bluuebunny/crossref_metadata_2025 huggingface dataset:
The future of nutrition education for health systems capacity building
Authors: Grosso G , Ray S
Published: October 2024

In the ever-evolving landscape of global health, nutrition education plays a pivotal role in shaping the well-being of populations. The future of nutrition education encompasses a holistic understanding of health, considering not nutritional adequacy in health and disease, but also cultural, social, and environmental factors. Tomorrow’s health professionals must also be equipped to address the interconnectedness of nutrition with mental health, sustainability, and community dynamics. Nutrition education will increasingly involve collaboration across disciplines. Health professionals, educators, policymakers, and community leaders must work together to create a comprehensive ecosystem that fosters nutrition literacy. This collaboration extends beyond traditional healthcare settings to schools, workplaces, and local communities. Furthermore, digital transformation will also revolutionise nutrition education. Online platforms, mobile apps, and virtual simulations will enhance learning experiences whilst interactive modules, webinars, and gamified content will engage learners and facilitate continuous professional development. Moreover, telehealth and tele-nutrition will bridge geographical gaps, ensuring access to quality education globally. Cultural sensitivity in nutrition education is also needed across geo-demographic boundaries to appreciate diverse dietary practices, food taboos, and traditional knowledge. Nutrition education should also empower health professionals to advocate for policy change across food systems, promote sustainable practices, and address food insecurity and therefore understanding policy frameworks and participating in advocacy efforts will be key. Finally, embracing the future requires a commitment to lifelong learning to remain at the forefront of nutrition science and its cutting edge as the questions may remain the same but the answers vary significantly as we garner new evidence to navigate evolving global challenges.
An analysis into the rise of private healthcare in England by geographical location and time period
Authors: McCannn L , Holdroyd I , Emberson R , Painter H , Ford J
Published: October 2024

Background

Private healthcare is a rapidly growing industry in the UK, particularly for surgical procedures. Across the pandemic period, waiting lists for elective surgical and consultant-led care increased from 4.4 to 7.5 million patients. This study aimed to analyse the trends and geographical variations in privately funded and NHS-funded orthopaedic private procedures across England compared to NHS waiting times.

Methods

We conducted a longitudinal study using quarterly national data between 2019 and 2023 in England. Descriptive analysis of quarterly orthopaedic surgical volumes per 10,000 people, and quarterly orthopaedic surgery wait times stratified by geographical location and time period was conducted.

Results

Between 2019 and 2023 there were a total of 1,469,450 procedures across the private sector, comprising 1,030,095 NHS-commissioned private orthopaedic procedures and 439,355 private orthopaedic procedures. The South of England performed a higher total number of private procedures per year compared to the North (63 vs 57/10,000 people); whilst there was almost double the number of privately funded procedures (23 vs 12/10,000), the difference was less amongst NHS-funded procedures (45 vs 40/10,000 respectively). There was a large variation in the number of NHS-funded procedures per 10,000 between regions. The North has consistently shorter waiting times than the South.

Conclusions

Our findings indicate considerable geographical variation in the use of private healthcare between regions, suggesting a two-tier healthcare system. The founding principles of the NHS, healthcare free at the point of use based on clinical need irrespective of ability to pay, continue to be eroded. Policy makers and politicians urgently need to find solutions to ensure all members of society can access the same high quality health care.

Key messages

• Private healthcare utilization in the UK for orthopaedic procedures, has increased significantly, contributing to an emerging two-tier healthcare system.

• There are large geographical disparities in access to healthcare services, with he South of England performing more private proceeds with longer NHS waiting times compared to the North.
Vaccine conspiracy beliefs are the main determinant of adult vaccine hesitancy
Authors: Smola P , Zwierczyk U , Kowalska-Duplaga K , Duplaga M
Published: October 2024

Background

Many factors influence the level of vaccine hesitancy. The COVID-19 pandemic demonstrated that conspiracy beliefs are an important element of overwhelming misinformation. The main aim of the study was to assess the relationship between vaccine hesitancy (VH) and vaccine conspiracy beliefs (VCB) in Polish society.

Methods

The analysis was conducted using data from an online survey of 2189 Internet users conducted in November 2021. Uni- (ULRM) and multivariable linear regression (MLRM) models were developed for vaccine hesitancy as a dependent variable. The independent variables included VCB score (VCBS), health (HL) and e-health literacy (eHL), Internet (IU) and social media use (SMU), political views (PV), and sociodemographic variables.

Results

The VCBS, eHL, HL, age, income, vocational and marital status, place of residence, PV, IU, and SMU were significant predictors of VH in ULRMs. A significant relationship with VH was maintained in MLRM for all independent variables enlisted earlier, apart from age, income, and vocational status. Respondents with higher VCBS were more likely to have higher VH (B, 95%CI: 0.38, 0.37-0.40). Those with undetermined HL had higher VH than persons with sufficient HL (B, 95%CI: 0.13, 0.06-0.20). A higher level of eHL predicted a lower level of VH (B, 95%CI: -0.01, -0.012 - -0.03). Lower IU and higher SMU were associated with higher VH (B, 95%CI: 0.16, 0.02-0.30, and 0.10, 0.03-0.17, respectively). Supporters of far right-wing party showed higher HV than supporters of the governmental party (B, 95%CI: 0.16, 0.07-0.27). Finally, singles showed higher HV than married (B, 95%CI: 0.07, 0.01-0.13), and residents of small cities had higher HV than residents of rural areas (B, 95%CI: 0.08, 0.004-0.15).

Conclusions

The vaccine conspiracy beliefs play a major role in the development of VH. The interventions aimed at the change of antivaccination attitudes should address the problem of widespread conspiracy beliefs.

Key messages

• Conspiracy beliefs are an important determinant of attitudes toward vaccination.

• The development of adequate digital health literacy may be a protective factor against vaccine hesitancy.
Mother-to-child Transmission using the National HBV Perinatal Prevention Data in Korea, 2002-2021
Authors: Ki M , Kim B W , Baik D , Kim J H
Published: October 2024

Aims

To define risk factors associated with mother-to-child transmission (MTCT) and to create supporting evidence for the National Hepatitis B Perinatal Prevention Program (HBPPP) in Korea.

Methods

We analyzed HBPPP mother-infant pair data enrolled from 2002 to 2021. The major outcome was the HBsAg status of the infant resulting from post-vaccination serological testing. Additionally, we used prescription records of antivirals against the hepatitis B virus (telbivudine, tenofovir disoproxil fumarate) from 2010 to 2021 by data linkage with the National Health Insurance claims data. To select significant risk factors by maternal HBeAg status based on the data from 34 to 42 weeks of pregnancy, multivariate logistic regression analysis was used.

Results

Data from 232,242 mother-infant pairs were analyzed. Among 154,331 (66.5%) infants with post-vaccination serological testing results, 3,620 (2.3%) were HBsAg-positive. The incidence of MTCT has shown a decreasing trend, from 4.1% in 2002 to 1.0% in 2021. However, the rate was high at 5.5% (1822/32986) for infants of HBeAg-positive mothers. Maternal antiviral prescription during the pregnancy period, old age, HBeAg negative, delivery type (C-section), and breastfeeding were significant factors in decreasing the risk of MTCT. Among the HBeAg-positive, there was a significant difference in the antiviral prescription 0.7% (11/1692) compared to the non-prescription 4.9% (789/16264) [aOR, 7.71; 95% CI, 4.24-14.02]. The result was similar for the HBeAg-negative group, 0.7% (302/44888).

Conclusions

To eradicate the hepatitis B virus on a national level, MTCT must be further reduced. To achieve this, it is necessary to introduce strong additional preventive measures, including quantitative HBV DNA testing for mothers with chronic hepatitis B and administering antiviral prophylaxis at the third trimester of pregnancy with HBV-DNA ≥200,000 IU/mL into the HBPPP.

Key messages

• The incidence of mother-to-child transmission has shown a decreasing trend, from 4.1% in 2002 to 1.0% in 2021.

• Maternal antiviral prescription, old age, HBeAg negative, delivery type (C-section), and breastfeeding were significantly decrease the risk of mother-to-child transmission.
Involving children in health literacy research
Authors: Jenkins C
Published: October 2024

Background

The range of health literacy research related to children has not normalised children’s involvement as advisors in health literacy research about them. While research with children can be difficult to facilitate, the principles of involvement and engagement should guide all health literacy work. This presentation shares learning from convening a Children’s Advisory Group to consult children about health literacy research priorities, ethics and methods.

Methods

Children (n-8) aged 7-11, referred by adults whose networks included children, joined a Children’s Advisory Group as Child Advisors. Consultations focused on a proposed study of how children’s critical health literacy could be supported in a community setting. Child Advisors piloted methods for rapport-building and data collection to be adapted for use with child participants later. Child rights-informed evaluation forms captured children’s reflections on their involvement.

Results

Consulting with a Children’s Advisory Group has challenges and benefits. Despite equity-focused strategies, e.g. introductory phonecalls and postcard updates, seldom-heard children remained less involved and the extent of parent/caregiver support varied. Child Advisors valued independent consultations led by their interests. Contributions included child-friendly consent documents, livestreamed draw-and-describe inspired by favourite influencers, and a novel Interview to the Alien protocol designed to appeal to middle childhood.

Conclusions

Taking an equity-focused approach is relevant for research with children focused on critical health literacy. Consulting with Child Advisors provides a way to involve children in health literacy research that holds adult researchers accountable for acting on children’s contributions. It is important to offer Child Advisors more than one option to get involved in research so that their insights can be foregrounded in future health literacy research with children.
Challenges and possibilities in adolescent loneliness interventions
Authors: Lasgaard M , Friis Bo A , Christiansen J
Published: October 2024

Researchers typically associate the high prevalence of loneliness during adolescence with evolving dynamics and changes in relationships, both familial and peer-related. Consequently, transient feelings of loneliness are anticipated and considered part of the normative developmental process. While many adolescents naturally navigate through periods of loneliness by reconnecting with peers, a subset experiences prolonged feelings of loneliness. This group faces an increased risk of additional mental health issues and potential adverse health consequences. Such findings underscore the importance of effective and scalable interventions. This presentation draws upon a comprehensive meta-analytical review of loneliness interventions and a dedicated chapter in the upcoming Cambridge Handbook of Loneliness. focusing on interventions for adolescents. It will offer a brief overview of contemporary loneliness interventions and intervention strategies. Furthermore, it will discuss the unique considerations required when addressing loneliness in adolescents compared to other age groups. This includes the critical importance of loneliness prevention for adolescents, particularly within the school environment. Furthermore, the presentation will discuss the potential of community-based interventions aimed at tackling adolescent loneliness, showcasing the ongoing Danish community-based intervention ‘More Together.’ ‘More Together’ is a large-scale, complex, multi-component and multi-level intervention for community change that aims to reduce loneliness among young and elderly people. The intervention is rooted in an extensive cross-sector partnership. The presentation will highlight potentials and pitfalls encountered when addressing adolescent loneliness within a community setting.
Interventions to reduce loneliness in children and adolescents: A systematic review and meta-analysis
Authors: Burke L
Published: October 2024

Despite the growing focus on adolescent loneliness and loneliness interventions, our understanding of successful approaches for tackling loneliness in childhood and adolescence remains limited. While recent reviews have made advances in exploring loneliness interventions for this age group, our understanding of successful approaches remains limited. Key knowledge gaps persist, particularly concerning potential moderators - specifically, the characteristics that may determine the effectiveness of an intervention is sparse, leaving a significant gap in our understanding of which interventions are most effective and for whom. This presentation aims to fill this gap by presenting the findings of a systematic review and meta-analysis on interventions to reduce loneliness in children and adolescents. The presentation will provide a brief overview of the methodology employed and provide insights into the characteristics of the interventions reviewed, including an assessment of their overall effectiveness in alleviating loneliness. The primary focus, however, will be on presenting findings regarding the effectiveness of interventions across different participant groups, including variations based on socio-economic status, age group, pre-existing mental and physical health conditions, as well as baseline levels of loneliness. Additionally, the presentation will explore the impact of different intervention strategies on the effectiveness of loneliness interventions for children and adolescents. Lastly, the presentation will offer reflections on avenues for future research and practice based on the findings.
Self-determination and self-affirmative paths of trans* and gender diverse people in Portugal: Diverse identities and healthcare
Authors: Moleiro C , Alarcão V , Pinheiro G , Giami A
Published: October 2024

Background

Trans* and gender diverse (TGD) people are very heterogeneous. While legal contexts and healthcare practices have been growingly endorsing self-determination and consent for gender affirmative care in some countries, gender affirmation trajectories need to be understood as unique and fluid processes, constructed and negotiated by each individual in a given social and cultural context. This study aimed to characterize diverse profiles of TGD people in Portugal, regarding individual choices and trajectories in social, legal, and medical gender affirmative processes.

Methods

A questionnaire, first developed in France and used in Brazil, Italy, Norway, and Chile, was adapted to the Portuguese context. The conducted survey is comprised of 120 questions, organized into six sections: 1) sociodemographic variables; 2) gender affirmation processes and medical and psychological care; 3) general health and sexual health; 4) mental health; 5) sexuality and sexual concerns; 6) experiences of discrimination and gender identity. Data were collected from a convenience sample of 115 adults who identified as TGD. Content analysis was performed on the written responses, and later categorized.

Results

Approximately 21% of people identified as men, 17% as trans men, 7% as women, 12% as trans women, 26% as non-binary persons, and 17% as agender or other identifications. Differences were calculated among profiles of TGD participants and their choices for affirmative care, social, and legal transition, revealing an association between the way people self-identify and the request for legal recognition of gender identity, as well as the choices of procedures (or aspirations) for medical affirmation (i.e., hormonal treatments, top surgery, bottom surgery).

Conclusions

The provision of health care practices consistent with the principles of self-determination requires training of health care professionals and adjustment of public policies, to allow for unique trajectories and profiles.
1.P. Round table: How could a perfect monitoring and response system look like?
Authors:   Organised by: Social Physics and Complexity Lab (Portugal),   Chair persons: Joana Gonçalves-Sá (Portugal), Ana Bento (USA)
Published: October 2024

Robert FitzRoy, captain of the Beagle, was ridiculed when he started to assemble a network of telegraphs to be able to follow storms at sea: in the 19th century, predicting the weather, even in the short term, was considered impossible. 150 years later, meteorological institutes around the world may have helped prevent millions of deaths. Dynamic and complex systems are particularly difficult to predict: we still don’t know exactly when the glaciers will collapse, when the next variant of a virus will appear, how intense the next earthquake will be. In fact, and as the COVID-19 pandemic has shown, most services are unprepared to adjust to such fast evolving-situations: in general, we are limited to trying to react and adapt, but systematically fail at prediction and planning, with important consequences. Moreover, disease outbreaks, scientific research, public health response(s) and legislation happen at completely different time scales, and are not prepared to communicate with (or even understand) each other. Therefore, a fundamental question is how we can create structures that, similar to what FitzRoy imagined, are prepared to anticipate and respond to health threats, when they appear. During this round table, we will bring together experts that use different perspectives (One Health, Digital Epidemiology, Health Policy) and discuss what is needed to build the “perfect” system, in an ideal world. We will argue in favor of 1) creating efficient systems for collecting and processing good quality data, fundamental for any decision making; 2) training multidisciplinary teams to work on the full pipeline from performing complex analyses, using mathematical and computational tools, to communicating with the decision-makers and the population; 3) prepare institutions to network, nationally and internationally; and 4) simulate different scenarios and design medium-term strategies. We will recognize and highlight many of the challenges of such an integrated approach, from data availability and sharing, to communicating under uncertainty, but also the risks of not even trying to do so. We expect to make very brief presentations, to leave abundant time for audience feedback and discussion.

Key messages

• It is urgent to create structures prepared to anticipate and respond to health threats. These should be local but integrated at the international level.

• Their creation faces many challenges, from data collection and sharing to decision making and communication, that should be recognized and tackled using multidisciplinary, integrative approaches.

Speakers/Panelists

Joana Gonçalves-Sá

Social Physics and Complexity Lab, Lisbon, Portugal

Ana Bento

Cornell University, Ithaca, USA

Daniela Paolotti

ISI Foundation, Turin, Italy

André Peralta-Santos

ENSP, Lisbon, Portugal
The primary healthcare workforce crisis: a comparative assessment of the European region
Authors: Kuhlmann E , Falkenbach M , Brinzac M G , Correia T , Panagioti M , Rechel B , Sagan A , Santric-Milicevic M , Ungureanu M-I , Burau V
Published: October 2024

Background

The healthcare workforce crisis strongly affects the primary healthcare sector, worsening the work conditions of healthcare workers and hampering service delivery and health system resilience. This study introduces a health system and governance approach to identify transformative capacities in health system contexts.

Methods

A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England.

Results

Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark and the Netherlands, and to a lesser extent also Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation. The WHO primary healthcare model only marginally informs policy decisions, but it may receive some more attention in Kazakhstan.

Conclusions

We conclude that aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas.

Speakers/Panelists

Tiago Correia

NOVA IHMT, Lisbon, Portugal

Viola Burau

Aarhus University, Aarhus C, Denmark

Marius-Ionuț Ungureanu

Babeș-Bolyai University, Cluj-Napoca, Romania

Anna Sagan

WHO European Centre for Primary Health Care, Almaty, Kazakhstan
Introducing the Policy Lab Method
Authors: Pollitt Alexandra
Published: October 2024

The workshop will begin with a brief presentation providing an overview of the Policy Lab method. The presentation will address how to develop a policy-relevant question from research, introduce stakeholder mapping, and introduce techniques for designing a lab agenda and engagement material. This introductory presentation will lay the groundwork for the practical sections of the workshop in which participants will explore these techniques.
Monitoring the digital healthcare transition in the Netherlands: Challenges, achievements and future
Authors: Keuper J J , van Tuyl LHD
Published: October 2024

Since 2013, the Netherlands Institute of Health Service Research, along with other Dutch research institutes, has monitored the digital healthcare transition in The Netherlands. Through annual surveys of both healthcare professionals (from primary and secondary care) and users (patients as well as the general population) from 2013 to 2023, trends in digital health utilization and experiences have been tracked. Overall, there has been a steady increase in digital care adoption since 2013, but in 2023, growth among professionals stabilized while slightly rising among users. Some tools saw significant increases, like automatic medicine dispensers and home monitoring, freeing up nurses’ time. Utilization patterns differ among patients according to their educational attainment and age, showing lower usage rates among older individuals and those with lower levels of education. Most professionals, especially nurses, view digital care positively, but they recognize its limitations in solving healthcare challenges entirely. Healthcare professionals believe it offers only a limited contribution to cost management, workload reduction, and job satisfaction and emphasize the need for seamless integration into routine care. User opinions are divided, with those with chronic conditions often expressing skepticism. Both professionals and patients agree that personal experience is crucial in determining its value. Additionally, ensuring user-friendliness and clarifying reimbursement for digital healthcare are essential. This workshop provides an overview of developments in the Netherlands and a discussion of challenges, achievements, and prospects. Particular attention will be paid to the monitoring of digitalization progress and effects, and the use of digital solutions in primary and secondary care.
Monitoring the digital healthcare transition in Italy: Initiatives, metrics and feedback from Primary Care Physicians
Authors: Cascini F , Causio F A , Melnyk A
Published: October 2024

Italy’s healthcare sector has undergone significant digital transformation since 2008, driven by national strategies and reforms overseen by the Ministry of Health, the Ministry of Economy and Finance, and the Agency for Digital Italy. Key initiatives include the establishment of centralized booking systems, electronic health records (EHR), ePrescription, dematerialization of medical reports and disease certificates, patient summary, and telemedicine services. Despite regional variations, progress in the EHR adoption has been notable. Ongoing investments under the 2021 National Recovery Plan aim to further enhance digital healthcare infrastructure by 2025 through the involvement of the Italian National Agency for Regional Healthcare Services (AGENAS). Currently, Italy monitors progress through comprehensive measurement frameworks tracking digital health initiatives’ implementation and impact. These encompass indicators reported quarterly by public healthcare facilities regarding the implementation of patient portals, regional registries, network infrastructure, regional EHR systems (i.e., n° of users), and digital laboratory reports. In parallel, we conducted a cross-sectional survey assessing knowledge, opinions and concerns among primary care physicians (PCPs) following the 2022 reform, which introduced Community Hospitals, Community Houses, and telemedicine in primary care. The survey highlighted mixed opinions and insufficient knowledge among PCPs regarding the novelties. Clearer communication and coordination with territorial services appears necessary. Many GPs are engaging in telemedicine, but digital literacy gaps remain, as only 35.7% believed they had necessary digital literacy. This is an insight into Italy’s digital health roadmap, mainly involving primary care and focusing on achievements, challenges, and future prospects in utilizing digital solutions across healthcare settings.
Digital health spaces in the city of Lisbon. The role of digitalization in linking boundaryless hospitals and smart health cities
Authors: Lapão L
Published: October 2024

Digital transformation is reshaping every aspect of society, including healthcare. The concepts of ‘Boundaryless Hospitals’ (BH) and ‘Smart Health Cities’ (SHC) represent a forward-thinking approach to healthcare that leverages digital technologies to enhance service delivery, operational efficiency and patient outcomes, including healthy mobility. This session delves into the complex role of digitalization in creating interconnected health and spatial environments where the flow of data and resources across physical and virtual barriers is optimized. BH embody a healthcare model where digital tools, health information systems and AI-powered diagnostics are integrated to provide care that transcends traditional hospital walls into the city. This approach not only facilitates greater accessibility and flexibility in patient care but also enhances the capacity for healthcare providers to offer personalized and timely interventions, embracing public health altogether. SHC integrates health technology into urban planning and public health services to create ecosystems that actively contribute to the health and wellbeing of their populations. Using big data analytics, IoT and other digital infrastructures, these cities support sustainable health practices, disease prevention, and efficient crisis response, promoting an overall healthier populace. This session will explore how digital health spaces can bridge the gap between these concepts. Discussions will focus on public health challenges and opportunities, examining the case of the city of Lisbon on how digital platforms can facilitate interactions between healthcare providers, patients, and urban environments. Best practices from pioneering projects around the globe will be highlighted. Participants will engage in comprehensive analyses of Lisbon case that demonstrate successful integration of digital health technologies in various contexts, contributing to the resilience and adaptability of healthcare infrastructures.
Building bridges: mobile mental health care units in four European countries
Authors: Lindert J
Published: October 2024

Background

Individuals living in rural and remote areas may have limited access to mental healthcare due to lack of facilities, socioeconomic reasons, stigma and lack of mental health literacy. To meet the needs and provide needs-based care care mobile mental health care clinics were established in some countries in Europe, including in Belgium, Germany, Greece and in Moldowa. A mobile clinic is a customized motor vehicle that travels to communities to provide mental health care. The mobile clinics are an integral part of the health care system and help ensure access to mental care.

Aims

To describe mobile care clinics in two countries in Europe using a case study design.

Results

Mobile clinics deliver a wide variety of mental health services, are heterogeneous and consist of multidisciplinary teams, including physicians, social workers, and other health professionals. The organization and financing of the Mobile mental health clinics is different in the four countries (e.g. part of the mental health care system in Belgium, and Moldova, part of initiatives in Germany and Greece). Due to data protection no detailed data on patients can be provided at the moment. The structures on mental health care mobile clinics in the four countries will be described in detail in the talk.

Discussion

Mobile clinics often serve as a bridge between communities and the mental health care system. Another important issue in rural areas is the ongoing aging of the population. The number of Elderly patients is expected to rise in the future. The care of those patients is challenging for the mental health and the primary care system. There is a necessity for establishing bridges between mobile clinics and hospital care.
Health information system assessments: Opportunities for international collaboration
Authors: Calleja N , Saso M , Schutte N , Bogaert P , Kessissoglou I , Thissen M , Fehr A , Borg M
Published: October 2024

Since the late 1990s, with the development of European Core Health Indicators (ECHI) and the European Health Interview Survey (EHIS), the EU aims to strengthen its continental database for evidence-informed public health policy and research. BRIDGE Health (2015-2017), InfAct (Information for Action 2018-2021) and PHIRI (Population Health Information Research Infrastructure 2020-2023) projects prepared for the establishment of a sustainable European health information infrastructure. Country health information system (HIS) assessments were core project activities, performed on the basis of the WHO Euro ‘Support Tool to strengthen health information systems’. To serve project objectives, the original top-down Support Tool was modified and implemented in a peer-to-peer approach among project countries. InfAct and PHIRI conducted 9 country peer-assessments each. InfAct assessments were carried out through country visits, targeting overall health information inequalities and good practices. PHIRI performed virtual country visits, focusing on COVID-19 health information flows. The WHO Tool was further adapted by the Joint Action TEHDAS (2021-2023) to assess the readiness of HIS in Europe for the European Health Data Space. Experience with these different iterations led to the revision of the Support Tool in 2021 to include a more expanded and modular approach which enables HIS assessments to opt to focus on specific aspects. To date, a sustainable European health information infrastructure has not been set up. Currently, the EU funds a joint Health Information Network with WHO Euro. Building regional infrastructures for public health and NCDI/MH monitoring and reporting depend on structures and on the political will of supranational organizations and their members. Meanwhile, HIS assessments to improve surveillance, population health and to reduce health information inequalities lend themselves to increased international collaboration and knowledge exchange.
OHL-ALL: a theory-informed and practice-orientated organizational health literacy equity approach
Authors: Bindslev Iversen P , Terkildsen Maindal H
Published: October 2024

Background

The OHL-ALL initiative was launched by Steno Diabetes Center Sjaelland and the Department of Public Health, Aarhus University and the OHL-ALL scientific group in cooperation with EUPHA-HL and M-POHL in November 2023. The OHL-ALL (Organizational Health Literacy for All) approach offers an opportunity to rethink and develop organizational health literacy (OHL) with an explicit normative basis for equity. The goal is to establish a theory-informed, practice-oriented, multifaceted, and implementable approach. In the OHL-ALL approach, we define equity as the normative anchor, and we suggest using the Capabilities Approach to embed improved equity in design, implementation, and evaluation of interventions.

Methods

The process of developing the OHL-ALL was guided by applying core ideas from Amartya Sen’s Capability Approach. Five intervention principles were derived from the existing organizational health literacy literature: organizational change, workforce responsiveness, user involvement and person-centered care, access and navigation and internal and external partnerships. After an international expert working group meeting in November 2023, we formed four work packages.

Results

At the EPH conference, a status of the progress in the four work packages will be presented:

WP1. OHL-ALL Framework development based on capability, fairness, and equity.

WP2. Initiatives and testing of the OHL-ALL framework.

WP3. Evaluation of OHL-ALL (i) the capability approach and (ii) outcome domains.

WP4. Plans for the future, including advocacy and outreach - ideally via a conference in 2026.

Conclusions

The OHL-ALL project presents a novel approach to advancing equity in health by improving users’ capabilities. Based on an explicit normative framework it is expected to offer theoretical and practical guidance for organizations that chose to implement a health literacy approach.
Paediatric iGAS Morbidity and Mortality in Ireland 2022-2023 episodic upsurge
Authors: Cotter O , Foley D , Cloak F , Fallon U , Maoldomhnaigh CÓ , Mc Keown P
Published: October 2024

There was an unseasonal upsurge in invasive Group A Streptococcal (iGAS) activity in Ireland during the 2022/2023 winter period. In particular, there was an increase in the proportion of paediatric infections and a rise in the age specific death rate for those under the age of 18, from 0.10 to 1.43 per 100,000. This review aimed to describe the demographic and clinical factors associated with paediatric iGAS infection during this upsurge. All iGAS cases under the age of 16 years, notified to Public Health between 1st October and 30th June 2023, were included. A review of hospital records for each case was conducted using a standardised electronic data collection proforma. Descriptive, univariate and multivariate analysis was conducted using SPSS statistical package. There was a total of 183 cases of iGAS notified during this upsurge in Ireland. A hospital chart review was conducted for 169 of these cases, giving a response rate of 92.3%. The median age was 4 years (range 0-15,) with 44.4% (75) having a previous healthcare attendance during their illness. Varicella coinfection occurred in 27.8% (47) of cases. There was respiratory viral coinfection in 40.8% (69) of cases, and this was significantly associated with an increased risk of death RR 6.49 (95% CI 4.45 - 29.08) p < 0.05. A respiratory site of infection was also significantly associated with an increased risk of death RR 10.13 (95% CI 2.23 - 45.95) p < 0.001. However, both factors did not remain significant once adjusted for age, sex, ethnicity and deprivation index. This national review demonstrated the significant burden of paediatric iGAS morbidity and mortality during this upsurge. A significant proportion of cases, 37.9% (64) were associated with vaccine preventable illness, with respiratory viral infections and a respiratory site of infection both being significantly associated with an increased risk of death.

Key messages

• A significant proportion of iGAS cases were associated with a vaccine preventable illness.

• A respiratory site of iGAS infection was significantly associated with an increased risk of death in paediatric cases.
Intersectional inequality through economic difficulties and lifestyle on body mass index in Sweden
Authors: Moreno-Llamas A , San Sebastián M , Gustafsson P
Published: October 2024

Background

A high body mass index (BMI) is listed among the top five risk factors for the Swedish population. Socially disadvantaged groups, including women, low-educated, and immigrants, are even at higher risk of a high BMI who may also face economic constraints, physical inactivity, and poor-quality diets. However, complex intersectional transmission of inequalities to BMI remains unexplored. Therefore, we aimed to examine intersectional inequalities in BMI mediated by economic strain and lifestyle in the Swedish population.

Methods

By using the Health on Equal Terms cross-sectional surveys in 2016, 2018, 2020, and 2021 in the Swedish population (n = 44,177 inhabitants aged 24 and over), we performed an intersectional mediation analysis to estimate how inequalities across intersectional strata, by gender (women or men), education (primary, secondary or university), and migration status (Swedish native or migrant), may be sequentially transmitted through economic strain (yes or not in the last 12 months) and unhealthy lifestyle (physical inactivity or inadequate fruit/vegetables consumption) to BMI (continuous).

Results

Compared with high-educated native men, socially disadvantaged strata experienced more economic strain, which in turn led to poorer health-related lifestyles and ultimately to a higher BMI. Some strata such as high-educated women, despite having a lower BMI, still experienced more pronounced transmissions of inequality on BMI through economic difficulties.

Conclusions

Not only inequalities in BMI, but also the material and behavioral pathways underpinning the inequalities, act by intersectional patterns. Public health interventions should ensure adequate economic resources to access healthy food and physical activity across all social strata groups.

Key messages

• Intersectional inequalities in BMI were driven by economic strain and lifestyle.

• Economic strain and poorer lifestyles were not only more prevalent in lower stratus but also more detrimental.
Using HIS administrative data for initial assessment of comorbid patients’ status (Covid-19 case)
Authors: Mircheva I , Usheva N , Mirchev M , Kiselkova S
Published: October 2024

Background

Despite numerous published articles, most of the studies on COVID-19 focused on influence of clinical characteristics and treatments on severity. Yet, the epidemiological viewpoint was rarely discussed. Based on our experience with comorbid hospitalized COVID-19 patients, we aim to show that HIS administrative data can be used to identify individuals that are more prone to worse outcome thus improving patient management not only during pandemics.

Methods

A retrospective single-center study was conducted using archived anonymized HIS administrative data for all 8319 COVID-19 patients in the university hospital ‘Saint Marina’-Varna, Bulgaria, in the period 14/06/2020-31/12/2021. Up to 7 comorbidities per patient were registered in HIS with ICD-10 codes, used for our analyses. Non-parametric tests and logistic regression were used at α=.05, 95%CI.

Results

Comorbid patients were 5741(69%), 50.3% ≥69y, 52% male; 1602(27.9%) died, 64% ≥69y, 54.4% male. Deceased were older (p< .01) and had more comorbidities (p< .01). Multimorbid patients (OR = 4.43; 3.80-5.17), male (OR = 4.72; 3.83-5.82) and older ones (OR = 1.91; 1.57-2.34) had higher odds of dying. The odds of dying increased with the number of comorbidities from OR=.635; .559-.721 for 1 to OR = 4.23; 3.28-5.46 for 7. From 4967 comorbid diseases (451 ICD-10 codes), only those from code groups A, J, N, E, I, Z were suitable for analysis. Patients with A41.9 (OR = 213.69; 52.88-863.43), J80 (OR = 52.88; 32.58-85.56), N17 (OR = 18.63; 10.24-33.87), E11.7 (OR = 4.72; 3.09-7.19), I13.2 (OR = 4.67; 3.151-6.93), Z95 (OR = 3.81; 2.74-5.31), I63 (OR = 3.56; 2.25-5.61), E66 (OR = 3.12; 2.10-4.64) died more often.

Conclusions

Our findings match the results based on EMR data: death with COVID-19 was associated with comorbidities (sepsis, acute RDS and kidney, heart and renal failure, diabetes, cerebral infarction, obesity, implants and grafts), age, gender, i.e. HIS administrative data can be used for quick assessment of comorbid patients’ status.

Key messages

• HIS administrative data can be used for quick assessment of multimorbidity and following personalized treatment is highly recommended to decrease hospital mortality not only in times of pandemic.

• Older Bulgarians have many comorbidities from ICD code groups A, J, N, E, I, Z, and are more prone to death, especially in times of pandemic. Public health measures are needed to prevent comorbidity.
A Groundbreaking Prevalence Survey Conducted in Mauritania for Enhanced Sickle Cell Control
Authors: Cohen S , Baguet P , Bernit E , Soudier B , Petiteau L , Mahmoud E
Published: October 2024

Issue/Problem

Sickle cell disease is a major concern in sub-Saharan Africa, with a prevalence of 0.5 to 2% among children and a mortality rate exceeding 50% in untreated cases. However, the lack of reliable data hampers effective public health policies and resource allocation. To address this, Mauritania’s Ministry of Health, with technical support from NGO Santé Sud, conducted its first prevalence survey in 2023-24. The findings will support advocacy for a national strategy on the disease and offer valuable insights for neighboring countries with similar challenges.

Description of the problem

The prevalence survey comprised 3 field missions over 7 weeks, conducted across 24 primary healthcare facilities during immunization days, in Nouakchott, Dakhlet-Nouadibou, Trarza, Ghorgol, Brakna, Guidimakha and Assaba regions: 1,642 infants (0-9 months) underwent screening for sickle cell disease, with parents’ consent, and 30 paramedics and laboratory technicians were trained to administer point-of-care tests.

Results

The survey found that 9.7% of tested children were carriers of hemoglobinopathies, with 0.6% diagnosed with sickle cell disease. Lab technicians and nurses have improved knowledge about the disease and are better equipped for point-of-care testing. This initiative is expected to enhance sickle cell disease control by providing crucial data for advocacy and may lead to a nationwide newborn screening program, in line with WHO recommendations.

Lessons

This initiative highlighted the efficiency of screening infants for sickle cell disease, emphasizing the need for effective organization involving stakeholders from central to local levels. Screening during immunization days proved highly efficient in testing numerous children. Success depends on adequate human resources, technical skills, and dedicated health personnel. Additionally, having a team member to inform and counsel families, especially when test results are positive, proved crucial.

Key messages

• A prevalence survey on sickle cell disease to generate robust data for advocacy efforts in Mauritania.

• Conducting a prevalence survey on sickle cell disease in Mauritania for a better control of the disease.
Reactive surveillance of deaths involving a fall among the elderly in France, 2015 to March 2023
Authors: Torres M J , Fouillet A , Ung A , Hebbache Z , Martin D , Coudin E , Guldner L , Beltzer N
Published: October 2024

In 2022, France launched an elderly anti-fall plan with a goal to reduce fatal falls by 20% within 5 years. In a reactive monitoring approach ensuring comparability over the period, our study aims to develop an algorithm to identify deaths involving a fall using free-text medical causes in death certificates. This will enable proactive surveillance and evaluate plan effectiveness upon completion. We devised an algorithm based on textual search of fall-related expressions in death certificates. Performance metrics were assessed by contrasting algorithm-identified deaths with those flagged by ICD-10 fall-related codes. We compared also temporal dynamics between the algorithms from 2015 to 2021. Analysis was performed by age group, gender and place of death. Additionally, our algorithm enabled estimation of fall-related death trends from 2015 to 2023. The free-text algorithm exhibited robust performance, with a sensitivity and PPV of 95% when compared to deaths coded with an ICD-10 fall-related underlying or associated cause. Temporal trends between both were highly correlated (correlation coefficient=0.99). Instead of the usual 10000 deaths for fall, we revealed about 13000 deaths linked to falls considering both primary and associated causes. Among these, approximately three-quarters were coded as the underlying cause of death in ICD-10 coding. Regarding trends, the results are preliminary and suggested an increase in mortality rates related to falls detected by the algorithm between 2015 and 2022. Our approach distinguishes falls from other competing causes that often relegate them to secondary status in the chain of morbid events leading to death. With free-text medical causes accessible within 3 to 4 months, monitoring deaths involving falls can be done at a detailed geographic level and in a more reactive way. Looking ahead, we must also consider incorporating the impact of epidemics and/or heat waves to accurately evaluate the effectiveness of the anti-fall plan.

Key messages

• Algorithm using free-text of death certificates identify deaths involving falls.

• Our innovative approach isolates falls from other competing causes, elevating their significance in death processes.