European Public Health Research Articles

Insights from the PHIRI Network: How different Countries deal with Long-COVID related issues and developments

Abstract Long COVID research shows that on average, 10-20% of COVID-19 patients experience a variety of mid- to long-term effects after recovery from initial illness. This represents a serious issue for the healthcare sector and decision-makers and experts in the field. Against this backdrop the Population Health Information Research Infrastructure collaboration (PHIRI) established a Rapid Exchange Forum (REF). REF is a series of bi-weekly meetings addressing urgent questions in population health during the COVID-19 pandemic and beyond. Participants are national representatives from over 30EU countries, ranging from European public health institutes, Ministries of Health to research institutions, universities, and EU-level stakeholders. In preparation, questions on a given topic are sent in a systematic manner, allowing rapid exchange of information across countries and provides comparative learnings on different challenges, best practices, and tools used to overcome population health issues (e.g., communication strategies, mortality indicators, long-term pandemic monitoring and surveillance, and pandemic impacts). REF on Long-COVID focused on 5 key aspects of Management of long-COVID Patients. Across 19 different EU/EEA countries information shows, for example, that by March 2023. 1) none of the 19 countries have stated to have a specific working registry for Long-COVID patients 2) few countries so far have developed specialised clinics or medical institutions for the treatment of Long-COVID but at least 3) most countries have adopted a wide range of different tools, strategies, and activities to create national guidelines and models for better management of Long-COVID Patients. This discusses these findings and will take stock of the Long-COVID-19 situation from a population health perspective. It will offer unique insights on the development of different tools, strategies and structures in national healthcare systems and their fight against long-COVID.

10.M. Workshop: Community Health Practice and Research in Europe: Up front and centre!

Abstract Community Health (CH) is one of the most undervalued and poorly funded domains of action of health systems. Although evidence is strong on its contribution to population health, well-being and equity, national and regional health systems, and to some extent public health institutions, tend to pay little attention to its contribution. Community health encompasses the application of health promotion principles and strategies at the local level to improve equity and resilience of a community. It does so through three fundamental means: cross-sectoral collaborations, community involvement/engagement, and community health workers (CHW). It engages and works with communities in a culturally appropriate manner in order to implement effective strategies. In community health, capacity building is essential. The aim of this workshop is three-fold: 1) to generate a discussion among participants on the state of practice and research, 2) to reflect on strategies to strengthen and improve community health in Europe and, 3) to enhance the visibility of this domain within the ranks of the European Public Health Association (EUPHA). The workshop will provide a space for reflections and discussions. Each of our speakers, who are researchers from 5 different countries (Belgium, Czech Republic, Germany, Spain, and UK), will have 5 minutes to provide some elements of answers to the two following questions: • What is the state of community health practice and research in your country? • What difference does it make for health systems to implement community health strategies? Eric Breton (France) will briefly introduce the workshop providing a conceptual framework for community health and an overview of the different perspectives that drive practices and policies. Manfred Cassens (Germany) and Caroline Masquillier (Belgium) will discuss how the COVID-19 pandemic has enhanced the shortfalls of health systems and lead their countries to experiment community health strategies. Camila Picchio (Spain) will demonstrate how CHWs are essential in reaching out marginalised communities as will Ekaterina Volevach (Czech Republic) drawing lessons from a programme targeting the Roma population. Both will highlight the difficulties health systems face in answering the need of vulnerable population. Catherine Jenkins (United Kingdom), will describe a city-region intervention for galvanising community-level innovation to reduce gambling-related harms. Luis Saboga-Nunes, President of the EUPHA Health Promotion Section and Goof Buijs, Manager of the UNESCO Chair Global Health & Education will conclude the session. We trust that this very interactive workshop will help attendees of the EUPHA conference in Dublin working in community health to find each other and facilitate the development of partnerships. Key messages • Community Health strategies are essential in improving populations’ health and well-being. Yet, this contribution is hardly reflected in national health policies and in the resources invested locally. • The COVID-19 pandemic cast a harsh light on the limits of health systems under-investing in community engagement, community health workers and in the mobilisation of local stakeholders.

6.E. Workshop: Evaluating progress in adaptation in the European public health sector

Abstract Most national climate adaptation plans and strategies mention risks to human health. However, this is not often translated to specific policies, measures or targets to reduce these risks. The ENBEL project, funded by the European Commission under the H2020 program LC-CLA-22-2020, aims to support European policy making on climate change and health. In this workshop we present the results of recent research on the implementation of adaptation measures in Europe and review the evidence needs of EU, national and international decision makers. The workshop aims to support evidence translation for adaptation that prioritises health protection and equity. The workshop will include presentations on stakeholder mapping and interviews with key decion makers, as well as a comparison of current policies in health adaptation. We review the recent European policies on COIVID recovery and evaluate whether these will benefit adaptatoin. Economic evaluations are important for decision making and we review economic assessments for local climate action and for climate services for health. Key messages • Public health professionals can support adaptation actions through intersectoral working. • Post-COVID recovery is missed opportunity to improve adaptation in Europe.

Self-endangering work behaviour of Polish school principals during the COVID-19 pandemic

Abstract Background During the COVID-19 pandemic, the work-related demands of school principals grew incredibly, and many experienced overwork and stress. This study focuses on three self-endangering work behaviour (SEWB) subscales - work extensification (EW), intensification (IW), and quality reduction (QR) - among Polish school principals during COVID-19 and its association with respondents’ well-being (WHO), exhaustion (EXH), and psychosomatic complaints (PC). Taking care of the health of school principals and teachers is particularly important in the context of European public health as they are crucial models of health attitudes for students as future citizens. Methods The results come from an online survey among school principals in Poland. The survey was conducted in 8 provinces in Poland between June 2021 and December 2021. 1899 school principals participated in the survey, of which 928 completed the questionnaire. Descriptive statistics, Kendall's Tau correlation, and regression models were conducted. Sociodemographic characteristics (gender, age, and type of school) were considered the control variables. Results The study confirmed increasing respondents’ EW (62.6%) and IW (52.5%) during the COVID-19 pandemic. The rise in EW was associated with lower WHO (τ = -0.25), greater EXH (τ = 0.29), and PCs (τ = 0.23). The more respondents intensified their work, the lower well-being declared (τ = -0.36). With the increase in IW and QR, WHO decreased, and the level of EXH and PC grew. Male and older school principals less frequently felt PC. Conclusions The study suggests that SEWB presented by Polish school principals during the COVID-19 pandemic was associated with respondents’ WHO, EXH, and PC. These findings could be a baseline for policymakers for multidimensional interventions to reduce school principals’ SEWB and prevent overwork and burnout in Polish school principals.

Vaccine hesitancy in Europe: the long and winding road

Abstract Vaccine hesitancy has always been a hot topic in the European public health discussions and the COVID-19 pandemic has increased its relevance for consequences not exclusively related to health. In this presentation, results of a recent analysis carried out on data from the last round of the European Social Survey will be shown, highlighting that the relationship of vaccine hesitancy with many socio-cultural elements, among which conspiracy theories and distrust towards scientific community. As for other public health topics, these considerations underline the need for a multidisciplinary and multistakeholder approach to vaccine hesitancy, particularly important for countries like Eastern Europe where hesitancy and conspiracy theories appear to be widespread. This approach would be able to explore and understand all the addressable factors to structure the right way of communicating and disseminating evidence, engaging the population of any sociocultural area, and reducing hesitancy by increasing trust in scientists and institutions, driving safely on this long and winding vaccination road.

Evaluation of the impact of the complex intervention ‘10,000 Steps Duesseldorf’: Replication study

Abstract Background The World Health Organization (WHO) recommends 150-300 minutes of moderate physical activity (PA) per week (approximately 7,000-10,000 steps/day). In Germany, fewer than half of all adults achieve this goal. This highlights the need for population-based intervention approaches to promote regular daily PA. The aims of this replication study are to adapt, implement and evaluate a community-based complex PA intervention originally developed and successfully implemented in Belgium. The following research questions are investigated: 1. Is the intervention ‘10,000 Steps Ghent’ adaptable and transferrable to the German context? 2. Is the intervention ‘10,000 Steps Duesseldorf’ effective for the promotion of PA among residents of city districts selected for the study compared to city districts of a control city? Methods The intervention includes components at different intervention levels (i.e., individual level: website; organizational level: promotion of PA e.g., in companies, senior citizens’ associations; community level: media campaign, environmental changes, e.g., signage in parks). To investigate the effects of the intervention, PA-levels were assessed via telephone interviews and pedometers in two representative samples of adults aged 25-75 years in the cities of Duesseldorf (intervention) and Wuppertal (control) at baseline (April 2021 - March 2022). The one-year follow-up will start in May 2023. Results 376 participants in the intervention and 253 in the control city districts completed baseline (60% female, 32% wore accelerometers in addition to the pedometers). First study results will be presented at the annual European Public Health Conference after the trial is completed. Conclusions To our knowledge, this study is the first research project aiming to replicate the effects of a complex PA intervention successfully implemented in another European country. Key messages • Results regarding the adaptation and transferability of a complex PA intervention originally developed and implemented in Belgium will be presented. • Results regarding the impact of the community-based complex intervention ‘10,000 Steps Duesseldorf’ on residents’ PA levels will be shown.

European Public Health News.

European Public Health News.

Field Epidemiology: Fit for the future.

In recent years, field epidemiologists have embraced rapidly evolving digital tools, data sources and technologies, and collaborated with an ever-growing field of scientific specialisms. The COVID-19 pandemic put field epidemiology under unprecedented demand and scrutiny. As the COVID-19 emergency recedes, it is timely to reflect on the core values of our profession and the unique challenges and opportunities that lie ahead. In November 2022, alumni of the European Programme for Intervention Epidemiology Training (EPIET) and the European Public Health Microbiology (EUPHEM) training programme celebrated 25 years of EPIET, and the present and future of field epidemiology was discussed. The output was recorded and qualitatively analysed. This Perspective reflects the authors' interpretation of the discussion. We should reaffirm our commitment to field epidemiology's core strengths: competence and rigour in epidemiology, surveillance, outbreak investigation and applied research, leading to timely and actionable evidence for public health. Our future success will be defined by an ability to adapt, collaborate, harness innovation, communicate and, ultimately, by our tangible impact on protecting and improving health.

Field Epidemiology and Public Health Microbiology training: capturing the alumni perspectives of the training's impact.

We present the findings from the European Programme for Intervention Epidemiology Training (EPIET) Alumni Network (EAN) Member Survey conducted in October to December 2021. The EAN consists of field epidemiologists (EPIET) and public health microbiologists (European Public Health Microbiology Training Programme (EUPHEM)) who stay connected after their 2-year fellowship. This active alumni network provides opportunities for career development, mentorship, knowledge exchange and sharing of best practices for community members, affiliated professionals and public health organisations in Europe. Overall, 281 of 732 members participated in the survey. Of the 192 European fellowship alumni respondents, 173 (90%) indicated that skills and competencies acquired during their fellowship improved performance in their role compared with their abilities before the fellowship. Reported skills and competencies that could be further strengthened included data management/analysis, communication, mathematical modelling and leadership/team management. The EAN Member Survey provides valuable feedback to the EAN, as well as the fellowship programme offices at the European Centre for Disease Prevention and Control (ECDC) and affiliated field epidemiology programmes. The COVID-19 pandemic was a stark reminder of how essential cross-border collaborations are for continued European health security. Maintaining and increasing the professional, well-trained workforce remains crucial for optimal response to infectious diseases and protection of public health.

Fighting Antimicrobial Resistance and Healthcare-Associated Infections in EU-JAMRAI: The One-Health Response from Italy

Introduction: Antimicrobial resistance (AMR) is a serious health threat, and it has high priority among the European public health agenda. The development and implementation of the National Action Plans (NAPs) with a One-Health perspective to fight AMR was supported in 2017 by the European Union (EU) through a Joint Action on Antimicrobial Resistance and Healthcare Associated Infections (EU-JAMRAI). The Italian National Institute of Health (Istituto Superiore di Sanità), supported by the University of Udine, and the University of Foggia were among the 44 partners involved. This paper describes the results of EU-JAMRAI relevant to Italy and its impact on national policies. Methods: The activities involved national and international experts who worked in groups, either in virtual or face-to-face meetings. Country-to-country visits were organized to assess and compare the national strategies to counteract AMR and to exchange best practices. In addition, qualitative research methods, particularly focus groups (FGs) and structured interviews, were carried out to collect information and opinions from the experts. Results: The Italian team of experts from the Ministry of Health and the University of Foggia visited the Netherlands and hosted the Polish expert team in Italy. In two FG, stakeholders’ opinions from different organizations were collected and analyzed to identify critical areas and provide recommendations to ensure implementation of the NAP and effective One-Health integration. In addition, attitudes of medical professionals toward antimicrobial stewardship were evaluated in a medium/large Italian hospital. Strengths were identified in the multidisciplinary approach and the hospital management’s proactive involvement. As for the veterinary sector, Italy was among the 10 EU countries that did not have any national AMR surveillance in place for animal bacterial pathogens. Consequently, a European surveillance system was proposed with the adhesion of Italy. Regarding research and innovation to fight AMR and healthcare-associated infection, Italy worked with the other European partners to identify national research gaps and opportunities. As a result, recommendations were issued to the authorities to promote research and innovation with a One-Health approach. Conclusions: The Italian participation in the EU JAMRAI provided experience and examples to the Italian government for implementing the NAP and planning the roadmap to fight AMR and helped point out the system’s criticalities. It also supported the promotion of the One-Health integrated vision that was included in the updated NAP.

European Public Health News.

European Public Health News.

The European Public Health Community is mourning Richard Horst Noack.

The European Public Health Community is mourning Richard Horst Noack.

Editors' Commentary on the 2023 ESH Management of Arterial Hypertension Guidelines.

Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes. Although the ESH guidelines are primarily written for European clinicians and public health workers, there is a high degree of concordance between its recommendations and those in the other major BP guidelines. Despite the large number of national and international BP guidelines around the world, general population surveys demonstrate that BP guidelines are not being well implemented in any part of the world. The level of BP, which is the basis for diagnosis and management, continues to be poorly measured in routine clinical practice and control of hypertension remains suboptimal, even to a conservative BP target such as a systolic/diastolic BP <140/90 mm Hg. BP guidelines need to focus much more on implementation of recommendations for accurate diagnosis and strategies for improved control in those being treated for hypertension. An evolving body of implementation science can assist in meeting this goal. Given the enormous health, social, and financial burden of high BP, better diagnosis and management should be an imperative for clinicians, government, and others responsible for the provision of health care services. Hopefully, the 2023 ESH will help enable this.

Meeting the long-term health needs of Ukrainian refugees

ObjectivesSince Russia's full-scale invasion of Ukraine on 24 February 2022, millions of people have fled the country. Most people have gone to the neighbouring countries of Poland, Slovakia, Hungary, Romania, and Moldova. This vulnerable population has significant healthcare needs. Among the most challenging to address will be chronic non-communicable diseases (NCDs), including mental disorders, as these require long-term, continuous care and access to medicines. Host country health systems are faced with the challenge of ensuring accessible and affordable care for NCDs and mental disorders to this population. Our objectives were to review host country health system experiences and identify priorities for research to inform sustainable health system responses to the health care needs of refugees from Ukraine. Study DesignIn-person conference workshop. MethodsA workshop on this subject was held in November 2022 at the European Public Health Conference in Berlin. ResultsThe workshop included participants from academia and non-governmental organisations, health practitioners, and World Health Organisation regional and country offices. This short communication reports the main conclusions from the workshop. ConclusionAddressing the challenges and research priorities identified will require international solidarity and co-operation.

European Public Health News.

European Public Health News.

Coastal proximity and visits are associated with better health but may not buffer health inequalities

Societies value the marine environment for its health-promoting potential. In this preregistered study, we used cross-sectional, secondary data from the Seas, Oceans, and Public Health In Europe (SOPHIE) and Australia (SOPHIA) surveys to investigate: (a) relationships of self-reported home coastal proximity and coastal visits with self-reported general health; (b) the potential of both to buffer income-related health inequalities; and (c) the generalizability of these propositions across 15 countries (n = 11,916–14,702). We find broad cross-country generalizability that living nearer to the coast and visiting it more often are associated with better self-reported general health. These results suggest that coastal access may be a viable and generalized route to promote public health across Europe and Australia. However, the relationships are not strongest among individuals with low household incomes, thereby challenging widespread assumptions of equigenesis that access to coastal environments can buffer income-related health inequalities.

No time for complacency on COVID-19 in Europe

No time for complacency on COVID-19 in Europe

The best laid plans?: international governance perspectives in AMR national action plans in Europe.

There is a broad consensus in the European public health community that international collaboration and coordination are key in the fight against antimicrobial resistance (AMR). Yet, while experts typically testify the importance of cross-national learning and a coordinated effort to reduce the spread of multi-resistant bacteria, there are mixed views about how that is best realized in practice, particularly on the dichotomy between horizontal and vertical activities. National action plans (NAP) from all EU member states were systematically overviewed by two independent researchers. We followed a fixed procedure for locating a broad and comparable content on the international dimensions, and letting these vary on scales. We find that countries adhere to four different strategies for international coordination, varying between 'high' and 'low' on values of vertical and horizontal activities. Most countries spend none or very little space to discuss international activities, while some countries use their NAPs to outline their aspiration for taking leading roles in the international struggle. Moreover, in line with previous research, we find that many countries directly mimic the Global Action Plan, but also that a large share of countries describe independent arrangements in their international strategies. European countries recognize AMR and its inherent international governance challenge differently in their NAPs, which may have implications for coordinated action to address the issue.

European Public Health News.

In this edition of the Public Health News, EUPHA’s executive director addresses the European Health Data Space and the promises it holds for (public) health research as well as the challenges that lie ahead during the development of this infrastructure. Geller et al. from WHO Regional Office from Europe look at human trafficking and the role of health workers in the identification, treatment and protection of trafficked persons and those at risk. Finally, Staines and Barnhoorn invite the readers to submit abstracts for the next European Public Health Conference in November 2023 in Dublin. The theme of this year’s conference is Our Food, Our Health, Our Earth: A Sustainable Future for Humanity. One of the key elements of the European Health Union is the creation of the European Health Data Space (EHDS). The EHDS is a health-specific data sharing framework establishing clear rules, common standards and practices, infrastructures and a governance framework for the use of electronic health data by patients and for research, innovation, policy-making, patient safety, statistics or regulatory purposes. It is aimed to improve healthcare delivery across the EU, by empowering people to control their health data in their home country or in other EU countries; offer a consistent, secure, trustworthy and efficient framework for the secondary use of health data; and foster a genuine single market for digital health services and products.

Psychometric properties of the Spanish version of the Activities Scale for Kids (ASK): reliability, validity and the Rasch model

AimsTo evaluate the psychometric properties of the Spanish version of the Activities Scale for Kids capability (ASKc) and ASK performance (ASKp) questionnaires.DesignIt includes an analysis of different types of reliability...