bluuebunny/crossref_metadata_2025_split huggingface dataset:
4.B. Workshop: Addressing backlogs and managing waiting lists during and beyond the COVID-19 pandemic
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Ewout Van Ginneken (Germany), Sarah Reed (UK)
Published: October 2022

Abstract

As COVID-19 cases started to rise in early 2020 and hospitalisation rates increased, health systems began to postpone non-emergency (elective) procedures to keep capacity available for COVID-19 patients, and to avoid elective patients being infected. This has subsequently led to longer waiting lists and waiting times in virtually all countries. Issues around staff recruitment and retention, which have been exacerbated by the COVID-19 pandemic, have further aggravated the problem. For patients with common elective surgeries, such as hip and knee replacements, the backlog in care means that improvements in health and quality of life are postponed. For urgent care, such as missed chemotherapy sessions for cancer care, the delays can have more severe consequences. For other patients, the postponement of specialist appointments may lead to missed referrals for serious ailments. Increasingly also primary care has become affected leading to late diagnosis of chronic diseases, as well as inadequate follow up and control of these patients. Each delay in diagnosis and treatment may worsen health problems, prolong recovery and decrease the patients’ chances of survival. Countries are now left playing catch-up on these backlogs. There is however great uncertainty regarding the size of the backlogs, how much current and future capacity will be required to address them, and how much provider and workforce capacity will be needed for COVID-19 patients which will detract capacity for non-COVID patients. If health systems do not manage to reduce the backlog, they risk worsening health outcomes and wasting important health gains made in the last years. This workshop will discuss what we know about (1) the level of service disruptions and resulting backlog, (2) the drivers of backlog, and (3) which policies countries are using to address this. The workshop will conclude with an audience discussion about how to measure the true size of the backlog, the policy options for overcoming backlog and key priorities for further research.

Key messages
• The COVID-19 pandemic has led to substantial disruptions in care delivery leading to care backlogs in virtually all countries.
• Countries have various policy options to tackle backlogs and bring down waiting times in the wake of the pandemic.
Engaging and supporting national public health institutes as key climate actors
Authors: Ballart A , Denys S 
Published: October 2022

Abstract
The International Association of National Public Health Institutes (IANPHI) collectively builds public health capacity by connecting, developing and strengthening national public health institutes worldwide. IANPHI recognizes climate action as a critical global public health intervention and acknowledges that public health interventions on environmental and socio-economic determinants of health are essential drivers of climate adaptation and mitigation. Recovery from the COVID-19 pandemic also provides a unique opportunity to reset business as usual and strengthen actions on climate change, biodiversity and health, while reducing social and health inequities in the long term. However, effective contributions of National Public Health Institutes (NPHIs) to adaptation plans and mitigation strategies for climate change have remained limited, with a primary focus on health surveillance to date. In this context, IANPHI developed a roadmap to support and reinforce the role of NPHIs in climate change mitigation and adaptation policies. Five priority actions were identified:
1. Advocate for strengthening NPHIs capacities to contribute effectively to climate and biodiversity research, policies, and action
2. Enhance capacity, competence and training through peer-to-peer support and knowledge sharing between NPHIs
3. Increase collaboration with international and regional organizations active in the fields of public health and climate change
4. Support the greening of public health services
5. Monitor progress in the NPHIs’ involvement in climate change policies through key indicators
In addition to discussing the roadmap, the presentation will focus on actions that IANPHI's Climate Change and Health committee initiated to reinforce the role of NPHIs in climate change mitigation and adaptation policies. This presentation will also provide information on how IANPHI can engage and support national public health institutes as key actors in the fight against climate change.
The NIPH’s response to the climate and environmental crisis
Authors: Aakra A 
Published: October 2022

Abstract
The vision of the Norwegian Institute of Public Health (NIPH) is better health for all. Climate changes and health are among our main strategic priorities. The NIPH aims to become a key actor in questions relating to climate, environment, food and health. An action plan on climate changes and environmental health is under development and will be presented. Climate and environmental changes affect the mental and physical health in several ways. The NIPH will in the coming years develop new knowledge on health consequences of climate changes: causes, risks, health effects and measures, based on our methodological expertise, research activities and infrastructures, such as health registers, health examinations, laboratories and biobanks. A key issue, and a main priority of the NIPH, is sustainable and climate-adapted food systems. There is a strong need to strengthen knowledge on healthy, safe and globally sustainable food. We will present and discuss our action plan for addressing climate and environmental health: Priorities, experiences, and challenges in implementation regarding e.g. competence and capacity building.
The following examples will be given:
– Research that addresses the food problem, and how to ensure a sustainable diet.
– The development of the MoBa Human Environmental Biobank to understand how climate and environmental changes affect exposure and public health, and how to follow the changes over time and help prevent disease.
– Examples of activities relating to clean air, clean and safe drinking water, and safe products from a One Health perspective: Achievements, projects, networks.
– Challenges in communicating health risks associated with the climate, environmental and pollution crisis to the public.
We encourage feedback and suggestions on NIPH's efforts to address the climate crisis, to ensure good knowledge sharing and that we are fully supporting our stakeholders.
Economic evaluation of legislation-based public health interventions – the case of tobacco control
Authors: Perelman J , Leão T , Serrano-Alarcon M 
Published: October 2022

Abstract
Economic evaluation of public health interventions have mostly been performed for interventions whose cost and effectiveness can be well identified, such as protective interventions (vaccination or screening), clinical interventions (prevention drugs) or counselling and education programs. Yet, following the Thomas Frieden's health impact pyramid, these public health interventions are less effective than those “changing the context to make individuals’ default decision healthy”. The economic evaluation of population-based interventions that modify the context is rather challenging. First, such interventions include various components, e.g., taxes and subsidies, media campaigns or bans. Second, since they correspond to political decisions applied at a wide scale, their effectiveness can hardly be measured using experimental designs. Third, the cost of such interventions is difficult to assess, since they are not represented by a specific product or service, but rather by political decisions and their implementation, whose costing is not straightforward. Using the case of tobacco control policies, we show how alternative methods can be used to assess their economic value. We show that quasi-experimental methods with country comparisons allow identify the effectiveness of specific policies, and that qualitative approaches are needed to quantify their costs. Results indicate that tobacco-control policies have low costs and are highly effective, so that their cost-effectiveness is quite favorable in light of commonly referred thresholds, and in comparison with widely financed clinical interventions. Population-based interventions that focus contextual factors must also be carefully evaluated from an economic viewpoint. Although economic evaluations are challenging, alternative approaches help obtain results that are valuable for decision making.
Access of Syrian Refugee Women to Sexual and Reproductive Health Services in Turkey during COVID-19
Authors: Ontas E , Bahar Ozvaris S , Guciz Dogan B , Kutluk T 
Published: October 2022

Abstract

Women and girls are more disadvantaged in times of crisis, and their chances of surviving and fleeing are limited. As the Syrian crisis enters its eleventh year, Turkey alone hosts the largest population (over 3.7 million). It aimed to evaluate essential reproductive health services in the shadow of the pandemic that deepens the crisis. The research was conducted in April 2021 with 637 married Syrian refugee women aged 15-49 living in Ankara (mean age: 29.6). The median age at first marriage was 17, and consanguinity with her spouse was 29.8%. 8.6% were illiterate. 36.3% did not/could not benefit from public hospitals free of charge, and 89.8% did not have health insurance. 96.7% had a previous pregnancy (median:4). Since the pandemic's beginning, 35.6% have been pregnant (n = 219), and 14% are still pregnant (n = 86). Of 133 women whose pregnancies ended during this period, 78.2% gave birth (n = 104) and 21.8% miscarried. 12.8% of pregnancy was terminated at home (n = 17, 14 of which could not receive support from anyone). 41.1% of those who became pregnant during the pandemic were not followed up in pregnancy; 45.1% of those whose pregnancies ended were not followed up in the puerperium. 29.5% of all the participants stated that they had not used any birth control method. The most common reason for not using family planning is fear of harm to health and their spouse's disapproval. Only 3.3% of those currently using birth control methods stated difficulty accessing birth control methods. The most used information resources about pregnancy, childbirth and contraception methods were hospitals and Migrant Health Centres.
This study is funded through the UK Research and Innovation GCRF Research for Health In Conflict (R4HC-MENA), developing capability, partnerships and research in the Middle and Near East (MENA) [ES/P010962/1].

Key messages
• In refugee crises, women's health should be structured as a separate heading in the health system and unmet sexual health needs should be met, especially in culture-oriented primary care services.
• Women should be empowered with a health system where women can determine their own needs and make decisions about their bodies.
The 2009-2014 economic crisis and deaths by suicide in Portugal: time series analysis
Authors: Pinheiro V , Caetano C , Pereira da Silva S , Nunes B 
Published: October 2022

Abstract

Introduction
Population health, including mental health, is influenced by its socioeconomic context. After the 2008 global economic crisis, studies found contradicting results: some showed an increased risk for self-harm and suicidal behavior, while others found the opposite association. To the best of our knowledge, there is no research in Portugal on the subject. Thus, our aim was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the death rate by suicide and self-inflicted injury in Portugal.

Methods
A retrospective ecological study with an interrupted time series analysis of deaths by suicide and self-inflicted injury (data from the National Statistics Institute) in mainland Portugal, in 2003-2014, was performed. Resident population data was also retrieved from the National Statistics Institute. Binomial negative generalized linear models were used to compare rates and trends before (2003-2008) and during (2009-2014) the economic crisis. All rates were stratified and adjusted for seasonality.

Results
The economic crisis was associated with 13% a step increase in the death rate due to suicide and self-inflicted injury, with unemployment playing a significant mediating role, being negatively associated to the outcome. Differences between groups exist, with males, working-age groups and the North and Centre regions being the most impacted, globally.

Conclusions
Economic downturns pose risks for suicidal behavior. Unemployment may play a role in this association. Employment protection schemes can prevent this impact, so urgent action is needed to prevent economic crisis leading to additional suicides, especially in the context of the COVID-19 pandemic and the economic crisis it caused.

Key messages
• The Portuguese economic crisis of 2009-2014 was associated with an increased death rate due to suicide, especially in males, working-age groups and the North and Centre regions.
• Unemployment may play a role in this association, and active labour market programmes can prevent the negative impacts of economic crisis leading to additional suicides.
Finding the fitting framework for the implementation of policies promoting healthy nutrition and physically active lifestyle: Results from a systematic review
Authors: Forberger S , Lobczowska K , Banik A , Romaniuk P , Kubiak T , Meshkovska B , Neumann-Podczaska A , Kaczmarek M , Scheidmeir M ,   al
Published: October 2022

Abstract

Background
Policies are an important upstream component of health promotion to influence the general population. Various frameworks exist to help implement policies. However, there is currently no overarching synthesis that describes the differences between policy implementation frameworks. In this study, we examined frameworks for implementing policies to promote healthy eating, physical activity and reduce physical inactivity and aimed to explore the scope of the frameworks, the content of the constructs they contain (e.g. processes, determinants, evaluation), the level at which these constructs operate and the inclusion of equity factors.

Methods
A systematic review (PROSPERO registration number: CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analysed.

Results
All three constructs were covered by 18 frameworks: description of the process, determinants and evaluation of implementation. The majority of frameworks (25/38) considered constructs from three levels: the individual, organisational/community and system levels, with system level constructs being included less frequently than individual level or organisational/community level constructs. Most frameworks (32/38) contained sections that were exclusively descriptive. In addition, 19 frameworks contained prescriptive and 23 explanatory sections. The complex systems approach was included in 8 of the frameworks. More than half of the frameworks (21/38) did not consider equity constructs.

Conclusions
Most frameworks have a complex scope, include multi-level constructs, combine sections that are purely descriptive with sections that consider prescriptive and/or explanatory associations, and include few or no equity constructs. The findings of this study can facilitate the process of selecting the framework that best fits the needs and goals of policy makers, researchers and policy implementation actors seeking guidance.
The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity
Authors: Woods C , Kelly L , Volf K , Gelius P , Messing S , Forberger S , Lakerveld J , den Braver N , Zukowska J ,   PEN consortium
Published: October 2022

Abstract

Background
Insufficient physical activity (PA) is a global issue for health. A multifaceted response, including government action, is essential to improve population levels of PA. The purpose of this study was to develop the ‘Physical Activity Environment Policy Index’ (PA-EPI) monitoring framework to assess government policies and actions for creating a healthy PA environment.

Methods
An iterative process was undertaken. This involved a review of policy documents from authoritative organisations, a policy audit of four European countries, and systematic reviews of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops where quantitative and qualitative data alongside theoretical and pragmatic considerations were used to inform PA-EPI development.

Results
The PA-EPI is conceptualised as a two-component ‘policy’ and ‘infrastructure support’ framework. The two components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development, and health-in-all-policies. Forty-five ‘good practice statements’ (GPS) or indicators of ideal good practice within each domain concludes the PA-EPI. A potential eight-step process for conducting the PA-EPI is described.

Conclusions
Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI GPS will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.
Development of the Health Promoting Sports Club - National Audit Tool
Authors: Van Hoye A , Vuillemin A , Lane A , Dowd K , Geidne S , Kokko S , Donaldson A , Seghers J , Whiting S , Johnson S 
Published: October 2022

Abstract

Background
Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This manuscript outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs.

Methods
A 5-step process was undertaken by an international project team: (1) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (2) a thematic analysis to categorize items, (3) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (4) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (5) audit tool finalization though project team consensus.

Results
Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with three broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation & Dissemination; Evaluation & Measurement methods; Sub-national level policies; Funding & Coordination; Participative approach; Actors & Stakeholders; National sporting events; Case studies and Implicated stakeholders.

Conclusions
To progress HP in the sports club context it is necessary to understand existing national level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.
Was there any delay in the treatment of breast cancer patients because of the COVID-19 stringency measures?
Authors: Estupiñán-Romero F , González-Galindo J , Martínez-Lizaga N , González-García J , Derycke P , Aldridge S , Faragalli A , Raimundo Maia M , Zile I , Bernal-Delgado E 
Published: October 2022

Abstract

Background
Healthcare systems across Europe reorganized services to provide attention to COVID-19 patients. In the event of the surge of cases, countries were forced to cancel or postpone non-urgent care. The objective of this work is to investigate whether there were time-to-treatment delays in breast cancer due to April-May 2020 restrictions, and whether the delays were permanent and different across countries.

Methods
Design: Quasi-experimental pre-post study with a historical control. Population: Virtually the universe of breast cancer patients receiving elective surgery, radiotherapy, hormonal therapy or chemotherapy since January 2017 (until December 2021) in the participant regions - Belgium, Marché (IT), Riga (LV), Portugal, Wales, and Aragon (ES). The main endpoint is the change in the median time-to-treatment before and after an empirical joint-point. The study variables are detailed here https://doi.org/10.5281/zenodo.5148022. Analysis: Distributed generalized additive models using https://cran.r-project.org/package=mgcv.

Results
Preliminary results show that the impact in March-April 2020 time-to-treatment evolved differently across countries. For instance, while the median time from diagnosis to surgery, as the first treatment, increased from approximately 39 days (2018-2019) to more than 45 days (2020-2021) in Wales, in the Marche region (IT) the median time decreased from 52 days in 2017-2019 to 47 days in 2020. Complete analyses for the rest of the participant countries are currently undergoing.

Conclusions
We have observed differences in time to treatment in women with breast cancer across countries; however, the magnitude and direction of the effect has been uneven across countries.