bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case report Norway
Authors: Lyshol H 
Published: October 2023

Abstract
Norway gathers health information about the population through the 18 central law-regulated health registries and a system of questionnaire-based health surveys. The health registries, including the Medical Birth Registry (founded in 1967) and the Cause of Death Registry (founded in 1951) contain information about the entire population, with data linked to the unique personal identification number, which makes them valuable and trustworthy data sources. In general, surveys can be less dependable, in that participation rates are falling, and participants may not be representative. International data reporting has been regarded as important for Norway, which has reported data to WHO's Health for All database back to 1970. When the SDG indicators were requested by the UN and WHO, Norway was able to deliver 26 of the 28 indicators (93%) on the UN list, though some indicators, such as 3.3.3 (Malaria incidence), were regarded as unnecessary. Indicators 3.5.1 (Substance use treatment interventions) and 3.b.3 (Health facilities with essential medicines) are not reported because of the organisation of the health system. From 2015, the Norwegian Ministry of Health and other national agencies have discussed the validity of the SDG targets for Norway. In 2017, Statistics Norway published a report about the availability of SDG indicators for Norway, and in 2018 a meeting between the relevant ministries resulted in a decision to start reporting the official UN indicators. In 2021 Statistics Norway published a taxonomy of the SDG indicators, and the same year, published all available indicators in a bilingual SDG portal on their web pages. The same year, the Norwegian Ministry of Health decided to start adding to the official UN SDG 3 indicators, and in collaboration between the Norwegian Institute of Public Health and Statistics Norway, 16 extra indicators describing the SDG 3 targets have been defined and are being published, with another 20 in the pipeline.
Trends of HAI and AMR in Italian intensive care units: findings from the SPIN-UTI network
Authors: Agodi A , Maugeri A , Favara G , Magnano San Lio R ,   SPIN-UTI network
Published: October 2023

Abstract

Introduction
Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose a significant burden on Public Health. Although it is undeniable that the COVID-19 pandemic provoked challenges in routine clinical practices and surveillance, especially in intensive care units (ICUs), its impact on HAIs and AMR is still highly debated. The present analysis describes trends of HAIs and multidrug-resistant (MDR) microorganisms in Italian ICUs from 2006 to 2021.

Methods
According to the European Center for Disease Prevention and Control (ECDC) protocol, we used data on nearly 22,000 patients and 4,500 isolates from the “Italian Nosocomial Infections Surveillance in Intensive Care Units, SPIN-UTI” project. The study population consists of all patients admitted to Italian ICUs for more than 48 hours. Isolates of Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniae were classified as MDR if susceptible to at least one antimicrobial agent in three or more antibiotic classes.

Results
Overall, the incidence density of HAIs increased from 17.1 per 1,000 patient-days in 2006-2007 to 24.1 in 2020-2021. Part of this increase can be attributed to the increasing incidence density of pneumoniae (p &lt; 0.001). Although the proportion of MDR microorganisms did not significantly change over the years, increasing trends were evident in the incidence density of MDR isolates for A. baumannii (from 1.3 to 3.2 per 1,000 patient-days) and K. pneumoniae (from 0.5 to 3.1 per 1,000 patient-days). By contrast, the proportion of methicillin-resistant Staphylococcus aureus decreased from 46.9% in 2006 to 30.2% in 2021 (p-&lt;0.05).

Conclusions
Our analysis shows an increasing trend in the incidence of HAIs and MDR microorganisms in Italian ICUs. This scenario has been surely worsened by the COVID-19 pandemic. It is still unclear, however, if the increasing incidence of AMR can be attributed to an overall increase in HAIs or to other causes.

Key messages
• In Italian ICUs, the incidence of HAIs and MDR microorganisms increased from 2006 to 2021.
• Further studies should be conducted to estimate the impact of COVID-19 pandemic on HAIs and AMR.
A WHO/UNICEF manual for health workforce on how to build an infodemic insights report in 6 steps
Authors: Purnat T , Wilhelm E , Abeyesekera S , White B K , Hassan N , Pastorino A , Machiri S , Briand S , Nguyen T 
Published: October 2023

Abstract

Background
An infodemic is an overwhelming amount of information, including mis- and disinformation, that accompanies health emergencies such as outbreaks. Infodemics contain questions, concerns, information voids (where people seek credible, accurate information but cannot find it) and circulating mis- and disinformation. When there is a gap between health guidance and population behavior within a noisy information environment that affects people's perceptions, attitudes and health decisions, infodemic insights can help inform how an emergency response or a health program responds.

Objectives
A manual was developed through an iterative discussion and consultative process between November 2022 and February 2023, to provide a quick overview of the steps required to develop an infodemic insights report that can be used for emergency response or for routine health programming.

Results
The manual and teaching materials have been iteratively adapted based on their delivery at conferences and workshops. The process the manual describes reflects the learnings and experiences of WHO, UNICEF and other partner organizations on conducting social listening and infodemic insights report generation during the COVID-19 pandemic. it explains 6 steps, starting with questions that infodemic insights can help answer, through selection of data sources, conduct of integrated analysis, development of strategies and recommendations, to development and dissemination of the report. Annexes include checklists, templates, worksheets, and key messages for use by practitioners. Accompanying out-of-the box teaching simulation and other reference and training materials facilitate adoption.

Conclusions
The manual is part of the WHO toolbox for infodemic managers which applies latest evidence-based approaches to monitor, detect, respond to and mitigate harm form infodemics during health emergencies. It will be applied across training and capacity building programmes on infodemic management.

Key messages
• A systematic approach to monitoring infodemics and developing infodemic insights that are reproducible and evidence-based are needed.
• Guidance on integrating diverse datasets in analyzing and understanding infodemics in specific populations and contexts will be published in a manual by WHO and UNICEF.
Integrating Equity Considerations in an International Pandemic Instrument
Authors: Plamondon K , Dixon J ,   A SOLVE research team
Published: October 2023

Abstract

Background
The COVID-19 pandemic is widely regarded as a catastrophic failure of global governance with far-reaching consequences. Actions from wealthy countries severely limited access to essential medicines and supplies for the majority of the world's population. While the World Health Assembly has established an intergovernmental negotiating body (INB) to draft an instrument to strengthen pandemic prevention, preparedness and response, and equity considerations have been positioned as central to this process, there remains a danger that international power imbalances sabotage meaningful equity action. What priorities should an equity-centred pandemic instrument reflect?

Methods
Using a sequential deliberative dialogue (DD) methodology, international participants were purposefully selected for expertise, life experience, and spheres of influence. Two Fall 2022 dialogues were virtually convened to coincide with the study's official representation at the INB process and participants were engaged to respond specifically to the instrument's development. Dialogue findings were synthesized with a Systematic Equity Action-Analysis1 and participants were invited to review and respond.

Results
Alongside specific recommendations to prevent future inequitable pandemic responses, three overarching equity-centred approaches were identified as crucial: (1) consistently align stated intentions with operational proposals; (2) openly acknowledge causes and contexts of global inequity; and (3) create mechanisms for accountability and enforcement.

Conclusions
Achieving equity in international instruments is possible, but vague language threatens this potential. Beyond aspirational rhetoric, deliberate and coherent equity-promoting mechanisms are needed throughout the pandemic instrument in order to avoid the next catastrophic failure of global governance.
1. Plamondon et al. Turning the tide on inequity through systematic equity action-analysis. BMC Public Health. 2023;23(1):890.

Key messages
• Despite a rhetoric of ‘virtuous’ equity statements by the world's power and resource-wealthy countries, global contexts of inequity will continue or worsen without mitigation.
• Given future pandemics are likely, the cost of not mitigating inequities through this treaty poses risks to global public health.
Social media, conspiracies, and political partisanship must be accounted for during the pandemic
Authors: Duplaga M , Wilk M , Zwierczyk U 
Published: October 2023

Abstract

Background
The infodemic accompanying the COVID-19 pandemic made us aware that many factors not directly associated with the public health system can influence society's adherence to preventive measures. This study aimed to analyze the effects of social media use (SMU), generic conspiracist beliefs (GCB), and political sympathies (PS) on the compliance with general preventive measures (GPM) recommended during the pandemic and uptake of vaccination against COVID-19 (UC19V).

Methods
Data were obtained during an Internet-based survey performed 1.5 years from the beginning of the COVID-19 pandemic in Poland in a representative sample. The effects of SMU, GCB, and PS on the GPM score (wearing the mask, washing hands, and keeping a distance) were analyzed with multivariable linear regression (MLiR) model. The role of these variables in the UC19V was assessed with the multivariable logistic regression (MLoR) model. For MLiR, B coefficients and 95% confidential intervals (95%CI) were reported, and for MLoR, odds ratio (OR) and 95%CI.

Results
Among 2189 respondents, those who accepted COVID-19 vaccination were 73.5%. Users of social media were 93.6%. All three independent variables were significantly associated with the GPM score and UC19V. GCB score was adversely associated with UC19V (OR, 95%CI: 0.42; 0.36-0.48) and with the GPM score (B; 95%CI: -0.15; -0.23 - - 0.76). The most intense SM users were less likely to adhere to GPM than non-users (B, 95%CI: -0.20; -0.37 -0.02). They were also 40% less likely to receive vaccination than non-users (OR, 95%CI: 0.59; 0.43-0.81). The extreme right-wing party supporters less frequently complied with GPM (B, 95%CI: -1.01; -1.28 -0.75) and were 50% less likely to get vaccinated than supporters of the ruling party (OR, 95%CI: 0.47; 0.31-0.70).

Conclusions
The SMU, GCB, and PS remain independent negative predictors of accepting COVID-19 vaccination and adherence to general preventive measures.

Key messages
• Effective implementation of preventive measures during the pandemic requires incorporating several circumstances outside health and public health systems.
• Political sympathies, general conspiracist thinking, and immersion in social media independently decrease compliance with preventive measures and vaccination during epidemic threats.
Mental health literacy of students: evaluation of school-based intervention in Germany
Authors: Fretian A , Kirchhoff S , Okan O 
Published: October 2023

Abstract

Background
Low mental health literacy, which encompasses a set of skills related to recognizing, managing, and preventing mental disorders, has been identified as a crucial cause for low rates of mental health help-seeking, especially among young people. Thus, a strategy for strengthening the mental health literacy of youth is through provision of universal school interventions. In order to add to the evidence-base of the effectiveness of such interventions, an already existing program (“Mental Health and High School Curriculum Guide”) was translated into German and carried out in schools.

Methods
A non-randomized pretest-posttest control group design was chosen to verify whether mental health knowledge, stigmatizing attitudes, help-seeking efficacy (as central indicators for mental health literacy) improved after the implementation of the program. A pen and paper survey was conducted in schools to gather data from participating students. Statistical analysis was conducted through paired sample t-tests for the intervention and control group individually.

Results
Nine classes with 169 students (Ø 15.7 years old) participated as intervention group, while five classes with 82 students (Ø 15.3 years old) served as a control group. Statistically significant improvements were observed after participating in the program for mental health knowledge, stigmatizing attitudes and help-seeking efficacy in the intervention group.

Conclusions
This study shows that a mental health literacy resource could be successfully adapted and used in the German school context and was able to improve relevant indicators of mental health literacy. More data needs to be collected in order to inform on the stability of the results in time and to verify whether effectiveness varies with characteristics related to school environment or socio-demographics of participating youth. Further, comprehensive nationwide roll-outs of the intervention can be implemented as a public mental health strategy.
20 years of declining hospital length-of-stay in different European healthcare models and systems
Authors: Golinelli D , Sanmarchi F , Toscano F , Bucci A , Nante N 
Published: October 2023

Abstract

Background
Hospital length of stay (LOS) is an important indicator of healthcare systems’ performance. Several factors are closely related to LOS, which is characterized by high heterogeneity among countries. This study aims to investigate the 20-year time-trends of LOS and their association with different healthcare systems’ and reimbursement models among 25 European countries.

Methods
We conducted a 20-year time-trend analysis (2000-2019) using a Weighted Least Squares model for panel data to investigate the association between LOS, healthcare systems’ models (National Health Service, NHS, National Health Insurance, NHI, Social Health Insurance, SHI, and Etatist Social Health Insurance, ESH), reimbursement schemes (Prospective Global Budget, PGB, Diagnosis Related Groups, DRG, and Procedure Service Payment, PSP), and several control variables. Data were extracted from the Eurostat and GBD study databases.

Results
The analysis showed a generalized reduction of LOS across the 25 countries, ranging from 9.20 days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to the reference category (NHS) (b=−0.6327, p &lt; 0.05). Both DRG (b = 1.2399, p &lt; 0.05) and PSP (b = 1.1677, p &lt; 0.05) reimbursement models were positively associated with LOS when compared to PGB.

Conclusions
Our results confirmed the downward trend of LOS in the last 20 years among European countries, highlighting the strong influence of the healthcare system model. The results of this study offer insight into the factors influencing healthcare utilization and can inform the design of more efficient and sustainable healthcare systems.

Key messages
• This study investigated the relationship between HS models, financing, regulation, service provision, reimbursement schemes, and LOS, across 25 European countries in the last 20 years.
• This study found a dominant influence of the HS models on LOS. SHI models were associated with shorter LOS compared to National Health Systems, after accounting for several factors.
A roadmap out of medical deserts into supportive health workforce initiatives and policies, results from the ROUTE-HWF study
Authors: Flinterman L 
Published: October 2023

Abstract

Background
Medical deserts are coined as a specific term for areas dealing with low levels of health workers and health services. Health-underserved areas are a Europe wide problem, but still there is a lack of understanding on the different types and causes of medical ‘desertification’. In absence of a clear definition and categorization, countries acknowledge the severity of medical desert problems and take action. But they do so without taking opportunities to learn from each other, in terms of finding the rationale underlying the appropriate choice of policies and measures.

Aims and Objectives
The aim of the ROUTE-HWF project that will be presented is to develop an elaborated taxonomy on medical deserts that supports country comparison, and improves the matching of different policy initiatives with different types of medical deserts. This includes guidelines on how to monitor and measure medical deserts, and solutions like task shifting and retention of health workers.

Methods
The ROUTE-HWF project is based on a systematic literature review, a survey among European countries, and workshops with case studies among a selected number of countries. During each stage of the project the taxonomy and a roadmap ‘out of medical deserts’ is further developed.

Results
We present the ROUTE-HWF taxonomy and roadmap with guidelines for monitoring and measuring medical deserts. Three main distinctive types of medical deserts are defined: medical deserts mainly caused by problems with the accessibility of health workers and facilities, medical deserts mainly caused by problems with population needs in area, and medical deserts with (cumulation) of problems both at the demand and supply side of the local health system. We show that this categorization is useful to tailor health policy measures to the distinctive causes and solutions for medical deserts, enabling mutual or cluster country learning within Europe.
OASES project: promoting evidence-based reforms on medical deserts
Authors: Vitello F 
Published: October 2023

Abstract
The OASES project aims to strengthen the capacity of public health authorities to reform their health systems and address all the key issues to successfully deal with the challenges posed by medical deserts. The project has adopted a broad definition of “medical desert”: it encompasses any situation in which critical issues arise in the meeting of health needs, demand and supply of health care, i.e. not only the simple shortage of health professionals and services, but also poor quality and low accessibility of health care.
The project has developed:
• a set of indicators to assess medical desertification, in terms of availability, quality and accessibility of health workers and services;
• an analysis of the main causes of the phenomena and possible solutions or mitigation actions, through the literature review;
• pilot studies in seven European countries consisting in measuring medical deserts and discussing the antecedents and possible solutions with local stakeholders (consensus building exercise).
So far, the project has completed the activities related to the measurement methodology. Currently, pilot studies have been launched, with the aim to:
• provide a national overview of medical deserts in the participating countries (Cyprus, Finland, France, Hungary, Italy, Republic of Moldova and Romania);
• assess and characterise the medical desert at national and/or regional level, and the mitigation strategies in place and/or planned;
• facilitate consensus on medical deserts mitigation strategies among national/local stakeholders;
• provide evidence-based recommendations to mitigate medical deserts in the seven participating countries.
The results of the project will provide a proposal for policy actions and solutions against medical desertification for all the EU Member States.
Evaluation of a digital intervention for depression among Lebanese&Syrian refugees in Lebanon
Authors: Abi Ramia J , Khoury S , Cuijper P , Heim E , Burchert S , Cornelisz I , van Klaveren C , van’t Hof E , Sijbrandij M , El Chammay R 
Published: October 2023

Abstract

Background
Lebanon is a low-to-middle-income country, hosting more than 1.1 million Syrian refugees, with 90% mental health treatment gap. The National Mental Health Programme (NMHP) in Lebanon along with the World Health Organization (WHO) launched the Step-by-Step (SbS) e-mental health intervention for adults with depression. Step-by-Step is a 5-sessions, self-help, minimally guided digital program for adults with depression. Two Randomized Controlled Trials (RCTs) assessed its effectiveness and cost-effectiveness in the local setting.

Methods
Participants (n = 569 Syr, n = 680 Leb) were recruited online and randomly allocated to Step-by-Step (n = 283 Syr, n = 331), or Enhanced Care as Usual (n = 286 Syr, n = 349). The ECAU group received one-page psychoeducation and a referral list to services. Online assessments were administered at baseline, post-assessments at eight weeks after enrolment, and follow-up assessments at 20 weeks after enrolment. Primary outcomes were the Patient Health Questionnaire-9 and World Health Organization Disability Assessment Scale 2.0 scores at all post-assessments.

Results
Intention-to-treat analyses showed significant effects on depression scores (standardized mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97 for Lebanese, and SMD: 0.48; 95% CI: 0.26; 0.70 for Syrians). Significant results were maintained on all secondary outcomes and at follow-up assessments.

Conclusions
SbS proved effective for depressive and functionality symptoms. Subsequently, it was adopted by MoPH as an official, free-of-charge, and first-line service for depression. A global version of SbS is currently being developed by WHO to be replicated and used in several settings worldwide.

Key messages
• This landmark study provided unique evidence on the effectiveness of guided-e-mental health interventions for the Lebanese and Syrian refugees affected by adversity in Lebanon.
• This study guided the scaled-up of SbS into a widely accessible service among the general population.