-lived climate change forcer (SDG 13). A conservative estimate of the current contribution of biomass smoke to premature mortality in Europe amounts to at least 40,000 deaths per year. The inefficient use of the biomass means higher costs for already ‘disadvantaged' citizens and those in risk of (energy) poverty. Energy poverty is a distinct form of poverty associated with a range of adverse consequences for people's health and wellbeing (respiratory diseases, CVD, mental health, and stress associated with unaffordable energy bills). Poverty and energy issues as environmental and health challenges should seen through SDG 1 and SDG 7, but also through SDG 8, SDG1 1 and SD G3.
Challenges of innovation and implementation of care and payment models
Authors: Venema Marcel
Published: October 2021

This presentation will serve as an introduction towards the particularities of organisational innovation, particularly highlighting the challenge of implementing innovative ideas due to the unique context that healthcare providers are rooted in.
The experience of the Center for Medicare and Medicaid Innovation (USA)
Authors: Bassano Amy
Published: October 2021

Since 2010, the CMMI has been testing new payment and service delivery models, evaluating the results and advancing best practices, and engaging with a broad range of stakeholders to develop additional models for testing. This presentation will showcase over 10 years of experience in managing an innovation funding programme, allowing for an interesting comparison to their European counterparts.
Action Plan on Women's Health' with 40 measures for women's health in Austria (2018) – From reporting to action
Authors: Gaiswinkler S
Published: October 2021

Background

4,5 million women are living in Austria, in different life-phases and living conditions. Women's health situations, health-related behaviour and disease courses differ from men. The Austrian Action Plan on Women's Health addresses the need to increase equal health opportunities for women.

Methods

The Action Plan is developed by a broad, multidimensional, cross-political (HiAP) process with around 50 experts and organizations. A survey at the beginning provided the basis for identifying issues of health that affect “only women, mainly women or women differently”. Goals and measures are based on 8 socio-economic principles and connected to WHÓs Strategy on Women's Health. The outlined actions are following three life-phases of women (girls/young women, working age, older women) and include one age-spanning focus.

Results

The Action Plan addresses all women in Austria. It includes measures in the fields of research, care, health literacy, women-related diseases (e.g. cervical and breast cancer), sexual-reproductive health or mental health. It is also strongly emphasizing socio-economic determinants that influence health outcomes. Within 17 goals and 40 measures disadvantaged women (e.g. migrant women, women affected by poverty and violence, disabled women) are prioritizes. Measures also target women-related working conditions like the distribution of paid and unpaid work.

Conclusions

The Action Plan was presented by the Austrian Minister of Health in 2017 at the 1st Women's Health Dialogue. The implementation is carried by a triangle of pillars: Focal Points in each federal state as coordination link, Focal Point Meetings for expert exchange and once a year a Women's Health Dialogue. The strategy provides a structure of experts on womeńs health, drives the implementation of measures and supports activities for raising the awareness on sex and gender-related health-issues.
Spectacle wear and refractive errors in Dutch children
Authors: Iyer V , Enthoven CA , van Dommelen P , Samkar A van , Groenewoud JH , Reijneveld SA , Jaddoe VWV , Klaver CCW
Published: October 2021

Background

Myopia is a refractive error that is increasing dramatically all over the world. Early onset is associated with a significant visual burden later in life, but little is known about refractive errors in preschool children. The aim of this study was to assess prevalence of spectacle wear, visual acuity and refractive errors in young Dutch children and to make global comparisons.

Methods

We analyzed data of three prospective population-based studies: 99,660 3- to 5-year-olds undergoing vision screening at preventive child healthcare organizations, 6,934 6-year-olds from the Generation R study, and 2,974 7-year-olds from the RAMSES study. Visual acuity was measured with Landolt-C or LEA charts, spectacle wear was assessed, and refractive errors at age 6 and 7 were measured with cycloplegic refraction. Spectacle wear was compared with international studies.

Results

The prevalence of spectacle wear was 1.5%, 2.3%, 6.6%, 8.2% and 11.8% at 36, 45, 60, 72 and 84 months, respectively, with no major sex differences. Among children with spectacle wear at 72 months (N = 583) and 84 months (N = 351) 29.8% and 34.6% had myopia respectively, of which 21.1% and 21.6% combined with astigmatism, 19.6% and 6.8% had hyperopia, 37.2% and 11.1% hyperopia and astigmatism, and 12.5% and 33.3% astigmatism only. The prevalence of spectacle wear globally varied between 1.5% to 21%.

Conclusions

Spectacle wear in these European children started early in preschool and increased to substantial figures at school age. Among children with spectacle wear, >30% were already myopic, illustrating the urgency to implement myopia prevention strategies in child health centers.

Key messages

Early onset myopia is a public health issue. Of the 6- to 7-year-olds with spectacles 30-34% were already myopic. Monitoring of refractive errors and preventive lifestyle interventions are warranted.
Discrimination impairs cognitive function in ageing men and women
Authors: Lindert J , Paul K , Lachman M , Ritz B , Seeman T
Published: October 2021

Background

We sought to assess changes in episodic memory and executive functioning among men and women in the Midlife in the United States (MIDUS) cohort study; and to delineate variations in episodic memory and executive functioning by gender; and to determine the impact of discrimination on longitudinal changes in episodic memory and executive functioning.

Methods

We used data from the MIDUS study - a national probability sample of non-institutionalized, English speaking respondents aged 25-74 living in the 48 contiguous states of the United States. The initial wave in our study (1995) included 4963 non-institutionalized adults aged 32 to 84 (M = 55, SD = 12.4). Dependent variables are episodic memory and executive functioning, assessed with the Brief Test for Cognition. The independent variables were discrimination (lifetime and daily discrimination) variables. Furthermore, we investigated baseline cognition score, race/ethnicity (White, Hispanic, other), education (some college or more vs high school of less), whether or not living with partner, income (per 100% above Federal Poverty Level), unemployed (vs employed), retired (vs employed), physical health (self-reported), vigorous physical activity, depression (continuous scale), anxiety (continuous scale). To assess cognition changes we estimated adjusted linear regression models.

Results

Cross-sectional, work discrimination was associated with cognition in men and women. Longitudinally, adjusting for baseline cognition score, race/ethnicity, education, living situation, income, (un)employed, (not)retired, physical health, vigorous physical activity, depression, and anxiety, we found an association of family strain with cognition changes in high-income men, and an association of daily discrimination with cognition changes in men (Beta 0.01, P-value: 0.001).

Conclusions

Reducing discrimination might be an important measure to support cognitive function in ageing populations.