bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring health service utilization among elderly populations in Hungary: A comparison of rural and urban settings in the context of Unhealthy Ageing
Authors: Kovacs N , Piko P , Kolozsvari L , Kovacs E , Ungvari Z , Adany R 
Published: October 2023

Abstract

Background
The demographic transition presents a significant challenge for health systems due to increasing healthcare needs of ageing population, particularly in Central and Eastern European (CEE) countries. In first step, we aimed to describe the health status and use of health services among elderly living in the most deprived region in Hungary, and to compare the use of health services (including preventive and healthcare services) among older adults living in urban and rural areas.

Methods
A complex health survey was carried out on randomly selected sample of individuals aged 65 years and older (n = 443) in Northeast Hungary in 2022. Demographic, socioeconomic characteristics and use of health services were analysed by type of residence.

Results
Generally, 15.3% of elderlies rated their health as poor/very poor (14.9% in rural and 15.7% in urban areas), and 57.8% (63.5% and 52.6%) reported limitation in daily activities. Elderlies living in rural area in comparison with that living in urban area reported lower frequency of visiting a dentist (21% vs. 32.9%; p = 0.006), and specialists (53.4% vs. 63.8%; p = 0.028), having fecal occult blood testing (8.8% vs. 21.7%; p &lt; 0.001), colorectal cancer screening (12.1% vs. 20.9%; p = 0.014), and mammography (16% vs. 26.6%; p = 0.035), and reported higher frequency of blood pressure measurement (90.9% vs. 84.4%; p = 0.042). After adjustment for demographic, socioeconomic and health related factors, urban residence showed positive association with having fecal occult blood testing (OR = 2.72, 95% CI: 1.42-5.22), and negative association with blood pressure (OR = 0.44, 95% CI: 0.23-0.86) and blood glucose measurements (OR = 0.55, 95% CI: 0.33-0.92).

Conclusions
Our findings suggest the impact of residence on health (especially preventive) service utilization among older adults in Hungary. Further comprehensive studies are needed to describe the health needs of older people to implement policies to promote healthy ageing in CEE countries.
Food and Nutrition Literacy as means to fight against inequalities in diet and nutrition
Authors: Bonaccorsi G , Lorini C 
Published: October 2023

Abstract
The concepts of nutrition (or nutritional) (NL) literacy, food literacy (FL), and the extensively described concept of health literacy (HL) are based on the same idea of increasing the degree to which individuals and groups can access and use specific information needed to make health decisions that benefit the community. More specifically, the terms of FL and NL refer to a set of knowledge, competencies, and abilities that are necessary for people to use information regarding food and nutrition in order to achieve and preserve a healthful diet. Nonetheless, the core elements of the two constructs partially differ, since NL mostly involves nutritional information and individuals’ capacity or interest in relation to accessing and using such information in order to maintain nutritional health status, while FL considers mainly the relationship between people and food (or food system) and the capacity to use food responsibly. From a public health nutrition perspective, NL/FL could help to identify individuals with low diet quality and unhealthy eating habits that make them at higher risk of chronic diseases and other health consequences. In fact, although a very large amount of information about food and nutrition is now available to citizens/consumers, they often struggle to recognize evidence-based information and effectively manage their diet in the current “dietary infodemic”. Thus, there is a need to develop and implement interventions in order to increase the public's NL/FL level, beginning from establishing valid instruments to measure the NL/FL and finding specific targets on which to intervene by education and other preventive measures, so as to develop specific awareness to counteract the pressure from GDOs and the effects generated by commercial determinants.
4.F. Workshop: Supporting present policy making to address future challenges: foresight and public health policies
Authors:   Organised by: EUPHA-FS,   Chair persons: Henk Hilderink (EUPHA-FS), Claudia Habl (Austria)
Published: October 2023

Abstract

The COVID-19 pandemic and its impact on health showed that we were not prepared for uncertain health events and its uncertain consequences and impact in society. To be prepared for the uncertainty of the future, foresight provides a systematic, participatory, and vision-building process that explores the future to anticipate trends and support present-day actions. Foresight explores possible futures and their impact on society and population health. Foresight can enable better informed present-day decision-making and thereby better short-term and long-term preparedness in European Union (EU) Member States (MS) and the European region for possible future health crises. With foresight, experts and policy makers can explore long-term decisions that need to be made in the present to be prepared for the future. Using foresight to formulate long-term decisions can allow setting priorities, planning budgets and spending to address health threats and challenges, and learning how to cope with challenges while keeping resilient and sustainable health systems. In this workshop, we will focus on how foresight can be integrated into the policy cycle to support policy makers to be prepared for the future. It will provide an outlook on how a foresight exercise can provide insights into future challenges to provide recommendations and explore policy implications. The workshop will start with an interactive Mentimeter session to get a better view on how the audience is familiar with foresight in the policy cycle. Then, a brief presentation is given as introduction to foresight and its role in policy making. This is followed by a presentation of a Foresight study that provides recommendations for policy makers to address present and future challenges related to mental health. The second foresight study provides an example on how digitalization in primary healthcare can address present and future challenges. The last presentation gives an overview on the role that foresight can play in the policy cycle at different stages of the foresight exercise when discussing the use of personalized medicine in cancer prevention. The workshop will be concluded by a discussion with the four presenters on the lessons learned regarding foresight and policy making.

Key messages
• Foresight provides a systematic and participatory process to support policy making towards sustainable and resilient health systems.
• Foresight can enable better informed present-day decision-making towards better short- and long-term preparedness in the European region and its Member States for possible future health challenges.
15 years of Gaining Health strategy in Italy: what's new about behavioral risk factors?
Authors: Pettinicchio V , Marotta D , Trinito M O , Casigliani V , Asta F , Possenti V , Contoli B , Minardi V , Masocco M 
Published: October 2023

Abstract

In Europe chronic non-communicable diseases (NCDs) are responsible for the majority of deaths, premature deaths and disabilities. Actions to fight against smoking, excessive alcohol consumption, sedentary behaviours and obesity are central for the prevention of NCDs. In Italy in 2007 the National Program Gaining Health (GH) was launched and the behavioral risk factor surveillance system (including PASSI and PASSI d’Argento) was promoted. This study has the aim to contribute to assess the impact of the strategies implemented with GH, analyzing over time data on behavioral risk factors in Italy since 2008. Data from PASSI 2008-2021 (468.000 interviews of 18-69 years old people) and PASSI d’Argento 2016-2021 (74.000 interviews of over 65 years old people).
i) time series models on smoking, alcohol, sedentary behaviours and obesity data in adults, stratified by gender, age, residence and social determinants;
ii) Regression models to evaluate the changes in associations over time between behavioral and social determinants.
Smokers’ prevalence dropped from 30% to 24%, not equally in population groups. Excessive consumption of alcohol is stable since 2010 (∼16%); although, it is the result of opposite trends in the different components of the indicator (binge, between meals and usually high) and of improvements in some groups and worsening in others: it increases in the North but not in the Center-South, it is reduced in men but increased among women; it remains stable among young people aged 18-24 (∼27%). Sedentariness is increasing everywhere (31% in 2021), especially in the South (43%) and among the youngest. Obesity also increased in the South and in the North; today about one out of 10 is obese. Social inequalities continue and worse in affecting these phenomena. These data show no improvement in the last 15 years. Prevention Plan is an opportunity to change course. Surveillance is strategic, as long as it is used to guide policies and to monitor their effectiveness over time.

Key messages
• Data on behavioral risk factors show no improvement in Italy since 2008.
• Surveillance is strategic to guide health policies and to monitor their effectiveness over time.
5.B. Round table: From Knowledge to Action: Inclusive & Tailored Interventions for Underserved Groups
Authors:   Organised by: Pandemic and Disaster Preparedness Center (Netherlands),   Chair persons: Jeannette de Boer (Netherlands), Valerie Eijrond (Netherlands)
Published: October 2023

Abstract

The disease burden of COVID-19 infection, morbidity, and mortality is unevenly distributed across different groups in the population, affecting especially those of lower socioeconomic status, and with a migration background. The one-size-fits all policy and practice approach during the COVID-19 pandemic did not reach certain subgroups of the population. Information campaigns, access to vaccination and testing facilities were not tailored to the barriers experienced in some communities. Furthermore, behavioral insights studies were not sufficiently targeted for different population groups, including those underserved. Although behavioral insights were gathered during the global pandemic, implementing them in the pandemic response remained a challenge for policy makers. The pandemic shined a spotlight on the existing disparities in health and the unmet needs of underserved groups. In the absence of a coordinated government approach to address health inequities, local, bottom-up interventions emerged to address underserved groups’ needs. Examples include the COVID-19 vaccination doubt line initiated by medical professionals of the Erasmus Medical Center in Rotterdam, the Netherlands and doctors offering information about vaccinations in marketplaces and other public areas such as churches and mosques. Lessons from these interventions can guide policy makers and health care professionals in designing more tailored and inclusive approaches, addressing the beliefs, needs and fears of underserved groups specifically. Against this background, this solution-based workshop will bring together representatives from healthcare, public health, academia and WHO to: 1. leverage their experience and share practical examples of interventions for underserved groups during COVID-19 from different countries, 2. discuss which targeted and structural interventions are needed as well as 3. which structures, expertise, capacities, stakeholders, and tools are required to ensure that no one is left behind.

Key messages
• What is needed to translate available knowledge into action for more effective preparedness and response to pandemic threats.
• How to ensure that tailored interventions reach those that need them most.

Speakers/Panelists
Prabhjot Kour
University of Bergen, Bergen, Norway
Katrine Bach Habersaat
WHO/Europe, Copenhagen OE, Denmark
Robin Peeters
Erasmus MC, Rotterdam, Netherlands
Shakib Sana
Erasmus University Rotterdam, Rotterdam, Netherlands
Anja Schreijer
Erasmus Medical Center, Rotterdam, Netherlands
5.E. Workshop: Salutogenic Cities: European experiences in Urban Health
Authors:   Organised by: EUPHA-URB, EUPHA-PMH, EUPHA-ENV,   Chair persons: Stefano Capolongo (EUPHA-URB), Jutta Lindert (EUPHA-PMH)
Published: October 2023

Abstract

The Workshop titled “Salutogenic Cities: European experiences in Urban Health” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), policy/decision makers and city users, to establish a multidisciplinary approach for understanding together how to create and manage healthy living outdoor urban environments. The Workshops mainly address both the “Climate emergency / Environment and health / Urban health” and the “Global health and Europe's role in global health” EPH23 conference topics. The Workshops purpose is to explore the link between the morpho-typological features of the urban environment and Public Health outcomes, that's crucial in the scientific scenario, taking into consideration the urbanization phenomena that characterizes contemporary society. Health is no longer a specifically individual health issue, but a collective priority strongly influenced by the environmental context and by strategies implemented by local Governments. Urban planning, at large and small scales, can be considered a key tool to protect and promote Urban Public Health. In this scenario, the COVID-19 emergency, has accelerated and emphasized several social, environmental and digital challenges, underling the focus on several aspects such as Urban mobility and walkable environment; Urban Green Spaces and ecosystem services assessment; Urban Health policies and actions. The Workshops program include inputs which they argue current experiences, emerging practices and scientific outcomes related to the Urban Health discipline. From methods, in “Improving health and wellbeing through health-centered, evidence-based urban planning methodologies” to actions, in “The urban burden of disease estimation for policy-making in 1000 European cities”. From epidemiological outcomes, in “Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study” to hospitalizations implications, in “Daily temperature variability in cities and mental health-related hospitalizations”.

Key messages
• Explore the link between the morpho-typological features of the urban environment and Public Health outcomes, taking into consideration the urbanization phenomena that affect the contemporary society.
• Establish a multidisciplinary approach for understanding together how to create and manage healthy living outdoor urban environments.
The urban burden of disease estimation for policy-making in 1000 European cities
Authors: Matkovic V , Abbas A , Angelova J , Berardi E , Bussalleu A , Chen X , Daher C , De Hoogh K , Flückiger B , Gehring U 
Published: October 2023

Abstract
In Europe, over 70% of the population lives in urban areas. Cities promote innovation and wealth creation; however, they are also a main source of pollution, disease and mortality, to some extent linked with suboptimal urban and transport planning practices. The aim of the project is to improve the estimation of health impacts and socioeconomic costs of environmental stressors related to urban and transport planning, advance modelling approaches and strengthen evidence-based policy-making.
The analyses focus on air pollution, noise, temperature/heat and lack of green spaces for nearly 1000 European cities. We are (1) developing an overall urban burden of disease impact assessment framework; (2) identifying health and wellbeing indicators; (3) obtaining exposure-response relationships for environmental stressors and health outcomes of interest; (4) developing tools and guidelines for cost-benefit analyses; (5) obtaining health and environmental stressors data for cities for 2015, 2018, 2021 and 2024 and (6) calculating health and socioeconomic impacts and monitor trends. Specific urban and transport planning scenarios will be developed for case-studies cities (Barcelona, Brussels, Manchester, Munich, Utrecht, Sofia, Warsaw and Zagreb) and include additional aspects such as mobility, physical activity and inequities. The science-to-policy translation is a strong component of this research project where we are conducting consultation with and providing knowledge translation to cities and stakeholders, and sharing good practices, for greater science-policy impact. We strive to make the change on city-level policy and action plans, as well as on national and EU level policy making. By improving health impact and socioeconomic costs estimations and engaging with stakeholders we expect to generate impact and promote healthier urban and transport planning practices in European cities.
Significant inequalities in the cost of food for households with children in Israel in 2018
Authors: Kaufman Shriqui V , Blaychfeld Magnazi M , Yaroslaviz-Degania N 
Published: October 2023

Abstract

Background
Dietary guidelines for families with children are designed to reach the Dietary Recommended Intake. However, the cost of a healthy diet and the extent to which families can afford it in Israel is unclear.

Methods
The distribution of ages and the number of children per household in Israel in 2018 was obtained from the Central Bureau of Statistics. Food prices were purchased from the commercial company Stornext. The cost of the recommended food items in the healthy diet for adults and children was calculated using standard food portions and meal frequency as well as a percentage of the household's net income. The proportion of households for which food expenditures exceed 15% of the net income was calculated by income quintiles, followed by changes in food prices during 2018.

Results
The average daily cost of a healthy diet was 35.51±7.7 new Israeli shekels (NIS). The older the individual, the more food costs increase. The ratio between the average cost of breakfast, lunch, dinner, and two intermediate meals was 1.5:3.4:1.2:1, respectively. The median monthly dietary cost for households with children as a percentage of net income was 20%. There was an inverse association with socioeconomic status (SES) as the median monthly food expenses for the first (lowest) quintile was 55% of the household's income and only 9.3% of the 5th (highest) income quintile. The food group that composed the highest component of the food budget was the vegetable group, with an average cost of 29% monthly, followed by the meat and meat substitutes group (19%).

Discussions
Policymakers should consider steps to decrease health inequality in food affordability targeting the three middle-lower income quintiles. The cost of a healthy diet compared with food expenditure in high-income countries was 1.8 higher in Israel. Our findings indicate that expanding the program to provide school lunches five days a week to more students would reduce household food expenditures by 15%.

Key messages
• Households with children in Israel would need to spend 20% of their net income to meet dietary guidelines.
• Significant gaps by income quintile, number of children, and food group were identified.
“I feel healthy, I don’t need to go”: Analysis of the cancer screening barrier
Authors: Altová A , Lustigová M , Kulhánová I 
Published: October 2023

Abstract

Background
Cancer screening is an essential tool for reducing cancer mortality. However, screening hesitancy is still a quite common issue in many countries. In this study, we focus on one of the most commonly declared reasons for breast and cervical screening non-attendance among Czech women, which is ‘feeling healthy’.

Methods
We use a mixed-methods approach to investigate the ‘feeling healthy’ barrier, trying to connect three data sources. First, we use a representative sample of Czech women to find the most common reasons for screening non-attendance. Second, we used semi-structured interviews with 10 women to investigate the barriers to screening more deeply. Third, we analyse the data from the European Health Interview Survey (EHIS) 2019, trying to confirm some of the previous findings, using the self-perceived general health variable as a proxy for ‘feeling healthy’.

Results
‘Not experiencing any symptoms’ was the most common reason for cervical (36.7% of non-attendees) and the second most common reason for breast screening (29.2%) non-attendance. Women in the semi-structured interviews talked about that they felt healthy and thus did not feel the urge to attend screening. This feeling was often related to living a healthy life in the form of eating healthy, having enough exercise, not smoking or not drinking. EHIS data show that women with ‘good’ and ‘fair’ self-perceived health compared to those with ‘very good’ health had higher chances of attending both cervical (OR = 1.67, 95%CI 1.32-2.13 and OR = 1.34, 95%CI 1.03-1.74) and breast screening (OR = 2.14, 95%CI 1.76-2.61 and OR = 1.44, 95%CI 1.14-1.82; all models controlled for age and education).

Conclusions
‘Feeling healthy’ can lead women to believe they do not need to attend cancer screening. Measures should be taken to improve health literacy and cancer awareness to dispel misconceptions about cancer symptoms and encourage women to prioritise screening.

Key messages
• One of the most common resaons of screening non-attandance is ‘feeling healthy’.
• Women with ‘good’ and ‘fair’ self-perceived health compared to those with ‘very good’ health had higher chances of attending both cervical and breast screening.
Private equity investment in Sweden's primary care sector and regulatory responses to avoid risk selection
Authors: Winblad U 
Published: October 2023

Abstract

Background
Until the 1990s primary care centres in Sweden were almost exclusively public and operated by the country's regions. A primary care reform in 2010 that increased competition between approved providers for public funding led to a rapid growth of private providers. Concerns were raised that profit-driven providers would select patients with lower risks.

Methods
We analysed contracts between county councils and private care providers and reviewed strategies employed by local governments to avoid risk selection and whether there were any differences between left- and right-wing governments.

Results
By 2020 over 270 new private primary care centres had been established, most of which were for-profit. Of the overall approximately 1200 primary care centres, about 60% are still owned by the regions and about 40% are privately owned. About a third of the private for-profit practices were owned by international private equity firms in 2018. Three main strategies were used by local governments to avoid risk selection: risk adjustment of the financial reimbursements on the basis of health and/or socio-economic status of listed patients; design of patient listing systems; and regulatory requirements regarding the scope and content of the services that had to be offered by all providers. Left-wing local governments were more prone than right-wing governments to adopt risk adjustment strategies at the onset of the reform but these differences diminished over time.

Conclusions
A variety of regulatory instruments can be used to avoid risk selection by private providers. However, due to a lack of systematic research, no firm conclusions can be drawn so far on the overall impact of private equity ownership on primary care provision in Sweden.