Abstract
Introduction
Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose a significant burden on Public Health. Although it is undeniable that the COVID-19 pandemic ...provoked challenges in routine clinical practices and surveillance, especially in intensive care units (ICUs), its impact on HAIs and AMR is still highly debated. The present analysis describes trends of HAIs and multidrug-resistant (MDR) microorganisms in Italian ICUs from 2006 to 2021.
Methods
According to the European Center for Disease Prevention and Control (ECDC) protocol, we used data on nearly 22,000 patients and 4,500 isolates from the “Italian Nosocomial Infections Surveillance in Intensive Care Units, SPIN-UTI” project. The study population consists of all patients admitted to Italian ICUs for more than 48 hours. Isolates of Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniae were classified as MDR if susceptible to at least one antimicrobial agent in three or more antibiotic classes.
Results
Overall, the incidence density of HAIs increased from 17.1 per 1,000 patient-days in 2006-2007 to 24.1 in 2020-2021. Part of this increase can be attributed to the increasing incidence density of pneumoniae (p < 0.001). Although the proportion of MDR microorganisms did not significantly change over the years, increasing trends were evident in the incidence density of MDR isolates for A. baumannii (from 1.3 to 3.2 per 1,000 patient-days) and K. pneumoniae (from 0.5 to 3.1 per 1,000 patient-days). By contrast, the proportion of methicillin-resistant Staphylococcus aureus decreased from 46.9% in 2006 to 30.2% in 2021 (p-<0.05).
Conclusions
Our analysis shows an increasing trend in the incidence of HAIs and MDR microorganisms in Italian ICUs. This scenario has been surely worsened by the COVID-19 pandemic. It is still unclear, however, if the increasing incidence of AMR can be attributed to an overall increase in HAIs or to other causes.
Key messages
• In Italian ICUs, the incidence of HAIs and MDR microorganisms increased from 2006 to 2021.
• Further studies should be conducted to estimate the impact of COVID-19 pandemic on HAIs and AMR.
Abstract
Background
The Nordic Nutrition Recommendations (NNR) gives the scientific basis for national dietary guidelines for the Nordic and Baltic countries. The Global Burden of Diseases, Injuries, ...and Risk Factors study (GBD) provides comparative estimates of the disease burden related to suboptimal diet in 195 countries. The aim of the study was to employ data from GBD 2021 to improve the knowledge base for NNR.
Methods
A comparative risk assessment approach was used to estimate the proportion of disease-specific burden that could be attributed to fifteen dietary risk factors in the population aged 25 and older in the Nordic and Baltic countries. The analyses included four steps: (1) estimating dietary intake on a population level; (2) determining the relative risks of dietary factors on disease endpoints; (3) determining the level of exposure with minimum risk; and (4) estimating the final disease burden, defined as disability-adjusted life-years (DALYs), attributed to each dietary risk.
Results
A suboptimal intake was found for all dietary risk factors in all countries. A total of 60 350 deaths and 1 079 087 DALYs were attributed to dietary factors. The highest age standardised mortality rates attributed to diet were found in Lithuania (371 per 100 000), and lowest in Norway (101 per 100 000). Low intake of whole grains was the largest dietary risk factor for mortality and DALYs in all countries except Estonia. Other highly-ranked factors in all countries included a diet high in processed meat and low in fruit. The results are preliminary, with final GBD 2021 estimates expected to be published medio 2023.
Conclusions
GBD offers a powerful resource to model trends in diet-related burden of diseases in the Nordic and Baltic countries. Estimates from GBD can provide countries with insight into the potential of reducing disease burden by targeting specific dietary risks.
Key messages
• Suboptimal diet leads to a substantial and avoidable mortality and disease burden in the Nordic and Baltic countries.
• Detailed and comparative estimates from GBD can help countries identify their most important dietary risk factors.
Abstract
Moving towards holistic approaches that assess trade-offs among health, sustainability, and economics is imperative to minimize emergent risks and drivers of environmental degradation ...associated with food systems. Health risk-benefit assessments provide informative outputs to support decision-making within the public health domain. However, integrating indicators from different dimensions requires tailoring current risk-benefit methods. In this context, multicriteria decision analysis methodologies can be relevant to account for different factors and weighing trade-offs of real-life scenarios of changes in food systems. In addition, further research building on initiatives attempting to integrate frameworks within health (e.g., risk analysis) and environment (e.g., Life-Cycle Assessment and linear programming) or health and economics (e.g., cost-benefit and cost of illness), is needed to establish a holistic risk-benefit assessment framework. This presentation will introduce current efforts in the development of holistic assessment methods that evaluate impacts beyond the health risk and benefits perspective. In addition, the presentation will highlight the potential gains of such methods in policymaking.
Abstract
In Europe chronic non-communicable diseases (NCDs) are responsible for the majority of deaths, premature deaths and disabilities. Actions to fight against smoking, excessive alcohol ...consumption, sedentary behaviours and obesity are central for the prevention of NCDs. In Italy in 2007 the National Program Gaining Health (GH) was launched and the behavioral risk factor surveillance system (including PASSI and PASSI d’Argento) was promoted. This study has the aim to contribute to assess the impact of the strategies implemented with GH, analyzing over time data on behavioral risk factors in Italy since 2008. Data from PASSI 2008-2021 (468.000 interviews of 18-69 years old people) and PASSI d’Argento 2016-2021 (74.000 interviews of over 65 years old people).
i) time series models on smoking, alcohol, sedentary behaviours and obesity data in adults, stratified by gender, age, residence and social determinants;
ii) Regression models to evaluate the changes in associations over time between behavioral and social determinants.
Smokers’ prevalence dropped from 30% to 24%, not equally in population groups. Excessive consumption of alcohol is stable since 2010 (∼16%); although, it is the result of opposite trends in the different components of the indicator (binge, between meals and usually high) and of improvements in some groups and worsening in others: it increases in the North but not in the Center-South, it is reduced in men but increased among women; it remains stable among young people aged 18-24 (∼27%). Sedentariness is increasing everywhere (31% in 2021), especially in the South (43%) and among the youngest. Obesity also increased in the South and in the North; today about one out of 10 is obese. Social inequalities continue and worse in affecting these phenomena. These data show no improvement in the last 15 years. Prevention Plan is an opportunity to change course. Surveillance is strategic, as long as it is used to guide policies and to monitor their effectiveness over time.
Key messages
• Data on behavioral risk factors show no improvement in Italy since 2008.
• Surveillance is strategic to guide health policies and to monitor their effectiveness over time.
Abstract
Air pollution is detrimental for health, climate, national economies and well-being in the European Union (EU) and in EU candidate countries. In many locations air quality levels are above ...the EU or national legal standards and/or the guidelines recommended by the World Health Organization. Very often EU neighbours and countries in the process of accessing the EU are disproportionately more affected by the impact of air pollution than others. The newest global evidence is suggesting that human health is affected even at low pollution levels below the current European standards and WHO guideline values. In 2021, the WHO published new air quality guidelines structured in Intermediate targets and final targets which are lower than the previous recommendations published in 2005. Estimating the costs of air pollution requires analysis of extensive data sets by means of econometric and statistical methodologies. In this session is discussed the assessment at country level for Europe and worldwide which is particularly valuable for estimating statistical value of life (VSL) and the value of a life year (VOLY) for counties that have not been the focus of global estimations so far. Moreover, this workshop adds valuable new information on the Western Balkans and Ukraine that could be used in systematic efforts to develop evidence-based air pollution reduction plans and to track progress toward reducing air pollution and consequently the health impacts. The studies included in this session represent valuable efforts to acquire evidence in support of further alignment of national air quality policies with those of the EU.
Key messages
• The newest evidence supports efforts to further aligning the Western Balkans and Ukrainian air quality policies with those of the EU and contribute to national and local implementation.
• The meta-analysis of existing literature leads to the development of econometric models for estimating VSL and VOLY at country level worldwide.
Abstract
Polyunsaturated fatty acids (PUFAs) may be pertinent to the development of mental disorders, for example 28 via modulation of inflammation and synaptogenesis. We wished to examine ...cross-sectional and longitudinal 29 associations between PUFAs and mental disorders in a large cohort of young people. Participants in the 30 Avon Longitudinal Study of Parents and Children were interviewed and provided blood samples at two 31 sampling periods when approximately 17 and 24 years old. Plasma PUFA measures (total omega-6 n-6, 32 total omega-3 n-3, n-6:n-3 ratio and docosahexaenoic acid DHA percentage of total fatty acids) were 33 assessed using nuclear magnetic resonance spectroscopy. Cross-sectional and longitudinal associations 34 between standardised PUFA measures and three mental disorders (psychotic disorder, moderate/severe 35 depressive disorder and generalised anxiety disorder GAD) were measured by logistic regression, adjusting 36 for age, sex, body mass index and cigarette smoking. There was little evidence of cross-sectional 37 associations between PUFA measures and mental disorders at age 17. At age 24, the n-6:n-3 ratio was 38 positively associated with psychotic disorder, depressive disorder and GAD, while DHA was inversely 39 associated with psychotic disorder. In longitudinal analyses, there was evidence of an inverse association 40 between DHA at age 17 and incident psychotic disorder at age 24 (adjusted odds ratio 0.44, 95% confidence 41 interval 0.22 - 0.87) with little such evidence for depressive disorder or GAD. There was little evidence for 42 associations between change in PUFA measures from 17 to 24 years and incident mental disorders at 24 43 years. These findings provide support for associations between PUFAs and mental disorders in early 44 adulthood, and in particular, for DHA in adolescence in relation to prevention of psychosis.
Abstract
Health systems have been subject to a series of crises over the last fifteen years from economic austerity to the COVID-19 pandemic and now the cost of living crisis. At the same time many ...high-income countries have bolstered their own deficient supply of health workers by importing skilled health professionals from other countries. The health workforce has borne the brunt of each of these shocks and it is no surprise that there is demotivation, burnout and high attrition across staff cadres across Europe. Not enough is known about the root causes of these phenomena and therefore what can be done to effectively enhance workforce wellbeing and engagement and also assist health systems to deal effectively with the legacy of pent up demand from the pandemic which is threatening to overwhelm services. This session seeks to identify and evaluate the different factors that have led to disengagement of staff and assess strategies to improve staff wellbeing, retention and health system recovery, based on quantitative and qualitative research. Three case studies from Ireland distinguish different elements of the problem: 1) an investigation of the dimensions of disengagement and their underlying causes after austerity across staff cadres with particular focus on bullying and discrimination 2) an evaluation of turnover amongst nurses post COVID and the factors which are linked to this, and 3) an examination of racial attitudes and discrimination towards non-Irish health professionals in Irish hospitals. Each study highlights particular factors which have caused disengagement and evaluates their consequences and causes. Together they paint a powerful picture of a health system and its workforce struggling to cope with crisis after crisis, mismanagement and ambitious change programmes. A fourth presentation will compare and contrast this picture with analysis from other high-income countries and examine optimal investment strategies to solve the heath workforce problems. This high-level analysis places the Irish case studies in perspective and allows a more thorough evaluation of key factors and strategies to turn round the situation across Europe. Each presenter will be given a strict deadline of 10 minutes each by the chair and then the audience will be invited to debate the problems identified and strategies proposed to discuss: (i) the appropriate course of action for health systems in Europe at this time, (ii) the conditions under which strategies will achieve the desired results for the health workforce and (iii) how and whether a coordinated approach across Europe would be more effective.
Key messages
• This session will improve understanding of the causes of burnout, disengagement and high turnover amongst the health workforce in order to address these problems.
• Strategies for investing in the education, protection and wellbeing of the European health workforce will be evaluated to assist with our readiness for future shocks.
Abstract
Background
Until the 1990s primary care centres in Sweden were almost exclusively public and operated by the country's regions. A primary care reform in 2010 that increased competition ...between approved providers for public funding led to a rapid growth of private providers. Concerns were raised that profit-driven providers would select patients with lower risks.
Methods
We analysed contracts between county councils and private care providers and reviewed strategies employed by local governments to avoid risk selection and whether there were any differences between left- and right-wing governments.
Results
By 2020 over 270 new private primary care centres had been established, most of which were for-profit. Of the overall approximately 1200 primary care centres, about 60% are still owned by the regions and about 40% are privately owned. About a third of the private for-profit practices were owned by international private equity firms in 2018. Three main strategies were used by local governments to avoid risk selection: risk adjustment of the financial reimbursements on the basis of health and/or socio-economic status of listed patients; design of patient listing systems; and regulatory requirements regarding the scope and content of the services that had to be offered by all providers. Left-wing local governments were more prone than right-wing governments to adopt risk adjustment strategies at the onset of the reform but these differences diminished over time.
Conclusions
A variety of regulatory instruments can be used to avoid risk selection by private providers. However, due to a lack of systematic research, no firm conclusions can be drawn so far on the overall impact of private equity ownership on primary care provision in Sweden.
