bluuebunny/crossref_metadata_2025_split huggingface dataset:
Compositional analysis
Authors: McKinley J 
Published: October 2023

Abstract
Health outcomes are often multi-faceted as many environmental variables have synergistic impacts. By integrating data on chemical agents from the lithosphere, hydrosphere, and atmosphere, it will be possible to note the roles each play, and which are having the most demonstrable effect on long term cognitive health outcomes. This presentation will showcase an integrated and compositional approach taken to model the effects that chemical agents in each sphere are having on long term cognitive health outcomes. Firstly, chemical agent data will be extracted using circular buffers. Secondly, the relationships that chemical agents share across the environmental spheres are validated through correlation (complex heatmap/clustering) and dimension reduction (PCA) techniques. Thirdly, cognitive health outcome variables are integrated into this framework, to note which chemical agents and health variables show correlations. Lastly, a forward-selection algorithm like selbal is demonstrated to indicate the level of significance that each health outcome shares with each chemical agent(s). Through the integration of these techniques, it will be notable which chemical agents and environmental sphere is having the most significant effect on long term cognitive health outcomes.
Can applying behaviour change principles make public health policies more impactful and sustainable?
Authors: Bacon S 
Published: October 2023

Abstract

Issue/problem
The incorporation of evidence-based recommendations into policy documents and health guidance often does not lead to measurable changes in public health outcomes.

Description of the problem
All the preventative measures of COVID-19 were behavioural in nature, e.g., getting vaccinated, wearing masks, physically and socially distancing, getting tested, etc. However, most government policies did not consider behavioural science or behaviour change frameworks when crafting them. This led to a significant reduction in trust in governments and a resistance to the evolving policies.

Results
Through the international iCARE study (www.icarestudy.com), we captured data throughout the pandemic on people's capabilities, opportunities, and motivation to engage in COVID-19 prevention behaviours, as well as their actual behaviours. This data has led to key insights into how policies could have been crafted to actively engage individuals in the varying measures that they needed to undertake to reduce the impact of COVID-19.

Lessons learned
The incorporation of behaviour change principles in the development and implementation of policies has the potential to engage more shareholders and drive behaviour change. However, more evidence is needed to determine the optimal way to do so, and to assess the effectiveness of these efforts in improving public health outcomes. To achieve this, a rigorous monitoring plan is necessary to evaluate the impact of policy changes and health guidance on public health outcomes.
7.L. Round table: Population health management in PHC: a proactive approach to improve health and well-being
Authors:   Organised by: WHO European Centre for PHC,   Chair persons: Natasha Azzopardi Muscat (WHO/Europe)
Published: October 2023

Abstract

Population Health Management (PHM) can play a critical role in strengthening Primary Health Care (PHC) by providing a data-driven, people-centred, and proactive approach to managing the health and well-being of a defined population. It entails data-driven assessment of the health status of a specific population followed by prediction of health outcomes and anticipating the resources needed to proactively address these. By identifying subgroups with similar characteristics and needs, PHM can enable PHC providers to move from a one-size-fits-all approach to targeted and tailored interventions that account for the needs of different groups. Moreover, by focusing on the social determinants of health and psychosocial needs, PHM can help PHC providers adopt a more holistic approach. PHM can provide a pragmatic framework to help PHC providers in operationalizing several essential public health functions, which are at the core of PHC. It can also help PHC deploy a proportionate universalism approach to address health inequalities at community level. By showcasing practical examples of how PHM is being used in PHC across Europe; discussing enabling factors for adopting a PHM approach; and presenting pragmatic policy recommendations; the workshop will inspire the public health community and help countries move towards the adoption of a PHM approach in PHC. The workshop will consist of an actively moderated panel discussion, short presentations by panelists and Q&A sessions.

Key messages
• Population health management rooted in PHC can help improve health outcomes for populations, reduce health inequalities, and strengthen health systems.
• The relationship between PHM and PHC can be described as a virtuous circle; PHM helps make PHC more effective, and many elements of a strong PHC model are essential for effective PHM.
Implementing population health management in England. A GP perspective
Authors: Alton D 
Published: October 2023

Abstract
PHC professionals often already have deep understanding of the population that they serve, their needs and the wider determinants of their health. A data-driven population health management approach does not replace this understanding but rather complements it, quantifies it, enables even deeper understanding and, at times, can challenge pre-existing assumptions. PHC professionals’ understanding of their community (in which they often live) naturally facilitates population health management as an effective approach within PHC. There are resultant benefits when clinicians participate in leading this transformational change, even though most of the day-to-day work required is often not done by the clinicians themselves and, in fact, often reduces their workload. This presentation will describe the implementation of a PHM approach in Berkshire West (England) and will provide examples of their practical applications before, during and in the wake of the COVID-19 pandemic.
Risk stratification tools in primary care in Europe
Authors: De Manuel-Keenoy E 
Published: October 2023

Abstract
Risk stratification is an intentional, planned and proactive process that predicts the probability of adverse events occurring and assigns an individual a risk status or score. Based on individual risk assessment, patients are typically classified into high-, medium- (rising-) and low-risk groups. Risk levels should correspond to the likelihood that patients experience negative health outcomes and/or higher rates of unnecessary or preventable health care utilization. This allows targeting effective interventions to prevent them and promotes resource utilization based on individual and population needs rather than demand. Risk stratification is essential for PHC practices to be proactive and reach out to individuals based on their risk profile even if they do not present to PHC facilities and to tailor PHC service delivery accordingly. Even if risk stratification (especially as it becomes more sophisticated) is not done at the PHC level, the results can be made available to PHC professionals, often through integrated electronic health record systems, so they can benefit from it in their daily practice. Risk stratification may be carried out in PHC settings with varying degrees of complexity depending on local resources and with different purposes depending on the context. This presentation will discuss the different risk stratification tools used in country across the European region, and provide practical examples on their uses in PHC. The presentation will discuss enabling factors for advanced risk stratification that accounts for multimorbidity and social complexity.
How 2008 financial crisis legacies impacted future health workforce resilience – a realist review
Authors: Fleming P 
Published: October 2023

Abstract
The 2008 financial crisis and subsequent recession led many Governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks. A realist review identified legacies associated with austerity, with a particular focus on workforce resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007- May’21), followed by additional theory-driven searches. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of Context, Mechanism, Outcomes Configurations (CMOCs), alongside stakeholder engagement to confirm, refine or refute emerging results. CMOCs revealed how: 1) priorities influenced by outside agents (e.g. Troika, governmental departments) led to a focus on external transparency and distrust in policy agenda, compounded by poor communication; 2) efficiency driven culture and performance monitoring meant professionals could not recognise their interests and values leading to sense of powerlessness, detachment and professional dissonance; 3) sustained restrictive economic policies that impacted patient care, eroded values, leading to a diminished view of profession; 4) health professionals maintained control by circumventing policy to deliver care - further isolating decision makers; and 5) street-level bureaucracy eventually leads to moral distress resulting in apathy and burn-out. Austerity challenged health system resilience but lessons can be leveraged by policy-makers and management to develop resilient strategies that protect and promote sustainable outcomes for the health workforce. This review reveals the importance of transparent, open communication, in addition to co-produced and value-driven policies.
Using crises to leverage change and build resilience: Legacies and learnings from shocks
Authors: Farsaci L 
Published: October 2023

Abstract

Background
The economic crisis of 2008 and the Covid-19 pandemic acted as profound shocks on health systems around the world. During the financial crisis, Ireland was one of five European countries to receive a bailout from the Troika. The loss of sovereignty in governance and six austerity budgets created a huge challenge for the Irish health system and its ability to be resilient in the face of long-lasting shock. These constraints on resources and a shift in governance meant that Ireland's health infrastructure was weak going into the Covid-19 pandemic. Furthermore, the depletion of workforce numbers and low morale also presented challenges.

Methods
Semi-structured interviews were conducted with seven senior stakeholders as part of the wider RESTORE research project, following ethical approval from the research Institution. Nvivo software was used to conduct thematic analysis independently by three researchers.

Results
The financial crisis deeply impacted the Irish health system throughout the years of austerity. Due to these legacy issues, the system was in a relatively weak position when faced with the Covid-19 pandemic. Furthermore, a lack of long-term planning was evident during the recovery period and the system was unable to reverse many of the negative impacts brought on during austerity. However, the system proved adaptive and innovative in response to Covid-19, and the pandemic proved to be a catalyst for positive change, providing opportunities for long-term reform, alongside an immediate response to the crisis. This was facilitated by increased funding and a devolution in decision-making structures.

Conclusions
The findings raise the question of whether health systems are entering a state of permacrisis and if so what can be done to promote resilience and prepare for future shocks. Furthermore, it asks whether health systems should put resources into acute shocks or everyday crises and explores the relationship between these two foci and resilience.
Record Linkage of secondary data in the NAKO: Overview of data sources with focus on health insurance claims data
Authors: Ahrens W , Pigeot I , Stallmann C , Swart E 
Published: October 2023

Abstract

Background
The collected primary data are enriched with secondary and registry data from different data owners to support morbidity follow-up and to obtain important exposure and progression data that could not be obtained otherwise.

Goal
A sophisticated data protection procedure had to be developed and agreed upon with hundreds of data owners. The outlines of this procedure and the various data bodies to be linked are presented, and consent behavior is described. Furthermore, it is discussed which hurdles still have to be overcome for a successful implementation of record linkage in Germany.

Methods
Study participants were asked for informed written consent to link their secondary and registry data. Confidentiality was ensured, among other things, by means of a complex pseudonymization procedure by an independent trust center. Legal and technical requirements for annual transmission and long-term use of their data were established with the data owners.

Results
At baseline, a total of 205,000 study participants were screened and interviewed in 18 study centers distributed across Germany starting in 2014. A second study wave followed from 2019, with a third starting in 2024. A high willingness to consent of 90.5% to use health insurance data was achieved. Willingness to consent is higher in the west than in the east of Germany, with 88.1% of consenters insured by one of the 113 statutory health insurance providers and 11.9% insured by one of the 46 private health insurance providers.

Conclusions
Large-scale record linkage of secondary data is a novelty in Germany. In addition to the identification of incident diseases, an almost complete medication history can be collected for the majority of study participants, independent of health insurance. However, linking is associated with a high administrative and technical effort, and some of the required data protection regulations will have a negative impact on data quality if improvements are not made here.
Health Smart City towards improving Public Health and Citizen Engagement
Authors: Lapão L 
Published: October 2023

Abstract
Climate change is modifying weather patterns, producing far-reaching effects on the environment, the economy and society as a whole, endangering global livelihoods, health, food and energy security, and water resources. Europe will not escape its effects, aggravating risks and threats to public health (PH). Today cities are leading the effort to tackle climate change. Cities are embracing digitalization and establishing smart cities (SC). SC should address people mobility, but also the impact of extreme weather phenomena. The degradation of the environment will foreseeably create security and health crisis that could benefit with digital technologies. The development of urban policies should be guided by evidence-based PH practices. The inclusion of PH into the pillars of the SC will contribute toward mitigating PH crises, such as the COVID-19 pandemic. Design Science Research Methodology was used to elicit a Smart Public Health City (SPHEC) framework. A set of PH and SC experts participated in the process, using diabetes as a case study. The European Green Deal served as a blueprint toward a healthier and more sustainable city. The SPHEC framework was defined by elucidating the PH functions within a SC, with the identification of a set of digital PH services that are required to support the SPHEC framework. This allows to assess the benefits obtained with the digital PH services, and provides evidence for guiding decision-making. The role of digital PH services emerges from the analysis of the framework, through the development of proper digital PH services, strengthening capacity and resilience in future climate emergencies, and motivating policy makers to endorse this challenge. Climate change is a serious threat with impact in PH and cities need to be prepared to tackle it. The use of the SPHEC framework enable to understand the role of both digitalization and the green deal in supporting public policies to tackle chronic diseases like diabetes.
Case report Germany
Authors: Sarganas G , Tetzlaff F , Buchmann M , Neuhauser H , Scheidt-Nave C 
Published: October 2023

Abstract
Health data in Germany is collected through official statistics, registries, health insurance and population-based health information surveys. These data are used for monitoring progress of the Sustainable Development Goal on Good Health and Well-being (SDG3). According to the Sustainable Development Report 2022, Germany has achieved an overall high-performance score; however, there are still two health indicators which are stagnating or back-warding: “Gap in self-reported health status by income” and “Gap in life expectancy at birth among regions”. In order to illustrate regional inequalities in health, the Robert Koch Institute has developed the German Index of Socioeconomic Deprivation, which merges the dimensions of education, employment and income. It has been estimated that life expectancy between the least and most deprived district in Germany in 2017 differed by 6.0 years among men and by 3.2 years among women. In addition, data on all-cause premature mortality in Germany between 1992 and 2016 showed that while 13% of women and 27% of men from the lowest income group died before reaching the age of 65, this was the case for 8% of women and 14% of men from the highest income group. Self-rated health (SRH) according to income showed in Germany 2019 the largest gap (31% points) compared to other high-income OECD countries. Data from the German Health Update 2019/2020 also showed differences in SRH according to educational background. These differences were more pronounced among women (54% vs. 82%) than men (64% vs. 81%) and largely persisted across all age groups. Unfavorable SRH is an indicator known to be associated with increased morbidity and health-related limitations in daily life as well as a predictor of premature mortality. In Germany progress towards achieving SDG3 has been made; however, it is important to identify vulnerable groups and health inequalities in order to develop target-oriented interventions.
Adapting to changing healthcare landscapes: international trends and practices in inpatient experience surveys
Authors: Kennedy L A , Boland T , Ruiz-O'sullivan G , Foley C , O'Carroll T , Flynn R 
Published: October 2023

Abstract

Background
The National Inpatient Experience Survey was first implemented in Ireland in 2017. After five iterations, an international review was conducted to identify current practices and trends in inpatient surveys in other jurisdictions, as part of a broader review to ensure the survey remains fit for purpose and responsive to the needs of stakeholders.

Methods
Nine surveys were included in the review, based on a desktop search of jurisdictions that had implemented new, or revised existing, inpatient experience surveys. Documentary analysis of relevant reports and other sources from included jurisdictions was undertaken, in addition to detailed discussions with key personnel from organisations in these jurisdictions.

Results
All included surveys have been subject to a review process or are currently undergoing a review. Most jurisdictions are seeking to reduce or eliminate reliance on postal surveys due to increasing postal costs, the burden of data entry and transcription of qualitative responses, and are moving towards the use of online or digital modes of administration. Trends toward more frequent administration and shorter surveys were also noted. More frequent data collection is useful for quality improvement within hospital settings, as it aids in the attribution of results to current, rather than historic, healthcare practices. Shorter surveys may increase response rates. Various attempts to increase participation of hard-to-reach groups have been made, including targeted surveys for particular minority groups, translation of surveys, and ‘easy-read’ options.

Conclusions
The findings indicate the importance and relevance of patient experience surveys to the wide range of stakeholders in each jurisdiction. Reviewing survey methods and methodologies is essential in responding to new priorities, changes to the healthcare landscape including modes of healthcare delivery and policies, public expectations, and to exploit advances in technology.
8.H. Workshop: The commercial determinants of health strategies and tactics: cases from 3 health harming industries
Authors:   Organised by: American University of Beirut (Lebanon),   Chair persons: Jihad Makhoul (Lebanon)
Published: October 2023

Abstract

The social determinants of health framework and the socioecological model have established the strong influence of the physical and wider social contexts on health and health inequities globally, although the circumstances where people live, work and grow up have been documented for a long time. These determinants can have health promoting and health damaging effects on population, environmental and planetary health. Recent scholarship on the commercial determinants of health focusing specifically on commercial actors, has exponentially proliferated and draws attention to for-profit industries, actors and strategies that promote products and choices which are detrimental to health. The recent Lancet series provides frameworks to better understand and regulate CDH, and has been endorsed by the WHO. This workshop aims to present the unethical health harming strategies and tactics of the for-profit sector with cases from three industries: the tobacco/vaping, the alcohol, and fossil fuel industries. The workshop begins with an overview of the commercial determinants, their multiple influences on people's well-being and their surroundings globally, and the strategies of action they use to market their products, influencing and threatening public health. The first case discusses how the vape industry advertises its Electronic Nicotine Delivery Systems to youth, particularly targeting the young LGBTQ+ population. The second presentation describes the alcohol industry strategies, such as introducing beverages which have confusing definitions to indirectly advertise for alcohol brands where alcohol advertising is restricted, as well as undermining science and purging alliances with policy makers. The last presenter discusses further unethical efforts of the fossil fuel industry to hide evidence of the harms from benzene over more than half a century, promote false data and influence legislation. Implications for global policy and practice are offered.

Key messages
• Commercial determinants of health endanger one health and this require concerted global efforts.
• Commercial actors influence public health though unethical strategies to promote their businesses.