The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019.

BACKGROUND: 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.

Impact of drought on mental and behavioral disorders, contributions of research in a climate change context. A narrative review.

Mental and behavioral disorders are an important public health problem and constitute a priority for the WHO, whose recommendations include the surveillance of their risk factors. On the other hand, drought episodes have been increasing in frequency and severity in Europe since 1980. Therefore, to review the present knowledge about the impact of drought on mental and behavioral disorders, in the present climate change context, and to underline potential research gaps, could be of major interest. Thus, we performed a narrative review using online academic databases with the aim of identifying relevant literature about the impact of drought on mental and behavioral disorders. To the best of our knowledge, no study in Europe quantifies the potential association between drought and mental disorders. A limited number of studies have found significant associations between droughts (with different temporal ranges) and various measures of mental health. However, according to our review, only three of them quantified the association between drought and objective mental health outcomes, such as number of emergencies due to clinically diagnosed mental disorders or suicides. Additionally, few studies used specific indices as a measure of drought; and finally, as far as authors are aware, none of them has analyzed this relationship adjusting for various other potential environmental confounders. Moreover, the eventual association could vary between different geographical areas within the same country. Therefore, national and regional studies would be especially necessary. Thus, there is a need for specific national and regional studies, in Europe and globally, that assess the impact of specific indices of drought (with different temporal ranges) on objective mental health outcomes controlling for potential environmental confounders. Moreover, the quantification of its cost would be necessary for health prioritization, evidence-based policies and strategic health planning.

The InfAct proposal for a sustainable European health information infrastructure on population health: the Distributed Infrastructure on Population Health (DIPoH).

BACKGROUND: In Europe, data on population health is fragmented, difficult to access, project-based and prone to health information inequalities in terms of availability, accessibility and especially in quality between and within countries. This situation is further exacerbated and exposed by the recent COVID-19 pandemic. The Joint Action on Health Information (InfAct) that builds on previous works of the BRIDGE Health project, carried out collaborative action to set up a sustainable infrastructure for health information in the European Union (EU). The aim of this paper is to present InfAct's proposal for a sustainable research infrastructure, the Distributed Infrastructure on Population Health (DIPoH), which includes the setup of a Health Information Portal on population health to be maintained beyond InfAct's time span. METHODS: The strategy for the proposal was based on three components: scientific initiatives and proposals to improve Health Information Systems (HIS), exploration of technical acceptability and feasibility, and finally obtaining high-level political support.. The technical exploration (Technical Dialogues-TD) was assumed by technical experts proposed by the countries, and political guidance was provided by the Assembly of Members (AoM), which gathered representatives from Ministries of Health and Science of EU/EEA countries. The results from the AoM and the TD were integrated in the sustainability plan compiling all the major outputs of InfAct. RESULTS: The InfAct sustainability plan was organized in three main sections: a proposal of a new research infrastructure on population health (the DIPoH), new health information tools and innovative proposals for HIS, and a comprehensive capacity building programme. These activities were carried out in InfAct and are being further developed in the Population Health Information Research Infrastructure (PHIRI). PHIRI is a practical rollout of DIPoH facilitating and generating the best available evidence for research on health and wellbeing of populations as impacted by COVID-19. CONCLUSIONS: The sustainability plan received wide support from Member States and was recognized to have an added value at EU level. Nevertheless, there were several aspects which still need to be considered for the near future such as: (i) a commitment of stable financial and political support by Member States (MSs), (ii) the availability of resources at regional, national and European level to deal with innovations, and (iii) a more direct involvement from EU and international institutions such as the European Centre for Disease Prevention and Control (ECDC), the World Health Organization (WHO) and the Organisation for Economic Cooperation and Development OECD for providing support and sustainable contributions.

Integrating technical and political views for a sustainable European Distributed Infrastructure on Population Health.

BACKGROUND: Non-Communicable diseases (NCD) are the main contributors to mortality and burden of disease. There is no infrastructure in Europe that could provide health information (HI) on Public Health monitoring and Health Systems Performance (HSP) for research and evidence-informed decision-making. Moreover, there was no EU and European Economic Area Member States (EU/EEA MSs) general consensus, on developing this initiative and guarantee its sustainability. The aim of this study is to analyze the integration of technical and political views made by the Joint Action on Health Information (InfAct; Information for Action) and the results obtained from those activities, in terms of advice and national and institutional support to develop an integrated and sustainable European Distributed Infrastructure on Population Health (DIPoH) for research and evidence-informed policy-making. METHODS: InfAct established two main boards, the Technical Dialogues (TDs) and the Assembly of Members (AoM), to provide a platform for discussion with EU/EEA MSs to establish a sustainable infrastructure for HI: 1) The TDs were composed by national technical experts (NTE) with the aim to discuss and provide feedback about scientific aspects, feasibility and EU-added value of the infrastructure proposed by InfAct. 2) The AoM gathered country representatives from Ministries of Health and Research at the highest political level, with the aim of providing policy-oriented advice for the future political acceptance, support, implementation, and development of InfAct's outcomes including DIPoH. The documentation provided for the meetings consisted in Fact-Sheets, where the main results, new methods and proposals were clearly exposed for discussion and assessment; altogether with more extended information of the DIPoH. The documentation was provided to national representatives within one more before each TD and AoM meeting. The Agenda and methodological approaches for each TD and AoM meeting consisted in the presentations of the InfAct outcomes extending the information provided in the Fact-Sheets; followed by a non-structured interaction, exchange of information, discussion and suggestions by the MSs representatives. The outcomes of the non-structured discussions were collected in Minutes of the TD and AoM meetings, and the final version was obtained with the consensus of all participants. Additionally, structured letters of political support were provided to the AoM representatives, for them to consider providing their MS written support for DIPoH. RESULTS: NTE, within the TDs, considered that DIPoH was useful for technical mutual learning and cooperation among and within countries; although they considered that the technical feasibility to uptake InfAct deliverables at the national and EU level was complex. The AoM focused on political support, resources, and expected MSs returns. The AoM representatives agreed in the interest of setting up an integrated and sustainable HI infrastructure and they considered DIPoH to be well-articulated and defined; although, some of them, expressed some barriers for providing DIPoH political support. The AoM representatives stated that the AoM is the most suitable way to inform EU MSs/ACs about future advances of DIPoH. Both boards provided valuable feedback to develop this infrastructure. Eleven countries and sixteen institutions supported the proposal, either by letters of political support or by signing the Memorandum of Understandings (MoU) and three countries, additionally, provided expression of financial commitment, for DIPoH to be added to the ESFRI 2021 roadmap. CONCLUSIONS: TDs and AoM were key forums to develop, advise, advocate and provide support for a sustainable European research infrastructure for Population Health.

Comparison of metabolic syndrome prevalence using four different definitions - a population-based study in Finland.

BACKGROUND: Metabolic syndrome (MetS) is a public health problem in Europe, affecting all age groups. Several MetS definitions are available. The aim of this study was to compare four different MetS definitions in the Finnish adult population, to assess their agreement and to evaluate the impact of the choice of the definition on the prevalence of MetS. METHODS: Data from FinHealth 2017, a cross-sectional national population health survey, focusing on adults aged 25 years or older were used in the analysis (n=5687). Measured data on anthropometrics, blood pressure and biomarkers together with questionnaire data were used to classify the participants into the MetS categories according to the four definitions. The definitions chosen for the comparison were those by the World Health Organization (WHO) (1998), National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) (2004), International Diabetes Federation (IDF) (2005), and Joint Interim Statement (JIS) (2009). RESULTS: The four MetS definitions resulted in substantially different MetS prevalence: 17.7% by WHO, 33.3% by NCEP-ATP III, 41.5% by IDF, and 43.0% by JIS. Regardless of the definition used, the prevalence of MetS increased with age. The prevalence of the different components varied between the definitions, depending on the different cut-off points adopted. Out of all participants, only 13.6% were identified to have MetS according to all four definitions. Agreement between participants recognised by different MetS definitions, estimated through kappa coefficients, was almost perfect for IDF vs. JIS (0.97), strong for JIS vs. NCEP-ATP III (0.80), moderate for IDF vs. NCEP-ATP III (0.76) and weak for WHO vs. NCEP-ATP III (0.42), WHO vs. IDF (0.41) and WHO vs. JIS (0.40). CONCLUSIONS: Differences between observed prevalence of MetS in Finnish men and women using different MetS definitions were large. For cross-country comparisons, as well as for trend analyses within a country, it is essential to use the same MetS definition to avoid discrepancies in classification due to differences in used definitions.

[Epidemiological surveillance of sexually-transmitted diseases. Spain 1995-2003]. / Vigilancia epidemiológica de las infecciones de transmisión sexual. España, 1995-2003.

BACKGROUND AND OBJECTIVE: Sexually transmitted infections (STIs) are a major public health problem due to their morbidity, complications and sequels, and also by their relationships with human immunodeficiency virus infection. Several countries have been described a resurgence of STIs since the mid-1990's. MATERIAL AND METHOD: Descriptive study of the STIs monitored by epidemiological surveillance, using as source of information the Spanish National Network of Epidemiological Surveillance data, from 1995 to 2003. RESULTS: In 2003, 1069 new cases of gonorrhoea (rate: 2.55 per 100,000 population) and 917 new cases of syphilis (rate: 2.19 per 100,000 population) were notified to the Spanish Compulsory Disease Reporting System. Between 1995 and 2003, gonorrhoea incidence rates decreased in a 78% and syphilis rates diminish in a 15%. Nevertheless, between 2001 and 2003, both gonorrhoea and syphilis incidence rates have increased in a 29% and 27% respectively. CONCLUSIONS: The data analyzed in this period show an evident change in the trend of the incidence of these STIs. This fact has to be confirmed in the future.

La vigilancia de la salud pública como instrumento para el control de enfermedades y factores de riesgo y sus aplicaciones a la salud laboral / Monitoring of public health as a tool for disease control and risk factors and applications to

Todos los profesionales al servicio de la salud y en concreto de la administración sanitaria tenemos puntos en común y actividades susceptibles de coordinación y mejora. En este encuentro quiero mencionar dos experiencias y saberes: la de la Inspección de servicios sanitarios y también gestores de las consecuencias incapacitantes de las enfermedades. Y la nuestra, los epidemiólogos o gestores de la información sobre las enfermedades y factores de riesgo de la población, al servicio de la autoridad sanitaria y de los ciudadanos. Existen grandes áreas de colaboración entre nuestras funciones que quisiera destacar especialmente, de cara a una mayor coordinación y mejora de nuestro servicio en salud pública. Conclusiones: A través del análisis de los datos y la interpretación de los mismos se concretan los elementos finales para poder elaborar informes y recomendaciones específicas que van a parar a la autoridad sanitaria, en nuestro caso autonómica (si es un problema regional) o nacional si se requiere una intervención a nivel del Estado. Las prioridades y los protocolos de trabajo relacionados con la vigilancia epidemiológica se debaten en las ‘Ponencia de Vigilancia Epidemiológica’, constituidas por los responsables de todas las administraciones del Estado con competencias en materia de Vigilancia, así como por todas las CCAA, y por el CNE. Es el MSSSI quien coordina esta ponencia y quien elabora, junto con el CNE la agenda de temas. Valorando especialmente las enfermedades trasmisibles, las de carácter crónico, y las enfermedades mentales, como procesos de mayor impacto sanitario, social y laboral. Así mismo procediendo a través de la vigilancia de la salud pública a la evaluación de políticas e intervenciones de salud

All professionals serving health and in particular health administration have in common and activities likely to coordination and improvement. At this meeting I want to mention two experiences and knowledge: the Inspection of health services and also managers of the disabling consequences of disease. And ours, epidemiologists and managers information on diseases and risk factors of the population, serving the health authority and citizens. There are large areas of collaboration between features that would emphasize especially, facing greater coordination and improving our public health service. Conclusions: Through data analysis and interpretation of these the final elements are specified to produce reports and specific recommendations goes to the health authority in our regional case (if it is a regional problem) or national if an intervention at the state level is required. Priorities and working protocols related to epidemiological surveillance are discussed in the ‘Presentation Epidemiological Surveillance’, consisting of the heads of all state administrations with responsibility for monitoring, and for all regions, and the CNE. It is the MSSSI who coordinates this paper and who makes, along with the CNE’s agenda topics. Valuing especially communicable diseases, chronic, and mental illness, as processes of greater health, employment and social impact. Also proceeding through the monitoring of public health to the evaluation of health policies and interventions

Vigilancia epidemiológica de las infecciones de transmisión sexual. España, 1995-2003 / Epidemiological surveillance of sexually-transmitted diseases. Spain 1995-2003

Fundamento y objetivo: Las infecciones de transmisión sexual (ITS) son un importante problema de salud pública, tanto por su morbilidad, complicaciones y secuelas, como por su relación con el virus de la inmunodeficiencia humana. Varios países han descrito un resurgimiento de las ITS a partir de mediados de la década de los años noventa. Material y método: Estudio descriptivo de las ITS sometidas a vigilancia epidemiológica utilizando como fuente de información los datos de la Red Nacional de Vigilancia Epidemiológica entre 1995 y 2003. Resultados: En el año 2003 se notificaron al Sistema de Enfermedades de Declaración Obligatoria 1.069 casos nuevos de infección gonocócica (tasa, 2,55 por 100.000 habitantes) y 917 de sífilis (tasa, 2,19 por 100.000 habitantes). Durante el período 1995-2003 la tasa de incidencia de infección gonocócica disminuyó un 78% y un 15% la de sífilis. Sin embargo, entre 2001 y 2003 la incidencia de gonococia ha aumentado un 29% y en un 27% la de sífilis. Conclusiones: Los datos analizados en el período muestran un aumento de la incidencia de las ITS

Background and objective: Sexually transmitted infections (STIs) are a major public health problem due to their morbidity, complications and sequels, and also by their relationships with human immunodeficiency virus infection. Several countries have been described a resurgence of STIs since the mid-1990's. Material and method: Descriptive study of the STIs monitored by epidemiological surveillance, using as source of information the Spanish National Network of Epidemiological Surveillance data, from 1995 to 2003. Results: In 2003, 1069 new cases of gonorrhoea (rate: 2.55 per 100,000 population) and 917 new cases of syphilis (rate: 2.19 per 100,000 population) were notified to the Spanish Compulsory Disease Reporting System. Between 1995 and 2003, gonorrhoea incidence rates decreased in a 78% and syphilis rates diminish in a 15%. Nevertheless, between 2001 and 2003, both gonorrhoea and syphilis incidence rates have increased in a 29% and 27% respectively. Conclusions: The data analyzed in this period show an evident change in the trend of the incidence of these STIs. This fact has to be confirmed in the future