bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decreasing trends in suboptimal prescribing in older people: a French nationwide study
Authors: Drusch S , Le Tri T , Ankri J , Zureik M , Herr M 
Published: October 2021

Abstract

Background
Potentially Inappropriate Medications (PIMs) and polypharmacy are widely used indicators of suboptimal prescribing in older people. These indicators have been associated with an increased risk of adverse drugs event, hospitalization and healthcare use. However there is no recent evaluation of the evolution of these indicators in France. The aim of this study was to describe the prevalence of PIM and polypharmacy and its evolution among older people between 2011 and 2019 in France.

Methods
A repeated cross sectional study was conducted every two calendar years between 2011 and 2019 using the French health insurance data system. People aged 75 years and over and not deceased in a given study year were included. Sixteen PIM criteria from the 2015 Beers or STOPP lists were assessed. Moderate polypharmacy (5 to 9 drugs) and hyper-polypharmacy (≥10 drugs) were defined based on the average number of drugs dispensed per quarter. Age and sex-standardized prevalence of PIMs and polypharmacy were assessed and stratified by age (75 to 84/85+) and sex. To estimate trends over time, the Annual Percent Change (APC) was calculated with linear regression models.

Results
The study population included 5,777,645 individuals in 2011 and 6,328,155 in 2019. The prevalence of PIMs decreased from 49.6% to 39.6% over the study period (APC=-1.2%). Benzodiazepines were the most frequent PIMs (APC=-1.3%), followed by drugs with anticholinergic effects (APC=-2.1%), oral non-steroidal anti-inflammatory drugs (APC=-2.0%), and antihypertensive drugs (APC=-1.1%). Overall, women and individuals aged 85 years and older were more likely to receive PIMs. The prevalence of hyper-polypharmacy decreased from 30.5% to 25.9% over the study period.

Conclusions
Prevalence of PIMs and hyper-polypharmacy declined in France between 2011 and 2019 and may reflect an improvement in prescribing practices. Still, suboptimal prescribing remains frequent in older people and often involves benzodiazepines.

Key messages
The prevalence of most potentially inappropriate medications decreased between 2011 and 2019 in France, consistently with trends previously reported in European countries, although still high. The observed diminution of hyper-polypharmacy over the study period also sends a positive and original signal.
Mental health and access of care during Covid-19 pandemics: an italian cross-sectional study
Authors: Previti C , Gualano MR , Lo Moro G , Voglino G , Dogliani S , Bert F , Siliquini R 
Published: October 2021

Abstract

Background
COVID-19 emergency forced nations to introduce containment measures to reduce the spread of the virus. This study assessed the possible effects of the pandemic on mental health and care access.

Methods
A cross-sectional study was conducted in Italy in two observation periods in 2020: April-May (first lockdown) and November-December (no lockdown). Categorical variables were compared with χ2 tests. Mental health outcomes (PHQ-2 ≥ 3; or GAD-2 ≥ 3) and outcomes related to care access were considered. Multivariable logistic regression models were performed.

Results
Participants were 2673 (66.8% female; mean age=44 years, SD = 15). Depressive symptoms were found in 24.7% of participants, while 24.2% showed an anxious symptomatology. A total of 12.5% said they voluntarily gave up scheduled medical service, 6.4% avoided acute treatments, and 5% changed therapy themselves. Comparing the two periods, there were no significant differences in the outcomes under study. Students were at higher risk of depressive symptoms (OR = 2.23; 95% CI 1.42-3.52; p = 0.001). Women and those who increased the time on internet presented an increased risk of developing depressive and anxious symptomatology. The scheduled medical service was mainly postponed by those who said they were afraid to go out of necessity (OR = 2.49; 95% CI 1.87-3.32; p &lt; 0.001) or to cause themselves an injury (OR = 1.78; 95% CI 1.32-2.40; p &lt; 0.001). Foreigners (OR = 4.24; 95% CI 1.70-10.55; p &lt; 0.002) are more likely to avoid acute treatment. Workers and those with anxious disorders appear to be more inclined to self-medicate (OR = 2.05; 95% CI 1.29-3.26; p = 0.003).

Conclusions
Compared to the pre-pandemic period, higher levels of anxiety and depression were observed. No differences in mental health and care access were shown between the two observation periods. Being afraid to go out of necessity and avoidance of physical activity for fear of injury is related to reduced access to care, but not to self-medication.

Key messages
The 24.7 % of the sample reported depressive symptoms, and 24.2 % anxious symptoms. Similar increases were observed in both periods: April-May (first lockdown) and November-December (no lockdown). During the pandemic, delayed access to planned and acute care, avoidance of physical activity for fear of injury, and self-medication pose a major public health challenge in the coming period.
10.I. Workshop: Lessons from funding programmes for the development and testing of new care and payment models
Authors:   Organised by: European Observatory,   Chair persons: Nick Fahy (UK), Dimitra Panteli (Belgium)
Published: October 2021

Abstract

To keep health care sustainable while ensuring that patients receive the best possible care, there is a need to find suitable ways of organising and structuring health care that are better applicable to for example the treatment of non-communicable diseases and multimorbidity. Improving coordination processes across different health and social care actors is crucial and as pressures on health systems have mounted, there has been increasing interest in how different methods of delivering or paying for healthcare can help in achieving overall health system goals. Some countries have set up specific ‘Innovation funds' to support the testing of new care and payment models. In this workshop we will have a closer look at how such dedicated funding programmes can be used as a tool to foster this particular type of innovation. This is especially valuable for participants who are interested in the initial or further development of such funding streams. The workshop will have the format of a regular workshop and will start with four presentations followed by ample time for an interactive discussion on specific subtopics or questions raised by the audience.

Key messages
This workshop will allow for cross country learning and evaluation of funding programmes that invest in new care and payment models and create opportunities for shared learning and collaboration. This workshop will also draw more attention towards current developments on how new care and payment models can be developed, invested in and implemented.
The French innovation funding programme (Article 51)
Authors: Lemaire Natacha 
Published: October 2021

Abstract
The “art 51” of the social security financing act was launched in 2018 and created an experimental framework to test a programme for healthcare delivery and payment innovation. Its aim is to fund projects that promote coordination, group practices, integration of care, through adequate payment mechanisms. Projects emerge from the field, identifying unmet needs and proposing innovative health care organisations and payment schemes. This presentation will provide insights into this new experience, into the obstacles and the lessons learned.
The German Innovation Fund (Innovationsfonds)
Authors: Pfaff Holger 
Published: October 2021

Abstract
The Innovationsfonds was launched by the German Federal Government in 2016 and funds both experimental new care models and health services research projects. The applicants respond to annual funding announcements with a broad range of topics. Insights from more than five years of experience encompass prioritisation of topics, types of projects funded, governance pathways and potential future directions.
Closing the preparedness-response gap in time: Operational readiness at points of entry in Europe
Authors: de Rooij D , Janse J , Raab J , Timen A 
Published: October 2021

Abstract

Background
As points of entry (POE) - ports, airports and ground-crossings - are important structures for international travel and trade, their timely activated capacity to respond to infectious disease threats is of utmost importance. How can POE timely adjust their capacity from generic preparedness to specific response?

Methods
We developed a conceptual framework for public health response at POE, based on a military used model, leading to a step-wise approach from preparedness to response. Subsequently, our framework has been used to analyze interview data of professionals working at European ports (n = 12), airports (n = 15) and ground-crossings (n = 4) in 11 European countries in June - August 2020 covering the activation of the response to COVID-19.

Results
By integrating the military model, we learned that in preparedness frameworks the pre-defined time expected to activate required capacity is missing. While combining time with capacity creates the possibility of defining a readiness range for different capacity requirements. E.g. information provision to passengers is arranged within hours, while entry-screening may take up to days to be operational. We hypothesized that this readiness range provides the opportunity to split strategic thinking from operational readiness, and may support proactive thinking. The interviews confirmed a very implicit and non-formalized reference to the time needed to activate the response. POE differed highly as regards proactive or reactive response strategies. A much stated problem was fast and often changing strategies on measures, leading to extreme required flexibility and workload in operations.

Conclusions
Explicitly acknowledging the time needed to activate appropriate capacity during the transition from preparedness to response can contribute to a better definition of the operational consequences of readiness. These findings may also be of added value in other public health area than POE.
Promoting and preserving safe and active mobility in Istanbul during the COVID-19 pandemic
Authors: Demir O , Rojhani A , Hung C 
Published: October 2021

Abstract
The COVID-19 pandemic severely impacted all facets of daily life, including and especially mobility within urban centres. As part of efforts to control the virus by encouraging citizens to stay at home, local governments imposed public health and social measures (PHSMs) restricting the availability and use of public transit. The result was an immediate, sharp decline in the use of public transit, and later as the pandemic was brought under control in certain geographies, a reluctance to return to using public transportation due to sustained fears of virus transmission. In Istanbul, Turkey, the use of public transportation decreased by over 90%, coupled with a significant rise in the use of private motorised transportation. To counter this trend, the Istanbul Metropolitan Municipality (IMM) joined cities around the world in implementing a two-pronged strategy to support safe and active mobility during the pandemic. IMM first launched a communication campaign to promote adherence to PHSMs, to rebuild trust in the safety of public transportation as restrictions eased, and to educate citizens on transportation alternatives. Billboards, social media and digital screens on public transportation promoted continued mask use, hand-washing and physical distancing and encouraged citizens wary of returning to public transit to consider walking or cycling as a safe and healthy alternative to private car use. IMM simultaneously enhanced their cycling infrastructure, creating new temporary and permanent bike lanes that closed connectivity gaps within the city. This talk will further elaborate on IMM's actions and the results and explore how they and other cities can sustain the focus on safe and active mobility as a longer-term strategy to reduce private car use and improve health outcomes.
Competences in the management of health regions: Hungary, Bulgaria, Austria
Authors: Kollányi Z , Horváth G , Movia M , Amort F , Todorovska N , Yordanov H , Iltschev V 
Published: October 2021

Abstract

Background
Competences were analysed through desktop research and semi-structured/guided interviews with relevant stakeholders and experts. Subsequently the results of Hungary, Bulgaria, and Austria will be presented and discussed.

Results
Hungary has 9,9 Mio inhabitants. The health status of the population is generally poor and characterized by inequalities. The country has one of the highest mortality rate in the EU. The public health system contains elements compatible with the concept of RHNM. Based on expert opinions main competency areas needed would be of Communication, Management, Public Health and Data Management and Analysis. Bulgaria's population is 6.9 Mio. The mortality rate is highest among the EU. The country has laid down foundations in terms of essential structures, facilities and academic programmes. Identified competences for RHNM are Management, digital health qualifications and soft skills. Austria has 8,9 Mio inhabitants. The mortality rate is close to the EU average. Austria is already aware of the concept of RHNM as it exists on small scale within the country. Identified competences from expert interviews are project management, Public Health and Health Promotion, social skills and communication.

Discussion
The function of RHNM is already existing in AT on small scale, in HU it is in function but diverse and in BG it is not existing. The countries are facing similarities in terms of health needs e.g. aging population, chronic diseases but there are differences in terms of the health status as BG and HU have higher mortality rates than AT. In Austria and Bulgaria there is more focus on management competences for RHNM, Hungary has greater emphasis on the health competences.

Main message
Overall, the function of RHNM would add a value in all countries and overall there is a good prospect for the introduction or reinforcement.
“Health Situation of Women in Germany 2020” - The new report of the Federal Health Reporting is published
Authors: Sass AC , Krause L , Hintzpeter B , Ludwig S , Prütz F 
Published: October 2021

Abstract

Introduction
In Germany, there are more than 35 million women. The German Women's Health Report being published in December 2020 by the Federal Health Reporting Unit at the Robert Koch Institute describes their health status.

Methods
The report uses a broad data basis and shows differences and similarities in the health of women and men (‘differences between') as well as within the group of women (‘differences within'). It includes an overview on their health status, health behaviour and health care. Focus chapters are devoted to health over the life course, specific groups of women, e.g. women with disabilities, and specific health topics, e.g. sexual and reproductive health.

Results
Women's average life expectancy has been increasing for many decades. Two thirds of women rate their health as good or very good. The most common cause of death among women are cardiovascular diseases, accounting for around 40% of all deaths. Nevertheless, they are still considered as ‘male' diseases, thus women often underestimate their risk of disease. Women are in general more health conscious than men, e.g. they have a healthier diet. Women use prevention measures, health promotion and health care services more often. Two thirds of those in need of care are women and it is mainly women who are responsible for the care of others. Data gaps exist for certain conditions such as benign gynaecological diseases as well as for certain groups of women, e.g. migrant women.

Conclusions
In Germany, the health status and health care for women are at a high level. But inequalities in the opportunities for a healthy life exist: socio-economic factors such as age, education, occupation, income, family type, migration background and many other aspects have an important impact on their health status. The report provides current data and information for policymakers, science and practice and raises the awareness and the need for sex and gender-appropriate health promotion, prevention and care.
“Better for women. Improving the health and wellbeing of girls and women” (2019) - Towards a women's health strategy for the UK
Authors: Regan L 
Published: October 2021

Abstract
The following key questions will be addressed in the presentations: 1. What women's health issues are of particular concern in the report? 2. What is the data situation on important women's health topics in the UK, are there data gaps? 3. On which groups of women is there a particular focus in the report? 4. How can the findings be translated into policy? What has happened so far?
The importance of smoking cessation during pregnancy and its association with perinatal outcomes
Authors: Silva AI , Camelo A , Madureira J , Reis AT , Barbosa F , Teixeira JP , Costa C 
Published: October 2021

Abstract

In utero exposure to tobacco smoke is associated with an increased risk of multiple adverse perinatal outcomes. Smoking cessation during pregnancy has been related to the improvement of these outcomes, but often relies on self-reporting, impairing an accurate assessment of smoking cessation impact on newborńs health. Building on data obtained in the frame of the NEOGENE project, this work aimed to estimate the association between smoking cessation among pregnant women, confirmed by maternal urinary cotinine concentrations, and perinatal outcomes. The study population included 595 pregnant women who sought prenatal care in a public hospital in Porto (Portugal), from April 2017 to July 2018. Data on tobacco consumption and cessation was obtained in a face-to-face interview, during the hospital stay. Perinatal outcomes, namely birth weight (BW), length (BL) and head circumference (HC) were retrieved from the hospital medical records. Maternal self-reported tobacco use was validated by urinary cotinine concentrations, using the solid-phase competitive ELISA technique. Maternal active smoking was associated with a significant decrease in BW, BL and HC of 157.66 g (p &lt; 0.001), 0.78 cm (p = 0.001) and 0.39 cm (p = 0.016). Notably, maternal smoking cessation led to a significant increase in BW of approximately 172 g (p = 0.006), when compared to mothers who have not ceased. Increases in BL and HC did not reach significance. This study upholds that tobacco consumption is still an important public health threat in Portugal and that smoking cessation during pregnancy reverses smoking-associated deficits in perinatal outcomes, emphasizing the crucial need for awareness campaigns to promote smoking cessation during pregnancy.
Acknowledgments: This work was supported by FCT and FAPESP (FAPESP/19914/2014). AIS, JM and CC also acknowledge FCT for individual funding (SFRH/BD/145101/2019, SFRH/BPD/115112/2016 and SFRH/BPD/96196/2013 grants, respectively).

Key messages
Maternal active smoking was significantly associated with lower birth weight, length and head circumference. Maternal smoking cessation reverses the smoking-associated deficits in birth weight.
10.P. Workshop: Mental health of older people
Authors:   Organised by: EUPHA-PMH,   Chair persons: Johan Bilsen (EUPHA-PMH), Jutta Lindert (EUPHA-PMH)
Published: October 2021

Abstract

Due to a general health deterioration, decline in functional ability, accumulated stressful events related to loss and bereavement, and unfavorable socio-economic circumstances, older adults are known to be vulnerable to the development of mental health problems, sometimes leading to serious mental disorders. Approximately 20% of adults aged 60 and over, suffer nowadays from a mental or neurological disorder. This problem is possibly even more distinct in the context of the recent Covid-19 pandemic where health protecting measurements like restricting physical and social contact, disproportionally affect the mental health of older people who are already at higher risk of social isolation and loneliness. However, according to the WHO, mental health impairment in older people is still a highly under-identified, and under-estimated public health issue, often surrounded by shame and stigma, which hinders an adequate mental health promoting approach in this population. This workshop wants to contribute to new findings in the role that certain factors can play in protecting and promoting the mental health of older people. Research during circumstances of a crisis, like the Covid-19 pandemic, may reveal new insights in this context, although the long-term effects are not yet clear, and longstanding factors may not be overlooked.
Dr Sunwoo Lee (Czech Republic) performed a large survey about mental health of older adults in 27 European countries and will discuss the important role that resilience and optimism can play in promoting mental health in older adults in the midst of a pandemic crisis.
Dr. Cynthia Engels (France) investigated changes in daily activities and mental health of older adults during the lockdown period in France. She will report about the most important changes found and what it meant for peoples' wellbeing and social contacts.
Prof. Patricia De Vriendt (Belgium) further focused on the daily activities of older men and women during the Covid lockdown in Belgium and discovered a significant gender difference in the extent to which they succeed to engage in meaningful activities during this crisis. She will discuss how crucial this meaning in activities is for older adults to maintain in good mental health.
Finally, Prof. Jutta Lindert (Germany and US) will share the rather surprising findings of a large nationwide study in the United States among older adults showing how daily discrimination is related to impaired cognitive functioning in older men and women. She points to the importance of reducing discrimination, especially when the Covid-crisis is behind us, as an important factor in supporting mental health in this older population.

Key messages
Resilience, optimism and meaningful activities are important factors in mental health promotion for older adults. Discrimination has a negative impact on older adults' cognitive function.