bluuebunny/crossref_metadata_2025_split huggingface dataset:
Policy Recommendations for healthy living environments and municipal health promotion in Europe
Authors: Plantz C , Peiró Pérez R , Mattioli B , Weber M 
Published: October 2021

Abstract

Municipalities can be the motor for health equity. But how should health promotion policies at all levels be formulated in order to mobilize local action for health? The Work package (WP) “Healthy Living Environments” in the Joint Action Health Equity Europe (2018 - 2021) focussed its work on this question. Based on a common Policy Framework for Action (PFA) and 14 Country Assessments (CA), actions were implemented representing a wide spectrum of policy responses to promote health equity through a municipal health promotion approach. At the end of the project, policy recommendations subsume the expertise and experience of the partners contributing to the sustainability of results.
The policy recommendations were generated in 3 steps:
Relevant project documents were collected and analysed, including the PFA, the CA, the reports and evaluation of actions and the results of a Delphi study conducted in the frame of the project. A synopsis of these documents was analysed in a workshop with the WP partners, resulting in decisions about the concept and necessary messages the policy recommendations should include. Some of the implemented actions and collected practices from the project were selected to elaborate the individual recommendations along these examples. A working group drafted the policy recommendations. After a second workshop to discuss the draft, the final recommendations were consented by the WP partners.

The preliminary results include recommendations for different political levels, as health equity needs multi-level and multi-stakeholder health in all polices approaches along a quality-oriented process. A specific equity lens and a focus on existing frameworks, tools and capacity-building approaches is needed. Also the stronger deficits of municipal health promotion like the lack of scientific evidence or data at local level were identified. Ways of applicability and integration into the agendas of the audience will be discussed.
Local municipalities experiences in managing the covid19 pandemic in Israel – a qualitative study
Authors: Nehushtan H , Donchin M , Bar-Zeev Y 
Published: October 2021

Abstract

Background
Local municipalities have played a central role in the management of the COVID19 pandemic and the mitigation of its grave health, economic and social consequences. In Israel, 57 local municipalities (out of 257) are part of the Healthy Cities Network (HCN). HCN Municipalities have a strong commitment to health promotion and reducing health inequalities. This study explores Israeli local municipalities' management of the pandemic and assesses whether belonging to the HCN impacted this management.

Methods
Fourteen municipalities were chosen - seven HCN municipalities, matched to seven non-HCN municipalities. Matching was based on geographical location, socio-economic status, size and ethnicity. In each municipality semi-structured telephone interviews were conducted with the Mayor or CEO, Head of the Welfare Department, and the person responsible for health (in HCN municipalities this would be the HCN coordinator). Interviews were transcribed and coded using inductive thematic coding.

Results (preliminary)
Themes that emerged from all municipalities included: a) difference in the management during the first lockdown compared to following lockdowns and pandemic ‘routine'; b) difficulties with data management within the municipality; c) need for a central governmental contact; d) desire for more independence and control at the local level; e) distinct regional characteristics impact pandemic management. The Healthy Cities coordinator played a key role in some municipalities, but not in others.

Conclusions
Local municipalities in Israel had an essential role in the pandemic response, adapting their actions as the pandemic and governmental measures unfolded. Challenges and responses were similar across municipalities, regardless of their HCN status. However, in some municipalities, the role of the HCN coordinator was crucial for the pandemic response.

Key messages
Challenges and responses were similar across municipalities, regardless of their HCN status. In some municipalities, the role of the HCN coordinator was crucial for the pandemic response.
Green Space and Mental Health outcomes: a cross-sectional survey as a starting point to bridge Green Areas' features to the post-pandemic needs
Authors: Lindert J , Sisenop F 
Published: October 2021

Abstract

Background
Green space has been associated with health and mental health. Given the high prevalence of mental disorders and costs of worldwide mental ill health and the concurrent rise in mental disorders during the pandemic, there is a need of a better understanding of the impact of different types of green space on mental health. The aim of this study was to assess the impact of characteristics of green space on mental health in a population in a rural area of Germany.

Methods
We conducted a cross-sectional survey based on face-to-face on an online assessment instrument. The instrument consisted of sociodemographic questions (assessing age, gender, income, education), mental health related question (PHQ - 9). Green space was dichotomized into green space with agrarian features and green space without agrarian features and subsequently geocoded using ATkis TN.

Results
In total n = 484 persons participated (female: 240 (49, 6%), male: N = 239 (49, 9%), n= missing). Mean age was 58,17 years (SD: 18,83) with an age range of 19-96 years. Depression symptoms showed n = 122 (54.9%) persons. Green space without agrarian features was associated with lower symptom levels of depression (Beta: 0.045, SE: 0.023, p = 0.015). However, green space with agrarian features was not related to depression.

Discussion
Characteristics of green spaces are associated with better mental health; however, the clear definition of quality green space needs further elaboration. The sample is a rural sample and results need further validation in an urban sample. Outlook: In the post-pandemic era green space itself seems to have no impact on mental health, however quality green space does. These results need further validation in multinational studies.
SARS-CoV2 vaccination roll-out in European prisons
Authors: Tavoschi L 
Published: October 2021

Abstract

Introduction
As SARS-CoV2 mass vaccination campaigns are rolled out, there is debate about which population groups to prioritize. Prison staff and prison residents should be considered a priority. Prison staff are essential workers and absenteeism should be minimized to enable safe and decent regimes. They play a pivotal role in SARS-CoV2 transmission within prison, contributing to disease spread. Prison residents are characterized by high burden of underlying disease, including non-communicable diseases. Furthermore, it is difficult to effectively protect prison populations by means of infection prevention and control and non-pharmaceutical measures, due to the constraints of the prison system.

Methods
Evidence on the inclusion of prison population within national SARS-CoV2 vaccination plans, level of implementation and models of vaccine delivery in prison settings is being collected through a questionnaire developed and disseminated within the European research project “Reaching the hard-to-reach: Increasing access and vaccine uptake among prison population in Europe -RISE-Vac”.

Results and discussion
There are notable differences between countries across Europe regarding inclusion in and priority attributed to prison residents and staff within national vaccination plans. Several challenges have been identified for the implementation of SARS-CoV2 vaccination programs in prison.

Conclusions
Suboptimal healthcare delivery and information systems with poor links to community systems are a major issue to overcome to ensure accurate and timely monitoring of vaccination. Prison residents are highly heterogeneous when it comes to age, ethnicity, level of education and health literacy. Ensuring their meaningful engagement is key to high vaccine uptake. This includes appropriate information and communication strategies prior to and at the point of vaccine delivery, covering inter alia possible side effects and informed consent.
Health Literacy and COVID-19 preventive behaviours in during the Lock-Down Phase in Tuscany (Italy)
Authors: Del Riccio M , Lastrucci V , Bechini A , Boccalini S , Chiesi F , Gori E , Lorini C , Moscadelli A , Zanella B , Bonaccorsi G 
Published: October 2021

Abstract

In the first COVID-19 pandemic period, when no vaccines were available, individual behaviours were essential for controlling the spread of the virus. In this context of rapidly changing guidance, emerging new evidence, fake news and misinformation, there have been new challenges for health literacy (HL). This study explored whether guidance-compliant healthy behaviours were associated with HL in individuals who have performed essential activities (public employees and volunteers of the Civil Protection) during the lock-down period in the Province of Prato, Italy. Items on knowledge, attitudes and practices (KAP) towards COVID-19 preventive measures and COVID-19 risk perception, along with the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6), were collected using a self-administered structured questionnaire. In May 2020, 751 responses were collected; respondents were mostly males (59%), younger than 65 years old (83.5%), with sufficient HL (56%), and never smokers (54.2%). Most of the items related to the KAP towards COVID-19 preventive measures were significantly correlated with the HLS-EU-Q6 score in the total sample. In the multiple linear model, HL results to be a predictor of both a better self-reported knowledge of COVID-19 preventive measures (beta 0.32 for sufficient HL, 0.11 for problematic HL, 1.00 for inadequate HL) and a higher score of attitude towards the importance of COVID-19 preventive measures (beta 0.33 for sufficient HL, 0.17 for problematic HL, 1.00 for inadequate HL), while it has no role in predicting a higher risk perception. These findings can be useful to understand the importance of HL in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

Key messages
Lower levels of Health Literacy predict poor COVID-19 related knowledge and a worse attitudes towards the importance of COVID-19 preventive measures. Health Literacy may be an important factor in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.
Population wellbeing and psychosocial burden during the COVID-19 Pandemic in Germany – results from (bi-)weekly monitoring data and the resulting health promoting activities on the national level
Authors: De Bock F 
Published: October 2021

Abstract
Since march 2020, data on risk perception, behavior and psychosocial wellbeing of the population with regard to the COVID-19 pandemic have been collected regularly (biweekly to weekly) in Germany as part of the COVID-19 Snapshot Monitoring (COSMO). The data i.e. show that the psychosocial burden is higher in specific population subgroups, such as younger adults and families.
Based on these data, the Federal Centre for Health Education as part of the federal government developed health promoting activities on the national level to maintain wellbeing and buffer the burden. Over the course of the pandemic, these activities changed dynamically according to the differing situation (lock-down, incidence). With the second wave, as incidences increased dramatically without vaccination available, the activities were expanded from a web-based platform ‘Psychisch stabil bleiben' (Mind your mental health), supported by a nationwide telephone counseling service, to a nationwide mail distribution of postcards in five different languages, with links to the virtual platform and various telephone counselling services. The website offers information on coping strategies and psychotherapeutic services, edited for specific population groups (e.g. parents, people with preexisting mental illness, health professionals) in five different languages. The postcards were distributed through primary care providers, pharmacies and social services in socially disadvantaged geographical areas, trying to increase reach in vulnerable populations.
Mind the gap: population ageing and health financing sustainability
Authors: Cylus J , Williams G , Barber S , Roubal T 
Published: October 2021

Abstract

Background
Models used to forecast the effects of population ageing on health financing usually only explore effects on health spending, while neglecting effects on health revenues.

Methods
Using publicly available data, we construct simulation models to project how changes in the population age mix affect both public sector health revenues and expenditures across a range of countries representing a diverse mix of health financing systems in Europe as well as the Western Pacific (Australia, Bulgaria, Japan, Slovenia, United Kingdom and Vietnam).

Results
By 2100, the largest gap between health revenues and expenditures due to population ageing under current health financing arrangements is expected in Vietnam; the majority of that health financing gap (87.1%) is attributable to expected growth in health expenditures. In Slovenia and Japan, the financing gaps are forecast to reach less than half that of Vietnam by 2100; however, the reasons for the increases in gaps vary. In Slovenia, nearly half of the increase in the gap (44.2%) is due to reductions in health revenues compared with just under one-third (28.7%) in Japan.

Conclusions
There is a perception that population ageing will have deleterious effects on the sustainability of public sector health financing. However, this is highly dependent on how financing systems are designed. Our simulation models demonstrate that comparative analyses that give equal attention to both health expenditures and revenues provide decision makers a balanced set of policy options for addressing the challenges of population ageing. The options range from targeting expenditures and utilization of services to diversifying revenue generation.
A Scoping Review on the Role of Access toward achieving Universal Health Coverage in Oral Health
Authors: Ghanbarzadegan A , Balasubramanian M , Luzzi L , Brennan D , Bastani P 
Published: October 2021

Abstract

Background
Improving access to health services is a way towards achieving Universal Health Coverage (UHC) in oral health. The purpose of this review was to map the determinants of access to dental services within a UHC framework.

Methods
Scoping review methods were adopted for the review. PUBMED, Scopus, ISI Web of Science and ProQuest were searched for academic literature on determinants of access to dental services in OCED countries. Articles published in the last 10 years were included. No restriction was placed on study methods; only articles in the English language were included. Qualitative synthesis was conducted, also including trend analysis and mapping exercise

Results
A total of 4320 articles were identified in the initial search; 60 articles were included in the qualitative synthesis. The results indicate 7 main themes as the determinants of access to dental services: family level, culture, health status, affordability of services, Social environment, geographic and transportation. Defined determinants of access to dental services, family-level factors, culture and geographical access to dental services, can fill the population axis of the UHC cube. Social environment determinants and affordability of services fill the gap of financial protection as another axis of the UHC cube and finally, availability of dental services and the individual's health status are aligned with the appropriateness of services, the third axis of the UHC cube.

Conclusions
This scoping review has identified family-level and cultural, health status, affordability, and availability of services, social environment, and geographic factors contributing towards the inequality in access towards dental services. In addition to considering these main determinants, it is important for policymakers to pay more attention to social and cultural access determinants.

Key messages
An exact definition of access to services should be defined and implemented in the dental literature. Health Policymakers besides considering the derived themes of access into dental services should pay attention to social and cultural access determinants.
Self-reported sick leave following a brief preventive intervention on work-related stress
Authors: Hultén A-M , Bjerkeli P , Holmgren K 
Published: October 2021

Abstract

Background
General practitioners (GPs) play an important role for early identification and prevention of sick leave among patients perceiving ill health due to work-relates stress. In order to fulfil the role, they need adequate methodologies and tools. This study aimed to evaluate the effectiveness of a brief intervention in primary health care including early identification of work-related stress combined with feedback at consultation on the number of self-reported sick leave days.

Methods
A randomised controlled trial was performed at seven primary health care centres in western Sweden. Self-reported sick leave data collected between November 2015 and January 2017 were analysed prospectively. The study included 271 employed, non-sick-listed patients aged 18-64 years seeking care for mental and/or physical health complaints. The intervention group received a brief intervention about work-related stress, including training for GPs, screening of patients' work-related stress, feedback to patients on screening results and discussion of measures at GP consultation. The control group received treatment as usual.

Results
At 6-month follow-up 59/105 (56%) in the intervention group and 61/115 (53%) in the control group reported no sick leave. At 12-month follow-up the corresponding numbers were 61/119 (51%) and 57/122 (47%) respectively. There were no statistically significant differences between the intervention group and the control group in the median number of self-reported sick leave days.

Conclusions
The brief intervention showed no effect on the numbers of self-reported sick leave days. However, using sick leave as an outcome measure was difficult, as sick leave is multifactorial and the data has a non-normal distribution. In addition, sick leave might be used as an indicator as well as a possible treatment of ill health. Other actions and interventions to address patients perceiving ill health due to work-related stress should be explored.

Key messages
Sick leave is used as an indicator and as a treatment of ill health, which can complicate the evaluation of studies. The complexity of primary health care trials calls for other evaluation methods.
Referral to treatment of absent employees diagnosed with burnout in the Netherlands
Authors: de Rijk AE , De Witte J , van Steenderen S , Schaufeli WB 
Published: October 2021

Abstract

Background
Despite large amounts of research on determinants of burnout, research on its treatment is scarce. In the Netherlands, occupational physicians (OPs) can officially diagnose burnout and have to offer return-to-work (RTW) guidance to employees on sick leave, which includes referral to treatment. This research aimed to explore 1) characteristics of treatment for burnout and 2) how employee-, complaint- and employer characteristics relate to referral to treatment by the OP and to employee RTW expectation.

Methods
All 212 employees (45% male, 42.5 years of age, 35% high educated) diagnosed with burnout at one occupational health service during February-June 2020 were included. Register data (gender, age (years), education, organization size) and self-reported data collected online (living situation; Burnout Assessment Tool (BAT) score; cause of absence mainly work-related (0/1); treatment (0/1); on waiting list (0/1); type of treatment; treatment focused on RTW (0/1); employee RTW expectation high (0/1)) were tested with Chi2, ANOVA and logistic regression analyses.

Results
Of all employees, 75.9% (n = 161) were referred to treatment by their OP, of which 25.5% (n = 41) were currently on a waiting list. The majority received treatment from a nurse practitioner (51.7%) or psychologist (23.3%) These practitioners focused on RTW less often (51.6%-60.7%) than the other practitioners (81.5-100%) (p = 0.042). Multivariate tests showed age to relate to referral to treatment (OR 0.956; 95% CI 0.928-0.986) and BAT score to employee RTW expectation (OR 0.635; 95% CI 0.407-0.991).

Conclusions
OPs referred three quarters of the employees on sick leave with burnout to treatment. Referral by OPs related only to younger age and employee RTW expectation only to BAT score. The practitioners that were referred to most often, focused less on RTW. As burnout is a work-related syndrome, these findings suggest room for improving the treatment's focus on (returning to) work.

Key messages
OPs referred 75.9% of the burned out employees on sick leave to treatment, particularly younger employees. The practitioners that were referred to most often, focused less on RTW.
Socioeconomic differences in major depressive disorder onset and the role of lifestyle factors
Authors: Hoveling LA , Liefbroer AC , Schweren LJS , Bültmann U , Smidt N 
Published: October 2021

Abstract

Background
Major depressive disorder (MDD) onset strongly varies by socioeconomic position (SEP). One of the pathways that could explain the SEP-MDD onset relationship is via lifestyle factors, but little is known about this pathway. This study aims to disentangle the complex interplay between SEP measures, education, income and occupational prestige, and MDD development and to what extent the associations are mediated by lifestyle (related) factors, occupational and leisure time physical activity, smoking, alcohol intake, diet quality, sleep and central adiposity.

Methods
An adult subsample (n = 76,045) of the Lifelines Cohort Study without MDD at baseline was used. MDD onset was measured after a median follow-up time of 3.8 years with the Mini International Neuropsychiatric Interview (MINI). Direct associations between the SEP measures, the lifestyle factors and MDD onset were estimated, independent of age, sex, depression history and time between baseline and second assessment, using logistic regression analyses. Mediating percentages were estimated using the Karlson-Holm-Breen method.

Results
A total of 1,864 participants (2.5%) developed MDD during follow-up. Education, income and occupational prestige were inversely associated with MDD onset. Educational differences in MDD onset were for 18.7% explained by lifestyle factors, with smoking (9.1%) and central adiposity (6.7%) being the strongest mediating factors. Income differences in MDD onset were for 5.9% explained by lifestyle factors, with alcohol intake (4.0%) and central adiposity (2.6%) being the strongest mediating factors. Occupational prestige differences in MDD onset were not explained by lifestyle factors.

Conclusions
Individuals with a higher education, income or occupational prestige had a lower risk of MDD onset compared to their lower SEP counterparts. This was mainly due to a healthier lifestyle, with smoking, alcohol intake and central adiposity being the most important factors.

Key messages
Education, income and occupational prestige were inversely associated with MDD onset. Educational and income differences were mainly explained by smoking, alcohol intake and central adiposity.