bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can people afford to pay for health care? Evidence on inequity in financial protection in Europe
Authors:   Organised by: WHO Europe,   Moderator: Natasha Azzopardi Muscat (WHO Europe)
Published: October 2022

Abstract

Governments have repeatedly affirmed their commitment to meeting the goals of universal health coverage (UHC) – to ensure that everyone can use the quality health services they need without experiencing financial hardship. In spite of strong political commitment to UHC, research from the WHO Regional Office for Europe shows that:

This session aims to raise awareness about the most prevalent gaps in coverage in European health systems, the policies that cause them and what countries can do to address them. It will draw on findings from an updated version of the WHO study ‘Can people afford to pay for health care? New evidence on financial protection in Europe’, which covers over 35 countries in Europe, including all EU member states and many middle-income countries
The session will highlight common gaps in coverage that systematically harm people with low incomes:

The session will focus on how to make progress by:

Keynote speaker:
Charles Normand
Trinity College Dublin, Dublin, Ireland

Panellists:
Sarah Thomson
WHO Europe
Kaisa Immonen
European Patients' Forum (EPF)
Food additive emulsifiers and cancer risk: results from the French prospective NutriNet-Santé cohort
Authors: Sellem L , Srour B , Chazelas E , Debras C , Chassaing B , Huybrechts I , Pierre F , Coumoul X , Deschasaux-Tanguy M , Touvier M 
Published: October 2022

Abstract

Background
Food additive emulsifiers are found in thousands of industrial foods and may exert deleterious effects on gut microbiota and carcinogenesis according to experimental studies. However, their associations with cancer risk has not been investigated yet. This study aimed to investigate these associations in a large population-based prospective cohort.

Methods
This study included 102,485 French adults from the NutriNet-Santé cohort (42.1y [14.5], 78.8% female, 2009-2021). Food additive emulsifier intakes were estimated using repeated 24h dietary records linked to brand-specific food composition databases on food additives. Associations with incident cancer risk were assessed using Multivariable Cox models.

Results
3,511 incident cancer cases were diagnosed during follow-up (1,026 breast, 431 prostate, and 279 colorectal cancers). Intakes of sodium citrate (E331, HR = 1.12 [1.02-1.23], p-trend=0.009), xanthan gum (E415, HR = 1.11 [1.02-1.21], p-trend=0.02), and mono- and diglycerides of fatty acids (E471, HR = 1.17 [1.06-1.28], p-trend=0.001 and total: E471, E472a-b-c-e, HR = 1.11, [1.02-1.22], p-trend=0.02) were associated with increased overall cancer risk. Higher intakes of E331 (p-trend = 0.046), sodium stearoyl-2-lactylate (E481, p-trend=0.01), total lactylates (E481-482, p-trend=0.01), total celluloses (E460-468, p-trend=0.03), carob bean gum (E410, p-trend=0.01), and E471 (p-trend=0.006) were associated with increased overall breast cancer risk. Higher intakes of carrageenan (E407, p-trend=0.04), E415 (p-trend=0.02), and triphosphates (E451, p-trend=0.03) were associated with increased post-menopausal breast cancer risk.

Conclusions
These results are the first to investigate and report direct associations between cancer risk and exposures to seven individual and three groups of food additive emulsifiers. If replicated, they may have an important public health impact, considering the omnipresence of these additives in industrial foods globally.

Key messages
• This study is the first to precisely assess exposures to food additive emulsifiers in a population-based study.
• Intakes of food additive emulsifiers were associated with increased risk of cancer.
SARS-CoV-2 Seroprevalence in Germany: results from the second wave of the RKI-SOEP study
Authors: Mercuri E , Poethko-Müller C , Schaffrath Rosario A , Schmid L , Schlaud M , Gößwald A ,   RKI-SOEP-2-study group
Published: October 2022

Abstract

Introduction
The first wave of the “Corona Monitoring bundesweit” (RKI-SOEP) study showed that shortly before the start of the German vaccination program only about 2% of adults (&gt; 18 years) had already experienced SARS-CoV-2 infection and more than half of these cases had been detected and notified. The objectives of the second wave of this study are to further investigate the spread of SARS-CoV-2 in Germanýs population aged over 14 years. It aims to determine the seroprevalence of infection- and vaccine-induced IgG antibodies against SARS-CoV-2. Finally, it examines health, demographic and socioeconomic risk and protective factors for infection and vaccine acceptance.

Methods
From November 2021 to February 2022, the second wave of this cross-sectional study collected biospecimens (capillary blood samples) and interview data, including information on infection and vaccination, from a nationwide population sample drawn from the German Socio-Economic Panel (SOEP). The dried self-collected blood samples were then analyzed for the detection of SARS-CoV-2 IgG antibodies by Euroimmun ELISA assay.

Results
Based on preliminary, unweighted data of around 11,000 participants aged &gt;14 years (52% response rate), we expect the final seroprevalence of SARS-CoV-2 antibodies to be in the range of 80 to 90%. Thus, around 10 to 20% of the German population may still be susceptible to a severe disease progression because they are neither infected nor vaccinated. Final results, weighted for non-response and adjusted for test sensitivity and specificity, will be presented.

Conclusions
The RKI-SOEP-2 study will be pivotal in both, contributing to an improved understanding of SARS-CoV-2 propagation in different regional and sub-group settings and in identifying vulnerable target groups that need to be protected against future infections.

Key messages
• Dried blood self-sampling in a nationwide sample is a robust tool to estimate seroprevalence at a population level.
• As of February 2022, presumably 80 to 90% of the German population has previously been infected and/or vaccinated against SARS-CoV-2.
Health impact Assessment practice in Wales: factors conditioning its success
Authors: Green L 
Published: October 2022

Abstract
Historically, Public Health Institutes (PHIs) were formed to address emergency public health and environmental health related challenges for example, infectious disease outbreaks and sanitary conditions which will affect health. The COVID-19 pandemic has demonstrated the importance and value of PHIs and the specific knowledge and expertise sat within them in the 21st century in relation to critical health issues. However, PHIs have also the potential expertise to look at the wider determinants of health and how they might affect population health and inequalities. In doing so, they play a critical role to advocate for Health in All Policies (HiAP) and Health Impact Assessment (HIA) by engaging with decision makers from health and non-health sectors and providing evidence and health intelligence. Public Health Wales (PHW) has conducted very complex studies as the HIA of the impact of Brexit on the population of Wales, which was praised as very useful by the Welsh Government and local decision makers at a time when, otherwise, little robust evidence-based information was available. Other positive HIA experiences are the recently published HIA about impacts of climate change or COVID-19 pandemic. Those achievements were possible thanks to the establishment of a specific unit dedicated to HIA within PHW, and to the political support and resources. This has built awareness raising and trust in HIA as a tool to support decision making from all sectors in Wales, enabled also by much training and stakeholder participation.
How multimorbidity and socio-economic factors affect Long Covid: Evidence from European Countries
Authors: Wilk P , Ruiz-Castell M , Moran V , Noel Pi Alperin M , Bohn T , Fagherazzi G , Suhrcke M 
Published: October 2022

Abstract

Introduction
An increasing number of individuals continue reporting symptoms following the acute stage of Covid-19 infection. Few studies have investigated the factors related to Long Covid. Our aim was to assess how multimorbidity, socio-economic factors (immigration, education, employment, and income), and country of residence affect the presence and number of persistent symptoms attributable to Covid-19 illness in Europe.

Methods
We used data from the SHARE Corona surveys collected in 2020 and 2021. The sample included 4,004 respondents aged 50 years and older who were affected by the Corona virus. The outcome was the number of persistent symptoms attributable to Covid-19 illness, including: fatigue; cough, congestion, shortness of breath; loss of taste or smell; headache; body aches, joint pain; chest or abdominal pain; diarrhoea, nausea; and confusion. We conducted a multilevel analysis for a hurdle model with negative binomial distribution.

Results
Overall, 73% of respondents were estimated to have at least one persistent symptom associated with Covid-19 illness and, on average, they had 2.73 symptoms. However, there were some statistically significant across country differences in the presence and number of symptoms. Respondents who were employed were more likely to report at least one symptom (OR = 1.40) and those with higher levels of education were less likely to report any symptoms (OR = 0.67). Respondents with multimorbidity had an increased risk of experiencing an additional symptom (RR = 1.12) while respondents who were employed had a decreased risk of experiencing an additional symptom (RR = 0.85).

Discussion and conclusions
Presence and number of persistent symptoms associated with Covid-19 illness was highly prevalent and varied significantly across European countries. Evidence from the present work underscores the need to target high-risk groups and those with multimorbidity to reduce long-term health consequences of Covid-19.
The European response and transformation towards healthy energy
Authors: Matkovic V , Anne S 
Published: October 2022

Abstract
The EU Green Deal is the framework to achieve carbon neutrality by 2050, and decarbonisation and sustainability in the main economic sectors. This includes a revised greenhouse gas reductions goal of at least 55% for 2030, as well as commitments on zero pollution, healthier agricultural production, sustainable mobility and energy. Moreover, as part of the EU Green Deal, the European Commission has established a Just Transition Mechanism (JTM), to ensure that the transition towards a climate-neutral economy happens in a fair way, leaving no one behind. The aim is to mobilise at least €100 billion over the period 2021-2027 for carbon-intensive industries. But health costs of pollution are absent in Just Transition considerations. The Green Deal includes all the right “buzz words” and commitments for a healthy planet for healthy people. However, policy-makers also need to walk the talk when it comes to adopting the right laws and measures. The science and the acceleration of the climate change, environmental and health crises show us that we need to step up. HEAL believes a zero pollution- and health-based approach can be the overarching principle to deliver on these ambitions. The war in Ukraine as the latest crisis has brought up once again the need for the swift, without any delay, phase-out of all fossil fuels. In Europe, the recently proposed RePower EU plan aims to set a pathway for increased renewables, energy savings and diversification well before 2030. However, with a holistic view of the problem under a health lens, it is clear that in this transition from fossil fuels inequalities and social considerations need to be placed central. Of particular importance is to not give space for false solutions such as replacing Russian imports with fuels from other authoritarian regimes or economies which will only continue to perpetuate Europe's energy dependence, or to build up infrastructure that will continue the pollution (gas and biomass included).
How much global climate adaptation finance is targeting the health sector?
Authors: Alcayna T , O'Donnell D 
Published: October 2022

Abstract

Climate change seriously threatens health and wellbeing with projected health burdens estimated to cost USD 2-4 billion a year by 2030. Adaptation in the health sector is critical to keep pace with the ongoing consequences of the climate crisis and the impacts projected to occur in the next decade and beyond. Yet estimates by the WHO indicate that climate finance targeting the health sector to date is extremely low: less than 0.5% of multilateral climate adaptation funding has targeted the health sector. In this study, we trace and quantify the amount of adaptation financing targeting the health sector from both multilateral and bilateral sources using publicly available information on the OECD-DAC database and Climate Funds Update. We find that between 2009-2019 only 0.39% of multilateral and bilateral climate adaptation funding targeted health-related efforts specifically. Despite the relatively higher number of health-related projects in Sub-Saharan Africa compared to other regions, a smaller amount of funding is allocated per project compared to other regions. Regional variations in funding are concerning as the countries with the most vulnerability to the climate crisis coincide with regions getting the least amount of funding per project. There is a significant gap in globally financed adaptation efforts in the health sector. Swift and committed remediation is needed to minimise the spiralling risk of high negative health outcomes.

Key messages
• Between 2009-2019 only 0.39% of multilateral and bilateral climate adaptation funding targeted health-related efforts specifically.
• The countries with the most vulnerability to the climate crisis coincide with regions getting the least amount of funding per health project.
Sexual health inequalities among women aged 16-24
Authors: Solomon D , Gibbs J , Burns F , Mohammed H , Migchelsen SJ , Sabin CA 
Published: October 2022

Abstract

Introduction
Gonorrhoea is the second most commonly diagnosed sexually transmitted infection in England, and diagnoses among young women increased 31% between 2018 and 2019. Understanding the patterns of testing and diagnosis among young women is likely to aid prevention among the most vulnerable segments of this population.

Methods
Data on gonorrhoea diagnoses at sexual health services among women aged 16-24 in England were obtained using the GUMCAD STI Surveillance System. We investigated the relationship between two exposure variables (deprivation and ethnicity), and two outcome variables (number of gonorrhoea tests and number of gonorrhoea diagnoses). Poisson regression was used to calculate rate ratios for the relationship between the exposure and outcome variables. The testing analysis was offset for the size of the population, and the diagnosis analysis was offset for the number of tests within the population.

Results
Between 2012 and 2019, gonorrhoea testing and diagnosis rates were highest among women living in the most deprived areas. The rate of testing in the least deprived 10% of neighbourhoods was significantly lower than that seen in the most deprived 10% of neighbourhoods (rate ratio (RR) 0.79; 95% confidence interval 0.79 - 0.80), and the rate of diagnosis in the least deprived 10% of neighbourhoods was around a third of that seen in the most deprived 10% of neighbourhoods (0.35; 0.33 - 0.36). When compared to White British women, the rate of gonorrhoea diagnosis was lower among Bangladeshi (RR 0.89; 0.75 - 1.05), Indian (0.76; 0.68 - 0.84), Pakistani (0.87; 0.77 - 1.00) and Chinese women (0.60; 0.51 - 0.71) and was highest among Black Caribbean (2.26; 2.18 - 2.33) and Black African (1.40; 1.34 - 1.45) women.

Conclusions
This analysis found inequalities in the distribution of gonorrhoea among young women in England that may indicate structural barriers to STI prevention that are affecting Black women and those living within the most deprived populations.

Key messages
• Gonorrhoea testing rates among young women in England are highest among women from deprived areas and Black women.
• Gonorrhoea diagnosis rates among young women in England are highest among women from deprived areas and Black women.
How can school-based interventions reduce health inequalities? Results from two reviews
Authors: Moor I , Schneider A , Niederschuh L , Winter K , Richter M 
Published: October 2022

Abstract

Background
Even in young people the chances to grow up healthy are unequal, depending on their socioeconomic position (SEP). In order to reduce these health inequalities, the school is an important field of action for health promotion. However, the evidence is limited regarding interventions focusing on health inequalities. Thus, the aim of the current research is to investigate 1) which school-based interventions contribute to the reduction of socio-economic inequalities in health and health behaviour of children and adolescents and 2) how and under what conditions they are successful.

Methods
A systematic and a realist review were conducted. Some steps of the methodological approach were used synergistically for both reviews: development of the search strategy, selection of the databases (MEDLINE, SSCI, SCIE, DoPHER and TRoPHI) and some inclusion and exclusion criteria. The search covered the years 2000-2020. The screening and subsequent steps were applied specific to each review design.

Preliminary results
The search resulted in 10,524 hits of which 37 publications were included for the systematic review. Most of the interventions focused on nutrition (14), followed by mental health (8) and substance use (5). The results indicate that structural preventive interventions are more likely to reduce health inequalities compared to behavioral preventive interventions. For the Realist Review 7 studies were included. Intrapersonal, interpersonal, and institutional factors were extracted that are relevant for school-based interventions focusing on adolescents with low SEP.

Conclusions
The systematic review showed that school-based interventions are able to reduce health inequalities, but also to increase them. Structural preventive measures seem to be helpful in increasing health equity. The Realist review identified mechanisms of interventions which help to address students with lower SEP.

Key messages
• The evidence regarding interventions with focus on health inequalities is limited. We present two reviews analysing what interventions are needed and how and why they work.
• Structural preventive measures seem to be helpful in increasing health equity. Factors on the intrapersonal, interpersonal, and institutional level are important to address students with low SEP.
Stronger together: Community participation, structural stigma, and depressive symptoms of sexual and gender minority individuals living across 28 European countries
Authors: Ünsal B , Demetrovics Z , Reinhardt M 
Published: October 2022

Abstract

Background
Although previous studies demonstrated that structural stigma (i.e., discriminatory state laws, public policies, and attitudes) predicts adverse mental health outcomes among sexual and gender minority (SGM) populations, less is known how protective factors interact with structural stigma. Thus, we aimed to examine the associations between structural stigma, community participation, and depressive symptoms in a large sample of SGM adults.

Methods
Discriminatory laws, policies, and attitudes affecting SGM people were assessed to measure each country's structural stigma levels (i.e., sexual and gender). Data from the 2019 EU-LGBTI-II-Survey assessing community participation levels and depressive symptoms of sexual minority men (n = 62.825), women (n = 38.912), and gender minority adults (n = 15.801) in 28 European countries were analyzed by using multilevel models.

Results
The results demonstrated that structural stigma was positively, and community participation was negatively associated with depressive symptoms of sexual minority men (β = .147, p &lt; .001; β = -.020, p &lt; .05), women (β = .149, p &lt; .01; β = −.040, p &lt; .01), and gender minority adults (β = .085, p &lt; .05; β = -.088, p &lt; .001), respectively. Unlike sexual minority women and gender minority adults, for sexual minority men, a statistically significant interaction was found (β = .018, p &lt; .05) such that participating to the community predicted lower depressive symptoms only in lower-stigma countries.

Conclusions
The results highlight the need for changes in discriminatory laws, social policies, and negative attitudes that impact depressive symptoms of SGM individuals. Although community participation protects individuals from depression, these findings suggest that sexual minority men in higher-stigma countries benefit less from community participation. Thus, interventions aiming to increase SGM individuals’ community participation should consider structural factors and gender differences.
What are the drivers of waiting times, waiting lists and backlog during and following the COVID-19 pandemic?
Authors: Siciliani L 
Published: October 2022

Abstract
The COVID-19 pandemic put a halt to the number of patients being treated thus generating larger excess demand and a greater mismatch between demand for health care services and the supply of services provided. This presentation will provide a conceptual framework for understanding the dynamic interrelation between waiting times, waiting lists and the backlog over time. Data from different countries will be used to illustrate and rationalise how waiting times, lists and volumes evolved over time. It will then discuss factors driving the demand and supply of care during Covid, and emphasise the critical role of supply in absorbing the backlog and reducing the waiting list under different scenarios, as well as factors on the demand side both in the short run and the long run. Supply determinants include the availability of health workers as key factor to “bounce back”, their productivity and provider capacity (hospital beds, operating theatres), the cost of providing treatment in a safe environment, financial capacity to fund additional supply both by public and private providers, interventions to minimise staff exhaustion and burnout, payment systems which are aligned with higher volumes, and technologies and digital solutions. Demand determinants include ageing and rising chronic conditions, and multi-morbidity patients (including long-COVID patients), increasing expectations, new technologies, prioritisation protocols, but also fear of infection which can leading to a temporary or permanent reduction in demand but an increase in unmet need. The framework will be used to discuss policy options both on the demand and the supply side to deal with the backlog, but also to improve the resilience and efficiency of health systems.