bluuebunny/crossref_metadata_2025 huggingface dataset:
28.H. Workshop: Health Preparedness
Authors:   Organised by: EUPHA, CHAFEA, DG SANTE,   Chair persons: Anne-Marie Yazbeck - CHAFEA
Published: October 2020

This session will take stock of national, EU and global health preparedness for serious cross border threats to health. As we have all seen, health preparedness and global health emergency preparedness frameworks are essential, as highlighted by the advent of COVID-19. Events such as these may be rare but are a perfect example of why engaging in health preparedness and response planning is essential. These novel types of viruses are not the only cause for the need for health preparedness, which extends to more standard planning of health systems, pandemic influenza plans and other unexpected but serious events such as the deliberate release of biological or chemical agents. This discussion will therefore review health preparedness, using the example of COVID-19, as well as reviewing the gaps identified and what more must be done at EU, national, regional and global levels to ensure health preparedness is effective to protect our societies.

Key messages

Health preparedness and global health emergency preparedness frameworks are essential for protecting health. Engaging in health preparedness and response planning is essential for an effective response to public health emergencies.
Monitoring health inequalities in Barcelona
Authors: Borrell C , Artazcoz L , Pasarín I , Rodríguez-Sanz M , Palència L , Pérez K
Published: October 2020

In Spain, the Public Health Law approved in 2011 foresees the creation of a Surveillance System on Social Determinants of Health and Equity. However, although information on health inequalities has been reported in technical reports and scientific articles before, it is not until now with the change of the Spanish government the political will to set up the more strategic surveillance system approved and foreseen in 2011 is there.

The change of government in some cities can be an opportunity to advance in the surveillance of health inequalities and policies to tackle them. In Barcelona, for instance, there is a wealth of information and research on health inequalities, but in the past health inequalities was not clearly prioritised on the political agenda. Hence, although health inequalities have been presented in many reports, a monitoring and surveillance system has not been available nor a prioritised task. This has now changed and as part of Spain's engagement in the Joint Action Health Equity Europe project (JAHEE) a system for Monitoring Health Inequalities in the city of Barcelona is being established. During the course of the JAHEE project the objectives of the system and target populations will be defined, sources of information and indicators identified, dissemination and evaluation structures set up before finally, in the next step, the system is to be implemented. The ambition is that the new monitoring system on health inequalities set up in Barcelona in its final form, will make out a part of the information systems of the Public Health Observatory of the city of Barcelona.

In this presentation, we will learn more about the establishment, the content and the experiences gained while setting up the new monitoring system on health inequalities in Barcelona - from defining the objective of the system to implementing it.
Common mental disorders in young refugees in Sweden: the role of education and duration of residency
Authors: Mittendorfer Rutz E , Helgesson M , Norredam M , Sijbrandij M , Jamil de Montgomery C , Björkenstam E
Published: October 2020

Background

Studies investigating risks of common mental disorders (CMDs) in refugee youth are sparse. The current study examined health care use due to CMDs in unaccompanied and accompanied refugee youth and Swedish-born, and the role of education and residency duration.

Methods

This register-based, longitudinal cohort study included 743,671 individuals (whereof 33,501 refugees) between 19-25 years, residing in Sweden in 2009. Refugees were classified as unaccompanied/accompanied. Risk estimates of CMDs, measured as health care and antidepressant treatment, between 2010-2016 were calculated as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Highest attained education in 2009, and residency duration were examined as potential modifiers.

Results

Compared to Swedish-born youth, refugees had a lower risk of treated major depressive and anxiety disorders (aHR): 0.73 (95% CI 0.68-0.78) and 0.74 (95% CI 0.70-0.79) respectively), but a higher risk for posttraumatic stress disorders (PTSD). Compared to Swedish-born, unaccompanied had an 8-fold elevated risk for PTSD (aHR: 8.40, 95% CI 6.16-11.47) and accompanied refugees had a nearly 3-fold risk of PTSD (aHR: 2.78, 95% CI 2.29-3.37). Rates of PTSD decreased with years spent in Sweden. The risk of CMDs decreased with increasing education.

Conclusions

Young refugees had a lower risk of treated depressive and anxiety disorders, but a higher risk for PTSD. In refugees, the rates of anxiety disorders increased slightly over time, whereas the rates of PTSD decreased. Last, low education was an important predictor for CMDs.

Key messages

Our study highlights the need to specifically focus on stress-related mental disorders in studies on refugees as risk estimates might differ. Moreover, providing scalable low-intensity interventions to address CMDs including posttraumatic stress are an important first step in order to prevent prolonged suffering and persistence of PTSD in refugee youth.
Adaptation of the Problem Management Plus programme for Syrian, Eritrean and Afghan refugee youth
Authors: Alozkan Sever C , Cuijpers P , Bryant R , Dawson K , Mittendorfer-Rutz E , Holmes E , Sijbrandi M
Published: October 2020

Background

Common mental health problems are prevalent among refugee minors and impair their daily functioning. Due to various barriers such as lack of culturally appropriate treatments, waiting lists, and stigma they have limited access to care. Problem Management Plus (PM+) was developed by the World Health Organization to address these barriers. PM+ is transdiagnostic, delivered by non-professional helpers, and consists of 5 sessions of problem-solving skills, behavioural activation and stress management. PM+ is effective in reducing adults' distress and improve functioning. We aimed to adapt PM+ for refugee minors and add an emotional processing module to target symptoms of posttraumatic stress disorder.

Methods

We culturally and contextually adapted PM+ for use in Syrian, Eritrean and Afghan refugee minors (age 16-18 years). Data were collected through: 1) free list interviews with Syrian, Eritrean and Afghan refugee minors (n = 30), 2) key informant interviews with knowledgeable refugees (n = 6), professionals (n = 6), policy makers (n = 6) and 3) focus group discussions (n = 24). Data were analysed in ATLAS.ti through inductive and deductive framework analysis.

Results

The interviews with youth revealed daily life problems around the following themes: language, family and peers, and substance use. The overall results suggested the need for culture- and age-specific adaptations of 1) the PM+ manual content (language, metaphors, illustrations) and 2) intervention delivery (modality, content and presentation of the trauma processing module, and duration).

Conclusions

This study led to specific adaptations of PM+ for refugee adolescents to be used in two randomized controlled trials in the Netherlands and Sweden.

Key message

Refugee minors face numerous barriers reaching mental health care. Scalable, culturally adapted psychological interventions should be developed and evaluated to address common mental disorders in refugee youth.
New models and taxonomies to understand and address the commercial determinants of health
Authors: Gilmore A B , Robertson L , Petticrew M , Maani Hessari N
Published: October 2020

Current models of the determinants of health risk framing public health problems and solutions in ways that obscure the role that the private sector, in particular large transnational companies, play in shaping population health. This presentation will propose a new conceptual model of the commercial determinants of health which recognises the commercial sector's direct, indirect, upstream and downstream influences on health. It will also present emerging evidence-based taxonomies that draw together evidence on the key corporate practices which stymie the implementation of effective public health policies. In so doing, the presentation will explore how we move from understanding to addressing the commercial determinants of health.
Towards reimbursement of mobile digital health applications? An international comparison of practices
Authors: Degelsegger-Márquez A , Panteli D
Published: October 2020

Background

The hitherto largely unregulated market of mobile digital health applications is undergoing significant changes, particularly concerning the growing segment of apps that aim at integrating care processes or replacing traditional forms of diagnosis or therapy. The inclusion in the benefit basket of statutory health systems is of relevance when exploring viable business models for app developers.

Description of the problem

So far, countries largely limit coverage to apps developed by authorities within the statutory health system, or provide guidance for payers in the form of app lists or quality assessment criteria. However, there are new regulatory efforts aiming to promote innovation for mobile digital health applications by creating pathways to general reimbursement, as exemplified by the 2019 German Digital Healthcare Act.

Results

Our contribution illustrates how evidence-based reimbursement decisions can be configured for mobile digital health applications. We will compare frameworks from different contexts, including the new German regulation, the UK's NHS App Store and the Evidence Standards Framework for Digital Health by NICE as well as the work of the French National Health Authority (Haute Autorité de Santé). Building on case studies, we will provide a typology of practices, which covers elements spanning consumer guidance to assessment approaches to full reimbursement decision-making.

Conclusions

Based on the proposed typology, we will discuss challenges and opportunities of reimbursement systems for mobile health apps from a public health perspective and seek to refine the typology by incorporating input from session participants and profiting from the global nature of the conference.
Violence prevention in vulnerable groups: the case of children and gender-based violence
Authors: Kumar B
Published: October 2020

As of January 2018, nearly 50 million children had been uprooted from their homes due to violence, poverty or natural disasters. In 2016, one in four people seeking asylum in the EU are children.

An analysis of nationally representative survey data on the prevalence of violence against children in 96 countries estimates that 1 billion children globally have experienced emotional, physical or sexual violence in the past year. The UN Convention on the Rights of the Child, ratified by nearly all states, must be fully implemented complied with. To support the implementation of the Convention, ten UN agencies incl. WHO have published the INSPIRE Handbook a technical package with seven strategies to end violence against children.

Another significant public health issue that needs to be addressed is sexual and gender-based violence (SGBV). Evidence shows that being an irregular migrant or asylum seeker appears to make an individual more vulnerable to SGBV, including sexual assault and rape by traffickers and smugglers. Working alongside displaced communities and with different partners across multiple sectors are the strategies to reduce the risks of SGBV and to ensure support for survivors.
What factors are related to non-participation in colorectal cancer screening?
Authors: Portillo Villares I , Solis Ibinagagoitia M , Unanue-Arza S , Martinez-Indart L , Lebeña Maluf A , Idigoras I , Bilbao I , Diaz-Seoane M
Published: October 2020

Background

The Basque Health Service (Spain) approved the Colorectal Cancer (CRC) screening programme in 2008; targeted at residents (50 to 69 years old) by biennial faecal immunochemical test and colonoscopy in positive cases. Total coverage was reached in 2014. Despite our high participation rate (72.3%), some people have never been screened, probably due to several factors (socio-economic factors, lifestyles, comorbidities, health preventive actions, etc.). The identification of these factors could be crucial in order to improve the results and impact of the programme.

Methods

Cross sectional descriptive study. All invited population in a complete round between 2015 and the first trimester of 2017 were included. Data base was linked to registered health risk factors, preventive activities managed by Primary Care and socioeconomic deprivation index. Univariate and multivariate analyses were performed by SPSS 23.0.

Results

515,388 people were invited and 71.9% participated. Non-participation is significantly (p ≤ 0.001) related to: being men (OR = 1.10); younger than 60 (OR = 1.18); smoker (OR = 1.20); hypertensive (OR = 1.14) and diabetic (OR = 1.40), as well as to having a severe comorbidity (OR = 2.09) and very high deprivation (OR = 1.15). Low use of Primary Care services (OR = 2.39) and inappropriate control of risk factors also increase the likelihood of not participating.

Conclusions

Several factors addressed in Primary Care influence the participation in the CRC Screening Programme. Its results and impact (decreasing incidence and mortality) could be improved if individual and socioeconomic factors are taken into account to increase participation. Primary care and social networks are key in further planned interventions.

Key messages

Decreasing inequalities in the screening participation is one of the most important objectives in this Public Health strategy. Primary Care plays a key role in all the screening programmes’ implementations.
Transforming a global order in New Zealand to reduce health inequities in service provision
Authors: Rawson E
Published: October 2020

St John has been providing service in New Zealand for nearly 140 years since its arrival. It has now close to 4000 staff and nearly 20000 Members and over 8500 volunteers.

In New Zealand the major work of St John is its Ambulance service providing front line first responders to crash, medical emergency and other life-threatening situations. St John New Zealand also provides a number of 'Community Health' initiatives focused on strengthening communities and prevention. In recent years St John has recognised that they have not engaged well with Indigenous communities and that their organisation in New Zealand must become skilled and relevant in addressing the needs of the Indigenous people of New Zealand, as they suffer the greater burden of disease and illness than any other population in the country. St John NZ Community and Health Services are embarking on a process of transformation through re-orienting its culture and practice by adopting Public Health approaches and an equity lens over all its programmes. They also have committed to understanding and using Indigenous knowledge to support this re-orientation to most effectively engage and implement programmes that will reduce Indigenous health inequities. This presentation will describe the process by which they will be implementing their strategy for change and highlight best practice for working with Indigenous communities.

Key messages

Indigenous Knowledge is key to addressing Indigenous Health inequities. Mainstream Public Health can learn from Indigenous Public Health approaches.
Social differences in 20-year trends in daily smoking among Lithuanian adult population
Authors: Petkeviciene J , Kriaucioniene V , Raskiliene A
Published: October 2020

Background

Tobacco control measures carried out in the countries can affect social inequalities in the smoking habit. This study aimed to examine the 20-year trends in social patterning of daily smoking in Lithuania.

Methods

The data were obtained from 11 biannual cross-sectional postal surveys of Lithuanian Health Behaviour Monitoring, beginning in 1994. Each survey used a randomly selected nationally representative independent sample of 3000-4000 inhabitants aged 20-64 drawn from the population register. In total, 8738 men and 11822 women participated in the surveys. The analysis of daily smoking involved the respondents who had smoked daily for at least one year.

Results

The prevalence of daily smoking was increasing up to the year 2000, especially among women, while a decreasing trend in men and levelling off a trend in women was observed afterwards. In the last survey, 33.3% of men and 12.5% of women were daily smokers. The proportion of daily smokers was higher among younger than older participants; however, the age difference in smoking decreased over time. The highly educated men and women smoked less than those with low education. The odds ratio (OR) of smoking in men with university versus lower education was 0.42 (95% CI 0.37-0.47) and in women - 0.68 (95% CI 0.60-0.78). The proportion of smoking men decreased in all educational groups; however, the differences in the smoking prevalence remained. Since 2000, the educational gradient in smoking among women was increasing due to a decline in smoking prevalence among women with university education. More women living in big cities than in non-urban areas were daily smokers (OR 1.29; 95% CI 1.15-1.44). Over 20 years, no consistent difference in the smoking trends by place of residence was found in both genders.

Conclusions

The 20-year trends in social patterning of daily smoking differed between men and women. Inequalities in daily smoking by age and education remained in both genders.

Key messages

In Lithuania, the trends and social differences in daily smoking were related to gender. Comprehensive tobacco control measures targeting young and lower educated groups should be implemented aiming to reduce social inequalities in smoking.
Association between smoking cessation and quality of life among patients with COPD in Tunisia
Authors: Dardouri M , Limam M , Ajmi T , Mtiraoui A , Zedini C , Mallouli M
Published: October 2020

Introduction

Smoking cessation is the most important step to limit the complications of chronic obstructive pulmonary disease (COPD). Outcomes from studies that assessed the association between health-related quality of life (HRQL) and smoking cessation have been controversial. This study aimed to assess the relationship between HRQL and smoking cessation in patients with COPD in Tunisia.

Methods

A cross-sectional study was carried out in the two main primary care centers in the center of Tunisia over a period of three months (April-June 2016). Clinic and socio-demographic data were collected from patients' records. HRQL was assessed by the Medical Outcomes Study Short-form 36 (SF-36). This instrument is composed of two dimensions: physical and mental components. The questionnaire outcomes were described as means and standard deviation. T-test was performed to assess the statistical difference between the dependent and categorical variables.

Results

A total of 249 COPD patients participated in the study with a mean age of 67.77±11.13. Of this sample, 169 (67.9%) ceased smoking. The average period of smoking cessation was 10 years. The mean of total HRQL score in patients who ceased smoking was lower in comparison to patients who did not quit smoking (40.65±24.49, 43.37±24.49; respectively). The T-test reported a significant difference between the physical component of HRQL and smoking status. Patients with current smoking status had a better physical component score in comparison with patients who quit smoking (43.76±22.62, 37,86±18.21, p = 0.04, respectively). No significant differences were found between smoking cessation, mental component, and HRQL total score (p = 0.89, p = 0.39; respectively).

Conclusions

This study revealed that smoking cessation was associated with the physical component of HRQL. The smoking dependence in patients with COPD could explain this finding. Health care professionals should work harder on effective smoking cessation strategies.

Key messages

These findings suggested that HRQL was better among patients who did not quit smoking. Patients who did not cease smoking reported better physical status and poorer mental status in comparison with patients who quit smoking.
Opportunities for achieving the sustainable development goals through assessing health in environmental assessments
Authors: Nowacki J , Mekel O , Martin-Olmedo P , Cave B
Published: October 2020

The 2030 Agenda for Sustainable Development calls for tackling environmental risks at their root, that is, through a shift towards primary preventive actions and the promotion of healthy choices. Reducing the 13 million deaths resulting from environmental risks each year requires efficient scale-up of primary preventive action involving all key stakeholders, across all sectors. Decisions taken on the drivers of health risks should have the attainment and protection of good health as an explicit aim in key sectors such as energy, transport, housing, labour, industry, food systems and agriculture, water and sanitation, and urban planning. A key tool for such actions can be seen in Health Impact Assessments (HIAs) and an enhanced integration of health assessments into environmental impact assessments (EIA).

In many countries worldwide, legally binding instruments exist which are concerned with assessing the impacts of policies, programmes, plans and projects on the environment to contributes to a high level of protection of the environment and human health. Within the European Union (EU) the EIA Directive 2014/52/EU names human health among the topics to be addressed when conducting an EIA. The amended EIA Directive also includes issues that are relevant to human health, for example, climate change and vulnerability (exposure and resilience) to major accidents and/or disasters. These amendments are relevant also beyond EU borders through, for example, the policies of the European Investment Bank. A paper recently developed by IAIA and EUPHA provides insights to the EIA Directive to raise awareness among health authorities and public health professionals on the potential for primary preventive actions and promotion of healthy choices outside the health sector. Key messages will be presented and further discussed with the audience on how achieving the 2030 Agenda can be supported through impact assessments and the enhanced involvement of health authorities.
Fostering methodological advances and technical capacity building
Authors: Grant I , Plass D , von der Lippe E , Lesnik T , Idavain J
Published: October 2020

Countries all over the world, and especially in Europe, are increasingly using the burden of disease approach to assess the health status of populations and to identify the main drivers of ill health. Thus, there is an increasing need for equitable capacity building on the one hand (including an improved understanding of the complex methods behind global and national burden estimates), and harmonization of methods on the other hand to keep the results comparable. Furthermore, involved researchers also strive for a platform to exchange experiences and foster collaboration.

To address the current challenges in burden of disease research, our COST Action CA18218-European Burden of Disease Network will build strongly on the COST mechanisms, such as short-term scientific missions and training schools to foster and increase capacity building activities across Europe. Our Action will also serve as a technical platform where knowledge and expertise can be shared among experienced and less experienced researchers. Collaboratively, the technical platform will provide unique opportunities for developing a joint research agenda in the domain of burden of disease, for fostering methodological developments, and for developing new collaborative research.

With this presentation, we aim to show how the COST Action is fostering methodological advances and technical capacity building, focusing on 1) the role and aim of short-term scientific missions including real case examples; 2) the concept and structure of the Action's training schools; and 3) examples of specific methodological activities underway as part of the Action. The session will conclude with an interaction with the audience during which the needs and expectations of the attendees will be elicited.
Recommendations for a Health literacy Policy Plan for Belgium: Learning from experiences of other countries
Authors: Van Den Broucke S , Rondia K , Adriaenssens J , Kohn L
Published: October 2020

Background

In Belgium, the past decade has seen a large number of initiatives by various stakeholders to address health literacy (HL) at different levels, but an encompassing policy plan to coordinate efforts across sectors is missing. The Belgian Federal Public Service of Health, Food Chain Safety and Environment commissioned a study to investigate HL policy plans of other countries, with the intention to make recommendations for the development of a Belgian National Health Literacy Plan (NHLP).

Methods

To identify elements and criteria for a NHLP, a transversal analysis was performed of HL policies in Australia, Austria, Ireland, The Netherlands, Portugal, and Scotland, following a preliminary scoping review regarding the availability of relevant information. Information about HL policies was analysed using a combination of document analysis and key informant approach, structured by means of an analytical grid specifying methods, resources, goals, actors, beneficiaries, actions, timing, opportunities, threats, evaluation, monitoring and impact.

Results

Policy approaches and action plans on HL vary widely in scope, focus and depth. Three pathways to developing a national HL plan were identified: (1) a conceptual approach whereby targets are formulated at the national or federal level, showing the country's determination to improve HL throughout its political system, but with a weak leverage for action (A, AUS, P); (2) a pragmatic approach targeting the healthcare sector first but progressively broadening the scope towards other sectors (SCOT); (3) a delegated approach whereby the authorities delegate the initiatives regarding HL to an active and dynamic civil society (NL, IRL).

Conclusions

There is no single best way to coordinate efforts to address HL across sectors. Policy makers should consider the strengths and weaknesses within their country to develop a substantiated HL approach that best fits the country's situation.
What can everyone do about it? Sustainable individual choices that contribute to the SDGs
Authors: Vareda R
Published: October 2020

Background

The Sustainable Development Goals (SDG) aim to solve the world's most wicked problems, which requires global partnership. That means governments, national and international organizations and worldwide leaders working together, but it also implies individuals, families and communities, which make up most of the world, must contribute.

Households, schools, the health system and others have a responsibility in the consumption and demand for energy and resources of our planet and contribute largely to climate change. Awareness and population education are essential to promote action on an individual level.

Objective

This presentation is part of a workshop on how individuals and public health (PH) can create a more sustainable world. It aims to present the science and challenges behind changing and creating new habits, and examples of individual habits and choices everyone can make in order to contribute to the SDG and to sustainable health prevention. This presentation is based on the United Nation (UN) available material for the SDG, as well as other independent research on the subject.

Results

Sustainable individual actions can be divided in 3 different main themes:

Food and Water - Examples. Eat a more plant-based diet; use apps like Too Good To Go®; reutilize the water from your shower...

Energy - Examples. Plug all appliances into a power strip and turn them off completely when not in use; adjust your fridge and home thermostat to winter and summer temperatures; use energy efficient light bulbs; fill your house with rugs...

Resources - Examples. Pay your bills online; delete your spam email; compost your food; choose a better diaper option; shop second-hand clothes...

Conclusions

There are a lot of habits and small choices everyone can adopt in order to contribute to a more sustainable world and to promote healthy habits. These changes may seem trivial on an individual level, but they add up to millions of resources saved for the planet at a global scale.
31.E. Workshop: Food processing in the modern era: implication for public health
Authors:   Organised by: EUPHA Food and nutrition section, EUPHA Chronic diseases section,   Chair persons: Giuseppe Grosso – EUPHA-FN
Published: October 2020

Current scientific evidence and reports from governmental organizations agree that healthy nutrition represents a key factor to prevent death and disability from major nutrition-related chronic diseases. For many years, the essential goal of healthy dietary recommendations included eating nutrient dense foods and limiting consumption of foods high in energy (sugar, starch and/or fat) to maintain a healthy weight. However, the scientific community abandoned the more simplistic approach of energy balance between calorie in and out, shifting into investigation of the whole diet quality as main determinant of health. With development of new technologies and globalization of the markets, the food availability improved worldwide, often in spite of (nutritional) quality and loss of local products production/consumption. As a result, there is an industry-supported wide spread of “non-traditional” foods, including processed foods characterized by various ingredients, added sugars, and additives that are highly influencing consumers' behaviors and, only recently, questioned for their role on general public health. This workshop aims to provide insights on consumption of ultra-processed foods up to the extreme processing of dietary supplements and their use and misuse, emphasizing on their potential impact on traditional dietary patterns.

The objectives of the present workshop are the following: To provide a science-based definition of processed and ultra-processed foods; To explore current evidence of the association between ultra-processed foods and risk of chronic non-communicable diseases and mortality; To explore current evidence of the association between dietary supplements and human health; To discuss whether introduction of non-traditional foods may affect the relation between traditional dietary patterns and health.

Given the novelty of the topic, it is crucial to summarize current evidence from lead experts on this field of research and sharing opinions with the audience in light of the presented results. The conclusions might have crucial implications for potential policy and research outcomes.

Key messages

Uncontrolled consumption of ultra-processed foods and dietary supplements represent a potential threat for general public health. The inclusion of ultra-processed foods into traditional healthy dietary patterns may affect their efficacy in preventing chronic non-communicable diseases.
Ultra-processed/Ultra-formulated foods: association with chronic disease risk
Authors: Touvier M
Published: October 2020

During the past decades, diets have shifted towards an important increase in the degree of food processing and formulation. “Ultra-processed foods” (UPF) now represent more than 50% of energy intakes in several Western countries. In the very last years, an impressive accumulation of evidence from large-scale epidemiological studies linked regular UPF consumption to diverse adverse health outcomes. In this framework, our team of conducted pioneer studies within the prospective e-cohort NutriNet-Santé (n = 170 000) launched in 2009 in France. Dietary intakes were collected using repeated and validated 24-hour dietary records, covering >3,500 food items, which have been categorized using the NOVA classification according to their degree of processing. These analyses highlighted robust significant associations between the consumption of UPF and increased risks of overall and breast cancers, cardiovascular, cerebrovascular, and coronary heart diseases, mortality, type 2-diabetes, overweight, obesity and weight gain, depressive symptoms, and gastro-intestinal disorders. Research perspectives now consist in elucidating the potential mechanisms that underlie these associations. Our team is launching an Europe-funded project built as a combination of epidemiological studies and in-vitro/in-vivo experiments, in order to shed light on individual exposure to food additive 'cocktails' in relation to human health. Meanwhile and even if further studies are needed to better understand the relative contributions of these factors, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods.
Working toward a common HSPA framework
Authors: Figueras J
Published: October 2020

HSPA has been viewed by international organisations, including the WHO, as primarily a country-specific process for which there is no single accepted template. As a result, while HSPA efforts generally agree on the basics, the practice of their application for assessing health systems varies depending on the methodology of a specific approach, capacity to conduct a comprehensive evaluation, as well as on county context.

The UHC2030 Technical Working Group sought to examine the similarities and differences across various tools used to carry out health system assessment to make use of the information they collect in a more harmonised and performance-focussed way. This was done through a rigorous review of existing tools and frameworks, as well as through conceptual work on further development of HSPA process to link health system functions and sub-functions to performance across specific assessment areas, intermediate health system objectives and final goals.

This presentation will provide an overview of the approach taken to harmonise the existing tools, which led to the creation of the HSPA framework for UHC. It will introduce the methodology and the basic analytical framework, and put this work into a wider context of the role of health systems.
Testing the framework in real life – application for country HSPA process
Authors: Lai T
Published: October 2020

The ability to use the existing health system assessment tools, HSPA processes and widely available indicators is an important, although not exhaustive, part of the practical application of the framework. With this in mind, we created an annotated template that can be used along with HSPA framework for UHC to facilitate information collection and harmonisation.

This annotated template was tested for Estonia and Azerbaijan with the aim to help with evaluating the transferability of HSPA information between existing approaches and in different settings. More specifically, we tested the extent to which information on assessment areas of the framework can be extracted from the existing sources; the ease of use and clarity of the annotated template; and how the information collected through the annotated template can be combined into a meaningful health system performance assessment, in line with health system goals.

The test showed that the information for Estonia and Azerbaijan could be obtained to complete much of the template. This can be done through a country-led performance assessment process that ensures that the indicative measures in the annotated template are relevant to the country context. The information collected also needs to be assessed in the context of policy priorities of the national health systems. Thus, more detailed guidance on the use of the framework can help to streamline such national processes and clarify the linkages between performance of specific functions and overall health system performance.
Reliability of studies published as SR/MA on nutrition in cancer prevention - a systematic survey
Authors: Storman D , Bala M M , Koperny M , Zajac J , Tobola P , Swierz M , Staskiewicz W , Gorecka M , Skuza A , Johnston B
Published: October 2020

Background

In several fields of medicine, the quality of studies published as systematic reviews/meta-analyses (SR/MAs) is low. Similar problems may exist for SR/MA on nutrition in cancer prevention. We aimed to assess overall quality and risk of bias (RoB) of studies published as SR/MA on nutritional interventions in cancer prevention with two instruments: AMSTAR 2 ('a measurement tool to assess systematic review 2') and ROBIS ('Risk of Bias in Systematic Reviews') respectively.

Methods

Following a systematic search in 3 databases we included studies identified as SR/MA published between 2010 and 2018 assessing any nutritional interventions in cancer prevention in the general population or among people with cancer risk (Protocol in PROSPERO CRD42019121116). All the steps of study selection and data extraction were done by two independent reviewers with conflicts solved by discussion or by the third reviewer.

Results

We focused on a subsample of 101 SR/MA randomly selected from 737 included SR/MA. Included SR/MA on average searched 2 databases with Medline in 98% and included cohort studies (93%). They focused on specific food (36%), specific nutrients (27%) or beverages (24%, mostly tea and coffee). The assessment using AMSTAR 2 tool indicated that 93% of SR/MA had no pre-specified methodology, in 77% - research questions and inclusion criteria did not include the components of PICO, RoB assessment of primary studies was not used or did not contain all elements (87%) and RoB was not accounted for in the interpretation of the results (75%). Overall, the quality of 97% of studies was assessed as critically low. In the ROBIS tool for 97% of included studies, the overall high risk of bias was detected. The most important methodological flaws in ROBIS were similar to identified in AMSTAR tool.

Conclusions

Poor quality of SR/MA due to flawed methodology may lead to many concerns and mislead public media and consumers.

Key messages

Poor quality of SR/MA due to flawed methodology may lead to many concerns and mislead public media and consumers. The studies published as SR/MAs addressing nutrition for cancer prevention have major flaws, which limit the reliability of their conclusions.
Survival and prognostic factors of patients with breast cancer in the state of São Paulo
Authors: Almeida R J , Luizaga C T M , Eluf-Neto J , Pessoa E C , Chiarotti A M M , Souza R A , Murta-Nascimento C
Published: October 2020

Introduction

Breast cancer is a public health problem worldwide, being the most common malignant neoplasm in the female population.

Objectives

To estimate 5- and 10-year breast cancer-specific survival probabilities of patients included in the hospital-based cancer registry (HBCR) of the Fundação Oncocentro de São Paulo (FOSP, in Portuguese) and to assess the prognostic factors for this neoplasm.

Methods

Historical cohort study that included women with breast cancer included in HBCR-FOSP and diagnosed between 2002 and 2012. The event of interest was breast cancer-specific mortality. Living cases at the end of follow-up (December 31, 2017), loss to follow-up and death other than that due to breast cancer were considered censored on the date of the last contact or date of death. Descriptive analysis and survival analysis were performed using the Kaplan-Meyer method. Survival curves were compared using the log-rank test. Hazard ratios (HR) and their 95%CI were estimated using Cox's proportional hazards model. The study was approved by the Human Research Ethics Committee of the Botucatu Medical School, São Paulo State University, Brazil.

Results

53,146 cases of invasive breast cancer were registered at HBCR-FOSP between 2002-2012. The median age at diagnosis was 55.9 years. By the end of the follow-up, 20,683 patients died, and 71.4% were due to breast cancer. The 5- and 10-year breast cancer-specific survival for the entire cohort was 76.1% (95%CI 75.7-76.5%) and 64.8% (95% CI 64.2-65.3%), respectively. In the multivariate analysis, the factors associated with prognosis were age at diagnosis, year of diagnosis, educational level, clinical stage, and histological type.

Conclusions

These findings may contribute to the development of policies for the identification of breast tumors at earlier stages.

Key messages

Breast cancer is an important public health problem in Brazil and worldwide. The findings of this study may contribute to the development of public policies for the control of breast cancer in the state of São Paulo.
Personal experiences of medical school education: methods to evaluate competency and ways to improve
Authors: Khan H , Fundano N , Ghazal Asswad A , Holm S , Petráková A
Published: October 2020

Personal experiences of medical school education and the manner in which it is delivered will be discussed. Examples of approaches used for student evaluation of different competencies and the methods to track their progress and development were identified. They were appraised, with their strengths and weaknesses discussed. Ideas to improve the approaches for competencies assessment in medical students were also explored.
Integrated approaches for the assessment of health impacts of environmental chemicals: our experience in the GraMo cohort study
Authors: Arebola J P , Martin-Olmedo P , Pérez-Carrascosa F M , León J , Echeverría R , Salcedo-Bellido I , Gomez-Peña C
Published: October 2020

The assessment of the health implications of human exposure to low doses of multiple environmental chemical pollutants represents an important challenge for environmental epidemiology. Current studies must go beyond simple exposure-disease associations and need further characterization of a complete exposure disease continuum, including exposure routes, adverse outcome pathways, potential subclinical effects, interactions between chemicals, and intra-individual susceptibility. This needs an effective synergism with basic sciences, which can enrich epidemiologic findings with very detailed information at a molecular level, but also with clinicians, who would help to provide accurate diagnoses and interpretation in a real-world scenario.

On the other hand, environmental exposures can affect the general population at different levels, including economic and social dimensions, which have been frequently overlooked. These approaches would require specific methodologies that are relatively novel in the field of environmental epidemiology, such as cost-benefit analyses and qualitative techniques.

Public health campaigns can clearly benefit from these mixed approaches.
Continuing online education to health workforce: elderly’s health care training experience
Authors: Savassi L C M , dosSantos A O , Gasque K C S , Lemos A F , Alves L D S , Vilaça J P V , Hoffmann M C C L , Campos N V P , Amstalden A L F
Published: October 2020

Background

The Open University of the Unified Health System (UNA-SUS) was created in 2010 to promote continuing professional education using online distance education (ODE) to Brazilian health workforce - mainly primary care – spread over 8.5 million kilometers. It comprehends a 34-universities network developing free open technology-enhanced courses and has more than 3 million enrollments and 1 million single learners, covering 98% of the country's cities.

Objectives

Elderly's Health Care Educational Program aims to improve professional education for public health workers, focused on aged people's care, based in 5 independent microlearning courses developed in the past 2 years. It follows “action mapping” design, in which the action objectives and practice demands are defined before content, meeting real-world demands, intending to improve completion rates (CR) as well as modeling continuing education in world's health systems.

Results

These ODE courses were available for 18 months (2018-2019), with 66,655 enrollments and 36,714(55%) certificated; CR ranged from 46.4% to 70.5% among 15 health professions and “students”, being higher for Community Health Agents (70.5%) and Nursing Technicians (65,4%). Enrollments were from all 5 Brazilian regions, mean age was 32.6 years, 81.6% were female.

Conclusions

Instructional design allowed professionals to learn according to specific gaps; microlearning strategy promoted higher CR compared to traditional ODE courses. High school and technical educational levels also had higher CR suggesting that ODE can be adequate to this target audience, who possibly have less educational opportunities than graduated ones. Considering the success obtained in a continental-size country, this model could be reproduced worldwide.

Key messages

Continuing ODE is a worldwide demand. Initiatives that use information technology to improve learning process of health professionals, including healthcare technicians, should be considered.
Total worker health® is the future of worker safety, health, and well-being
Authors: Tamers S
Published: October 2020

The future of work is being shaped by rapid changes in the workplace, work, and workforce. Driven by advances in industry, this movement is marked by the accelerated pace of developments connecting people, places, and things. All these advances and developments have implications for worker safety, health, and well-being and require innovative occupational safety and health strategies.

Because of these new realities, the U.S. Centers for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH) recently launched the Future of Work (FOW) Initiative. This Initiative is a collaborative effort of multidisciplinary research, communication, and partnerships throughout NIOSH, other agencies, and organizations that aims to identify novel research solutions, practical approaches, and partnership opportunities to address the future of work. To more broadly address worker safety, health, and well-being, the FOW Initiative applies the Total Worker Health® (TWH) framework. TWH is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. The TWH approach prioritizes changes to improve physical, organizational, and psychosocial factors that present possible risks in the work environment for today's and tomorrow's workforce.

This presentation will first introduce CDC/NIOSH's FOW Initiative. Next, the TWH integrated approach will be defined and described. Centering on CDC/NIOSH's future of work priority topics in the areas of workplace (organizational design, technological displacement, work arrangements), work (artificial intelligence, robotics, technologies), and workforce (demographics, economic security, skills), the presenter will then provide evidence-based solutions to address future of work issues and related outcomes, using the TWH approach.

Key messages

The future of work has world-wide implications for the workplace, work, workforce. The Total Worker Health framework is a transdisciplinary approach by which to view and address the future of work. Public health professionals and other stakeholders must take a proactive approach to address worker safety, health, and well-being issues impacted by the future of work.