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The aim of this paper is to contribute technical arguments to the debate about the importance of health examination surveys and their continued use during the post-pandemic health financing crisis, and in the context of a technological innovation boom that offers new ways of collecting and analysing individual health data (e.g. artificial intelligence). Technical considerations demonstrate that health examination surveys make an irreplaceable contribution to the local availability of primary health data that can be used in a range of further studies (e.g. normative, burden-of-disease, care cascade, cost and policy impact studies) essential for informing several phases of the health planning cycle (e.g. surveillance, prioritization, resource mobilization and policy development). Examples of the use of health examination survey data in the World Health Organization (WHO) European Region (i.e. Finland, Italy, Malta and the United Kingdom of Great Britain and Northern Ireland) and the WHO Region of the Americas (i.e. Chile, Mexico, Peru and the United States of America) are presented, and reasons why health provider-led data cannot replace health examination survey data are discussed (e.g. underestimation of morbidity and susceptibility to bias). In addition, the importance of having nationally representative random samples of the general population is highlighted and we argue that health examination surveys make a critical contribution to external quality control for a country's health system by increasing the transparency and accountability of health spending. Finally, we consider future technological advances that can improve survey fieldwork and suggest ways of ensuring health examination surveys are sustainable in low-resource settings. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long-term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented. [ABSTRACT FROM AUTHOR]

Disease mapping seeks to represent the risk of a disease. This paper focuses on the spatial analysis of risk for pandemic COVID-19 in Europe and the Mediterranean. Morbidity and mortality data for 54 countries in ratio format were used. Two hypotheses were considered, the first one is that the data are homogeneous and the second one is that the ratios are defined in a heterogeneous manner requiring the stratification on the basis of covariables and the methodology of Jenks' intervals. Spatial risk models were applied as well as methods for the representation of clusters. The results show that the best representation is obtained with the Poisson-Gamma Model under stratification. The variations in the ratios are due to the individual policies of each country for the management of the pandemic. The cluster analysis shows that there is a high mortality process in Eastern Europe. The behavior of the pandemic should be evaluated in the space-time process as well as in other heterogeneous and highly unequal regions. [ABSTRACT FROM AUTHOR]

Background: Within the European Union (EU), substantial efforts are being made to achieve economic and social cohesion, and the reduction of health inequalities between EU regions is integral to this process. This paper is the first to examine how self-reported conditions and non-communicable diseases (NCDs) vary spatially between and within countries. Methods: Using 2014 European Social Survey (ESS) data from 20 countries, this paper examines how regional inequalities in self-reported conditions and NCDs vary for men and women in 174 regions (levels 1 and 2 Nomenclature of Statistical Territorial Units, 'NUTS'). We document absolute and relative inequalities across Europe in the prevalence of eight conditions: general health, overweight/obesity, mental health, heart or circulation problems, high blood pressure, back, neck, muscular or joint pain, diabetes and cancer. Results: There is considerable inequality in self-reported conditions and NCDs between the regions of Europe, with rates highest in the regions of continental Europe, some Scandinavian regions and parts of the UK and lowest around regions bordering the Alps, in Ireland and France. However, for mental health and cancer, rates are highest in regions of Eastern European and lowest in some Nordic regions, Ireland and isolated regions in continental Europe. There are also widespread and consistent absolute and relative regional inequalities in all conditions within countries. These are largest in France, Germany and the UK, and smallest in Denmark, Sweden and Norway. There were higher inequalities amongst women. Conclusion: Using newly available harmonized morbidity data from across Europe, this paper shows that there are considerable regional inequalities within and between European countries in the distribution of self-reported conditions and NCDs. [ABSTRACT FROM AUTHOR]

Background: A range of non-communicable diseases (NCDs) has been found to follow a social pattern whereby socioeconomic status predicts either a higher or lower risk of disease. Comprehensive evidence on the socioeconomic distribution of NCDs across Europe, however, has been limited. Methods: Using cross-sectional 2014 European Social Survey data from 20 countries, this paper examines socioeconomic inequalities in 14 self-reported NCDs separately for women and men: heart/circulatory problems, high blood pressure, back pain, arm/ hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Using education to measure socioeconomic status, age-controlled adjusted risk ratios were calculated and separately compared a lower and medium education group with a high education group. Results: At the pooled European level, a social gradient in health was observed for 10 NCDs: depression, diabetes, obesity, heart/circulation problems, hand/arm pain, high blood pressure, breathing problems, severe headaches, foot/leg pain and cancer. An inverse social gradient was observed for allergies. Social gradients were observed among both genders, but a greater number of inequalities were observed among women. Country-specific analyses show that inequalities in NCDs are present everywhere across Europe and that inequalities exist to different extents for each of the conditions. Conclusion: This study provides the most up-to-date overview of socioeconomic inequalities for a large number of NCDs across 20 European countries for both women and men. Future investigations should further consider the diseases, and their associated determinants, for which socioeconomic differences are the greatest. [ABSTRACT FROM AUTHOR]

Background: Although there is evidence that tailored implementation strategies can be effective, there is little evidence on which methods of tailoring improve the effect. We designed and evaluated five tailored programs (TPs) each consisting of various strategies. The aim of this study was to examine (a) how determinants of practice prioritized in the design phase of the TPs were perceived by health care professionals who had been exposed to the TPs and whether they suggested other important determinants of practice and (b) how professionals used the offered strategies and whether they suggested other strategies that might have been more effective.Methods: We conducted a mixed-method process evaluation linked to five cluster-randomized trials carried out in five European countries to implement recommendations for five chronic conditions in primary care settings. The five TPs used a total of 28 strategies which aimed to address 38 determinants of practice. Interviews of professionals in the intervention groups and a survey of professionals in the intervention and control groups were performed. Data collection was conducted by each research team in the respective national language. The interview data were first analyzed inductively by each research team, and subsequently, a meta-synthesis was conducted. The survey was analyzed descriptively.Results: We conducted 71 interviews; 125 professionals completed the survey. The survey showed that 76 % (n = 29) of targeted determinants of practice were perceived as relevant and 95 % (n = 36) as being modified by the implementation interventions by 66 to 100 % of professionals. On average, 47 % of professionals reported using the strategies and 51 % considered them helpful, albeit with substantial variance between countries and strategies. In the interviews, 89 determinants of practice were identified, of which 70 % (n = 62) had been identified and 45 % (n = 40) had been prioritized in the design phase. The interviewees suggested 65 additional strategies, of which 54 % (n = 35) had been identified and 20 % (n = 13) had been prioritized, but not selected in the final programs.Conclusions: This study largely confirmed the perceived relevance of the targeted determinants of practice. This contrasts with the fact that no impact of the trials on the implementation of the recommendations could be observed. The findings suggest that better methods for prioritization of determinants and strategies are needed.Trial Registration: Each of the five trials was registered separately in recognized trial registries. Details are given in the respective trial outcome papers. [ABSTRACT FROM AUTHOR]

Objectives: Health Impact Assessments (HIA) approach can be executed by calculating the attributable burden of disease. The most common indicators used in the HIA methodology are: premature mortality, morbidity, life-expectancy, and Disability Adjusted Life-Year (DALY). The term Disability Adjusted Life-Years (DALYs) indicates months/years lost due to a premature death or disability. The aim of the study was to present health benefits, expressed in terms of lower total mortality and cardio-respiratory hospitalization rates, due to a decreased particulate matter (PM) concentration in ambient air, in Silesian voivodeship.Material and Methods: In this paper, results obtained from the APHEKOM (Improving Knowledge and Communication for Decision Making on Air Pollution and Health in Europe) project, which provided specialized HIA tools, useful for assessing health benefits resulting from reducing air pollution, were used. Both short-term and long-term exposure HIA tools were applied with regard to the appropriate data for Silesian voivodeship. Exposure data were obtained from the Regional Environmental Inspectorate in Katowice, while population and health data were obtained from the Central Statistical Office of Poland or from the Silesian Voivodeship Office, respectively.Results: Health benefits that are related to an improvement of ambient air quality in Silesia region are similar to previous estimates obtained for Kraków city. The reduction of short-term exposure to PM10 by 5 μg/m3 results in a lower number of yearly non-external deaths (2.6-2.75 per 100 000 inhabitants). This effect was also shown to be similar in the city of Zabrze, as well as in the whole Silesia region.Conclusions: The Health Impact Assessments tools developed by the World Health Organization (WHO) can help public health experts make decisions in order to improve the health of populations living in particular regions of Europe. [ABSTRACT FROM AUTHOR]

Background A better understanding of predictors of risk for pancreatic ductal adenocarcinoma (PDAC) could inform preventive efforts against this lethal cancer. While aspirin (ASA) and non-steroidal anti-inflammatory drugs (NSAIDS) might protect against several gastrointestinal cancers, their role in the development of PDAC remains unclear. Aim To conduct a systematic review and meta-analysis on the relation between ASA/NSAIDs exposure and the risk of PDAC. Methods We searched Pubmed, Embase, Scopus, Cochrane database of systematic reviews and reference lists of identified papers and included observational (cohort or case-control) studies and randomized controlled trials examining exposure to ASA and/or NSAIDs and the incidence or mortality of PDAC. We defined three categories (low, intermediate, high), based on exposure duration and dose. Results Eight studies fulfilled our inclusion criteria (four cohort, three case controls, and one randomized controlled trial studies) enrolling 6301 patients between 1971–2004; all but one study took place in the US. The pooled OR were 0.99 (0.83–1.19), 1.11 (0.84–1.47) and 1.09 (0.67–1.75) in the low, intermediate and high exposure groups respectively, with considerable heterogeneity (I2 ranging 60–86%). Sensitivity analysis by ASA use only, study design or sex did not reveal additional important information. Conclusions This study did not show an association between ASA/NSAIDs and PDAC. The large baseline exposure in controls in North-America may have obscured an association. There is need for additional studies, especially in Europe, to clarify this issue. [ABSTRACT FROM AUTHOR]

Introduction The situation in Tasmania represents a unique perspective. Within the public system, the entire patient population is available for examination in a linked and costed dataset covering the past 10 years. This dataset provides the opportunity to examine the effect of high levels of comorbidity on patient-care pathways, as well as the associated cost estimates. Methods For the present analysis, a subset of the existing casemix dataset - encompassing admitted and emergency department care - was examined. An approach to identifying multi-morbidity cases was created based on the occurrence of distinct conditions in the coded dataset. A further analysis of PCCL scores was made by using a modified version of the AR_DRG-V5.1 grouper. Results The primary dataset comprised 191,000 individuals with 433,000 episodes of admitted data over a four-year period. The 3,376 individuals having multi-morbidity were identified. These individuals encompass nearly 48,000 episodes with 1,550 deaths. Conclusion The paper outlines an approach to identifying these individuals, and analyzing some aspects in terms of occurrence, cost, and outcome. It builds on work already undertaken in identifying the impact of tertiary care using Australian and European data. The high level of disease burden, and disproportionate use of hospital resources, requires that this analysis be undertaken to identify the scope for improvement in the care of these individuals, as well as creating a model for a better allocation of resources. [ABSTRACT FROM AUTHOR]