bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urban health guidelines implementation: evidence and practice
Authors: Vigezzi GP , Barchiesi AT , Alquati M , Voltini E , Gianfredi V , Odone A , Signorelli C 
Published: October 2021

Abstract

Issue
Urban planning plays a crucial role in healthy lifestyle promotion, impacting physical activity and non-communicable diseases prevalence. National and regional strategies rely on an integrated approach. Under the chapter of collective prevention and public health, the new LEA (Assistance Essential Levels) include evaluating land-use plans (PGT in Italy) with a preventive assessment on the relationship between health and urban environment.

Description of the problem
The Italian Ministry of Health and the Lombardy Region with Polytechnic University of Milan proposed good practices for health impact evaluation of urban and environmental interventions of regeneration and redevelopment. After bibliographic research, on-site and on-field training, community practice and experts' evaluation, a multicriterial tool was built. A set of indicators (7 macro-areas) was selected to measure the propensity of urban plans to promote health. In 2020 the new guidelines were introduced in the administrative process of health impact assessment for receptors and of quinquennial PGT re-evaluation.

Results
The Health Protection Agency of the Po Valley (provinces of Cremona and Mantova, in Northern Italy) was asked to produce 344 judgements on civil buildings during 2020. Among them, 12 opinions referred to partial variations of PGT in 12 different municipalities. No comprehensive urban plan evaluation was requested in 2020.

Lessons
PGT evaluation through the proposed tool allows estimating the capacity to control population risk factors and promote a context organized to satisfy social needs and improve quality of life. In the rural context of small municipalities of Cremona and Mantova, an encountered limitation was the small size of urban centres. Thus, applying strategies conceived for metropolitan areas was challenging. A contextual evaluation of bordering municipalities urban plans would be desirable to promote bigger-scale interventions about transports, soil use and emission sources.

Key messages
Applying urban health good practices to land-use plan evaluation in rural areas with small municipalities poses some issues due to reduced interventions scale. It would be helpful to promote the simultaneous evaluation of bordering municipalities' urban plans so as to suggest integrated health interventions on a larger scale.
Prevention of breast&ovarian cancer in women with BRCA-1/2 mutations - A decision-analytic evaluation
Authors: Hallsson LR , Sroczynski G , Engel J , Siebert U 
Published: October 2021

Abstract

Background
Women who have inherited BRCA-1/2 mutations have substantially elevated lifetime risks for developing breast and/or ovarian cancer and may develop these cancers around age 30. Therefore, breast and ovarian cancer prevention should be administered relatively early in life for those women. We systematically evaluate the long-term effectiveness and cost-effectiveness of different breast and ovarian cancer prevention strategies in women with BRCA-1/2 mutations in Germany.

Methods
A decision-analytic Markov model simulating lifetime breast and ovarian cancer development in BRCA-1/2 carriers was developed to evaluate different strategies including intensified surveillance (IS), prophylactic bilateral mastectomy (PBM), and prophylactic bilateral oophorectomy (PBSO) alone or in combination at different ages. German clinical, epidemiological and cost (in 2018 Euro) data were used. Outcomes included cancer incidences, mortality, life years (LYs), quality-adjusted life years (QALYs), and discounted incremental cost-effectiveness ratios (ICER).

Results
All intervention strategies are more effective and less costly than IS alone. Prevention with PBM plus PBSO at age 30 maximizes life expectancy with 6.3 LYs gained, whereas PBM at age 30 with delayed PBSO at age 35 improves quality of life with 11.1 QALYs gained, when compared to IS alone. Both strategies are cost effective with ICER significantly below 10,000 EUR/LY or QALY gained.

Conclusions
Based on our results, PBM at age 30 plus PBSO between age 30 and 40 prolongs life and is cost effective in women with BRCA-1/2 mutations in Germany. Serial preventive surgeries with delayed PBSO potentially improve quality of life for women. We therefore suggest that efforts should be directed to carefully and thoroughly inform women with BRCA-1/2 mutations about their options to prevent breast and ovarian cancer.

Key messages
Prophylactic mastectomy at age 30 combined with prophylactic oophorectomy between age 30 and 40 may prolong lives and be cost effective in German women with BRCA- 1/2 mutations. Women’s quality of life might be improved by a delayed prophylactic oophorectomy after a prophylactic mastectomy.
Mortality in residential care services for people with disabilities in Ireland
Authors: McMahon M , Dunbar P , O’Connor A , Grogan C , Dunnion M , O’Connor L 
Published: October 2021

Abstract

Background
All-cause mortality is higher in people with disability than in people without disability. There is a need for descriptive epidemiological studies of deaths in people with disability to inform the development of public health interventions. All deaths in residential disability services in Ireland are notified to the Chief Inspector in the Health Information and Quality Authority (HIQA). These include notification of unexpected and expected deaths. The herein aim was to describe total, unexpected and expected deaths, and identify leading causes of death in residential disability services in Ireland.

Methods
Data on deaths in residential disability services in 2019 and 2020 were extracted from the Database of Statutory Notifications from Social Care in Ireland. The number of total deaths was calculated along with the percent and number of unexpected and expected deaths. The primary cause of death notified by services was coded using ICD-11 chapter headings.

Results
During 2019 and 2020, on average 9,115 people resided in residential disability services. Of these, 395 died, of which 45% (n = 178) were notified as unexpected. The leading causes of unexpected deaths were respiratory system diseases (35%, n = 62) and circulatory system diseases (18%, n = 32). The leading causes of expected death were respiratory system diseases (41%, n = 89) and cancers (31%, n = 67).

Conclusions
Almost half of deaths in residential disability services were notified as unexpected. Respiratory disease was the leading cause of both expected and unexpected death in people with disability residing in residential services in Ireland; three-fold the general Irish population (10.7%). Public health interventions aimed at reducing respiratory disease may reduce deaths in this group.

Key messages
In 2019 and 2020, nearly half of deaths of people with a disability residing in residential services were notified as unexpected. Death from respiratory diseases was substantially higher in people with disability living in residential services in Ireland than in the general population and warrants public health intervention.
Sharing of public health information in response to maritime outbreaks – report from an exercise conducted at a European level
Authors: Kourentis L , Kostara E , Christoforidou E , Mouchtouri V , Hadjichristodoulou C , Militzer K , von Münster T , Ehlers L , Dirksen-Fischer M , Heidrich J 
Published: October 2021

Abstract

Background
Inter-country communication and structured information flow is of major importance in outbreak management potentially affecting more than one country, particularly in case of a public health event of international concern. Though there are established communication systems in European Member States (MS), public health events in the maritime sector challenge authorities and stakeholders.

Methods
Guidelines for inter-country communication developed by the joint action were tested via a 1-day web-based multi-sectorial, discussion-based table-top exercise (TTE) for ports at European level. Two outbreak scenarios (gastroenteritis and COVID-19) on passenger ships in separate regions (Mediterranean, North Sea) were acted out consecutively.

Results
Thirty participants and 63 observers from 20 MS, cruise ships, international and European institutions took part in the TTE. The TTE identified two different information flows: (1) authorities at local level implementing public health measures on ships share information with the next and previous ports of call, either directly or via national level authorities using different platforms depending on the event without clearly predefined criteria and (2) the ship captain sends health information to the next port of call (via the National Single Window or Email or Telephone or other means). Relying on communication via emails and telephones however, has limitations: a) limited access, b) no central data storage, c) historical data unavailable. Lack of communication channels for feedback to the ship and of coordinating and closing an event was evident.

Conclusions
A successfully conducted European TTE in maritime outbreak scenarios identified lack of clear international communication as communication channels were not always clear and depend on local/national conditions. There is potential for improving international communication. Guidelines for inter-country communication in this setting may help enhance communication practice.
What is next? Vision statement and reflections for sustaining project outcomes in a possibly post-pandemic era
Authors: Heidrich J , Militzer K , Mouchtouri V , Dionisio M , Janiec J , Kairiene B , Otorepec P , Timen A , Dirksen-Fischer M , Hadjichristodoulou C 
Published: October 2021

Abstract

Introduction
The ongoing COVID-19 pandemic has demonstrated the importance in strengthening cooperation and coordinated action of Member States (MS) to improve preparedness and response capacities at points of entry (PoE). This emphasizes the need for perpetuating the work of EU HEALTHY GATEWAYS (EU HG) and the availability of this cross-European network to transfer lessons learned for future public health threats.

Methods
An interdisciplinary sustainability working group identified options for continuity of activities at EU level and provided a template national sustainability plan to be adapted by MS based on national needs and priorities.

Results
Since the beginning of the pandemic EU HG provided 37 consultations to MS, developed 15 advice documents, delivered training courses, produced a study on preparedness and response at PoE and developed the EU digital Passenger Locator Form (EUdPLF) system. A European web-based network for PoE was developed including discussion forums, e-learning platform, searchable network of professionals' at PoE registry, bibliographies, web-based training resources and best practice catalogues. Overall, the 533 inspectors in the EU SHIPSAN INFORMATION SYSTEM (EU SIS) recorded 29268 IHR (International Health Regulations) certificates, followed up 69 public health events via the communication network for EU ports, and recorded &gt;4600 hygienic deficiencies.

Conclusions
EU HG has a holistic approach, supporting operations on local, regional, national and European level and by taking into account all transport sectors. The web-based systems and capacity building activities support EU Decision 1082/2013/EU for serious cross-border health threats and the EUdPLF supports implementing Decision (EU) 2017/253 for the contact tracing of passengers identified through PLFs. Adoption of components of EU SIS will support implementation of Regulation (EU) 2019/1239 which includes the provision of a common ship sanitation database.
The influence of the COVID-19 pandemic on the prevalence of severe injuries in The Netherlands
Authors: Blatter B , Krul IM 
Published: October 2021

Abstract
Our goal was to study the influence of COVID-19 measures and coinciding changes in activities on the prevalence of severe injuries treated at the Emergency Departments (EDs) in The Netherlands. We performed a retrospective observational study with data from the Dutch Injury Surveillance System (DISS) and compared prevalences of ED-visits during lockdown period (March 16 - May 10 2020) with prevalences in the same period in 2019. We also compared a period from May 11 to July 5 2020, in which the measures were relaxed, with the same period in 2019. To exclude a possible effect of avoiding hospitals and EDs duet o COVID-19, we included only treatments for severe injuries. The prevalence of ED-visits due to severe injuries was 27% lower during lockdown than during the same period in 2019 (6755 vs. 4902, p &lt; 0,05). This decrease was seen among all types of injuries and all age categories, but was largest within sports injuries and among 10-19 year old persons (-55%). Opposite to those decreases we saw increases in specific types of injuries such as doing home maintenace work (+31%), and skeelering or skating. (+233%). Among 0-11 year olds, the prevalence of injuries due to trampoline use increased by 68%. During the relaxation period regarding COVID-19 measures, the prevalence of severe injuries increased by 19% compared to lockdown, but was still 11% lower than compared with the same period in 2019. We concluded that changes in activities due to COVID-19 measures during lockdown have led to changes in the number of severe injuries treated at the ED. Variations in prevalence primarily seem to relate to variations in sports and traffic participation, and stay in and around the home.
The European Union Confronts COVID-19
Authors: Greer S , Brooks E 
Published: October 2021

Abstract

Issue
The politics of European Union (EU) health policy are also the politics of European integration. Debate about EU policies always entails debate about the appropriate role and powers granted to the EU.
Description
From some angles, the EU looks more like a federation (ex EUA), deeply entrenched in its citizens' lives. It has a powerful shared culture among leaders and strong, entrepreneurial, and statelike political institutions. Its legal system is entwined with member state law to such an extent that member state courts have driven legal integration and change as much as EU institutions, both in general and in health. From another angle, it still looks like an international organization (ex WHO) or a regional trade block (ex Mercosur). We ask what policy a member state might make, but, in the case of the EU, many ask if the EU should have a policy at all. Should it respond, and, if so, how and to whose benefit?

Results
Like international organizations or confederations, though, the EU responds primarily to and is shaped by the demands of its member states. They have actively maintained this dichotomous structure so as to prevent transfer of power and loss of sovereignty. Member states ultimately determine the direction of the EU, and they have supported EU expansion only when they require a “European rescue of the nation state”.

Lessons
The EU's weak public health and social policy responses to the crisis reflect this effort on the part of member states to limit its role over the decades, whereas the major expansion in its role over the summer of 2020 reflects the perceived interests of member states, which now seek another European rescue of the nation state.

Main messages
This crisis of COVID-19 leave behind a different EU. Between the redefinition in salience, resource, and law of public health, shared European actions and the development of EU debt for member states, it is likely that a step forward promoted integration in health and beyond.
Three Approaches to Handling the COVID-19 Crisis in Federal Countries
Authors: Czypionka T , Reiss M 
Published: October 2021

Abstract

Issue
Despite their geographical and cultural proximity, Germany, Austria, and Switzerland can teach very different lessons on how to handle the COVID-19 pandemic. Timing and severity of outbreaks during the first wave were fairly similar in Germany and Austria, whereas Switzerland faced a higher infection rate at the peak of the crisis (although far from rates in France or Italy).

Description
The aim of this presentation is to examine the outbreak responses of the three countries in the spring of 2020 and give insight into the dynamics and rationales behind these responses.

Results
Although the three countries are all prime examples of federalism, Austria and Switzerland showed a decisive, uniform public health response resulting from epidemic laws granting the central level precedence under such circumstances. In Germany, by contrast, individual state governments played a central role. Response measures eventually taken by the three countries were not too different but how decisions were made and subsequently communicated to the public varied considerably. The three countries fared well in reducing transmission rates and never came close to reaching capacity limits in their health systems during the first wave. However, while all of them experienced a resurgence of infections in fall, the epidemiological development took a diverging course across the three countries in the following months.

Lessons
While all countries were successful in the first wave, differences in the paths chosen are likely to impact adherence to measures and may help explain divergent developments in the subsequent waves.

Main messages
Swift and decisive actions seem to have been successful answers to the first wave of the pandemic, but approaches to implementation and communication of these approaches to the public may make the difference in the further course of the pandemic.
COVID-19 in Central and Eastern Europe
Authors: King E , Loblova O 
Published: October 2021

Abstract

Issue
Countries of central and eastern Europe (CEE) are rarely accustomed to praise when compared to their western European neighbors. During the early months of the COVID-19 pandemic, however, as core European countries such as Italy, Spain, or the United Kingdom reported hundreds of confirmed cases and even deaths per day, all CEE countries managed to contain the disease with considerably lower rates of infection and deaths.

Description
This changed in late summer and fall of 2020, when many CEE countries overtook western Europe in the number of new COVID-19 cases, as well as deaths, per population, but for a few months the region could enjoy its unusual accomplishment. A number of hypotheses have been suggested to explain the surprising containment success in the spring, including the widespread prevalence of the bacille Calmette-Guérin tuberculosis vaccine, lower population density and exposure to tourism, lack of trust in the healthcare system and government in general, low testing numbers (which may have led to underreporting of cases), and an autocratic advantage leaders of imperfect democracies, such as in CEE, enjoy when imposing lockdowns and other restrictive policies.

Results
In the spring, CEE governments implemented strict measures to protect public health at a time when their countries had few COVID-19 cases and deaths at most in the single digits.

Lessons
The Russian approach to addressing COVID-19 reflects the messiness of classifying “regime type.” Some of the responses used were more authoritarian in their approach. A greater flow of information and more transparency in the data would allow a more complete assessment of Russia's response to COVID-19.

Main messages
Creating a “virus of silence,” short- cutting global standards for vaccine clinical trials, and not providing disaggregated and timely data make it difficult to evaluate the reasons for Russia's relatively low case count and low fatality rate.
How to deal with sickness absence among primary school pupils?
Authors: Pijl EK , Vanneste YTM , Mathijssen JJP , Feron FJM , de Rijk AE 
Published: October 2021

Abstract

Background
Missing school can lead to lower educational achievement, early school dropout and health problems. To address sickness absence in secondary schools the intervention Medical Advice for sick reported students (MASS) has been developed. Because of fundamental differences in relation to the children's age and in the schools' organisational structure, the original MASS is not suited to primary schools. The aim of this study was to adapt MASS to primary education.

Methods
The intervention mapping approach steps 1 through 4 were used to adapt MASS to primary schools (MASS-PS), including a literature search, stakeholder interviews and pre-testing.

Results
In step 1, a planning group was formed and a logic model of the problem was created based on a literature search and interviews with stakeholders. In step 2, a logic model of change was created to determine the behavioural and environmental factors that need to change to achieve the goals of the intervention. In step 3, a theoretical basis and practical strategies to adjust MASS to primary education were determined. In step 4, practical support materials were developed and two pre-tests of the materials were performed with stakeholders and end-users.

Conclusions
Intervention mapping was successfully used to adapt MASS to primary schools. The main changes were the lowering of the threshold for extensive sickness, consultations between teacher and absenteeism coordinator and the addition of a social worker and remedial educationalist as experts next to the child and youth healthcare physician. The second pre-test did not yield any adaptations, indicating good acceptance in practice. With MASS, extensive sickness absence among primary school pupils can be addressed as a ‘red flag' for underlying problems.

Key messages
Intervention mapping steps one through four were sucessfully used to adapt a secondary school intervention to adress sickness absence among students (MASS) to primary schools. With the adapted MASS intervention, extensive sickness absence among primary school pupils can be addressed as a ‘red flag’ for underlying problems.