WHO European Regional Office Research Articles

Progress in extreme heat management and warning systems: A systematic review of heat-health action plans (1995-2020)

In recent decades, rising trend in the number of heat waves (HWs) has exacerbated the risk of heat-related mortality and morbidity. The frequent deadly HWs precipitated a multitude of national and sub-national heat-health prevention and research efforts. In 2008, the WHO Regional Office for Europe developed and published guidance on heat-health action plans (HHAPs). This provided a blueprint for countries to design heat-related prevention efforts. Since then, a large corpus of new evidences and implementation experiences has emerged around adaptive measures, alert systems and urban planning interventions. The present study conducts a systematic review to critically assess the advent and development of HHAPs with a special focus on its integration with urban planning policies. It reviews the concept of threshold, indicators for heat event determination and measurement of HWs to understand trigger setting mechanisms. The results show that implementation of core elements of HHAPs varies significantly in the areas of long-term urban planning, real-time surveillance, monitoring and evaluation. Moreover, low levels of inclusion of HHAPs with national policies hinder the overall potential of adaptation measures. The growing impacts of HWs emphasize the urgent need to address spatial heat vulnerability and build urban heat resilience into implementable action plans.

Green CURIOCITY: a study protocol for a European birth cohort study analysing childhood heat-related health impacts and protective effects of urban natural environments

IntroductionThe European climate is getting warmer and the impact on childhood health and development is insufficiently understood. Equally, how heat-related health risks can be reduced through nature-based solutions, such as...

АНАЛИЗ ВЛИЯНИЯ САМООЦЕНКИ ЗДОРОВЬЯ ПАЦИЕНТАМИ НА УДОВЛЕТВОРЁННОСТЬ ПОЛУЧЕННЫМИ МЕДИЦИНСКИМИ УСЛУГАМИ В МЕДИЦИНСКИХ ОРГАНИЗАЦИЯХ СТАВРОПОЛЬСКОГО КРАЯ

Significance. Assessment by population of quality and access to medical services at all levels and stages of medical care delivery is of fundamental importance to improvement and strategic development of the entire healthcare system [1, 2, 3, 4]. Sociological surveys of population and scientific research in the field of health protection under implementation of the National Project "Healthcare" play the role of public measurements and assessment of changes taking place in the sector. At the same time, analysis of the results of sociological surveys showed only a general quantitative characteristic of assessment of medical care quality by population without taking into account factors affecting objectivity of individual assessments. [5, 6, 7, 8, 9]. This approach reduces importance of sociological research in substantiating measures to improve effectiveness of the health protection system. The purpose of the study was to analyze influence of subjective self-assessment of health by population on satisfaction with medical care received and the healthcare system in general. Material and Methods. The methodological basis of the study was the accepted standards, methods and tools developed under the EUROHIS project and recommended by the WHO Regional Office for Europe, including the use of common tools for the study of chronic somatic diseases, conditions, for the study of care-seeking and quality of life. [10,14,15,16,17]. The sociological survey was conducted in the Stavropol Region in 2020. A total of 2170 respondents (59% (1274 respondents) – women and 41% (896 respondents) – men) were interviewed about the state of medical care (including outpatient, inpatient, dispensary-preventive, ambulance, and high-tech care) in the Stavropol Region in general. Harmonization of the conducted studies was carried out as follows. All data obtained were distributed by sex and age group. Then the share of the respondents for each option was determined, and then the obtained values were approximated to the corresponding groups of the total population of the Stavropol Region. Methods of statistical analysis were used, including calculation of frequency of distribution of the studied features, obtaining intensive and extensive indicators for the respondents in general. Conclusion. Self-assessment of health has a significant impact on satisfaction with medical care received, regardless of quality of these services. A direct correlation between the level of self-assessment of health and material well-being has been established. In this regard, when conducting research on population satisfaction with medical services received and healthcare in general, it is necessary to adjust data depending on the indicator of self-assessment of health, as well as average per capita income in population. The identified concerns among the older population and residents of rural areas in regard to introduction of digital technologies in health should become subject of organizational measures on development and implementation of targeted educational programs on telecommunication technologies. Scope of application. Heads of health authorities, chief physicians of medical organizations, executors of the National Priority Project "Healthcare", in order to improve efficiency and effectiveness of the healthcare system.

Assessing the 2019 rubella elimination status in the Russian Federation

In 2002, the WHO Regional Office for Europe developed the Strategic Program for the Prevention of Measles and Congenital Rubella Infections in the European Region, which was revised in 2004. As a result of the revision, an additional target was set to eliminate endemic rubella in the region by 2010. Rubella is a disease well controlled by vaccination that accounts for a theoretical potential to interrupt its global transmission. Since 2013, the Russian Federation has been implementing the National Rubella Elimination Program. Elimination criteria have been revised as the Program proceeds. Currently, the main criterion for rubella elimination is the absence of endemic (local) virus transmission for at least 36 months, which should be confirmed by molecular genetic research methods. In addition, in the Russian Federation, an incidence rate of less than 1 case per 1 million population is also used as one of the elimination criteria. Since 2013, due to a high (over 95%) coverage of preventive vaccinations a decrease in incidence rates and their stabilization at a level of less than 1 per 1 million population since 2014 state in favor of successfully implemented Program. Genetic monitoring of rubella virus strains circulating in human population noted the termination of endemic virus transmission. While implementing the Elimination Program, the prevailing virus genotypes that circulate in Russia were found to be genotypes 1E and 2B showing a global distribution. The data obtained after molecular genetic monitoring allowed to find that the strains isolated during this period belonged to different clusters accounting for in favor of being imported. Considering the above factors such as high vaccination coverage, low incidence rate and lack of endemic virus transmission, the 2017 WHO Committee on verification of measles and rubella elimination assigned the Russian Federation the status of a country that has achieved rubella elimination. The continuation of the phase of infection elimination is confirmed annually. This article presents the results on comprehensive assessment of rubella elimination status in the Russian Federation by specialists from the National Scientific and Methodological Center for Measles and Rubella and WHO EURO Moscow regional reference laboratory for measles and rubella based on 2019 epidemiological data and molecular genetic studies.

List of essential public healthcare functions as a basis for analysis and evaluation of the public health system in a city

Introduction. The World Health Assembly in resolution WHA69.1 defined the essential public health operations (EPHO) as the most cost-effective, comprehensive and sustainable ways of improving population health and reducing the burden of disease. In recent years Russia has been actively working to introduce a system for motivating people to lead healthy lifestyles into the medical prevention system. A special place is given to the regions. Moscow as an independent region of the Russian Federation has a great potential in this field. However, for the effectiveness of health system planning and public health promotion measures at the national, regional and municipal levels, more clarity is needed on the issue of EPHOs. Objectives. To study the main characteristics of EPHO list and results of its application in the countries of the world as a tool of public health system construction on the level of a city. Materials and methods. A content analysis of World Health Organization documents, scientific publications of foreign and domestic authors, country reports on the development of EPHOs lists and evaluation of POPs implementation was performed. Results. The list of EPHOs varies from country to country because of different national priorities, demographics, financial resources, etc. The European Region's list of ten EPHOs describes elements inside and outside the public health system. The list of EPHOs is used as a tool for analyzing public health systems or organizations at the national and local level. Discussion. More conceptual clarity is needed for public health systems planning and public health advocacy, as well as adaptation of the EPHO assessment tool to the context of Moscow. Conclusion. The structure of the EPHOs list included in the instrument of WHO Regional Office for Europe can reflect the public health landscape in Moscow and be used as a tool for investigation of public health systems or organizations at the city level and can contribute to the elaboration of the unified city public health policy and establishment of integrated public health services.

Capturing the breadth and depth of the digital health era — beyond the COVID-19 pandemic

Abstract As digitalization is progressively permeating all aspects of society, how can be it employed to sustain the public health goals of quality, accessibility, efficiency and equity in health care and prevention now and beyond the COVID-19 pandemic? In this session jointly presented by WHO and EUPHA, we examine the extent to which technology is contributing positively or negatively to strengthening the resilience of health systems and empowering individuals and communities. Prior to the onset of the COVID-19 pandemic the WHO Regional Office for Europe had already identified the empowerment of people and transformation of health services through digital technologies as one of its four flagship areas in the European Programme of Work 2020-2025. Digital technologies can enable progress towards universal health coverage by improving access to quality person-centred services and complementing the efforts of the health workforce. Resilience of individuals and communities to prepare and respond to emergencies can be enhanced through the effective use of data and digital technologies. Empowerment of people to lead healthier lives and prevent disease through the appropriate use of digital technologies can transform our approach to health. In 2019 EUPHA published its manifesto for Public health digitalization in Europe, premised on the ability for digital technologies to support a transition from curative care to prevention, to support the empowerment of people and patients in taking ownership for their health and to render health care delivery more efficient, safer and cheaper. Prior to the global COVID-19 outbreak WHO Euro and EUPHA had already joined efforts towards shaping the debate around the ‘Beautiful Marriage’ where the digital health and public health communities work to co-create a healthy and fair future COVID-19 has brought a new impetus for the use of digital technologies, both for disease control as well as to support access to care in times of emergency. This presents an opportunity for critical reflections as we transition into a post-pandemic crisis future. The session which will be organised as a round table discussion will open by taking a candid look at how digital technologies have been harnessed to support the public-health response to COVID-19. Panellists will critically discuss how applications have been used in population surveillance, testing, tracking and tracing, in rolling out vaccinations as well as the controversial uses of smart vaccination certificates. They will be asked to reflect on infodemics and how these have hindered an optimal global pandemic response. In a second round, following a brief overview showing how the use of digital technologies has accelerated to support continuity of essential health services in a safe way at the peak of the pandemic, panellists will be asked to discuss and debate what this means for the sustained transformation of health services delivery and health systems in the future. They will be asked to discuss barriers to digital health implementation, including legal, ethical and privacy barriers, as well as organizational and workforce barriers Finally, panellists will be requested to respond to the criticism that the global health community is still using analogue tools in a fragmented manner to combat health threats in a digital era by proposing one key action that needs to be undertaken at supra-national level to ensure pan-European interoperability of health data that provides timely information on health and disease distribution within populations in Europe. Speakers: Iveta Nagyova EUPHA Naomi Lee The Lancet Ran Balicer Clalit Health Services, Israel

4.N. Skills building seminar: Making the elevator pitch perfect: how to convince a policymaker in less than 2 minutes

Since a number of years, the European Public Health Association (EUPHA), the European Public Health Conferences and other oganisations, have been working hard to translate the evidence in a such a format that policymakers take notice. For example, the WHO Regional Office for Europe works on ‘telling the public health narrative' and provides factsheets and infographics, in order to effectively communicate public health messages to policymakers. Over the years, EUPHA has organised several skills building workshops on translation of evidence in the past years. At the European Public Health Conference in Glasgow 2014, so-called pitch presentations were introduced where researchers are asked to present their work in 5 minutes with maximum 5 slides (no animations), as a way to learn to present key messages from research in just a few minutes. Since 2018, EUPHA organises this elevator pitch skills-building exercise with great success. Building forward on two successful and well-attended skills-building sessions, the current workshop will be a follow-up workshop in this series and is about perfecting the elevator pitch. Lessons learned at the previous elevator pitch workshops: Have a clear ask (keep it simple).Appeal to the policymaker's own interests and priorities.Spell out how action will be beneficial for the policymaker.Be aware of upcoming elections.Built a relationship with the assistants of politicians.Considering the ‘policy window'.Make the comparison with the policy plan.Identifying the relevant stakeholders and groups affected by the problem. The importance of effectively communicating the evidence to policymakers is highlighted by infodemics, e.g. last year called out by the WHO and UN in the context of the COVID-19 pandemic with the spreading of mis- and disinformation about the pandemic. In the context of physical distancing measures, the workshop will also cover virtual tactics. As in the era of teleworking (working from home), advocacy has become a whole different kind of sports. In this skills-building session, we will select a number of abstracts from young professionals/students that have been accepted by the International Scientific Committee as posters and we will invite the presenting authors to this dare: Present your work and key messages in less than 2 minutes. In order to see whether the policymaker is convinced, we are organising a small panel of policymakers and ask them to give their feedback. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work?Key messages Being able to present your key messages anywhere, anytime is needed (including virtual tactics).Telling the public health narrative and telling a story are important skills for public health professionals to have.

10.B. Workshop: The COVID-19 Health Systems Response Monitor: what can we learn for the future

Abstract The Health Systems Response Monitor (HSRM) was established in March 2020 at the beginning of the COVID-19 pandemic to collect and organize up-to-date information on how 50 countries in the WHO European Region and Canada are responding to the crisis. The HSRM uses a structured template, focusing primarily on the responses of health systems but also capturing wider public health initiatives. The HSRM is a joint undertaking of the WHO Regional Office for Europe, the European Observatory on Health Systems and Policies, and the European Commission. The HSRM builds on the Health Systems and Policy Network of the European Observatory, which brings together an international group of high-profile institutions from Europe and beyond with high academic standing in health systems and policy analysis. The content collected on the HSRM platform has been used to enhance cross country learnings through topical snapshots, papers, webinars and more. At the end of 2020, the European Observatory initiated a Health Policy Special Issue (SI) based on the work of the HSRM containing both thematic policy papers and full comparative descriptions and analysis of country responses. Overall, work from the HSRM aims to provide coherent and comprehensive insight on lessons learned from the COVID-19 response so far to support policymakers for future waves or in case of future pandemics. This workshop aims to provide the audience with an overview of the COVID-19 HSRM and the insights gleaned from the SI. An introductory overview will briefly introduce the COVID-19 HSRM and the SI. The first presentation will compare provider payment adjustments across 20 countries. The second presentation will focus on how countries planned services for potential surge capacity, managed care provision, and maintained routine services in both hospital and outpatient settings during the first wave of the pandemic. The third presentation will zoom in on experiences in primary health care. The last presentation will feature one of the country comparison papers from social health insurance countries. The workshop will conclude with an audience discussion about the lessons learned from the COVID-19 HSRM, and future opportunities for research using the HSRM. Key messages The COVID-19 Health System Response Monitor has tracked the progression of health policies throughout the pandemic and captures particularly policy relevant aspects. Both thematic and cross-country comparisons can illuminate how health systems have responded to the COVID-19 pandemic and provide lessons for future waves and pandemics.

What makes COVID-19 dashboards actionable? Lessons learned from international and country-specific studies of COVID-19 dashboards and with dashboard developers in the WHO European Region

Although COVID-19 dashboards may be widely accessible, their effective use to modify the course of the pandemic through the translation of data to information, information to opinions, and opinions to decision-making is determined by their actionability. To be actionable, the information should be both fit for purpose-meeting a specific information need-and fit for use-placing the right information into the right hands at the right time and in a manner that can be understood. Recognizing the sustained importance of COVID-19 dashboards as a tool for pandemic reporting, studies to describe this landscape and take stock of experiences are of critical importance for better preparedness in future public health crises. Since early 2020, the international network of healthcare performance intelligence researchers-HealthPros-in collaboration with partners including the WHO Regional Office for Europe, have worked to systematically study the actionability of COVID-19 dashboards by comparatively studying their composition, changes over time and development process. In this presentation, results from this series of research will be summarized. Topics to be covered include: A summary of seven key features constituting actionable dashboards resulting from a descriptive assessment and scoring of 158 dashboards from more than 53 countries worldwide.Insights into changes to dashboards over the course of 2020-21 from country-specific studies in Canada, the Netherlands and Italy.Lessons learned from the perspective of COVID-19 national, governmental dashboard developers in the WHO European Region, including key enablers and barriers to the development, maintenance and evolution of dashboards over the course of the pandemic.

5.L. Workshop: Advocation for sexuality education for children and young people with disabilities

Abstract Estimated 135 million persons with disabilities are living in the WHO European Region. The international community has made progress in strengthening its commitment to safeguard and promote the human rights of persons with disabilities. A core principle in these agreements is the right to non-discrimination and non-stigmatisation. This principle relates to various spheres of life, including education and health care. And yet, political, societal and individual barriers persist which hinder persons with disabilities across their life span to exercise the full range of their rights and to access equal opportunities. In this regard, the needs of children and young people with disabilities related to sexual and reproductive health are of particular concern. All persons with or without disabilities develop in different stages throughout the course of their lives. The sexual development is part of this process and includes physical, cognitive, mental, social, relational, ethical, religious and cultural components. The Self-determination of the own body - which includes the decision if, when, with whom and how many children someone wants and how to express the own sexuality - is one of the most essential human rights. Comprehensive sexuality education (CSE) enables and supports a responsible behaviour related to sexuality. The WHO Regional Office for Europe highlights CSE for children and young people with disabilities as crucial intervention to promote the health and well-being. But yet we observe a shortage of access to CSE and a lack of knowledge of sexuality, reproduction and STIs; as well as a lack of studies and data about CSE for children and young people with disabilities. Therefore, this workshop aims to raise awareness about the importance, the need and the right to CSE for children and young people with disabilities, strengthen the human rights and empowerment approach and offers advocating tools. The first part will present the status of research in the field. During the workshop the participants will learn about the barriers in the field of CSE, discuss recommendations to overcome them as well as best practices for doing research with children and young people with disabilities. The second part sets out avenues that help to promote and develop an enabling environment for CSE at different levels e.g. institutions, regions and countries. Participations will get to know the legal framework and international conventions, which imply sexual and reproductive health especially with the focus on CSE for children and young people with disabilities. It will give an overview about relevant conventions UN members have committed to and which legal mechanisms can be used to raise the awareness in countries towards CSE for children and young people with disabilities and provides tools for advocacy. Key messages Raise awareness to the human rights issues for children and young people with disabilities in the area of CSE. Delivering best practice and tools to advocate.

5.G. Skills building seminar: How to organise and benefit from a public health week in your country, region or continent

Abstract The European Public Health Week (EUPHW) is an annual activity by the European Public Health Association (EUPHA) that began in 2019, inspired by similar initiatives organised in Austria and the USA. This session aims to inspire and guide individuals and institutions to organise a public health day, week or month in a new city, country, region or continent. Having taken place both before and during the COVID-19 pandemic, the EUPHW has demonstrated that public health professionals, institutions and citizens across Europe are strongly committed to deliver its goals: to make the case for public health, amplify existing messages about important health topics, and create innovative ways of collaboration among all professionals contributing to public health - from local to international level. With a rich portfolio, the three editions of EUPHW recorded approximately 400 online and in-person activities hosted by more than 40 countries in multiple languages. In this skills-building seminar we will share examples, tips, best practices and lessons learned. This will be an interactive session combining group dynamics and Q&A to and from the audience, allowing participants to provide suggestions for improvement and share their experiences and perceptions as event hosts, disseminators or participants of past editions. The topics to be covered include governance, choice of themes and key messages, logistics, target audiences, communication, partnerships, stakeholder engagement, involvement types and evaluation, as well as concrete ways of applying the motto of EUPHW: “Joining forces for healthier populations”. Panellists will bring the perspective of organising a public health week at both national and European levels, including the day-to-day coordination work. They will also explain how we can engage with the future generation of public health professionals (EUPHAnxt) and build continuity and sustainable partnerships. The EUPHW is an initiative by the European Public Health Association (EUPHA), receives co-funding under an operating grant from the European Union's Health Programme and is supported by the WHO Regional Office for Europe. Speakers/Panelists Dineke Zeegers Paget EUPHA Thomas Dorner Austrian Public Health Association, Vienna, Austria Marie Guichardon EUPHA Monica Brinzac Cluj School of Public Health, Cluj Napoca, Romania Key messages The European Public Health Week is a unique opportunity to make the case for public health, raise awareness about important health themes and promote collaboration among the public health community. This seminar aims to inspire individuals and institutions to organise a public health awareness day, week or month in their own local community, country or even continent.

Indoor Air Pollution Exposure of Women in Adama, Ethiopia, and Assessment of Disease Burden Attributable to Risk Factor.

Introduction and aim: Air pollution, a major environmental threat to human health, contributes to the premature deaths of millions of people worldwide. Cooking with solid fuels, such as charcoal and wood, in low- and middle-income countries generates very high emissions of particulate matter within and near the household as a result of their inefficient combustion. Women are especially exposed, as they often perform the cooking. The purpose of this study was to assess the burden of disease attributable to household air pollution exposure from cooking among women in Adama, Ethiopia. Methods: AirQ+ software (WHO Regional Office for Europe, Copenhagen, Denmark) was used to assess the health impact of household air pollution by estimating the burden of disease (BoD) including Acute Lower Respiratory Infections (ALRI), Chronic Obstructive Pulmonary Disease (COPD), Ischemic Heart Disease (IHD), lung cancer, and stroke, among a cohort of women in Adama. Household air pollution exposure estimated by cooking fuel type was assessed through questionnaires. Results: Three-quarters (75%) of Adama’s population used solid fuel for cooking; with this, the household air pollution attributable mortality was estimated to be 50% (95% CI: 38–58%) due to ALRI, 50% (95% CI: 35–61%) due to COPD, 50% (95% CI: 27–58%) due to lung cancer, (95% CI: 23–48%) due to IHD, and (95% CI: 23–51%) due to stroke. The corresponding disability-adjusted life years (DALYs) per 100,000 women ranged between 6000 and 9000 per disease. Conclusions: This health impact assessment illustrates that household air pollution due to solid fuel use among women in Adama leads to premature death and a substantial quantity of DALYs. Therefore, decreasing or eliminating solid fuel use for cooking purposes could prevent deaths and improve quality of life.

Supporting National Immunization Technical Advisory Groups in the WHO European Region in developing national COVID-19 vaccination recommendations through online communication platform

National Immunization Technical Advisory Groups are groups of multi-disciplinary experts that provide scientific advice to policy makers to enable them to make informed immunization policy and programme decisions. NITAGs faced challengesusing their routine approach to develop recommendations for COVID-19 vaccines during the pandemic. In response, the WHORegional Office for Europe (Regional Office), with the support of theRobert Koch Institute, developedan innovative approach of a series of webinars, provision of materials, and remote technical assistance to address these challenges. Polls conducted during webinars were used to tailor future webinars and evaluate the effectiveness of these interventions. According to poll results, 76% of participants found the webinars and resources shared very useful in their work on COVID-19 vaccination.The Regional Office plans to build further upon the scope of online communication and establish a regional online platform for NITAGs to further support NITAGs and build capacity.

A new strategy for health and sustainable development in the light of the COVID-19 pandemic

To build a post-pandemic future, in which everyone's health is protected and promoted, what can we learn from the events of the COVID-19 pandemic and previous crises? The Pan-European Commission on Health and Sustainable Development, established by the WHO Regional Office for Europe and comprising experts from a wide range of backgrounds and across the pan-European region, has now set out an ambitious agenda to achieve a healthy and secure future for all in its new report.1

The EU Response to COVID-19: From Reactive Policies to Strategic Decision-Making.

The EU Response to COVID-19: From Reactive Policies to Strategic Decision-Making.

DEPRESSION IN CANCER PATIENTS DURING COVID-19 PANDEMIC.

More than 100 million confirmed accidents and more than 2 million deaths - this is the summary of СOVID-19 in mid-2021 when the whole world is experiencing the worst twilight of the pandemic. At the same time, the WHO European Regional Office considers this period to be the tipping point of the pandemic, linking it to the beginning of mass vaccination and the accumulated experience in the diagnosis and treatment of COVID-19 and its consequences, Despite the emergence of new mutations of the virus, the presence of prolonged forms of the disease (long-COVID, or post-COVID syndrome) (World Health Organization. Statement by Dr. Hans Henri P. Kluge, WHO Regional Director for Europe. Copenhagen, 7 January 2021). Apart from psychotic disorders of infectious origin in СOVID-19 (mental confusion, psychomotor agitation, delirious, hallucinatory, beacon-like, and affective disorders), non-productive changes in consciousness may develop, post-traumatic stress disorder (PTSD), non-psychotic asthenic states, depression, hypochondriacally disorders, sleep disorders, autonomic manifestations, cognitive deficit disorder, secondary encephalopathy, organ disorders (Kumar S., et al., 2021; Einvik G, et al., 2021). The prevalence of infectious psychosis has a pronounced tendency to decrease, while non-psychotic and cognitive deficit disorders after COVID-19 occur more frequently (Hampshire A., et al., 2020). At this time, the rate of depression and anxiety disorders due to the influence of coronavirus infection is significantly higher than in previous years (McCracken L.M., et al., 2020; Kujawa A., et al., 2020). Among the predictors of their development under pandemic conditions are COVID-19 symptoms, history of somatic disorders, oncological diseases, interim measures, and financial losses. A major stressor effect of the COVID-19 pandemic can provokenosocomial depression in COVID-19 postinfectious cancer patients, a complication in the course of postinfectious depression, and an exacerbation of depression in patients with an infectious disorder in their medical history (Petelin D.S, 2018; Dorozhenok I.Yu., 2021). Depression invariably attracts the attention of physicians. The main reasons for this are its widespread and widespread manifestations and variants of disorder that affect a significant number of people of different stature, age, social groups, and cultures. Women suffer from depression more often than men. According to the World Health Organization, more than 350 million people in the world suffer from depression (World Health Organization.Depression., 2018). The prevalence of depression in cancer is significantly higher than in the general population and, according to physicians, ranges from 33 to 42% (Otroshchenko N. P., et al., 2019). Symptoms of depression are diagnosed in every fourth oncologic patient and occur more frequently in the later stages of the disease. Unfortunately, these patients do not often come into the psychiatrist's field of vision, because, considering the specifics of the disease, they are under the care of oncologists, and they turn to psychiatrists only in cases of major depression or suicidal attempts. High rates of depression (23%) are diagnosed with the most common forms of gynecologic cancer, cervical cancer, and uterine cancer (Arnaboldy P., et al., 2016; Bulletin of the National Cancer Registry N 20 - Cancer in Ukraine, 2017-2018; Petelin D.S., 2018; Otroshchenko N. P., et al., 2019). Comorbidity of oncologic diseases and coronavirus disease causes the risk of serious complications of these viral infections and requires the development and implementation of medical, social, and other protection measures for cancer patients, as well as for patients who have had cancer or other diseases and diseases that impair the function of the immune system (Tian, Y., et al., 2021). Therefore, the relevance of the study of post-covid depression (Hampshire A., et al., 2020; Kumar S., et al., 2021), including in patients with cancer (Tian, Y., et al, 2021), is due to the significant number of cervical and uterine cancerpatients, comorbidity, lack of early effective diagnosis, psychological and psychiatric support, late call for help, the tendency to chronicity, and risk of self-harm (Arnaboldy P., et al., 2016; Petelin D.S., 2018; Otroshchenko N. P., et al., 2019).

The Health Belief Model as an explanatory framework for COVID-19 prevention practices

BackgroundThe COVID-19 government public health measures are necessary to prevent the spread of COVID-19, however, their efficacy is largely dependent on adherence. This study utilized the Health Belief Model (HBM) to explain the public’s adopted prevention practices during the COVID-19 outbreak in Saudi Arabia. MethodsThis study used “COVID-19 Snapshot MOnitoring (COSMO): monitoring knowledge, risk perceptions, preventive behaviours, and public trust in the current coronavirus outbreak” research protocol which is developed by the WHO Regional Office for Europe and the COSMO group. The COSMO questionnaire was translated into Arabic and distributed as an online survey via WhatsApp instant messaging application from May 2nd to May 26th, 2020. The dependent variable was the mean of adopting ten COVID-19 preventive practices. These practices were hand washing, avoiding touching eyes, nose and mouth, use of hand sanitizer, covering mouth and nose when coughing/sneezing, staying home when sick, avoiding close contact with infected persons, social distancing, wearing masks, home isolation, and lockdown. The independent variables included the HBM constructs (susceptibility to and severity of COVID-19, benefits of and barriers to adopting preventive behaviors, cues to action, health motivation, and self-efficacy), sociodemographic factors, presence of chronic illness, and perceived and actual knowledge. We conducted bivariate and multivariate analyses and reported significant findings (P ≤ 0.05). ResultsWe analyzed 1027 surveys. About 38% adhered to all COVID-19 preventive behaviors and the mean for adherence was 9. The HBM perceived benefits (p = 0.001), perceived barriers (p = 0.004), and cues to action (p = 0.046) were associated with adherence to COVID-19 preventive behaviors after adjusting for all other factors. Respondents with the highest levels of education and income were less likely to adopt COVID-19 preventive behaviors compared to those in the lower ranks of education and income. ConclusionOur findings suggest that the HBM can be applied to understand adherence to COVID-19 prevention practices. The recognition of perceived health beliefs and practices is important for developing effective COVID-19 health intervention strategies.

A comparison of 2020 health policy responses to the COVID-19 pandemic in Canada, Ireland, the United Kingdom and the United States of America

This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom and United States of America (US) from January to November 2020, with the aim of facilitating cross-country learning. Evidence is taken from the COVID-19 Health System Response Monitor, a joint initiative of the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Commission, which has documented country responses to COVID-19 using a structured template completed by country experts. We show all countries faced common challenges during the pandemic, including difficulties in scaling-up testing capacity, implementing timely and appropriate containment measures amid much uncertainty and overcoming shortages of health and social care workers, personal protective equipment and other medical technologies. Country responses to address these issues were similar in many ways, but dissimilar in others, reflecting differences in health system organization and financing, political leadership and governance structures. In the US, lack of universal health coverage have created barriers to accessing care, while political pushback against scientific leadership has likely undermined the crisis response. Our findings highlight the importance of consistent messaging and alignment between health experts and political leadership to increase the level of compliance with public health measures, alongside the need to invest in health infrastructure and training and retaining an adequate domestic health workforce. Building on innovations in care delivery seen during the pandemic, including increased use of digital technology, can also help inform development of more resilient health systems longer-term.

Variations in the Consumption of Antimicrobial Medicines in the European Region, 2014-2018: Findings and Implications from ESAC-Net and WHO Europe.

Background: Surveillance of antimicrobial consumption (AMC) is important to address inappropriate use. AMC data for countries in the European Union (EU) and European Economic Area (EEA) and Eastern European and Central Asian countries were compared to provide future guidance. Methods: Analyses of 2014–2018 data from 30 EU/EEA countries of the European Surveillance of Antibiotic Consumption network (ESAC-Net) and 15 countries of the WHO Regional Office for Europe (WHO Europe) AMC Network were conducted using the Anatomical Therapeutic Chemical (ATC) classification and Defined Daily Dose (DDD) methodology. Total consumption (DDD per 1000 inhabitants per day) of antibacterials for systemic use (ATC group J01), relative use (percentages), trends over time, alignment with the WHO Access, Watch, Reserve (AWaRe) classification, concordance with the WHO global indicator (60% of total consumption should be Access agents), and composition of the drug utilization 75% (DU75%) were calculated. Findings: In 2018, total consumption of antibacterials for systemic use (ATC J01) ranged from 8.9 to 34.1 DDD per 1000 inhabitants per day (population-weighted mean for ESAC-Net 20.0, WHO Europe AMC Network 19.6, ESAC-Net Study Group, and WHO Europe AMC Network Study Group). ESAC-Net countries consumed more penicillins (J01C; 8.7 versus 6.3 DDD per 1000 inhabitants per day), more tetracyclines (J01A; 2.2 versus 1.2), less cephalosporins (J01D; 2.3 versus 3.8) and less quinolones (J01M; 1.7 versus 3.4) than WHO Europe AMC Network countries. Between 2014 and 2018, there were statistically significant reductions in total consumption in eight ESAC-Net countries. In 2018, the relative population-weighted mean consumption of Access agents was 57.9% for ESAC-Net and 47.4% for the WHO Europe AMC Network. For each year during 2014–2018, 14 ESAC-Net and one WHO Europe AMC Network countries met the WHO global monitoring target of 60% of total consumption being Access agents. DU75% analyses showed differences in the choices of agents in the two networks. Interpretation: Although total consumption of antibacterials for systemic use was similar in the two networks, the composition of agents varied substantially. The greater consumption of Watch group agents in WHO Europe AMC Network countries suggests opportunities for improved prescribing. Significant decreases in consumption in several ESAC-Net countries illustrate the value of sustained actions to address antimicrobial resistance.

Providing health services effectively during the first wave of COVID-19: A cross-country comparison on planning services, managing cases, and maintaining essential services

The COVID-19 pandemic triggered abrupt challenges for health care providers, requiring them to simultaneously plan for and manage a rise of COVID-19 cases while maintaining essential health services. Since March 2020, the COVID-19 Health System Response Monitor, a joint initiative of the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Commission, has documented country responses to COVID-19 using a structured template which includes a section on provision of care. Using the information available on the platform, this paper analyzes how countries planned services for potential surge capacity, designed patient flows ensuring separation between COVID-19 and non-COVID-19 patients, and maintained routine services in both hospital and ambulatory settings. Despite very real differences in the organization of health and care services, there were many similarities in country responses. These include transitioning the management of COVID-19 mild cases from hospitals to outpatient settings, increasing the use of remote consultations, and cancelling or postponing non-urgent services during the height of the first wave. In the immediate future, countries will have to continue balancing care for COVID-19 and non-COVID-19 patients to minimize adverse health outcomes, ideally with supporting guidelines and COVID-19-specific care zones. Looking forward, policymakers will have to consider whether strategies adopted during the COVID-19 pandemic will become permanent features of care provision.