bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bridging towards the future of public health in Europe (I). Where can and should we go from here?
Authors:   Organized by: European Commission, EUPHA,   Moderators: Isabel de la Mata, DG SANTE, European Commission, Natasha Azzopardi Muscat, President EUPHA
Published: November 2019

Abstract

Europe is entering the third decade of the 21st century and health is on the agenda. Or is it? It seems that with Europeans healthier than ever and enormously improving our ability to prevent and treat current diseases, health seems to be a theme of the past. At the same time, the society is in turmoil and both old and new health challenges are threatening Europe. The changing demographics–climate change, urbanization, migration and ageing–the technological and digital revolution–given us both medical technology as fake news, genetic mapping and new addictions (gaming)–and the resurgence of old diseases such as measles, all lead to the necessity of bridging our previous successes with the need for a new public health in the future.
In 2019, several changes are occurring: we will have a new regional director for WHO Europe and we will have both a new European Parliament, a new European president of the European Commission, a new European Commission and a new European Commissioner for Health. And these changes have led to a new discussion on the necessity of health as a European topic.
In this plenary session, we will look at the priorities in public health from the perspective of the European Commission, the Finnish presidency of the European Council and the European Public Health Association. Finally, we have invited a young professional to reflect on the plans proposed in this session.

Panellists
Anne Bucher
Directorate-General for Health and Food Safety (DG SANTE), European Commission
Liisa-Maria Voipio-Pulkki
Ministry of Social Affairs and Health, Finland
Dineke Zeegers Paget
Executive Director EUPHA
Sara McQuinn
Coordinator EUPHAnxt
Community based approach to address health disparities among Roma in North Macedonia
Authors: Pavlovski B , Frishchikj J 
Published: November 2019

Abstract

Issue
Roma represent vulnerable group regarding health and health outcomes. Most health research and policies perceive Roma as a coherent group, although there are disparities within different subgroups. This is due to social determinants of health and other causes. Perceiving Roma community as monolith group may result in provision of activities for persons that don’t have need and leaving behind the vulnerable. Situation is similar with other marginalized and vulnerable populations.

Description
In 2016 started community based intervention including social accountability and legal empowerment regarding coverage,quality of health services and health rights violation. Work conducted in ShutoOrizari municipality with estimated 30.000 Roma. In 4 localities where most vulnerable Roma live, each comprised of 200 households. 2 persons from Roma NGOs and 4 community members work as team in 1 locality. Mapping of the community conducted and community inquiry. Findings shared with the community members. Findings used to conduct education of community and toconduct advocacy on local and national level with community participation in 2018for improvement of coverage and quality of services.

Results
Approach identified disparities among Roma.1256 persons surveyed from 4 localities. 4 localities have high unemployment rate (above 70%),monthly income related to the locality (p &lt; 0.0002). Disparities in health and access to health services among localities noted. Self-reported health status is related to locality(p &lt; 0.002). Coverage with health services also,including having registered gynecologist(p &lt; 0.001),regular gynecological examinations(p &lt; 0.00001),antenatal care(p &lt; 0.0003).

Lessons
Identifying needs among Roma living in smaller localities enables tailoring of health interventions based on needs. Identification of the problems on micro level is relevant for the community concerned,increasing their involvement in demanding improvement and advocacy.

Key messages
Working in strictly defined localities/groups from Roma communities provides accurate insight in the health related issues. Working with defined localities/groups enables greater involvement of the community in advocacy for fulfillment of their rights.
1.B. Skills building seminar: How to include migrant and refugee populations health monitoring and surveillance in Europe
Authors:   Organised by: Robert Koch Institute Chair persons: Claudia Santos-Hövener - Germany, Nicole Rosenkötter - EUPHA (PHMR)
Published: November 2019

Abstract

Objectives
The level of diversity in most European societies is increasing, especially due to ongoing migration to and within Europe. Migrants are very heterogeneous in terms of reasons for migration, region of origin and chances in the countries of destination and thus, differ greatly in regards to health resources and risks. It is crucial to gain valid data on migrant health status to inform policy makers in order to plan, implement and adjust health interventions and services. This highlights the importance of including migrant populations into health monitoring and surveillance. The objective of this workshop is 1) to demonstrate the importance of including migrants into health surveys, 2) to describe barriers that might hinder migrants from participating, 3) to critically appraise the strategies being used to include migrant populations and 4) to give clear recommendations on how to assure the responsiveness of migrant populations in health monitoring and surveillance. Three countries will present how they reach migrants with national health surveys and focus on selected strategies that increase accessibility of migrant groups. These approaches may include innovative sampling strategies, ways to bridge language gaps and enhancing participation of migrant groups in developing and conducting surveys. We will focus on different migrant groups, including refugees as a particularly vulnerable population. Following the presentations we will have enough time to discuss these strategies in terms of transferability and cost in order to synthesize ideas, learn from each other and discuss pitfalls and lessons learned.

Main messages
Europe is diversifying, and it is thus crucial to capture migrants’ health in health monitoring and surveillance. The national public health institutes are in charge of ensuring sufficient representation of migrant populations in health surveys and to tackle potential barriers. Cross-country collaboration allows sharing successful strategies.

Key messages
In a diversifying Europe, it is crucial to include migrant populations into health monitoring and surveillance. Approaches include include innovative sampling strategies, ways to bridge language gaps and enhancing participation of migrant groups in developing and conducting surveys.
France: A Public health system built on competing paradigms
Authors: Rozenblum S 
Published: November 2019

Abstract

Background
Although France helped establish public health as a scientific discipline, it is well known that the country was slow to implement public health measures on a national scale. The central government played a limited role in public health until the second half of the 20th century. Public health became a privileged space for political action in the 1990s, as a direct outcome of the “blood crisis” and a series of other health “scandals”.

Methods
A comparative historical analysis (CHA) based on government documents, law, and secondary sources.

Results
Between the early 1990s and 2016, France saw the emergence of two competing understandings of public health. It was legally defined as a responsibility of the state to protect its population against disease risks and to ensure equal access to and representation in the healthcare system, captured by the notions of sécurité sanitaire (“health security”) and démocratie sanitaire (“health democracy”). Public health actions framed in the language of “security” changed its place in the hierarchical structure of the state. It both reinforced public health as a legitimate field of intervention (now presented as an important function of government, similarly to finance, foreign affairs, defense, etc.) and reinforced the central state, as the legitimate protector of population health and provider of public health services. The French public health arena also witnessed the (re)emergence of local and private actors, motivated by their own interests and competing understanding of public health.
Germany: The reformation of public health
Authors: Falkenbach M. 
Published: November 2019

Abstract

Background
Germany was amongst the most successful advocates and implementors of public health ideas in the 19th and early 20th centuries. Dominated by the social hygiene theory in the early 1900s population health was a main priority. With the recognition that bacteria caused diseases in both animals and humans municipal and national public health programs peaked resulting in increased research and education in the field. With the aftermath of WWII, public health in the country seemingly disappeared until the 70s when the AIDS epidemic forced it out of hiding.

Methods
A comparative historical analysis (CHA) based on government documents, law, and secondary sources.

Results
Germany is still struggling to elevate public health to the same level of importance and respect that curative health enjoys. Despite its many shortcomings (limited tobacco control, the struggle to integrate public health and medicine, and the lack of recognition for public health scholars, researchers and doctors), largely due to its collapse after WWII, the German public health system can be seen as transformational in the sense that it is giving public health a new and perhaps more timely role namely that of a health advocate.

Conclusions
Public health in Germany has undergone a number of transitions throughout the past centuries moving from a practice initially based in economic theory with the goal of improving sanitation onto being increasingly supported by eugenics and with that the policing of an entire population to finally landing in the 21st century with the intention of advocating for European level public health agencies focusing on monitoring and reporting.
The politics of public health in the United Kingdom between medical, social, and local
Authors: Greer S 
Published: November 2019

Abstract

Background
Public health in the UK exists on a continuum from a national and medical pole to a local and social pole, with each end threatening obliteration as a distinctive field of expertise and action. The national-medical produces a subfield of medicine, with a range of highly developed skills including epidemiology. The local-social, manifested in social medicine as well as equivalent approaches in social work, education, and local government, produces health, which need not be medical, as a result of investment in integrated services that enable solidary, dignified communities. This model is more invested in local communities and local governments, and more likely to blur borders with social work, leisure, and other areas, and have an overtly social democratic ethics and set of arguments.

Methods
A comparative historical analysis (CHA) based on government documents, law, and secondary sources.

Results
Public health in the UK has changed shape many times, from the end of most formal public health between 1948 and 1974, to the creation of a public health function in the 1980s, to the moment of divergence in 2012 when England reverted to a local public health and the devolved administrations did not.

Conclusions
The scope of public health might formally be the causes of avoidable ill health. In practice, the accepted expertise and autonomy of public health is found in narrower areas related to medicine: communicable disease control, health education, a few social services such as outpatient and outreach mental and sexual health, and the search for politically acceptable policies to address NCD threats. With public health moved to local government in England, its relationship with the NHS and medicine is likely to weaken further, to the likely detriment of the formal public health function and public health.
Are lifestyle behaviors correlated to mental health disorders in medical students?
Authors: Ben Ayed H , Jedidi J , Cheikhrouhou F , Ayadi A , Yaich S , Damak J 
Published: November 2019

Abstract

Background
Recently, there has been a renew interest to medical students’ mental health, which may be influenced by several sociodemographic and cultural factors, academic overload, but also by lifestyle behaviours. This study aimed to assess the correlation between major lifestyle behaviors and mental health in medical students.

Methods
A cross-sectional questionnaire survey was conducted among 521 medical students randomized from different levels, at Southern Tunisia Medical School, 2017. The 12-item General Health Questionnaire (GHQ-12) and the Simple Lifestyle Indicator Questionnaire (SLIQ) were used to assess mental health and lifestyle, respectively.

Results
The mean values of GHQ-12 and SLIQ were 4.1±2.8 and 6.2±1.4, respectively. According to SLIQ components, we noted an unhealthy lifestyle in 36.9%, 50.1% and 20.2% for diet, physical activities and stress level, respectively. The prevalence of psychological distress (GHQ-12≥4) was 50.1%. The GHQ-12 items analysis revealed that 235 cases (45.1%) were unable to concentrate, 237 cases (45.5%) felt unhappy and depressed and 195 cases (37.4%) had a loss of sleep over worry. Low family financial situation (Odds Ratio (OR)=1.5;95%CI = [1.1-2.3]), internship level, (OR = 1.8;95%CI = [1.1-3.3]) and medium/poor academic performance (OR = 2.2;95%CI = [1.5-3.2]) were significantly associated with psychological distress. Multivariate analysis showed that unhealthy lifestyle was independently associated with psychological distress (Adjusted OR = 5.8;95%CI = [2.4-14.8]).

Conclusions
Our study highlighted the magnitude of psychological distress in medical students. Unhealthy life style was a potential predictive of mental disorders. These findings are extremely useful for guiding future curricular changes upon entry into medical schools.

Key messages
Mental disorder prevalence ranked at an alarming rate among medical students. Promoting healthy life style represents a reliable tool to sustain a good quality of life for the future-doctors.
Italian adolescents and sexual health: what has changed during the last 20 years?
Authors: Kundisova L , Nante N , Lorenzini C , Valeri V , Messina G , Alaimo L 
Published: November 2019

Abstract

Background
In the majority of European countries, sex education is mandatory, but Italy is still an exception. Despite sexually transmitted diseases (STD) are believed to be less common today, long-time “forgotten” disease, as syphilis, are returning. The aims of study are i) to examine the knowledge and perceptions of adolescents regarding sex education and STD and ii) to compare our results with Italian national survey.

Methods
This descriptive cross-sectional study was conducted in 6 middle schools in Siena (Italy) during May-June 2018. Data were anonymous collected using a validate questionnaire previously adopted by the Italian National Institute of Health (NIH). The results were compared with the national survey realized in 1998 by NIH. The analysis was performed using Stata 12.

Results
From 691 questionnaires, 540 returned fulfilled (78% response rate). The majority (95%) of respondents considered sex education “important” and thought it should be guaranteed by the school; 48% described information received so far as “sufficient”, 40% as “adequate”. “School” was indicated as the principal source of information (44%), instead of “friends” which resulted in 1998. The respondents were asked to choose from the list the STDs they knew: 96% indicated “AIDS”, 62% “syphilis”, 38% “HBV” and 36% “gonorrhoea”. In comparison to 1998, knowledge of syphilis has decresed (2018:17% vs. 1998:62%) and HBV (2018:38% vs. 1998:58%). Regarding STD, the “mass media” were cited as the principal source of information (56%), followed by “school” (41%) and “General Practitioner” (20%).

Conclusions
In comparison to 1998 sex education in Italian schools improved, but the knowledge of adolescents regarding the STD worsened. This result can be attributed to the fact that the survey of 1998 was realized during the years when the AIDS awareness was higher. It is necessary to further improve the sex education in Italy in order to prevent STDs.

Key messages
The “forgotten” sexually transmitted diseases are becoming common again, the adequate sex education in schools is necessary to prevent them. In confrontation to 1998, the sex education in Italian schools improved, but the knowledge of adolescents regarding the STD worsened.
Psychosocial difficulties, obesity and disadvantage in a cohort of Irish children
Authors: Dow M , Brinkley A , O’Malley G , Murrin C 
Published: November 2019

Abstract

Background
Childhood obesity is stabilising in Ireland, but less so in children from disadvantaged backgrounds. There is also evidence for a relationship between psychosocial difficulties and obesity in youth, but findings are often mixed. This study aimed to describe the relationships between psychosocial difficulties, obesity, and disadvantage in a national cohort of children in Ireland.

Methods
Participants (n = 7275) were surveyed and measured at age nine and thirteen as part of the Growing Up in Ireland study (GUI). Psychosocial difficulties were measured using the Strengths and Difficulties Questionnaire (SDQ). Disadvantage was represented by the education status of the primary caregiver. BMI was calculated using measured height and weight. Weight status categories were created using the UK 1990 Growth Data. Correlation analyses were used to examine the relationship between child BMI and SDQ scores. Associations between weight categories, psychosocial difficulties and education status were examined using Chi-square analysis.

Results
In children whose parents had secondary education, the obesity rate was 27.9%, compared to 24.7% in those with a college degree (p &lt; 0.01). This relationship was also significant at age thirteen (&lt;0.01). Furthermore, BMI was positively correlated with SDQ total score, (r=.107, p = 0.01) at age nine and at age thirteen (r=.089, p = 0.01). A significant association was also found between weight status categories and psychosocial difficulties at ages nine (p &lt; 0.1), and thirteen (p &lt; 0.1). Further findings will be reported following a preliminary longitudinal analysis.

Conclusions
Obesity is associated with psychosocial difficulties, as well as the education status of the primary caregiver, in a large sample of Irish children. These findings are important for understanding the relationship between childhood obesity and psychological health and have implications for the treatment of obesity in young people.

Key messages
There are higher rates of obesity in children whose parents do not have a college degree. Childhood obesity remains a serious public health issue, and is associated with psychosocial difficulties in an Irish cohort of children.
Sustainable Development Goals and the challenge of Human resources for health in Congo
Authors: Ndziessi G , Bileckot R 
Published: November 2019

Abstract

Background
In order to achieve the Sustainable Development Goals (SDGs), equitable access to skilled and motivated health workers within a performing health system is need to be ensured. The health system in Congo is characterized by low quantity and quality of Human resources for health (HRH), which constitutes an important barrier to achieving to expanding coverage and integrated primary health care.

Objectives
To estimate needs of HRH in Congo from 2019 to 2030 and analysed the capacity of the country to address the estimated needs.

Methods
Cross-sectional study was conducted in Ministry of Health from June to November 2018. Data from 2011 national HRH Census was used as the baseline for projections. We performed annual projections based on current numbers of midwives, nurses and physicians. Health workforce-population ratios by year in national and department level were provided. Population estimations were computed using Spectrum software assuming a 3% growth rate. Mapping for distribution by department was performed used QSGI software.

Results
In 2019, Congo has 4849 midwives, nurses and physicians, including 465 doctors, 912 midwives and 3469 nurses. All of Congo departments have not surpassed the availability threshold of 4, 5 midwives, nurses and physicians per 1000 inhabitants in 2019. In overall, this ratio will rise from 0.9 per 1000 inhabitants in 2019 to 0.42 per 1000 inhabitants in 2030 due to the retirement. Needs for additional workforce were estimated at 29416 midwives, nurses and physicians by 2030, average of 2451 per year. However, current national production capacity of human resources for health is very low and will not cover the estimated needs as scheduled.

Conclusions
There is a crisis in the health workforce in Congo, expressed in acute shortage. Results highlight needs of building adequate policies to address production and management of the health workforce, to come close to reaching the MDGs for health.

Key messages
At current production capacity, Congo has not the number of physicians, nurses, and midwives it needs to address HRH shortages in the national Health system by 2030. The health human resources crisis in sub-Saharan Africa countries will be a major obstacle to achieving the Millennium Development Goals.
Effectiveness of Prompt Mental Health Care: Preliminary results from a randomized controlled trial
Authors: Knapstad M , Lervik L V , Saether S M M , Aaroe L E , Smith O R F 
Published: November 2019

Abstract

Background
Prompt Mental Health Care (PMHC) service is a Norwegian initiative, adapted from the English ‘Improved Access to Psychological Therapy’ (IAPT), aimed at improving access to primary care treatment for anxiety and depression. Thus far, both PMHC and IAPT have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled. This study investigates the effectiveness of PMHC compared to treatment as usual (TAU) at six months follow-up.

Methods
Randomized controlled trial with parallel assignment in two PMHC sites from November 2015 to March 2018. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression. These were randomly assigned on a 70:30 ratio. Main outcomes were recovery rates and changes in symptoms of depression and anxiety between baseline and follow-up. Primary outcome data were available for 73%/67% in the PMHC/TAU group. Sensitivity analyses based on observed patterns of missingness were conducted.

Results
A reliable recovery rate of 58.5% was observed in the PMHC group and 31.9% in the TAU group, yielding a between-group effect size (ES) of 0.61 [95% CI 0.37-0.85, p&lt;.001]. The differences in degree of improvement between PMHC and TAU yielded an ES of -0.88 [95% CI -1.23-0.43, p &lt; 0.001] for symptoms of depression and -0.60 [95% CI -0.90-0.30, p &lt; 0.001] for symptoms of anxiety in favour of PMHC. All sensitivity analyses pointed in the same direction with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms.

Conclusions
The PMHC treatment was substantially more effective than TAU in alleviating symptoms of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access of effective treatment for adults who suffer from anxiety and mild to moderate depression.

Key messages
This study is the first to evaluate the effectiveness of an IAPT-like treatment model in terms of a randomized controlled trial. Prompt Mental Health Care was substantially more effective than TAU in alleviating symptoms of depression and anxiety at 6-months follow-up.