383 research outputs found
Community Development for Health Promotion
Development of a healthy community today represents an important process from different stand point, especially for improvement of population health and for health promotion intervention among vulnerable population groups such as women and children, adolescents, poor people and refugees. Community orientated approach particularly ensures proper identification and meeting the needs of underserved population groups which are most often not recognised among under, either because they belong to special ethnical or cultural groups or to groups of poor. Community strengthening for improvement of their health is realised through the wide and sustainable partnership of local community members, their leaders, supportive organisations, financers and governmental institutions, which is present in all phases of health promotion intervention. Examples of community based health promotion programmes, in world and in Serbia, show that wide partnership ensures improvement of numerous health determinants which is impossible to achieve by isolated health service activities. Authentic community leaders that are educated for successful leadership during all phases have prominence in development of these programmes. Achievement of their long-term sustainability through the multidisciplinary approach is a constant challenge to community based health promotion programmes
The layered crisis of the primary care medical workforce in the European region: what evidence do we need to identify causes and solutions?
Publisher Copyright: © 2023, The Author(s).Primary care services are key to population health and for the efficient and equitable organisation of national health systems. This is why they are often financed through public funds. Primary care doctors are instrumental for the delivery of preventive services, continuity of care, and for the referral of patients through the system. These cadres are also the single largest health expenditure at the core of such services. Although recruitment and retention of primary care doctors have always been challenging, shortages are now exacerbated by higher demand for services from aging populations, increased burden of chronic diseases, backlogs from the COVID-19 pandemic, and patient expectations. At the same time, the supply of primary care physicians is constrained by rising retirement rates, internal and external migration, worsening working conditions, budget cuts, and increased burnout. Misalignment between national education sectors and labour markets is becoming apparent, compounding staff shortages and maldistribution. With their predominantly publicly funded health systems and in the aftermath of COVID-19, countries of the European region appear to be now on the cusp of a multi-layered, slow-burning primary care crisis, with almost every country reporting long waiting lists for doctor appointments, shortages of physicians, unfilled vacancies, and consequently, added pressures on hospitals’ Accident and Emergency services. This articles collection aims at pulling together the evidence from countries of the European Region on root causes of such workforce crisis, impacts, and effectiveness of existing policies to mitigate it. Original research is needed, offering analysis and fresh insights into the primary care medical workforce crisis in wider Europe. Ultimately, the aim of this articles collection is to provide an evidence basis for the identification of policy solutions to present and future primary health care crises in high as well as lower-income countries.publishersversionpublishe
Community Development for Health Promotion
Development of a healthy community today represents an important process from different stand point, especially for improvement of population health and for health promotion intervention among vulnerable population groups such as women and children, adolescents, poor people and refugees. Community orientated approach particularly ensures proper identification and meeting the needs of underserved population groups which are most often not recognised among under, either because they belong to special ethnical or cultural groups or to groups of poor. Community strengthening for improvement of their health is realised through the wide and sustainable partnership of local community members, their leaders, supportive organisations, financers and governmental institutions, which is present in all phases of health promotion intervention. Examples of community based health promotion programmes, in world and in Serbia, show that wide partnership ensures improvement of numerous health determinants which is impossible to achieve by isolated health service activities. Authentic community leaders that are educated for successful leadership during all phases have prominence in development of these programmes. Achievement of their long-term sustainability through the multidisciplinary approach is a constant challenge to community based health promotion programmes
Serbia within the European context: An analysis of premature mortality
<p>Abstract</p> <p>Background</p> <p>Based on the global predictions majority of deaths will be collectively caused by cancer, cardiovascular diseases, and traffic accidents over the coming 25 years. In planning future national health policy actions, inter – regional assessments play an important role. The purpose of the study was to analyze similarities and differences in premature mortality between Serbia, EURO A, EURO B, and EURO C regions in 2000.</p> <p>Methods</p> <p>Mortality and premature mortality patterns were analysed according to cause of death, by gender and seven age intervals. The study results are presented in relative (%) and absolute terms (age-specific and age-standardized death rates per 100,000 population, and age-standardized rates of years of life lost – YLL per 1,000). Direct standardization of rates was undertaken using the standard population of Europe. The inter-regional comparison was based on a calculation of differences in YLL structures and with a ratio of age-standardized YLL rates per 1,000. A multivariate generalized linear model was used to explore mortality of Serbia and Europe sub-regions with <it>ln </it>age-specific death rates. The dissimilarity was achieved with a p ≤ 0.05.</p> <p>Results</p> <p>According to the mortality pattern, Serbia was similar to EURO B, but with a lower average YLL per death case. YLL patterns indicated similarities between Serbia and EURO A, while SRR YLL had similarities between Serbia and EURO B. Compared to all Europe sub-regions, Serbia had a major excess of premature mortality in neoplasms and diabetes mellitus. Serbia had lost more years of life than EURO A due to cardiovascular, genitourinary diseases, and intentional injuries. Yet, Serbia was not as burdened with communicable diseases and injuries as were EURO B and EURO C.</p> <p>Conclusion</p> <p>With a premature mortality pattern, Serbia is placed in the middle position of the Europe triangle. The main excess of YLL in Serbia was due to cardiovascular, malignant diseases, and diabetes mellitus. The results may be used for assessment of unacceptable social risks resulting from health inequalities. Within intentions to reduce an unfavourable premature mortality gap, it is necessary to reconsider certain local polices and practices as well as financial and human resources incorporated in the prevention of disease and injury burden.</p
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Brief Commentary: Why We Need More Equitable Human Resources for Health to Manage the Covid-19 Pandemic
Methodological considerations in injury burden of disease studies across Europe: a systematic literature review
Background: Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. Methods: We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. Results: We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables. Conclusions: Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability of injury BoD estimates across Europe and beyond. © 2022, The Author(s)
Do health care workforce, population, and service provision significantly contribute to the total health expenditure? An econometric analysis of Serbia
A call for action to establish a research agenda for building a future health workforce in Europe
This Call for Action is closely linked to the European Public Health Association (EUPHA) and its new section ‘Health Workforce Research’. The idea was first developed during a pre-conference and two workshops at the EUPHA Conference in November 2016 in Vienna and further investigated at the EUPHA Conference in November 2017. We wish to thank all participants for inspiring discussions and for sharing ideas and knowledge.Peer reviewedPublisher PD
The Burden of Disease due to COVID-19 (BoCO-19): A study protocol for a secondary analysis of surveillance data in Southern and Eastern Europe, and Central Asia
Introduction
The COVID-19 pandemic has had an extensive impact on public health worldwide. However, in many countries burden of disease indicators for COVID-19 have not yet been calculated or used for monitoring. The present study protocol describes an approach developed in the project “The Burden of Disease due to COVID-19. Towards a harmonization of population health metrics for the surveillance of dynamic outbreaks” (BoCO-19). The process of data collection and aggregation across 14 different countries and sub-national regions in Southern and Eastern Europe and Central Asia is described, as well as the methodological approaches used.
Materials and methods
The study implemented in BoCO-19 is a secondary data analysis, using information from national surveillance systems as part of mandatory reporting on notifiable diseases. A customized data collection template is used to gather aggregated data on population size as well as COVID-19 cases and deaths. Years of life lost (YLL), as one component of the number of Disability Adjusted Life Years (DALY), are calculated as described in a recently proposed COVID-19 disease model (the ‘Burden-EU’ model) for the calculation of DALY. All-cause mortality data are collected for excess mortality sensitivity analyses. For the calculation of Years lived with disability (YLD), the Burden-EU model is adapted based on recent evidence. Because Covid-19 cases vary in terms of disease severity, the possibility and suitability of applying a uniform severity distribution of cases across all countries and sub-national regions will be explored. An approach recently developed for the Global Burden of Disease Study, that considers post-acute consequences of COVID-19, is likely to be adopted. Findings will be compared to explore the quality and usability of the existing data, to identify trends across age-groups and sexes and to formulate recommendations concerning potential improvements in data availability and quality.
Discussion
BoCO-19 serves as a collaborative platform in order to build international capacity for the calculation of burden of disease indicators, and to support national experts in the analysis and interpretation of country-specific data, including their strengths and weaknesses. Challenges include inherent differences in data collection and reporting systems between countries, as well as assumptions that have to be made during the calculation process.Peer Reviewe
Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019
Background Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of
social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries,
and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key
indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational
locations from 1950 to 2019.
Methods 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other
sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR)
was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to
age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific
fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult
mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured
as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling
histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5
and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed agespecific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality
generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other
sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of
net migration and population for each country and territory were generated using a Bayesian hierarchical cohort
component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and
747 population registry years. We classified location-years into seven categories on the basis of the natural rate of
increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration
rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and
standard demographic methods. Uncertainty was propagated throughout the demographic estimation process,
including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric.
Findings The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in
2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million
(133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and
territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of
replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted
for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI
66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million
(49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000
to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to
7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population
declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased
from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and
territories between 2000 and 2019.
Interpretation Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing,
with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such
as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries
have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more
populations into the late stages of the demographic transition. Tracking demographic change and the emergence of
new patterns will be essential for global health monitorin
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