bluuebunny/crossref_metadata_2025_split huggingface dataset:
The critical role of Digital Health in Public Health
Authors: Buttigieg S , Vital Brito D , Wong B 
Published: October 2021

Abstract
Digitalization in itself is not simply a means to an end but involves an operational change in workflows that is on the critical-path to the digital transformation of public health. The COVID-19 pandemic has been a unique opportunity to put a shining light on all the different technologies that were available and also consider a large number of new and innovative technologies that were developed in a breath-taking place over a period of one year. These different initiatives also brought relevant advances in public health needs such as epidemiological surveillance, rapid case identification, interruption of community transmission and communication with different audiences. Moreover, social media channels, blogs and websites confirmed to be a fertile ground to find data for research, but also to spread misinformation - and public health professionals should be ready to counter that threat effectively. This presentation aims to provide a comprehensive background on digital tools and strategies that can be used in national and local public health services and how stakeholder alignment across different sectors could propel forward the implementation of digital solutions.
High-resolution spatiotemporal analysis in 6,791 English areas reveals declines in life expectancy
Authors: Rashid T ,   On behalf of Pathways to Equitable Healthy Cities London
Published: October 2021

Abstract

Background
Health inequalities in the UK and other advanced economies are receiving renewed attention by the public and governments in light of the Covid-19 pandemic. Current data on mortality and longevity in England lack precision either in space or in time. We estimated trends from 2002 to 2019 in life expectancy for all 6,791 English Middle-layer Super Output Areas (MSOAs, median population 7,985 in 2019).

Methods
We used data for all deaths in England from 2002 to 2019 with information on age, sex and MSOA of residence and data on population by age, sex and MSOA. We used a Bayesian hierarchical model to obtain stable estimates of age-specific death rates by sharing information across age groups, MSOAs and years. We used life-table methods to calculate life expectancy at birth by sex and MSOA.

Results
In 2002-2006 and 2006-2010, the vast majority of MSOAs experienced a life expectancy increase for both sexes. In 2010-2014, female life expectancy decreased in 322 (5%) of MSOAs for women. By 2014-2019, the number of MSOAs with declining life expectancy was 1,178 (17%) for women and 635 (9%) for men. The life expectancy increase from 2002 to 2019 was smaller where life expectancy had been lower in 2002, mostly northern urban MSOAs, and larger where life expectancy had been higher in 2002, mostly MSOAs in and around London. As a result of these trends, the gap between the lowest and highest MSOA life expectancy increased from 2002 to 2019, to reach 20.6 (95% credible interval 17.3-24.4) years for women and 27.2 (23.4-31.7) years for men.

Conclusions
This study highlights not only rising inequality, but also declining life expectancy in a large proportion of English communities. The post-Covid rebuild policies in England must include pro-equity economic and educational policies, and expansion of public health and healthcare.

Key messages
Between 2014 and 2019, 17% and 9% of communities in England underwent a decrease in life expectancy for women and men respectively, highlighting the immediate need for equity-focussed policies. For women, 2% of small areas in England have experienced a long-term decline in life expectancy between 2002 and 2019.
Refined avoidable mortality for comparative health systems performance assessment: an impact study
Authors: Hrzic R , Vogt T , Burazeri G , Brand H 
Published: October 2021

Abstract

Background
Avoidable mortality is headline indicator of relative health system performance in European Union policy processes. However, the reliability of this indicator for cross-national comparisons of health system performance is limited by the lack of control for cross-country differences in population health status, and the challenges in selecting causes of death and age limits. This study examined the feasibility and impact of several refinements of avoidable mortality addressing these concerns.

Methods
Using a sample of 30 European countries, including EU Member States, United Kingdom, Norway, and Iceland, we examined the feasibility and impact of adjusting avoidable mortality for cross-country differences in disease prevalence and disease stage, using extended age thresholds, and calculating the avoidable burden of disease. We measured the impact of the feasible adjustments by calculating the average absolute change in country ranks compared to the 2014 country ranking based on the standard avoidable mortality.

Results
Given publicly available data, only the calculation of years of life lost due to avoidable causes of death and using different age thresholds to calculate avoidable mortality are currently feasible. The impact of the feasible adjustments varied between countries with no visible geographic pattern. Including deaths due to avoidable causes at all ages changed the country ranks by an average of 1.9 places in men and 2.8 in women. Using years of life lost due to avoidable causes of death changed the rank by an average of 8.1 places in men and 8.7 in women.

Conclusions
Country rankings are highly sensitive to the type of refinement. However, a full assessment of refinements was not possible due to missing data. To ease the implementation of morbidity-based refinements of avoidable mortality, we recommend that a shorter list of avoidable causes of death is developed.

Key messages
A continuous refinement of relative health system performance measures and improving the availability of internationally comparable health data are critical to effectively support policy making. Updating the age thresholds used to calculate avoidable mortality and using years of life lost due to avoidable causes of death are currently feasible and have a sizeable impact on country rankings.
School-based sexuality education in Italy 2016-2020: a highly heterogeneous scenario
Authors: Chinelli A , Salfa MC , Cellini A , Rancilio L , Farinella M , Galipò R , Ceccarelli L , Caraglia A , Suligoi B , Tavoschi L 
Published: October 2021

Abstract

Background
In Italy, sexuality education (SE) is not part of school curricula. SE and, specifically, comprehensive SE (CSE), as defined by UNESCO, is one of the most important means of promoting sexual well-being among young people and a key component for sexually transmitted infections' (STI) prevention. School-based SE has the potential to reach most young people, is cost-effective and valued by students. The aim of this study was to describe school-based SE educational activities (EA) implemented in Italy during 2016-2020.

Methods
An online survey was developed and piloted to collect information on duration, content and methods used to implement the EA. The survey was disseminated at national and regional level between August-October 2020. IBM SPSS Statistics 26 was used to perform descriptive analysis of the data, while a framework from UNESCO was adapted to perform a qualitative analysis.

Results
A total of 219 reported EA were carried out in secondary schools. The analysis describes a highly heterogeneous scenario in terms of EA geographical coverage across the country (most EA delivered in 4/20 regions), providers (70% private, 30% public) and objectives. The qualitative analysis of content, objectives, and methodology identified 62 EA (29%) classifiable as CSE, with median duration of 3 days. The remainder EA had a risk-based approach, largely focussing on STI prevention (35%). Many EA (29%) were single-session interventions. Limited time availability for extra-curricular activities was reported as a key challenge. Only 97 EA performed evaluation (44%). In 53 EA (24%) both pre and post knowledge assessment were delivered and in 114 (52%) satisfaction was evaluated.

Conclusions
Italy is one of a few European countries still lacking a dedicated policy for school-based SE. According to available data, SE is not systematically and equally delivered across the country. Action is urgently needed to incorporate SE in school curricula. (Funding: Italian Ministry of Health)

Key messages
This study shows the absence of a comprehensive and shared approach to SE in Italy, with heterogeneous geographical coverage and providers and a lack of systematic objectives and evaluation. The results highlight the need to develop theoretical and practical guidelines for the implementation of CSE in Italy and the integration of sexuality education in school curricula.
Food and lifestyle education in Tuscan schoolchildren: 2018-2019 follow-up of a long-term campaign
Authors: Tarroni M , Messina D , Balestri C , Cocchi F , Messina G , Nante N 
Published: October 2021

Abstract

Background
Nutritional profile, physical activity level and sedentary behaviours, in preteen age, are determinants able to influence both short and long-term state of health, therefore succeeding in health education campaigns addressed to this age group is critical for the interested population. Is currently underway the multiannual follow-up of the Italian “sCOOL FOOD - Per un Futuro di tutto Rispetto” project of Monte dei Paschi Foundation of Siena, Tuscany, which offers year-round cycles of classes and workshops about the themes listed above. Our objective was to assess whether this intervention could significantly influence over time healthy, and unhealthy, behaviours of the participants.

Methods
We structured the follow-up as a prospective cohort study with one-group pretest-posttest design. We used the CAWI technique, building a questionnaire based on the Italian “OKkio alla Salute” survey, and collected data from the whole population of students enrolled in the project (in the school year 2018-2019 they were 3787, aged from 7 to 12) before and after the intervention. Afterwards, we conducted paired data analysis on the frequencies of specific behaviours.

Results
We analysed paired data from 310 respondents. Improvements were gained in: afternoon TV watching (OR 0.54; 0.34 - 0.84; p &lt; 0.01), consumption of sweet (OR 0.39; 0.16 - 0.88; p &lt; 0.05) and salty (0.42; 0.18 - 0.90; p &lt; 0.05) snacks, attitude to play outdoors after school (OR 2.6; 1.21 - 6.04; p &lt; 0.01), sedentary behaviour in leisure time (OR 0.27; 0.16 - 0.44; p &lt; 0.0001), mean weekly sport activity (+0.14 days; +0.02 - +0.27; p &lt; 0.05). No variable has deteriorated.

Conclusions
The improved compliance with healthy behaviours in the participants at this project suggests its viability as a health promotion campaign. Further parallel surveys on control groups are pending, in order to control potential confounders such as the seasonality of some habits and the awareness of the participants on the addressed subjects.

Key messages
A coordinated and cross-disciplinary food and lifestyle year-round education campaign at school can affect health determinants of children. School can correct unfavourable eating and lifestyle behaviours determined by family habits.
Disaster response and COVID-19: was safety and health a priority among medical doctors in Serbia?
Authors: Mandić-Rajčević S , Dinić M , Tripković K , Šantrić Milićević M 
Published: October 2021

Abstract

The coronavirus disease (COVID-19) pandemic has an unimaginable impact on the global health workforce. Health workers are deployed as frontline workers to rapidly respond to increasing patient needs. This study aimed to examine the preparedness of healthcare workers during the COVID-19 pandemic to protect their own safety and health. An online survey was conducted among physicians licensed by the Serbian Medical Chamber in September 2020. The Ethics Committee of the Serbian Medical Chamber approved this study (Decision No: 1462/September 15, 2020). The sample consisted of 1,553 physicians who completed the online questionnaire. Almost two thirds (64%) of the physicians worked with COVID-19 patients, and around one third (34%) were deployed to a different work position. Physicians working with COVID-19 patients were younger, less-experienced (mean work experience 14 years vs. 19.5 years) and more commonly non-specialists. Less than 39% of physicians deployed to work with COVID-19 patients had gone through the training on the use of personal protective equipment (PPE), 60% had adequate PPE available daily, and 86% reported using the PPE according to the recommendations. Having proper training regarding the use of PPE and using the PPE according to the recommendations was less common in private compared to public health institutions (31% vs 40% for training, and 89% vs 75% for adequate use, respectively). Workers engaged to work with COVID-19 patients, compared to those who were not engaged, indicated the need for professional changes to respond to the COVID-19 emergency, especially in the areas of workforce planning, education and training, workload measurement and tracking. Younger and less experienced physicians with questionable training and availability of PPE were deployed to work in COVID-19 hospitals and units, and their health and safety was a secondary priority to the primary duty of caring for patients in need.

Key messages
Younger and less experienced physicians with questionable training and availability of PPE were deployed to work in COVID-19 hospitals and units. Health and safety was a secondary priority to the primary duty of caring for patients in need.
European Code against Cancer: Europe’s key cancer prevention tool in informing the general public how to reduce their cancer risk
Authors: Schüz J 
Published: October 2021

Abstract
The European Code against Cancer (ECAC), launched in 1987 and after several periodical updates now used in its 4th edition published in 2014-15 in all official European languages, is a key cancer prevention tool that translates scientific evidence into unambiguous public health recommendations for the general public of how to reduce their risk of getting or dying from cancer. The 4th edition is the most comprehensive one, providing context and background information for a better understanding of the twelve recommendations. It is further supported by a recently launched self-learning course for health promoters, hosted in the E-Learning Center of Europe's leading network of cancer prevention research institutions: Cancer Prevention Europe (CPE). With an abundance of rather confusing “cancer news” the public receives through media and the Internet almost everyday, there is indeed a need for a reliable, authoritative and evidence-based information source for cancer prevention. For that reason, the ECAC recommendations follow three key scientific principles: it only recommends scientifically established actions for reducing cancer risk, its messages are relevant for a broader general public, and it communicates them in a non-scientific language so they are easy to follow. In 2020, IARC/WHO, CPE, Association of European Cancer Leagues and other ECAC stakeholders, have developed a roadmap for the ECAC's sustainability within the innovative Partnership on Action Against Cancer (iPAAC). This plan being essential towards achieving the 80% awareness goal, its main elements include a scientific revision, an expansion to include scientifically established successful interventions in cancer prevention on both individual and population levels, an expansion on the target groups encompassing health professionals and policymakers, and an outreach for synergies with other non-communicable diseases prevention strategies.
Data collection during time of crisis – experiences from the COPERS study
Authors: Begotaraj E 
Published: October 2021

Abstract

Background
The pandemic situation has been present for more than a year all over the world. In almost all countries actions were taken following WHO recommendations of social distance, smart work, online lectures, using of masks, etc. These procedures reduced physical distance but increased social isolation, encouraging virtual connection among people and eventually, increasing psychological repercussions. In many countries, equivalent measures were taken, but the cultural vulnerability to the virus could be dissimilar, influencing on social disruption and economic inequalities among countries. COPERS study aims to examine the association between the exposure and depression, perceived stress, anxiety, suicidal ideation, social capital in different cultural contexts.

Methods
We carefully focused on measuring exposure. Exposure can be described and assessed by intensity and by duration. We assessed both intensity and duration of exposure to the pandemic itself and to the containment measures. IES-R was used to assess the impact of the pandemic Covid-19 among people, assessing among others, feelings, sleeping troubles, stressful life events and emotional reactions.

Results
The assessments included specific issues on exposure range to Covid-19 in different countries. Specifically, could be mentioned the mandatory isolation policy in specific hours, freely vaccination willingness and high suicidal occurrences as the Albanian case. Despite the high mortality and suicidal cases in Albania, many people acted as if virus was not around. However, it was possible to obtain data in a cultural environment which was reluctant to participate.

Conclusions
The measure to overcome skepticism to participate was mainly possible due to building trust to key persons. More measure how to conduct studies in populations which are reluctant to participate in research will be discussed. To obtain results in times of crises it is necessary to get data as well in difficult to reach populations.
Governing the COVID-19 response
Authors: Sagan A , Karanikolos M 
Published: October 2021

Abstract
The COVID-19 pandemic has demonstrated that effective leadership and strong governance are essential for resilience in the face of a shock to the health system. Even though adequate financing of health systems, and ensuring that they have an adequate workforce, physical infrastructure and material supplies can bolster health system resilience, resilience is not merely a function of hard resources but also of soft factors, including capacities of leaders, strengths of institutions, and societal values and culture. Indeed, countries that topped the Global Health Security Index (GHSI), an index that focuses on measuring technical preparedness for epidemics and pandemics, in 2019 were among those that performed the worst during the COVID-19 crisis, as measured in deaths or damage to the economy. A country's initial governance capacity, at the onset of the pandemic, shaped its ability to respond. For example, countries with effective leaders, strong institutions and higher levels of societal trust were often better positioned to respond adequately. But government capacity and trust could change over the course of the response. For example, deliberative decision making that is inclusive, transparent, and accountable, coupled with effective public engagement, can build legitimacy and support for difficult decisions. In the longer term, it can contribute to building trust and improving policy making. This presentation will provide an overview of the strategies that countries-mainly in Europe but also with examples from other regions-have implemented to achieve effective leadership and decision making, coordination, generation and use of information in COVID-19 response decisions. A brief overview of key metrics to assess resilience in the area of governance will also be provided.
Psychosocial Approaches and Discursive Gaps in Intersex Healthcare
Authors: Meoded Danon L , Schweizer K 
Published: October 2021

Abstract

Background
In the past several decades, conflicting discourses have coexisted in the field of intersex studies, including the pathologizing discourse of the biomedical disciplines and the affirmative, subjective psychosocial discourse of people born with intersex bodies and their advocates. Intersex activists call for a positive discourse and a humanistic healthcare approach that accepts and protects intersex bodily autonomy and change the continuing harmful, traumatic treatments aimed at normalizing variations of sex characteristics (VSC).

Methods
We created a collaborative German-Israeli action study, in with 30 health care professionals, intersex activists and scholars from Israel and Germany, were gathered to learn different perspectives on intersexuality, interact and work together on projects aim to improve the care for intersex people and families.

Results
The participants created different collaborative projects, including “intersex workshops” for caregivers and professionals in Israel and Germany; unique materials for raising an awareness, e.g., booklets on intersex bodies with a positive and affirmative approach and language and an article for health care within the ultraorthodox Jewish community; parents' groups and implementation of programs that aim to build bridges between biomedical professionals, caregivers, parents, and intersex people in Israel and Germany.

Conclusions
The participants increased their knowledge and awareness of and sensitivity to intersex issues, and implemented these in their daily work and practices. The participants acknowledged the differences between the countries, especially in relation to the heightened Israeli use of assisted reproductive technology, which effect on the treatment practices, early genetic diagnosis and the preventive medical attitude. In Germany, more activism for intersex human rights and significant laws which regulate the medical treatment practices.
Towards an Agency-based Model of Intersexuality, Variations of Sex Characteristics, and DSD Health
Authors: Crocetti D , Monro S , Vecchietti V , Yeadon-Lee T 
Published: October 2021

Abstract

Background
The health harms caused by sex-normalising and unnecessary irreversible medical interventions on intersex infants and children can include chronic pain, a need for repeat surgeries, damage to sexuality, serious mental health problems, and sterility. However, access to appropriate healthcare is needed - occasionally for lifesaving treatments in minors, but more often for reparative treatment or condition management in those able to give consent. A social model of intersex health, drawing on disability theory, is useful but insufficient to address intersex issues. Agency and bodily autonomy are key for this population, and this paper aims to develop an agency-based model.

Methods
Qualitative semi-structured interviews were conducted with 40 stakeholders in Italy, Switzerland and the UK, and participant observation and action research was carried out with the intersex activist organisation Zwischengeschlecht. The research was funded by the European Commission (grant number 703352).

Results
At present there are still serious healthcare deficits which are underpinned by social norms that include rigid ideas that there are only discrete categories of male and female, and entrenched medical practices that continue to violate intersex minor's bodily integrity, whilst overlooking healthcare needs that intersex people may have. Key impediments to intersex agency include body normativity and sex and gender binarism.

Conclusions
Agency-based approaches to the health of intersex people and those with differences of sex development (DSD) focus on bodily autonomy and the cessation of normalising medical interventions until an under-age person can exercise fully informed choice regarding treatment. These approaches can be useful in incorporating the social model's critique of the pathologisation of bodily diversities, whilst supporting the provision of effective healthcare where needed.