Search

Facing the considerable variation in the computation of disability-adjusted life years (DALY) in the numerous updates of the Global Burden of Disease (GBD) study and many independent studies, the European burden of disease network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key assumptions used in the European burden of disease (BoD) studies. The SLR will provide an overview of the existing BoD studies and the computational variations used and will also help identifying ways to harmonize the approaches enhancing the comparability of BoD estimates. The SLR was split in four parallel reviews: noncommunicable diseases (NCDs), communicable diseases (CDs), injuries and risk factors. For the first three, the search strategy included terms describing the population (GBD area ‘‘European region’’) and the BoD measures (years lived with disability, years of life lost, and DALYs). We included studies published between January 1990 and April 2020, without language restrictions. The search strategy was run in PubMed, Web of Science, Cochrane, and Embase. OpenGrey, OAIster, CABDirect, WHO and targeted public health agency websites were screened for grey literature. In addition, burden-eu members were asked to supplement the list of publications with any material available within their national public health institutes. Data extraction focused on methodological information. The title, abstract and full-text screening resulted in the final inclusion of 165 papers regarding NCDs, 189 with CDs, and 124 papers regarding injuries. The final list includes peer-reviewed articles and reports showing a variability in data sources used (e.g. patient medical records, disease registries, insurance claims sources) and model assumptions (e.g. use of multi-morbidity adjustments, use of disability weights). Further data extraction and analysis is in process, and will be presented during the workshop. [ABSTRACT FROM AUTHOR]

The article provides updates on issues related to the European Public Health Association (EUPHA) as of October 2019. Topics covered include opportunity of the World Health Organization to renew its vision for health in Europe beyond 2020, a white paper published by the European Commission in March 2017 setting out five possible paths for the future of Europe, and EUPHA's statement on what European political parties are stating on health.

Background Frailty is a common, multi-factorial, age-related syndrome commonly observed in people with diabetes. Although older diabetics are prone to adverse healthcare outcomes and diabetes increases the risk of developing frailty, little is known about the effects of frailty on diabetes. This paper examines the association between diabetes, frailty, and mortality in Europeans aged ≥50 years. Methods Data were included from The Survey of Health, Ageing and Retirement in Europe (SHARE) waves one and six. A participant's first interview was taken as the baseline and subsequent waves were used for mortality follow-up (time and cause). Frailty and pre-frailty were measured using established cut-offs using the Physical Phenotype (SHARE-FI) and a 55-item Frailty Index (FI-55). Kaplan-Meier survival analysis was used to assess the relationship between frailty and mortality in people with diabetes and significance tested using log-rank test. Cox regression was used to adjust for potential confounders (age, sex, education, income, employment, alcohol use, smoking, hypertension, hypercholesterolaemia, myocardial infarction, stroke, metastatic cancer, chronic lung disease, polypharmacy, self-perceived health and depression). Results Data from 8,954 diabetics aged 50-99 years were included with 1,598 deaths (17.8%). According to the SHARE-FI, 1,971 (22.0%) were frail, 4,183 (46.7%) pre-frail and 2,800 (31.3%) robust. According to the Kaplan-Meier log-rank test survival varied significantly across frailty strata according to both indexes (p<0.001). At 10-year follow-up, adjusting for confounders SHARE-FI frailty and pre-frailty were significantly associated with mortality, adjusted Hazard Ratio (HR) 2.19, (95% CI:1.66-2.89), and 1.38 (95% CI:1.09-1.74), respectively. Results were similar using the FI-55, HR for frailty 1.66 (95% CI:1.09-2.54). Causes of mortality were significantly different according to frailty status (p<0.05). Conclusion Frailty and pre-frailty are independent risk factors for mortality in diabetics. The identification of frailty is important for the risk-stratification and management of middle aged and older patients with diabetes and should be included in the routine assessment of these high-risk individuals. [ABSTRACT FROM AUTHOR]

The annual meeting of the European Association of Cardiovascular Imaging, EuroEcho-Imaging, was held in Milan, Italy, in December 2018. In the present paper, we report a summary of the 'Highlights' session. [ABSTRACT FROM AUTHOR]

The article highlights the importance of collaboration and collective action in advancing public health. Topics discussed include the strategic retreat of the European Public Health association (EUPHA), important factors of social factors in determining the health outcomes of different population groups, and the 17th European Public Health Conference in Lisbon, Portugal on November 13-15, 2024.

This report provides abstracts of papers to be presented at the 8th European Public Health Conference in Milan, Italy, from October 14 to 17, 2015, covering topics such as chronic diseases, mental health and health promotion.

Background: Aim of Com.HeNet is among others to identify competences which are needed to implement and manage a health network on regional level in European countries. Description: All participating countries have used the same method for data gathering. Templates in terms of method guidelines were developed and used uniformly. First, a structured literature search was conducted to gather data regarding circumstances, structures and challenges in relation to RHNM. Relevant existing papers, reports and officially released documents from public facilities or e.g. reports from governmental authorities have been included. Grey literature from online websites and resources were also accessed. The second method represents semi-structured guided expert interviews. The interview guideline was developed by European experts (n = 10) from divers fields e.g. Public Health, Sport science and Management. Afterwards pre-testing the interview guideline, relevant experts and stakeholders from diverse fields, were interviewed e.g. Public Health, Health Promotion, clinical services, politics, practitioners or research. Overall n = 33 interviews were carried out [Austria = 5, Bulgaria = 5, Germany = 5, Hungary =5, Spain= 6, Poland =7]. Afterwards the interviews have been transcribed and analysed. The statements were evaluated in a structured and summarizing analysis for homogeneity / diversity / quantity of the various opinions. All results were incorporated in a uniform predefined template (competence profile). Conclusions: Semi-structured/ guided interviews represent a suitable method to gather data in terms of required competences for health network management. Desktop research / literature search is appropriate to support the qualitative data gathering. [ABSTRACT FROM AUTHOR]

Social prescribing is seen as a mechanism for addressing the social determinants of health, preventing exacerbation of preexisting diseases, reducing attendance in primary and emergency care and improving general population health and well-being. Social prescribing involves individuals being referred/self-referring to non-medical interventions run by a third-party organisation. Social prescribing has received widespread attention internationally; however, the evidence base to support social prescribing lacks rigour, and gaps remain. The complexity of social prescribing, in that it involves multiple referral routes, partners, pathways and outcomes, poses challenges for its evaluation and research. Researchers across Europe have developed different projects of research to address the challenges associated with evaluating social prescribing. Development of the evidence base for social prescribing is crucial in informing policy and public health systems to deliver effective interventions that contribute to individual, community and systemic outcomes. This workshop aims to share different approaches that have been taken across Europe to address issues in producing evidence base and share learning about the challenges and solutions that researchers have developed, specifically regarding research about implementation and evaluation of social prescribing. The workshop will be structured in a first part of presentations and the second part of open discussion with presenters and the audience. This workshop will present five papers which will address two key questions: 1. What have we learned about developing the evidence in social prescribing?; 2. What challenges have we experienced, and what solutions have we come up with? The short presentations will cover examples of social prescribing initiatives based on implementation and evaluation studies conducted in diverse European countries. Learning shared with the audience through the presentations will stimulate discussions around challenges with implementing and evaluating social prescribing. This workshop will inform the development of an overarching guidance on implementing social prescribing interventions, as well as identify parallel challenges in other areas of public health. Key messages: • Interactive session to discuss strategies for successful social prescribing projects addressing complex health issues that are relevant to stakeholders and for research to inform practice and policy. • Collaboration with interdisciplinary stakeholders is crucial in developing the evidence base for social prescribing. [ABSTRACT FROM AUTHOR]

This section offers public health news briefs in Europe, as of October 2023. Topics covered include how much the European Public Health Association is able to do with its small secretariat, the regional roadmap on antimicrobial resistance for 2023-2030 which member states of the World Health Organization European Region are invited to adopt and the 16th European Public Health Conference to be held in Dublin, Ireland on November 8-11, 2023.

The quinquennial Nuclear Non-Proliferation Treaty (NPT) Review Conference represents a highly important event from the perspective of the EU Common Foreign and Security Policy (CFSP). Though not a party to the treaty itself, the EU has made a consistent effort since the 1990s to coordinate the positions of its member states and achieve higher visibility in the NPT review process. The aim of this article is to examine the role of the EU in the 2015 NPT Review Conference deliberations. Drawing on on-site observations, statements and in-depth research interviews, it argues that the recent institutional changes notwithstanding, the influence of the EU as a distinct actor in the NPT context remains very limited, and the EU's common position is in bigger disarray than ever before. This year's Review Conference demonstrated the widening rift between the member states, in particular in the area of nuclear disarmament and the related issues. The inability to maintain a coherent common position limits the EU 'actorness' and impedes its striving for relevance in the NPT forums. The dynamics outlined in this article further highlight the limits of the EU CFSP in security matters in which the national positions of individual member states are as divergent as in the case of nuclear disarmament. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has reinforced the centrality of health workers at the core of a well performing and resilient health system. It has concomitantly exposed the risks of staffing and skills shortages and the importance of protecting the health workforce. This paper focuses on highlighting some of the lessons learnt, challenges and future needs of the health workforce in Europe in the context of COVID-19. Methods: We use secondary sources and expert information. Results: During the pandemic innovative and flexible approaches were implemented to meet increasing demand for health workers and new skills and responsibilities were adopted over a short period of time. We have seen the rapid adaptation and use of new technologies to deliver care. The pandemic has underlined the importance of valuing, protecting and caring for our health workforce and the need to invest appropriately and adequately in the health workforce to have sufficient, capable and wellmotivated health workers. Some of the main challenges that lie ahead of us include the imperative for better investment, to need to improve recruitment and retraining whilst better retaining health workers, a focus on domestic sustainability, redeploying and developing new skills and competences among health workers, enabling more effective multi-professional collaboration and team work, improving the quality of education and training, increasing the public health focus and promoting ethical and sustainable international recruitment of health workers. Conclusions: The WHO European Region through its European Programme of Work 2020-2025 is fully committed to support countries in their efforts to continue to respond to COVID-19 and whilst addressing upcoming health workforce challenges. [ABSTRACT FROM AUTHOR]

Background: End-of-life care attracts major policy interest. Place of death is an important metric of individual experience and health system performance. Most people prefer to die at home, but hospital is the most common place of death in high-income countries. Little is known about international trends in place of death over time. Methods: We aimed to collate population-level data on place of death in Europe for the years 2005-2017, and to evaluate association with national characteristics and policy choices. We sought outcome data from the 32 European Economic Area countries. We identified national economic, societal, demographic and health system predictors from Eurostat, OECD and the WHO. We analysed these cross-national panel data using linear regression with panel-corrected standard errors. Results: Our analytic dataset included 30 countries accounting for over 95% of Europe’s population and economic activity. Average national proportion of deaths occurring in hospital in the study period ranged from 26% to 68%, with a median of 52%. Trends vary markedly by region and wealth, with low and decreasing hospital deaths in the North-West, and high and increasing prevalence in the South and East. Controlling for demographic and economic factors, strong palliative care provision and generous government finance of long-term care were associated with fewer hospital deaths. Conclusions: We found modifiable policy choices associated with hospital mortality, as well as wider structural economic and societal factors. Policymakers can act to curb worrisome trends inhospital mortality. Data on places of death outside hospital can improve future research, policy and practice. Key messages: Cross-national longitudinal analysis. Trends of hospital deaths in Europe, association between hospital mortality rate, palliative care and other healthcare factors. [ABSTRACT FROM AUTHOR]

The article highlights developments in public health in Europe as of October 2022. Topics mentioned include the acquisition of an operating grant by European Public Health Association from the European Commission, the lessons about health emergencies that can be learned from COVID-19 pandemic, and the advocacy of Association of Schools of Public Health in the European Region for public health.

This section offers public health-related news briefs in Europe as of December 1, 2021. The World Health Organization (WHO) Global Air Quality Guidelines was launched in September 2021 offering updated air quality guideline (AQG) levels for six key air pollutants. The European Union (EU) vaccines strategy has led to the delivery of over 890 million COVID-19 vaccine doses to Member States, vaccinating over 290 million citizens. The 15th European Public Health Conference will be held in Germany.

Background older people remain underrepresented in clinical trials, and evidence generated in younger populations cannot always be generalized to older patients. Objective to identify key barriers and to discuss solutions to specific issues affecting recruitment and retention of older participants in clinical trials based on experience gained from six current European randomised controlled trials (RCTs) focusing on older people. Methods a multidisciplinary group of experts including representatives of the six RCTs held two networking conferences and compiled lists of potential barriers and solutions. Every item was subsequently allocated points by each study team according to how important it was perceived to be for their RCTs. Results the six RCTs enrolled 7,612 older patients. Key barriers to recruitment were impaired health status, comorbidities and diverse health beliefs including priorities within different cultural systems. All trials had to increase the number of recruitment sites. Other measures felt to be effective included the provision of extra time, communication training for the study staff and a re-design of patient information. Key barriers for retention included the presence of severe comorbidities and the occurrence of adverse events. Long study duration, frequent study visits and difficulties accessing the study site were also mentioned. Solutions felt to be effective included spending more time maintaining close contact with the participants, appropriate measures to show appreciation and reimbursement of travel arrangements. Conclusion recruitment and retention of older patients in trials requires special recognition and a targeted approach. Our results provide scientifically-based practical recommendations for optimizing future studies in this population. [ABSTRACT FROM AUTHOR]

The article offers information on a workshop at the 16th World Congress on Public Health 2020 on the European burden of disease network.

The article offers information on a workshop at the 16th World Congress on Public Health 2020 on mental ill-health and social exclusion among refugee minors/youth in European countries.

The article offers information on a workshop at the 16th World Congress on Public Health 2020 which aims to facilitate a conversation on understanding the structural situation and exploring ways to reduce the disproportionate health burden and risk factors of HIV.

The article offers information on a workshop at the 16th World Congress on Public Health 2020 on health and integration of young refugees in Nordic Welfare countries.

Background: Health regions are defined clusters that can contribute significantly to the improvement of health care for the population through the networking of actors and their coordination. In Europe, this concept exists in only a few countries. The Erasmus+ project Com.HeNet aims to develop and pilot curriculum modules for training regional health network managers. The aim is to successfully implement and manage health regions across Europe. Methods: The team of Com.HeNet developed the competences needed to implement and manage health regions in six countries through literature research and expert interviews (n = 33). The countries involved are Austria, Bulgaria, Germany, Hungary, Poland and Spain. The competences identified were analysed in terms of content and converted into six competence profiles. Subsequently, a cross-national core competence profile was created. The core competence profiles of AHPA, WHO & ASPHER were included in the compilation. The core competency profile consists of three areas: Health Content Planning Cycle, Network Management Cycle and Sustainability services. It was presented and discussed with stakeholders from the health economy, health science and representatives of health regions at seven international discussions. Results and discussion: The developed method of the semi-structured questionnaire for the survey of the required competences in the management of health regions has proven to be target-oriented internationally. The six European countries show different stages of health regions. In Austria, Germany, Spain and Hungary, different stages of health regions exist. In Poland and Bulgaria this model has not been used so far. A comparison of the competences identified shows similarities and differences. The commonalities include: Management skills, fund raising and health competences. The developed international core competency profile is considered practical and relevant by international stakeholders. Workshop objective: The workshop Competences in Health Network Management will present the identified competences for the management of health regions. The method of collecting the competences and the development of the European core competence profile will be presented in order to strengthen future research in this area. The validity of the competences and the potential of an international core competence profile and the resulting curriculum for the training of regional health network managers will be discussed together with representatives of ASPHER. Funding: The creation of these resources has been (partially) funded by the ERASMUS+ grant program of the European Union under grant no. 2019 1 DE01 KA203 005025. Neither the European Commission nor the project’s national funding agency DAAD are responsible for the content or liable for any losses or damage resulting of the use of these resources. [ABSTRACT FROM AUTHOR]

This section offers news briefs on European public health as of August 2020. Topics discussed include solidarity amid the Covid-19 pandemic and after the crisis, ways of improving equitable access to medicines and technologies, and decision of the Congress Management Committee to move the 16th World Congress on Public Health (WCPH 2020) into a virtual congress.

An introduction is presented in which the author discusses articles within the issue on topics including ecosystems approach for promoting health-enhancing physical activity, the European Union (EU) Physical Activity Focal Points Network and physical activity interventions in type 2 diabetes management.

Several abstracts on heart care topics are presented including use of coping effectiveness training in chronic heart failure patients, evaluation of cognitive function in patients with heart failure, and evaluation of a preventive cardiology programme in Ireland.

We will provide a review of the knowledge base from studies on injuries in the WHO European Region from 2010 to 2019, both cross-country and within-country, for all causes and cause-specific. The focus is whether inequalities between countries and within countries persist such that people from low socioeconomic status and from less affluent areas tend to die by injury to a greater extent than others. This has previously been observed for most causes of injury (e.g., traffic, self-directed violence, interpersonal violence, poisoning, burns) but also for several settings (e.g., home, work, transport) based on a review of socioeconomic disparities in injury risks from 1990-2006. In addition, the pandemic touches upon factors with a known impact, directly or indirectly, on the risk and social distribution of injuries (e.g. social isolation, change in transportation mode and volume, alcohohol consumption, etc.). Until the 2020-2021GBD data are available at the regional level for Europe, we hypothesise on how the pandemic may have affected the social distribution of injuries in the Region. For example, we hypothesise a significant decrease in road traffic related injuries due to lockdown measures (reduced commuting to work, 24-hour curfews). There may also be an increase in unintentional injuries related to children spending increased hours in the home environment and an increase in do-it-yourself injuries in adults. We also see a possible increase in self-harm injuries due to the mental ill health burden related to confinement and social isolation, but data thus far from single EU countries do not report an increase in suicides. We will then present a research agenda for investigating how the pandemic has affected the injury burden in the Europe Region. [ABSTRACT FROM AUTHOR]

The article offers news briefs related to public health in Europe as of June 2022. Topics mentioned include the celebration of 30th year anniversary of the European Public Health Association (EUPHA), the participation of the International Federation of Medical Students' Associations during the World Health Organization's (WHO) meeting on health and migration in March 2022, and some challenges and barriers in youth participation in health decision making.

Across Europe, the role of the welfare state is constantly being questioned and even eroded. At the same time, funding sources for post-graduate medical education and training are under attack as regulators review the working relationships between physicians and industry. Both of these issues have profound consequences for cardiologists and their patients, and were, therefore, chosen as the themes of the European Heart Rhythm Association (EHRA) 2014 Spring Summit held at Heart House, Sophia Antipolis, 25-26 March 2014. The meeting noted that some of the changes are already affecting patient care standards and that this is exacerbated by a reduction in research and education programmes. The principle conclusion was that EHRA must find better means of engagement with the authorities across Europe to ensure that its views are considered and that ethical patient care is preserved. Participants were particularly alarmed by the example from Sweden in which future healthcare planning appears to exclude the views of physicians, although this is not yet the case in other countries. The demand for greater transparency in relationships between physicians and industry was also discussed. Although intended to eliminate corruption, concern was expressed that such moves would cause long-term damage to education and research, threatening the future of congresses, whose role in these areas appears underestimated by the authorities. [ABSTRACT FROM AUTHOR]

Background: Academic Medical Centers (AMCs) are organizations that link three functions: providing highly specialized medical services, teaching activities and conducting research. The aim of the study was to provide an international comparison of the governance and organization models of AMCs. The analysis covered 10 European countries (Cyprus, Czechia, Denmark, Germany, Italy, Latvia, Netherlands, Norway, Poland, Spain) and Israel. Methods: The study has an explorative and descriptive character. The methods involved: (1) the creation of a conceptual framework; (2) the development of a dedicated questionnaire; (3) data collection and analysis. The data was collected based on purposive sampling. There were 26 respondents from 11 countries. Results: There is no standardized definition of AMCs across countries. Different types of hospital providers do link patientcare, teaching and research. Depending on the country and particular institution, the balance between these three functions, as well as the scope might vary a lot. The majority of the participating countries face either public or not-for-profit ownership for AMCs and medical faculties. However, the relationship between hospital and faculty varies substantially. Main internal governance challenges focus on lack of responsiveness to change and financial conflicts between the three core tasks. External challenges relate to financial sustainability and workforce shortages. Most respondents believe that in the nearby future the governance of AMCs will evolve to a more functionally integrated model of the three functions. Conclusions: The study fills the gap in the literature on organization and governance of European AMCs. Although, there are substantial differences in the models of governance across countries, many challenges are highly similar. This raises important questions for future research (e.g. focusing solely on one function) as well as policy (the potential for cross-national learning). Key messages:· There is no standardized definition of AMCs across countries and different types of organizations are used to link the three functions of providing patientcare, teaching activities and research. · Despite the organizational and legal differences, AMCs in different countries face similar challenges (nimbleness and financial conflicts between the three functions; health workforce shortages). [ABSTRACT FROM AUTHOR]

In recent years, both the EU Commission and the Belmont Forum have funded projects focusing on health and climate change with the aim of expanding research and evidence and improving intersectoral cooperation. The EU-funded ENBEL project is developing tools to streamline climate and health research to support policies and strategies and improve response and resilience. Methods: Within ENBEL a stakeholder analysis is being carried out for Europe to identify key decision makers involved in climate change and health adaptation, understand interlinkages and identify areas for action to promote collaboration and uptake. Semi-structured interviews with key institutions and stakeholders at different levels (International, European, national and local) will help identify key evidence needs and research gaps and findings will be used to define knowledge tools and policy briefs to enhance adaptation. Furthermore, current policies on adaptation in Europe and how health issues are addressed, especially taking into account the Next Generation EU (NGEU) funding in support of COVID-19 recovery as well as Green Deal and Climate Action, will be reviewed to ensure ENBEL products fit the EU policy agenda. Conclusions: ENBEL offers an opportunity to produce targeted research syntheses for decision makers as well an ensuring health becomes a key aspect in climate change policy decision making. The ENBEL project will engage with key decision makers involved in climate change and health adaptation across Europe, providing knowledge, understanding interlinkages and identifying areas for action to promote climate policies that enhance health benefits. [ABSTRACT FROM AUTHOR]

Background Health workers have been at the forefront of treating and caring for patients with COVID-19. They were often under immense pressure to care for severely ill patients with a new disease, under strict hygiene conditions and with lockdown measures creating practical barriers to working. This study aims to explore the range of mental health, financial and other practical support measures that 36 countries in Europe and Canada have put in place to support health workers and enable them to do their job. Methods We use data extracted from the COVID-19 Health Systems Response Monitor (HSRM). We only consider initiatives implemented outside of clinical settings where COVID-19 patients are treated, and therefore exclude workplace provisions such as availability of personal protective equipment, working time limits or mandatory rest periods. Results We show that countries have implemented a range of measures, ranging from mental health and well-being support initiatives, to providing bonuses and temporary salary increases. Practical measures such as childcare provision and free transport and accommodation have also been implemented to ensure health workers can get to their workplace and have their children looked after. Other initiatives such as offering continuing professional development credits for knowledge learnt during the crisis were also offered in some countries, albeit less frequently. Conclusions While a large number of initiatives have been introduced, often as ad-hoc measures, their effectiveness in helping staff is unknown in most countries. The effectiveness of these initiatives should be evaluated to inform future crisis responses and strategies for health workforce development. [ABSTRACT FROM AUTHOR]

The article offers the author's insights on the European Public Health Association (EUPHA). Topics include the preparation of the abstracts for EUPHA conference in Milan, Italy, the launched of strategy for decision making of public health professionals for public health policy, and the partnership of EUPHA with several European organizations such as World Health Organization (WHO) which works on the nutrients profiling to reduce junk food marketing in children in April 2015.