Йодный статус населения в странах Европейского региона ВОЗ (сокращенный перевод отдельных разделов доклада Европейского бюро ВОЗ)

ObjectivesSystematic review of SARS-CoV-2 seroprevalence studies undertaken in the WHO European Region to measure pre-existing and cumulative seropositivity prior to the roll out of vaccination programmes.DesignA systematic review of the...

WHO polio laboratory network in Europe – safeguarding the frontiers using modern technology

Globally, non-communicable diseases (NCDs) are the leading cause of morbidity and mortality, including in the WHO European region. Within this region, the Member States with the greatest cardiovascular disease (CVD)...

In the EU, the heterogeneity of vaccination schedules has arisen for essentially historical reasons. In the past, vaccines were registered in an individual country according to licensing requirements that might vary substantially from country to country. Although licensure in a given country is still possible under restricted conditions, the marketing authorization of a new vaccine in the EU currently follows a unified process, either through mutual recognition or a centralized procedure. Nonetheless, there is no European legislation that reinforces harmonization of immunizations programs across the 27 countries of the EU. Public health policy, including immunization policy, is the responsibility of the member state under the principle of subsidiarity. Consequently, each country relies on a national advisory body that makes recommendations on immunization policies to the Ministry of Health [e.g., the Joint Committee on Vaccination and Immunisation (JCVI) in the United Kingdom, or the Sta¨ndige Impfkommision am Robert Koch Institut (STIKO) in Germany]. In addition, within a country, the level of centralization in public health policy and funding influences the recommendations and implementation of immunization programs. For example, in Spain, each ‘‘autonomous region’’ decides on its own immunization program, and recent recommendations on group C meningococcal (MenC) vaccines illustrate the lack of harmonization in this country as a result of regional decision making. Furthermore, in countries within the WHO European region, immunization policy is influenced by policies and objectives that have been set by WHO Regional Office for Europe (2).

Background: Surveillance of antimicrobial consumption (AMC) is important to address inappropriate use. AMC data for countries in the European Union (EU) and European Economic Area (EEA) and Eastern European and Central Asian countries were compared to provide future guidance.Methods: Analyses of 2014–2018 data from 30 EU/EEA countries of the European Surveillance of Antibiotic Consumption network (ESAC-Net) and 15 countries of the WHO Regional Office for Europe (WHO Europe) AMC Network were conducted using the Anatomical Therapeutic Chemical (ATC) classification and Defined Daily Dose (DDD) methodology. Total consumption (DDD per 1000 inhabitants per day) of antibacterials for systemic use (ATC group J01), relative use (percentages), trends over time, alignment with the WHO Access, Watch, Reserve (AWaRe) classification, concordance with the WHO global indicator (60% of total consumption should be Access agents), and composition of the drug utilization 75% (DU75%) were calculated.Findings: In 2018, total consumption of antibacterials for systemic use (ATC J01) ranged from 8.9 to 34.1 DDD per 1000 inhabitants per day (population-weighted mean for ESAC-Net 20.0, WHO Europe AMC Network 19.6, ESAC-Net Study Group, and WHO Europe AMC Network Study Group). ESAC-Net countries consumed more penicillins (J01C; 8.7 versus 6.3 DDD per 1000 inhabitants per day), more tetracyclines (J01A; 2.2 versus 1.2), less cephalosporins (J01D; 2.3 versus 3.8) and less quinolones (J01M; 1.7 versus 3.4) than WHO Europe AMC Network countries. Between 2014 and 2018, there were statistically significant reductions in total consumption in eight ESAC-Net countries. In 2018, the relative population-weighted mean consumption of Access agents was 57.9% for ESAC-Net and 47.4% for the WHO Europe AMC Network. For each year during 2014–2018, 14 ESAC-Net and one WHO Europe AMC Network countries met the WHO global monitoring target of 60% of total consumption being Access agents. DU75% analyses showed differences in the choices of agents in the two networks.Interpretation: Although total consumption of antibacterials for systemic use was similar in the two networks, the composition of agents varied substantially. The greater consumption of Watch group agents in WHO Europe AMC Network countries suggests opportunities for improved prescribing. Significant decreases in consumption in several ESAC-Net countries illustrate the value of sustained actions to address antimicrobial resistance.

Estimating antimicrobial resistance burden in Europe—what are the next steps?

The Report on Social Determinants of Health has already been presented twice to the 53 Member States of the European Region. The first time in Tallinn, Estonia, in June 2008, during the WHO European Ministerial Conference on Health Systems: ‘Health systems, health and wealth’, and the second time in Tbilisi, Georgia, at the WHO Regional Committee for Europe, which is the annual meeting of the countries of the European Region of WHO. On both occasions it has been received with great interest. There have been many comments and questions to Sir Michael Marmot, who personally participated in the two meetings. This interest of Europe in a global report on the subject is not surprising, as for many years the European Region has put social determinants on the health agenda. In addition, the European Office has established a centre in Venice specifically dedicated to this subject. The Centre has been closely associated with the report. I would like to summarise the comments made by the representatives of the European Region. The first one concerns the appreciation of the recognition of the magnitude of the problem in the European Region. Very often it is felt that Europe has only high income countries with no real poverty. The Report shows the importance of poverty, even in high income societies. Of course, this is not a totally unknown concept, and work has been done for many years on health and poverty, social exclusion, ageing, etc. The concrete measurement presented in the Report make the subject stronger and more explicit, showing that Europe is not exclusively a rich continent with a healthy population. The second comment on the Report concerns its adaptation to each specific country. In the past, strategic mistakes have been made by advising all the countries in the same and general way. It is felt by the European Member States that the process of adaptation of the Report to the specificity of countries is by itself important to improve the situation. It is good to see how several countries like Ireland, Norway, Sweden and of course the United Kingdom are starting this process. It is of concern, even if it is not totally surprising, that the countries in greater need are not yet at that point. This shows the need for support to and collaboration with them. Coming to the WHO Regional Office, it is probably known that the first priority now is the strengthening of health systems. The three major

For Member States of the European Region, the promotion of healthy lifestyles is an important and continuing task in the field of public health. Addressing lifestyle issues entails adopting a multisectoral approach and taking into account of how behaviour favourable to health is perceired in sociocultural terms. The prevention of alcohol-related risks is a significant element in healthy public policy. It is in this spirit that a European conference on «Health, Society, and Alcohol» was organized by the WHO Regional Office for Europe in Paris from December 12 - 14, 1995. Participants included representatives of the governments of each Member State of the European Region of WHO, intergovernmental organizations, nongorernmental organizations, and other partners in the public, private and voluntary sections. The following Charter was developed and adopted at the Conference.

Introduction Road traffic injuries (RTI) are among the ten leading causes of death worldwide, and they are the leading cause of death among young adults aged 15-29 years. In Federation of Bosnia and Herzegovina (FBiH), with population of 2,1 million, around 380 people die every year and additional 11.000 get seriously injured in RTI. Aim The aim of this study was to investigate the incidence and fatality rate of RTI in FBiH in the period of 2006 until the end of 2020. Methods Data source of RTI (ICD-X) incidence and fatality rate was Statistical book for Federation of Bosnia and Herzegovina, which includes all injuries and deaths reported through Ministry of internal affairs. Fatality rate was calculated as number of confirmed deaths in total number of reported RTI. To compare frequencies of reported deaths Chi square test was used. YLD were calculated based on information on injury that was caused in road traffic accidents. Results In the last 15 years, in FBiH, total 39,455 injuries related to road traffic were reported. According to the official data, over the period 2006-2020 the peak of fatality rate (8.52% deaths among all cases with RTI) was in 2016, while it had a statistically significant decline in 2018: 6.51%; 2019: 6.35%; and 2020: 6.32% (x2=7728,584; p < 0,0001). It is estimated that young adults (in the age group 30 to 39 years) injured in the road traffic accidents have 197.01 patient-years of total 881.17 years to live with disabilities just based on serious RTI in 2020. Conclusions RTI pose a significant burden on the health of the population in FBiH. After implementing strict laws in the year 2017, and 2018, a significant decrease of RTI was registered, including the number of deaths due to RTI (fatality rate). This abstract is support and sponsorship by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe. Key messages • RTI are significant burden for health of population in FBH. Strict laws and stronger punishments and fees are decreasing number of RTI. • This abstract is support and sponsorship by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe.

The Eighth International Meeting of the European Laboratory Working Group on Diphtheria (ELWGD) and the Diphtheria Surveillance Network (DIPNET) was held and co-organised with the WHO Regional Office for Europe, Copenhagen, Denmark, in June 2004. This article provides an international updated review of progress in clinical, epidemiological and microbiological aspects of diphtheria in the European region as presented at the meeting. It highlights the need for improved immunisation coverage, surveillance and epidemiological studies to sustain control of diphtheria in European Region.

Mental disorders in children and youth are on the rise worldwide, affecting approximately one in five young people in Europe. The negative educational, social and economic consequences of mental health problems underline the urgent need for accessible, high-quality mental health services. In response, the WHO Regional Office for Europe has developed Quality Standards for Child and Youth Mental Health Services to provide a framework for evidence-based, youth-centred care. Previous efforts have shown that translating quality standards and guidelines into practice remains a major challenge. While implementation science offers valuable approaches to improving the uptake of evidence-based quality standards and has been successfully applied in various healthcare fields, it remains underutilised in child and youth mental health care. This article explores how implementation science can be leveraged to improve the quality of child and youth mental health care. Using the implementation of the WHO European Quality Standards for Child and Youth Mental Health Services as a practical case example, we highlight the importance of a structured approach to implementation, guidance by theories, models and frameworks, timely stakeholder engagement, and context-specific adaptation. Harnessing implementation science in youth mental health policy and practice has the potential to bridge the gap between policy formulation and real-world service delivery, ensuring that all young people receive the high-quality mental health care they deserve.

Curbing the obesity epidemic

Objectives Acceptance of sexual and reproductive health as fundamental to the sustainable development of societies has allowed for creation of new reproductive health programmes and policies. WHO sexual and reproductive health (SRH) strategies were developed in the WHO Regional Office for Europe (2001), as well as globally (2004). Adolescent SRH is important in both strategies. Despite these commitments, adolescents remain vulnerable to poor reproductive health. The goal of this paper is to analyse the current status of SRH of adolescents in Europe.Methods Key reproductive health indicators were chosen. Information was obtained from published studies, databases and questionnaires sent to WHO reproductive health counterparts within the health ministries in the Member States of the WHO European Region.Results Pregnancy rate, age at first sexual intercourse, contraceptive use at first and last intercourse, contraceptive prevalence, HIV knowledge, and STI rates vary widely according to the population considered. Gender difference and lack of information pertaining to SRH of all adolescent populations are other key findings.Conclusions While the SRH of most European adolescents is good, they remain a vulnerable population. Lack of standardized reproductive indicators and age specific aggregate data make it difficult to accurately assess the situation in individual countries or perform cross country comparison.

Issue and method Health information systems (HIS) in Europe are complex and involve multiple stakeholders. To strategically assess HIS, a support tool has been developed by the WHO Regional Office for Europe. It has been applied in nine countries by WHO Europe since October 2015. Additionally, nine countries are using the tool in a peer review format within the context of the Joint Action on Health Information (InfAct) between January and December 2019. What can you expect to find out during such an assessment? What are countries commonly struggling with? In this presentation, the wealth of experiences using the support tool will be shared and participants will learn about common strengths and weaknesses in HIS across Europe. Results While each country possesses a unique HIS, common strengths and challenges emerge from across assessments. A few major ones will be presented in this session. In many countries promising e-health developments are ongoing such as electronic health records, e-prescription and cloud solutions for data storage. There is a clear desire to shift towards e-health technologies which is a real opportunity. However, well-developed step-wise approaches in interaction with key players are sometimes lacking and sustainability in financing can be of concern. Central multisectoral coordination mechanisms are often lacking, leading to inefficiencies in bringing together data and information, and in the use of financial and human resources. Finally, in many cases data is available, but legal aspects (e.g. impact of General Data Protection Regulation) are limiting the exchange and linkage possibilities for research and monitoring. Lessons HIS assessments help to determine common strength and challenges. By sharing common experiences, participants are better prepared to face common hurdles in their country and will have been exposed to good practices on how to address these.

This paper examines changes in substance use, and compares the resulting attributable burden of disease in the WHO European Region between 2010 and 2016. Data for 2010 and 2016 on the number of deaths, years of life lost (YLL) and disability-adjusted life years (DALYs) lost were obtained by sex and country from the 2016 Global Burden of Disease (GBD) study. Exposure data for all substances except alcohol were obtained from the same study, while alcohol data were obtained from the WHO. Proportional changes were calculated for the WHO European Region as a whole to identify trends and for sub-regions to identify which regions contributed most to trends. In the WHO European Region in 2016, substance use caused 2.1 million deaths, 48.6 million YLL and 57.9 million DALYs lost, representing 22.4, 29.0 and 20.4% of all deaths, YLL and DALYs, respectively. The substance-attributable burden of disease was higher among men than women and highest in the eastern parts of the WHO European Region. Changes in the number of deaths, YLL and DALYs lost between 2010 and 2016 were almost uniformly downward, with the largest proportional changes observed for men. Exposure to tobacco, alcohol and illicit drugs also decreased uniformly. Substance use and its attributable mortality and burden of disease have decreased in the WHO European Region since 2010. However, overall levels of substance use and the resulting burden of disease in the Region remain high compared with other regions of the world.