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European Health Information Portal: a one-stop shop for health information
No full textBackground: Timely and high-quality population-level health information is needed to support evidenceinformed decision-making, for planning and evaluation of prevention, care and cure activities as well as for research to generate new knowledge. FAIR (Findable, Accessible, Interoperable and Reusable) principles are one of the key elements supporting health research and making it more cost-effective through the reuse of already existing data. Currently, health data are in many countries dispersed and difficult to find and access. Methods: Two EU Public Health Programmes co-funded Joint Actions, Information for Action (InfAct) and Population Health Information Research Infrastructure (PHIRI) have established a European Health Information Portal, a web-based service, to facilitate better findability, access, interoperability and reuse of existing health information. Results: The European Health Information Portal (www.healthinformationportal.eu) has been established including sections on National Nodes, data sources, publications, health information projects within countries and across Europe, research networks and research infrastructures, ethical and legal issues for health information exchange and use, capacity-building activities in all areas of population health and a dedicated COVID-19 section. Conclusions: The European Health Information Portal, being a central place for a wide range of population health information from EU Member States, is an information source for researchers, policy-makers and other relevant stakeholders. It is important to ensure the sustainability of the portal, especially in light of the European Health Data Space (EHDS) Regulation proposal and its requirements regarding the secondary use of health data. </p
Multimorbidity and frailty are associated with poorer SARS-CoV-2-related outcomes: systematic review of population-based studies
No full textBackground
Estimating the risks and impacts of COVID-19 for different health groups at the population level is essential for orienting public health measures. Adopting a population-based approach, we conducted a systematic review to explore: (1) the etiological role of multimorbidity and frailty in developing SARS-CoV-2 infection and COVID-19-related short-term outcomes; and (2) the prognostic role of multimorbidity and frailty in developing short- and long-term outcomes. This review presents the state of the evidence in the early years of the pandemic. It was conducted within the European Union Horizon 2020 program (No: 101018317); Prospero registration: CRD42021249444.
Methods
PubMed, Embase, World Health Organisation COVID-19 Global literature on coronavirus disease, and PsycINFO were searched between January 2020 and 7 April 2021 for multimorbidity and 1 February 2022 for frailty. Quantitative peer-reviewed studies published in English with population-representative samples and validated multimorbidity and frailty tools were considered.
Results
Overall, 9,701 records were screened by title/abstract and 267 with full text. Finally, 14 studies were retained for multimorbidity (etiological role, n = 2; prognostic, n = 13) and 5 for frailty (etiological role, n = 2; prognostic, n = 4). Only short-term outcomes, mainly mortality, were identified. An elevated likelihood of poorer outcomes was associated with an increasing number of diseases, a higher Charlson Comorbidity Index, different disease combinations, and an increasing frailty level.
Discussion
Future studies, which include the effects of recent virus variants, repeated exposure and vaccination, will be useful for comparing the possible evolution of the associations observed in the earlier waves.</p
The potential impact fraction of population weight reduction scenarios on non-communicable diseases in Belgium: application of the g-computation approach
No full textBackground
Overweight is a major risk factor for non-communicable diseases (NCDs) in Europe, affecting almost 60% of all adults. Tackling obesity is therefore a key long-term health challenge and is vital to reduce premature mortality from NCDs. Methodological challenges remain however, to provide actionable evidence on the potential health benefits of population weight reduction interventions. This study aims to use a g-computation approach to assess the impact of hypothetical weight reduction scenarios on NCDs in Belgium in a multi-exposure context.
Methods
Belgian health interview survey data (2008/2013/2018, n = 27 536) were linked to environmental data at the residential address. A g-computation approach was used to evaluate the potential impact fraction (PIF) of population weight reduction scenarios on four NCDs: diabetes, hypertension, cardiovascular disease (CVD), and musculoskeletal (MSK) disease. Four scenarios were considered: 1) a distribution shift where, for each individual with overweight, a counterfactual weight was drawn from the distribution of individuals with a “normal” BMI 2) a one-unit reduction of the BMI of individuals with overweight, 3) a modification of the BMI of individuals with overweight based on a weight loss of 10%, 4) a reduction of the waist circumference (WC) to half of the height among all people with a WC:height ratio greater than 0.5. Regression models were adjusted for socio-demographic, lifestyle, and environmental factors.
Results
The first scenario resulted in preventing a proportion of cases ranging from 32.3% for diabetes to 6% for MSK diseases. The second scenario prevented a proportion of cases ranging from 4.5% for diabetes to 0.8% for MSK diseases. The third scenario prevented a proportion of cases, ranging from 13.6% for diabetes to 2.4% for MSK diseases and the fourth scenario prevented a proportion of cases ranging from 36.4% for diabetes to 7.1% for MSK diseases.
Conclusion
Implementing weight reduction scenarios among individuals with excess weight could lead to a substantial and statistically significant decrease in the prevalence of diabetes, hypertension, cardiovascular disease (CVD), and musculoskeletal (MSK) diseases in Belgium. The g-computation approach to assess PIF of interventions represents a straightforward approach for drawing causal inferences from observational data while providing useful information for policy makers.</p
The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019
No full textBackground
The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010.
Methods
We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE).
Results
In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5%).
Conclusions
There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease.</p
L'influence de facteurs démographiques et socio-économiques sur la vaccination covid-19
No full textLessons Learned from Active Clinical and Laboratory Surveillance during the Sheep Pox Virus Outbreak in Spain, 2022-2023.
No full textIn September 2022, more than 50 years after its eradication from Spain, Sheep pox virus was confirmed by laboratory analysis in sheep showing characteristic lesions. This was the start of an outbreak that lasted 9 months and infected 30 farms dispersed over two different areas, Andalusia and Castilla-La Mancha. Early after the initial confirmation, an active surveillance based on clinical inspection with laboratory confirmation of sheep with clinical signs was started in restricted areas. This allowed the confirmation of Sheep pox in 22 out of 28 suspected farms, where limited numbers of sheep with mainly erythema and papules were found, indicative of early detection. Nevertheless, to improve active surveillance and stop the outbreak, clinical inspection was reinforced by laboratory analysis in all inspected farms, even when no clinically diseased sheep were detected. Although more than 35,000 oral swabs from 335 farms were analysed by real-time PCR in pools of five, only two out of six reported outbreaks in this period were detected by laboratory analysis before clinical signs were observed. Furthermore, additional insights were gained from the extensive laboratory surveillance performed on samples collected under field conditions. No evidence of Sheep pox virus infection was found in goats. Oral swabs proved to be the sample of choice for early detection in the absence of scabs and could be tested in pools of five without extensive loss in sensitivity; serology by ELISA was not useful in outbreak detection. Finally, a non-infectious genome of the virus could be detected months after cleaning and disinfection; thus, real-time PCR results should be interpreted with caution in sentinel animals during repopulation. In conclusion, the outbreak of Sheep pox virus in Spain showed that active clinical inspection with laboratory confirmation of clinically diseased sheep via oral swab testing proved a sensitive method for detection of infected farms, providing insights in laboratory surveillance that will be helpful for other countries confronted with Sheep pox outbreaks.</p
Potential (co-)contamination of dairy milk with AFM1 and MC-LR and their synergistic interaction in inducing mitochondrial dysfunction in HepG2 cells
No full textPopulation health information research infrastructure—from data to public health actions
No full textWhen the first COVID-19 cases were registered in Europe, the health information systems (HIS) of European countries were not ready to quickly adapt and respond to the crisis. Given the acuteness and novelty of this public health threat, data on what was effective against the virus were scarce. As a result, diverse policy responses and strategies were followed across the region causing the spread of contrasting messages and interventions, negatively impacting the health of the citizens. In times of crisis and beyond, the availability and trustworthiness of health information is indispensable.1 This edition, themed From Data to Public Health Actions, features work carried out by the Population Health Information Research Infrastructure (PHIRI).
The EU and its Member States need strong and resilient HIS that can deliver timely, sound and high-quality health information to support policymaking, strengthen (health) programme action and improve individual and population health outcomes.2,3 Both the European Commission and the Council of the European Union expressed the wish to examine how an improved alignment of health information activities at an EU level would function in terms of coherence, coordination and sustainability; data harmonization, collection, processing and reporting; research, capacity building; and transferability into evidence-based policy making.
The PHIRI provides powerful research tools and services to build collective intelligence, strengthen the public health workforce and build stronger HIS in order to increase preparedness and support the coordination of European efforts. This is achieved through a close collaboration with 41 partners across 30 countries. The PHIRI team is more than sum of its parts: it is a strong consortium that builds on almost a decade of collaboration and the achievements of BRIDGE Health4 and the Joint Action on Health Information (InfAct).5
PHIRI covers essential pillars to support strong and resilient HIS and research for evidence-based policy making across Europe. These are reflected in the papers covered in this special edition.
The first pillar focuses on the exchange of health data, information and knowledge. The European Health Information Portal (www.healthinformationportal.eu) serves as a one-stop shop facilitating the reuse through access to population health and health care data, information and expertise in Europe. The Portal includes metadata catalogues on health data sources, its providers and managers; trainings in population health information; European health information projects; and a dedicated COVID-19 policy measures corner. Furthermore, the PHIRI Rapid Exchange Forum allows for a quick exchange of knowledge and good practices during crises and to address urgent public health questions in peace time. Such a forum can be instrumental for upcoming work, e.g. defining indicators that need to be monitored for better resilience and preparedness. Finally, a sustainable, efficient HIS requires the development of new digital health information technologies managed by highly skilled professionals.
The second pillar focuses on research and innovation. PHIRI supports research across Europe through the identification, access, assessment and reuse of population health and non-health data to underpin public health policy decisions. A federated research infrastructure can overcome data reuse and data sharing hindrances for rapid policy-relevant research response. The current PHIRI Federated Research Infrastructure has been designed to comply with the General Data Protection Regulation, with each node being in charge of taking responsibility for compliance, minimizing the use of potentially sensitive data avoiding any personal data transmission in the federated analysis schema.
The third pillar focuses on recommendations for policy actions. When the COVID-19 crisis hit, the resilience of HIS differed substantially in European countries. PHIRI performed COVID-19 HIS assessments to learn important lessons from countries’ response to the pandemic and support the strengthening of HIS in Europe. In addition, public health foresight activities provided valuable information for decision makers to develop strategies and implement present day actions aiming at healthier futures. PHIRI developed a compact guide to support countries to develop their own public health foresight study. Such activities are a critical step to be better prepared for future crises and need to be performed on a regular basis.
In short, PHIRI is an integral research cornerstone for the implementation of the European Health Data Space (EHDS), aiming to invigorate the European health data ecosystem by facilitating tools and services for secondary use of health data. The three pillars presented in the papers are the services that the ‘PHIRI Research Infrastructure’ can provide to the research community to facilitate the reuse of data across countries, highlighting the large added value PHIRI can have for the EHDS. With the provision of its services, PHIRI will continue to build capacity across European countries, support ‘federated analysis of sensitive data’ and real-world data and consolidate ‘strong networks and platforms’ to collect information, start research projects and share expertise in an efficient manner.</p
