European Public Health Research Articles

Unconventional Answers to Unprecedented Challenges: The Swedish Experience During the COVID-19 Outbreak.

Since its early stages, the coronavirus disease 2019 (COVID-19) pandemic has posed immense challenges in meeting the public health and healthcare and social care needs of migrants. In line with other reports from United Kingdom and United States, data from Sweden’s health authority show that migrants have been disproportionately affected by COVID-19. Following the World Health Organization’s statements, as well as the European Public Health Association’s call for action, several centres in Sweden’s most populated areas have activated tools to implement national plans for community outreach through initiatives targeting migrants and ethnic minority groups. Unconventional means should be promoted to mitigate the impact of COVID-19 on migrants and the health of the public at large.

Legal and Regulatory Approaches to Rehabilitation Planning: A Concise Overview of Current Laws and Policies Addressing Access to Rehabilitation in Five European Countries.

Background: The rising prevalence of disability due to noncommunicable diseases and the aging process in tandem with under-prioritization and underdevelopment of rehabilitation services remains a significant concern for European public health. Over recent years, health system responses to population health needs, including rehabilitation needs, have been increasingly acknowledging the power of law and formal written policies as strategic governance tools to improve population health outcomes. However, the contents and scope of enacted legislation and adopted policies concerning rehabilitation services in Europe has not been synthesized. This paper presents a concise overview of laws and policies addressing rehabilitation in five European countries. Methods: Publicly available laws, policies, and national action plans addressing rehabilitation issues of Sweden, Italy, Germany, the Netherlands and the United Kingdom were reviewed and descriptive documents analyzed. Actions found in national health policies were also evaluated for compliance with the key recommendations specified in the World Health Organization’s Rehabilitation 2030: Call for Action. Results: Across countries, legal and policy approaches to rehabilitation planning varied in scope and reach. While all countries entitle citizens to rehabilitation services, comprehensiveness of coverage varied. Health legislation of Germany and Netherlands recognizes access to rehabilitation as a human right for persons with disabilities, while Sweden and the United Kingdom acknowledge its importance in disability laws for achieving substantive equality for persons with disabilities. Regarding policies, in all countries but Italy, targeted universalism remains the predominant strategy governing rehabilitation services, as demonstrated by the lack of comprehensive, national action plans for rehabilitation addressing the general population. Nevertheless, references found in disease specific policies indicate a solid consensus that rehabilitation remains an integral component of the care continuum for those experiencing disability. Conclusion: Although a universal approach to rehabilitation coverage is institutionalized in national legislation of the countries examined, this approach is not expressed in formal policies. Targeted strategies aiming to ensure access to subpopulation groups with higher perceived needs for rehabilitation prevail, indicating a strong political will towards the reduction of health inequalities and the promotion of human rights of people experiencing disability. Results obtained from conducting this descriptive review provide the basis for future appraisals of the situation regarding rehabilitation service and policy development in Europe.

Detection of antibodies against tick-borne encephalitis flaviviruses in breeding and sport horses from Spain

Tick-borne encephalitis virus (TBEV) and louping-ill virus (LIV) are two closely related zoonotic flaviviruses leading to neurological diseases and belonging to the tick-borne encephalitis (TBE) serocomplex. Both viruses are transmitted by the same ixodid tick vector, Ixodes ricinus. Due to global warming affecting vector biology and pathogen transmission, the viruses pose an emerging threat for public health in Europe and Asia. These flaviviruses share some hosts, like sheep, goats and humans, although the main hosts for LIV and TBEV are sheep and small rodents, respectively. Whereas LIV has been detected in Spanish sheep and goat herds, circulating antibodies against TBEV have only been reported in dogs and horses from particular regions in this country. The limited available information about the prevalence of these viruses in Spain led us to investigate the serological evidence of TBE flaviviruses in horses from Spain. Serum neutralization tests (SNT) were performed using sera from 495 breeding and sport horses collected during two periods (2011−2013 and 2015−2016). A seroprevalence of 3.1 % (95 % CI 1.5–4.6) was found and cross-reactivity with West Nile virus was excluded in the positive samples. Sport horses showed a significantly higher TBE serocomplex seropositivity compared to breeding horses. An increased seroprevalence was observed in the second sampling period (2015−2016). Our results demonstrate for the first time the presence of antibodies against TBE flaviviruses in horses residing in mainland Spain; further epidemiological surveys are necessary in order to understand and monitor the active transmission of TBE flaviviruses in this country and rule out the presence of other flaviviruses co-circulating in Spain.

European Public Health News.

This is the 22nd President’s column I am writing since I penned my first column in October 2016 Over the past four years I have proudly seen EUPHA grow from strength to strength This is definitely in part due to the fact that EUPHA gives space to individuals of all ages, nationalities and disciplines to participate The only requisite is to be passionate about improving health and well-being for all—be it through research, policy, practice or education and training This openness has allowed us to draw the best talent and most highly motivated individuals in European Public Health to contribute on a voluntary basis to take forward analysis, advocacy and action for the future of health and humanity EUPHA is now in a strong position and well recognized as a credible partner by key supranational organizations including the World Health Organization and the European Commission Having established a Brussels-based office, developed new sections, grown the conference into the largest and most important public health event in Europe and leaving a vibrant office and community of engaged young persons, augurs well for the sustainability of the organization This could not have happened at a more significant moment in the history of public health As the world follows with interest and intensity the international public health emergency posed by the novel corona virus #COVID19, we are starkly reminded of the importance and role of public health and health systems This outbreak is a convergence of an infectious disease epidemic triggered through zoonotic transmission, abetted by an epidemic of misinformation having a marked social, economic and political impact It is a watershed in the history of global health and after this nothing will ever else be the same in European and global public health Whilst lessons are still being learned and much will eventually be written, this outbreak has underlined the interdependence of nations through economic global interconnectedness, the value of science and the importance of democracy, transparency and respect for human rights as issues that merit a new approach and a new order For months now, I have written about the dangers of complacency when it comes to health policy in Europe and about the risks of considering health as having been well achieved in the developed world due to the spectacular increases in life expectancy achieved over the past decades This outbreak has confirmed without any doubt the need to continue to invest in science and research, but also in strong health systems and in new areas of scholarly endeavour based on anthropological and social science No doubt the World Congress of Public Health being organized in Rome in October 2020 comes at a most timely manner and is well placed to discuss what needs to be done no holds barred to prevent and manage public health emergencies not only linked to infectious disease but also other health ‘emergencies’ including climate change, air pollution, mental health, obesity, diabetes and cancer On a personal note, this column is the last one I shall be writing as EUPHA President The Executive Council has accepted my proposal to move slightly earlier than originally planned into the role of past President since I have assumed a temporary position in the Transition Team of Dr Hans Kluge, the incoming WHO Regional Director for the European Region This is the moment for me to thank all those who have supported EUPHA and myself personally over the past 4 years To my colleagues in the Executive Council, Conference Foundation and Section Council—thank you for walking with me in this journey to continue to build EUPHA into a strong, visible and credible actor for public health in the European region To the wonderful EUPHA office staff working with the incredible Director Dineke Zeegers Paget—thank you for working tirelessly to make our thoughts, dreams and projects come true To our partner organizations on the European Public Health scene and to colleagues working in supranational organizations—thank you for working with us particularly on the European Public Health conferences and the European Public Health Week—these would not happen without your joint participation! Finally, I wish to close by thanking my past Presidents, friends and mentors Martin McKee and Walter Ricciardi for having encouraged, advised and supported me over these years I am wishing my successor Dr Iveta Nagyova every success during her tenure as EUPHA President Under her leadership, I am convinced that EUPHA will continue to flourish and play an important role in European Public Health

HIV prevention and treatment in Southern Europe in the aftermath of bailout programmes

The global financial crisis impacted public health in Europe, and had a particularly critical detriment to health systems in Southern Europe. We aim to describe HIV response and progress towards the current global HIV targets in specific Southern European countries, which received financial adjustment programmes. We examined and compared a set of HIV indicators in Cyprus, Greece, Portugal and Spain. The indicators included: (i) HIV epidemiology; (ii) adoption of WHO's 'Treat All' recommendation; (iii) progress towards the UNAIDS global targets of 90-90-90; (iv) adoption/implementation of pre-exposure prophylaxis (PrEP); and (v) adoption/implementation of WHO's HIV self-testing (HIVST) recommendation. HIV incidence varied across countries since 2010, with sustained declines in Portugal and Spain, and marked increases in Greece and Cyprus. By 2016, all four countries have adopted WHO's 'Treat All' recommendation, leading to a marked increase in people receiving ART. Improvements were seen in all 90-90-90 targets, with Portugal achieving those in 2017, but Greece lagging somewhat behind, as of 2016. Portugal and Spain have also started implementing PrEP, and Greece has completed a pilot with no additional access to PrEP for pilot participants and no national programme in place. Cyprus has been the slowest in terms of adopting PrEP and HIVST. Countries need to focus on prioritizing effective and comprehensive prevention measures, including HIVST and PrEP, and scale-up access to quality treatment and care for those diagnosed, in order to accelerate the reduction of new HIVs infections and successfully meet the global targets for HIV treatment.

Biological weed control to relieve millions from Ambrosia allergies in Europe

Invasive alien species (IAS) can substantially affect ecosystem services and human well-being. However, quantitative assessments of their impact on human health are rare and the benefits of implementing IAS management likely to be underestimated. Here we report the effects of the allergenic plant Ambrosia artemisiifolia on public health in Europe and the potential impact of the accidentally introduced leaf beetle Ophraella communa on the number of patients and healthcare costs. We find that, prior to the establishment of O. communa, some 13.5 million persons suffered from Ambrosia-induced allergies in Europe, causing costs of Euro 7.4 billion annually. Our projections reveal that biological control of A. artemisiifolia will reduce the number of patients by approximately 2.3 million and the health costs by Euro 1.1 billion per year. Our conservative calculations indicate that the currently discussed economic costs of IAS underestimate the real costs and thus also the benefits from biological control.

Genomics knowledge and attitudes among European public health professionals: Results of a cross-sectional survey

The international public health (PH) community is debating the opportunity to incorporate genomic technologies into PH practice. A survey was conducted to assess attitudes of the European Public Health Association (EUPHA) members towards their role in the implementation of public health genomics (PHG), and their knowledge and attitudes towards genetic testing and the delivery of genetic services. EUPHA members were invited via monthly newsletter and e-mail to take part in an online survey from February 2017 to January 2018. A descriptive analysis of knowledge and attitudes was conducted, along with a univariate and multivariate analysis of their determinants. Five hundred and two people completed the questionnaire, 17.9% were involved in PHG activities. Only 28.9% correctly identified all medical conditions for which there is (or not) evidence for implementing genetic testing; over 60% thought that investing in genomics may divert economic resources from social and environmental determinants of health. The majority agreed that PH professionals may play different roles in incorporating genomics into their activities. Better knowledge was associated with positive attitudes towards the use of genetic testing and the delivery of genetic services in PH (OR = 1.48; 95% CI 1.01-2.18). Our study revealed quite positive attitudes, but also a need to increase awareness on genomics among European PH professionals. Those directly involved in PHG activities tend to have a more positive attitude and better knowledge; however, gaps are also evident in this group, suggesting the need to harmonize practice and encourage greater exchange of knowledge among professionals.

European Public Health News

European Public Health News

Outbreak of pneumococcal pneumonia among shipyard workers in Marseille, France, January to February 2020.

We report the third outbreak of pneumococcal pneumonia within one year among workers in European shipyards. During January and February 2020, 37 cases of pneumonia were identified in a shipyard in Marseille, south-eastern France. Outbreak control measures were implemented, including a mass vaccination campaign with 23-valent pneumococcal polysaccharide vaccine targeting all shipyard workers. Given the high mobility of shipyard workers, coordinated responses between European public health institutes are necessary to avoid further outbreaks.

Health-related Sustainable Development Goals: countdown on alcohol use, smoking prevalence, child overweight and suicide mortality.

The Sustainable Development Goals (SDGs) are a set of goals that aspire to ‘leave no one behind’, adopted by all members of the United Nations and to be achieved by 2030. Now, four years after the SDGs entered into force, we examine the progress towards the health-related SDGs in the European region. In this region, least progress is made towards the targets set for alcohol consumption, smoking prevalence, child overweight, and suicide mortality. For each of these challenges we take stock of current policies, continuing challenges, and ways forward. Written from the perspective of European Public Health Association (EUPHA) we emphasize the potential contribution of civil society organizations in attaining the health-related SDGs.

Aquatain AMF efficacy on juvenile mosquito stages in control of Culex pipiens complex and Aedes albopictus

AbstractAquatain® mosquito formulation (AMF) is a silicone‐based monomolecular film, which has recently been approved for use in the European Union. The physical mode of action based on lowering water surface tension prevents mosquito larvae/pupae respiration. Additionally, AMF disables gravid females from landing on the water surface and obstructs the natural oviposition process. Due to multistage effects on mosquitoes, AMF could be a product of choice for defined water body and container breeders such as Culex pipiens L. complex, principal vector of West Nile virus in Europe, and the invasive Aedes albopictus (Skuse) (both Diptera: Culicidae), vector of dengue and chikungunya viruses. The primary objectives of this study were to evaluate the efficacy of AMF, to determine the susceptibility of the immature forms of C. pipiens and A. albopictus, and the persistence/longevity of the product to suppress the eclosion of adults. AMF achieved high mortality rates of juvenile A. albopictus and C. pipiens under laboratory conditions. However, in the field C. pipiens larvae showed higher susceptibility to AMF than A. albopictus. Pupae of the two mosquito species were highly susceptible to the presence of AMF. When C. pipiens juveniles were exposed to AMF in the wild, effects lasted for 21 days in densely covered water bodies and 56 days in water recipients with less vegetation. In both breeding sites, natural habitat and artificial water recipient, the two mosquito species with high impact on public health in Europe could successfully be suppressed by application of AMF (1 ml m−2).

Fetal alcohol spectrum disorders awareness in health professionals: implications for psychiatry.

Fetal Alcohol Spectrum Disorders (FASD) are a plethora of malformative conditions leading to mental retardation that affect newborns and children who have been exposed to alcohol during pregnancy or breastfeeding. FASD is a relevant topic for public health in Europe: European area is first in ranking for alcohol use during pregnancy with a prevalence of 25.2%. Italy ranked third among European countries with higher prevalence of FASD (45.0 per 1000 population). Furthermore, FASD could still be underestimated because of numerous undiagnosed and misdiagnosed cases. Aims of the study were to briefly summarize existing evidences about FASD and its psychiatric aspects to assess knowledge, attitudes and practice towards alcohol drinking during pregnancy in an Italian sample of health care professionals in order to provide information about FASD prevention. An anonymous online questionnaire containing the AUDIT-C, T-ACE model and the Drinking Motive Questionnaire was sent to 400 Italian healthcare professionals and students. The survey included socio-demographic information, questions about drinking habits and about knowledge, attitude and practice towards alcohol assumption during pregnancy. Among 320 respondents, 96.3% were women. AUDIT-C revealed that 52.4% were low risk drinkers but 27.6% were hazardous drinkers. The 90.6% of participants denied to ever attended a course about the fetus damage induced by alcohol consumption during pregnancy but 91.3% were willing to participate to professional update initiatives on the topic. Only 19.1% of participants talk regularly about the deleterious effects for the fetus of prenatal alcohol drinking to women and only 51.1% advise the 'zero alcohol' policy. Around 41% of participants tolerates the assumption of low-alcohol beverages. No differences were found between no drinkers and low and hazardous drinkers. In conclusion, data show that only specific and continuing updating for health care professionals about drinking habits may have impactful actions to prevent gestational alcohol intake in order to prevent the main cause of mental retardation in western countries.

European Public Health News

European Public Health News

Break or Bend in Case of Emergency? Rule of Law and State of Emergency in European Public Health Administration

When emergencies strike in the EU – a forest fire, a pandemic outbreak or a terrorist attack – these events are initially addressed by the executive branch. More particularly, they are addressed within the administrative branches where the authority, expertise and specialisation is organized for the particular urgent matters involved. In this paper, we ask what the impact is of the EU’s administrations role in responding to these events in terms of (changes to) the rule of law. A response to an emergency in some cases creates exceptions to upholding the rule of law guarantees that bind the authorities to procedural rules and fundamental rights. These changes can become more permanent and hence change the constitutional order of the EU. We ask if the EU administration breaks or bends the constitutionally derived administrative rules in case of an emergency and what are the constitutional implications of this practice? We conclude that emergencies can both bend and break the EU rule of law requirements for the EU administration, which poses significant questions of legitimacy, particularly so in cases of major health threats.

Public Health in Europe during the Covid-19 Emergency

Public Health in Europe during the Covid-19 Emergency

Quality Control of Immunological Veterinary Medicinal Products in Europe.

Medicinal products in Europe are under the strict control of many organisations headed by the European Directorate for the Quality of Medicines and HealthCare (EDQM) in Strasbourg and its related General European Official Medicines Control Laboratories (OMCLs) Network (GEON). The EDQM works in cooperation with the European Medicines Agency (EMA) and the World Health Organisation (WHO). All of these institutions have one main goal – to protect public health in Europe and around the world. One of the more important effects of the harmonisation of pharmaceutical law in Europe was the introduction of the mutual recognition principle for the Official Control Authority Batch Release (OCABR)/Official Batch Protocol Review (OBPR) certificates in the European Union. The National Veterinary Research Institute (NVRI) in Poland is an example of an OMCL laboratory within the Veterinary Batch Release Network (VBRN) that issues the European certificates. The NVRI is actively involved in the batch release of immunological veterinary medicinal products (IVMPs), with approximately 1,800 certificates for IVMPs issued per year. It is also one of only four veterinary OMCLs that perform Post Marketing Surveillance (PMS) studies including approximately 47 IVMPs per year. All the results of the testing data are sent to the Chief Veterinary Officer, and also to the electronic Network platforms of the EDQM, which enables transparent information exchange.

European Public Health News.

European Public Health News.

Break or Bend in Case of Emergency?: Rule of Law and State of Emergency in European Public Health Administration

In this article, we ask what the impact is of the role of the EU administration in responding to emergencies in terms of (changes to) the rule of law. A response to an emergency in some cases creates exceptions to rule of law guarantees that bind the authorities to procedural rules and fundamental rights. These exceptions can become more permanent and even change the constitutional order of the EU. We articulate the legal framework for health emergencies, and discuss how the EU court has interpreted and developed this framework in two key decisions. We then ask whether this framework offers adequate safeguards for upholding the rule of law in cases of major health emergencies. We conclude that public health emergencies can bend and even break rule of law requirements for the EU administration, and advocate for more legal guidance on proportionality, which may offer better safeguards suited for protecting the rights of affected parties.

Workshop: Bridging the Gap in Digital Public Health in Europe

Abstract Europe is facing several health challenges and public health plays an important role in it. However, to address the increasing demand for public health services, public health institutions need to tackle digitalization in a proper and evidence-based way. Digital health comprises both an organizational and a technological component. While the technological one has been widely addressed, the organizational one got little attention so far. This is due to a lack of knowledge regarding the understanding of the new role of organizations that provide digital health services. Public health is a field deeply dependent on data and with an important opportunity to leverage information technology. Digital health could, within 10 years establish a new paradigm in public health. The public health professionals need urgently to tackle digital health to bridge the gap with others areas of healthcare. Moreover, since public health is a multi-disciplinary activity we want to take the opportunity to debate digital public health with European experts from different fields of knowledge. Three presentations from the point of view of People, Technology and Services. Digital health should be addressed as an evidenced-based approach towards both improving health professionals performance and quality of life of patients. This workshop aims at: To create the momentum towards the proper use of digital technologies in public health by discussing the main challenges and opportunities for European Public Health.To establish a forum to discuss digital public health solutions based on evidence to better improve the adoption of these tools in the public health profession;To have a serious discussion after 3 presentations that will clarify the main challenges and opportunities;After de presentations, a debate will be guide to help identify the main challenges for digital public health in Europe; Key messages Public Health Digitalization is essential to address health inequalities in Europe. The workshop identifies what are the main priorities for a sustainable EU public Health digitalization. Mutual learning, knowledge and good practice exchange in using digital technology can be organised in various ways – we show practical current examples on how it has been done.

Building bridges for migration in a planetary context

Abstract Europe is experiencing high volumes of migration, both within and to the region. Globally, several factors contributing to high-volume migration, ranging from economic ones (migrant workers) to forced displacement caused by conflict, persecution and climate changes (draught or other extreme weather conditions) severely affecting living conditions. The International Organisation for Migration (IOM) has estimated that in 2017, the number of international migrants living in Europe reached 78 million, over 10% of the European population, and that two-thirds of international migrants live in Europe or Asia. In EU countries, an estimated 22.3 million migrants are non-EU citizens (data as of 1 January 2018) and in 2017 alone, the EU has seen 2.4 million new arrivals from non-EU citizens to its Member States. Inevitably, this trend has significant implications for public health in Europe. Migration has significant implications for public health in Europe. Beyond potential pressures on healthcare systems, that can occur especially in instances of large scale rapid migration, some subgroups of migrants, particularly those forcibly displaced or those originating from countries with weak health systems (i.e. refugees, asylum seekers and irregular migrants) are particularly vulnerable and susceptible to infections. This may be due to the fact that they could come from countries with high prevalence of infectious diseases and/or low vaccine coverage. In addition, the migration journeys or substandard living conditions in overcrowded migrant centres may have increased the risk of contracting an infection. This plenary session will showcase several bridges contributing to strengthening public health functions and services in terms of migration, pinpointing the crucial importance of: public health resources and cross-sectoral cooperation: the case of the Mediterranean Programme for Intervention Epidemiology Training (MediPIET) building capacity in the EU enlargement and European Neighbourhood countries with particular focus on global health security; the impact of the programme on capacity building among infectious disease epidemiologists in a small country with a large influx of migrants;public health guidance: the case of guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA;public health policy and advocacy: the case of WHO Global Action Plan to promote the health of refugees and migrants;involvement of the affected population in the discussion and decision-making. The aim of this one-hour session is to stir the debate around migrant health issues and infectious diseases in the European context. The panel will start with a keynote speaker, followed by a lively expert discussion reflecting different perspectives. Key question/s addressed: How important is cross-sectoral and cross-regional cooperation in terms of migration and public health? How can we approach migration within and to Europe as a benefit for the region? Keynote speaker Sally Hargreaves Lecturer in Global Health, St George's University of London, United Kingdom Panellists Nada Ghosn Epidemiological Surveillance Unit, Ministry of Public Health, Lebanon Sally Hargreaves Imperial College London, UK Abal Moindazde France Isabel de la Mata DG SANTE, European Commission