bluuebunny/crossref_metadata_2025 huggingface dataset:
8.H. Workshop: People-centered approach in TB treatment. Experience from Eastern European countries
Authors:   Organised by: American University of Armenia (Armenia),   Chair persons: Varduhi Petrosyan - Armenia
Published: October 2020

Objectives

The current global “END TB” strategy emphasizes the importance of people-centered approach in TB treatment. The latter gives patients a central role in the course of treatment, prioritizing social circumstances, needs, and values of patients.

Some high burden TB countries in the European region have integrated different models of people-centered TB treatment in their national TB control programs, while others are working towards adopting and introducing relevant models for their settings.

The objectives of the workshop are: To bring together existing evidence and experience of countries that are in different stages in terms of implementing people-centered approach in TB care.To contribute to the integration of evidence-based practices, including people-centered approach, in different settings and countries.To promote regional cooperation through information exchange, networking and discussion.

The session will include experts, researchers and public health practitioners from Armenia and Ukraine.

The proposed workshop will follow the regular format with five presentations, each of them dedicated to a country-specific experience in people-centered approach in TB treatment. The presenters will provide examples about different components of people-centered approach implementation in different settings. The discussion session with workshop presenters and attendees will facilitate further conversation about lessons learned from recent successes/failures in each country. This will provide practical advice and recommendations regarding development and implementation of best practices of people-centered approach in TB care.

Key messages

The workshop will advance the understanding about successes, challenges, and lessons learned from implementation of people–centered approach in TB treatment in different settings. The workshop will facilitate discussion and information exchange among participants, helping public health practitioners to adapt people–centered approach in TB treatment in their countries.
8.I. Workshop: Populist radical right and health: National policies and global trends
Authors:   Organised by: University of Michigan (USA),   Chair persons: Marleen Bekker – EUPHA Public health policy and politics section, Scott Greer - USA
Published: October 2020

Populist radical right (PRR) parties have been steadily expanding, not only in the number of supporters they gain and the seats they win in governments, but more importantly they have been increasingly elected into governmental coalitions as well as presidential offices. With the prominence of these authoritarian, nationalistic and populist parties, it is often difficult to discern what kind of policies they actually stand for. Particularly with regards to the welfare state and public health, it is not always clear what these parties stand for. At times they call for a reduction of health-related welfare provision, despite the fact that this goes against the will of the “ordinary people”, their core supporters; they often promote radical reductions of welfare benefits among socially excluded groups - usually immigrants, whom are most in need of such services; and finally they often mobilize against evidence-based policies. The purpose of this workshop is to present the PRRs actual involvement in health care and health policies across various countries. As PRR parties increase and develop within but also outside of the European continent it is necessary to keep track of their impact, particularly with regards to health and social policies. Although research surrounding PRR parties has significantly expanded over the last years, their impact on the welfare state and more specifically health policies still remains sparse. This workshop will present findings from the first comprehensive book connecting populist radical right parties with actual health and social policy effects in Europe (Eastern and Western) as well as in the United States.

This workshop presents five country cases (Austria, Poland, the Netherlands, the United States) from the book Populist Radical Right and Health: National Policies and Global Trends. All five presentations will address PRR parties or leaders and their influence on health, asking the questions “How influential are PRR parties or leaders when it comes to health policy?” “Do the PRR actually have an impact on policy outcomes?” and “What is the actual impact of the health policies implemented by PRR parties or leaders?” After these five presentations, the participants of the workshop will be engaged in an interactive discussion.

Key messages

As the number of PRR parties increase worldwide and their involvement in national governments become inevitable, new light must be shed on the impact these political parties have on public health. Politics needs to become better integrated into public health research. The rise of PRR parties in Europe might have serious consequences for public health and needs to be further explored.
Hungary
Authors: Scheiring G , Löblová O , Moise A
Published: October 2020

Background

The impact of Populist Radical Right (PRR) parties on health policy has so far been neglected by health policy and welfare state literature. The case of the Alliance of Young Democrats (Fidesz) in Hungary, a large PPR party which secured three consecutive supermajorities since 2010, is illustrative of the priorities PPR parties.

Methods

We conducted a review of available primary sources (legal and policy documents) and secondary literature (academic, press, and think-tank publications). Resulting data was analyzed thematically.

Results

Under Viktor Orban, Fidesz nominally stopped marketization reforms of the previous governments by re-nationalizing hospitals in its first term. However, voluntary and employer-sponsored private insurance has grown rapidly, resulting in a parallel system of health care financing and provision, likely due to continued underfunding and understaffing of the public sector. The government has not stopped the exodus of health professionals. In public health, Fidesz sought to reduce smoking rates by imposing a wide-reaching smoking ban and by nationalizing the sale of tobacco in its first mandate.

Conclusions

Fidesz' election in 2010 was brought in part due to protests against health privatization. Health care continued to be a prominent theme of the 2018 elections, this time mobilized by the far-right opposition as a grievance against the government. Fidesz's electoral success is less attributable to health policy than to nationalist and populist rhetoric.
Collecting Data on Sexual & Reproductive Health in Humanitarian Settings
Authors: Ferne J
Published: October 2020

Unsafe abortion is a major contributor to maternal death and disability in humanitarian/ contexts, and women and girls are at considerable risk of experiencing forced marriage and sexual violence, as well as acquiring HIV and other sexually transmitted infections. Routine, reliable and rigorously collected data on sexual and reproductive health (SRH) in humanitarian settings are sparse globally irrespective of region or state of emergency. This problem is pronounced in politicized SRH issues such as abortion. This innovation has piloted a variety of strategies including data mapping, resource inventory, focus group/interviews, and other approaches to map challenges associated with collection and indicator development. Indicators have been developed, a toolkit with pre-programmed tablets to record information and detailed instructions for how to collect abortion information has been piloted, and a central database will be established to make SRHR data (particularly abortion and advocacy data) more widely available.
Adolescent sexual and reproductive health and rights: generating evidence and strengthening country capacity
Authors: Ferne J
Published: October 2020

Knowledge generation and use of evidence on Adolescent SRHR and related gender issues, (such as gender inequalities and female empowerment) is weak and is not being harnessed effectively. Country institutional capacity is often inadequate for effective analysis and communication of ASRHR data, and data on the youngest adolescent age-cohorts are lacking. Available ASRHR and related gender data through surveys are poorly harnessed by policy makers, program staff and project managers. As such, available ASRHR data are often ignored due to low confidence in research quality across data collection methods. This innovation has developed and tested improved methods of measurement, monitoring, and knowledge translation in ASRHR and gender across multiple sub-Saharan countries. It has further created and piloted methods and tools to better analyze, communicate, and translate into action ASRHR-relevant data, with a focus on better integration of national survey data (including subnational analyses, district data) to support and inform: (i) government policies and programs and local projects led by Canadian and other NGOs; and (ii) contextualized local programmatic monitoring, learning and evaluation.
Impact of lockdown measures in abating the COVID-19 pandemic: Lessons from India’s phased approach
Authors: Singh R , Sharma K
Published: October 2020

Background

World Health Organization (WHO) declared that the outbreak of novel coronavirus (2019-nCoV) constituted a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 and characterized the novel coronavirus disease (COVID-19) as a pandemic on 11 March 2020. India enacted such measures early on for effective mitigation and suppression to reduce community transmission, including an onerous national lockdown. The impact of the health system governance is quite apparent among all stakeholders including the public in such emergency contexts.

Methods

We compiled the daily data on the number of COVID-19 cases, recoveries and deaths from January 30th until June 16th, 2020. Different stages were categorized from post PHEIC declaration (pre-lockdown) phase to lockdown phases and unlocking phase as implemented. The several measures adopted by the national government were structured in four broad categories as Governance and socioeconomic, travel restrictions, lockdown and public health measures. These measures were compared during each phase.

Results

It was revealed that while the cases are rising the phased restrictions has helped in delaying the peak and remarkably interrupted the rate of transmission. The national average doubling rate was 3 days at the beginning which improved to 22 days. The basic reproduction number remained close to 1 during the last week of lockdown. However, the initial interruption of needed aid and technical support had negative social and economic impacts on the affected population.

Conclusions

As the situation abates following the measures adopted by the government, an articulate strategy of unlocking through increased testing and prompt isolation needs to be developed for more effective reduction and protecting the livelihoods allowing to further relax the lockdown measures.

Key messages

There is need for the local government to consider a strategic easing of the lockdown for protecting the rights of the most affected population. As the transmission rates are low, the easing of lockdown can be benefited from improved testing and prompt isolation.
Management of the newborn baby of a mother with suspected or confirmed Covid-19 positivity
Authors: Golin R , Conversano E , Lo Menzo S , Peruzzetto C A , Piovan V , Rizzardi E , Ramina P , Rulli R , Spinello M C , Zilli E
Published: October 2020

The Sars-CoV-2 pandemic has created concern and uncertainty about the management of the newborn and breastfeeding, particularly if the mother has suspected or known coronavirus positivity. In our neonatology department, a second-level center, separate pathways were defined for Covid-positive (or suspected) and Covid-free patients at the beginning of March 2020; isolation rooms were identified, and indications were given regarding the management of the newborn in the delivery room and within the Neonatal Pathology department, with the aim of preventing the spread of the SARS-Cov-2 infection and encouraging breastfeeding.

Resuscitation of the newborn occurs according to the recommended guidelines, taking care to quickly clean the newborn of the mother's blood and fluids. At the end of the stabilization of the newborn, four scenarios can occur: Newborn who does not require intensive care, born of a mother in good condition and with a positive SARS-CoV-2 swab; follows the mother as she is transferred to the maternal ward of the Covid Hospital (superHub Padova).Newborn born to a suspected mother, who does not require intensive or semi-intensive assistance; can be managed by favoring rooming-in, compatibly with the mother's conditions.Newborn who needs intensive or semi-intensive care for neonatal reasons, born from a suspected or SARS-CoV2-positive mother; requires STEN - Neonatal Emergency Transport Service, according to the procedure and dedicated routes.Newborn born to a positive or suspected mother, who has severe symptoms of respiratory infection or general state impairment; will be separated from the mother and placed in semi-intensive isolation in a dedicated incubator in the neonatal ward.

This paper provides a proposal for the management of the newborn born to a suspected or coronavirus-positive mother, and was formulated to avoid the spread of the infection and to implement neonatal care.

Key messages

A proposal for the management of the newborn born to a suspected or coronavirus-positive mother formulated to avoid the spread of the infection and to implement neonatal care in second-level centers. Operational indications for the management of the newborn baby of a mother with suspected or confirmed Covid-19 positivity and neonatal care in second-level centers.
An urban, community-based whole of systems approach to address childhood overweight and obesity
Authors: Wardle K , Maitland N , Allender S , Jalaludin B , Haigh F
Published: October 2020

Background

In 2015 two billion people were estimated to be above a healthy weight globally, contributing to a rapid increase of non-communicable diseases. Evidence indicates multi-faceted and community-led interventions are most effective in addressing the complexity of childhood overweight and obesity. Campbelltown - Changing our Future is a practical example of an urban, community-based whole of system approach to identify, develop and implement community-led interventions to address this issue.

Methods

Key community stakeholders and leaders, who had power to change environments and norms, were engaged in a series of three workshops to develop a systems map. A Group Model Building (GMB) framework was used across the workshops to facilitate community perception of the key factors that compose the system that influences childhood overweight and obesity within an urban community. Community members were asked to identify and commit to community-led actions to effect change on various elements of the system.

Results

Over 200 community members were engaged in the GMB process, establishing the following systems map themes: physical activity and sedentary behaviour, healthy eating, knowledge and education and social factors. A further 200 community members are contributing to 90 ongoing community-led comprehensive interventions to address childhood overweight and obesity.

Conclusions

Over 90 actions are active within the community, ranging from high profile athletes’ role modelling reading to children through to a Council healthy food and drink policy. These actions contribute to creating change across multiple levels of the system, an effective, sustainable solution to addressing childhood overweight and obesity.

Key messages

Practical implementation of a whole of system approach in an urban community produces community-led action. A whole of systems approach facilitates community engagement to address complex issues.
Are ambulatory care sensitive conditions a valid indicator for quality of primary health care?
Authors: Keskimäki I , Satokangas M , Lumme S , Partanen V-M , Arffman M , Manderbacka K
Published: October 2020

Background

Hospitalisations due to ambulatory care sensitive conditions (ACSCs) have been used for assessing access to and quality of primary health care (PHC) in many countries. To assess the validity of ACSCs for assessing PHC performance we carried out a series of studies on regional and sociodemographic variations and time trends in ACSC hospitalisations and related mortality.

Methods

Hospitalisations due to ACSCs in Finland in 1992-2013 came from the national Hospital Discharge Register. The data were linked to population at risk data and individual sociodemographic indicators from Statistics Finland, and subsequently to area indicators of population health and socioeconomics, and health care organisation. Depending on study questions, we analysed ACSCs divided into acute, chronic and vaccine-preventable causes using appropriate statistical methods, such as multilevel Poisson models and trajectory modelling.

Results

We found ACSC hospitalisations to be highly associated to subsequent mortality with 4-10-fold excess 1-year mortality compared to the general population. ACSC hospitalisations showed substantial regional variations which declined over the study period due to decreasing variations in hospitalisations related to chronic ACSCs. The variations were mainly attributed to the hospital district level. In detailed analyses, about a quarter of the variance in ACSC hospitalisations was explained by individual level socioeconomic and health factors. In addition, population health indicators and factors related to hospital care organisation explained up to one third of the variance.

Conclusions

At patient level a hospitalisation due to ACSC is a sentinel event and associated to a high risk of poor health outcomes. However, using ACSC for benchmarking PHC providers should be addressed with caution and differences in sociodemographic factors and (co)morbidity of populations at risk, and regional heath and hospital care arrangements should be taken into account.

Key messages

Variations in hospitalisations due to ambulatory care sensitive conditions may mainly be linked to other factors than access to and quality of primary health care. More research is needed to validate ambulatory care sensitive conditions for use in assessing primary health care.
Monitoring health inequalities to inform action- the Pan-Canadian Health Inequalities Reporting Initiative
Authors: Miszkurka M
Published: October 2020

Improving national health inequalities monitoring and reporting systems is critical for informing effective action to improve health equity. The Pan-Canadian Health Inequalities Reporting Initiative (HIRI) provides a foundation of data and evidence to support collaborative efforts to reduce health inequalities in Canada.

HIRI is led by the Public Health Agency of Canada, in collaboration with the Pan-Canadian Public Health Network, Statistics Canada, First Nation Information Governance Centre and other partners. HIRI brings together inequity measures for more than 100 indicators of health outcomes, risk factors, and social determinants of health disaggregated across a range of socioeconomic and sociodemographic variables meaningful to health equity including: sex/gender; age; income; education; employment; occupation; immigrant status; Indigenous identity; race/ethnicity; urban/rural residence; material and social deprivation, functional health/participation and activity limitation and sexual orientation.

HIRI aims to strengthen health inequalities measurement, monitoring, and reporting capacity in Canada. It informs policy and program decision making to more effectively reduce health inequalities, and enables the monitoring of progress in this area.

This presentation will provide an overview of the HIRI along with the key health inequalities in Canada. It will elaborate on the importance of the engagement with multiple partners in creating a broad range of data and knowledge translation products, and discuss how making it accessible to others: Allows for a comprehensive and systematic assessment of the state of health inequalities in CanadaSupports focused action through increased access to health inequalities knowledgePromotes collaboration and accountability for the reduction of health inequalities in order to achieve SDGs
Using research sponsorship to skew the evidence base towards policies and interventions that favour industry
Authors: Fabbri A
Published: October 2020

In recent years, commercial organizations have become more and more prominent in research sponsorship. However, these arrangements pose high risks of bias to the research environment and consequently risks to public health. Corporate sponsorship can influence the design, conduct, and publication of research. Although more difficult to define, industry sponsorship can also influence the research agenda, namely the initial step in conducting research, during which the research questions are chosen.

The results of a scoping review on influence of industry sponsorship on research agendas will be presented to delegates. In this review, we found that corporations adopted similar strategies across different industry sectors. Corporations fund research that can be used to promote their products, distract from their harms, support their policy and legal positions, and decrease regulation of their products. By influencing the research agenda, corporate interests have the potential to influence public debate and policy-making.
Assessing the public health impact of climate change in Wales
Authors: Green L
Published: October 2020

In April 2019, Wales declared a climate emergency. Public Health Wales commissioned a Health Impact Assessment (HIA) to assess the potential impact of Climate Change on the population of Wales to be carried out to inform key strategic decision makers to understand/plan for the potential differential health impacts that may occur in Wales from climate change.

A comprehensive mixed-method HIA was conducted over a 6-month period in 2019/20. A review of peer-reviewed evidence on the potential impact of climate change/climate change events on health and population groups and a review of grey literature on direct impacts such as the environment, mental wellbeing and health care settings was conducted. The search was undertaken using MEDLINE, Embase, Proquest. 2 stakeholder workshops, qualitative interviews, a community health profile utilising recognised data sources (i.e. The National Survey for Wales) and a survey to identify the publics' views on climate change were also carried out. All findings were analysed, synthesized and collated into a report.

The HIA initial findings indicate significant potential impacts across the wider determinants of health and mental well-being i.e. Air quality, excess heat/cold; flooding; economic productivity; working conditions; access to services; infrastructure; and community resilience. A range of impacts were identified across population groups, settings, geographical areas including urban and rural contexts; outdoor workers; children and young people; older people; schools; hospitals/care homes and workplaces.

The impacts identified are both confirmed and potential. Undertaken in a short timeframe, the findings have been beneficial to inform decision-makers to prepare for Climate Change plans/policies using an evidence-informed approach. The work has demonstrated the value of a HIA approach for significant, complex policies by mobilising a range of evidence through a transparent process, resulting in transferrable learning for others.
Indicators to monitor policy progress in health adaptation to climate change: do they really do the job?
Authors: Sanchez Martinez G , von der Pahlen MC Tirado , Kendrovski V , Linares C , Diaz J
Published: October 2020

There is a need for urgent adaptive action to protect human health against climate change. Overall assessments based on a selection of indicators suggest that we are unable to cope with current climate impacts on health and unprepared to respond to increased pressures on climate-sensitive exposures and outcomes.

The health sector has been addressing climate adaptation to health, through siloed approaches limited to the health system, which reduces their capacity and effectiveness. Successful strategies for addressing climate and environmental degradation challenges to health, and related issues such as environmental health, nutrition or equity, require integrated adaptation approaches among the health systems, social protection systems, water and sanitation systems, urban planning, environmental health and climate services among others. For example, integrated monitoring and surveillance (human-animal-environmental-ecosystems health) is critical for the early identification of emerging risks, diseases or trends, and for resource planning and evaluation of the adaptation and control strategies. In addition, when climate and health indicators are put to use for prevention, and eventually adaptation, they are also frequently used in isolation, disregarding interactions. For example, early warning systems for the prevention of climate-influenced impacts on health, such as Heat Health Action Plans, air pollution warnings or allergenic pollen information systems are usually activated individually commonly fail to address the synergies across various climate-related or climate-aggravated exposures. Since various of those exposures tend to occur concurrently (e.g. heat, anthropogenic air pollution from thermal inversions, and Saharan dust intrusions), failure to integrate them in prevention efforts could affect their effectiveness and reach. Thus, there is a need to carry out an integrative approach for the multiple effects that climate change has on population health.
An overview of food insecurity in Europe and what works and what doesn’t work to tackle food insecurity
Authors: Loopstra R
Published: October 2020

Data based on the FAO's Food Insecurity Experience Scale suggest prevalence rates as low as 3.1% in some countries, to more than 20% in others across Europe. In the past two decades, rising food bank use suggests a growing problem of severe food insecurity and is symptomatic of a lack of systematic governmental responses to hunger. In this absence, charities are often relied on to fill the gaps in the social security net.

The pairing of the problem of hunger with the problem of food waste often fuels further development and entrenchment of charitable food redistribution through food banks, even though there is little evidence that these responses effectively reduce food insecurity. Research on the impacts of social security interventions, however, evidence the close links between these and food insecurity.

How provision through social security systems can additionally accommodate the acquisition of sustainable and nutritious food is a challenge for the future, as current social security rates are often well below costs of living. These challenges reflect the need for systems thinking for tackling the challenges of sustainability, food insecurity, and low household incomes, underpinned by underemployment, low wages, unemployment, disability and caregiving.
The Mobility Transition in Health Professional Emigration
Authors: Nwadiuko J , Rao K , Paina L
Published: October 2020

Introduction

Human resources for health (HRH) emigration is a topic of great concern to policymakers. In what is called the “mobility transition”, emigration rates for the general population follow an inverted U-shaped curve, with migration rising at a positive relationship to GDP/capita until source countries reach a GDP/capita of $7,000 or more, after which emigration rates fall. It is unclear whether HRH emigration trends follow a similar pattern.

Methods

We drew OECD-destination physician and nurse emigration data from the OECD.Stat database from 2000-2016 and charted it against real GDP/capita (2011 $ international). We censored data from small island states and country-years with known coups or conflicts. We fit a mixed-effects model testing for a quadratic (U-shaped) relationship between the natural log of real GDP/capita and annual emigration flows, controlled for source country physician/nurse density and year.

Results

We drew data from 145 sending countries and 28 destination countries over 17 years. Scatter and fitted trend plots showed a regular, not inverted, U-shaped distribution of physician/nurse emigration rates, with low-income countries represented on the left end of the curve (with declining emigration with increasing GDP/capita) and high income, European nations represented on the rightmost end (with rising emigration with increasing GDP/capita) after an inflection point around $7,000 GDP/capita. Model estimates demonstrated a significant positive quadratic relationship between the natural log of GDP/capita and physician (p = 0.005) but not nurse emigration rates when controlled for other variables.

Conclusions

There appears to be a mobility transition in HRH emigration rates, with an increase in HRH emigration with rising GDP/capita in countries with greater than $7,000 GDP/capita. Of note, some European nations have emigration rates of similar magnitude to low-income African nations, likely due to relatively relaxed EU mobility regulations.

Key messages

Physician Emigration Trends follow a U-shaped transition with elevated rates in low- and high-income countries and depressed rates in middle income countries. Some European nations have emigration rates similar to low-income African/Asian countries.
Strengthening the public health workforce in Slovakia through professionalization
Authors: Katreniakova Z , Kallayova D
Published: October 2020

Issue

The Coalition of Partners (CoP) takes collective action to strengthen public health (PH) services and capacities across the WHO European Region. A review of the implementation of the European Action Plan for Strengthening PH Capacities and Services showed that, despite robust action, its potential remained largely unrealized. In 2017-2018 Slovakia has joined the WHO activities aimed to accelerate a progress in Europe and in individual Member States. One of the main problem of the Slovak PH system is a lack of experts and unbalanced infrastructure.

Description of the problem

The critical shortage of PH workforce in Slovakia is a result of increasing retirement of physicians, decreasing interest of young physicians and PH professionals to enter to PH practice, and limited opportunities for other professionals in the current PH system. Therefore, the Ministry of Health (MOH) and the Public Health Authority of the SR, the relevant academic institutions and non-governmental organisations agreed to deal with strengthening the PH workforce and took the responsibility for mobilizing the resources needed to implement the Agenda for Action.

Results

In September 2019, regional PH institutes, universities, professional associations, and other experts were invited to evaluate the PH workforce professionalization using a rapid assessment tool (Czabanowska, Slock, 2019). In October-December 2019, three national round tables were held with aim to formulate the areas for cooperation. In February 2020, the core team and three expertś teams were nominated by the State secretary of the MOH to continue on prioritising the future recommendations in the fields of: education and training, research and development, system and financing.

Lessons

The initiative supporting PH professionalization has a potential to form a national CoP on strengthening PH capacities and services. Its long-term vision is focused on effectively and efficiently governed PH system in Slovakia.

Key messages

In Slovakia, strengthening the public health workforce is essential. Started cooperation on supporting public health professionalization is an important step for future actions at national level.
We still dońt know who bleeds in Dengue. A systematic review of the literature
Authors: Boucsein J , Antia K , Deckert A , Horstick O , Nabieva J , Winkler V , Jänisch T
Published: October 2020

Background

Already, Dengue affects 400 million individuals every year. Its main drivers, urbanization, globalization, and climate change, however, will spread the disease even further and potentially threaten billions. In Dengue, bleeding occurs frequently. Severe bleeding strongly increases mortality and immediate medical response is crucial for survival. Predicting the occurrence and course of bleeding in advance would improve clinical outcome, reduce unnecessary hospitalization, and improve economic efficiency.

Methods

Following the PRISMA-guidelines, we conducted a systematic review of the literature to identify predictors of bleeding in acute confirmed Dengue. We searched Pubmed, Web of Science, IRIS, LILACS, and the Cochrane Archives and included all prospective longitudinal studies restricting neither language nor study sample characteristics.

Results

We included 19 studies but found that most data suffered from high risk of bias because of poor reporting and not accounting for confounding. Only five studies were more reliable, and they unanimously reported that age-, and platelet count predicted bleeding severity. The body of evidence was too weak to draw conclusions for the other 23 markers investigated. Crucially, the researchers had defined central concepts in fundamentally different ways and thus prevented the comparison of their findings.

Conclusions

Our systematic review of the literature showed that more research is needed to create a reliable prediction model for bleeding in Dengue. We have moderate certainty that platelet count- and age predict bleeding severity. Our study exposed the urgent need to improve the quality of research in Dengue epidemiology. Most importantly, our findings illustrate the necessity to harmonize central concepts within the Dengue research community. To tackle the challenge that Dengue is bound to become, we need dialogue across research groups and collaboration that overcomes the limited impact of individual studies.

Key messages

We know too little about predictors of bleeding in Dengue. Reliable data is needed to identify new markers and to confirm existing markers that are carried by a weak body of evidence. We urge investigators to collaborate. To overcome the limitations of individual studies, we need better comparability and a scientific dialogue based on common definitions of core concepts in Dengue.
Environmental and climatic risk factors for cystic and alveolar echinococcosis in Kyrgyzstan
Authors: Paternoster G , Boo G , Flury R , Raimkulov K M , Minbaeva G , Usubalieva J , Müllhaupt B , Deplazes P , Furrer R , Torgerson P R
Published: October 2020

Cystic and alveolar echinococcosis-CE and AE-are parasitic zoonoses caused by tapeworms Echinococcus granulosus and E. multilocularis. Their lifecycle is associated with particular environmental and climatic conditions, which have been identified as risk factors for CE and AE transmission. In this study, we assessed potential environmental and climatic risk factors for CE and AE in Kyrgyzstan where both diseases are endemic.

We previously estimated CE and AE surgical incidence and standardised incidence ratio (SIR) at the local community level in Kyrgyzstan for the period 2014-2016. We obtained 190 geospatial covariates on potential environmental and climatic risk factors for the two diseases from remotely sensed datasets. To account for the prolonged latency of CE and AE, we used covariates for different years (i.e. 2000, 2005 and 2010) and for an extended period of 30 years (i.e. monthly mean). We summarised the different covariates at the local community level and assessed correlations with the SIR of CE and AE using the Spearman's rank correlation test. We also computed the variance inflation factor (VIF) to assess multicollinearity between covariates. We then fitted three types of conditional autoregressive (CAR) models for each disease, namely an independent, a convolution, and a so-called Leroux model. We used covariates exhibiting significant correlation with the SIR of CE or AE and no multicollinearity as explanatory variables, and case counts as response variables. We selected the best CAR model and further refined the covariate selection using the Deviance Information Criterion (DIC).

Convolution models exhibited the best fit in terms of DIC for both diseases. None of the selected environmental variables exhibited significant effect on the number of CE cases, whilst there was a significative negative effect of mean annual temperature in 2005 on AE cases. These preliminary findings might inform targeted prevention and control in high-risk areas.

Key messages

We assessed environmental and climatic risk factors for cystic and alveolar echinococcosis in Kyrgyzstan. Our preliminary findings suggest that alveolar echinococcosis risk in Kyrgyzstan is associated with climatic factors such as 10-year lag mean annual temperature.
Post-stroke epilepsy and mortality: an observational study on healthcare administrative database
Authors: Antonazzo I C , Cozzolino P , Cortesi P A , Cesana G , Mantovani L , Mazzaglia G
Published: October 2020

Background

Post-stroke epilepsy (PSE) has been associated with hospitalization and increased mortality risk. So far, evidence on PSE and mortality risk is lacking. Therefore, this study aimed to evaluate the association between PSE and mortality in different type of stroke.

Methods

A retrospective observational study was conducted using healthcare administrative databases of Lombardy, a northern Italian region (16.4% of the Italian population). Patients aged 40 years or older admitted to the hospital between 1/1/2004 and 31/12/2008 with diagnosis of hemorrhagic (HS)- or ischemic (IS)- stroke were included. Diagnosis of seizure/epilepsy was identified by using discharge ICD9-CM codes, exemption code or use of antiepileptic drugs. This date was considered the index date. For each stroke cohort case of PSE was matched with 2 non post-stroke epileptic (PNS) individuals. Demographic and clinical characteristics were compared between PSE and PSN among the stroke cohorts. Cox proportional regression model was used to estimate the hazard ratio (HRs) and 95% confidence intervals (95%CI) of mortality.

Results

In the observed period, 13,749 of patients (4,583 PSE Vs 9,166 PSN) had IS and 4,875 (1,625 PSE Vs 3,250 PNS) had HS. Individuals were ≥75-year-old with no difference among cohorts (p value >0.9). Similarly, no differences were observed for gender (p = 1.00) and Charlson'comorbidity index (p = 1.00). Early seizure occurred in 15% of ischemic cohort and 20% of hemorrhagic one. Differences in antithrombotic drug use were observed among PSE and PSN in IS (p = 0.009) and HS cohort (p = 0.03). In ischemic cohort PSE was positively associated with increased mortality risk (HRadj: 1.67; 95%CI: 1.57-1.79), whereas no significant result was observed in hemorrhagic cohort (1.06; 0.94-1.20).

Conclusions

This study demonstrated a twofold increased risk of mortality in IS cohort. Further studies need to deeply characterize possible association between PSE and mortality in HS individuals.

Key messages

Occurrence of seizure/epilepsy in ischemic post-stroke patients represents a risk factor for morality. New studies need to clarify the contrasting result observed for hemorrhagic PSE patients.
Towards NCD surveillance in Germany – diabetes as a paradigm
Authors: Reitzle L , Paprott R , Heidemann C , Schmidt C , Baumert J , Färber F , Du Y , Scheidt-Nave C , Ziese T
Published: October 2020

Background

Non-communicable diseases (NCD) are a major public health challenge in Germany and throughout the world. The epidemiology of diabetes, in particular type 2 diabetes, exemplifies the need for effective prevention and control. To support policy making with actionable evidence, the Robert Koch Institute (RKI) is developing a diabetes surveillance system for Germany serving as model for NCD surveillance.

Methods

First, we consented a conceptual framework and key indicators among experts and stakeholders based on an extensive literature review including national and international NCD surveillance systems. After prioritization of indicators applying a two-step Delphi method, we identified data sources for sustainable surveillance including data from nationwide RKI health surveys as well as external data such as claims or registry data. Lastly, in cooperation with stakeholders we developed first dissemination products.

Results

During concept phase, we identified 40 indicators ranging from risk factors, disease incidence and prevalence to quality of care, mortality and burden of disease. During implementation, suitable data sources and results on temporal trends have been obtained for a large part of the indicators. For dissemination we developed a website with interactive visualization of results supported by an explainer video on YouTube. Additionally, we prepared a printed diabetes report summarizing and interpreting key findings for a broader audience, including health politicians and public health researchers.

Conclusions

We demonstrated the feasibility of the systematic collection and analysis of health data to describe the disease and care situation of diabetes in Germany. The methodology and data sources of indicators can be transferred to further NCDs and shared risk factors are already depicted. Next steps are to close remaining data gaps and to advance dissemination products in collaboration with our stakeholder network tailored to their information needs.

Key messages

Considering available health data, we showed the feasibility of implementing a diabetes surveillance system for Germany providing reliable information on disease dynamics for various stakeholders. The knowledge on methodology and data sources gained establishing a diabetes surveillance system can be extended to other noncommunicable diseases.
Mental health from childhood to adulthood: Results of the 11-year follow-up of the BELLA study
Authors: Wüstner A , Otto C , Reiss F , Voss C , Meyrose A-K , Hölling H , Ravens-Sieberer U
Published: October 2020

Background

Mental health problems in children, adolescents and young adults are highly prevalent and cause a significant burden for both individuals and society, resulting in a high relevance to public health. Longitudinal studies are needed to provide profound population-based data on mental health and well-being. In the present study, first results of the 11-year follow-up of the German BELLA study are presented. These include age- and gender-specific courses of general health and well-being, long-term health outcomes of mental health problems, and the utilisation of mental health services.

Methods

The longitudinal BELLA study is the module on mental health and well-being within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The BELLA study has gathered data since 2003 at five measurement points using standardised measures. In the most recent 11-year follow-up, N = 3,492 young people aged 7 to 31 years participated. Individual growth modeling, linear regression and descriptive analyses were conducted.

Results

Self-reported general health and well-being were both better in younger than older and in male compared to female participants using data from all five measurement points. Mental health problems in childhood and adolescence (measured at baseline) were associated with adverse general, mental and physical health outcomes at 6-year and 11-year follow-ups. About 75 % of children and adolescents with a diagnosed mental disorder were under mental health treatment.

Conclusions

With its 11-year follow-up, the longitudinal BELLA study provides new data on mental health and well-being in German children, adolescents and young adults. Our findings are important for the development of targeted mental health promotion and early prevention strategies. Promising future analyses are planned.

Key messages

The BELLA study provides data on developmental trajectories of mental health from childhood to adulthood, on long-term health outcomes of mental health problems and on mental health care use. The findings of the present study are of great relevance for the development of targeted health promotion and prevention programs.
Preventing postpartum depression using an educational video on infant crying
Authors: Doi S , Fujiwara T , Isumi A , Nakai A , Ogita K , Mitsuda N
Published: October 2020

Background

Perception of and reactive behaviors towards infant crying is one of the modifiable risk factors for postpartum depression. The aim of this study was to examine the impact of watching an educational video on infant crying within 1 week of age after delivery at maternity wards to reduce the prevalence of postpartum depressive symptoms at 1 month after giving birth.

Methods

Study design was a cluster randomized controlled trial (UMIN000015558). The intervention hospitals were randomly assigned, stratified by area and function of the hospital. Participants included 47 obstetrics hospitals or clinics out of 150 hospitals or clinics in Osaka Prefecture, Japan. In total, 44 hospitals or clinics completed the trial and 2,601 (intervention group=1,040, control group=1,561) caregivers responded to the questionnaire on postpartum depression. Mothers in the intervention group watched a 11-minute educational video, within 1 week of age, during hospitalization at maternity wards. Primary outcome in this study was postpartum depression assessed by the Edinburgh Postnatal Depression Scale as 9+, and assessed via questionnaire at a 1-month health checkup.

Results

In the intervention group, 142 (13.7%) mothers reported postpartum depression compared to 250 (16.0%) in the control group. Intention-to-treat analysis showed no significant difference in the prevalence of postpartum depression between the groups. However, among young mothers (<25 years old), the analysis showed a 67% reduction in postpartum depression (OR:0.33, 95%CI:0.15-0.72).

Conclusions

Watching an educational video on infant crying did not reduce postpartum depression at 1 month after giving birth, but it was effective for young mothers aged less than 25 years old. It may be easier to introduce our approach to any opportunity for meeting mothers during perinatal period because it does not require specialized manpower and a significant amount of time for the intervention.

Key messages

The educational video on infant crying, “Baby Doesn't Stop Crying,” had no effect in preventing postpartum depressive symptoms. Among young mothers aged <25 years, the educational video had a protective effect on postpartum depressive symptoms, which was not observed for mothers aged ≥25 years.