bluuebunny/crossref_metadata_2025_split huggingface dataset:
The WHO support tool: how is it used and what kind of adaptations are needed?
Authors: Rosenkötter N , Ortiz D Novillo 
Published: November 2019

Abstract

Issue and method
In December 2013, the Standing Committee of the Regional Committee for Europe asked the WHO Regional Office for Europe (WHO EURO) to develop a practical tool for Member States that provides assistance in developing and improving national health information systems (HIS) through the development of a national health information strategy.
The developed tool, the Support Tool, was informed by existing tools developed earlier by WHO’s Health Metrics Network and was adapted for the planned assessments in the WHO EURO region. The Support Tool was published in 2015 and was used until now for nine national HIS assessment missions.

Results
By using the Support tool all dimensions of a HIS are assessed: the general resources needed, the indicators used, the data sources available, the applied data management procedures, data quality, and the dissemination process and use of the HIS outputs. The Support Tool structures the assessment process and supports the identification of strength, weaknesses, opportunities, and challenges that inform HIS strategy development in the second stage.

Lessons
So far, the application of the Support Tool had a strong focus on the assessment stage. It turned out that it is necessary to develop a joint understanding of what a HIS entails. The Support Tool offers great potential to start a structured dialogue with all actors linked to the HIS including policy makers. The assessment provides an opportunity for HIS strengthening and the development of a joint understanding. However, it turned also out that further adaptations of the assessment content are needed to better cover topics prevalent in European HISs, like electronic health records, modern IT-resources, modern reporting approaches, and knowledge translation.
The WHO support tool: what can you learn and how have others experienced it?
Authors: Bogaert P , Abboud L A , Calleja N , Zelviene A , Schmidt A , Rösenkotter N , Ortiz D Novillo , Verschuuren M , van Oers H , Van Oyen H 
Published: November 2019

Abstract

Issue and method
Health information systems (HIS) in Europe are complex and involve multiple stakeholders. To strategically assess HIS, a support tool has been developed by the WHO Regional Office for Europe.
It has been applied in nine countries by WHO Europe since October 2015. Additionally, nine countries are using the tool in a peer review format within the context of the Joint Action on Health Information (InfAct) between January and December 2019. What can you expect to find out during such an assessment? What are countries commonly struggling with? In this presentation, the wealth of experiences using the support tool will be shared and participants will learn about common strengths and weaknesses in HIS across Europe.

Results
While each country possesses a unique HIS, common strengths and challenges emerge from across assessments. A few major ones will be presented in this session. In many countries promising e-health developments are ongoing such as electronic health records, e-prescription and cloud solutions for data storage. There is a clear desire to shift towards e-health technologies which is a real opportunity. However, well-developed step-wise approaches in interaction with key players are sometimes lacking and sustainability in financing can be of concern. Central multisectoral coordination mechanisms are often lacking, leading to inefficiencies in bringing together data and information, and in the use of financial and human resources. Finally, in many cases data is available, but legal aspects (e.g. impact of General Data Protection Regulation) are limiting the exchange and linkage possibilities for research and monitoring.

Lessons
HIS assessments help to determine common strength and challenges. By sharing common experiences, participants are better prepared to face common hurdles in their country and will have been exposed to good practices on how to address these.
Workshop: Social-to-biological processes over the lifecourse and social inequalities in health
Authors:   Organised by: French National Institute of Health and Medical Research Chair persons: Michelle Kelly Irving - France, Marc Chadeau-Hyam - France
Published: November 2019

Abstract

Context
Socioeconomic inequalities in health and ageing are observed across contexts and over time, presenting a challenge for public health. The mechanisms driving associations between social conditions and health include biological responses, which in turn are associated with health outcomes. This workshop aims to describe and discuss evidence on the biological embedding of the social environment from research carried out within a large European consortium, and place it within the context of public health.

Methods
The Lifepath project was funded by the European Commission between 2014-19 and brought together longitudinal datasets from across Europe, as well as an interdisciplinary collective of researchers keen to examine how social inequalities in health are constructed over the lifecourse.

Results
Four separate studies are presented here. First, Carmeli et al examine the relationship between social position and systemic inflammation through the mediating role of gene regulation. Second, Fraga et al describe the social patterning of chronic inflammation observed in early adolescence. Third, Castagné et al analyse the relationship between social position across the lifecourse and systemic inflammation, and the role of inflammation within the allostatic load heuristic. Fourth, Chadeau-Hyam et al describe social gradients in a multi-system biological health score, and its subsequent relationship with a number of major health outcomes.

Discussion
We will coordinate a discussion between the audience and workshop participants. The contribution of the inflammatory system to capturing social inequalities and in its association with chronic disease will be discussed. Is it a key player in the construction of health inequalities, or merely an effective signal for many diverse processes? The role biological markers can play in enhancing our understanding of health inequalities, and how the public health community can respond to the evidence will be discussed.

Conclusions
Socially patterned biological responses begin early in the lifecourse and may be key factors in the construction of social inequalities in health and ageing. As such, they should be taken into account in public health activities and policy.

Key messages
The biological embodiment of social conditions is observed from early life and across the lifecourse. Systemic inflammation appears to be a central mechanism which is socially patterned and associated with many health outcomes.
Social patterning of inflammation over the lifecourse and its relationship with mortality
Authors: Castagné R , Chadeau-Hyam M , Karimi M , Stringhini S , Vineis P , Delpierre C , Kelly-Irving M 
Published: November 2019

Abstract

Background
This study explores (i) the relationship between socioeconomic position (SEP) across the life course and circulating C-reactive protein (CRP), a marker of systemic inflammation, in 6 European cohort studies (in up to N = 23 008) participating in the Lifepath project and (ii) interrogate the hypothesis of a cumulative biological risk (allostatic load, AL) reflecting 4 physiological systems, including inflammation, potentially predicting future risk of death in one of the cohort.

Methods
First, we estimated the association between measures of three time point SEP and adulthood CRP, adjusting for health behaviours and body mass index (BMI). To mimic life course experiences, we sequentially adjusted for the chronologically ordered measures of SEP. Next we used mortality data from the 1958 British birth cohort to operationalise AL from 14 biomarkers collected at age 44. Multivariate Cox proportional hazards regression was used to estimate hazard ratios for the association between AL, biological sub-scores and individual biomarkers with mortality.

Results
Educational attainment was most strongly related to inflammation where low educational attainment was associated with higher log-transformed levels of CRP (β = 0.30, (0.22-0.38)). Higher AL at 44 years old was a significant predictor of mortality 11 years later (HR = 3.56 (2.3 to 5.53)). Among the four physiological systems, only the immune-inflammatory and cardiovascular sub-scores were significantly related to mortality.

Conclusions
Socioeconomic circumstances across the life course are associated with higher levels of inflammation in adulthood which in turn predict subsequent risk of death. But our findings also suggest that the cumulative AL measure consisting of all the biomarkers was a better measure for predicting death adding evidence on the biological embodiment in response to chronic stress, suggesting that social-to-biological processes are at play, beyond the impact of health behaviours and BMI.
A socially patterned Biological Health Score and mortality in Understanding Society and UKBiobank
Authors: Chadeau-Hyam M , Karimi M , Castagné R , Bodinier B , Delpierre C , Kelly-Irving M 
Published: November 2019

Abstract

Background
It now established that social factors impact the quality of ageing, through the lifecourse stimulation/dysregulation of key physiological systems. Composite scores such as allostatic load, focusing on the response to stress, can be used to measure individual physiological wear-and-tear.

Methods
Using data from the Understanding Society study, a cross-sectional panel study including 9,088 participants representative of the UK population, we defined a synthetic biological health score (BHS) capturing the wear-and-tear of four physiological systems (endocrine, inflammatory, cardiovascular, and metabolic systems), and of two key organs (liver and kidney). We used 16 established blood-derived biomarkers of these systems to calculate the BHS and explored the relative contribution of socio-economic position to the BHS and its main components across age groups. Using data from UK biobank, including over 400,000 UK participants in whom similar biomarkers have been assayed in blood, we sought validation of our results and investigated the role of the BHS on all-cause and disease specific mortality, and disease incidence.

Results
We identified a systematic decreasing education-related gradient of the BHS (p &lt; 0·001) leading to lower biological risk in participants with higher educational attainment. Education-related differences in the BHS were detected early in life, and were not attributable to lifestyle and behavioural factors. Analyses of the UK biobank data validated these findings and also showed that the BHS contributed in turn, irrespective of established health risk factors, to all-cause and disease specific mortality.

Interpretation
Our findings highlight the social-to-biological processes ultimately leading to health inequalities, and suggest that such disparities can already be detected in the 20-40 year age group.
Using survey data on population health literacy for developing a National Action Plan in Germany
Authors: Berens E , Schaeffer D 
Published: November 2019

Abstract
Promoted by the results of the European Health Literacy survey, the first representative German Health Literacy Survey (HLS-GER) was conducted in 2014. The results showed that every second individual in Germany (54.3 %) has limited health literacy. Thus, a majority of the German population is confronted with difficulties in finding, understanding, appraising, and applying health information. Particularly, vulnerable groups as people with migration background, low education attainment, and in older age as well as chronically ill have even more problems in processing health information and thus are confronted with challenges to maintain health, prevent diseases and use the healthcare system.
Based on the initial research findings of the HLS-GER and the increasing attention and discussions arising with its results, the National Action Plan Health Literacy was developed by a group of experts to systematically improve and strengthen health literacy in Germany. After agreements with representatives of politics and society, health professions and patient and citizen organizations it was published in 2018. It includes 15 specific recommendations in four areas of action and focusses on fostering health literacy in daily life, creating a user-friendly and health literate healthcare system, HL and chronic illness and expanding health literacy research. Five underlying key principles are mentioned to consider in implementing the National Action Plan. The HLS-GER survey data were further used to discuss some recommendations within specialized workshops leading to more detailed strategy papers. The current political and practical developments and discussions initiated by National Action Plan, will be picked up in the second German Health Literacy Survey (HLS-GER2), which is part of HLS19. By repeatedly assessing population HL in Germany the implementation of the National Action Plan can be monitored and further specified, thus survey data help to create policy.
Italian participation to the WHO action network on measuring health literacy: policy implications
Authors: Cadeddu C , Palmieri L , Galeone D , Mastrilli V , D'Elia R , Rosano A 
Published: November 2019

Abstract

Issue
Health literacy (HL) is recognized as a determinant, mediator or moderator of health and of use and results of health care services Inadequate HL is associated with patient disengagement, inappropriateness of care, increased health care costs, and higher mortality rates.

Description of the problem
Few previous studies suggested that inadequate HL is a prevailing problem in Italy. As compared with the European Countries, Italy has peculiar characteristics of socio-demographic determinants of HL levels, which constitute a challenge for policy making. In so far HL has not been considered as a strategic priority for the Italian National Health Service. The Italian National Institute of Health and Ministry of Health are promoting a national program on HL by adhering to the WHO action network on measuring population and organizational health literacy (M-POHL). Main aim of the program is to propose policies that could enable all citizens to share the benefits of improved HL. A national population survey, coordinated at European level, has been planned in each participating country in 2019.

Preliminary results
We are setting up the survey using the questionnaire with 47 specific questions about HL and 32 about lifestyles and demographic characteristics. Updated results of this survey will be analysed in order to define a strategic line for the implementation of actions for the improvement of HL in the next National Prevention Plan. Furthermore, the national survey will be scheduled and repeated to monitor results.

Lesson State
Policies can be implemented at individual, community, organization or system level. Italy is at the beginning of its experience in this field. A national steering committee of experts has also been appointed to support HL policy initiatives. The comparison with existing policies in other countries within the M-POHL action will be another asset to develop HL policies and related activities to benefit citizens, patients and communities.
Step-by-step process of making the case for sustainable investment in wellbeing and health equity
Authors: Dyakova M , Ashton K , Stielke A , Bellis M A 
Published: November 2019

Abstract

Issue
Urgent action is needed to address the growing health, inequity, economic and planetary challenges that threaten the wellbeing of present and future generations. Business as usual has proven unsustainable with high human, social, economic and environmental costs. Coordinated policy action on the determinants of health combined with well-designed and implemented governance and innovative investment approaches can have a dual effect: a) reducing the health gap; and b) improving overall population health.

Description
The WHO Collaborating Centre on Investment for Health and Wellbeing has developed a practical step-by-step guide, outlining the process of how to synthesise, translate and communicate public health and economics evidence into policy and practice, in order to make the case for investment in wellbeing and health equity. It aims to: 1) prevent disinvestment in health; 2) increase investment in prevention / public health; and 3) mainstream cross-sector investment to address the wider determinants of health and equity, driving prosperity for all.
Building on the Knowledge-to-Action framework and an extensive international multi-disciplinary consultation, four key phases are described: 1) Project scoping and planning; 2) Evidence gathering, synthesis and design; 3) Dissemination and communication; and 4) Monitoring and evaluation. Key messages, different products and a number of practical tools and tips are highlighted. An essential element is using health economics approaches and tools to build the case, showing the burden of inaction in parallel with available sustainable solutions, which can bring ‘social return on investment’.

Results/Lessons
The result of the above-described process is the development of evidence-informed, context-tailored advocacy documents and tools, enabling healthy policy- and decision-making across different sectors, levels of government and country settings.
Mobile clinic approach towards hard-to-reach populations’ health in Roman suburban settings
Authors: Corsaro A , Marotta R , Angelone D F , Biagiarelli F S , Terenzi F , Zampa A , Buonuomo E , Galizi M C , Giuffrida F , Giampaolo R 
Published: November 2019

Abstract

Among other vulnerable populations, Sinti and Roma ethnicity people are the ones more likely living in precarious housing conditions such as settlements, especially in Roman suburban and deprived neighbourhood. These hard-to-reach communities usually present poor health outcomes and reduced life expectancy. Since 2016, the project Nontiscordardimé (a partnership of Bambino Gesù Children’s Hospital, OSA Health Workers Cooperative and Vicariatus Urbis) provided 3 outreach per week in two different peripheral settings ensuring to children specialized visits, nutritional screening, growth monitoring and vaccinations by means of a mobile clinic. When necessary, second level examinations have been arranged in the hospital. Personal data, detected pathologies and services provided have been collected from January 2016 to December 2018.
Main diseases detected during 2.226 examinations in Gipsy settlements were respiratory infection (26,3%), skin infection and parasitosis (13.3.%). Moreover 7,5% of visited children had malnutrition and 3,4 % presented oral hygiene related issues. Only 40% of planned second level examination and only 51% of planned hospital admission have been carried out. During outreach in parishes of suburban areas, 1.411 examinations have been performed, encountering mostly respiratory disease (30%), asthmatic bronchitis (8%), dermatitis (5,8%) and allergic rhinitis (3,8%). Adherence to hospital examination and admission reach respectively 72% and 85%.
Poor housing, isolation and overcrowding are significant barriers to prevention and health care even if the national health system provides universal coverage, and free care. Indeed disease prevalence in gipsy settlements was mainly related to socio-economical and housing condition (poor hygiene, overcrowding) whereas others peripheral urban setting, even when deprived, showed an epidemiological framework close to the general population where asthmatic and allergic disorders are prevalent.

Key messages
Mobile clinics can close the gap between health services and disadvantaged children and hard-to-reach populations. Outreach can be a mean of promotion, prevention and health services inclusion.
Refugee Escape Room©: a new gamification tool to deepen learning about Migration and Health
Authors: Ruben Moreno N , Wylie L , Serre-Delcor N 
Published: November 2019

Abstract

Background
The aim of gamification is to provide an experiential exercise that invokes emotions to deepen learning. MyHealth project is interested in developing tools that facilitate healthcare access to newly arrived immigrants in Europe. One important barrier is the low levels of intercultural competency among healthcare professionals and the pervasiveness of negative health-related stereotypes.

Methods
We aim to demonstrate the educational value and social impact of the Refugee Escape Room©, to 1) raise awareness about the social and health challenges faced by vulnerable migrants and 2) provide an effective intercultural competence and self-efficacy training for hosting community. The game was created in 2017 by healthcare professionals and university students with personal migratory experience. It is divided in two parts. The first part addresses knowledge gaps about relevant aspects of Migration and Health. The second part is a fictional border control exercise with multiple bureaucratic challenges that participants, organized as “families”, must overcome to succeed. A pre-post pilot was executed to test for tool effectiveness. The piloting phase involved carrying out multiple instances of the activity for separate target groups. A questionnaire was developed with items related to knowledge, self-efficacy and intercultural competence. The questionnaire was filled by participants at baseline and post intervention to assess for statistically significant changes in all outcomes.

Results
while the piloting phase is still ongoing preliminary results show a high level of acceptability and engagement with the tool.

Conclusions
Refugee Escape Room© is a newly created tool that posits as a promising awareness-raising, competency-building gamification tool that is easily adaptable to multiple settings and participants.

Key messages
Gamification provides an experiential exercise that invokes emotions to deepen learning. Refugee Escape Room© is a promising tool for raising awareness about challenges faced by vulnerable migrants.