Late preterm (34–36 weeks of gestational age (GA)), and early term (37–38 weeks GA) birth rates among singleton live births vary from 3% to 6% and from 15% to 31%, respectively, across countries, ...although data from low- and middle-income countries are sparse. Countries with high preterm birth rates are more likely to have high early term birth rates; many risk factors are shared, including pregnancy complications (hypertension, diabetes), medical practices (provider-initiated delivery, assisted reproduction), maternal socio-demographic and lifestyle characteristics and environmental factors. Exceptions include nulliparity and inflammation which increase risks for preterm, but not early term birth. Birth before 39 weeks GA is associated with adverse child health outcomes across a wide range of settings. International rate variations suggest that reductions in early delivery are achievable; implementation of best practice guidelines for obstetrical interventions and public health policies targeting population risk factors could contribute to prevention of both late preterm and early term births.
In countries with comparable levels of development and healthcare systems, preterm birth rates vary markedly--a range from 5 to 10% among live births in Europe. This review seeks to identify the most ...likely sources of heterogeneity in preterm birth rates, which could explain differences between European countries.
Multiple risk factors impact on preterm birth. Recent studies reported on measurement issues, population characteristics, reproductive health policies as well as medical practices, including those related to subfertility treatments and indicated deliveries, which affect preterm birth rates and trends in high-income countries. We showed wide variation in population characteristics, including multiple pregnancies, maternal age, BMI, smoking, and percentage of migrants in European countries.
Many potentially modifiable population factors (BMI, smoking, and environmental exposures) as well as health system factors (practices related to indicated preterm deliveries) play a role in determining preterm birth risk. More knowledge about how these factors contribute to low and stable preterm birth rates in some countries is needed for shaping future policy. It is also important to clarify the potential contribution of artifactual differences owing to measurement.
Well-constructed indicators are used to measure and monitor the health and well-being of children and young people (CYP), aged 0 to 24. There are substantial differences between European Member ...States (MS) health systems, and in how each country measures and monitors population health and well-being, making it difficult to construct valid comparisons. Reliable, valid and comparable data are required to enable evidence-based health policies to maximise the quality of lives for CYP. Using indicators identified in existing databases and knowledge, this research aimed to establish consensus on an agreed set of indicators to measure and monitor the health and well-being of CYP across Europe. A review of relevant indicator-specific projects was carried out to identify possible indicators. As part of a three-round Delphi process, online surveys were distributed to health professionals across Europe who work with health information on CYP. A list of 94 indicators was established across 16 domains and four dimensions. The final set contained 32 indicators to measure and monitor CYP’s health and well-being across Europe. Of these, 21 indicators were reported as widely available. The remaining 11 were reported as not widely available but recommended by panellists to be made compulsory for all MSs to collect. There are considerable differences in reported information availability. Gaps in health data should be properly addressed. These findings provide a basis on which an international set of CYP’s health and well-being indicators can be established. Much more work is needed at EU-Level for this to happen.
While international variations in overall cesarean delivery rates are well documented, less information is available for clinical sub-groups. Cesarean data presented by subgroups can be used to ...evaluate uptake of cesarean reduction policies or to monitor delivery practices for high and low risk pregnancies based on new scientific evidence. We studied differences and patterns in cesarean delivery rates by multiplicity and gestational age in Europe and the United States.
This study used routine aggregate data from 17 European countries and the United States on the number of singleton and multiple live births with cesarean versus vaginal delivery by week of gestation in 2008. Overall and gestation-specific cesarean delivery rates were analyzed. We computed rate differences to compare mode of delivery (cesarean vs vaginal birth) between selected gestational age groups and studied associations between rates in these subgroups namely: very preterm (26-31 weeks GA), moderate preterm (32-36 weeks GA), near term (37-38 weeks GA), term (39-41 weeks GA) and post-term (42+ weeks GA) births, using Spearman's rank tests.
High variations in cesarean rates for singletons and multiples were observed everywhere. Rates for singletons varied from 15% in The Netherlands and Slovenia, to over 30% in the US and Germany. In singletons, rates were highest for very preterm births and declined to a nadir at 40 weeks of gestation, ranging from 8.0% in Sweden and Norway, to 22.5% in the US. These patterns differed across countries; the average rate difference between very preterm and term births was 43 percentage points, but ranged from 14% to 61%. High variations in rate differences were also observed for near term versus term births. For multiples, rates declined by gestational age in some countries, whereas in others rates were similar across all weeks of gestation. Countries' overall cesarean rates were highly correlated with gestation-specific subgroup rates, except for very preterm births.
Gestational age patterns in cesarean delivery were heterogeneous across countries; these differences highlight areas where consensus on best practices is lacking and could be used in developing strategies to reduce cesareans.
Health information (HI) strategies exist in several EU Member States, however, they mainly focus on technical issues and improving governance rather than on content-related priority setting. There is ...also little research available about national prioritization processes underlying HI development for policy support in the EU. The aim of this study was to broaden the knowledge base on HI prioritization strategies and to encourage expert exchange towards good practice models. A specific focus was put on HI produced for national health reporting, this being a crucial tool for policy advice.
We conducted a literature search to identify published and grey literature on national HI prioritization. This was followed by a two-round Policy Delphi study, where we explored which processes and methods exist in EU Member States and associated countries for the prioritization of HI collection. In the first round, information about these processes was gathered in semi-structured questions; in the second round, participants were asked to rank the identified approaches for desirability and feasibility. The survey was conducted online; participants were recruited from the membership of the Joint Action on Health Information (InfAct - Information for Action).
119 experts were contacted, representing 40 InfAct partner institutions in 28 EU Member States and associated countries. Of these, 28 experts responded fully or partially to the first round, and six to the second round. In the first round, more than half of the respondents reported the existence of structured HI prioritization processes in their countries. To prioritize HI, a clear preference was given in the second round for a formal, horizontal process which includes different experts and stakeholders. National public health institutes were named desirable key stakeholders in this process, and also desirable and feasible coordinators for stakeholder coordination.
Health information prioritization methods and procedures reflect the heterogeneity of national public health systems in European countries. Mapping, sharing and ranking prioritization methods and procedures for "good practices" provides a meaningful basis for expert knowledge exchange on HI development. We recommend to make this process part of a future sustainable EU health information system and to use the information gathered in this project to initiate the development of a guidance "Good Practice HI Prioritization" among EU Member States and associated countries.
The availability of data generated from different sources is increasing with the possibility to link these data sources with each other. However, linked administrative data can be complex to use and ...may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of data linkage at the individual level and artificial intelligence (AI) in routine public health activities, to identify the related estimated health indicators (i.e., outcome and intervention indicators) and health determinants of non-communicable diseases and the obstacles to linking different data sources.
We performed a survey across European countries to explore the current practices applied by national institutes of public health, health information and statistics for innovative use of data sources (i.e., the use of data linkage and/or AI).
The use of data linkage and AI at national institutes of public health, health information and statistics in Europe varies. The majority of European countries use data linkage in routine by applying a deterministic method or a combination of two types of linkages (i.e., deterministic & probabilistic) for public health surveillance and research purposes. The use of AI to estimate health indicators is not frequent at national institutes of public health, health information and statistics. Using linked data, 46 health outcome indicators, 34 health determinants and 23 health intervention indicators were estimated in routine. The complex data regulation laws, lack of human resources, skills and problems with data governance, were reported by European countries as obstacles to routine data linkage for public health surveillance and research.
Our results highlight that the majority of European countries have integrated data linkage in their routine public health activities but only a few use AI. A sustainable national health information system and a robust data governance framework allowing to link different data sources are essential to support evidence-informed health policy development. Building analytical capacity and raising awareness of the added value of data linkage in national institutes is necessary for improving the use of linked data in order to improve the quality of public health surveillance and monitoring activities.
Belgian implementation of recent EC initiatives Van den Bulcke, Marc; Delnord, Marie
European journal of cancer prevention,
2021-Dec-01, 2021-12-00, Letnik:
31, Številka:
Suppl 1
Journal Article
Precision medicine represents a paradigm shift in health systems, moving from a one-size-fits-all approach to a more individualized form of care, spanning multiple scientific disciplines including ...drug discovery, genomics, and health communication. This study aims to explore the contextual factors influencing the equitable implementation of precision medicine in Belgium for incorporating precision medicine into routine cancer care within the Belgian health system.
As part of a foresight study, our approach evaluates critical factors affecting the implementation of precision oncology. The study scrutinizes contextual, i.e. demographic, economic, societal, technological, environmental, and political/policy-related (DESTEP) factors, identified through a comprehensive literature review and validated by a multidisciplinary group at the Belgian Cancer Center, Sciensano. An expert survey further assesses the importance and likelihood of these factors, illuminating potential barriers and facilitators to implementation.
Based on the expert survey, five key elements (rising cancer rates, dedicated healthcare reimbursement budgets, increasing healthcare expenditures, advanced information technology solutions for data transfer, and demand for high-quality data) are expected to influence the equitable implementation of precision medicine in routine cancer care in Belgium in the future.
This work contributes to the knowledge base on precision medicine in Belgium and public health foresight, exploring the implementation challenges and suggesting solutions with an emphasis on the importance of comparative analyses of health systems, evaluation of health technology assessment methods, and the exploration of ethical issues in data privacy and equity.
Abstract
Cancer is one of the most pressing issues in public health, one that places that carries a large burden on society, governments, and healthcare systems. Without strong action, cancer ...incidence in Europe is expected to increase by a fifth in 2040, translating into more than 5 million cancer cases (5,328,323) (IARC,2020) . While over 40 % of cases are preventable, 3.9 million people in the EU are diagnosed each year, and 1.9 million deaths are cancer-related. In an effort to tackle cancer, the European Commission (EC) launched two major initiatives: Europe's Beating Cancer Plan (EBCP), and the Mission on Cancer. The EBCP, launched in 2021, is a policy-driven initiative aimed at supporting Member States in addressing every stage of the disease: prevention, early detection, diagnosis, and treatment. The EBCP is supported by a research driven initiative which is the Mission on Cancer. The ambition of these initiative is to reduce the burden of cancer in Europe and save 3 million lives by 2030. Knowledge exchange and capacity building between member states are essential to create a common understanding of the challenges and opportunities in cancer prevention and control, as is facilitating exchange and collaboration between the plethora of actors within each national context. To guarantee the successful implementation of the EBCP and the Mission on Cancer, one must consider the diversity of national contexts. The aim of the workshop is to explore how countries evaluate their needs in the field, through engaging public health actors and community members, with a participatory approach, to implement the EBCP while taking into account the diversity of contexts within countries. In this workshop, we seek contextualise the EC's EBCP and explore implementation strategies from different Member States, with a particular focus on participatory approach to public health initiatives and policy design and implementation. More specifically, a panel will share experiences and discuss examples from Belgium and other European countries in supporting the national implementation of cancer initiatives. The panel will lay the foundation for a discussion with the audience on the opportunities and challenges in various EU countries on participatory public health policy design and implementation, using cancer policy related to prevention, diagnosis, treatment and research, as a case study.
Key messages
• Europe's Beating Cancer Plan should be contextualised taking into consideration Member States and their citizen's heterogeneity and needs, while also adapting to health systems characteristics.
• Knowledge and capacity building between Member States is essential to create a common understanding of the challenges and opportunities in cancer prevention and control in Europe.
Speakers/Panelists
Jinane Ghattas
EUPHAnxt
Anabela Isidro
Agência de Investigação Clínica e Inovação Biomédica, Lisbon, Portugal
Linda Abboud
Sciensano, Brussels, Belgium
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