bluuebunny/crossref_metadata_2025 huggingface dataset:
Alarming issue of suicides and their indirect costs in Slovenia
Authors: Sedlak S , Jelenc M , Sambt J
Published: October 2023

Background

Suicides represent a major public health problem and a heavy burden on healthcare systems. Suicide is not a disease, but it can be the final result of various diseases and conditions, including various mental illnesses (depression, psychosis, etc.) as well as alcohol and drug addiction. High premature mortality due to suicide has social and economic consequences for society. The purpose of the present study was to analyze for the first time in Slovenia the partial indirect costs of suicide, on average, for the period from 2008 to 2019.

Methods

At the Slovenian National Institute of Public Health we analyzed the lost income from work due to suicide based on routine health data of the deceased, for the period from 2008 to 2019. The study was conducted in collaboration with the Faculty of Economics of the University of Ljubljana. The National Transfer Accounts (NTA) methodology was used. The estimated economic costs of suicide were based on the calculation of indirect costs, which are related to lost productivity due to death.

Results

Partial indirect costs due to suicide amounted to EUR 8.2 million on average or around 0.2% of all healthcare expenditures, which amounts to 0.02% of gross domestic product in the studied period. Lost income from work due to death amounted to EUR 4.8 million, and unpaid household work lost due to death amounted to EUR 3.4 million, as an annual average for the period 2008-2019.

Conclusions

The range of indirect and direct costs, also from the point of view of various mental illnesses should be included in the calculation in the future, a list of selected illnesses prepared and the available resources and their limitations showed. By including additional economic costs, the burden of suicide would certainly be higher.

Key messages

• Suicide prevention must be the national priority in Slovenia.

• By treating the diseases that can lead to suicide, the number of suicides and the direct and indirect costs could be partially lowered.
Prevalence and Shifts in Antibiotic Use in an Italian Hospital: A Comparison of 2016 and 2022 Data
Authors: Fortunato C , Mengarelli detto Rinaldini D , Dolcini J , Barbadoro P
Published: October 2023

Background

Antibiotics are among the most commonly prescribed drugs, but inappropriate prescription rates (molecule, duration or dosage) remain high, leading to the selection of multidrug-resistant microorganisms. This study aims to describe the most commonly used antibiotics in our hospital and compare them to 2016 data.

Methods

Conducted in November 2022 at the Azienda Ospedaliera Universitaria delle Marche of Ancona (Italy), the study followed the protocol proposed by the European Center for Disease Prevention and Control (ECDC). Patients admitted to wards before 8 a.m. and not discharged at the time of the survey were included. Data from 2022 were compared to the 2016 study.

Results

In 2022, 41.7% (N = 284) of the 681 patients were taking at least one antibiotic, with 400 antibiotic therapies administered, of which 90.5% were given parenterally. Among the patients on antimicrobial therapy, 40% were being treated for a community infection, 27% for a hospital acquired infection and 19% for surgical prophylaxis. Among all the antimicrobial prescriptions used, the most used class of antibiotics in 2022 was penicillin / beta lactamase inhibitor (21.6%, N = 86), followed by third-generation cephalosporins (11.8%, N = 47), carbapenems (11.6%, N = 46), glycopeptides (8.8%, N = 35), first-generation cephalosporins (8.8%, N = 35) and fluoroquinolones (7.0%, N = 28). Data from 2016 registered a 21.2% prevalence of penicillin / beta lactamase inhibitor, 15.7% of fluoroquinolones, 14.7% of third-generation cephalosporins, 10.5% first-generation cephalosporins, 7.6% of carbapenems and 4.1% of glycopeptides.

Conclusions

The prevalence of antibiotics used in our hospital has changed after six years. This shift may be due to new patterns of bacterial resistance and new antimicrobial drugs (e.g. cefiderocol).

Key messages

• Our study found a shift in prevalence of antibiotic use in our hospital after six years.

• Penicillin/beta lactamase inhibitors are still the most commonly used antibiotics in our hospital.
Blood pressure measurement device change in the Healthy Finland health examination survey
Authors: Lehtoranta L , Palosaari T , Tolonen H , Lundqvist A
Published: October 2023

Background

Blood pressure (BP) measurements in health examination surveys (HESs) are needed for public health monitoring. In Finland, population-based HESs with BP measurements have been performed with mercury sphygmomanometers since the 1960's. The use of oscillometric devices has rendered sphygmomanometers impractical for health surveys. This study describes the change in BP measurement method and mean BP values in Finnish HESs.

Methods

66 000 randomly selected adults living in Finland were invited to the Healthy Finland questionnaire-based health survey in 2022-2023. Of those, 10 000 were asked to participate in a HES including BP, anthropometric, and functional capacity measurements as well as collection of biological samples. Prior to the selection of the new oscillometric BP device, validation studies for devices were evaluated, and the availability was checked. BP measurements were performed using WatchBP Office Vascular (TWIN200 VSR) device.

Results

Two consecutive BP measurements were obtained from 3424 participants aged 30 years or older (ongoing until 6/2023). The mean (95% CI) systolic blood pressures (SBP) for men and women were 137.1 (136.2-140.0) and 134.7 mmHg (133.7-135.6), respectively. The corresponding values for diastolic blood pressure (DBP) were 82.3 (81.8-82.8) and 79.3 mmHg (78.9-79.8). The mean difference (95% CI) between the 1st and the 2nd SBP measurements were -2.4 (-2.7- -2.0) and -1.8 (-2.1- -1.4) in men and women, while the corresponding values for DBP were -1.1 (-1.4- -0.9) and -1.2 (-1.5- -1.0). Distribution of measurements was Gaussian apat from some values, that were unlikely to be obtained (SBP: 155, 156, 157; DBP: 96, 99).

Conclusions

Oscillometric BP provide reliable data in HESs. Finnish BP levels may be on the rise. Further reseach is needed to estimate the effects of gaps in the measurement algorithm of TWIN200 VSR and the differences in consecutive measurements.

Key messages

• In a health examination survey, oscillometric blood pressure measurements led to similar results as with a sphygmomanometer.

• Algorithm gaps and smaller difference on successive measurements were seen.
Impact of the tobacco law on hospitalizations for tobacco-related diseases in adults in Portugal
Authors: Santos M , Perleman J , Díonisio J , Vasconcelos R , Peralta-Santos A
Published: October 2023

Introduction

Tobacco contributes to about 8 million deaths per year worldwide, of which 1.2 million are due to passive exposure to tobacco smoke, according to WHO data. Ambitious anti-tobacco policies have been implemented in European countries, but few have been evaluated. The present research measures the impact of the anti-tobacco laws implemented in Portugal in 2007, and reinforced in 2015, in the adult population residing in Portugal, between January 1, 2002 and December 31, 2018.

Methods

We used data for all in-patient stays at all public hospitals over the 2002-2018 period. A quasi-experimental interrupted time series study was applied, considering the years 2008 and 2016 as exogenous shocks. The dependent variables under study are the incidence of hospitalizations by municipality of residence and year for tobacco-related diseases, namely: AMS, stroke, lower respiratory tract infections, COPD and asthma. We adjusted the analysis by the percentage of women, percentage of people aged >65, and purchasing power. We produced time trend graphs for each variable, with subsequent adjustment to the Poisson regression model to predict its evolution. A comparison was made between the values observed after the implementation of the law and its reformulation and the values projected based on the regression model selected, to identify the percentage difference between the two.

Expected Results

In line with the international literature, a generalized decrease in the incidence of hospitalizations for tobacco-related diseases was observed after the implementation of the tobacco law. Likewise, after the changes added in its reformulation, the reduction in incidence was stronger, although not as sharply, compared to 2007.

Conclusions

Anti-tobacco laws in Portugal have been effective in reducing tobacco-related hospitalizations, with expected gains in life expectancy and reduced burden for the health system.

Key messages

• Tobacco contributes to about 8 million deaths per year worldwide, of which 1.2 million are due to passive exposure to tobacco smoke.

• Generalized decrease in the incidence of hospitalizations for tobacco-related diseases was observed after the implementation of the tobacco law.
From Geroscience Discoveries to Public Health Practice: Shifting the Paradigm towards Healthy Ageing
Authors: Csiszar A , Adany R , Tarantini S , Ungvari Z
Published: October 2023

The global population is ageing rapidly, and the paradigm towards healthy ageing is shifting from a challenge to an opportunity. Advances in geroscience have shown promise in delaying/preventing age-related diseases. However, public health research targeting healthy ageing needs to consider these advances and develop interventions that target fundamental ageing processes. This presentation highlights the need for a paradigm shift towards healthy ageing and the incorporation of geroscience discoveries into public health practice. Traditional behavioral and biological risk factors have been the mainstay of public health interventions targeting age-related diseases. However, epidemiological studies need to consider mechanistic links between lifestyle risk factors and ageing processes and include newly developed transcriptomic, epigenetic, proteomic, and metabolomic biomarkers of ageing to identify groups of people who are ageing faster. Public health interventions should be designed with cellular/molecular mechanisms of ageing kept in mind. In addition to established interventions addressing traditional risk factors, emerging dietary modifications such as intermittent fasting paradigms, and diets enriched in NAD+ precursors show promise. These emerging concepts can be incorporated into a complex anti-ageing paradigm that also includes physical activity and cognitive trainings to interrupt the bridge between ageing and physical/intellectual decline. Finally, interdisciplinary Healthy Ageing programs are needed to address the growing socio-demographic challenges associated with rapid population ageing. These programs bring together expertise in public health, geroscience, nutritional sciences, and preventive medication against non-communicable diseases. By shifting the paradigm towards healthy ageing and incorporating geroscience discoveries into public health practice, we can promote healthy ageing and reduce the burden of age-related diseases.
Using popular culture to fill in the gaps in public health knowledge – the case of school toilets
Authors: Molcho M
Published: October 2023

Background

Avoiding going to the toilets during the school day has serious implications on children's health and education. Concerns about using the toilets may also lead to reduce intake of fluid, resulting in dehydration and associated dizziness, fatigue and poor concentration, compromising children's education as well as their overall well-being. Yet, there is limited evidence on the reasons behind children's tendency to avoid using the school's toilets. To address this paper presents the representation of school in popular culture, as a way to understand how children perceive school toilets.

Methods

Popular culture play a significant role in shaping perceptions of places and people, serving as the primary way in which they learn about people's experiences. Thus, the way the toilets are represented in popular culture such as books or films may influence adolescents’ use of public toilets, even if they are not aware of that. This paper explores some films, young adults books and children books to identify the narratives around school toilets as portrayed in popular culture/

Results

The narrative of school toilets in popular media can be divided to three main themes, toilets as a place that provides safety and privacy from the prying eyes of both peers and the authorities; toilets as a space for illegitimate activities, aggression and bullying; spaces where sub-cultures and anti-establishment activities emerge. While these themes are not mutually exclusive, each has its unique aspect in the perception and representation of the role that school toilets play in children's lives.

Discussion

This presentation will help shaping the conversation about a public health problem that is rarely discussed. It will shed a light on the perceived role of public toilets and will help finding way to address and alleviate concerns about using toilets in school.
Nutritional and non-nutritional content in food: targets for front-to-package labels
Authors: Grosso G , Bonaccio M
Published: October 2023

A global shift from traditional to “Westernized” dietary patterns is being considered responsible for the substantial worsening of global diets and the consequent impact on human health. The need for easily accessible, palatable, and affordable food has driven an industry-led globalization of the markets with products easily available worldwide often at cost of nutritional quality, with evidence of substantial substitution of local food production/consumption. A growingly large share of commercial food products are dangerously high in added sugar, starch and/or fat and poor in vitamins and fiber. Additional concerns also rely on the poorly investigated role of food chemical additives on human health, with substantial documented effects on human gut microbiota and potential threats for long term exposure. Given the poor nutritional profile, the unknown effects of industrial additives, and the “substitution effect” for healthy foods, the consumption of industrially processed foods is of great interest for public health experts because the massive market invasion and the potential global impact on the general population. More importantly, foods quality and level of processing is currently not of concern for nutritional guidelines while it started being questioned for its role on general public health.
The estimated health impact of sustainable diets in the Danish population: a risk-benefit assessment
Authors: Jacob A E , Pires S M , Jakobsen M U , Jolliet O , Davydova A , Poulsen M , Jakobsen L S
Published: October 2023

Background

To mitigate the climate emergency and support a growing world population, sustainable diets have become a popular topic. These plant-forward diets are promising in terms of health effects, but estimated population health impacts linked to changes in nutrition and exposure to food contaminants have yet to be quantified. We used a risk-benefit assessment (RBA) to quantify the net health impact of theoretical dietary changes.

Methods

We collected dietary consumption data from the Danish National Survey of Diet and Physical Activity, exposure data for selected chemical contaminants (cadmium, methyl mercury, lead, and inorganic arsenic) from Danish food monitoring, and dose-response data for various health outcomes from published epidemiological data. The average Danish diet was compared to multiple dietary scenarios: a Danish-adjusted EAT-Lancet diet and other alternative scenarios that looked at proportional decreases in animal-based foods with plant-based substitutions.

Results

Shifting to a Danish-adjusted EAT-Lancet diet would require increased consumption of legumes by 6,352%, nuts by 1,036%, bread and cereals by 100%, fruits and berries by 40%, and fish and shellfish by 39%. Red meat and dairy consumption would need decreases of 83% and 25%, respectively. With these changes, we estimated that a net of 22,900 DALYs would be averted in one year in the Danish population. The food groups contributing most to positive health impacts were nuts (-7,721 DALYs), bread and cereals (-6,244), decreased red meat (-5,681), legumes (-2,509), and fruits and berries (-1,396). These results are preliminary; all scenarios will be compared.

Conclusions

Our results support a beneficial impact on the health of the Danish population due to sustainable dietary transitions. Similar benefits are expected for other populations across Europe. We argue that RBAs are a powerful decision-support tool and can provide quantitative evidence for sustainable diets and future interventions.

Key messages

• Our comprehensive risk-benefit assessment concluded that transitioning towards a more sustainable diet leads to positive health impacts.

• Our conclusions support policy and decision makers in implementing plant-forward dietary recommendations and agendas in the Danish population.
Welsh Health Equity Solutions Platform
Authors: Couzens L , Hill R , Dyakova M , Allen J , Stewart D , Peden J
Published: October 2023

Health inequities are a longstanding issue in Wales, as they are across the globe. They disproportionately affect the health& wellbeing outcomes of disadvantaged groups, restricting opportunities to live full and prosperous lives. Post COVID-19 new groups are emerging with disproportionately higher risk of poor health and premature death and disease, especially those with unmet needs and vulnerabilities. More recently, the rising cost of living is amplifying health inequities. Despite their prevalence, health inequities are avoidable. Caused by multiple, interlinked factors; efforts to reduce health inequities thus require action on all the social determinants of health across the life course. Improved understanding of the key drivers of health gaps is needed to address the problem& provide support for solutions-driven action to break down the barriers to health equity. The Welsh Health Equity Solutions Platform (WHESP) is a new innovative tool developed around the WHO Health Equity Status Report initiative framework of the ‘five essential conditions’ for healthy, prosperous lives for all. WHESP aims to inform and facilitate policy and decision making to improve population health and address the increasing health gap. WHESP is an online gateway to data, health economics and modelling, policies, resources and innovative tools on health equity. Emerging evidence is highlighted to identify tools and solutions for achieving healthy prosperous lives for all in Wales and beyond. WHESP will be linked with and feed into a WHO health equity gateway, providing an example and inspiration for countries to learn and follow, as well as to contribute and share. WHESP recognises that there is not a ‘one size fits all’ approach. It provides an extensive body of evidence to inform evidence-based decision making to reduce the health gap, improve overall population health and wellbeing, and achieve inclusive and sustainable economic growth and prosperity for all.

Key messages

• Efforts to reduce health inequalities require action across all of the social determinants of health.

• WHESP provides extensive evidence to facilitate cross-sectoral action and policy change.
Men who have sex with men under mpox threat- changes in sexual behaviors and mpox-vaccines uptake
Authors: Mor Z , Poliker E , Avni G , Anis E
Published: October 2023

Introduction

Since May 2022, 261 cases of mpox were reported in Israel. Of those 259 (99.2%) were men who had sex with men (MSM). The outbreak was contained following the use of MVA-BN vaccines, which became available in August 2022. This longitudinal study aims to assess MSM’ change in sexual behaviors (CSB) due to mpox and appraise the adherence for vaccination.

Methods

The anonymous questionnaires were published in a popular geospatial application frequented by MSM (Grindr) between September and October 2022. Participants were asked to report their demographic characteristics, use of pre-exposure prophylaxis (PrEP), CSB and MVA-BN vaccines uptake.

Results

In total, 665 MSM included in the study with an average age of 35.5 years, 425 (63.6%) lived in Tel Aviv area, and 169 (25.4%) were in steady relationships. Mpox diagnosis and HIV infection were reported by 19 (2.9%) and 21 (3.2%), respectively. The 317 (47.7%) who CSB due to mpox concern were more likely to live in Tel Aviv, more commonly in open relationships, performed sex in gay-related venues, involved in unprotected anal sex, were concerned about mpox and more commonly vaccinated against mpox compared with participants who did not CSB. In multivariate analysis, living in Tel Aviv, open relationships, unprotected anal sex, being concerned with mpox and vaccination predicted CSB. The 221 (33.3%) who were vaccinated were more commonly older, more likely to live in Tel Aviv, in steady relationships, performed sex in gay-related venues, were infected with HIV, used PrEP and CSB compared with non-vaccinated participants. In multivariate analysis, living in Tel Aviv, being in steady relationships, HIV infection, PrEP use and CSB predicted vaccination.

Conclusions

Nearly half of the participants CSB and one-third were vaccinated- both outcomes were more common among MSM who were at high risk for mpox infection. MSM are responsive to potential sexual risks and adopt their sexual behaviors according to the threat.

Key messages

• Nearly half of the MSM who participants in the study changed their sexual behavior and 1/3 were vaccinated against mpox.

• MSM are responsive to potential sexual risks and adopt their sexual behaviors according to the threat, whether it is HIV, STD or mpox.
An optimisation study to reduce greenhouse gas emissions from adults’ current diet in Italy
Authors: Biasini B , Donati M , Rosi A , Kalmpourtzidou A , Bonaccio M , Ruggiero E , Iacoviello L , Scazzina F
Published: October 2023

Background

Trade-offs between health and sustainability dimensions should be addressed since environmentally sustainable diets can require a substantial dietary shift and result in nutrient deficiencies. The study aimed at modelling the current dietary consumption of the adult population in Italy to reduce diet-related greenhouse gas emission (GHGe) while complying with the National Recommended Energy and Nutrient Intake Levels (LARN), food-based dietary guidelines, and preferences.

Methods

Food consumption data from the Italian Nutrition & HEalth Survey (INHES) study (n = 8944, 53% females) have been used as reference diet. Through a non-linear programming model, two intermediate nutritionally adequate dietary scenarios, which alternatively minimised the impact on climate change or modifications in current food consumption, have been generated contextually to a final diet model combining both outcomes. Several constraints ranging from recommended dietary intakes to proper food associations and substitutions were applied to the model.

Results

The final modelled diet had an average energy content of 2100 kcal/d with carbohydrates, proteins, lipids, and fibers accounting respectively for 49%, 16%, 31%, and 4% of the total energy. The associated GHGe were 2.01 kg CO2 eq/d: 49% less than the current diet, 22% more than the balanced diet with the lowest GHGe, and 12% less than the balanced diet closest to actual food consumption. Wholegrain bread, peas, seasonal fruit and vegetables, chicken, tuna, whole milk and extra-virgin olive oil were the most represented products within each corresponding food group.

Conclusions

The study proposes a balanced and climate-friendly diet which simultaneously minimises changes in food preferences, reducing barriers towards more sustainable food choices. Diet optimisation can be a promising tool to support public health strategies by suggesting less environmentally impactful and culturally acceptable dietary shifts at the country level.

Key messages

• The present study provides a culturally acceptable and nutritionally balanced dietary scenario optimised for greenhouse gas emissions to be proposed as a model for the adult population in Italy.

• The study contributes to the development of public health policies by supporting feasible dietary behavioural shifts towards healthy and sustainable dietary choices.
Assessing care quality: impact on renal outcomes in non-diabetic chronic kidney disease patients
Authors: Wu H-Y , Hsu L-Y , Tsai P-H , Chien K-L
Published: October 2023

Background

Chronic kidney disease (CKD) is a major global noncommunicable disease, with significant burden on healthcare systems. Quality indicators (QIs) are useful tools for evaluating healthcare quality, but existing QIs for renal care mainly focus on dialysis population. This study aims to explore the association between quality of renal care and outcomes in non-diabetic CKD patients.

Methods

This study utilized Taiwan's National Health Insurance claims data and death registries to enroll non-diabetic adults with advanced CKD (stage 3B-5) from 2016 to 2019, following them through 2020. QIs evaluated included prescription of renin-angiotensin system (RAS) inhibitors, testing for proteinuria, and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs). An overall quality score was calculated by summing scores of each QI. The primary outcome was long-term dialysis, and secondary outcomes included death, acute kidney injury (AKI), hyperkalemia, and acidosis. Univariate and multivariate Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the effects of QIs on outcomes.

Results

Among 27,842 patients, 59.8% received RAS inhibitors, 56.5% underwent proteinuria testing, and NSAIDs were avoided in 97.9% of cases. Only 33.5% received the highest QI score of 3. Multivariate Cox proportional hazard models showed that higher overall quality scores were associated with a lower risk of long-term dialysis (HR 0.87, 95% CI 0.83-0.92), death (HR 0.90, 95% CI 0.86-0.94), and acidosis (HR 0.87, 95% CI 0.79-0.96). Additionally, higher overall quality scores were borderline associated with a lower risk of AKI and hyperkalemia.

Conclusions

QIs for renal care were associated with better outcomes in non-diabetic patients with advanced-stage CKD, particularly in long-term dialysis, death, and acidosis. More patients need to be prescribed RAS inhibitors and tested for proteinuria to achieve better quality of renal care.

Key messages

• Our study shows quality of renal care can impact outcomes for non-diabetic CKD patients, with higher quality indicator scores associated with lower risk of long-term dialysis, death, and acidosis.

• Prescription of RAS inhibitors had the most significant protective effect, but more patients need to be prescribed RAS inhibitors and tested for proteinuria to achieve better renal care quality.
Costs and benefits of climate services for heat-health adaptation in Europe
Authors: Rao-Skirbekk S , Budin-Ljøsne I , Chaudhary P , Sitoula S , Chersich M
Published: October 2023

Background

Climate services for health aim to support informed decision-making and enable early action and preparedness. More knowledge is still needed regarding the costs and benefits of climate services, as well as effectiveness, and technical, structural, and societal barriers and facilitators to implementation and use.

Aim

To map the evidence on the economic assessment and use of climate services for health in reducing heat-associated mortality and morbidity and explore the societal impact of climate services, particularly in Europe.

Methods

We focus on two methods in this study: 1) a scoping review of literature on the economic assessment and health benefit of climate services 2) a set of interviews with climate service developers and providers in Europe to understand further technical and societal aspects as well as evaluation of such services.

Findings

From the scoping review, a total of 27 peer-reviewed articles all presenting heat early warning systems (HEWS) that work on a weather timescale were identified. The results from economic assessment studies suggested HEWS can produce health benefits greater than the operational cost, even during future climate change scenarios. While most of the studies assessing health outcomes have suggested that HEWS can help in reducing heat-related mortality and morbidity, some concluded no significant impact and some suggested increased healthcare services utilization after implementation of HEWS. The findings from the six interviews conducted across Europe identifies barriers for climate service development and implementation such as insufficient financing and cultural differences between climate and health professionals.

Conclusions

Our results find limited evidence on the economic assessment of climate services, gap in knowledge regarding health benefits from climate services using seasonal/sub-seasonal and long-term climate information and several barriers to making these services useful for end-users.
6.F. Workshop: Digital public health in Europe - What is the new normal?
Authors:   Organised by: EUPHA-DH,   Chair persons: Laura Maass (Germany), Anthony Staines (Ireland)
Published: October 2023

Digital public health has influenced how countries use health data for research and practice, how we deliver healthcare, and how health professionals monitor infectious diseases. The COVID-19 pandemic accelerated the international adoption of digital health interventions for public health aims. While some European countries were already advanced in digital health and digital public health before the pandemic, other nations took the opportunity to catch up. Internationally, governments introduced contact-tracing apps, telemedical services, digitally supported health promotion programs, nationally regulated medical apps, and education programs for citizens and experts to improve digital (health) literacy. The planned European Health Data Space will lift the level of digital public health in Europe once more. However, the maturity of digital public health among European countries varies drastically. While some are global leaders in digitalizing their health systems, others barely implemented the necessary infrastructure. But there is also a third perspective: Some countries that led Europe through the pandemic from a digital public health perspective started withdrawing from digitalizing their healthcare and health promotion and returning to “normal”. It is time to examine what this new “normal” post-pandemic means and how countries evolved. We will learn from the experience of 4 different European countries (Romania, Ireland, Slovenia, and Germany) how COVID-19 changed their health system and if digital public health is still applied now that the pandemic is officially over. The workshop's ultimate goal is to highlight and discuss which digital transformations in European health systems were permanent and whether or not Europe will continue to take a leading role in digital public health in the future. Each representative will have 10 minutes to contextualize their country's digital public health strategy before the pandemic (the old normal), their strategy to address the crisis, and how the country includes digital public health in its health system after the pandemic (the new normal). We will use the remaining 20 minutes of the workshop for a discussion between the speakers and the audience.

Key messages

• The COVID-19 crisis pushed Europe's digital public health transformation so that countries were enabled to use digital health data for improved healthcare and health promotion on a national level.

• In order for the transformation to be sustainable, countries need to fundamentally rethink their health systems and make way for better digital innovation.
Development of a Core Outcome Set for Patient Safety in Perioperative Care: Insights from the SAFEST Project
Authors: Nunes A B
Published: October 2023

Although surgical-related adverse effects are among the most common in-hospital adverse events, no set of indicators has yet been defined for a comprehensive and patient-centred analysis of this phenomenon. Thus, it is crucial to standardise a minimum set of indicators, a Core Outcome Set (COS), to allow for monitoring and evaluation of implemented patient safety best practices in perioperative care. The SAFEST project aimed to develop a relevant and feasible COS for patient safety in perioperative care, including patient-relevant data. Following a multimethod approach, an initial list of indicators (ILO) was developed by conducting an umbrella review on patient safety in perioperative care in surgical adult patients. The ILO was prioritised by a diverse group of experts, including patients, through a two-round eDelphi Technique, according to the importance and feasibility of each indicator. Exploring the challenges of measuring specific indicators, the same experts will define the final list of indicators in a consensus conference. From 588 indicators extracted in the umbrella review, 247 indicators were included in the ILO to be independently rated, on a 9-point Likert scale, by participating experts. The indicators were grouped by the perioperative period (preoperative, intraoperative, postoperative and mixed) and further subgrouped by Donabedian's quality of care conceptual model Structure - Process - Outcome. During the eDelphi process, some indicators were reworded, split, merged, added or removed, according to experts’ comments. The final set of indicators results is not yet available as this study is still undergoing. This COS contributes to enhancing standardised reporting in perioperative patient safety, allowing for benchmarking across EU countries and facilitating data comparison across studies.
Effect of school-based HPV vaccine campaigns on inequalities in uptake in France: the PrevHPV trial
Authors: Dussault J , Le Duc-Banaszuk A S , Gagneux-Brunon A , Bruel S , Gauchet A , Barret A S , Sicsic J , Thilly N , Mueller J E ,   PrevHPV consortium
Published: October 2023

Background

HPV vaccination is recommended in France for all adolescents aged 11-14. Coverage has increased over recent years but remains below 50% by age 15, with social disparities by area deprivation level, parental education and income. We analysed the effect of school-wide campaigns on adolescent vaccine uptake and related disparities.

Methods

PrevHPV is a controlled cluster-randomised trial to assess the effectiveness and efficiency of a multi-component intervention targeting middle schools and general practitioners. Sixty-one French middle schools were randomised in a partial factorial design to one of six intervention arms, some of which included school-based vaccine campaigns combined with in-class education and motivation. We assessed HPV vaccine status using online questionnaires that were administered in class to pupils (aged 13-15 years) at baseline and after 5 months. Using linear regression, we explored the decomposed effect of campaigns on vaccine uptake and interactions of the effect with sociodemographic variables.

Results

In total, 2639 adolescents provided complete vaccination data on both questionnaires, with a ≥ 1-dose coverage of 24% at baseline. Among previously unvaccinated pupils (N = 2017), 21% (7%) of girls (boys) in the control group reported receipt of first vaccine dose during the follow-up period, compared to 49% (33%) in arms with vaccine campaigns. Adjusting for baseline vaccine intention, vaccine campaigns increased the 5-month probability of a first dose by 25 (95% confidence interval: 19-31) percentage points compared to the control group. The effect of vaccine campaigns on student-reported vaccine uptake did not substantially vary by school area deprivation level, parental education level, or family multilingualism (compared to French monolingual family).

Conclusions

School-based campaigns substantially increased vaccine coverage among all adolescents within a short time period. Yet, underlying disparities in HPV vaccination were unchanged.

Key messages

• School-based vaccine campaigns can quickly increase HPV vaccine uptake among adolescents.

• Vaccination campaigns need tailored implementation strategies to eventually reduce social disparities in HPV vaccination.
Changes in health of older adults during the COVID-19 pandemic: a longitudinal cohort study
Authors: Besselink D , Herber GCM , van der Lucht F , Sealy M J , Krijnen W P , Jager-Wittenaar H , Finnema E J
Published: October 2023

Background

COVID-19 measures affected the lives of many older adults. Yet, little is known on changes in health among older adults, especially in periods when COVID-19 measures relaxed. We aimed to assess changes in health of older adults during multiple turning points of the COVID-19 pandemic and to analyse differences in changes in health between subpopulations of older adults.

Methods

This longitudinal study includes data from Dutch older adults (≥65 years) participating in the Lifelines COVID-19 Cohort and consists of seven questionnaires administered every 2-4 months between May ‘20 and October ‘21. The outcomes were quality of life (n = 14,682), physical fitness (n = 14,761) and feelings of isolation (n = 14,611). Changes in health and differences between subpopulations were analysed by multivariable linear mixed-effects models. Fluctuations in COVID-19 measures were described by the Government Stringency Index.

Results

Changes in quality of life and feelings of isolation of older adults coincided with fluctuations in the stringency of COVID-19 measures. In periods when measures were tightened, quality of life and feelings of isolation decreased and when measures relaxed, they improved. For example, when measures relaxed after the first lockdown in May ‘20, quality of life improved with 0.23 [95%CI: 0.16, 0.29] (p<.001). For physical fitness, changes were characterised by a slight decline of 0.26 [95%CI: 0.15, 0.37] (p=.001) during the study period. Differences in subpopulations were found for feelings of isolation for which differences between men and women congregated after a longer period of relaxed measures with 0.59 [95%CI: 0.49, 0.69] (p<.001).

Conclusions

Quality of life and feelings of isolation among older adults recover after periods of stringent measures. For physical fitness, the slight but continuing decline suggests a negative impact of COVID-19 measures. Our findings might indicate the need for health policy strategies to mitigate this effect.

Key messages

• Changes in quality of life and feelings of isolation of older adults coincided with fluctuations in stringency of COVID-19 measures and display recovery after periods of stringent measures.

• Changes in physical fitness were characterized by slight decline and did not recover after stringent measures, suggesting an impact of COVID-19 measures on physical health of older adults.
National vaccination program compliance in northern Lisbon's primary healthcare: 2022 assessment
Authors: Mateus da Costa M , Alho A M , Elias N , Vieira A T , Quinaz Romana G , Pestana Gonçalves T
Published: October 2023

Background

The National Vaccination Program (NVP) aims to protect all citizens and residents of Portugal from communicable diseases, safeguarding public health. It is coordinated by the Directorate-General of Health and locally implemented by the primary healthcare centers. Currently, a 95% vaccination coverage is set for all vaccines, except for human papillomavirus (HPV) which is 85%.

Methods

Assess the accomplishment of NVP in 2022, based on the national vaccination platform, for the 15 primary healthcare units of Northern Lisbon. The evaluation included the proportion of users who I) completed vaccination schedule at the recommended age (recommended NVP), and II) completed vaccination schedule, regardless administration date (fulfilled NVP), according to birth cohort.

Results

The 2021 and 2022 cohorts achieved a 95% vaccination coverage target for the 4 evaluated vaccines; the 2020 cohort only achieved for 3/5 vaccines evaluated, due to a lower vaccination against tetanus (93.42%) and Neisseria meningitidis B (94.58%). Both 2015 and 2016 cohorts missed the vaccination target for tetanus (89.75% and 88.89%, respectively) and measles (92.84% and 91.12%, respectively). The vaccination target for HPV was not achieved in any of the evaluated cohorts, highlighting the low coverage in males (46.26%) and females (52.34%) from 2012. Concerning tetanus, an increasing trend coverage was found along the cohorts from 1956 (54.47%) to 2016 (91.23%).

Conclusions

Globally, the NVP targets were achieved in several cohorts. However, immunization against HPV and among older cohorts fell short of expectations. Several factors contribute to explain this low coverage, such as vaccine stock-out (for HPV and N. meningitidis B); residing abroad; private health care follow up without proper vaccine registration; vaccine hesitancy. On the other hand, the positive variation in immunization coverage for most of the assessed vaccines reflects some strategies used to increase adherence.

Key messages

• The accomplishment of vaccination schedules is key to safeguard individuals and communities from vaccine-preventable illnesses.

• The continuous assessment of vaccination targets and trend monitoring is critical to implement strategies to increase vaccine coverage and safeguard public health.
Trend in mandatory vaccination coverage in Italy from 2000 to 2021. A joinpoint Regression Analysis
Authors: Villani L , Savoia C , Causio F A , Pastorino R , Ricciardi W , Boccia S
Published: October 2023

Introduction

Vaccination is one of the most effective public health interventions, preventing more than 4 million deaths each year. However, the complex and multifactorial phenomenon of vaccine hesitancy has increased over the years, causing a reduction in vaccination coverage (VC) and the resurgence of epidemics from vaccine-preventable diseases (VPD). Moreover, the COVID-19 pandemic had a major impact on the capacity of health systems to continue the delivery of essential health services, including vaccination. In this context, the objective of this study is to analyse the trend of 10 vaccinations in Italy (measles, mumps, rubella, tetanus, diphtheria, pertussis, chickenpox, hemophilus, hepatitis B, and polio), from 2000 to 2021, evaluating the impact of the introduction of the mandatory law in 2017 and the pandemic.

Methods

Data were obtained from the Italian Ministry of Health. The joinpoint regression model was used to estimate changes in vaccination coverage trends for each indicator. It allows estimation of an annual percentage change (APC) in vaccination coverage, reflecting an increase or decrease over time. For each indicator, the presence of a joinpoint expressed significant changes in APC trends. APC was considered significant when p < 0.05.

Results

Until 2017, a gradual decline in VC is observed, with values below 95% for all indicators considered. For all indicators analysed, an increase (p < 0.005 for measles and chickenpox) in VC is observed following the mandatory law of 2017. Similarly, a reduction in all values is observed from 2020 (p < 0.005 for Tetanus).

Conclusions

The mandatory law represented an effective intervention, leading to an increase in all VC, which for 6 vaccinations reached a value >95%. On the other hand, the pandemic had a significant impact on the reduction of VC in Italy. It is necessary to plan recovery interventions for children in pandemic-affected cohorts to ensure adequate VC values and avoid epidemics from VPD.

Key messages

• The mandatory law represented an effective intervention increasing vaccination coverage.

• It is necessary to plan recovery interventions for children in pandemic-affected cohorts to ensure adequate vaccination coverage.
Green Deal and Climate Pact as a Lighthouse and for Public Health in Europe
Authors: Jevtic M
Published: October 2023

Public health professionals (PHP) have a dual task in climate change. They should persuade colleagues in clinical medicine of the importance of all the issues covered by the European Green Deal (EGD). The fact that the health sector contributes to the overall emissions of 4.4% states to the lack of awareness within the health sector itself. Strengthening the opportunities and development of the circular economy within healthcare is more than just a current issue. The second task of PHP is targeting the population digitally. The PH mission is being implemented, inter alia, through numerous activities related to environmental monitoring and assessment of the impact on health. EGD and European Climate Pact (ECP) are a lighthouse for priorities and actions in PH, bearing in mind: an ambitious goal of climate neutrality, an insistence on clean, affordable and safe energy, a strategy for a clean and circular economy. The ECP is an opportunity for citizens but especially for health professionals, to participate in climate action across Europe, to learn about climate change, develop and implement solutions. As part of the EGD, ECP aims to become a space to act on the climate crisis, and offer support for a European climate movement but also to health care professionals to act and implement innovative solutions. ECP and role of Climate pact Ambassadors give opportunities for actions in health care and wider. EGD is a leadership step in the global framework towards a healthier future and comprises all the non-EU members. The PH sector should involve the EGD as an argument for achieving goals at national levels, and align national PH policies with the goals of this document. There is a need for stronger advocacy of public health interests and sustainability into all health policies. Achieving goals requires more environmentally education process for healthcare professionals covering all of topics of climate change, PH digitalization and air pollution to a much greater extent.
Cities, Walkability and Health. A multi-disciplinary walking experience at EPH22 in Berlin
Authors: Rebecchi A
Published: October 2023

Abstract: Several studies in Public Health focused on determining the influences of the built environment on the population's physical health status. To collect perception of the environment and the ability to promote Physical Activity, a walking experience was developed during the EPH23 Conference in Berlin. A survey had been used, according to an evaluation method (Design&Health Lab. DABC-POLIMI) based on the comparison and critical selection of qualitative urban indicators. The Micro dimension (analyzing Usefulness, Safeness, Comfort, and Aesthetics criteria) investigates the city at the street scale level; features like green/blue/grey infrastructures; intermodal public transport system; vehicular traffic reduction; cycling, and pedestrian routes availability; and accessibility of public spaces, were observed and commented by the Attendees. The survey was conducted via Google form platform and consists of two sections, one with questions for statistical purposes such as gender, age, and expertise, while the second presents questions related to the four Micro dimension criteria. The survey was applied to four areas in the city of Berlin: Pariser Platz, Unter den Linden, Gendarmenmarkt, and Bebel Platz, and was completed by 29 participants. Predominantly Public Health experts (70 percent), aged 46-65 (50 percent), participated in the survey. The results showed the strengths and weaknesses of various urban areas, highlighting possible scenarios for improvement. Limitations of the experience were the number of respondents and the analysis of some parts of the city center. Implementation for the future can be to include a higher number of city users’ as well as performing the same tool in different cities to test the effectiveness. The pre-Conference overall purpose was to foster the dialogue between designers and Public Health experts, to establish a multidisciplinary approach for understanding together how to create a living environment more linked to a healthy lifestyle.