Regional Public Health Authorities Research Articles

Reconstruction of railroads at Klaipéda da National Seaport: Local Health Impact Assessment Case in Lithuania

Background: Introduction of health impact assessment (HIA) as a national legal requirement for planned economic activity projects in 2002 and the further development of related procedures and methodological requirements has boosted the number of HIAs carried out both as an integrated part of environmental impact assessment (EIA) procedures as well as an independent activity. Most of HIAs have been conduct for local projects. The HIA for the reconstruction of the southern section of the railroads in Klaip da National Seaport is one of the local HIAs in Lithuania carried out as an independent procedure. Methods: The HIA for the reconstruction of the southern section of the railroads in Klaipda National Seaport was carried out following the national legal procedure for the cases not foreseen in the Law on Environmental Impact Assessment of Planned Economic Activity and the national HIA methodological regulations. The HIA included a literature review, analysis of related technical documentation, data on existing and estimated air pollution and environmental noise levels and possible health consequences, analysis of local demographic and health statistics; interviews with the residents living in proximity of the planned activity, analysis of public complaints on existing activities at Klaip da National Seaport, site visit and round table discussions with the proponent of the planned activity, planning company and representatives of the public health authority. The standard or intermediate type of perspective HIA was applied. Results: The HIA report has pointed out noise, vibration, ambient air pollution, psychological factors as related to possible negative impact on health of residents living in the mostly exposed locations. Interviews with inhabitants living in proximity of the planned activity have shown that majority of them knew nothing about the reconstruction plans. Recommendations were provided in the report how to minimise existing and prevent newly emerging negative health impacts from the planned economic development related to ambient air and environmental noise pollution as well as recommendations for communication improvement. with the residents. Conclusion: The HIA provided the proponent of planned activity, as well as the regional public health authority and the concerned public with relevant information on the main health determinants and possible health impacts of the planned reconstruction of the railway segment. HIA recommendations stimulated the proponent to agree on additional measures reducing negative health impact of the planned activity. This case of HIA also revealed some strengths and weaknesses of the overall HIA framework in Lithuania.

Role of the first WHO mutation catalogue in the diagnosis of antibiotic resistance in Mycobacterium tuberculosis in the Valencia Region, Spain: a retrospective genomic analysis

In June, 2021, WHO published the most complete catalogue to date of resistance-conferring mutations in Mycobacterium tuberculosis. Here, we aimed to assess the performance of genome-based antimicrobial resistance prediction using the catalogue and its potential for improving diagnostics in a real low-burden setting. In this retrospective population-based genomic study M tuberculosis isolates were collected from 25 clinical laboratories in the low-burden setting of the Valencia Region, Spain. Culture-positive tuberculosis cases reported by regional public health authorities between Jan 1, 2014, and Dec 31, 2016, were included. The drug resistance profiles of these isolates were predicted by the genomic identification, via whole-genome sequencing (WGS), of the high-confidence resistance-causing variants included in the catalogue and compared with the phenotype. We determined the minimum inhibitory concentration (MIC) of the isolates with discordant resistance profiles using the resazurin microtitre assay. WGS was performed on 785 M tuberculosis complex culture-positive isolates, and the WGS resistance prediction sensitivities were: 85·4% (95% CI 70·8-94·4) for isoniazid, 73·3% (44·9-92·2) for rifampicin, 50·0% (21·1-78·9) for ethambutol, and 57·1% (34·0-78·2) for pyrazinamide; all specificities were more than 99·6%. Sensitivity values were lower than previously reported, but the overall pan-susceptibility accuracy was 96·4%. Genotypic analysis revealed that four phenotypically susceptible isolates carried mutations (rpoB Leu430Pro and rpoB Ile491Phe for rifampicin and fabG1 Leu203Leu for isoniazid) known to give borderline resistance in standard phenotypic tests. Additionally, we identified three putative resistance-associated mutations (inhA Ser94Ala, katG Leu48Pro, and katG Gly273Arg for isoniazid) in samples with substantially higher MICs than those of susceptible isolates. Combining both genomic and phenotypic data, in accordance with the WHO diagnostic guidelines, we could detect two new multidrug-resistant cases. Additionally, we detected 11 (1·6%) of 706 isolates to be monoresistant to fluoroquinolone, which had been previously undetected. We showed that the WHO catalogue enables the detection of resistant cases missed in phenotypic testing in a low-burden region, thus allowing for better patient-tailored treatment. We also identified mutations not included in the catalogue, relevant at the local level. Evidence from this study, together with future updates of the catalogue, will probably lead in the future to the partial replacement of culture testing with WGS-based drug susceptibility testing in our setting. European Research Council and the Spanish Ministerio de Ciencia.

An analytical approach to evaluate the impact of age demographics in a pandemic.

The time required to identify and confirm risk factors for new diseases and to design an appropriate treatment strategy is one of the most significant obstacles medical professionals face. Traditionally, this approach entails several clinical studies that may last several years, during which time strict preventative measures must be in place to contain the epidemic and limit the number of fatalities. Analytical tools may be used to direct and accelerate this process. This study introduces a six-state compartmental model to explain and assess the impact of age demographics by designing a dynamic, explainable analytics model of the SARS-CoV-2 coronavirus. An age-stratified mathematical model taking the form of a deterministic system of ordinary differential equations divides the population into different age groups to better understand and assess the impact of age on mortality. It also provides a more accurate and effective interpretation of the disease evolution, specifically in terms of the cumulative numbers of infected cases and deaths. The proposed Kermack-Mckendrick model is incorporated into a non-linear least-squares optimization curve-fitting problem whose optimized parameters are numerically obtained using the Levenberg-Marquard algorithm. The curve-fitting model's efficiency is proved by testing the age-stratified model's performance on three U.S. states: Connecticut, North Dakota, and South Dakota. Our results confirm that splitting the population into different age groups leads to better fitting and forecasting results overall as compared to those achieved by the traditional method, i.e., without age groups. By using comprehensive models that account for age, gender, and ethnicity, regional public health authorities may be able to avoid future epidemics from inflicting more fatalities and establish a public health policy that reduces the burden on the elderly population.

Linking Public Health Monitoring to Dialogue-based Decision-making During the COVID-19 Pandemic: Experiences from a Participatory Pilot in the Netherlands

Introduction:In the Netherlands, a nationally coordinated research program has been initiated to monitor the immediate and long-term public health impact of the COVID-19 pandemic. This contribution describes the design and early results of a continuous dialectic process to involve national and local public health authorities and professionals in monitor-driven decision-making to anticipate the health impact of viral infections and mitigation measures.Method:An ongoing series of dialogue sessions was organized upon the release of quarterly and annual results of the monitoring program. Apart from supporting public health decision-making, the stepwise dialectic process aimed to ensure multi-sectoral learning and co-creation and nurture a sense of ownership among stakeholders from policy, practice and science. National and regional public health authorities served as hub coordinators and participated in determining and approaching relevant stakeholders. Whenever considered relevant, new stakeholders were invited to participate.Results:In the first year, three dialogue sessions were organized, with an emphasis on youth and young adults. Representatives from ministries, municipalities, health organizations, experiential experts and knowledge institutes attended the sessions. Based on the exchange, policy recommendations were formulated and shared among participants. The themes prioritized included mental health issues, overburdened healthcare services, involvement of vulnerable groups in policy development and understanding the complex myriad of risk factors. Moreover, several factors were identified that might facilitate or hinder the implementation and uptake of monitoring findings.Conclusion:The dissemination and discussion of monitoring data proved to be of added value in developing evidence-informed solutions and areas of attention for future monitoring, including the need to track progress of local and national implementation of recommendations. More broadly, the methodology piloted during the program requires further testing as a community engagement strategy and might be meaningful in other crises or problem contexts as well.

Evaluation of the Completeness and Timeliness of the Infant Pertussis Surveillance System in the Czech Republic in 2015, 2017 and 2019.

The completeness and timeliness of the pertussis questionnaire-based enhanced surveillance system (ESS) among infants and reported pertussis data within the electronic nationwide notification system (NNS) in the years 2015, 2017 and 2019 were evaluated in a pilot study. The completeness of the variables for demographic characteristics, date of symptom onset, hospitalisation and vaccination status were assessed in both systems. Timeliness of reporting in the NNS was analysed as the interval between symptom onset and a) the date of first specimen collection (diagnostic delay), and b) the date of the Regional Public Health Authority receiving notification (notification delay). A total of 121 confirmed pertussis cases were reported to the NNS in the study years, while in the ESS a total of 104 confirmed cases were reported in infants. In both systems most cases were in the age group of one completed month of life (20% versus 23%) and males (55% versus 55%). The majority of cases were hospitalised (81% versus 85%) and unvaccinated (77% versus 78%). Within the NNS, the first dose of vaccine was reported in 13 cases, the second dose in 11, and third dose in three cases. Within the NNS, 100% completeness of following variables was found: symptom onset, week and region of reporting, age, gender and place of isolation. Median diagnostic delay was nine days. Median notification delay was 18 days. Data completeness was high in the NNS, except for lack of vaccination data in those eligible by age. Efforts to improve the completeness of laboratory-related variables and timeliness are essential. Based on the study results, the project of improving the ESS for infants will continue with regular evaluation.

Prevalence of Obesity and its Associated Factors Among the 35-70-Year-Old Population of Bandare-Kong: A Cross-sectional Survey (Findings of the Persian Cohort Study)

Background: Obesity is a major health problem in many countries such as Iran. This study aimed to evaluate the prevalence of overweight and obesity and their associated risk factors in Bandare-Kong, Hormozgan, Iran. Materials and Methods: This cross-sectional survey included 3921 participants of the Bandare-Kong Cohort Study (BKNCD). Their baseline data were used for analysis. General obesity was defined as the body mass index (BMI)≥30 kg/m2 and overweight as 25≤BMI<30. Central obesity was defined as waist circumference (WC)≥95 cm. Results: The prevalence of overweight, general, and central obesity was 39%, 24%, and 30.5%, respectively. Female gender (adjusted odds ratio [aOR]=5.11, 95% confidence interval [CI]: 3.74-6.96 and aOR=1.70, 95% CI: 1.34-2.16), hypertension (aOR=2.43, 95% CI: 1.81-3.26 and aOR=1.26, 95% CI: 1.04-1.52), and hypertriglyceridemia (aOR=1.76, 95% CI: 1.31-2.38 and aOR=1.26, 95% CI: 1.05-1.51) were significantly associated with both general and central obesity. Higher WC (aOR=503.89, 95% CI: 331.76-765.32), higher calorie intake (aOR=1.03, 95% CI: 1.02-1.04), and urban residency (aOR=2.99, 95% CI: 2.06-4.32) were correlated with general obesity. BMI≥25 kg/m² (aOR=46.81, 95% CI: 35.53-61.67), higher fasting plasma glucose (aOR=1.03, 95% CI: 1.01-1.04), older age (aOR=1.03, 95% CI: 1.02-1.04) and being unemployed (aOR=1.49, 95% CI: 1.18-1.89) were significantly associated with central obesity. Conclusion: Overall, a significant correlation was found among female gender, hypertension, and hypertriglyceridemia with general and central obesity in this study. Given the high prevalence of obesity in this population, regional public health authorities should take appropriate measures to reduce these rates in order to prevent obesity-associated complications.

The Berlin index of health and social deprivation: a data based tool to tackle health inequality

Abstract Background Reducing socially induced health inequalities is a key task of urban and regional public health authorities. The Berlin index of health and social deprivation (BIHSD) 2022 aims to show regional differences in health and social situation in sub-areas of the city, to observe developments over time and to identify socially deprived sub-areas of the city. Methods The BIHSD 2022 is based on 20 indicators, most of which come from official statistics. Principal component analyses were applied to calculate subindices for the dimensions employment (e.g. unemployment rate), social conditions (e.g. risk-of-poverty rate) and health (e.g. premature mortality). Based on these subindices the final health and social index was derived. The (sub)indices are available on different spatial levels. Relative changes compared to the BIHSD 2013 were calculated to identify regional trends in the transitions in the social structure and health of the city over time. Results Besides improvements for most indicators over time in most regions of Berlin, there is still significant evidence for health and social inequality across the city. For example, long-term unemployment rate varies between 0.5% and 40.4% on the lowest spatial level. Following a secular trend, there are substantial improvements in former deprived areas in the inner city while in many peripheral residential areas with an average social structure in the past a downwards trend was observed. Conclusions Deprivation indices are helpful tools for research and health reporting in providing evidence for regional inequality. Additionally, they can be used to tailor health promotion strategies and to promote a targeted allocation of financial resources. For example, results of the BIHSD 2022 are being used in epidemiological analyses (e.g. regional inequalities in the risk of SARS-CoV-2 infection) and for (health) policy planning (e.g. needs- and demand-based planning of healthcare). Key messages • The Berlin index of health and social deprivation 2022 show regional differences in health and social situation in sub-areas of the city and documents developments over time. • The index is being used in epidemiological analyses, to tailor health promotion strategies, and to promote a targeted allocation of financial resources.

Investigation of a Methemoglobinemia Outbreak Caused by Eating Sausages with High Concentrations of Nitrates and Nitrites in Trang Province, Thailand, January 2022

In late January 2022, a cluster of methemoglobinemia cases across five provinces of Thailand was notified to the regional public health authorities. A joint investigation was conducted aiming to describe characteristics of the outbreak in one of the provinces, traceback the suspected food, and recommend prevention and control measures. We conducted a cross-sectional descriptive study, interviewing the cases, reviewing their medical records, and interviewing their parents and treating physicians. An active case finding was conducted. A probable case was defined as a person who presented with acute central cyanosis with oxygen saturation less than 92% by pulse oximetry. Suspected food samples were collected for nitrates and nitrites testing. Three cases (2 males, 1 female) were identified and there was no death. Their ages ranged from 8–12 years. The sausages came from the same source and were found to have high concentrations of nitrates (1,270.8–1,690.0 mg/kg) and nitrites (3,554.5–3,776.2 mg/kg). The sausages were identified as a likely cause of the outbreak. Government regulation, product liability laws, and food safety concerns among food retailers and customers are important to reduce the impact of consuming unsafe foods.

Heterologous COVID-19 Vaccination in Spain: A Case Study of Individual Autonomy in the Real World

In Spain, 1.5 million essential < 60-year-old workers were vaccinated with a first AstraZeneca vaccine dose. After assessing the cases of thrombosis with thrombocytopenia associated to this vaccine, the European Medicines Agency (EMA) supported the administration of 2 doses of the AstraZeneca vaccine with no age restrictions. Nevertheless, Spain decided not to administer the second dose of this vaccine to < 60-year-olds. The government sponsored a clinical trial (CombiVacS) to assess the immunogenicity response to a Pfizer/BioNTech vaccine dose in adults primed with the AstraZeneca vaccine. The positive results backed the Public Health Commission and the Spanish Ministry of Health to offer the Pfizer/BioNTech vaccine as the booster. Nevertheless, regional public health authorities—responsible for administering vaccines—believed that, following the EMA’s decision, an AstraZeneca booster dose should be given. The public confrontation of these 2 positions forced the Spanish Health Ministry to request the signature of an informed consent form to those individuals willing to receive the AstraZeneca vaccine booster and rejecting the Pfizer/BioNTech vaccine dose. Eventually, it was decided that these essential workers could choose the vaccine but signing an informed consent form. All relevant information was posted on the Ministry of Health and regional health authorities’ websites and provided to potential vaccine recipients at vaccination sites. Most individuals (≥ 75%) chose the AstraZeneca vaccine: perhaps because they likely trusted the EMA more than the CombiVacS results. This unprecedented and massive exercise of individual autonomy about the choice of COVID-19 vaccines from 2 different platforms has shown that adequately informed persons can autonomously weigh their options, regardless of government decisions. Exercising individual autonomy may contribute to the success of future COVID-19 booster vaccination campaigns.

6.L. Workshop: On the way to health equity – strengthening health promotion governance at local level in Europe

Abstract Health equity is influenced by the local social and physical environment people are living in. Municipalities all over Europe have a key role in shaping and addressing these living conditions. This is why one of the Work packages in the Joint Action Health Equity Europe focussed on how municipalities can contribute to health promoting and equity-oriented living environments. 17 national, regional and local public health authorities from 13 countries collaborated in this 3-year policy-level project, exchanged knowledge and practices, and implemented actions, tools and policies that promote healthy living environments. The first step in the project was to adopt a common Policy Framework for Action which summarizes the current evidence for healthy living environments and the role of municipalities. It provides a conceptual model for integrated municipal approaches. As a second step in the project, country assessments were conducted. Municipalities have a clear mandate to promote health. However, there is a big heterogeneity in resources, structures and capacities within and between countries. Key challenges are deficits in political commitment, accountability and intersectoral working. Yet, national and regional public health authorities have the potential to contribute a lot to support municipalities, like quality development, providing data, integrating health equity in existing structures, plans and approaches or collaborating with the broad range of existing stakeholders and networks. A synopsis from all the project documents, evaluation and an accompanying research project resulted in the final Policy Recommendations for Healthy Living Environments that this workshop presents, focussing on the following questions: How should health promotion policies be formulated in order to mobilize local action for health? What are the opportunities and barriers for health promotion at local level? How can the experience from JAHEE be integrated into the different structures of municipal health promotion in different countries? The first question will be taken up in the first presentation, presenting the development and contents of the final Policy Recommendations for Healthy Living Environments. The second presentation addresses the opportunities and barriers identified by a Delphi Study that has been conducted in the frame of the project work. The last question around sustainability and transferability of structures will be addressed through a roundtable discussion bringing in the experience from project partners and a local policy-maker. The workshop will give the possibility for stakeholders that were not involved in the Joint Action to inform themselves about the activities in different European countries. The broadening of the audience is also crucial for enhancing awareness of health equity and healthy living environments, increasing the acceptance and dissemination of the policy recommendations at national levels and developing a perspective for future actions. Key messages Municipalities can be the motor to build sustainable and equitable health promotion policies and structures. A common quality process has to be promoted and supported by frameworks, tools and capacity-building across political levels and sectors.

COVID-19 Dashboard for the Lisbon Region - an advisory tool for policy

Issue/problemAt the time of arrival of the COVID-19 pandemic to Portugal, the Public Health Department of Lisbon and Tagus Valley Regional Health Administration was confronted with its obsolete information system, which could not provide the information that Public Health Authorities needed to bring the pandemic under control. In order to tackle this issue, our goal was to aggregate all the relevant epidemiological data for the region in an accessible and user-friendly dashboard.MethodsStarting from March 2020 we created a dashboard, which compiled and analyzed COVID-19 data, such as: confirmed and active cases, deaths, hospitalizations (including ICU beds), high/low risk contacts, mandatory confinements, tests, and clusters. This dashboard had anonymized data and was updated daily as well as constantly upgraded by taking into consideration new incoming data and feedback provided by users, serving its purpose as an advisory tool for policy.ResultsThe dashboard was available to Local, Regional, and National Public Health Authorities and made possible to monitor trends and predict epidemiological changes that, prior to its existence, were dispersed in several datasets. Most importantly, it allowed for a better allocation of human resources for contact tracing and case management activities, to easily identify basic social needs for the most vulnerable citizens. It also provided for policy measures adjusted to the smallest administrative division in Portugal, the parish, that ultimately allowed for a better epidemiological control in Lisbon Metropolitan Area in 2020.LessonsThe regional dashboard is far from perfect, but it highlights the constant need for robust information and epidemiological surveillance systems, serving both National, Regional and Local Public Health Authorities. It appeared out of necessity during a pandemic and it proved once more the importance of data analytics for guiding public health action based on evidence.Key messages Data analytics can serve both as an advisory tool for policy as well as to guide public health interventions.The COVID-19 Dashboard for the Lisbon Region aggregates relevant epidemiological data that helped Public Health authorities better understand and control the Pandemic in the region.

Detection of COVID-19 case clusters in Qu\xe9bec, May\u2013October 2020

ObjectivesThe Quebec Public Health Institute (INSPQ) was mandated to develop an automated tool for detecting space-time COVID-19 case clusters to assist regional public health authorities in identifying situations that require public health interventions. This article aims to describe the methodology used and to document the main outcomes achieved.MethodsNew COVID-19 cases are supplied by the “Trajectoire de santé publique” information system, geolocated to civic addresses and then aggregated by day and dissemination area. To target community-level clusters, cases identified as residents of congregate living settings are excluded from the cluster detection analysis. Detection is performed using the space-time scan statistic and Poisson statistical model, and implemented in the SaTScan software. Information on detected clusters is disseminated daily via an online interactive mapping interface.ResultsThe number of clusters detected tracked with the number of new cases. Slightly more than 4900 statistically significant (p ≤ 0.01) space-time clusters were detected over 14 health regions from May to October 2020. The Montréal region was the most affected.ConclusionConsidering the objective of timely cluster detection, the use of near-real-time health surveillance data of varying quality over time and by region constitutes an acceptable compromise between timeliness and data quality. This tool serves to supplement the epidemiologic investigations carried out by regional public health authorities for purposes of COVID-19 management and prevention.

РЕЗУЛЬТАТЫ РЕАЛИЗАЦИИ ПИЛОТНОГО ПРОЕКТА ПО ПОВЫШЕНИЮ ДОСТУПНОСТИ ПЕРВИЧНОЙ МЕДИКО-САНИТАРНОЙ ПОМОЩИ ЛИЦАМ СТАРШЕ 65 ЛЕТ, ПРОЖИВАЮЩИМ В СЕЛЬСКОЙ МЕСТНОСТИ

Significance. Today, the issue of preserving health, especially in older ages, is considered both in the context of care delivery and development of enabling conditions for remaining socially active. In order to increase the period of active longevity and healthy life expectancy, the national project “Demography”, federal and regional projects "Development and implementation of the program of systemic support and improvement of quality of life of older citizens “Older Generation”, which are of an interdepartmental nature, include measures for rural dwellers aged over 65, to ensure transportation of this contingent to health care facilities for additional screenings by vehicles of the social service. For the first time ever, this organizational technology was implemented in the Chelyabinsk Region in 2019 as a pilot. The purpose of the study is to analyze results of the project on improving availability of primary health care to rural dwellers aged over 65. Material and methods Material: materials of the pilot project “Transportation of people aged over 65 to health care facilities”. Methods include mathematical-statistical, analytical, and organizational experiment. Results. During the implementation of the pilot project, 1,892 people were transported to health care facilities, 75.6% of them completed their clinical examination. 80.97% of people of older working age with detected diseases and pathological conditions were taken under medical follow-up, this indicator is 24.4% higher than the regional one. Conclusion. Results evaluation of the project implementation proves effectiveness of the developed measures aimed at improving availability of primary health care to rural dwellers aged over 65. Scope of application. The presented results of the analysis can be used by heads of health care facilities and regional public health authorities for developing measures aimed at improving availability of primary health care for rural dwellers in the region and effectiveness of preventive measures.

XarxaSalut, network of municipalities for health, Valencia Region (Spain): policy process evaluation

Abstract “XarxaSalut” started in 2017, with the municipalities that have taken the commitment to boost the Promotion of Health (HP) at the local level through community participation, intersectorality and equity perspective. The objective is to present a policy process evaluation (2'5 years) of the implementation of XarxaSalut. Different approaches have been used; a questionnaire addressed to the municipalities at the time of adhesion including data on intersectorality, participation, HP actions and open questions; description of instruments that Regional Public Health Authorities (RPHA) has mobilized and an analysis of barriers and strengths made by the coordination office. In 2017, 17 municipalities were joined, being 197 in February 2020 (70% of the population). 65% are in a process of an organizational change through the intersectoral, decision making and participative working group. 35% are doing analysis of determinants and /or health situation, assets maps and a prioritization of HP actions. The main barriers identified by municipalities are lack of economic and personal resources, and difficulties in achieve citizen participation. The main benefits were the optimization of resources, the exchange of experiences, training, or economic support from the RPHA. Some support instruments develop for RPHA are a collection of guides for community development, funds that the municipalities can apply to support actions related with training, HP action on vulnerable population, on asset maps, participation processes, vulnerable neighborhoods, etc.; Community actions have been included in the “Health Observatory” to give visibility and social support to XarxaSalut. Interdisciplinary training processes with health and municipal professionals have been made in order to develop a common language and strength the competences for HP. Lesson learned: The need to improve coordination and a common language between different types of participants and professionals Key messages The decision makers and professionals in the municipalities understand the impact in health of the policies developed at local level but needs guide and support to deal with it. The coordination between different administrations and primary health at local level and the misunderstandings about health and their determinants are the main aspect to reinforce.

Occupational exposure to inorganic lead and its compounds in Romania

Abstract Lead and its compounds are hazardous chemical agents; some lead compounds, are classified as carcinogens in humans. In Romania, the occupational exposure to inorganic lead and its compounds occurs in many sectors: production of lead, manufacture of batteries, manufacture of thermal ceramic products (terracotta), production of electric and electronic components, manufacture of articles of metal wire, production of dyes and additives for plastics, recovery of lead from waste batteries, waste collection and treatment of electrical and electronic equipment, etc. The binding occupational limit value for inorganic lead compounds established under the national regulations is 0.15 mg/m3 in the air (measured in relation to a reference period of eight hours, time-weighted average, TWA). The binding biological limit value is 70 μg Pb/100 ml blood. We have summarized lead occupational exposure data collected from the regional public health authorities in Romania, for the period 2011-2019. The concentrations of lead recorded in the workplaces air varied between “not detected” and 0.22 mg/m3. The lead concentrations in the blood had high values (over the alert value of 40 μg/100 ml blood) in several activities (production of lead, recovery-recycling of lead from waste batteries, manufacture of batteries, and manufacture of articles of metal wire) leading to the need of continuous surveillance of health status for the exposed workers.

ASE Statement on the Reintroduction of Echocardiographic Services during the COVID-19 Pandemic

• Echocardiography services have been interrupted by the COVID pandemic. • Services are being gradually reintroduced as healthcare facilities reopen. • Operational, workflow and prioritization considerations are suggested.

Integrated Surveillance in Italy: outputs and related activities

to describe the integrated surveillance system of COVID-19 in Italy, to illustrate the outputs used to return epidemiological information on the spread of the epidemic to the competent public health bodies and to the Italian population, and to describe how the surveillance data contributes to the ongoing weekly regional monitoring and risk assessment system. the COVID-19 integrated surveillance system is the result of a close and continuous collaboration between the Italian National Institute of Health (ISS), the Italian Ministry of Health, and the regional and local health authorities. Through a web platform, it collects individual data of laboratory confirmed cases of SARS-CoV-2 infection and gathers information on their residence, laboratory diagnosis, hospitalisation, clinical status, risk factors, and outcome. Results, for different levels of aggregation and risk categories, are published daily and weekly on the ISS website, and made available to national and regional public health authorities; these results contribute one of the information sources of the regional monitoring and risk assessment system. the COVID-19 integrated surveillance system monitors the space-time distribution of cases and their characteristics. Indicators used in the weekly regional monitoring and risk assessment system include process indicators on completeness and results indicators on weekly trends of newly diagnosed cases per Region. the outputs of the integrated surveillance system for COVID-19 provide timely information to health authorities and to the general population on the evolution of the epidemic in Italy. They also contribute to the continuous re-assessment of risk related to transmission and impact of the epidemic thus contributing to the management of COVID-19 in Italy.

Public health response to methanol mass poisoning in the Czech Republic in 2012: a case study.

The study focuses on the 2012 methanol outbreak in the Czech Republic. The main goal of the present study was to apply analytical and descriptive tools to selected qualitative and quantitative processes related to the 2012 methanol outbreak in the Czech Republic. The secondary goal was to study and evaluate in detail their potential for creating integrated conceptual national policies aimed at eliminating the risk of methanol poisoning in the future. The presented qualitative analysis focused on the content of documents published by Czech public authorities - the Ministry of Health, the Ministry of the Interior, the Czech Agriculture and Food Inspection Authority, and the Regional Public Health Authorities - as well as the content of the relevant legal regulations. Moreover, statistical data concerning the number of hospitalisations and deaths due to the methanol intoxication were used to provide a background to a detailed description of the relevant facts. In procedural terms, most of the analysed measures focused on a strongly restrictive regulation of sales, regular information channels designed to protect consumers on the national as well as international level, and elimination of further health and economic risks stemming from the dangerous alcoholic products that had already entered distribution networks. The health, social and economic consequences of such activities are quantified at a highly aggregated level. The analysed institutional ties are evaluated also in the context of international documents: the European Action Plan to Reduce Harmful Use of Alcohol 2012-2020 and the Global Strategy to Reduce Harmful Use of Alcohol, and their current potential for steering public policies is assessed. The analysis and evaluation of procedural activities carried out after the methanol outbreak have laid the foundations for a multidimensional study that can contribute to integrated national policy concepts aimed at preventing these and similar negative health, societal and economic consequences. Six years after the methanol outbreak, national and regional health policies have reflected no findings concerning the experience of patients whose health was impaired due to methanol, and the economic cost of the event has not been calculated. The quality of life of these patients has greatly decreased due to permanent or partial incapacity and serious upheavals of their and their families' economic and social conditions. This opens the question of researching and evaluating multiple aspects of health, social and economic impacts of harmful use of alcohol and setting up processes to mitigate these impacts.

A common European framework on how to create healthy living environments on the local level

Abstract In a consensus-process, 17 national and regional Public Health authorities from 13 European countries agreed upon a common Policy Framework of Action (PFA) that summarizes the current evidence making the case for healthy living environments and the role of municipalities. The PFA provides a conceptual model for interventions including an ideal process, quality criteria and guiding principles that municipal approaches should be based on. The PFA is a consensus document based on the results and decisions of the first meeting of the JAHEE-work package partners. It was then circulated among the Work package partners and the JAHEE Steering Committee in two feedback rounds. The PFA development was supported by an interdisciplinary German expert group in the field of public health. To draw up a catalogue of criteria to identify promising practice projects, a number of existing quality assurance instruments for health promotion and prevention focusing on reducing health inequalities were examined and central aspects of the various instruments were identified. The suggested catalogue of criteria is based on good practice as defined by European experience (EQUIHP, JANPA, CHRODIS, INHERIT and the good practice criteria of the German network Equity in Health). These instruments were systematically compared and the criteria found in most instruments were included in the criteria catalogue for the PFA. Result: 16 good-practice-criteria could be identified - such as “target group orientation”, “concept driven strategy”, “empowerment”, “networking” etc. These criteria form an essential basis for the further partner process in the Joint Action. Furthermore, the PFA provides a conceptual model for interventions including an ideal process based on the public health action cycle and guiding principles that municipal approaches should include.

Current capacities and challenges for equity-oriented municipal health promotion in Europe

Abstract As a basis for implementing actions in the frame of Work package 6 - healthy living environments in the Joint Action Health Equity Europe, each of the 13 participating countries conducted a country assessment. Methods The country assessments were self-assessments conducted in the first quarter of 2019. Partners received templates that had been agreed upon beforehand. Most of them conducted the country assessments by themselves or with the help of colleagues from their institutions as a desk-based review, and validated results with external experts and stakeholders. The first part of the country assessment referred to how municipal health promotion capacities are currently developed in the countries. Through the second part of the country assessment, each of the 13 countries selected up to 4 promising practices. Results In most of the 13 countries, municipalities have a clear mandate to promote health. However, there is a big heterogeneity in resources, structures and capacities of municipal health promotion within and between countries. One key challenge is the self-government of municipalities and health promotion as a voluntary task. One of the main problems is a deficit in intersectoral working. It appears that poor municipalities are even more disadvantaged in terms of capacities for municipal health promotion. 33 promising practices were identified, covering programmes, strategies, tools and interventions mostly from the local level, with a big variety of topics and approaches for health equity. Conclusions There is a big fragmentation and heterogeneity in municipal health promotion between and within European countries. National and regional public health authorities are in the position to contribute a lot to support municipalities. This can include promoting quality development, providing data, integrating health equity in existing structures, plans and approaches or collaborating with the broad range of existing stakeholders and networks.