bluuebunny/crossref_metadata_2025 huggingface dataset:
Rethinking electronic health records implementation in Germany: a value-based health system approach
Authors: Schmitt T
Published: October 2024

Problem

The Digital Act (Digital-Gesetz) in Germany stipulates that electronic health records (elektronische Patientenakte; ePA) will be set up for all persons under the statutory health insurance (SHI) in 2025; those who do not wish to use ePA can object. This opt-out approach aims to increase the coverage of ePA among the SHI population to 80%, which has been ca. 1.5% since its launch in 2021. According to law, ePA is managed solely by the patient and does not replace the conventional patient file stored in the medical practice management system. Without appropriate measures, it is likely that multiple parallel patient files are created, with the risk of ePA being side-lined over time.

Description

The Ministry of Health aims to make ePA the central platform for patients’ healthcare provision throughout their life. With ePA, patients should receive useful information about their healthcare as well as reminders and tailor-made medical advice. For healthcare providers, ePA should become an essential part of the healthcare process with containing reliable information and supporting the treatment. However, understanding ePA as more than a digital health solution, factors beyond technical interoperability must be considered for its successful implementation.

Results

The full potential of ePA and its positive impact on healthcare to tackle the fragmentation issue can only be realised when it is viewed as a helpful tool of collaboration for all involved parties. The existing regulatory frameworks in Germany create disincentives for greater integration, coordination, and interconnection, with each sector following its own reimbursement system and reinforcing the division between them. This contradicts with the idea of ePA fostering patient-centredness and inter-sectoral collaboration.

Lessons

How a health system functions and how health services are governed and remunerated have a substantial impact on the healthcare providers’ acceptance of digital services.

Key messages

• Changes in the governance of health systems may be necessary when implementing electronic health records to bring person-centred care and overcome the separation of in-patient and out-patient sectors.

• Rather than a paternalistic approach, the relationship between the patient and healthcare provider should move towards a partnership model, based on the motivation of keeping individuals healthy.
The association between health literacy and colorectal cancer screening uptake in Taiwan
Authors: Hsu C W , Lin Y J , Shen Y C , Wang Y R
Published: October 2024

Background

Population-based cancer screening programs have been confirmed as a cost-effective strategy for early detection of colorectal cancer, leading to reduced mortality and morbidity. In Taiwan, the government has provided an immunochemical fecal occult blood test (iFOBT) every two years to all citizens aged 50 to 74 years since 2013. The study aims to determine the association between iFOBT uptake and health literacy (HL).

Methods

Data from the National Health Interview Survey (NHIS), a population-based cross-sectional survey conducted in 2021-22 in Taiwan, were applied. The European Health Literacy Survey Short Form (HLS-EU-Q16), self-reported iFOBT participation within the past 2 years, and covariates assessed by face-to-face interview. The present analysis included those age-eligible for screening (n = 3,871) and applied the survey-weighted multivariable logistic regression to estimate odds of iFOBT uptake between HL skill levels, controlling for age, education attainment, socioeconomic status, health status, and household urbanicity level.

Results

In general, 44.6% of participants had utilized the iFOBT, and 79.9% had adequate HL skills which reported higher iFOBT uptake rates (45.9%) than their counterparts (39.4%). Multivariable analysis showed that having adequate HL was associated with greater odds of iFOBT utilization (adjusted odds ratio [aOR] = 1.79; 95% CI: 1.29-2.49). Additionally, compared to those households registered in the township, participants in higher urbanicity levels had lower iFOBT uptake: city (aOR = 0.62; 95% CI: 0.47-0.82). Other predictors that contributed significantly were participants’ gender and having 2 or more chronic diseases.

Conclusions

Inadequate HL skills and urban residency may reduce participation in the CRC screening program, despite its free availability. More efforts should include literacy-friendly designed materials and the provision of tailored support in urban settings.

Key messages

• HL skills are significantly associated with the CRC screening uptake in Taiwan. Improving HL could have positive effects on people’s participation.

• Urbanicity levels are also predictors associated with screening utilization. Disseminating health service information in localized ways should be a potential option.
Validating weight optimization’s Impact on participants via Social Impact Bonds
Authors: Haga C , Bang E , Jeong S , Inoue Y , Kondo K
Published: October 2024

Background

To promote health for everyone, even the health-unconcerned, Okayama City has established the Social Impact Bond (SIB), which funds and executes social programs for defined outcomes, with third-party assessment. This study examined the normalization of participants’ physiques three years later to verify the effectiveness of SIB.

Methods

We conducted a study of a quasi-experimental design, non-randomized controlled trial. A total of 8,251 eligible people applied for the program. Of these, 1,599 were enrolled in the National Health Insurance System (NIH), and 731 of them were included in the intervention group in 2018. Among 705 non-participating matched members and randomly selected, 170 were used as the control group. Whether or not the standard physique in the endpoint (EP) FY2021, was used as the dependent variable, and the participation as the independent variable. Age, gender, and physique at baseline (BL) were used as covariates for logistic regression analysis.

Results

A total of 532 patients underwent health checkups for both BL and EP, and the follow-up rate was 60.5% in the intervention group and 52.9% in the control group. Examination of between-group differences in BL revealed that the mean age was 66.7 years significantly higher in the males’ intervention group and 60.6 years in the control group (p < 0.01). The crude odds ratio (OR) of maintaining or achieving standard BMI in the participating group was 0.90, and the adjusted OR was 1.23 and 1.31 after propensity score matching, both were not significant. On the other hand, when restricted to people with thinness, the pre-adjusted OR was 5.00 and the adjusted OR was 12.43.

Conclusions

Participation in the project contributed about 20% to 30% to weight optimization, and it could not be denied that it was brought about by chance. However, when limited to thin physiques, project participation was about twelve times higher, and the probability of having an appropriate physique was increased.

Key messages

• SIB might affect the BMI optimization for older people in improving thinness.

• Efforts will be needed to encourage participation among younger age groups.
What if we could eradicate cervical cancer?
Authors: De Luca A , Capitani E , Limaj S , Taddeini F , Cosimi A , Turillazzi R , D’Amato M G , Montomoli E , Nante N , D’Urso A
Published: October 2024

Introduction

WHO wants to achieve the elimination of Cervical Cancer: all countries must achieve and maintain an incidence rate of less than 4 per 100,000 women. Three key pillars: 90% of girls fully vaccinated against HPV by 15 years of age; 70% of women aged 35-45 years screened; 90% of women with pre-tumour lesion and invasive tumour treated. Our study assessed the position of the Tuscany South East Local Health Authority(LHA TSE) with respect to these three pillars and how to improve it.

Methods

A retrospective observational study was conducted. The following were used: ISTAT data of incidence of cervical cancer standardised by age from 2013 to 2017;data from ISPRO on screening(PAP and HPV test)from 2013 to 2022;data of vaccination coverage taken from the Health Information System of Collective Prevention(SISPC) from 2012 to 2023 for children<12 years,

Results

The incidence rate of cervical cancer in LHA TSE is 9.4 per 100 thousand. About HPV vaccine coverage by age 12, for girls it has been rising from 80.5% in 2012 to a peak of 84.8% in 2019 and then progressively decreasing to 76.3% in 2023.Coverage for boys has also been progressively increasing from 0.8% in 2012 to a peak in 2019 of 74.9% and then decreasing to 69.8% in 2023. A total of 52 thousand children are vaccinated. As for the adjusted adherence to screening, we started from an average adherence of 51.8% in 2013 (75 thousand women invited with 102% coverage) to 53.2% in 2022 (54 thousand women invited with 107% coverage). In 2013, ASC-US+ lesions were found in 6.4 % of women by PAP Test and in 2022 in 6.3 % of women. In the examined period, more than 90% of women with pre-tumour lesion and more than 90% with invasive tumour were treated.

Conclusions

LHA TSE will have to implement actions to increase vaccination coverage and screening adherence rates through awareness campaigns and open days, also considering whether a change in the age range for starting screening is necessary as vaccination coverage increases.

Key messages

• Cervical cancer is one of the most preventable cancers, but too few young women are vaccinated against HPV infection, the main causative factor.

• Prevention through adherence to screening enables early identification of lesions caused by HPV virus.
Exploring the perceived dynamic system driving inequities in the community obesogenic environment
Authors: D’Hooghe S , Inaç Y , Dury S , Deforche B , De Ridder K , Vandevijvere S , Van Dyck D , Van de Weghe N , Guariguata L
Published: October 2024

Introduction

Persons in socioeconomically disadvantaged situations (PSEDS) are more susceptible and disproportionally exposed to obesogenic environments, resulting in poorer dietary outcomes and lower levels of physical activity. This study aimed to map the complex dynamic system within the community obesogenic environment driving unhealthy eating and insufficient physical activity among PSEDS in Flanders, and to identify potential local actions.

Methods

Participatory group model building (GMB), a qualitative system dynamics method, was used to engage PSEDS (n = 7), local decision makers (n = 7) and local stakeholders (n = 5) in two Flemish municipalities. A two-day GMB session was held in each municipality during which a causal loop diagram (CLD) was created and potential local actions were identified by considering causal pathways and reinforcing loops in the system.

Results

The CLD was designed around two main variables (i) healthy eating and (ii) physical activity among PSEDS. Seven sub-systems could be identified: 1) social environment, 2) facilities and activities, 3) mobility options, 4) information, 5) affordability, 6) safety (specifically for physical activity), and 7) industry and advertisement (specifically for eating behaviour). Several actions to improve the local environment to promote eating behaviour and physical activity among PSEDS were identified.

Conclusions

The CLD illustrates the complex interactions between individual and environmental determinants contributing to inequalities in eating behaviour and physical activity by including multiple perspectives of community members in socioeconomically disadvantaged situations, local decision makers and local stakeholders. Both the participatory GMB approach and the final CLD visualization can provide the basis for planning local actions for promoting healthy eating behaviour and physical activity among PSEDS.

Key messages

• Group model building is an effective approach to explore and understand a dynamic complex system through a shared understanding among diverse stakeholders.

• A systems approach is valuable to provide a more comprehensive and context-specific understanding of the perceived factors contributing to inequities in the obesogenic environment.
Promoting sexual health in schools: a systematic review of the European studies
Authors: Abrams R , Nordmyr J , Forsman A K
Published: October 2024

Background

Sexual ill-health causes a high health burden. There is, therefore, a need for more effective sexual health promotion interventions. Previous research has focused on preventive sexual health interventions and the limited evidence concerning school-based sexual health promotion interventions has not been synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in European schools.

Methods

A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and a narrative synthesis of the included studies was performed, highlighting the collective results.

Results

The review included 17 records, reporting 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All qualitative studies described positive effects as experienced by the participants, and ten of the quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest.

Conclusions

The findings indicate good evidence for the effectiveness of interventions with a health promotion approach, underscoring the importance of sexual health resources such as respect, communication skills, and attitudes. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas, e.g., sexual health literacy is less studied and can be recommended to be included in future research.

Key messages

• The synthesized evidence sheds light on the lack of evaluated interventions employing holistic and positive, resource-focused sexual health promotion interventions targeting European adolescents.

• The included school-based sexual health promotion studies, although limited in number, show evidence of promising effects on sexual health outcomes among participants.
Understanding labour exploitation as a social determinant of health in migrant populations – insights from the Danish population-based registers
Authors: Lau K
Published: October 2024

Despite recent global events such as the COVID-19 pandemic and the Qatar world cup drawing attention to the significant loss of human lives of labour migrants in precarious working conditions, evidence on the comparative mortality of migrant workers remains sparse and inconsistent. Studying the comparative mortality of migrant workers with local workers is challenging for several reasons. Data on migrants’ employment conditions and health outcomes are often incomplete, and when available captured in separate databases. In addition, there is a need to disentangle the healthy migrant effect from the healthy worker effect, which presents challenges in the selection of reference populations and temporality when studying mortality of migrants. In view of such challenges, Denmark provides an ideal context to study labour migration and mortality. The Danish population-based registers offer linked longitudinal data on migrants’ employment history and mortality outcomes. Denmark’s migrant integration policy also has a history of weaving immigration and labour policies, and migrants in Denmark continue to be prone to labour exploitation in high-risk industries such as construction and agriculture. This presentation shall use Denmark as a case study to compare the mortality outcomes of migrant workers with Danish workers to better understand labour exploitation as a social determinant of health.
Sporting clubs’ perceptions about harmful industry sponsorship: Lessons from gambling research
Authors: McCarthy S , Thomas S , Pitt H , Arnot G , Randle M , Daube M
Published: October 2024

Background

Unlike tobacco, there are no restrictions relating to gambling sponsorship in Australian sports. While some sporting teams have voluntarily refused sponsorship deals with gambling companies and other harmful industries, many are still actively entering into or renewing such deals. There is limited understanding of why, despite widespread public concern, sporting organisations continue to engage in commercial partnerships with gambling companies and venues. This study aimed to qualitatively explore the ethical and related practical issues associated with gambling sponsorship.

Methods

In-depth interviews were held with 24 key decision makers in Australian community sporting organisations. Participants were asked questions relating to attitudes towards gambling, decisions about gambling sponsorship within their clubs, and issues relating to alternative sponsors and sponsorship disparities. Data was analysed using reflexive thematic analysis.

Results

Interviews revealed the difficulty for sporting organisations to avoid harmful industry sponsorship. When deciding to align with gambling companies, sporting organisations had to consider their own values and the reputational impact of such deals, and balance this with the financial viability of the sporting organisation. Despite sporting organisations relying heavily on sponsorship deals, some stated they would refuse gambling sponsorship for ethical reasons but recognised that sporting clubs in poorer financial positions may be more vulnerable to taking up gambling sponsorship.

Conclusions

As elite sporting organisations begin to move away from gambling sponsorship, gambling companies may target community sport. The authors consider practical strategies to protect communities from sponsorship from harmful industries.

Key messages

• Sporting organisations navigate ethical dilemmas when considering gambling sponsorships, weighing values, reputation, and financial viability. Policy action is needed to protect local communities.

• Community sporting organisations face increased risk of gambling sponsorship as elite sporting clubs move away, prompting the need for protective strategies.
Determinants of health prevention behaviors in Portugal
Authors: Novais A , Barros P P
Published: October 2024

Background

One of the main causes of death in developed societies are chronic non-communicable diseases, often originated by risky behaviors as tobacco consumption, poor diet, excessive alcohol consumption and lack of physical activity. Changing lifestyles can thus lead to a reduction in chronic diseases and in their economic costs. The objective of this study is to understand what the main factors associated with health behaviors are.

Methods

We used the data collected through the Portuguese National Health Surveys from 2014 and 2019. The sample analyzed was composed of individuals aged 15 or more years old living in the national territory at the time the surveys were conducted. Data on demographics, socio-economic variables and health related variables was used. A maximum likelihood estimation was performed using a multivariate probit model, by using health behaviors (weekly exercise, healthy diet, non-smoking, and prudent alcohol consumption) as the outcomes of the analysis.

Results

The results point to a strong association between social class and health behaviors, particularly between higher income and healthy diet. It is important to highlight that having an appointment with a General Practitioner is positively associated with all healthy behaviors. For all behaviors but healthy diet, the coefficients are statistically significant at a 5% significance level and non-smoking displays the highest one (0.135).

Conclusions

This study presents the first step to understand the determinants of health prevention behaviors, which is important to design policies targeting lifestyles. One of its main conclusions indicates that social class (income and education) and GP appointments are associated with health behaviors. Further research would be needed to study the underlying mechanisms through which some of these factors impact behaviors. This presentation was supported by National Funds through FCT, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020).

Key messages

• This study is an important step in the formulation of policies targeting lifestyles since it allows us to understand which factors are associated with health behaviors.

• From this study one can conclude that social class characteristics, particularly income, and access to GP appointments are associated positively with health behaviors.
Navigating Burnout: Exploring Pharmacists’ Attitudes toward Patient Care
Authors: Jocić D , Krajnović D
Published: October 2024

Background

The study aimed to investigate the link between pharmacists’ burnout levels and their attitudes toward patient care, crucial for addressing burnout’s impact on service quality and fostering positive patient interactions.

Methods

The study utilized the Shirom-Melamed Burnout Questionnaire (SMBQ) to assess burnout levels among 442 community pharmacists. Additionally, the five-point Likert Scale of General Attitudes and Beliefs of Pharmacists about their Work with Patients (SOSUF), developed by the authors, was employed to measure pharmacists’ cognitive, affective, and behavioral attitudes toward patient care. Statistical analyses involved correlation and regression procedures.

Results

Moderate burnout levels among pharmacists observed (mean SMBQ score: 4.18 ± 0.96, range: 1.45 to 6.55), alongside generally positive attitudes toward patient care (mean SOSUF score: 3.44 ± 0.37). Regression analysis revealed a moderate positive correlation between burnout and attitudes toward patient care (R = 0.336, R Square = 0.113, Adjusted R Square = 0.111, p < .001). Burnout impacted pharmacists’ attitudes, notably in perceptions of patients not appreciating their efforts (r = -0.317, p < 0.001), finding patient interactions challenging (r = -0.409, p < 0.001), and disregarding their advice (r = -0.333, p < 0.001).

Conclusions

Despite generally positive attitudes toward patient care, burnout moderately correlates with negativity, notably impacting perceptions of patient appreciation, interaction challenges, and adherence to advice. Addressing burnout is crucial for maintaining positive patient care attitudes and ensuring quality service delivery.

Key messages

• Burnout impacts pharmacists’ patient care attitudes, emphasizing the need for intervention to enhance healthcare delivery.

• Implementing strategies to reduce burnout among pharmacists can improve patient care outcomes.
A Training-of-Trainers program for health facilitators fighting malaria in a vulnerable community
Authors: Carboni C , Jimeno Maroto I , Galindo M , Plessis L , Lambert Y , Vreden S , Suarez-Mutis M , Miller Bordalo J , Douine M , Sanna A
Published: October 2024

Background

When Public Health is challenged by issues related to migrant and vulnerable populations, health facilitators’ profiles are crucial to accessing communities and increasing intervention effectiveness and acceptability. The French overseas region, French Guiana, is concerned with a migrant population living in vulnerable conditions far from healthcare and being a major reservoir of malaria. Curema is an intervention implemented to fight malaria in this population by distributing RDTs, and treatments after an appropriate training of participants. Facilitators from the community are employed to provide health education and enroll participants.

Objectives

An intensive theoretical-practical training program was realized to enable facilitators to master procedures related to the intervention. The training was designed using the CDC Training-of-Trainers (ToT) framework and adult learning principles. It was composed of initial and on-the-field training, both based on bidirectional, participative, and dynamic working spaces. A mixed-method evaluation was carried out to assess training effectiveness and quality.

Results

Group dynamics and adaptations driven by facilitators’ needs were key elements of a high-quality training program. Satisfaction was elevated for training format and learning results. Statistically significant improvements in knowledge level demonstrated good effectiveness. During the initial training, difficulties persisted regarding some tasks to be performed during the intervention: further on-the-job training addressed them, improving facilitators’ practices in the field.

Conclusions

High-quality, effective, and appropriate training programs are required for intervention involving facilitators’ profiles. Training design is crucial to achieve it. ToT model has been shown to allow high satisfaction, learning results, and good implementation in the field. Initial and on-the-job training are an indispensable continuum to sustain good practices and motivation.

Key messages

• If health facilitators from the community are actors in public health interventions, appropriate training is necessary to ensure good implementation.

• ToT seems an optimal model for training health facilitators.
Consumption and expenditure of antidepressants and anxiolitycs in 14 European countries
Authors: Martella M , Minutiello E , Gianino M M
Published: October 2024

Background

Since the burden of depressive and anxiety disorders, assessing the use and spending of drugs commonly prescribed for treating such conditions is a valuable barometer of mental health assistance and healthcare services. The current research aims to evaluate the consumption of antidepressants and anxiolytics and the relative expenditure among 14 European countries (Austria, Czech Republic, Finland, Germany, Hungary, Italy, Latvia, Luxembourg, Norway, Portugal, Slovak Republic, Slovenia, Spain and Sweden).

Methods

A retrospective longitudinal study was assessed based on pooled time series analysis of secondary data over ten years (2012-2021). Defined Daily Doses (DDD) per 1,000 inhabitants and health expenditure per capita (current US$, computed on purchasing power parity) were considered. Linear and quadratic trends were calculated for defining relationships between the variables of interest.

Results

Prevailing patterns of consumption and spending show an increase in antidepressants and a decrease in anxiolytics. Noteworthy is the growth slope of antidepressant consumption in three selected countries, Portugal, Spain, and Sweden, by over two and a half times from 2012 to 2021. In addition, for a few countries, there is a pattern contrary to most countries for anxiolytics (Latvia, Spain) and discordant between consumption and expenditure for antidepressants (Austria, Hungary).

Conclusions

The widespread growth of antidepressant use deserves attention. As a public health issue, the prescription and use of antidepressants should be addressed by targeted policies for integrating multifaceted strategies.

Key messages

• Monitoring consumption and expenditure of antidepressant and anxiolytic drugs represents a valid tool for assessing the efficacy and availability of mental healthcare services among the population.

• The growth in the consumption of antidepressants represents a relevant public health issue and deserves attention for the evaluation of an integrated approach of assistance.
A healthcare workforce assessment model using reimbursement data in Luxembourg
Authors: Leite S , Goetzinger C , Urbain M , Berthet F , Shinn C
Published: October 2024

Background

The assessment of the healthcare professional (HCP) headcount and level of activity is a real challenge for policy makers. In Luxembourg, there is no uniform definition of practicing HCP. This work focused on identifying a method to assess HCP headcount and their level of activity in Luxembourg, while finding national consensus.

Methods

A thorough literature review was conducted to find methods that assess practicing HCP and identify their level of activity. Eligible were scientific papers or national reports discussing methods on employed and self-employed HCP. National reimbursement data were used for preliminary data explorations conducted alongside the ‘General Inspectorate of Social Security’ in Luxembourg and discussed with the ‘Institut national d’assurance maladie-invalidité (INAMI)’ in Belgium. Two working groups were planned with national stakeholders to discuss HCP assessment methodologies. Both the collaborations and the working groups led to a preliminary validated HCP assessment method. To reach national consensus, a Delphi study is planned in June 2024, using the eDelphi.org platform. Invited panelists include researchers, professionals, healthcare practitioners, decision makers and policy makers, patient representatives, and insurers.

Results

The literature review found 16 eligible papers on HCP headcount and HCP’ level of activity. Finally, the Belgian method, developed by experts from INAMI, using reimbursement data and establishing a median reimbursement for each medical specialty was retained for Luxembourg. The results of the Delphi study will inform on the level of agreement on relevance, clarity and completeness of the proposed methodology for Luxembourg.

Discussion

Finding national consensus represents a strong foundation for efforts to advance the use of the proposed methodology in healthcare workforce assessment and planning.

Key messages

• Counting something as simple as healthcare professionals requires a strong methodology that held the buy-in of all major stakeholder.

• As working behavior of HCP evolves over time, it is crucial to not only count professionals but also full-time equivalents for policy makers to plan ahead in an accurate manner.
Reflective model assessment of adherence to COVID-19 non-pharmaceutical interventions
Authors: Pavić M P , Pranić S M , Matelić T , Kljucević Z , Gotovac M , Jurčev Savicević A , Kozina T , Kozina S
Published: October 2024

Background

Non-pharmaceutical interventions (NPIs) decrease COVID-19 transmission. We identified behavioral factors that affected NPI adherence according to Normalization Process Theory (NPT) in medical students, travel seekers, and people with substance use disorder using reflective model measurement, which previously had not been conducted. Public health officials should consider factors that influence adherence to create preventive strategies for COVID-19.

Methods

In a cross-sectional design, medical students and people with substance use disorders in treatment comprised a probabilistic sample, and travelers and COVID-19 suspected persons comprised a convenience sample. Participants were from Split-Dalmatia County (n = 656) in the Mediterranean and consented to self-administered surveys in 02/2021. Sociodemographic data, locus of control (LoC), and moral behavior were collected. Partial least squares structural equation modeling (PLS-SEM) was used to measure reflective assessment of NPI adherence according to NPT.

Results

PLS-SEM reflective model assessment provided two-group specific factors in inverse relationships which determined NPI adherence with excellent goodness of fit (χ2=1.292, df = 1; p = 0.297). Significant negative factors covariance estimate (-0.716) revealed an increase in adherence to the first factor, NPIs and internal LoC [0.640], as the second factor, age (≤25) and highest education level (1.362), decreased. LoC was the mechanism by which sex (MLsex=-0.017, SE = 0.007, p < 0.016) and being a student or person with substance use disorder (MLgroup=-0.008, SE = 0.003, p = 0.015) showed indirect effect on NPI adherence.

Conclusions

Students and people with substance use disorders more adhered to NPIs. Higher-educated younger adults with a tendency toward external LoC facilitated the normalization. Public health interventions could encourage these subgroups to act as promoters to increase NPI adherence in similar settings.

Key messages

• COVID-19 non-pharmaceutical interventions and psychological factors of students and people with substance abuse disorder influenced adherence. Targeted interventions could promote adherence.

• Public health officials should consider that preventive strategies may be more effective in highly educated adults younger than 25 years of age.
Uncovering the health system burden of pneumococcal infections in adult and elderly populations
Authors: Desson Z , Levi J , Margheri F
Published: October 2024

Background

Health system resources dedicated to vaccination and infectious disease prevention are often directed towards infants and children, through extensive childhood vaccination schedules. This focus has led to the near eradication of several preventable childhood diseases and had positive impacts on population health, but despite this track record of success, the ability of our health systems to make vaccinations accessible throughout the full life course has been less consistent. This project aims to address this issue by providing new data about the burden that pneumococcal infections, which are vaccine-preventable, have on adult and elderly populations.

Methods

This research aims to uncover the health system burden of invasive pneumococcal disease and pneumococcal pneumonia at all levels of the health system in 5 EU countries (Austria, Belgium, France, Italy & Portugal). This involves a survey of managers and care providers working in hospitals, long-term care facilities, and primary care centres who may be affected by the health system impacts of pneumococcal infections. The survey covers several dimensions of health service delivery to collect a broad range of data on existing disruptions. The survey was translated into the study country languages and its formulation was further validated through interviews with experts in each study country to ensure that it can capture context-specific health system insights. The data collected through this survey will be further enhanced through a series of in-depth interviews before being synthesised, analysed and eventually published in a detailed report.

Results

Data collection begins as of 15 May 2024, and full results are expected to be published and available for the EPH Conference in November 2024. The results of this research will offer valuable evidence to public health professionals, health managers and policy-makers across Europe who are working to improve life-course access to pneumococcal vaccination.

Key messages

• Effective vaccination programmes for adult and elderly populations require expanding focus beyond childhood.

• Data about the health system burden of pneumococcal infections in adult and elderly populations improves evidence-based decision-making and public health services.
Infectious disease prevention among internally displaced people: Perspectives from Lviv, Ukraine
Authors: Shumylo K , Ivanchenko N , Kuziuk M , Aaronson W , Tomosky A M
Published: October 2024

Background

The ongoing war in Ukraine has increased the risk of infection spikes, especially among internally displaced people. The healthcare challenges in the war context necessitate teaching the population of preventative measures, which have become the primary vector of the activities of the Ukrainian Regional Centers for Disease Control and Prevention.

Objectives

The research aimed to highlight the activities of the Lviv Regional Center for Disease Control and Prevention (CDC) in relation to internally displaced people.

Methods

The research project analyzed the incidence rate of infectious diseases and vaccination coverage data among the population and internally displaced people in the region. The data were collected from monthly reports of CDC’s departments and alert messages sent by primary care institutions to the CDC.

Results

According to the Single register of internally displaced people (IDP), 13% of internally displaced people were permanently staying in the Lviv region (the second place was Zakarpattia region - 9% of IDP, and the third was Kyiv - 7% of IDP). In the Lviv region, 237,000 people registered as forcibly displaced. Total, over 700, 000 people are in the area, including the unregistered and 68,000 children. In 2022-2023, the morbidity rates among IDPs did not exceed the rates among the general population in the area. Each IDP residence place had its physician; 11 thousand IDPs were vaccinated, and 3,235 of those were children. In general, 46 mobile medical brigades worked on-site in the Lviv region. Only one spike of gastrointestinal infection was registered. CDC employees provided lectures and workshops on hygiene and food storage in 56 IDP residence places.

Conclusions

The review results show that coordination between CDCs, local physicians, and mobile medical brigades in the IDP residence areas prevents outbreaks of infectious diseases and swiftly responds to emerging threats.

Key messages

• The tragic events in Ukraine resulted in healthcare access issues. Lviv CDC, fighting at its own forefront, quickly assessed the risks and efficiently managed the potential hazards.

• The Lviv region remains one of the biggest hubs in Ukraine for the temporary residence of internally displaced people, with CDC employees ensuring that preventive measures are effectively carried out.
Social determinants and drivers of use of SARS-CoV-2 self-tests in a French national cohort study
Authors: Garnier S , Warszawski J ,   the EpiCov study group
Published: October 2024

Background

Self-tests for SARS-CoV-2 became quickly available after the onset of the epidemic. They were especially recommended for high-risk and hard-to-reach populations. This study examines whether self-tests successfully reached vulnerable groups during first months of availability in France.

Methods

The EpiCov study is a national population-based cohort study conducted in France during the Covid-19 pandemic. Primary outcome variable was use of self-test at last SARS-CoV-2 test, among those who reported testing at least once between May-July 2021. Univariate and multivariate binomial weighted logistic regressions were run, stratified by age group (16-24 yrs, 25-59, 60+), to identify social determinants and drivers of use of self-tests.

Results

Overall, 11% of the population who tested for SARS-CoV-2 between May-July 2021 reported using a self-test as last test. Demographic factors were highly predictive of use of self-tests among 25-59 y/o, but not among younger and older age groups. Use of self-tests was highest among 16-24 y/o, people with higher education, lowest population density areas, and people with high overall frequency of testing. Use was lowest among 60+ y/o, unemployed and retired people, and first-generation immigrants. When stratifying by age, 16-24 y/o with high perceived Covid-19 risk were more likely to use self-tests (aOR 1.99, 95% CI 1.10-3.59). Among 25-59 y/o, in-person workers were more likely to use self-tests than remote workers (aOR 1.91 [1.20-3.05]). Among 60+ y/o, employed people were more likely than retired people (aOR 3.97 [2.30-6.85]).

Conclusions

With higher utilization in low population density areas and among frequent testers, convenience may be a primary driver of use of self-tests. Additional drivers include perceived risk among younger people and exposure at work for those ≥25 yrs. Inequities in use were observed, with lower use among people with low education, older age, and immigrants.

Key messages

• Use of self-tests in France during the Covid-19 pandemic was low among vulnerable population groups, including people with lower education, immigrants, and older individuals.

• Drivers of use included geographical access to healthcare services, perception of risk among younger respondents, and exposure at work among adults aged ≥25 years.
Cross-sectional study of bystander roles in school bullying incidents in the United Arab Emirates
Authors: Elkonaisi I , AlKetbi A , Abdullahi A S , AbuHamada B , Elbarazi I , Grivna M
Published: October 2024

Background

School bullying is a widespread public health issue with far-reaching consequences on the psychological well-being and academic performance of students. This study focuses on the perspective of bystanders to better understand their role in the dynamics of bullying in school environments in the United Arab Emirates.

Methods

We employed a multi-stage random sampling approach to collect data from students in grades 6 to 9 at the sample of public and private schools in Al Ain, using a validated self-report questionnaire. IBM SPSS software version 28.0 was used for the analysis using appropriate statistical tests.

Results

Out of 728 surveyed students, 290 (40%) were from private and 438 (60%) from public schools. A total of 425 (58%) of students were bystanders observing bullying incidents across all schools, with 65% of males versus 45% of females witnessing such events. Physical bullying was the most frequent type of bullying observed by 67% of students. The classroom was most often location, 75% in private schools and 61% in public schools. Verbal abuses such as making fun and name-calling were commonly reported. Bullying targeting physical appearance was particularly noted, with 31% of bystanders stating that bullying was due to perceptions of a student’s face being ‘funny’ and 21% due to beliefs about weight. 59% felt sad, and 29% didn’t go to school as a result of the bullying. Reporting to teachers was limited (25%).

Conclusions

The high prevalence of bystanders in school bullying incidents in Al Ain was observed, especially among male students. The results emphasize the critical need for comprehensive anti-bullying programs that include bystander intervention strategies to promote a supportive and inclusive educational environment.

Key messages

• Many of students are witnessing bullying, highlighting the need for effective intervention programs.

• Empowering bystanders is crucial in preventing bullying and enhancing the safety at schools.
Social support for women undergoing induced abortions in Belgrade, Serbia
Authors: Gazibara T , Dotlic J , Maksimovic N , Maksimovic J , Bila J , Tulic L , Stojnic J , Miloradovic M , Plavsa D
Published: October 2024

Background

Having an unwanted pregnancy requires social support to help women ease the stress and stigma of having an induced abortion. The study aimed to investigate the main providers of social support to women having induced abortions.

Methods

Women undergoing induced abortions from 2022 to 2024 in a University clinic in Belgrade were invited to participate. Data were collected using an anonymous questionnaire examining socio-demographic data of women and sources of social support.

Results

This study included 433 women out of which 50.1% informed their mothers about the abortion, 23.1% their fathers, 87.3% their partners, 42.3% their friends, and 1.6% women told no one about the abortion. A total of 40% of women were supported to undergo the abortion by their parents, 80.1% by their partner, 34.9% by friends, and there were 2.1% of women who did not get any support to perform abortion. There were significantly more (p = 0.001) mothers (163 vs. 54), fathers (87 vs. 13), partners (331 vs. 47), and friends (136 vs. 47) who were informed about the abortion and also supported women compared to those who did not provide support. Getting support for the abortion by the parents was associated with younger age, not being in a relationship, and not having children. Support of the partner was linked to older age, higher education, being unemployed, being married with more children, and having abortions previously. Being supported by friends or not being supported at all did not correlate with socio-demographic data of the investigated women.

Conclusions

Women are generally supported by their family and friends in their decision to have induced abortions. This study identified socio-demographic factors that impact the choice of principal supporting person when undergoing induced abortion.

Key messages

• Partners are the main source of social support for married women who had induced abortion.

• Parents are principal social supporters for single younger women undergoing induced abortion.
Youth insights on a digital crowdsourcing intervention to reduce HIV stigma in Kazakhstan
Authors: Sun Y , Landers S E , Yang S , Mergenova G , Sarsembayeva L , Balabekova O , Davis A
Published: October 2024

Background

In Kazakhstan, nearly a quarter of new HIV infections occur among adolescents and young adults (AYA). Testing can reduce the spread of HIV, yet AYA have low testing rates in Kazakhstan, due in part to HIV-related stigma. This qualitative paper explores participants’ perceptions of digital crowdsourcing content designed to reduce HIV stigma and promote HIV self-testing among AYA in Kazakhstan.

Methods

We conducted semi-structured interviews with 20 AYA who participated in a digital crowdsourcing intervention. Questions focused on AYA’s perceptions of the crowdsourced content they viewed for the intervention, namely their likes, dislikes, the perceived impact of the content, and areas for improvement. Qualitative data analysis was conducted using a thematic approach.

Results

Findings revealed a perceived need for more youth-developed digital interventions. AYA favored artistic, interactive content featuring health specialists, youth characters, or real-life stories. Short videos and images were AYA’s favorite content formats. Many AYA showed less interest in longer videos and text-heavy content, finding them hard to understand. Most participants reported improved knowledge of HIV, reduced stereotypes related to HIV, heightened interests in HIV topics, more willingness to get tested, and changes of attitudes towards people living with HIV. Recommendations for future interventions include tailoring content to different AYA age groups and creating more engaging and easily digestible content.

Conclusions

This study highlights the potential of crowdsourced digital interventions in promoting HIV knowledge and awareness of HIV-related stigma among AYA in Kazakhstan. AYA appreciated youth-developed, interactive content that included real-life stories and artistic visual presentations.

Key messages

• This study highlights the potential of crowdsourced digital interventions in promoting HIV knowledge and awareness of HIV-related stigma among AYA in Kazakhstan.

• AYA appreciated youth-developed, interactive content that included real-life stories and artistic visual presentations.