bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in the utilisation of acute hospital care in Ireland during the first wave of COVID-19
Authors: Marron L , Burke S , Kavanagh P 
Published: October 2021

Abstract

Background
Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study was to quantify and characterise changes in acute hospital healthcare utilisation during the first wave of COVID-19 in Ireland to inform healthcare service planning and public health policy.

Methods
A retrospective, population-based, interrupted time-trend study was conducted, using two national datasets, from 6th January to 5th July 2020.

Results
Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed that there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%). Reductions were greatest at the peak of population restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, healthcare utilisation remained below pre-COVID-19 levels however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028).

Conclusions
Public health implications of delayed and lost care will become fully apparent over time. In the short-term, backlogs in care need to managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses, including the adoption of a pandemic recovery plan. In the long-term, COVID-19 has highlighted weaknesses in the health system and is an opportunity to progress reform towards a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.

Key messages
The COVID-19 pandemic impacted non-COVID-19 healthcare utilisation in Ireland with evidence of delayed and lost acute hospital care and increased need for emergency mental health and alcohol services. Population health and health system recovery from COVID-19 is a public health priority.
Impact of the COVID-19 pandemic on the intensity of health services use in general practice
Authors: Rachamin Y , Senn O , Streit S , Dubois J , Deml MJ , Jungo KT 
Published: October 2021

Abstract

Background
The COVID-19 pandemic affects non-COVID-19-related health services use due to shutdown measures and fears of potential coronavirus infection or fears of overwhelmed health systems. We aimed to explore the impact of the shutdown in spring 2020 on the intensity of health services use (consultation counts, chronic disease measurement counts) in Swiss general practice.

Methods
Based on electronic medical records from 278 general practitioners in Switzerland, we built two patient cohorts: (1) Jan-Jun 2019 (173,523 patients); (2) Jan-Jun 2020 (179,086 patients). We used linear regression analysis to model weekly consultation counts, as well as weekly blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts, per 100 patients. We calculated expected values in absence of a shutdown and compared them to actual observed values in 2020. The analyses were repeated for selected at-risk groups (patients with hypertension, diabetes, or cardiovascular disease) and different age groups (&lt;60 years, 60-80 years, and &gt;80 years).

Results
During the shutdown period (calendar weeks 13-19 in 2020), weekly consultation counts were lower than non-shutdown models predicted. Consultation rates reduced by 17.2% for the total population, 16.5% for patients with hypertension, 17.5% for patients with diabetes, and 17.6% for patients with cardiovascular disease. Between different age groups, consultation counts reduced by 15.7% for patients aged &lt;60 years, 20.4% for patients aged 60-80 years, and 14.5% for patients aged &gt;80 years. Weekly BP counts reduced by 35.3% in the total population and by 35.0% for patients with hypertension. Weekly HbA1c counts reduced by 33.2% in the total population and by 29.8% for patients with diabetes. P-values were &lt;0.001 for all reported estimates.

Conclusions
We found a significant decrease in the intensity of health services use in Swiss general practice during the shutdown in spring 2020.

Key messages
We demonstrate that the intensity of health services use in general practice decreased during the first Swiss shutdown in spring 2020, overall and among patients with chronic conditions. It is crucial that health systems remain able to meet the non-COVID-19-related health care needs of patients during shutdowns, especially for patients with chronic conditions who require regular care.
Effect of COVID-19 on maternal and neonatal healthcare services in Guinea: a hospital based study
Authors: Delamou A , Millimouno TM , Dioubate N , Semaan A , Delvaux T , Lenka B 
Published: October 2021

Abstract

Objective
The objective of this study was to analyze the effect of COVID-19 on routine maternal and newborn health services in three referral facilities in Guinea.

Methods
This was a cross-sectional study using routine facility data covering two years (2019-2021). COVID-19 effects were quantified using interrupted time series models. The use of services (intra-hospital deliveries and neonatal admissions) and outcomes (obstetric complications and neonatal deaths) were analyzed for the periods before (March 2019-February 2020), and during (March 2020-February 2021) the COVID-19.

Results
The mean number of monthly deliveries did not vary significantly before and during COVID-19 but that of induced labor increased significantly during COVID-19 (p &lt; 0.001). Also, the monthly mean of neonatal admissions significantly decreased during COVID-19 (167 versus 124; p &lt; 0.001). The mean number of monthly hospitalizations significantly decreased (123 before COVID-19 versus 87 during; p = 0.001). The mean number of monthly neonatal admissions in the pre-COVID-19 period significantly increased. Immediately after the start of the epidemic in Guinea (March 12, 2020), admissions declined significantly (64 admissions, 95%CI 102-27; p = 0.001). The mean number of monthly maternal deaths increased significantly during the pandemic (p = 0.002), as did the number of babies with low birth weight (p = 0.04). In the pre-COVID-19 period, there was a monthly increase of three neonatal deaths (95%CI 1.5 - 4; p = 0.001) but from the start of COVID-19, the monthly trend declined significantly and continued throughout the COVID-19 period (5 deaths/month, 95%CI 7-3).

Conclusions
The ongoing COVID-19 pandemic is jeopardizing efforts to achieve Millennium Development Goals for maternal and child health in urban settings in Guinea. For the country's health system to be resilient to crises such as COVID-19, there is a need for interventions to ensure the continuity of maternal and neonatal care.

Key messages
COVID-19 decreased monthly hospitalizations but increased maternal deaths in big urban maternities in Guinea. COVID-19 decreased neonatal admissions and deaths but increased low birth weight in referral neonatal units in Conakry, Guinea.
Covid-19 and population mental health in perspective
Authors: Galea Sandro 
Published: October 2021

Abstract
COVID-19 was accompanied by an increase in common mood-anxiety disorders in populations worldwide. This increase is consistent with what has been observed after other prior large-scale disasters but is larger in scale, scope, and duration. This has important implications both for our understanding of population mental health, and for how we may mitigate the mental health consequences of large-scale events.
Towards a human rights-based research ethics in intersex studies: Reflections from the INIA project
Authors: Mestre Martínez Y , Tamayo Velázquez MI , Suess Schwend A 
Published: October 2021

Abstract

Background
Intersex authors and allies identify human rights violations and ethical challenges in clinical practice and research. The Intersex - New Interdisciplinary Approaches (INIA) project trains 10 early stage researchers who develop research projects aimed at supporting the wellbeing and rights of intersex people. The INIA project includes the establishment of ethical procedures and discussion of ethical aspects. One of the INIA research projects focuses on the development of ethical principles in intersex studies.

Objectives
To present ethical procedures established in the INIA project, as well as reflections on research ethics. To summarise preliminary findings of the INIA research project “Research ethics in intersex studies”.

Results
The INIA project established ethical procedures based on international and European standards, an Ethics Advisory Board, as well as training activities on research ethics. The INIA consortium and researchers discussed ongoing ethical aspects, taking into account specific characteristics of research in the field of intersex studies. The INIA research project “Research ethics in intersex studies” reviewed ethical challenges in intersex-related research and ethical recommendations mentioned in the recent literature.

Conclusions
For guaranteeing the human rights of intersex people, the development of ethical principles for intersex-related research is identified as a relevant aspect. The INIA project aims at contributing to this process, understanding research ethics as an ongoing, reflexive practice.
How ready are European healthcare systems regarding the use of genomics in medicine? The Beyond 1 Million Genomes (B1MG) Maturity Level Model
Authors: Vicente A 
Published: October 2021

Abstract
The adoption of genomics by healthcare systems is crucial to fulfill the potential of Personalised Medicine for patients and citizens. This is a challenging undertaking, and requires from healthcare systems extensive adjustments in key issues, such as technical infrastructure, health professional competences or ethical and legal frameworks. The starting point requires an effective identification of specific challenges and barriers to the development and sustainability of each healthcare system regarding the efficient use of genomic data in medical or preventive care. For this purpose, we developed a Maturity Level Model (MLM) covering key aspects of genomic medicine programmes, including governance, ethics and legislation, genomics standards and best practices, clinical infrastructure and workforce organization, economic aspects and others. The alignment of healthcare systems to this MLM allows the identification of gaps and needs for progression within the model, and to systematically chart a path towards optimization of genomic data integration in mainstream healthcare.
Selecting indicators for signalling and monitoring the wider effects of the COVID-19 pandemic
Authors: Verschuuren M , Novillo D 
Published: October 2021

Abstract

Background
The COVID-19 pandemic and the actions taken to control the spread of the coronavirus have a substantial impact on population health beyond the morbidity and mortality caused by the virus directly. To provide a comprehensive picture of the pandemic's impact, suitable indicators for signalling and tracking these wider effects should be incorporated into monitoring activities. Therefore, WHO/Euro developed a tool to select indicators for this purpose.

Methods
Based on desk research and extensive expert consultation, a framework was developed for the main pathways through which the COVID-19 pandemic influences population health. For each pathway in the framework, underlying mechanisms and related indicator areas were defined. In addition, groups that are particularly vulnerable to the wider effects of the pandemic were identified, as these require specific attention in monitoring exercises.

Results
The main pathways through which the pandemic impacts general population health as used in the tool are:
Fear of getting infected or spreading infection Impaired healthcare for non-COVID-19 conditions Direct effects of containment measures Indirect effects of containment measures through risk factors Indirect effects of containment measures through wider determinants of health
A total of 27 underlying mechanisms and related indicator areas were defined. E.g., one underlying mechanism under the first pathway involves stockpiling disinfectants and cleaners. This results in people being more exposed to dangerous substances and applying disinfectants improperly, which leads to an increase in poisonings. Identified vulnerabilities relate to people's age, gender, socioeconomic status, place of residence/living situation, morbidity/disability status, and refugee or migrant status.

Conclusions
Developing a conceptual framework provides a useful approach for structuring widespread and complex developments such as the wider health impacts of the COVID-19 pandemic.
Digital Marketing of unhealthy products to children: evidence from the WHO CLICK framework
Authors: Wickramasinghek K , Hetz K , Zhiteneva O 
Published: October 2021

Abstract
The rates of childhood obesity are rising, the “on-screen” times of children are increasing, and the marketing strategies are more personalized and targeting than ever. Exposure to digital marketing of unhealthy foods to children and adolescents is a major concern as food and beverage companies can target advertisements to specific children or adolescents based on their online profiles, personal characteristics, and previous browsing history. The WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office) developed the CLICK monitoring framework to support Member States to objectively monitor digital marketing as well as to enable them taking action in regard to marketing related regulations and policies, and to support their implementation. The CLICK frameworks address several important aspects of marketing that countries should consider when evaluating the national digital ecosystem. In two steps of the framework applications are used to monitor the marketing exposure of children and adolescents. One application captures all paid for advertisements children see when spending time on smartphone apps like social media platforms or YouTube. The second app complements these collected data by capturing indirect marketing like product placements and products advertised and promoted by influencers. Even though the monitoring framework provides important insights and clearly presents the need for strict marketing regulations, some areas where children are heavily exposed to marketing of unhealthy products are still understudied. One example is the field of online gaming.
Developing a proposal for an updated digital public health curriculum
Authors: Vital Brito D , Wong B , Buttigieg S 
Published: October 2021

Abstract
Digital health is a strategic priority for the future of health in Europe. But development and deployment of digital solutions is not enough to guarantee a successful implementation. Public health services require a workforce that is ready to search and evaluate the best digital solutions for specific public health activities, such as epidemiological surveillance and health planning. Although there are some examples of digital health updated curricula in medical and public health schools, a coordinated and comprehensive approach should be proposed in Europe, including undergraduate, postgraduate and continuous education. Young professionals are certainly more digitally literate and should be involved in this discussion, but public health professionals from different ages and backgrounds should be considered. This presentation aims to promote discussion about digital public health education, identifying proposals for a renewed curriculum. During this discussion participants will be organized in small groups and will discuss proposals for a digital public health curricula, specifically tailored for three different target audiences: undergraduate medical students, public health students and public health professionals. This discussion will be guided by a facilitator and main conclusions will be considered for a concrete proposal prepared by the EUPHA Digital Health section. All participants will be offered the chance to be involved in following discussions.
3.H. Workshop: The role of HTA for COVID-19 vaccines: present and future perspectives
Authors:   Organised by: EUPHA-HTA, EUPHA-ECO, HTAi,   Chair persons: Chiara de Waure (EUPHA-HTA), Elena Petelos (EUPHA-HTA)
Published: October 2021

Abstract

It is well known how vaccines typically require many years of research and testing before being on the market, but in 2020 the COVID-19 pandemic pushed scientists to embark on a race to produce safe and effective SARS-CoV-2 vaccines in record time. In such an emergency situation, striking the right balance between urgency and acceptable safety and efficacy evidence is challenging. Furthermore, other relevant issues need to be more comprehensively addressed, including cost-effectiveness of vaccination campaigns and real-world data on effectiveness and safety. Currently the European Medicines Agency (EMA) has approved for use four vaccines against COVID-19. Data on their efficacy and safety will continue to be collected beyond licensure and submitted to EMA, but the need for a more complete assessment, which includes contextual and societal considerations (e.g. impact on population health, population's demand, attitudes and behaviours, ethical considerations) and economic analysis, is unquestionable to support national decision-maker processes. In this kind of “holistic” approach, the Health Technology Assessment (HTA) could be the answer in order to support the allocation of resources into different COVID-19 vaccines and to make it possible a timely and equitable access to vaccination. As also stated in the HTAi Position Paper on “HTA's Critical Role in the (Early) Assessment of (potential) Vaccines to prevent the spread of COVID-19 globally”, the following issues should be carefully tackled: 1) affordability, sustainability and distributional effects; 2) cost-effectiveness considerations; 3) fostering HTA collaborations; 4) need for early, adaptive and living HTA. Accounting for such issues is essential to ensure that HTA is successfully implemented in the field of COVID-19 vaccines, at the present time and in its future developments on a national and international scale. This workshop will discuss how HTA could help the EU-wide and national decision-making process about COVID-19 vaccines.

Key messages
An adapted and living HTA framework considering the unique characteristics of COVID-19 vaccines could be an answer to current and future challenges in vaccination campaigns. There are several challenges in current and future HTA of COVID-19 vaccines, namely the evaluation of their broad economic impacts, their effectiveness and safety and organization issues.
The role of HTA in COVID-19 vaccination campaign: the Italian experience
Authors: Cadeddu C , Ricciardi W 
Published: October 2021

Abstract

Issue/problem
Italy was one of the four European countries that started to join forces to accelerate access and distribution of a much-needed vaccine against COVID-19. When the first vaccine was approved, a National Strategic Plan for COVID-19 vaccination, examining the most relevant domains for Health Technology Assessment (HTA), has just been issued in Italy.

Description of the problem
Considering the possible provision of COVID-19 vaccines in the short time, in Autumn 2020 the necessity for a comprehensive assessment came up. In Italy HTA has been identified as the method for assessing the broad value of existing and new vaccines by the last two National Immunization Plans. However, the pandemic highlighted the need for a quick introduction and distribution of COVID-19 vaccines. A multidisciplinary Steering Group was therefore appointed by the Ministry of Health, in order to define vaccination strategies, organizational models, economic aspects, communication and social issues.

Results
Taking into account plans already released by other countries, a National Strategic Plan for COVID-19 vaccination was issued in December 2020. Main topics covered were: epidemiology and priority groups to be immunized, logistic and organization, efficacy and safety monitoring, economic and burden of disease assessments, communication. The application of these recommendations has finally proven to be difficult, because of vaccines procurement delays, suspected adverse events, inequalities in the different Regional settings.

Lessons
Given the concerns and difficulties faced by Italy and other European countries in the appraisal and management of COVID-19 vaccines, a HTA adapted framework could be an option for guiding the definition of National Strategic Plans. This could offer a common structured approach, make decision-making process more transparent, and be significant for a timely, convenient, and affordable access to new vaccines against SARS-CoV-2.
3.I. Workshop: Getting real with future shocks: How to test health system resilience?
Authors:   Organised by: European Commission, HaDEA,   Chair persons: Massimo Fagnini (European Commission)
Published: October 2021

Abstract

Resilient health systems should be able to both respond to sudden shocks and adapt to structural changes. Structural fragilities in the health systems of EU countries were present before the COVID-19 pandemic and the crisis has just exacerbated these weaknesses, along with creating acute response capacity shortages. It became clear that health systems were largely unprepared for a shock of this magnitude. In order to be better prepared and able to respond more effectively towards the next health emergency, it is important to have robust tools and methods to measure the level of resilience in health systems. The workshop will present a new concept to carry out resilience testing of health systems against potential future shocks and adverse scenarios based on the opinion of the European Commission's Expert Panel on effective ways of investing in health. This will be followed by a discussion with experts on the practical development and implementation of this methodology.
Format of the workshop:
Pitch on the resilience testing concept by a member of the Expert Panel on effective ways of investing in health (10 minutes) Responses by experts from three EU Member States and discussion (40 minutes) Concluding remarks by the OECD and the Observatory on Health Systems and Policies (10 minutes)

Speakers/Panelists
Heather L. Rogers Biocruces Bizkaia Health Research Institute, Barakaldo, Spain Lenka Poliaková Health Insurance Supervision Department, Ministry of Health, Czechia Judith de Jong NIVEL, Utrecht, Netherlands Sabrina Montante National Institute of Health of Italy, Brussels Office, Brussels, Belgium Gaetan Lafortune OECD, Paris, France