bluuebunny/crossref_metadata_2025_split huggingface dataset:
Smoking-attributable mortality at an infra-national level: regional estimates in France in 2015
Authors: Bonaldi C , Jezewski-Serra D , Nguyen-Thanh V 
Published: October 2020

Abstract

Background
Tobacco smoking is a major leading preventable cause of mortality. The Peto-Lopez method and its variants are commonly used for estimating smoking-attributable mortality in population in high-income countries. The method assumes the average cumulative exposure of tobacco smoking in the population can be approximated using lung cancer death rates. However, providing estimates at an infra-national level is often much more challenging because the observed number of deaths for lung cancer are generally too low to use directly the method. The aim of this study was to estimate the number of deaths attributable to smoking at the regional level in France in 2015.

Methods
Population attributable fractions were computed using the Peto-Lopez method modified by Parkin which combines mortality statistics, lung cancer death rates and adjusted relative risks of deaths associated with smoking. To estimate the proxy for smoking prevalence in regional level by sex and age group, we pooled lung cancer mortality on several years according to the size of the regional populations and we smoothed the non-linear relationship of age with the estimates of the proxy. The attributable fractions were estimated for the 13 metropolitan regions and 4 French overseas regions.

Results
In whole France, we estimated that 19% of deaths among men and 7% among women were attributable to smoking in 2015. Deaths attributable to smoking ranged across metropolitan regions from 17% to 23% among men and from 5.5% to 8.7% among women. In overseas territories, estimates presented much more variability with a range from 6% to 18% for men and from 1.2% to 4.3% for women.

Conclusions
We highlighted disparities in regional mortality attributable to smoking. Producing estimates of the burden of smoking at an infra-national level is a tool offering many perspectives for better analyzing territorial inequalities and ultimately to further guide more effective localized interventions to reduce tobacco consumptions.

Key messages
We provide a straightforward solution to estimate the infra-national burden attributable to tobacco from a usual method. Our results highlight the disparities in mortality attributable to smoking across regions in France in 2015.
30.G. Round table: Health planning In Europe: preparing for the expected and the unexpected
Authors:   Organised by: Karolinska Institutet (Sweden),   Chair persons: Birger Forsberg - Sweden, Bernd Rechel - European Observatory
Published: October 2020

Abstract
The objective of this round table discussion is to highlight the need for careful and systematic health planning of health systems in Europe, illustrate how health planning can be used for policy and management and provide some useful tools for participants to bring home and apply in their own contexts. Participants will acquire knowledge on current health care planning in some leading international organisations, with examples from some countries and region
Health in Europe is facing challenges and threats of both immediate and longer term character. In recent years, discussions on health care in the future has focussed on pressures coming from the increase in chronic diseases and demographic changes, such as the growing number of older people. Recently, the covid-19 outbreak has shown that newly emerging diseases can cause massive challenges to public health and health services. Both developments illustrate the need of health systems to be prepared for both expected and unexpected developments and to engage in careful planning of resource needs to ensure good health services to all. This session seeks to present approaches to health planning and discuss with the audience different methods for simulation and analysis of future health care needs and the resulting requirements for financial and human resources. The session will contribute to the development of health services and public health in Europe by highlighting the necessity to establish structures for comprehensive health planning and to seek ways to meet future challenges well in time. The round-table will have four participants, each of them giving an initial brief on some essential elements of health planning: projections of disease burden and health care needs,forecasting of health care costs and funding sources,health workforce needs in relation to disease burden projections, andplanning for unexpected events such as pandemics and climate threats
Each brief will be given a short comment by one of the other participants. After all four briefs, panel members will give general or specific comments on the topic and subsequently, the audience will be invited to provide input and pose questions to the panel members. Based on the presentations given and the information provided in the discussions, a report on the session will be compiled and made available to participants and the wider public electronically.

Key messages
Health care planning is important for emergency preparedness and long term sustainable delivery of health services. The best available estimates of population health developments and the resulting needs for prevention and health care should be the basis for health services planning.
Opportunities and strategies for HIA implementation – from a public health perspective
Authors: Mekel O , Martin-Olmedo P , Classen T 
Published: October 2020

Abstract
Health Impact Assessment (HIA) has various origins: environmental health, health promotion with the perspective of the wider determinants of health, and health equity. These three individual but related areas are linked by the overall aim of promoting healthier programmes, policies and projects, which are developed in non-health sectors mostly. As a consequence, this led to a significant use of HIA worldwide. The areas are complementary, but given their different original frameworks, applied methodologies may differ. Another typology of characterizing HIA can be done by the purpose for which HIA has been conducted in practice: mandated, decision support, advocacy and community-led HIA. These forms are important with regard to HIA implementation strategies. By now, the consideration of health in Environmental Impact Assessment (EIA) has become an established feature, not least due to the mandatory legal basis in many countries of the world. However, this situation is different for application in other policy areas so far. Some countries, in the absence of specific HIA legislation, have established HIA support units to conduct, commission, support HIA and deliver training. Advocacy and community-led HIA are mainly carried out by non-governmental organisations and universities. However, in general the potential of HIA has not yet been fully recognised: HIA is seen as a time-consuming and costly process and the effectiveness of HIA has not yet been communicated convincingly. The Health in All Policies approach is becoming increasingly important in the policy arena as a strategy to reduce non-communicable diseases by policies from non-health sectors. This requires different public health methods for implementation. HIA is particularly suitable for this. This development offers new opportunities for the implementation of HIA, which will be presented in detail.
Nutritional Supplements and Chronic Disease: Bridging the Gap between Myth and Reality
Authors: Stranges S 
Published: October 2020

Abstract
Several studies have appraised the role of vitamin and mineral supplements in primary or secondary prevention of chronic disease have consistently found null results or possible harms. Evidence involving tens of thousands of people randomly assigned in many clinical trials shows that β-carotene, vitamin E, and possibly high doses of vitamin A supplements increase mortality and that other antioxidants, folic acid, B and D vitamins, and multivitamin supplements have no clear benefit.
The large body of accumulated evidence has important public health and clinical implications. Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries.
The evidence also has implications for research. Antioxidants, folic acid, and B vitamins are harmful or ineffective for chronic disease prevention, and further large prevention trials are no longer justified. Vitamin D supplementation, however, is an open area of investigation, particularly in deficient persons. However, clinical trials have been equivocal and sometimes contradictory. Finally, implications on the clinical management and public health recommendations concerning the use of nutritional supplements in chronic disease will be addressed. Likewise, issues around the marketing and advertising of these supplements in the general public will be also discussed.
Extended HSPA framework for UHC
Authors: Karanikolos M 
Published: October 2020

Abstract
Based on the work presented earlier, this presentation shows the entire extended HSPA framework for UHC. The framework consists of the functions and their subfunctions, linked to performance assessment areas and leading, ultimately, to the achievement of health system goals (population health, responsiveness, financial protection; as well as equity and efficiency as distribution of outcomes and ratio of inputs respectively).
This approach shows that it is possible to have a common denominator between the existing HSPA frameworks and tools, that can be allied in various income settings globally. The added value of this approach is that country reports generated through the use of the existing health system assessment tools can be used not just to describe health system structures and functioning, but also to assess performance of individual health system components down to sub-function level. While not intended to provide a deep-dive into smaller, specific parts within health systems, the HSPA framework for UHC can help in identifying potential areas of strengths and weaknesses, which can then be related to actions or responsibilities of specific actors within a health system, or linkages to other sectors.
Tackling challenges in cancer care and improving its governance in the European Union
Authors: Wesselmann S , Borras J-M 
Published: October 2020

Abstract

Background
The aim of a cancer care system should be to give all patients access to a high-quality care that covers all components of the cancer continuum from early diagnosis to treatment and palliative care. Fragmentation of health services providers among different levels of care and lack of coordination among them is the main obstacle to achieving the desired continuity of patient care.

Results
These can be summarized in the following main outputs: Strategies to improve cancer outcomes in pancreatic cancer as case study. A consensus among relevant stakeholders was developed and analysis of outcomes in several countries will be presented to support the proposed measures.Impact of Information Technologies on Multidisciplinary care will have consequences on the way care is organized.Comprehensive cancer care networks (CCCNs) are based on tumor specific management groups. Patient pathways are to provide continuity of care along the whole chain of health care, while quality of care will be measured using tumor specific quality indicators and Patient Reported Outcome Measures and a process for continuous quality improvement must be in place. The CCCN concept will be implemented in two pilot sites and the implementation process will be evaluated.

Conclusions
Development of strategies on how to improve outcomes for pancreatic cancer Development of a list of quality indicators for different areas of cancer care Criteria and standards for CCCNs and their implementation in two sites Definition of patient pathways in cancer care and their practical implementation Amend the existing structure of National Cancer Control Programmes to include all the challenges mentioned above.

Key message
International expert collaboration across countries with the support of the EU provides an excellent framework for the development of important policy responses to the current challenges in the organization of cancer care.
32.L. Workshop: Deconstructing the DALY: step by step guide to calculating YLL and YLD
Authors:   Organised by: COST Action CA18218,   Chair persons: Ian Grant - UK, Elena von der Lippe - Germany
Published: October 2020

Abstract
A Burden of Disease (BoD) approach can be used to summarise the debilitating effects of morbidity and premature mortality in a population in a consistent and comparable manner. Summary measures of population health such as the Disability-Adjusted Life Year (DALY) have become key metrics for quantifying burden of disease. DALYs quantify the health gap between a life lived in perfect health and current health status, as the number of healthy life years lost due to illness (Years Lived with Disability, YLDs) and premature death (Years of Life Lost, YLLs). DALYs combine the effects of morbidity and mortality in an equitable way, and can therefore be used to identify the leading causes of disease or injury that cause BoD and to quantify the relative importance of specific risk factors. BoD studies are becoming an increasingly popular way to assess national and local population health as a means to influence national and local policy decisions.
The increasing prominence of the burden of disease approach, however, comes at a cost. Calculations of DALYs involve multiple components and as such can be difficult for people to interpret. Burden of disease methodology is complex and highly data intensive, which has led to major disparities across researchers and nations in their capacity to perform studies, to interpret the soundness of available estimates, or to evidence and advocate for the use of particular methodological choices.
In this skills-building seminar, we will give an overview of the methodology of calculating the DALY. It will outline the single steps to be undertaken, and the necessary assumptions that have to be taken, on the way to the calculation of the DALYs. This workshop will be supported by technical presentations from burden of disease experts about different choices of estimation methods to calculate both the fatal burden (YLL) and the non-fatal burden (YLD). Throughout the presentations, cerebrovascular disease will be used as a case study, giving a complete, real-life example of how DALYs are calculated. Overall, the aim is to demonstrate the importance of the choices researchers make when designing and interpreting BoD studies as a means of supporting evidence-based decision making. The workshop will foresee ample time for interaction with the audience and discussion of the implications of the different methodological choices.

Key messages
Although burden of disease methodology is complex, with calculations of DALYs involving multiple components, simple roadmaps can be created to enhance methodological knowledge. The choices and assumptions researchers make are important when designing and interpreting burden of disease studies.
32.M. Workshop: Mig-HealthCare project: Reducing health inequalities of vulnerable migrants in Europe
Authors:   Organised by: Mig-HealthCare,   Chair persons: Pania Karnaki - Greece, Alejandro Gil-Salmerón - Spain
Published: October 2020

Abstract
This MigHealthCare Workshop will be a forum to present and discuss the project's final results with a wide range of health and social care professionals working on the field of migrant/refugee health. The Mig-HealthCare project is a collaboration of 14 partners, among them universities, national authorities and NGOs from 10 countries across Europe (Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria). The major aim of the project is to reduce health inequalities and improve the integration of vulnerable migrants and refugees into local communities in Europe. The project is co-funded by the III Health Programme of the European Commission from 2017-2020.
The Mig-HealthCare project addresses the need for structural changes in the health systems to respond to the unmet needs of vulnerable migrants and refugees in Europe and promotes community-based care. Community-based health care has proven to be effective in reducing health inequalities in health, as well as improving accessibility to appropriate care. For this purpose, the consortium has produced an evidence-based Roadmap and Toolbox to reorient health care services to a community level which is a user-friendly online application focusing on the key steps for optimal health care delivery to migrants and refugees. In this regard and as part of these operative tools, within the Mig-HealthCare project, effective community-based care interventions focused on health promotion or prevention were designed and piloted in 8 different contexts and countries.
As main results of the MigHealthCare project, the Roadmap and Toolbox comprise both the necessary factors that health policy and practice need to deliver culturally competent care as well as the particular health issues especially faced by migrants and refugees in order to better prepare public health response.

Key messages
Community-based care for vulnerable migrants and refugees has proven to be effective in reducing health inequalities. Evidence on the drivers of the success or failure of health promotion strategies for migrants and refugees should be considered when planning interventions.
The challenge of combined exposure to multiple chemicals: scientific and regulatory approaches to protect human health
Authors: Bopp S , Kienzler A , Worth A 
Published: October 2020

Abstract
Every day we are exposed to low levels of hundreds of different manmade chemicals present for example in our food, consumer products and the air we breathe. Combined exposure to multiple chemicals can lead to adverse effects on human health or the ecosystem, even if single chemicals in the mixtures are below their individual safety thresholds. However, current safety assessment practice is primarily based on understanding the potential risk posed by single chemicals rather than their 'real life' combinations. In particular, while manufactured products such as pesticide formulations or cosmetic products are covered, unintentional mixtures which are coincidentally formed such as mixtures of contaminants in indoor air, are not consistently addressed. Their composition is often unknown and changes over time. The assessment of unintentional mixtures is therefore usually limited to specific legislative sectors only, such as pesticide residues in food.
Generally, methodologies to address chemical mixtures have been developed; however, there are still several data and methodological gaps to be addressed. New approach methodologies can support the filling of knowledge gaps on the toxicity and mode(s) of action of individual chemicals, to unravel links between chemical exposure and health effects. (Bio)Monitoring, modelling, and better data sharing will support the derivation of more realistic co-exposure scenarios. Considering the large number of possible combinations of chemicals in mixtures, prioritization is needed, so that actions first address mixtures of highest concern and chemicals that drive the mixture risk. As chemicals with different applications and regulated separately might lead to similar toxicological effects, it is important to consider chemical mixtures across legislative sectors.
This contribution to the workshop will summarise current challenges and ways forward in the risk assessment and risk management of mixtures for protecting public health.
The Swiss Learning Health System: a national initiative supporting evidence-informed decision-making
Authors: Mantwill S , Kasper Wicki T , Boes S 
Published: October 2020

Abstract

Issue
Over the last years, there has been an ever-increasing interest in how to promote and support uptake of evidence and evidence-informed decision-making in health-systems related policy and practice. However, only few efforts have been made that aim at fully leveraging the knowledge and expertise of bigger networks to address this issue more comprehensively.

Description of the problem
Also, in Switzerland, the need to address this matter has been increasingly emphasized by actors in the health system. In particular, the lack of comprehensive coordination efforts in the field of health services research, and subsequent knowledge translation activities, has been stressed.

Results
In response, the Swiss Learning Health System (SLHS) was established as a nationwide project in 2017, currently involving 10 academic partners. One of the overarching objectives of the SLHS is to bridge research, policy, and practice by providing an infrastructure that supports learning cycles. Learning cycles enable the continuous integration of evidence into policy and practice by: continuously identifying issues relevant to the health system, systemizing relevant evidence, presenting potential courses of action, and revising and reshaping responses. Key features of learning cycles in the SLHS include the development of policy/evidence briefs that serve as a basis for official stakeholder dialogues, which are structured dialogues during which the best course of action is discussed and evaluated. Issues that are identified to be further pursued are monitored for potential implementation and eventually evaluated to inform new learning cycles and to support continuous learning within the system.

Lessons
The SLHS is an important mechanism to institutionalize learning cycles within the Swiss health system by leveraging the expertise and knowledge of a comprehensive network, going beyond individual initiatives, and to respond effectively to newly occurring health system challenges.

Key messages
The Swiss Learning Health System is the first nationwide project that aims to establish learning cycles that support evidence-informed decision-making in health-system-related policy and practice. The Swiss Learning Health System is an infrastructure that supports the continuous flow of evidence into policy and practice, providing a mechanism to respond to occurring health system challenges.