bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospital admissions in Austria during the COVID-19 Pandemic – a rapid analysis for 2020 and 2021
Authors: Ostermann H , Eglau K
Published: October 2022

Background

The COVID-19 pandemic posed a substantial shock to health service provision, in particular regarding hospital services. The reasons and also rationales for reduced health service provision were manifold ranging from limited supply due to resource restrictions, limited demand in order to avoid infections or due to reduced incidence of various diseases, and postponement of elective services. Nevertheless, the provision of services for acute care at an adequate level is paramount to avoid patient harm.

Methods

Hospital admissions were analysed via administrative DRG data reported by Austrian hospitals. We compared health service provision on a monthly basis between 01/2018 and 12/2021. Services were classified according to ICD-10 and encompassed admissions due to acute heart failure, stroke, accidents, knee and hip surgery and breast cancer surgery.

Results

Our findings show that hospital admissions for acute heart failure decreased by up to 25% between 03/2020 and 05/2020. In contrast, no significant difference to the initial pre-pandemic levels could be observed in the later stages of the pandemic. Stroke admissions remained at the initial levels throughout the whole period of analysis, while a substantial decrease (up to 50%) in admissions because of accidents was observed whenever severe NPIs were in place. Knee and hip surgery levels dropped in line with increasing ICU occupancy rates caused by COVID-19 patients. Decreases in breast cancer surgery could only be observed (up to 20%) during the four months of the pandemic (03-06/2020).

Conclusions

Our analysis provides an aggregated insight into service provision management in Austrian hospitals throughout the pandemic. While acute care was continuously provided for most areas of diseases and elective surgeries were widely postponed in line with pressure on ICU capacities, the decline in breast cancer surgery demands attention and further clarification of whether this decline was supply- or demand-driven.

Key messages

• During the pandemic inpatient acute care services were continuously provided for most diseases in Austrian hospitals while elective surgeries were postponed in line with pressure on ICU capacities.

• The pandemic posed a substantial challenge to service provision management in hospitals and unwarranted levels of service provision so far indicate areas of action for future (pandemic) preparedness.
Ultra-processed food consumption and survival in older Italians from the Moli-sani Study
Authors: Bonaccio M , Di Castelnuovo A , Costanzo S , Ruggiero E , Esposito S , Persichillo M , Cerletti C , Donati MB , de Gaetano G , Iacoviello L
Published: October 2022

Background

Ultra-processed food (UPF) is a major public health concern being reportedly associated with increased risk of non-communicable diseases and lower survival. However, most of the epidemiological evidence has been almost exclusively provided by research conducted in populations of youths or middle-aged adults. We tested the hypothesis that a large dietary share of UPF could be a risk factor also for vulnerable groups, as older adults (≥65 years).

Methods

Longitudinal analysis on 5,215 men and women (mean age 72±5 y) from the Moli-sani Study (2005-2010, Italy) followed up for 10.9 y (median). Food intake was assessed by a 188-item FFQ. UPF was defined using the NOVA classification according to degree of processing, and categorized as quartiles of the ratio (%) between UPF (g/d) and total food consumed (g/d; weight ratio). The overall nutritional quality of the diet was measured by the Food Standard Agency nutrient profiling system dietary index (FSAm-NPS DI).

Results

UPF contributed to 8% (min-max 0.0-58.4%) of the total food eaten daily and represented 14.4% (0.0-70.0%) of daily energy intake. In multivariable-adjusted analyses controlled for known risk factors, higher intake of UPF (Q4, ≥10.2% of total food), as opposed to the lowest (Q1, UPF<4.3%), was associated with increased all-cause mortality (Hazard ratio [HR]=1.19; 95%CI 1.03-1.39); these results remained unchanged after adjustment for the FSAm-NPS DI (HR = 1.21; 95%CI, 1.04-1.41). A linear dose-response relationship of 1% increment in UPF intake with all-cause mortality was also observed (p = 0.017; p for non-linearity=0.85).

Conclusions

A large dietary share of UPF was associated with lower survival in older Italians consuming relatively low amounts of these foods. Expanding on previous studies on different age groups, these findings provide further justification to advise people to limit consumption of UPF even at older age.

Key messages

• A large dietary share of ultra-processed food was associated with lower survival in older Italians consuming relatively low amounts of these foods.

• These findings provide further justification to advise people to limit consumption of ultra-processed food even at older age.
Nurses’ coping with patients’ relatives: Attachment style, burnout, and intentions to leave nursing
Authors: Gur A , Gur-Yaish N , Sher-Censor E , Zisberg A
Published: October 2022

Background

Conflictual interactions with patients’ relatives are prevalent in the work of hospital nurses. These situations may increase burnout and result in intentions to leave the nursing profession and high rates of turnover. It is important to understand the coping mechanisms and behaviours that nurses employ in such conflicts, to help them develop more adequate strategies that could prevent these outcomes. This study aimed at revealing how nurses’ attachment styles colour their behavioural coping mechanisms when dealing with such interactions with patients’ relatives, and how they are related to burnout and intentions to leave the profession.

Methods

An online survey was completed by 140 hospital nurses that included three scenarios of typical conflicts with patients’ relatives. Each scenario was followed by questions that assess stress and inadequacy when handling such situations, and behaviours: problem-solving responses, emotional support seeking, avoidance, and escalating responses. The survey also included self-reports of attachment styles, burnout, and intentions to leave nursing. Data were analysed using SEM (Amos 23).

Results

The model shows an acceptable fit (χ2(24) = 39.33, p = .025; CFI = .963; RMSEA = .068). Higher anxious attachment was associated with higher stress and feelings of inadequacy in handling the situation, which in turn were associated with more emotional support seeking, avoidance, and escalating responses. Escalating responses were indirectly associated with intentions to leave the nursing profession via higher burnout. Higher avoidant attachment was associated with fewer problem-solving responses.

Conclusions

Evaluating nurses’ attachment style, cognitions, and behaviours in conflicts with patients’ relatives is imperative for understanding burnout and intentions to leave nursing. Nursing training should include simulations of conflictual interactions with patients’ relatives to help modify maladaptive coping.

Key messages

• Evaluating nurses’ attachment style, cognitions, and behaviours in conflicts with patients’ relatives is imperative for understanding burnout and intentions to leave nursing.

• Training for nursing staff should consider nurses’ awareness of their attachment style to modify maladaptive cognitions and behaviours in conflicts with patients’ relatives.
Individual and country-level variables associated with the medicalization of birth
Authors: Miani C , Wandschneider L , Batram-Zantvoort S , Covi B , Elden H , Hersoug Nedberg I , Drglin Z , Pumpere E , Costa R , Lazzerini M
Published: October 2022

Introduction

According to the World Health Organization, the medicalisation of birth tends “to undermine the woman's own capability to give birth and negatively impacts her childbirth experience”. The COVID-19 pandemic has disrupted maternity care, with potential increase in the medicalisation of birth and in occurrences of disrespectful maternity care. We aim to investigate potential associations between individual and country-level factors and medicalisation of birth in 15 European countries during the COVID-19 pandemic.

Methods

We collected data through an online, anonymous survey for women who gave birth in 2020-2021. We ran multivariable, multi-level logistic regression models estimating associations between indicators of medicalisation (caesarean section (CS), instrumental vaginal birth (IVB), episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country-level.

Results

Among 27173 women, 24.4% had a CS, and 8.8% an IVB. Among women with IVB, 41.9% reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalisation. For example, women who reported having CS, IVB and episiotomy reported not feeling treated with dignity more frequently than women who didn't have those interventions (respectively: OR: 1.37; OR: 1.61; OR: 1.51; all: p < 0.001). Country-level variables contributed to explaining some of the variance between countries.

Conclusions

We recommend a greater emphasis in health policies on the promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor the medicalisation of reproductive care.

Speakers/Panellists

Emanuelle Pessa Valente

WHO Collaborating Centre, Institute for Maternal and Child Health IRCCS, Trieste, Italy
3.O. Workshop: Structural stigma shapes LGBTQ+ mental health and well-being across countries
Authors:   Organised by: University of Exeter (UK),   Chair persons: David Doyle (UK)
Published: October 2022

Lesbian, gay, bisexual, transgender and queer (LGBTQ+) people around the world have been shown to suffer from disparities in mental health and well-being relative to cisgender heterosexual people. Past research aiming to explain these gaps has referenced the added stress experienced by LGBTQ+ people in the form of, for example, interpersonal discrimination, rejection, and harassment (i.e., minority stress). While these phenomena exist at the interpersonal level, emerging evidence suggests that discriminatory structural-level factors, such as policies, norms and rules (i.e., structural stigma), may be just as influential in shaping LGBTQ+ mental health and well-being. Given the passage of a slate of bills limiting sexual and gender minority rights and banning open speech around these issues across many different countries, this is an extremely timely issue for sexual and gender minority health. This workshop will give examples of cutting-edge research on the ways in which structural stigma affects mental health and well-being for LGBTQ+ people. Dr. Dinah Gutermuth (University of Exeter, UK) will discuss findings from a global study (conducted in partnership with the BBC) including older and younger LGB individuals from 113 different countries, showing that structural stigma impairs social capital and creates disparities in loneliness between younger and older LGB individuals. Berk Can Ünsal (Eötvös Loránd University, Hungary) will present data from Europe highlighting structural stigma as a risk factor, and community participation as a protective factor, for depression in sexual and gender minority people. Dr. John Pachankis (Yale University, USA) will present results on how migration from countries of varying levels of structural stigma shapes depression and suicidality in sexual minority men. Finally, Dr. Richard Bränström (Karolinska Instituet, Sweden), will discuss how average life satisfaction improved from 2012-2019 for sexual minority people across Europe, with greater increases in countries with higher levels of structural stigma. Together, these presentations will demonstrate the far-reaching effects of structural stigma on LGBTQ+ mental health and well-being around the world.

Key messages

• Lesbian, gay, bisexual, transgender and queer (LGBTQ+) people around the world have been shown to suffer from disparities in mental health and well-being relative to cisgender heterosexual people.

• Structural stigma is an important factor determining risk for poor mental health among LGBTQ+ individuals across countries.
4.B. Workshop: Addressing backlogs and managing waiting lists during and beyond the COVID-19 pandemic
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Ewout Van Ginneken (Germany), Sarah Reed (UK)
Published: October 2022

As COVID-19 cases started to rise in early 2020 and hospitalisation rates increased, health systems began to postpone non-emergency (elective) procedures to keep capacity available for COVID-19 patients, and to avoid elective patients being infected. This has subsequently led to longer waiting lists and waiting times in virtually all countries. Issues around staff recruitment and retention, which have been exacerbated by the COVID-19 pandemic, have further aggravated the problem. For patients with common elective surgeries, such as hip and knee replacements, the backlog in care means that improvements in health and quality of life are postponed. For urgent care, such as missed chemotherapy sessions for cancer care, the delays can have more severe consequences. For other patients, the postponement of specialist appointments may lead to missed referrals for serious ailments. Increasingly also primary care has become affected leading to late diagnosis of chronic diseases, as well as inadequate follow up and control of these patients. Each delay in diagnosis and treatment may worsen health problems, prolong recovery and decrease the patients’ chances of survival. Countries are now left playing catch-up on these backlogs. There is however great uncertainty regarding the size of the backlogs, how much current and future capacity will be required to address them, and how much provider and workforce capacity will be needed for COVID-19 patients which will detract capacity for non-COVID patients. If health systems do not manage to reduce the backlog, they risk worsening health outcomes and wasting important health gains made in the last years. This workshop will discuss what we know about (1) the level of service disruptions and resulting backlog, (2) the drivers of backlog, and (3) which policies countries are using to address this. The workshop will conclude with an audience discussion about how to measure the true size of the backlog, the policy options for overcoming backlog and key priorities for further research.

Key messages

• The COVID-19 pandemic has led to substantial disruptions in care delivery leading to care backlogs in virtually all countries.

• Countries have various policy options to tackle backlogs and bring down waiting times in the wake of the pandemic.
Engaging and supporting national public health institutes as key climate actors
Authors: Ballart A , Denys S
Published: October 2022

The International Association of National Public Health Institutes (IANPHI) collectively builds public health capacity by connecting, developing and strengthening national public health institutes worldwide. IANPHI recognizes climate action as a critical global public health intervention and acknowledges that public health interventions on environmental and socio-economic determinants of health are essential drivers of climate adaptation and mitigation. Recovery from the COVID-19 pandemic also provides a unique opportunity to reset business as usual and strengthen actions on climate change, biodiversity and health, while reducing social and health inequities in the long term. However, effective contributions of National Public Health Institutes (NPHIs) to adaptation plans and mitigation strategies for climate change have remained limited, with a primary focus on health surveillance to date. In this context, IANPHI developed a roadmap to support and reinforce the role of NPHIs in climate change mitigation and adaptation policies. Five priority actions were identified:

1. Advocate for strengthening NPHIs capacities to contribute effectively to climate and biodiversity research, policies, and action

2. Enhance capacity, competence and training through peer-to-peer support and knowledge sharing between NPHIs

3. Increase collaboration with international and regional organizations active in the fields of public health and climate change

4. Support the greening of public health services

5. Monitor progress in the NPHIs’ involvement in climate change policies through key indicators

In addition to discussing the roadmap, the presentation will focus on actions that IANPHI's Climate Change and Health committee initiated to reinforce the role of NPHIs in climate change mitigation and adaptation policies. This presentation will also provide information on how IANPHI can engage and support national public health institutes as key actors in the fight against climate change.
The NIPH’s response to the climate and environmental crisis
Authors: Aakra A
Published: October 2022

The vision of the Norwegian Institute of Public Health (NIPH) is better health for all. Climate changes and health are among our main strategic priorities. The NIPH aims to become a key actor in questions relating to climate, environment, food and health. An action plan on climate changes and environmental health is under development and will be presented. Climate and environmental changes affect the mental and physical health in several ways. The NIPH will in the coming years develop new knowledge on health consequences of climate changes: causes, risks, health effects and measures, based on our methodological expertise, research activities and infrastructures, such as health registers, health examinations, laboratories and biobanks. A key issue, and a main priority of the NIPH, is sustainable and climate-adapted food systems. There is a strong need to strengthen knowledge on healthy, safe and globally sustainable food. We will present and discuss our action plan for addressing climate and environmental health: Priorities, experiences, and challenges in implementation regarding e.g. competence and capacity building.

The following examples will be given:

– Research that addresses the food problem, and how to ensure a sustainable diet.

– The development of the MoBa Human Environmental Biobank to understand how climate and environmental changes affect exposure and public health, and how to follow the changes over time and help prevent disease.

– Examples of activities relating to clean air, clean and safe drinking water, and safe products from a One Health perspective: Achievements, projects, networks.

– Challenges in communicating health risks associated with the climate, environmental and pollution crisis to the public.

We encourage feedback and suggestions on NIPH's efforts to address the climate crisis, to ensure good knowledge sharing and that we are fully supporting our stakeholders.
Discussion table on computer science
Authors: Diethei D
Published: October 2022

Daniel Diethei is an expert in computer science, human-computer interaction and mobile health. He will support the workshop participants during the world coffee at the discussion table for computer science.
Economic evaluation of legislation-based public health interventions – the case of tobacco control
Authors: Perelman J , Leão T , Serrano-Alarcon M
Published: October 2022

Economic evaluation of public health interventions have mostly been performed for interventions whose cost and effectiveness can be well identified, such as protective interventions (vaccination or screening), clinical interventions (prevention drugs) or counselling and education programs. Yet, following the Thomas Frieden's health impact pyramid, these public health interventions are less effective than those “changing the context to make individuals’ default decision healthy”. The economic evaluation of population-based interventions that modify the context is rather challenging. First, such interventions include various components, e.g., taxes and subsidies, media campaigns or bans. Second, since they correspond to political decisions applied at a wide scale, their effectiveness can hardly be measured using experimental designs. Third, the cost of such interventions is difficult to assess, since they are not represented by a specific product or service, but rather by political decisions and their implementation, whose costing is not straightforward. Using the case of tobacco control policies, we show how alternative methods can be used to assess their economic value. We show that quasi-experimental methods with country comparisons allow identify the effectiveness of specific policies, and that qualitative approaches are needed to quantify their costs. Results indicate that tobacco-control policies have low costs and are highly effective, so that their cost-effectiveness is quite favorable in light of commonly referred thresholds, and in comparison with widely financed clinical interventions. Population-based interventions that focus contextual factors must also be carefully evaluated from an economic viewpoint. Although economic evaluations are challenging, alternative approaches help obtain results that are valuable for decision making.
Access of Syrian Refugee Women to Sexual and Reproductive Health Services in Turkey during COVID-19
Authors: Ontas E , Bahar Ozvaris S , Guciz Dogan B , Kutluk T
Published: October 2022

Women and girls are more disadvantaged in times of crisis, and their chances of surviving and fleeing are limited. As the Syrian crisis enters its eleventh year, Turkey alone hosts the largest population (over 3.7 million). It aimed to evaluate essential reproductive health services in the shadow of the pandemic that deepens the crisis. The research was conducted in April 2021 with 637 married Syrian refugee women aged 15-49 living in Ankara (mean age: 29.6). The median age at first marriage was 17, and consanguinity with her spouse was 29.8%. 8.6% were illiterate. 36.3% did not/could not benefit from public hospitals free of charge, and 89.8% did not have health insurance. 96.7% had a previous pregnancy (median:4). Since the pandemic's beginning, 35.6% have been pregnant (n = 219), and 14% are still pregnant (n = 86). Of 133 women whose pregnancies ended during this period, 78.2% gave birth (n = 104) and 21.8% miscarried. 12.8% of pregnancy was terminated at home (n = 17, 14 of which could not receive support from anyone). 41.1% of those who became pregnant during the pandemic were not followed up in pregnancy; 45.1% of those whose pregnancies ended were not followed up in the puerperium. 29.5% of all the participants stated that they had not used any birth control method. The most common reason for not using family planning is fear of harm to health and their spouse's disapproval. Only 3.3% of those currently using birth control methods stated difficulty accessing birth control methods. The most used information resources about pregnancy, childbirth and contraception methods were hospitals and Migrant Health Centres.

This study is funded through the UK Research and Innovation GCRF Research for Health In Conflict (R4HC-MENA), developing capability, partnerships and research in the Middle and Near East (MENA) [ES/P010962/1].

Key messages

• In refugee crises, women's health should be structured as a separate heading in the health system and unmet sexual health needs should be met, especially in culture-oriented primary care services.

• Women should be empowered with a health system where women can determine their own needs and make decisions about their bodies.
The 2009-2014 economic crisis and deaths by suicide in Portugal: time series analysis
Authors: Pinheiro V , Caetano C , Pereira da Silva S , Nunes B
Published: October 2022

Introduction

Population health, including mental health, is influenced by its socioeconomic context. After the 2008 global economic crisis, studies found contradicting results: some showed an increased risk for self-harm and suicidal behavior, while others found the opposite association. To the best of our knowledge, there is no research in Portugal on the subject. Thus, our aim was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the death rate by suicide and self-inflicted injury in Portugal.

Methods

A retrospective ecological study with an interrupted time series analysis of deaths by suicide and self-inflicted injury (data from the National Statistics Institute) in mainland Portugal, in 2003-2014, was performed. Resident population data was also retrieved from the National Statistics Institute. Binomial negative generalized linear models were used to compare rates and trends before (2003-2008) and during (2009-2014) the economic crisis. All rates were stratified and adjusted for seasonality.

Results

The economic crisis was associated with 13% a step increase in the death rate due to suicide and self-inflicted injury, with unemployment playing a significant mediating role, being negatively associated to the outcome. Differences between groups exist, with males, working-age groups and the North and Centre regions being the most impacted, globally.

Conclusions

Economic downturns pose risks for suicidal behavior. Unemployment may play a role in this association. Employment protection schemes can prevent this impact, so urgent action is needed to prevent economic crisis leading to additional suicides, especially in the context of the COVID-19 pandemic and the economic crisis it caused.

Key messages

• The Portuguese economic crisis of 2009-2014 was associated with an increased death rate due to suicide, especially in males, working-age groups and the North and Centre regions.

• Unemployment may play a role in this association, and active labour market programmes can prevent the negative impacts of economic crisis leading to additional suicides.
Finding the fitting framework for the implementation of policies promoting healthy nutrition and physically active lifestyle: Results from a systematic review
Authors: Forberger S , Lobczowska K , Banik A , Romaniuk P , Kubiak T , Meshkovska B , Neumann-Podczaska A , Kaczmarek M , Scheidmeir M ,   al
Published: October 2022

Background

Policies are an important upstream component of health promotion to influence the general population. Various frameworks exist to help implement policies. However, there is currently no overarching synthesis that describes the differences between policy implementation frameworks. In this study, we examined frameworks for implementing policies to promote healthy eating, physical activity and reduce physical inactivity and aimed to explore the scope of the frameworks, the content of the constructs they contain (e.g. processes, determinants, evaluation), the level at which these constructs operate and the inclusion of equity factors.

Methods

A systematic review (PROSPERO registration number: CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analysed.

Results

All three constructs were covered by 18 frameworks: description of the process, determinants and evaluation of implementation. The majority of frameworks (25/38) considered constructs from three levels: the individual, organisational/community and system levels, with system level constructs being included less frequently than individual level or organisational/community level constructs. Most frameworks (32/38) contained sections that were exclusively descriptive. In addition, 19 frameworks contained prescriptive and 23 explanatory sections. The complex systems approach was included in 8 of the frameworks. More than half of the frameworks (21/38) did not consider equity constructs.

Conclusions

Most frameworks have a complex scope, include multi-level constructs, combine sections that are purely descriptive with sections that consider prescriptive and/or explanatory associations, and include few or no equity constructs. The findings of this study can facilitate the process of selecting the framework that best fits the needs and goals of policy makers, researchers and policy implementation actors seeking guidance.
The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity
Authors: Woods C , Kelly L , Volf K , Gelius P , Messing S , Forberger S , Lakerveld J , den Braver N , Zukowska J ,   PEN consortium
Published: October 2022

Background

Insufficient physical activity (PA) is a global issue for health. A multifaceted response, including government action, is essential to improve population levels of PA. The purpose of this study was to develop the ‘Physical Activity Environment Policy Index’ (PA-EPI) monitoring framework to assess government policies and actions for creating a healthy PA environment.

Methods

An iterative process was undertaken. This involved a review of policy documents from authoritative organisations, a policy audit of four European countries, and systematic reviews of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops where quantitative and qualitative data alongside theoretical and pragmatic considerations were used to inform PA-EPI development.

Results

The PA-EPI is conceptualised as a two-component ‘policy’ and ‘infrastructure support’ framework. The two components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development, and health-in-all-policies. Forty-five ‘good practice statements’ (GPS) or indicators of ideal good practice within each domain concludes the PA-EPI. A potential eight-step process for conducting the PA-EPI is described.

Conclusions

Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI GPS will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.
Development of the Health Promoting Sports Club - National Audit Tool
Authors: Van Hoye A , Vuillemin A , Lane A , Dowd K , Geidne S , Kokko S , Donaldson A , Seghers J , Whiting S , Johnson S
Published: October 2022

Background

Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This manuscript outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs.

Methods

A 5-step process was undertaken by an international project team: (1) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (2) a thematic analysis to categorize items, (3) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (4) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (5) audit tool finalization though project team consensus.

Results

Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with three broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation & Dissemination; Evaluation & Measurement methods; Sub-national level policies; Funding & Coordination; Participative approach; Actors & Stakeholders; National sporting events; Case studies and Implicated stakeholders.

Conclusions

To progress HP in the sports club context it is necessary to understand existing national level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.
Was there any delay in the treatment of breast cancer patients because of the COVID-19 stringency measures?
Authors: Estupiñán-Romero F , González-Galindo J , Martínez-Lizaga N , González-García J , Derycke P , Aldridge S , Faragalli A , Raimundo Maia M , Zile I , Bernal-Delgado E
Published: October 2022

Background

Healthcare systems across Europe reorganized services to provide attention to COVID-19 patients. In the event of the surge of cases, countries were forced to cancel or postpone non-urgent care. The objective of this work is to investigate whether there were time-to-treatment delays in breast cancer due to April-May 2020 restrictions, and whether the delays were permanent and different across countries.

Methods

Design: Quasi-experimental pre-post study with a historical control. Population: Virtually the universe of breast cancer patients receiving elective surgery, radiotherapy, hormonal therapy or chemotherapy since January 2017 (until December 2021) in the participant regions - Belgium, Marché (IT), Riga (LV), Portugal, Wales, and Aragon (ES). The main endpoint is the change in the median time-to-treatment before and after an empirical joint-point. The study variables are detailed here https://doi.org/10.5281/zenodo.5148022. Analysis: Distributed generalized additive models using https://cran.r-project.org/package=mgcv.

Results

Preliminary results show that the impact in March-April 2020 time-to-treatment evolved differently across countries. For instance, while the median time from diagnosis to surgery, as the first treatment, increased from approximately 39 days (2018-2019) to more than 45 days (2020-2021) in Wales, in the Marche region (IT) the median time decreased from 52 days in 2017-2019 to 47 days in 2020. Complete analyses for the rest of the participant countries are currently undergoing.

Conclusions

We have observed differences in time to treatment in women with breast cancer across countries; however, the magnitude and direction of the effect has been uneven across countries.
Long COVID in France: prevalence, management and long-term impact
Authors: Makovski TT , Decio V , Carcaillon-Bentata L , Alleaume C , Beltzer N , Robineau O , Gallay A , Tebeka S , Coste J
Published: October 2022

Certain percentage of population experiences persistent symptoms months after an acute Covid-19 episode (Long-COVID), with a significant impact on daily-life. Few studies exist on its prevalence and its impact among the general population. The main objective of this survey was to estimate the prevalence of Long COVID among the general adult population in France. Secondary objectives were to evaluate Long COVID management and to assess impact of this clinical condition on quality of life and mental health. Cross-sectional study was performed in March-April 2022 using an online self-administered questionnaire. The sample was selected by the quota method from a panel of volunteers. Its representativeness was ensured by appropriate weighting. Three groups were described: Long-COVID, COVID without persistent symptoms, never COVID. Post COVID-19 condition as defined by the WHO was applied for prevalence estimation. The prevalence was calculated by age and sex. Health care consumption and impact of Long COVID on quality of life and mental health will be studied comparing the three groups, using weighted adjusted polytomic regressions. Here, we present preliminary findings on Long COVID prevalence. There were 27,537 respondents, 52% females, mean age (SD) 49 (±16.5). Confirmed or probable COVID-19 was reported by 33.9% of participants; of whom 85.1% had confirmed laboratory test. Majority (65.1%) had COVID-19 <3 months ago. Long COVID concerned 1,086 (4%) participants. Prevalence was higher for females 4.6% vs. 3.3% for males, and among younger population for both sex groups. Overall, prevalence of Long COVID by age group was: 18-34 (6%), 35-49 (4.7%), 50-64 (3.4%), ≥65 (1.8%). This is a first estimation of Long COVID prevalence among the French population. Representativeness of the sample should be interpreted with caution due to a sample based on volunteers’ response. Ongoing analyses will provide clearer understanding of the impact of Long COVID.

Key messages

• This is a first estimation of Long COVID prevalence among the French population.

• There is a significant portion of the French population impacted by persisting or reoccurring symptoms defined by Long COVID; its impact and care management will be further evaluated.
Ethnicity, deprivation, and the use of patient portals in England’s general practices 2018-2020
Authors: Alturkistani A , Greenfield G , Beaney T , Norton J , Costelloe CE
Published: October 2022

Background

Patient portals are made available and widely promoted in healthcare systems in the USA and Europe. These technologies can help patients access healthcare, receive timely treatment, and manage their health through services such as appointment booking and repeat prescription ordering. However, it is not clear if all patients who need the services are using them. This study explored patient portal use (online appointment booking and repeat prescription ordering features) and patient characteristics among NHS England GP practice patients.

Methods

The study used cross-sectional participant-level data from the GP Patient Survey (GPPS) of 2018, 2019, and 2020. Performing multilevel regression analysis, we explored the association between patient portal feature use and ethnicity and deprivation and controlled for eight other patient characteristics and one GP practice level characteristic, and modelled GP practice as a random effect in the model.

Results

In the fully adjusted model controlled for all patient characteristics and GP characteristics, participants of the Black and Other ethnic groups were less likely to have used online appointment booking (OR: 0.84, 95% CI:0.81, 0.86, and OR: 0.96, 95% CI: 0.92, 0.99, respectively) and online repeat prescription ordering (OR: 0.76, 95% CI: 0.74-0.78 and OR: 0.78, 95% CI: 0.75-0.81, respectively) compared to the White ethnic group. Association with patient portal use increased proportionally with reduced deprivation ranking.

Conclusions

In NHS England GP practices, certain ethnic minority groups and high deprivation ranking is associated with a reduced likelihood of using patient portals. If patient portals are the only route to access services, it is likely to lead to inequalities in use by some patient groups introducing unfair access to the services. Patients could continue to be provided with alternatives to patient portals to prevent potential inequities in access to services.

Key messages

• Patient portals are widely used in the healthcare system and can benefit all patients given that disparities are prevented by understanding patient groups who cannot access portals.

• Understanding patient groups less likely to use patient portals could help adapt healthcare system services and meet the needs of all patient groups.
Exploring children’s health literacy in the Netherlands – results in a sample of 8-11 year olds
Authors: Rademakers J , Hahnraths M , Bollweg T , Okan O , Willeboordse M , Heijmans M
Published: October 2022

Background

There are few valid, age-appropriate tools to assess children's HL. The German-language European Health Literacy Survey Questionnaire Adapted for Children (HLS-Child-Q15-DE) is a self-report questionnaire adapted from the adult European Health Literacy Survey Questionnaire. In 2021, this instrument was translated and validated in the Netherlands. In this presentation, we will describe the distribution of Health literacy in a sample of Dutch children, and relate their Health literacy level to certain aspects of their health behaviour such as food intake and physical activity.

Methods

The HLS-Child-Q15-DE was translated following WHO guidelines and administered digitally to 209 Dutch schoolchildren (eight-to-eleven-year-olds). Its psychometric properties were assessed and the sample's HL distribution was explored by demographic characteristics. Associations with food intake and physical activity were computed.

Results

Of the sample, 17.2% had a low health literacy score (first quintile), 61.1% medium (second to fourth quintile) and 21.7% high (fifth quintile). Higher HL scores were observed for ten-to-eleven-year-olds (compared with eight-to-nine-year-olds; p = 0.021) and fourth-grade students (compared with third-grade; p = 0.019). A positive association between children's HL and their vegetable consumption and PA behaviour was observed.

Conclusions

Children's health literacy can have an impact on some aspects of their lifestyle. This supports the idea that health literacy evolves throughout life and stresses the importance of both parents and schools in this process.
Key messages of the WHO European Regional Obesity Report
Authors: Wickramasinghek K , Williams J , Rakovac I , Grosso G , Heinen M
Published: October 2022

Obesity is a complex multifactorial disease defined by excessive adiposity and is linked to an increased risk for many noncommunicable diseases (NCDs). Overweight and obesity affect almost 60% of adults and nearly one in three children in the WHO European Region. Recent estimates suggest that overweight and obesity is the fourth most common risk factor for NCDs in the Region, after high blood pressure, dietary risks and tobacco. It is also the leading risk factor for disability and obesity is linked to greater morbidity and mortality from COVID-19. And obesity is considered a cause of at least 13 different types of cancer including cancers of the breast, colorectum, kidney, liver and ovary, multiple myeloma and meningioma. None of the countries in the Region are on track to achieve the obesity related target set in 2013. Early studies from a number of countries in the Region indicate that the prevalence of overweight and obesity and/or mean body mass index has increased in children and adolescents during the COVID-19 pandemic. This latest WHO European report on obesity examines the growing challenge and impact of obesity in the Region, building on past publications and aligning with initiatives to tackle cancer. The report focuses on managing obesity throughout the life course and tackling obesogenic environments; it also considers more recent challenges, including problematic digital marketing to children and the impact of the COVID-19 pandemic on obesity prevalence. Policy options to prevent obesity are outlined for consideration by Member States together with a suite of population-level approaches. The report highlights the importance of including prevention and control of obesity within measures to build back better in the wake of the COVID-19 pandemic. Whilst highlighting that single intervention will not be sufficient in any country, it examines the challenges faced by countries to implement known interventions to tackle obesity.
Risk factors and potentials for fostering mental health and wellbeing in urban space
Authors: Müller H , Rehn-Groenendijk J , Wasmer A
Published: October 2022

People shape their physical environments - and vice versa. As such, cities provide both resources (e.g., job opportunities, cultural diversity) as well as stressors (e.g., crowding, noise pollution) to their residents and visitors. In this context, numerous studies illustrate a considerable influence of the built environment (townscape, architecture) on health and well-being of interacting people. This impact ranges from physical aspects (e.g., traffic safety, particulate matter) to psychological processes (e.g., stress, loneliness) and behavioral aspects (e.g., physical activity, social behavior). At the same time, phenomena such as homelessness, crime, or mental disorders (e.g., substance addictions, schizophrenia) occur more frequently in cities compared to rural areas, illustrating causal as well as selective processes in the relation of urban environment and mental health. Increasing overall incidences in mental disorders (especially anxiety disorders and depression), the short-term shortage of psychotherapeutic care as well as the long-term economic burden on the health care system ask for a twofold strategy in public health: a) an extension of preventive measures with low threshold, i.e., accessible by large shares of the population, b) an extension of mental health literacy, which will empower the population to be attentive to mental health issues in themselves and others and which in turn can help to reduce stigmatization. While urban green and blue spaces have been researched in terms of restorative environments - allowing to regenerate resources consumed during the day - the built environment is still a resource for this strategy that has received insufficient attention to date. Utilizing the urban built environment not only as restorative but also informative and engaging environments thus affords an opportunity to address and potentially foster mental health and mental health literacy in citizens across socioeconomic backgrounds.
JAHEE external evaluation
Authors: Balaj M
Published: October 2022

The general aims and evaluation blocks concerned the extent to which JAHEE achieved its objectives, and the identification of lessons learned for future health inequalities programmes. More specific aims included: • Producing knowledge: to understand the outcomes of JAHEE and build knowledge on health inequalities. • Influencing decision-making: to produce results that can guide the development of policies and initiatives tackling health inequalities. • Accountability: to clarify responsibilities and outcomes of JAHEE. • Lessons learned: to provide recommendations for future initiatives.

The evaluation was grounded in five evaluation blocks: relevance, effectiveness and impact, sustainability, dissemination, and added value. The main results will be presented.