No country is safe from a pandemic : insights into small countries’ COVID-19 experiences

The end of 2019—beginning of 2020 imposed unprecedented stress on every country as the severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) spread across the globe resulting in the Coronavirus 2019 (COVID-19) pandemic. Every country, large and small, fell victim to this burden resulting in governments instituting various mitigation measures to curb the viral spread and protect their population. Small countries, defined as having 2 million or less inhabitants, are regularly overlooked in public health circles and considered featuring similar characteristics as larger countries but at a smaller scale. While this may be true for some aspects, small countries face unique challenges and advantages related to public health governance, healthcare services delivery and economic sustainability. The COVID-19 pandemic is a great example to highlight these factors, while bringing forward lessons learnt that may be translated as crucial evidence for future pandemic preparedness. [Excerpt]peer-reviewe

“To survey or to register” is that the question for estimating population incidence of injuries?

Abstract Background Measuring the true incidence of injury or medically attended injury is challenging. Population surveys, despite problems with recall and selection bias, remain the only source of information for injury incidence calculation in many countries. Emergency department (ED) registry based data provide an alternative source. The aim of this study is to compare the yearly incidence of hospital treated Home and Leisure Injuries (HLI), and Road Traffic Injuries (RTI) estimated by survey-based and register-based methods and combine information from both sources in to a comprehensive injury burden pyramide. Methods Data from Luxemburg’s European Health Examination Survey (EHES-LUX), European Health Interview Survey (EHIS) and ED surveillance system Injury Data Base (IDB) collected in 2013, were used. EHES-LUX data on 1529 residents 25–64 years old, were collected between February 2013–January 2015. EHIS data on 4004 other residents aged 15+ years old, were collected between February and December 2014. Participants reported last year’s injuries at home, leisure and traffic and treatment received. Two-sided exact binomial tests were used to compare incidences from registry with the incidences of each survey by age group and prevention domain. Data from surveys and register were combined to build an RTI and HLI burden pyramide for the 25–64 years old. This project was part of the European Union project BRIDGE-Health (BRidging Information and Data Generation for Evidence-based Health Policy and Research). Results Among 25–64 years old the incidence of hospital treated injuries per thousand population was 60.1 (95% CI: 59.2–60.9) according to IDB, 62.1 (95% CI: 50.6–75.4) according to EHES-LUX and 53.2 (95% CI: 45.0–62.4) according to EHIS. The incidence of hospital admissions was 3.7 (95% CI: 3.5–4.0) per thousand population from IDB-Luxembourg, 12.4 (95% CI: 7.5–19.3) from EHES-LUX and 18.0 (95% CI: 13.3–23.8) from EHIS. For 15+ years-old incidence of hospital treated HLI was 62.8 (95% CI: 62.1–63.5) per thousand population according to IDB whereas the corresponding EHIS estimate was lower at 46.9 (95% CI: 40.4–54.0). About half of HLI and RTI of the 25–64 years old were treated in hospital. Conclusion The overall incidence estimate of hospital treated injuries from both methods does not differ for the 25–64 years old. Surveys overestimate the number of hospital admissions, probably due to memory bias. For people aged 15+ years, the survey estimate is lower than the register estimate for hospital treated HLI injuries, probably due to selection and recall biases. ED based registry data is to be preferred as single source for estimating the incidence of hospital treated injuries in all age groups

A standardised protocol for assessment of relative SARS-CoV-2 variant severity, with application to severity risk for COVID-19 cases infected with Omicron BA.1 compared to Delta variants in six European countries

Several SARS-CoV-2 variants that evolved during the COVID-19 pandemic have appeared to differ in severity, based on analyses of single-country datasets. With decreased SARS-CoV-2 testing and sequencing, international collaborative studies will become increasingly important for timely assessment of the severity of newly emerged variants. The Joint WHO Regional Office for Europe and ECDC Infection Severity Working Group was formed to produce and pilot a standardised study protocol to estimate relative variant case-severity in settings with individual-level SARS-CoV-2 testing and COVID-19 outcome data during periods when two variants were co-circulating. To assess feasibility, the study protocol and its associated statistical analysis code was applied by local investigators in Denmark, England, Luxembourg, Norway, Portugal and Scotland to assess the case-severity of Omicron BA.1 relative to Delta cases. After pooling estimates using meta-analysis methods (random effects estimates), the risk of hospital admission (adjusted hazard ratio [aHR]=0.41, 95% CI 0.31-0.54), ICU admission (aHR=0.12, 95% CI 0.05-0.27), and death (aHR=0.31, 95% CI 0.28-0.35) was lower for Omicron BA.1 compared to Delta cases. The aHRs varied by age group and vaccination status. In conclusion, this study has demonstrated the feasibility of conducting variant severity analyses in a multinational collaborative framework. The results add further evidence for the reduced severity of the Omicron BA.1 variant.Comment: 21 pages, 6 figures (excluding supplementary material

Challenges of Regional Development in Albania

In practice, regional and territorial development is driven by various motivations and policy objectives. Being a context specific process, there is no ‘one size fits all’ process or method. Though approached differently in terms of territorial and institutional set-up, regional development is mainly used as an instrument to address issues of economic and social imbalances. Affected by the difficulty of undertaking regional development reforms to balance domestic needs, policies prescribed by EU accession requirements, and a lack of capacity, regional development reform in Albania is hampered by the uncertainty and indecision of governments to undertake only a socioeconomic development reform, or a governmental administrative reform as well. The discussion of regional development has been on and off several times in the last sixteen years. There are still uncertainties about the choice between regional development policy (which aims to ensure the proper funding/resource allocation and priority setting for socio-economic development) and regionalisation (with the goal to decentralise/deconcentrate policy making and service provision to the regional level). Both policy options, in their essence, intend to improve the quality of life of citizens. As such, this paper argues that these policy options are not mutually exclusive. On the contrary, regional development policy, if implemented successfully, can pave the way for further decentralising/ deconcentrating governance at regional level. This paper first describes the processes that have taken place so far with regards to regional development and its policy implications. Considering the current state of development and the EU integration process, the paper argues for the need to complete and implement the on-going Regional Development Reform by focusing on two main directions: institutional set-up and resource allocation on the one hand, and the governance model on the other

A Molecular and Epidemiological Investigation of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Luxembourg, 2021

In spring 2021, a long-term care facility (LTCF) of 154 residents in Luxembourg experienced a large severe, acute respiratory-syndrome coronavirus 2 (SARS-CoV-2) outbreak a few days after a vaccination campaign. We conducted an outbreak investigation and a serosurvey two months after the outbreak, compared attack rates (AR) among residents and staff, and calculated hospitalization and case-fatality rates (CFR). Whole genome sequencing (WGS) was performed to detect variants in available samples and results were compared to genomes published on GISAID. Eighty-four (55%) residents and forty-five (26%) staff members tested positive for SARS-CoV-2; eighteen (21%) residents and one (2.2%) staff member were hospitalized, and twenty-three (CFR: 27%) residents died. Twenty-seven (21% of cases) experienced a reinfection. Sequencing identified seventy-seven cases (97% of sequenced cases) with B.1.1.420 and two cases among staff with B.1.351. The outbreak strain B.1.1.420 formed a separate cluster from cases from other European countries. Convalescent and vaccinated residents had higher anti-SARS-CoV-2 IgG antibody concentrations than vaccinated residents without infection (98% vs. 52%, respectively, with >120 RU/mL, p < 0.001). We documented an extensive outbreak of SARS-CoV-2 in an LTCF due to the presence of a specific variant leading to high CFR. Infection in vaccinated residents increased antibody responses. A single vaccine dose was insufficient to mitigate the outbreak

Challenges and benefits of integrating diverse sampling strategies in the observation of cardiovascular risk factors (ORISCAV-LUX 2) study

Background: It is challenging to manage data collection as planned and creation of opportunities to adapt during the course of enrolment may be needed. This paper aims to summarize the different sampling strategies adopted in the second wave of Observation of Cardiovascular Risk Factors (ORISCAV-LUX, 2016-17), with a focus on population coverage and sample representativeness. Methods: Data from the first nationwide cross-sectional, population-based ORISCAV-LUX survey, 2007-08 and from the newly complementary sample recruited via different pathways, nine years later were analysed. First, we compare the socio-demographic characteristics and health profiles between baseline participants and non-participants to the second wave. Then, we describe the distribution of subjects across different strategy-specific samples and performed a comparison of the overall ORISCAV-LUX2 sample to the national population according to stratification criteria. Results: For the baseline sample (1209 subjects), the participants (660) were younger than the non-participants (549), with a significant difference in average ages (44 vs 45.8 years; P = 0.019). There was a significant difference in terms of education level (P \u3c 0.0001), 218 (33%) participants having university qualification vs. 95 (18%) non-participants. The participants seemed having better health perception (p \u3c 0.0001); 455 (70.3%) self-reported good or very good health perception compared to 312 (58.2%) non-participants. The prevalence of obesity (P \u3c 0.0001), hypertension (P \u3c 0.0001), diabetes (P = 0.007), and mean values of related biomarkers were significantly higher among the non-participants. The overall sample (1558 participants) was mainly composed of randomly selected subjects, including 660 from the baseline sample and 455 from other health examination survey sample and 269 from civil registry sample (constituting in total 88.8%), against only 174 volunteers (11.2%), with significantly different characteristics and health status. The ORISCAV-LUX2 sample was representative of national population for geographical district, but not for sex and age; the younger (25-34 years) and older (65-79 years) being underrepresented, whereas middle-aged adults being over-represented, with significant sex-specific difference (p \u3c 0.0001). Conclusion: This study represents a careful first-stage analysis of the ORISCAV-LUX2 sample, based on available information on participants and non-participants. The ORISCAV-LUX datasets represents a relevant tool for epidemiological research and a basis for health monitoring and evidence-based prevention of cardiometabolic risk in Luxembourg

A standardised protocol for relative SARS-CoV-2 variant severity assessment, applied to Omicron BA.1 and Delta in six European countries, October 2021 to February 2022.

Several SARS-CoV-2 variants that evolved during the COVID-19 pandemic have appeared to differ in severity, based on analyses of single-country datasets. With decreased testing and sequencing, international collaborative studies will become increasingly important for timely assessment of the severity of new variants. Therefore, a joint WHO Regional Office for Europe and ECDC working group was formed to produce and pilot a standardised study protocol to estimate relative case-severity of SARS-CoV-2 variants during periods when two variants were co-circulating. The study protocol and its associated statistical analysis code was applied by investigators in Denmark, England, Luxembourg, Norway, Portugal and Scotland to assess the severity of cases with the Omicron BA.1 virus variant relative to Delta. After pooling estimates using meta-analysis methods (random effects estimates), the risk of hospital admission (adjusted hazard ratio (aHR) = 0.41; 95% confidence interval (CI): 0.31-0.54), admission to intensive care unit (aHR = 0.12; 95% CI: 0.05-0.27) and death (aHR = 0.31; 95% CI: 0.28-0.35) was lower for Omicron BA.1 compared with Delta cases. The aHRs varied by age group and vaccination status. In conclusion, this study demonstrates the feasibility of conducting variant severity analyses in a multinational collaborative framework and adds evidence for the reduced severity of the Omicron BA.1 variant

Prévention primaire

Le chapitre prévention primaire se concentre sur les facteurs de risques externes établis comme principaux, liés au mode de vie des personnes, à savoir le tabac, l’alcool, l’alimentation, l’activité physique et la surcharge pondérale et l’obésité, susceptibles d’engendrer un cancer. L’éducation à la santé joue un rôle important, afin d’amener les individus à adopter des comportements préventifs, dans l’objectif de prévenir une maladie ou de la détecter à un stade asymptomatique. Les données des enquêtes European Health Interview Survey (EHIS, étude pilotée par le Ministère de la Santé et le Luxembourg Institute of Health) et Health Behaviour in School-Aged Children (HBSC, enquête coordonnée au Luxembourg par le Ministère de la Santé, le Ministère de l’Education nationale, de l’Enfance et de la Jeunesse, et l’Université de Luxembourg) ont été utilisées dans ce chapitre, pour compiler les données statistiques liées aux facteurs de risques. L’ensemble des comparaisons européennes est réalisé par Eurostat, (https://ec.europa.eu/), par l’étude internationale HBSC (http://www.hbsc.org/) et par le réseau international de chercheurs HBSC. Le chapitre se poursuit sur un descriptif des démarches de prévention mises en place sur le territoire national, au regard des facteurs de risques exposés au paragraphe 1, par exemple pour : Le tabac : Plan National de Lutte contre le Tabagisme (PNLT) 2016-2020, programme de sevrage tabagique (Ministère de la Santé/ Caisse Nationale de Santé), loi du 13 juin 2017 transposant la directive européenne 2014/40/UE sur les produits tabac ; L’alcool : Loi du 22 décembre 2006 portant interdiction de la vente de boissons alcoolisées à des mineurs de moins de seize ans, Plan d’Action Luxembourgeois de réduction du Mésusage de l’Alcool (PALMA) 2020-2024 ; L’alimentation et l’activité physique : Plan Cadre National « Gesond Iessen, Mei Bewegen » (PCN GIMB) 2018-2025. D’autres facteurs de risques additionnels ont par ailleurs été identifiés et font l’objet d’une prise en charge spécifique (ex : exposition au radon, recommandations de prescriptions en imagerie médicale, exposition aux UV, vaccination contre le HPV et l’hépatite B, exposition professionnelle à des agents cancérigènes…). Le rôle et les actions de la Direction de la Médecine Préventive de la Direction de la Santé, et de la Fondation Cancer, sont rappelés, dans ce cadre

Associations Between Wearable-Specific Indicators of Physical Activity Behaviour and Insulin Sensitivity and Glycated Haemoglobin in the General Population: Results from the ORISCAV-LUX 2 Study

International audienceBackground: Parameters derived from an acceleration signal, such as the time accumulated in sedentary behaviour or moderate to vigorous physical activity (MVPA), may not be sufficient to describe physical activity (PA) which is a complex behaviour. Incorporating more advanced wearable-specific indicators of PA behaviour (WIPAB) may be useful when characterising PA profiles and investigating associations with health. We investigated the associations of novel objective measures of PA behaviour with glycated haemoglobin (HbA1c) and insulin sensitivity (Quicki index). Methods: This observational study included 1026 adults (55% women) aged 18-79y who were recruited from the general population in Luxembourg. Participants provided ≥ 4 valid days of triaxial accelerometry data which was used to derive WIPAB variables related to the activity intensity, accumulation pattern and the temporal correlation and regularity of the acceleration time series. Results: Adjusted general linear models showed that more time spent in MVPA and a higher average acceleration were both associated with a higher insulin sensitivity. More time accumulated in sedentary behaviour was associated with lower insulin sensitivity. With regard to WIPAB variables, parameters that were indicative of higher PA intensity, including a shallower intensity gradient and higher average accelerations registered during the most active 8 h and 15 min of the day, were associated with higher insulin sensitivity. Results for the power law exponent alpha, and the proportion of daily time accumulated in sedentary bouts > 60 min, indicated that activity which was characterised by long sedentary bouts was associated with lower insulin sensitivity. A greater proportion of time spent in MVPA bouts > 10 min was associated with higher insulin sensitivity. A higher scaling exponent alpha at small time scales (< 90 min), which shows greater correlation in the acceleration time series over short durations, was associated with higher insulin sensitivity. When measured over the entirety of the time series, metrics that reflected a more complex, irregular and unpredictable activity profile, such as the sample entropy, were associated with lower HbA1c levels and higher insulin sensitivity. Conclusion: Our investigation of novel WIPAB variables shows that parameters related to activity intensity, accumulation pattern, temporal correlation and regularity are associated with insulin sensitivity in an adult general population