European Health Research Articles

Paediatric very rare tumours registration and management in European countries with low health expenditure average rates.

Within the Paediatric Rare Tumours Network-European Registry (PARTNER) project, we aimed to evaluate the situation on the registration and management of paediatric patients affected by very rare tumours (VRT) in the European low health expenditure average rates (LHEAR) countries. A survey regarding infrastructure, organisation, and clinical decision-making information on VRT was designed. This survey was distributed to the representatives of LHEAR countries involved in the activities of the PARTNER Work Package 7. Eighteen answers from 17 countries were collected regarding the national organisation, methods of registration of VRT cases, the availability of medical experts in VRT, the access to updated diagnostic and therapeutic procedures (such as proton therapy, immunotherapy and, targeted therapies), and research on paediatric VRT. A high variability in the registration and management of patients with VRT has been observed with additional wide inequalities in pathology review, uniformity of clinical decisions, availability of selected procedures, and diagnostic and research tools. In the majority of LHEAR countries, no clinical or research structures have been implemented for children and adolescents with VRT. Therefore, VRT still have an orphan status in these countries. These significant differences on the technology access and use between European regions need to be addressed.

Beyond resilience? A comparative sociological analysis of the impact of the Covid-19 pandemic on five European health care systems

Background The article questions the popularity of resilience as a concept and its application to health care systems as a main lens for understanding the impact the COVID-19 pandemic on them. Methods It develops a sociological definition following a thorough examination of the various proposed meanings for the term. Subsequently, it proposes a conceptual framework to analyze the vulnerability and sustainability of health care systems as a more comprehensive tool that moves beyond the limitations of resilience. This framework is then applied to evaluate its heuristic value in assessing the resilience strategies adopted in response to the COVID-19 pandemic in five European countries (France, Hungary, Italy, Sweden, and the United Kingdom), considered as problematic ‘sentinel cases’ within their health macro-regions. Adopting the six variables provided by the COVID-19 Health Systems Response Monitor of the European Observatory on Health Systems and Policies, a detailed comparative analysis is conducted. This analysis explores the resilience strategies of these countries in terms of the vulnerability outputs they produced and their consequent effects on the sustainability of their health care systems. Results The results show that the resilience strategies adopted during the pandemic were shaped by the different configurations of health care systems and policy decisions regarding resource mobilization. As such, these strategies produced various vulnerability outputs, resulting in different degrees of risk distribution and sustainability. Conclusions These results are pertinent for understanding that what matters from a sociological point of view is not simply how different health care systems cope with external shocks like a pandemic to retain control over their structure and functions (resilience), but the social consequences produced by their strategies.

Legislation and policy for involuntary mental healthcare across countries in the FOSTREN network: rationale, development of mapping survey and protocol.

Several countries are currently revising or have already revised their mental health laws to align with the global movement to reduce the use of coercive care. No government has yet fully implemented the recommendation of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) to eliminate the use of coercion in mental healthcare. Consequently, the international field of mental health law and policy is in a degree of flux. To describe the rationale, development and protocol for a project that will map and examine how mental health laws, policies and service capacity across European countries relate to the use of coercive measures, including involuntary admissions and treatment, restraints and seclusion. This will help to better understand the current situation and explore future directions of policies regarding coercive care. The project is being carried out under the purview of the European Cooperation in Science and Technology (COST) action network, entitled FOSTREN (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services). A multidisciplinary group of experts developed a comprehensive survey assessing mental health laws, policies and service frameworks, based on World Health Organization and UNCRPD recommendations. The survey was piloted in three countries, revised and disseminated to 30 FOSTREN country representatives. The survey will provide data for three strands of work on legislation, policies and service-level context. A comprehensive evaluation will be conducted, drawing on findings from all work packages. The project could inform the development of strategies, interventions and legislation to address gaps and promote compliance with international standards.

Self-medication among general population in the European Union: prevalence and associated factors

Self-medication (SM) forms an important part of public health strategy. Nonetheless, little research has been performed to understand the current state of self-medication in the European Union (EU). Utilizing data from the third wave of the European Health Interview Surveys, this study finds an estimated SM prevalence of 34.3% in the EU (95%CI = 34.1-34.5%; n = 255,758). SM prevalence, as well as SM prevalence inequality between men and women, varies substantially between EU member countries. Via multivariable analysis, we also identify a number of variables associated with SM, most notably the substantial impact of health systems on SM behavior (Adjusted Odds Ratio [AOR] = 4.00; 95% Confidence Interval [95%CI] = 3.81–4.21). Several demographics are also associated with greater SM prevalence, including those aged 25–44 (versus ages 75+: AOR = 1.21; 95%CI = 1.12–1.31), women (AOR = 1.74; 95%CI = 1.68–1.81), immigrants born in other EU states (AOR = 1.16; 95%CI = 1.04–1.30), those with higher education (AOR = 1.83; 95%CI = 1.60–2.09), and urban dwellers (AOR = 1.14; 95%CI = 1.04–1.30). Additionally, long-standing health problems (AOR = 1.39; 95%CI = 1.33–1.45), visits to doctors (both general practitioners and specialists) (AOR = 1.21, 95%CIs = 1.15–1.26, 1.17–1.26), and unmet needs for health care due to waiting lists (AOR = 1.38; 95%CI = 1.23–1.55) or inability to afford medical examinations/treatment (AOR = 1.27; 95%CI = 1.12–1.42) serve as conditioners for SM. We also find that smoking (AOR = 1.05; 95%CI = 1.01–1.10), vaping (AOR = 1.19; 95%CI = 1.06–1.32), drinking alcohol (AOR = 1.23; 95%CI = 1.19–1.28), and higher levels of physical activity (AOR = 1.27; 95%CI = 1.22–1.32) are factors associated with SM. Analysis of these variables reveals that though women self-medicate more than men, the patterns that govern their consumption are similar.

Exploring the Association between Socioeconomic Environment, Eating Habits and Level of Nutrition in Children of High School Age: A Part of National Survey.

One of the raising public health problems in the adolescent population is obesity, which has reached epidemic proportions worldwide. The aim of this work is to determine the prevalence of obesity in the population of children of secondary school, age 15 to 19 years in Serbia and the determinate connection with demographic and socio-economic characteristics of the respondents and their eating habits and physical activity. The research is part of the fourth National Population Health Survey conducted in 2019, which was conducted by the Republic Institute of Statistics, in cooperation with the Institute of Public Health of Serbia and the Ministry of Health of the Republic of Serbia. As a research instrument, questionnaires were used in accordance with the methodology of the European Health Survey. For the purposes of this research, data on the adult population aged 15-19 and over were used. The association of overweight with demographic and socioeconomic characteristics was examined using binary regression. In the univariate model, male gender (OR = 1.95), younger age (OR = 1.57) and Region of Vojvodina (OR = 2.47) stood out as significant predictors of overweight, which was confirmed by the multivariate model. The results of our study emphasize that the prevalence of obesity in the population of high school youth is at a significant level and that a lot more needs to be done to promote healthy lifestyles and raise awareness of their benefits on health status.

Policy brief Belgian EBCP mirror group Artificial Intelligence in cancer care

Artificial Intelligence (AI) is already a reality in health systems, bringing benefits to patients, healthcare providers, and other stakeholders in the health care. To further leverage AI in health, Belgium is advised to make policy-level decisions about how to fund, design and undertake actions focussing on data access and inclusion, IT-infrastructure, legal and ethical frameworks, public and professional trust, in addition to education and interpretation. EU initiatives, such as European Health data space (EHDS), the Genomics Data Infrastructure (GDI) and the EU Cancer Imaging Infrastructure (EUCAIM) are building EU data infrastructures. To continue these positive developments, Belgium should continue to invest and support existing European data infrastructures. At the national level, a clear vision and strategy need to be developed and infrastructures need to be harmonized at the European level.

Stronger together: The impact of Joint Advocacy efforts for European Union and National Cardiovascular Health Plans.

Stronger together: The impact of Joint Advocacy efforts for European Union and National Cardiovascular Health Plans.

Disease Trajectories from Healthcare Data: Methodologies, Key Results, and Future Perspectives.

Disease trajectories, defined as sequential, directional disease associations, have become an intense research field driven by the availability of electronic population-wide healthcare data and sufficient computational power. Here, we provide an overview of disease trajectory studies with a focus on European work, including ontologies used as well as computational methodologies for the construction of disease trajectories. We also discuss different applications of disease trajectories from descriptive risk identification to disease progression, patient stratification, and personalized predictions using machine learning. We describe challenges and opportunities in the area that eventually will benefit from initiatives such as the European Health Data Space, which, with time, will make it possible to analyze data from cohorts comprising hundreds of millions of patients.

Evaluating the impact of the 2010 Swedish choice reform in primary health care on avoidable hospitalization and socioeconomic inequities: an interrupted time series analysis using register data

BackgroundThe Swedish Primary Health Care (PHC) system has, like in other European countries, undergone a gradual transition towards marketization and privatization, most distinctly through a 2010 choice reform. The reform led to an overall but regionally heterogenous expansion of private PHC providers in Sweden, and with evidence also pointing to possible inequities in various aspects of PHC provision. Evidence on the reform’s impact on population-level primary health care performance and equity in performance remains scarce. The present study therefore aimed to examine whether the increase in private provision after the reform impacted on population-average rates of avoidable hospitalizations, as well as on corresponding socioeconomic inequities.MethodsThis register-based study used a multiple-group interrupted time-series design for the study period 2001–2017, with the study population (N = 51 million observations) randomly drawn from the total Swedish population aged 18–85 years. High, medium, and low implementing comparison groups were classified by tertiles of increase in private PHC providers after the reform. PHC performance was measured by avoidable hospitalizations, and socioeconomic position by education and income. Interrupted time series analysis based on individual-level data was used to estimate the reform impact on avoidable hospitalization risk, and on inequities through the Relative Index of Inequality (RII).ResultsAll three comparisons groups displayed decreasing risk of avoidable hospitalizations but increasing socioeconomic inequities across the study period. Compared to regions with little change in provision after the reform, regions with large increase in private provision saw a steeper decrease in avoidable hospitalizations after the reform (relative risk (95%): 1.6% (1.1; 2.1)), but at the same time steeper increase in inequities (by education: 2.0% (0.1%; 4.0); by income: 2.2% (-0.1; 4.3)).ConclusionsThe study suggests that the increase in private health care centers, enabled by the choice reform, contributed to a small improvement when it comes to overall PHC performance, but simultaneously to increased socioeconomic inequities in PHC performance. This duality in the impact of the Swedish reform also reflects the arguments in the European health policy debate on patient choice PHC models, with hopes of improved performance but fears of increased inequities.

Childhood Cancer Survivorship Passport Challenges in the European Health Data Space.

Innovation in cancer therapy has increased childhood cancer survival rates. However, survivors are still at risk of developing late effects. In the digital transformation of the health sector, the Survivorship Passport (SurPass) can support long-term follow-up care plans. Gaps in seamless connectivity among hospital departments, primary care, combined with the time of health professionals required to collect and fill-in health data in SurPass, are barriers to its adoption in daily clinical practice. The PanCareSurPass (PCSP) project was motivated to address these gaps by a new version of SurPass (v2.0) that supports semi-automatic assembly from organizational Electronic Health Record (EHR) systems of the treatment summary data using HL7 FHIR, to create SurPass, and to link it to regional or national digital health infrastructures in six European countries. In this paper we present the methodology used to develop the SurPass technical implementation strategy with special focus on the European Health Data Space (EHDS). The recently provisionally approved EHDS regulation instruments a digital health data ecosystem with opportunities for cost-effective SurPass implementation across Europe. Moving forward, a European HL7 FHIR SurPass Implementation Guide along with synthetic data sets, and validation tools can enrich the European Electronic Health Record Exchange Format (EEHRxF) with use cases on health & wellness of childhood cancer survivors.

Socioeconomic Gender Variables Impact the Association between Hypertension and Chronic Health Issues: Cross-Sectional Study.

Our aim is to investigate if sex and gender influence the association of hypertension and their comorbidities. We investigated how gender differences in five socioeconomic factors impact the relation between hypertension and ten comorbidities including diabetes mellitus, renal disease, and chronic pulmonary disease in European countries grouped by their gender inequality index using representative survey data from the European Health Interview Survey. Using logistic regressions, we compute the ratio of odds ratios in females versus males. Therefore, an ORR > 1 is associated with a higher odds ratio for females than for males while an ORR < 1 means the opposite. To account for multiple hypothesis testing, we applied the Bonferroni correction. Hypertension in both sexes was associated with lower educational level, being unemployed, and lower income. In males, being divorced/widowed (OR1.12, p < 0.001) had an association to hypertension, whereas in females, being common-law/married (OR1.30, p < 0.001) and being divorced/widowed (OR1.17, p < 0.001) was associated with a higher risk for hypertension. Moreover, in hypertension, females who worked had an association with myocardial infarction (OR1.39, p < 0.001) and having post-secondary education had an association with arthrosis (OR 1.35, p < 0.001) compared to males. Our findings show that gender variables influence the association of hypertension and comorbidities, especially in females. These results can be used to inform targeted prevention measures taking gender-specific contextual factors into account.

Towards Accountable E-Health Policies in the Nordic Countries.

The Nordic Countries are seen as forerunners in the field of digital health technologies and national implementation has been guided by sector specific strategies for many years. In the context of new European legislation such as the European Health Data Space (EHDS), a review of the existing strategies is indicated. The objective of this policy analysis is to assess and compare the scope, ambitions and extent of accountability in national-level digital health policies in the Nordic countries. The scope of the policies from the five countries were largely centred around a) empowering and activating citizens; b) a shift towards prevention and digital first; c) supporting health operations; d) doing the groundwork; e) making health data more available in research and innovation workflows and f) supporting health personnel. Finland comes out as the most ambitious country with the aim to transform their health system by means of digitalisation. Both Finland and Iceland work towards prevention and the digital first ambition due to large populations in rural areas. These two countries also present the most accountable policies, meaning that their policy documents are the most transparent as to how they arrived at the conclusions and how they are to evaluate the achievements.

Smart FOX - Enabling Citizen-Based Donation of EHR-Standardised Data for Clinical Research in Austria.

Access to healthcare data for secondary use in clinical research is often restricted due to privacy concerns or business interests, hindering comprehensive analysis across patient pathways. The Smart FOX project seeks to address this challenge by developing concepts, methods, and tools to facilitate citizen/patient-driven donations of health data for clinical research. Leveraging the groundwork, laid by the national Electronic Health Record implementation in Austria (called ELGA), Smart FOX aims to harness structured datasets from ELGA for research purposes through an opt-in approach. With funding secured from the Austrian Research Promotion Agency, the project embarks on innovative solutions encompassing governance frameworks, community engagement, and technical infrastructure. The Smart FOX consortium, comprising key stakeholders across various healthcare-associated domains, will evaluate these efforts through demonstrators focusing on clinical registries, patient-generated data, and recruitment services. The project targets to accompany the development of future data donation infrastructure while ultimately advancing clinical research efficiency and bolstering Austria's preparedness for the European Health Data Space. This paper presents the first systematic evaluation of the technical concept and proposal for the federated system architecture of the Austrian Health Data Donation Space, which is the socio-technical goal of Smart FOX.

An interlaboratory proficiency test using metagenomic sequencing as a diagnostic tool for the detection of RNA viruses in swine fecal material.

Metagenomic shotgun sequencing (mNGS) is a generic molecular diagnostic method, involving laboratory preparation of samples, sequencing, bioinformatic analysis of millions of short sequences, and interpretation of the results. In this paper, we investigated the performance of mNGS on the detection of porcine astroviruses, a model for RNA viruses in a pig fecal material, among six European veterinary and public health laboratories. We showed that different methods for data generation affect mNGS performance among participants and that the selection of reference genomes is crucial for read classification. Follow-up investigation remains a critical factor for the diagnostic interpretation of mNGS results. The paper contributes to potential improvements of mNGS as a diagnostic tool in clinical settings.

Assessing Cross-Border Telemedicine Data Exchange in the European Union: A Call to Action.

Background: Telemedicine offers potential benefits for health care delivery. However, evidence of cross-border telemedicine data exchange within the European Union (EU) remains limited. The objective of this communication provides a brief outline of the regulatory framework, initiatives, and challenges associated with cross-border telemedicine data exchange in the EU, setting the stage for a comprehensive evidence assessment. Methods: We explore the current regulatory landscape (European Health Data Space), existing initiatives (the European Electronic Health Record Exchange Format), and interoperability challenges (e.g., legal, technical, semantic) facing EU cross-border telemedicine data exchange. Results: There is a need for thorough evidence assessment of cross-border telemedicine and related data movements. Conclusion: Understanding the current landscape of cross-border telemedicine is crucial. This article highlights the need for evidence assessment through a formal review to inform future research and policy initiatives in this domain.

Influenza Vaccination Uptake and Associated Factors among Individuals with Diabetes Mellitus in Spain: A Cross-Sectional Study Using Data from the European Health Interview Survey 2020.

Vaccination against influenza has proven to reduce influenza-caused hospital entries, treatment times in intensive care units and hospitalisation costs for treating people with Diabetes Mellitus (DM). Despite the existing influenza vaccination recommendations for all persons with DM, in Spain, vaccination hesitancy remains substantial, and vaccination rates lag behind target. We aimed to assess predictors for influenza vaccination uptake and reasons for non-adherence among individuals with DM. Data from the 2020 European Health Interview Survey were analysed using uni- and multivariable logistic regression models, stratified by age group and including possible confounders and vaccination as an outcome. Associations with the sociodemographic profile, healthcare access and substance use were explored. Our analysis included 2194 individuals with DM over the age of 15, showing an influenza vaccination rate of 53%. The findings revealed significant predictors of vaccination uptake, including age over 60 years and robust social support. Conversely, younger age, higher education levels, infrequent healthcare interactions and economic barriers emerged as significant obstacles to vaccination. To enhance vaccination rates, targeted public health interventions should emphasise the importance of vaccination for younger, more educated individuals with DM, those facing economic barriers and those with lower levels of social support, which could bridge the existing gap in vaccination coverage.

Alignment of Patient Information Leaflets with the Health Literacy Skills of Future End-Users: Are We on the Same Page?

ABSTRACT Effective health communication will not be possible if the messages directed to patients do not adapt to their health literacy skills. In this sense, if the Patient Information Leaflets (PILs) are not understood properly, they will not fulfill their purpose. Secondary education aims to develop students’ fundamental skills, including reading comprehension, which should align with future patients. This study assesses reading comprehension of commonly used PILs among secondary education students. An observational cross-sectional study involved 590 Spanish secondary school students from March to June 2022. They read 3 original PILs and completed a questionnaire about medication use information. The European health literacy survey questionnaire (short version) and sociodemographic data were collected. The average correct answer rate was only 51%, with just 14.58% understanding when to take ibuprofen, results that fell significantly below the minimum 80% threshold required by the European Union. Age, gender, and cultural background didn’t significantly impact comprehension. In conclusion, health literacy skills acquired in secondary education are insufficient for understanding current PILs. Educational reform is necessary to improve students’ ability to comprehend medication instructions and enhance PILs for effective communication. At the same time, our work highlights that current PILs need to be redesigned to reduce the cognitive burden imposed on patients.

Relationship between Depression and Physical Activity Frequency in Spanish People with Low, Medium, and High Pain Levels.

Depression is a mental disorder that causes great discomfort, is associated with unhealthy lifestyle habits, and affects the quality of life. People with pain show high depressive symptoms and a prevalence of physical inactivity. This study aimed to analyse the associations between depression (self-reported depression, depression status, depressive symptoms, and depression types) and physical activity frequency (PAF) in leisure time in middle-aged and older people with different pain levels (low, medium, and severe) living in Spain. A cross-sectional study based on the European Health Survey data from Spain (2014-2020) was carried out, with a final sample of 13,686 people with pain. Associations between depression-related variables and PAF were studied at the three levels of pain, comparing the prevalence of depression as a function of PAF. Regression models were performed to assess adjusted risk factors for depression (self-reported depression and depression status). It was found that PAF was related to depression at all three pain levels. Inactive people at each pain level had higher depression prevalence (self-reported depression, depression status, depression symptoms, and depressive types). Physical inactivity emerged as a risk factor for depression, both for self-reported depression and for depression status. Thus, increased PAF could help prevent or reduce depression and depressive symptoms in people with pain.

Development and pilot implementation of a novel protocol to assess capacity and readiness of health systems to adopt HPV detection-based cervical cancer screening in Europe

BackgroundCervical cancer remains a significant public health concern in Europe. Effective introduction and scaling up of human papillomavirus (HPV) detection-based cervical cancer screening (CCS) requires a systematic assessment of health systems capacity. However, there is no validated capacity assessment methodology for CCS programmes, especially in European contexts. Addressing this gap, our study introduces an innovative and adaptable protocol for evaluating the capacity of CCS programmes across varying European health system settings.MethodsOur research team developed a three-step capacity assessment framework, incorporating a health policy review checklist, a facility visit survey, and key informants’ interview guide followed by a strengths, weaknesses, opportunities and threats (SWOT) analysis. Piloting this comprehensive approach, we explored the CCS capacity in three countries: Estonia, Portugal and Romania. These countries were selected due to their contrasting healthcare structures and resources, providing a diverse overview of the European context.ResultsConducted over a period of 9 months, the capacity assessment covered multiple resources, 27 screening centres, 16 colposcopy and treatment centres and 15 key informant interviews. Our analysis highlighted both shared and country-specific challenges. A key common issue was ensuring high compliance to follow-up and management of screen-positive women. We identified considerable heterogeneity in resources and organization across the three countries, underscoring the need for tailored, rather than one-size-fits-all, solutions.ConclusionsOur study’s novelty lies in the successful development of this capacity assessment methodology implementable within a relatively short time frame, proving its feasibility for use in various contexts and countries. The resulting set of materials, adaptable to different cancer types, is a ready-to-use toolkit to improve cancer screening processes and outcomes. This research marks a significant stride towards comprehensive capacity assessment for CCS programmes in Europe. Future directions include deploying these tools in other countries and cancer types, thereby contributing to the global fight against cancer.

The Relationship between Illness Acceptance and Health Literacy in Patients with Type 2 Diabetes

Introduction: To adopt healthy lifestyles for managing chronic diseases and ensure self-management and control of illness, individuals must accept their illness and have good health literacy knowledge. Aim: This paper investigated the correlation between health literacy and illness acceptance in patients with Type 2 diabetes. Method: The research was carried out as a cross-sectional study in Türkiye between December 2019 and April 2020. The sample consisted of 406 participants diagnosed with Type 2 diabetes admitted to a public hospital. Data were collected with an the “Information Form”, the “Acceptance of Illness Scale (AIS)”, and the “European Health Literacy Survey (HLS-EU)”. Results: Participants had a mean AIS score of 26.21 ± 7.11. They had a mean HLS-EU score of 92.25 ± 15.76. Health literacy (HL), age, gender, people living together, smoking status, hospitalization, knowing about chronic complications, the presence of other chronic illnesses, foot care, and blood glucose monitoring were predictors of the acceptance of illness. A positive correlation was observed between AIS and HLS-EU (r = 0.46; p &lt; 0.001). Conclusions: Participants demonstrated high levels of both HL and illness acceptance. The level of illness acceptance increased with the level of HL. It is necessary to develop educational content and materials tailored to the needs and HL levels of the patients to enhance their health literacy.