bluuebunny/crossref_metadata_2025_split huggingface dataset:
Climate Change and the need of a One Health Approach – from science to policy
Authors: Viegas S 
Published: October 2021

Abstract
Climate change is having a detrimental impact on the environment and on the animals and humans health. Recent research has highlighted the negative impact that climate change has on the social and environmental factors that determine human health, such as clean air, food security and safety, water quality, and much more such as the possible increase of infectious diseases and zoonoses. Climate change is indeed a global health problem, causing several health negative impacts that could be largely prevented in many cases if sufficient action is taken. However, to obtain the results needed we need a multi-sectorial approach and the preventive actions need to be developed in different sectors in a coherent manner. Threats to public health resulting from climate change need to be anticipated to allow adaptation and allow a proper answer. The One Health approach, which recognizes the interconnection between health in people, animals, plants, and their shared environment is a fundamental pillar of prevention. Several examples of climate change adaptation in different scenarios will be presented and discussed aiming to support multi-sectorial policy actions. The identification and implementation of policies that will bring co-benefits to human and animal health and environment should be the drivers for the next years. We need to act now and promote the mainstream of health into all policies, strategies and programmes.
Transforming health and care systems on the political agenda of the EU Presidency of Slovenia
Authors: Albreht Tit 
Published: October 2021

Abstract
In the second half of 2021, Slovenia will assume the Presidency of the Council of the European Union. As part of a trio, Slovenia will join Germany, which held the presidency in the second half of 2020, and Portugal in the first half of 2021. The EU Presidency aims to contribute to an open, fair and sustainable Europe in the world, which is a call to action for us all. Faced with a public health crisis, it is important to join hands to increase public support for a European Union that puts global solidarity, the Agenda 2030 for Sustainable Development, development cooperation, human rights, and the inclusive participation of civil society at the centre of its work. The presentation will reflect on the future Parthership in the context of the Presidency, with a particular focus on the operational level of establishing linkages between a Partnership and exsisting public health initatives, closely related to current recovery and reconstruction plans.
Ambient particulate matter exposure interacts with abdominal obesity to increase blood triglycerides
Authors: Gaio V , Roquette R , Matias Dias C , Nunes B 
Published: October 2021

Abstract

Background
Blood lipids levels dysregulation represent potential mechanism intermediating the adverse cardiovascular effects of ambient particulate matter (PM) exposure. The present study aims to estimate the effect of particulate matter (PM10) exposure on blood lipid levels (TC, Total Cholesterol; HDL-C, High-Density Lipoprotein Cholesterol; LDL-C, Low-Density Lipoprotein Cholesterol; TG, Triglycerides) in the adult Portuguese mainland population and to assess the potential mediation and/or modification action of abdominal obesity on this effect.

Methods
We used data from 2390 participants of the 1st Portuguese Health Examination Survey (INSEF, 2015) with available data on blood lipids parameters and living within a 30km radius of an air quality monitoring station with available PM10 measurements. PM10 concentrations were acquired from the air quality monitoring network of the Portuguese Environment Agency. Generalized linear models were used to assess the effect of 1-year PM10 exposure on blood lipids values. An interaction term was introduced in the models to test the modification action of abdominal obesity.

Results
We found an association between long-term exposure to PM10 and non-fasting blood TG levels after adjustment for age, sex, education, occupation, lifestyles related variables and temperature but only in participants with abdominal obesity (1.84% TG increase per each 1 µg/m3 PM10 increment, 95% CI: 0.02%; 3.69%) which is well supported by the sensitivity analysis.

Conclusions
Our study demonstrate that even at low levels of exposure, long-term PM10 exposure interacts with abdominal obesity to increase blood TG levels. To the best of our knowledge, this is the first study showing the modification action of abdominal obesity regarding the PM10 effect on a blood lipid parameter. Our findings suggest that reducing both abdominal obesity prevalence and PM10 below current standards would result in additional health benefits for the population.

Key messages
Long-term PM10 exposure interacts with abdominal obesity to increase non-fasting blood triglycerides levels by about 2% per each 1 µg/m3 PM10 increase. Reducing both abdominal obesity prevalence and PM10 below current standards would result in additional health benefits for the population.
Analysis of the current situation with water, sanitation and hygiene (WASH) in rural hospitals
Authors: Omarova A 
Published: October 2021

Abstract

Background
During the COVID-19 pandemic, the implementation of Sustainable Development Goals (SDG) 6 and SDG 3 in rural areas of Kazakhstan is a huge problem that the state must address as soon as possible. Therefore, it is necessary to examine the state of the infrastructure and the quality of water, sanitation and hygiene (WASH) services in rural hospitals.

Methods
The study was descriptive and included an analysis and assessment of the current situation on the ground. The analysis of the situation was based on the official data. The current services were assessed using an observational cross-sectional study based at the hospital of Abay district (49°37′52″ N 72°50′17″ E, 6725 km2) of Central Kazakhstan.

Results
The hospital in Abay district do not have a set of agreed WASH standards. When such standards exist, their implementation is limited by the lack of necessary conditions, sufficient funding or the interest of authorities. The budget of public health service is usually categorized by a disease group and covers expenditures for drugs and vaccines. The quality of WASH infrastructure in the hospital is poor due to deterioration or initial non-compliance with safety requirements. Investing in WASH infrastructure and its maintaining require effective intersectoral collaboration and financial resources. Another problem is the lack of motivation for improving WASH services among staff and managers of the hospital. If the former have no desire and knowledge in WASH due to their high workload, the latter often consider this problem insoluble and therefore do not want to spend their limited resources on it.

Conclusions
Thus, rural residents are at high risk of contracting and spreading COVID-19 due to deterioration of WASH infrastructure, non-compliance with requirements and insufficient funding of rural hospitals.

Acknowledgement
This research is funded by the Science Committee of the Ministry of Education and Science of the Republic of Kazakhstan (Grant No. AP09058465).

Key messages
The lack of data on WASH services in hospitals by region and on a nationwide scale is currently an obstacle to an effective response to the COVID-19 pandemic in Kazakhstan. Fatal outbreaks and epidemics will continue until the WASH infrastructure and hygiene skills of the population improve at both the household and hospital’s levels.
Comparison of admissions for Acute Coronary Syndrome between 2020 and two control periods in Abruzzo
Authors: Cedrone F , Di Giovanni P , D'Addezio M , Di Martino G , Meo F , Scampoli P , Staniscia T 
Published: October 2021

Abstract

Background
The coronavirus epidemic has put unprecedented strain on health services, threatening hospital capacity in facing such a high number of Covid-19 patients in need of treatment. The aim of this study is to compare the hospitalization rate for acute coronary syndrome (ACS) in the first nine months of 2020 with the same period of 2018 and 2019.

Methods
This is a retrospective study of hospital discharge records. The pathologies of interest were coded as follows: all the hospitalizations with main discharge diagnosis as ICD-9-CM 410.xx, 411.xx, 413.xx for Acute Coronary Syndrome (ACS); 410.xx was used in all diagnoses except in codes 410.7x or 410.9x for acute ST-elevation myocardial infarction (STEMI); 410.7x was used in all diagnoses except 410.9.x for acute non-STEMI. Hospitalization rate ratios (HRR) comparing the study period with each of the control periods were calculated using Poisson regression.

Results
During the study period there was a statistically significant decrease in hospitalizations for ACS both vs 2018 (HRR 0.80;95%CI 0.80-0.81; p &lt; 0.001) and vs 2019 (HRR 0.85;95%CI 0.84-0.86; p &lt; 0.001). A decrease also affected STEMI vs 2018 (HRR 0.91;95%CI 0.90-0.92; p &lt; 0.001) and vs 2019 (HRR 0.87;95%CI 0.86-0.88; p &lt; 0.001) and NSTEMI vs 2018 (HRR 0.76;95%CI 0.75-0.77; p &lt; 0.001) and vs 2019 (HRR 0.79;95%CI 0.78-0.80; p &lt; 0.001).

Conclusions
This report shows a significant decrease in ACS-related hospitalization rates across the Region during the study period. General out-of-hospital mortality need to be further investigated, as to focus on patients died of ACS without receiving adequate assistance from the emergency network.

Key messages
Hospitalizations for acute coronary syndromes, STEMI and NSTEMI underwent a statistically significant decrease. During the pandemic, some health needs related to fatal emergencies were not met by the health services.
The willingness to be vaccinated against SARS-CoV-2 in the Italian population
Authors: Contoli B , Minardi V , Possenti V , Lana S , Luzi P , Masocco M 
Published: October 2021

Abstract

Background
Italy was one of the earliest countries to experience a severe Covid-19 epidemic and vaccination is essential to controll it. The willingness to be vaccinated against Covid-19 was investigated by the Italian ongoing ;surveillance systems PASSI (18-69yy) and PASSI d'Argento (65+) with a Covid module added in August 2020.

Methods
To measure the prevalence of hesitancy and refusal to receive the COVID-19 vaccine, we used a sample collected between August and December 2020, before starting the Covid-19 vaccination campaign. Sample was appropriately weighted to take into account the regional number and the composition by gender and age. Using a multinomial regression model, a specfic analysis on elderly data were provided to examine the association between demographic and medical characteristics and Covid-19 attitudes.

Results
Among adults, 67% answered to be likely accepting the vaccine (one half not hesitating at all and the other half very likely in any way); younger individuals, aged 18-34, are highly incline (76%). On older sample, 55% would accept vaccination and 16% would likely refuse; the remaining 29% were categorized as hesitant. Compared with the acceptance group, the hesitancy group identified several risk factors in common with the refusal group, including not having gotten a flu vaccine during the previous flu season (hesitancy: RRR=2.0; 95% CI 1.4-2.9, refusal: RRR=12.1; 95%CI 7.6-19.37) and lower risk of having had a death from Covid-19 among family or friends (hesitancy: RRR=4.8; 95%CI 2.0-11.4, refusal: RRR=15.4; 95%CI 3.7-64.5). Hesitancy group has also lesser awareness and experience with the disease, a lower perception of being personally at risk and lower trust in the ability of health units to manage the pandemic situation.

Conclusions
Results show the importance of establishing and maintaining ongoing contact among the preventive services, primary care providers and the population since trust is difficult to establish during an emergency.

Key messages
On of the most important finding for public health prevention efforts was the importance of influenza vaccine in predicting COVID. Having an agile system that can monitor changing attitudes will be important to altering the messaging and identifying changes in the characteristics of those hesitant or unwilling to be vaccinated.
Ability of Nutri-Score to discriminate the nutritional quality of prepacked foods in Slovenia
Authors: Hafner E , Pravst I 
Published: October 2021

Abstract

European Commission recognised the benefits of front-of-package labelling (FOPL) with the proposal for a harmonised FOPL, which should be implemented by the end of 2022. Many European scientists support the implementation of Nutri-Score, a 5-colour nutrition labelling scheme. However, Nutri-Score is currently implemented mainly in Western Europe, and data for Central Europe are limited. This study aimed to evaluate the ability of Nutri-Score to discriminate the nutritional quality of prepacked products from the Slovenian food supply, and to compare results of nutrient profiling with national dietary recommendations, based on previously implemented WHO profile. Analyses was done using the Composition and Labelling Information System (CLAS), which contains labelling information on prepacked foods in Slovenia. We investigated the distribution of products across five Nutri-Score categories and investigated the agreement between Nutri-Score and nationally adapted WHO Europe profile. Results show that Nutri-Score has a high ability to discriminate food products based on their composition. Food categories that are more desirable in our diet (e.g., fruits, vegetables) have a better Nutri-Score when compared with less desirable categories such as sweets and animal fats. This ability was also shown within each subcategory. Nutri-Score overall showed a moderate agreement with the WHO Europe profile (0.57). The agreement was almost perfect for Cereals and cereal products, and lower for Edible oils and emulsions. Our results showed that the Nutri-Score is a relevant tool to discriminate the nutritional quality of products across different food groups and is in most cases consistent with national recommendations. This study gives additional information about Nutri-Score and can support policymakers in making evidence-based decisions about the implementation of harmonised FOPL in Europe.

Key messages
Results show that the Nutri-Score is a relevant tool to discriminate the nutritional quality of products across different food groups. Nutri-Score is in most cases consistent with Slovenian nutritional recommendations.
What makes COVID-19 dashboards actionable? Lessons learned from international and country-specific studies of COVID-19 dashboards and with dashboard developers in the WHO European Region
Authors: Barbazza E , Ivankovic D 
Published: October 2021

Abstract

Although COVID-19 dashboards may be widely accessible, their effective use to modify the course of the pandemic through the translation of data to information, information to opinions, and opinions to decision-making is determined by their actionability. To be actionable, the information should be both fit for purpose-meeting a specific information need-and fit for use-placing the right information into the right hands at the right time and in a manner that can be understood. Recognizing the sustained importance of COVID-19 dashboards as a tool for pandemic reporting, studies to describe this landscape and take stock of experiences are of critical importance for better preparedness in future public health crises. Since early 2020, the international network of healthcare performance intelligence researchers-HealthPros-in collaboration with partners including the WHO Regional Office for Europe, have worked to systematically study the actionability of COVID-19 dashboards by comparatively studying their composition, changes over time and development process.

In this presentation, results from this series of research will be summarized. Topics to be covered include:
A summary of seven key features constituting actionable dashboards resulting from a descriptive assessment and scoring of 158 dashboards from more than 53 countries worldwide. Insights into changes to dashboards over the course of 2020-21 from country-specific studies in Canada, the Netherlands and Italy. Lessons learned from the perspective of COVID-19 national, governmental dashboard developers in the WHO European Region, including key enablers and barriers to the development, maintenance and evolution of dashboards over the course of the pandemic.
8.H. Workshop: Policy and practice: the role Real-World Data (RWD) in Health Technology Assessment
Authors:   Organised by: EUPHA-HTA, EUPHA-PHMR, PHIRI, HTAi,   Chair persons: Chiara de Waure (EUPHA-HTA), Elena Petelos (EUPHA-HTA)
Published: October 2021

Abstract

The European Medicines Agency (EMA) has developed multiple schemes to improve access to medicines. Among them, the Conditional Marketing Authorisation (CMA), namely an approval based on less complete data followed by post-authorisation obligations, can be granted to medicines addressing unmet medical needs, debilitating or life-threatening diseases, rare diseases, or public health threats. In the post-authorisation obligations, real world data (RWD) routinely collected from different sources, such as electronic health records, administrative claims, or product and disease registries, are used for Real World Evidence (RWE) generation. In the context of the COVID-19 pandemic, this effort took the form of establishing an infrastructure and planning for the generation and synthesis of said data. Over the past few years, frameworks have emerged, and the European Union's new Pharmaceutical Strategy, adopted on November 2020, highlighted the need to systematically examine and transform current policies and practices to allow for the use of RWD/RWE to support the development, authorisation and use of medicines. Indeed, regulatory and Health Technology Assessment (HTA) bodies are opening the doors to the use of RWD/RWE in their evaluation frameworks. Nevertheless, currently there is a lack of established infrastructures to facilitate robust EU-wide data collection and transfer. Furthermore, there is a fragmented EU-wide landscape of heterogeneous policies on the acceptance and the appraisal of RWD/RWE. Given the COVID-19 pandemic, we also need to consider comparative effectiveness research and population information. This critically necessitates collaboration and mechanisms of information exchange supported by well-established research infrastructures. Additionally, several challenges need to be overcome, from methodological ones (quality and transferability of data) to governance issues and legislative challenges, including GDRP considerations in terms of data processing and transfer. During the 2019 HTA international (HTAi) Global Policy Forum, a call for actions and guidance to manage RWD/RWE to inform decision-making across the whole lifecycle of health technologies was launched. In fact, there is an urgent need for regulators and payers to make the best use of RWD/RWE also to allow a timely access to innovative health technologies and to reassess them across the lifecycle. This workshop is intended to carry forward the discussion on policies and practices on the use of RWD/RWE by regulatory and HTA bodies.

Key messages
Real world data (RWD) routinely collected from different sources and within different countries can be employed for rapid policy relevant research responses. HTA/Payer should agree on how collect and use data in the assessment and reassessment process of the value of health technologies.
Prescription medication misuse among students in Lithuanian universities
Authors: Guzikaitė B , Astrauskienė A 
Published: October 2021

Abstract

Background
Prescription drug misuse (PDM) is a known problem in Lithuania. However little information is known regarding the characteristics of prescription drug misusers and the extent of this problem among students of Lithuanian universities. This study attempted to further understand PDM by examining prevalence, PDM type, and students' attitudes towards PDM.

Methods
Survey data was collected in December 2020 - January 2021 via an online survey. 974 students from 8 State Universities of Lithuania completed the survey. Results include lifetime, past-year, past-month prevalence of PDM with analysis performed separately for stimulants, sedatives/tranquilizers, and sex, PDM was also analyzed according to stress levels, university year, etc.

Results
Lifetime prevalence of prescription sedative and tranquilizers misuse among students was 21% (CI 95% 18.6- 23.7), of stimulants - 5,4% (CI 95% 4.2- 7.1). Statistically significantly more male students misused prescription stimulants. Prevalence of PDM increased up to the 4th year of university. Primary reasons for PDM are to suppress anxiety and stress -62,4%, ‘to feel good/get high' -31 %, to improve academic performance -18%. 20.5% of the students that participated in PDM reported combining PDM with illicit drug use, 19.5% - with alcohol use and 7.6% used several prescription drugs non medically at once. Most students (61%) receive prescription medication from family members or friends and pay no attention to patient information leaflet.

Conclusions
These results further suggest the importance of assessing PDM risk factors for young adults. Students who often feel stress, anxiety are more likely to participate in PDM. Effective monitoring and prevention strategies should be developed.

Key messages
There is a need to increase public health literacy and to introduce innovative interventions to build mental resilience of young people. Greater availability of mental health services to students is likely to reduce PDM.
9.C. Round table: Digital innovation to fight the pandemic, what is here to stay?
Authors:   Organised by: EUPHA-DH,   Chair persons: Juan Rachadell (Portugal)
Published: October 2021

Abstract

The COVID-19 pandemic has been a challenge to all Public Health and Healthcare systems around the world. Although strategies and results have varied, there has been a clear investment in digital health tools as part of the response in European Countries. From contact tracing mobile apps to dedicated track and trace information systems, the digital transformation of Public Health practice has been accelerated in this moment of crisis. As countries perfect their digital Public Health tools and reform their information systems, a question comes to mind: which digital transformations might be permanent? What apps, systems or other changes can become the new national norm in each country? How will this affect the European landscape on digital health? Those are the questions we intend to discuss with this workshop, learning from the experience of 3 representatives from 3 different countries and debating those perspectives with the audience. The ultimate goal of the workshop is to explore the digital approaches of European countries in the pandemic fight and to extract best case practices both for future crises and for day-to-day public health activity. There will be one speaker from each of the 3 countries: Malta, Portugal and Switzerland. Each one will have 10 minutes to contextualize the Digital Health Strategy of the country before the pandemic, showcase the digital Public Health tools that were developed during the pandemic and conclude with a prediction of what may permanently change in their respective Public Health systems. The second 30 minutes of the roundtable will be reserved for questions and a debate between the speakers and the audience.

Speakers/Panelists
Stefan Buttigieg Malta Association of Public Health Medicine, St. Paul's Bay, Malta Eduardo Freire Rodrigues ARSLVT ACES Amadora, Amadora, Portugal Marie-Annick Le Pogam Unisanté - Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland

Key messages
With “building back better” as a mantra, sharing national level experiences is key to empower informed decision making and better digital innovation. The challenges of the COVID-19 pandemic accelerated the digital transformation in a way that affected how public health information systems are implemented and scaled up.