Viral hepatitis C – a challenge for the public health

Abstract Background Viral hepatitis C (VH C) is a global health problem with overall prevalence in 3-5% of the human population. This study provides the relevance of viral genome characterization in clinical settings. Methods Retrospective study was conducted upon epidemiological, demographic, clinical, laboratory and viral characteristics in fifty cases of VH C confirmed with positive anti-HCV, evaluated by ELISA. Thirty eight of cases were hospitalized in different clinics of the University Hospital “Dr Georgi Stranski” - Pleven (2017-2018) and remainders were blood-donors registered in Regional Center of Transfusion Hematology - Pleven. The viral load and genotype of HCV had been investigated by Real-Time PCR in Laboratory of Virology at Military Medical Academy - Sofia. Results The prevalence of cases was equal and highest in age groups 30-39 years and 60-69 years (24%, respectively). Males were 69.81% (p < 0.05). Surgical interventions (26.32%), blood infusions (23.68%) and hemodialysis (15.79%) were at highest risk for VHC (p > 0.05). Thirty hospital patients were with chronic VH C (78.95%) (p < 0.05). Clinical symptoms suggestive viral hepatitis were adynamia (39.47%; OR 5.25), anorexia (28.95%; OR 2.16), heaviness in the abdomen (21.05%; OR 23.33), and 52.63% of patients were asymptomatic (p < 0.0005). Laboratory investigations revealed slightly or moderately elevated total bilirubin (mean 53.27±37.38 µmol/L; 95% CI 18.48-88.06) and transaminases - ASAT (mean 231.36±155.82 IU/L; 95% CI 79.91-382.80) and ALAT (mean 294.48±196.26 IU/L; 95% CI 96.37-492.59) (p > 0.05). Investigation of viral load of HCV revealed 22 samples with detectable viral load (range 683-673 720 copies/ml). All isolates of HCV had been proved to be genotype 1b. Conclusions VH C is mostly asymptomatic. Screening for anti-HCV in risk groups and genotyping of HCV will improve surveillance, reduce nosocomial HCV-infections, facilitate therapeutic management and prevent complications of infected individuals. Key messages • Screening for anti-HCV in risk groups and genotyping of HCV improves surveillance and reduces nosocomial HCV-infections. • Screening for anti-HCV facilitates therapeutic management and prevents complications of infected individuals.

This study aims to calculate the health-adjusted life expectancy (HALE) by using years lived with disability (YLD) from the national claims data, as well as to identify the differences and inequalities in sex, income level and region. The study was carried out on total population receiving national health insurance and medical benefits. We calculated incidence-based YLD for 260 disease groups, and used it as the number of healthy years lost to calculate HALE. We adopted the insurance premium to calculate the income as a proxy indicator. For the region classification, we chose 250 Korean municipal-level administrative districts. The primary outcome was HALE in the Korean population. The second outcome was the HALE's gap in terms of sex, income, and region. Our results revealed that HALE increased from 2008 (68.89 years) to 2019 (70.58 years). HALE in males increased faster than that in females. HALE was higher in higher income levels. In 2019, the gap in HALE between Q1 and Q2, the lower income group, was about 5.70 years. The gap in females by income level was smaller than that in males. Moreover, the gap in HALE by region was found to increase. Results suggest that there is an inequality in YLD in terms of income level in Korea. Therefore, we need intensive management for the low-income group to increase HALE at the national level.

Key messages:
Males' health level may be more sensitive to the socioeconomic level than females' health level.
In the 5th National Health Plan (HP2030), it was decided to set a target value for the overall goals based on this result.

Background:
Alcohol drinking during pregnancy has harmful consequences. Warnings displayed on alcohol bottles are an effective measure to inform people about these risks and have been put in place in France. However, the alcohol industry (AI) resisted this measure when it was introduced in 2007 and during an expansion project in 2018. This study aims to identify arguments used by the AI against warnings targeting pregnant women.

Methods:
A documentary method was used to analyse these arguments disseminated by the AI and its partners (elected representatives of wine-producing regions, etc.) in the French mainstream press (the national, regional and specialised press) from 2000 to 2020 through the Europresse documentary database. A quantitative analysis (number and evolution of press articles, mapping of the actors of AI who expressed themselves) and an inductive thematic content analysis (analytical framework of the arguments identified) using NVivo Software were carried out.

Results:
Among the 85 articles included in this study, a majority of the arguments used by the AI are against this measure. It argues that this measure (1) is a questionable measure because ineffective in changing behaviours, (2) will have counterproductive effects (on women and on the economy); and (3) there are other preferred alternatives than warnings (targeted prevention programs, etc.). A minority is nevertheless in favour of this measure. Among the actors who expressed themselves, a large majority comes from the winegrowing sector.

Conclusions:
The analysis of these arguments will add new insights about AI lobbying against warnings, by analyzing the arguments over a 20 years period covering a failure and a success of industry lobbying. It will also be useful for public health advocacy to better counter this lobbying influence and these arguments, which are not necessarily evidence based.

Key messages:
Warnings displayed on alcohol bottles are an effective measure which is challenged by the alcohol industry. Analysing the arguments disseminated by the alcohol industry is useful for public health advocacy in order to counter them.

Introduction:
Better Regulation is a meta-regulatory tool designed to improve regulatory quality and reduce regulatory burden in the development of EU policy. Despite concerns by civil society that its operation may have a chilling effect on regulatory protections, its impact on health policy has not been researched systematically. Using provisions on high fat, sugar and salt (HFSS) food and alcohol advertising to children within the revision of the audiovisual media services directive (AVMSD) as a case study, we explore how the operation of Better Regulation affects EU health policy processes.

Methods:
We employ a qualitative process tracing approach based on policy documents, Freedom of Information requests, media reporting, and expert interview data.

Results:
After an evaluation in 2016, the revised AVMSD maintained a reliance on self-and co-regulation of alcohol and HFSS food advertising to children, despite significant evidence supportive of statutory measures and pressure from the public health community to strengthen provisions. This result aligns with calls from commercial actors to retain the status quo.
Preliminary results indicate that pathways via which Better Regulation guidelines may have contributed to this outcome include, for instance, the structure and approach used in the impact assessment and the related scrutiny process, the design of the consultation strategy, and the evaluation criteria of the AVMSD proposal.

Conclusions:
Considering how policymaking infrastructure -as a key political determinant of health -may shape the processes