bluuebunny/crossref_metadata_2025_split huggingface dataset:
6.F. Round table: What is the evidence for and against price transparency in pharmaceutical pricing and procurement?
Authors:   Organised by: European Observatory Chair person: Dimitra Panteli - Germany
Published: October 2020

Abstract
Although the potential for price transparency in pharmaceutical systems has been widely debated, there has been less discussion of the empirical basis to inform policymaking in this area. The lack of price transparency is viewed as one of the biggest barriers to joint pharmaceutical procurement, an initiative that has the potential to drive down pharmaceutical prices by pooling the purchasing power of smaller populations and thus improve the affordability of medicines. However, critics of the call for increased transparency in pharmaceutical pricing argue that such policies would lead to price inflation, particularly for countries with lower ability to pay or limited negotiating power.
Given the widespread use of negotiated confidential discounts granted to different payers by manufacturers and the pervasiveness of international reference pricing as a policy mechanism for determining pharmaceutical prices, transparency policies would not only affect countries directly implementing them. As a result, policy-makers are often reluctant and unsure about how to proceed; this became readily apparent in the discussions around the Transparency Resolution at the World Health Assembly in May 2019. A concise overview of the evidence on the consequences of transparency policies is lacking.
This panel draws on a wide-ranging literature review that sought to answer the following key research questions: Is there empirical evidence that examines the effect of price transparency on price development (within countries implementing the policy as well as other countries)
In the area of pharmaceuticals? Regarding other types of healthcare goods and services? Regarding products from other industries?
What insights can we learn from the available evidence and how transferrable is evidence from other healthcare dimensions or other industries to the issue of price transparency for pharmaceuticals?
In this workshop we will bring together researchers to discuss the type of evidence available the extent to which it is empirically grounded. The workshop aims to address this issue and highlight evidence gaps for and against price transparency policies. Each panellist will talk for a maximum of 10 minutes presenting insights from their work; audience members will be actively invited to share their insights and reflections.

Key messages
The debate on price transparency in pharmaceutical systems needs to advance by looking at the full range of evidence available. Highlighting evidence gaps can endorse real world experiments to test theoretical arguments.
“I won’t sleep tonight”: professional emotions related with family violence against child in Brazil
Authors: Mourão A M , Noronha C V N 
Published: October 2020

Abstract

Background
Interpersonal violence is a diverse cultural phenomenon. Worldwide, 300 million children aged 2 to 4 years has experienced violent discipline by their caregivers. In Brazil, Family Health Strategy (ESF) and Extended Family Health Core (NASF) are essential public policies of primary health care in Unified Health System (SUS). Emotions are extended psychological dimensions; however, society gets influence the way to express it. As a matter of fact, they cannot be an isolated case of contextual social interactions. This research aims to identify and discuss emotions that arises at health professional area which supports children victims of family violence.

Methods
Qualitative, descriptive research collecting data from observation, diary notes and interviews. Authorized by Human Research Ethics Committee of Federal University of Bahia. Held with 7 ESF teams and 1 NASF team, between November 2017 and June 2018, in Salvador-Bahia-Brazil. Empirical data were analysed through thematic analysis with ATLAS.ti 8.0.

Results
The code group 'subjectivity' grouped 2 codes: 'fear' and 'emotions'. The code 'fear' appeared in co-occurrence with 17 other codes, mostly: reception, reporting, avoiding case; and received 21 quotations. This topic stood out about nurses check notes, home visitors, psychologist and social worker, supporting their care needs. Fear appeared strongly related to those people who are “involved” with drug trafficking and avoiding of “getting into cases”. The code 'emotions' had 35 quotations and in co-occurrence with 11 other codes: suspicion, monitoring, referral, among others. Participants cited different emotions produced in these cases: revolt, sadness, anger, pain, despair, indignation, compassion.

Conclusions
Health professionals, both ESF and NASF teams were affected by family violence against children. The results suggest the necessity of a professional multidisciplinary supervision to improve child care.

Key messages
For managers: suggestion implementing systematic supervision with multidisciplinary team practicing primary health care services. For professionals: suggestion including the family violence topic to discuss in group, meetings and educational activities.
Infection prevention and control and antimicrobial stewardship in European long-term care, 2016-2017
Authors: Kinross P , Latour K , Ricchizzi E , Kärki T , Suetens C 
Published: October 2020

Abstract

Background
Europe's population is ageing. Long-term care facilities (LTCFs) for this vulnerable population are often relatively homelike with low staff-to-resident ratios. In 2016-2017, ECDC coordinated its third point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European long-term care facilities (LTCFs). It included collection of data on structure and process indicators (SPIs) of infection prevention and control (IPC) and antimicrobial stewardship, to support countries' identification of national and local interventions in LTCFs.

Methods
In each country, national contacts recruited a convenience sample of LTCFs. National/LTCF PPS teams used a standard protocol that included case definition algorithms (adapted US CDC/SHEA definitions) applied to each resident with signs/symptoms of infection on the PPS day, and questions for LTCF staff on SPIs of IPC and antimicrobial stewardship activities. Denominators indicate the number of responses available for analysis.

Results
3,052 LTCFs in 24 EU/EEA countries were recruited, with 102,301 residents included. The prevalence of HAIs (residents with ≥1 HAI) was 3.7%. Although 1,524/1,623 (94%) LTFS had a hand hygiene (HH) protocol, only 1,046/1,585 (66%) LTCFs had organised ≥1 HH training session for care professionals during the previous year. 1,185/1,561 (76%) LTCFs reported IPC training of nursing and paramedical staff. Only 340/1,639 (21%) of LTCFs reported training on appropriate prescribing and 493/1,623 (30%) LTCFs had provided feedback to GPs on antimicrobial consumption. On the PPS day, annual antimicrobial consumption data were available to only 530/1,623 (32%) LTCFs.

Conclusions
Even in LTCFs with the capacity to perform this PPS, IPC training was non-ubiquitous and antimicrobial stewardship activities, including training, were rarely reported. ECDC encourages EU/EEA countries to recruit LTCFs to participate in future PPSs, to allow them to benchmark HAI rates and practices.

Key messages
The prevalence of healthcare-associated infections in European long-term care facilities (LTCFs) highlights their requirement for infection prevention and control (IPC) and antimicrobial stewardship. This multi-national point prevalence survey (PPS) indicates that European countries can consider reinforcing IPC, antimicrobial stewardship practices and participation in PPSs in LTCFs.
Ethnic differences in incidence and mortality of stroke in Denmark
Authors: Mkoma G F , Johnsen S P , Iversen H K , Andersen G , Nørredam M L 
Published: October 2020

Abstract

Background
Stroke is a leading cause of disability and mortality worldwide. However, studies on incidence and mortality of stroke hereof among ethnic minorities compared with local born are still limited.

Methods
We conducted a Danish nationwide register-based cohort study between 2004 and 2018. All cases of first ever stroke aged 18-95 years were included. Country of birth was used to construct ethnic groups. Age standardized incidence rate ratio (IRR) of stroke stratified by country of birth and sex were estimated with the Danish born as a reference group. Ethnic minorities were grouped as Western and Non-western for mortality hazard ratio (HR) estimates.

Results
In overall, ethnic minorities had a higher risk of stroke compared with Danish born. Particularly, the IRR of all stroke was estimated to be 8.3 times higher among Polish men compared to Danish born men (IRR, 8.32; 95% CI, 6.89-10.05). Compared with Danish born women, Pakistan women had the highest risk of all stroke (IRR, 2.89; 95% CI, 2.46-3.39). By contrast, Swedish women had reduced risk of hemorrhagic stroke (IRR, 0.40; 95% CI, 0.18-0.89) and Norwegian women had reduced risk of ischemic stroke (IRR, 0.87; 95% CI, 0.72-1.06). Compared with Danish born men, all-cause 1-year mortality hazard for Non-western men was (HR, 1.61; 95% CI, 1.13-2.29) while for Western men was (HR, 1.07; 95% CI, 0.90-1.29) among ischemic stroke patients. Among hemorrhagic stroke patients, 1-year mortality hazard for Non-western men was (HR, 0.75; 95% CI, 0.39-1.47) whereas Western men had (HR, 1.48; 95% CI, 1.04-2.10). Among women, we observed reduced all cause 1-year mortality hazard in Non-western (HR, 0.32; 95% CI, 0.13-0.80) for hemorrhagic stroke whereas no difference in mortality hazard was observed for ischemic stroke.

Conclusions
Incidence and post stroke mortality appear to vary among ethnic minorities in comparison to Danish born. It may depend on the type of stroke and sex.

Key messages
The study contributes knowledge in migration and health. With good quality registers, we are in unique position to establish findings in Denmark, which has a growing migrant population.
Assessment of the impact of the European food industry on obesity and population nutrition
Authors: Van Dam I , Allais O , Vandevijvere S 
Published: October 2020

Abstract

Background
Our food environment is becoming increasingly dominated by ultra-processed foods and big industry players often escape accountability through self-regulation and vague commitments.

Methods
Applying the 'Business Impact Assessment' (BIA-Obesity), as proposed by INFORMAS, the commitments and performance of the biggest companies among packaged food and non-alcoholic beverage manufacturers, quick-service restaurants and supermarkets were assessed at a European level and in Belgium as a case study. The tool consists of six different domains comprising the corporate nutrition strategy, food formulation, labelling, marketing, accessibility of (un)healthy products and relationships with other organisations.

Results
Preliminary results for Belgian companies based on publicly available information show a median score of &lt; 30% and a maximum score of &lt; 60% for comprehensiveness, specificity and transparency of commitments. Hardly any commitments are in place to increase accessibility to healthier products. Even though several commitments are made regarding advertisement towards children below 12 years, on average 36% of sales is for products not-permitted to be marketed to children (WHO) and 71% for products that are ultra-processed (NOVA). Throughout Europe, companies selling ultra-processed foods on average generate 85% (77%-90%) of their sales from ultra-processed foods of which 50% (35%-74%) is not-permitted to be marketed to children.

Conclusions
Even though many commitments are made, they are not sufficiently specific or comprehensive and do not link well with performance. To reach the goals set out by the Sustainable Development goals and to improve the food environment it is crucial to ensure that commitments don't get lost in translation, but are strengthened and transformed into results.

Key messages
Food industry players make several nutrition and health related commitments, but these don’t always translate into performance. The BIA-tool clearly distinguishes between the comprehensiveness, specificity and transparency of nutrition related commitments made by the food industry.
Low system quality and job strain hamper information system benefits in nursing
Authors: Gluschkoff K , Kaipio J , Hyppönen H , Vehko T , Karhe L , Lääveri T , Kaihlanen A , Saranto K , Heponiemi T 
Published: October 2020

Abstract

Background
Health information systems (HIS) have been widely adopted in nursing to increase the efficiency and safety of patient care. Previous studies have shown that low HIS quality is a barrier to obtaining such benefits from HIS use. The association between HIS quality and HIS benefits has not, however, been studied taking into account the characteristics of the work environment, such as job strain. This study examined the joint associations of HIS quality and job strain with the perceived patient care-related benefits of HIS use in nursing.

Methods
Cross-sectional survey data of 2707 Finnish registered nurses were used to examine the associations of two indicators of HIS quality (ease of use and technical quality) and job strain with the benefits of HIS use. Missing data were addressed with multiple imputation and linear regression was used to examine the associations. All analyses were adjusted for age, gender, and employment sector.

Results
Together with the covariates, HIS quality explained 14% to 20% of the variance in the perceived benefits of HIS use. The additional variance explained by job strain was only 1%. HIS quality in terms of ease of use interacted with job strain in predicting HIS benefits. Nurses who found HIS difficult to use and experienced high job strain reported the lowest benefits from HIS use. By contrast, nurses who found HIS easy to use considered HIS beneficial for improving patient care even if they experienced high job strain.

Conclusions
The results suggest that healthcare organizations should focus on ensuring good HIS quality to improve patient care through HIS use in nursing. Exposure to job strain may intensify the association between low HIS quality and lower patient care-related benefits from HIS use. HIS with good quality seem to improve patient care even in a high-strain work environment.

Key messages
Nurses who work with low-quality health information systems and experience job strain perceive the systems least beneficial for improving patient care. High-quality information systems, by contrast, are perceived to improve patient care even in a high-strain work environment.
A regional approach to climate and health adaptation in the Middle East
Authors: Negev M , Shaheen M , Hochman A , Khreis H , Levine H , Salah I , Alpert P , Georgiades P , Davidovitch N , Jaghbir M 
Published: October 2020

Abstract

Background
The Middle East (ME) is expected to be influenced by climate changes that will significantly affect human health. An increase in temperature and in the intensity, length and frequency of heat waves, alongside a decrease in precipitation, have been observed, and longer summers and shorter winters are expected. Population growth intensifies the stress on water and the ecosystem in an already sensitive region. Moreover, political conflicts intensify the vulnerability of the region's population and prevent cross-border collaboration and knowledge transfer. The aims of this talk are to: 1) present climate scenarios and potential health risks for the ME; and 2) present a regional inter-disciplinary collaboration that focuses on climate and health research.

Methods
To prioritize regional research directions, a group of climatologists and public health researchers from the ME and Europe convened in an expert workshop, which included a process of consensus-building regarding research priorities and potential collaboration.

Results
Associated health risks are mainly increases in morbidity and mortality due to heatwaves, and increases in potentially deadly vector- water- air- and food-borne diseases such as chikungunya, yellow fever and dengue fever, due to expansion of invasive species of mosquitoes. There are wide economic and infrastructure gaps among the region's countries, entailing different levels of preparedness. Countries also face multiple intra- and inter-country political conflicts and instability which further weaken their ability to adapt at the regional level. However, climate change has regional impacts which should be understood and mitigated at that level. Research priorities include spatio-temporal research on heat and health outcomes; regional surveillance of infectious diseases; and preparedness of health systems and pathways for collaboration among health agencies in the midst of a political conflict with an emphasis on vulnerable populations.

Key messages
Inter-sectoral and inter-disciplinary work is a known requirement for tackling climate change challenges. Structural changes are needed at both the local and regional levels to fulfill this vision. Political conflicts in the Middle East weaken the ability to adapt to climate change in a vulnerable region.
Impact of ambient temperature on mental health in Bern, Switzerland: a time-series study
Authors: Bundo M , de Schrijver E , Federspiel A , Luterbacher J , Franco O H , Müller T , Vicedo-Cabrera A M 
Published: October 2020

Abstract

Background
Previous studies suggest that people with mental disorders are more vulnerable to increased ambient temperatures (AT). In Switzerland, neuropsychiatric diseases contribute up to 35.1% of the total burden of disease. This burden could possibly increase in the future under current climate change scenarios, if no appropriate public health measures were implemented. However, there is lack of evidence on the impact of AT on mental health in Switzerland.

Objective
This study aimed to investigate the short-term association between AT and mental health hospitalizations in Bern, Switzerland.

Methods
From 1973 to 2010, we collected individual data on daily hospitalizations for mental disorders (71,931) from the University Hospital of Psychiatry and Psychotherapy in Bern. We used population-weighted daily mean AT for the canton of Bern derived from the 2.2-km gridded weather data provided by MeteoSwiss. We applied conditional Poisson regression with distributed lag linear models to assess the association and to account for delayed effects up to 3 days after the exposure. We conducted stratified analysis and by age, sex and diagnosis.

Results
The overall risk of hospitalizations increased linearly by 3.0% (95% CI: 0.0%, 6.0%) for every 10C°C-increase in mean daily AT. No differences in risk estimates were found across sex (3.0% in males (95% CI: 0%, 7.0%) and 4.0% in females (95% CI: 0%, 8.0%)) and age groups (≥ 45 years old: 4.0% (95% CI: 0%, 9.0%) and &lt;45 years old: 3.0% (95% CI 0%, 7%)). Larger association estimates were found for schizophrenia (10.0%; 95% CI 4%, 16%), while no association was found for substance abuse (0.0%; 95% CI -7.0%, 6.0%).

Conclusions
Our preliminary findings suggest that increasing AT are associated with an increased risk in hospitalizations due to mental disorders in Bern. Specific public health policies should be urgently implemented in order to protect this vulnerable population sub-group from the challenges of climate change.

Key messages
Increased ambient temperatures are associated with an increased risk in hospitalizations due to mental health disorders. Specific health policies should be implement to protect mental health patients from the challenges of climate change.
Reducing inequalities in child health: a case study in an English local authority
Authors: Fairbrother H , Holding E , Powell K , Griffin N , Wistow J , Summerbell C 
Published: October 2020

Abstract

Background
Many health outcomes for children and young people in England, UK remain poor compared to international peers, with persistent inequalities across the country. Our study sought to understand, from the perspectives of local stakeholders, the key factors affecting the development and implementation of policy to improve child health and reduce inequalities.

Methods
We carried out a detailed case study in an English local authority area. Our fieldwork comprised: documentary review of local policies, observation of key strategic and operational meetings and semi-structured interviews with local stakeholders. We followed Jessop's (2016) approach in using specific policy areas and policies (mental health, obesity and the early years) as 'entry points' to understand the local context.

Results
First, and most importantly, there was an overriding consensus that local action to reduce inequalities in child health is hampered by a persistent unequal distribution of the social determinants of health. Second, local stakeholders highlighted the damaging impact of austerity measures and poverty in the UK, which, they argued, had impacted most upon the most vulnerable. Third, while national policies often provided a framework and incentive for local action, there was an emphasis on the importance of local knowledge and place-based approaches, developed through close work with communities.

Conclusions
Our study highlights the need for progressive policies to begin to reduce the uneven distribution of the social determinants of health to enable local stakeholders to make progress in tackling inequalities in child health. It emphasises the futility of funding national policies to improve child health and reduce inequalities in the context of greatly reduced budgets for local authorities. National policy should also facilitate the mobilisation of context specific knowledge, produced in conjunction with community members.

Key messages
Our work evidences the pressing need to address structural inequalities and adequately resource and facilitate work to reduce inequalities at a local level. National policy should facilitate the mobilisation of context specific knowledge, produced in conjunction with community members.