bluuebunny/crossref_metadata_2025 huggingface dataset:
Ensuring sustainable impact of the national report on climate change and health in Germany 2023
Authors: Mlinarić M , Kelleher K , Niemann H , Taylor A , Ziese T
Published: October 2024

Issue/problem

The Robert Koch Institute recently coordinated a status report on climate change and health for Germany, detailing the current and future impact of climate change on health through 14 chapters.

Description of the problem

A central aim was to ensure the report’s long-term impact and public health value. Essential areas of focus have therefore been stakeholder-specific communication and establishing a network of experts for continued scientific exchange.

Results

The publication of the report as peer-reviewed articles has served to reach the scientific community. Another target group are public health practitioners and decision makers at subnational levels, who can contribute towards climate change mitigation and adaptation measures relevant to health, as recommended in the report. This latter group was reached through various methods and formats of science communication, including conferences aimed at the public health sector, through target-group oriented podcasts, social media engagement and digital town hall discussions. Following publication, the experts involved in writing, reviewing and using the report were invited to establish a network in order to support long-term scientific exchange and collaborations and in turn ensure the report’s sustainable impact and value.

Lessons

Through follow-up evaluations, the reception of the report and the further communication needs of this target group were analysed. A major lesson was to include the insights of public health practitioners more systematically and at an earlier stage in any future reports. As for the establishment of a network, a survey amongst the authors and other experts showed what this group considers the goals of this network: creating synergies and connections with existing initiatives and providing a platform for further exchange, especially amongst researchers addressing similar questions, such as the efficacy of mitigation and adaptation measures, from different angles.

Key messages

• Local public health practitioners are important stakeholders for climate change and health for ensuring public health impact.

• The expertise in the network will support continued scientific exchange on climate change and health and thus ensure the national report’s sustainability.
Urban transformation interventions for the promotion of active home-school mobility: overview
Authors: Saulle R , Perilli A , Biscaglia L , Kalem T , Masini A , Mitrova Z , Faggiano F
Published: October 2024

Background

Active home-school mobility can contribute to a series of benefits, both for the health of children and adolescents (higher levels of physical activity, better cardio-metabolic profile, better school performance), and for the health of the general population and of environment (reduction of air pollution and greenhouse gas emissions). An overview of systematic reviews (RS) was conducted in order to evaluate mainly the effectiveness of interventions promoting active home-school mobility on physical activity, overweight/obesity, well-being and reduction of road accidents in children and adolescents.

Methods

The bibliographic search was carried out on the following databases: Cochrane Database of Systematic Reviews, MEDLINE, Embase and CINAHL, without any limits. Endnote software was used for the systematic reviews (SRs) selection. Data relating to the main characteristics and results of the SRs were extracted. The assessment of the methodological quality of the SRs was carried out using the “Health Evidence™ Quality Assessment Tool”.

Results

On the basis of the relevance and adherence to the research PICO, n. 12 systematic literature reviews evaluating effects of interventions of interest in the study population.

The strategies took multiple levels into consideration, i.e. they aimed at organizing the home-school journey to encourage active mobility, as well as training and information aimed at the population under study for the promotion of physical activity.

Conclusions

Combined interventions appear more effective in promoting active home-school mobility with a better impact on increasing physical activity levels. Further high quality studies are necessary to investigate the impact of these interventions also on the reduction of incidence of overweight/obesity and in terms of school performance.

Key messages

• Policy makers should promote programs to increase active home-school transport.

• Further high quality studies are necessary to investigate the impact of these interventions also on the reduction of incidence of overweight/obesity and in terms of school performance.
Proportions and types of different sweeteners in the Hungarian packaged food supply
Authors: Sarkadi-Nagy E , Guba G , Zámbó L , Susovits K , Bakacs M , Bica M , Harrington R , Rippin H , Wickramasinghe K , Zentai A
Published: October 2024

Branded food databases facilitate the analysis of sweetener use in commercial packaged food products. The purpose of this study was to map the use of sweeteners in relevant packaged food categories and to assess and compare the nutrient profile of non-sugar (including sugar alcohol) vs. added sugar sweetened food products in Hungary. The foodDB software, developed by University of Oxford, enables automated online data collection, and was used to compile data of all foods and drinks available from four major Hungarian supermarket websites, selected by market share in March 2021. Only products containing either added sugar and/or non-sugar sweeteners were included in the study. These were categorized into 12 food groups using specific search terms. After data cleaning the final product number was 2016. 72% of the products was sweetened with added sugars only, 15% of them with non-sugar sweeteners only and 13% contained both sugars and non-sugar sweeteners. Chewing gums (92%), soft drinks (60%), energy drinks (50%) and pickles (35%) contained non-sugar sweeteners in the largest proportion. More than 90% of flavoured alcoholic beers, chocolate bars, breakfast cereals and yogurts were sweetened with added sugar only. Nine categories included food items containing multiple non-sugar sweeteners per product. The most common non-sugar sweeteners were acesulfame-potassium, sucralose, aspartame present in 15%, 10%, 9% of the total products respectively. Muesli bars with non-sugar sweeteners contained less energy but also less fibre than muesli bars with added sugars only; whereas pickles with non-sugar sweeteners contained less energy but were significantly higher in salt than those products with added sugars only. The presence of non-sugar sweeteners is widespread in the Hungarian food supply; however, their use does not guarantee a more beneficial nutrient profile. Branded food databases are useful tools to analyse the nutrient composition of packaged foods.

Key messages

• Branded food databases are useful tools to monitor the composition of the packaged food supply.

• The nutrition profile of foods with non-sugar sweeteners can be less favourable than foods with added sugars.
The negative health assessment and the different consumption of dietary supplements
Authors: Arlauskas R , Austys D , Stukas R
Published: October 2024

Background

There is an insufficient level of research carried on the consumption of dietary supplements among diverse social and demographic groups, especially among those with a negative assessment of personal health. Therefore, the aim of this study was to assess the consumption of dietary supplements among working-age residents of Lithuania in the period from 2021 to 2023 with respect to social and demographic factors and the assessment of personal health.

Materials and methods

The data for this study were collected after conducting three independent cross-sectional surveys in 2021, in 2022, and in 2023. Each of the samples included 1600 working-age adult residents of Lithuania. Distribution of the respondents by the assessment of personal health and gender, age, marital status, education level, place of residence, employment, income, and COVID-19 cases among the respondents and members of their families was assessed.

Results

The consumption of dietary supplements differed each year and accounted for 78.1%, 71.6%, and 72.7% of the respondents, respectively (p < 0.05). In 2022, the prevalence of the consumption of dietary supplements was lower in the majority of social and demographic groups (p < 0.05). In 2023, it was higher among females, younger residents, and those from larger families, who suffered from COVID-19 (p < 0.05). Despite similar changes found in the consumption of dietary supplements among those who negatively assessed their health, this group showed more prevalent consumption of dietary supplements among residents with non-university education, unemployed respondents, and those with lower income (p < 0.05).

Conclusions

Despite a significantly lower prevalence in the consumption of dietary supplements in 2022, it was higher again in 2023. A negative assessment of personal health is associated with opposite tendencies in the prevalence of the consumption of dietary supplements in the general population.

Key messages

• Despite a significantly lower prevalence in the consumption of dietary supplements in 2022, it was higher again in 2023.

• The negative assessment of personal health should be taken into account when planning nutritional interventions due to its association with different consumption of dietary supplements.
Frailty and quality of life in italian older adults: implications for public health interventions
Authors: Donnoli C , De Luca V , Formosa V , Picardo G , Aprile A , Carnevale E , Bisogno M , Chimienti M , Liotta G , Illario M
Published: October 2024

Background

The increasing focus on frailty in older adults underscores the significance of a timely multidimensional assessments and early detection to avert adverse outcomes. The primary aim is to integrate digital technologies, specifically online assessment tools, for the identification of frailty and the assessment of Quality of Life (QoL) in elderly individuals.

Methods

A nationwide multicentric study was conducted. Seven Italian centers and regions evaluated frailty in older adults residing in the community, through a prospective observational cohort study. The chosen questionnaires, Sunfrail+ and SF-12, were implemented through an easily accessible online tool, swiftly generating final scores for each test. The cross-sectional analysis included 503 older adults. The cut off to define a person “frail” is 3 positive alerts in Sunfrail baseline items, according to the literature.

Results

In this sample an average of 2.31 positive alerts were generated. Significant associations were established between the number of positive warnings and SF-12 physical and mental indexes, indicated by X2=53.1 (p < 0.001) and X2=25.1 (p < 0.001), respectively. The difference between two groups (frail and not frail) in relation to QoL is statistical significantly (U di Mann Whithney p < 0.001). Mean QoL mental and physical indexes are 46.3 and 39.3 in frailty group, versus 51.7 and 46.5 in non frailty group, respectively. The correlation is conceptually consistent: as frailty increases, QoL decreases.

Conclusions

The frailty assessment associated with the QoL assessment provides relevant information to monitor the impact of prevention interventions at community level. The assessment of frailty leads the prevention intervention whose impact could be assessed also through QoL tools. This study underlines a meaningful association between assessment tools, substantiated by conceptual correlations.

Key messages

• Sunfrail and SF-12 are easily accessible online tool useful for identification of frailty and the assessment of Quality of Life (QoL) in elderly individuals.

• The older population in Europe is increasing a timely assessment of frailty must be a public health priority.
A Personal Health Record for patients with multiple sclerosis: A 2-year evaluation study
Authors: Aardoom J , Van den Berg L N , Kiveron L E , van den Akker M E , Hoitsma E , Chavannes N H
Published: October 2024

Background

Multiple sclerosis (MS) is a chronic disease impacting the central nervous system, affecting 2.8 million people worldwide. Effective self-management is crucial for treating chronic diseases, including MS. Personal health records (PHRs) show promise in supporting self-management, potentially empowering patients and enhancing their engagement in treatment and health. However, implementation challenges persist.

Objectives

This study aimed to) assess the feasibility and usability of the PHR according to patients and healthcare professionals (HCPs), and 2) evaluate implementation determinants, and exploring preliminary effects on a range of outcomes related to the quality, efficiency, and costs of care, as well as health-related outcomes.

Methods

A mixed-methods study was conducted in a Dutch hospital. Quantitative data from 80 patients and 12 HCPs were collected via questionnaires at baseline (T0), after one (T1) and 2 years (T2). Focus group interview were conducted at T2 with 7 patients and 4 HCPs.

Results

Most patients never logged in during the first year and logged in a couple of times during the second year, with 15 minutes per log-in session. The HCPs mainly logged in a couple of times per year, averaging six minutes per session. Patients’ and HCPs’ usability and satisfaction scores were below average and moderate respectively. Various facilitators and barriers were identified, including knowledge gaps, staff capacity issues, and ICT obstacles. No significant differences were found in preliminary effects. Qualitative data highlighted benefits in terms of gaining insight into health data but revealed challenges with log-in issues and information retrieval.

Conclusions

Implementation challenges hindered PHR adoption. The evolving nature of PHRs requires ongoing evaluation and adaptation to optimize their potential benefits. Utilizing a participatory design approach and a dedicated implementation team could enhance adoption and maximize benefits.

Key messages

• A personal health record (PHR) for patients with MS was evaluated within the care setting of a Dutch hospital, demonstrating limited usability and moderate satisfaction.

• Diverse obstacles impeded the adoption and uptake of the PHR, but potential solutions lie in continuous development with a participatory design approach and dedicated implementation team.
Overcoming non-usage of e-mental health: A qualitative study in a Dutch general practice
Authors: Van Der Heijde C M , Van Winkoop J D , Vonk P
Published: October 2024

Background

Worldwide percentages of people with mental health problems are substantial and increased during the COVID pandemic (to about 25 % in the general population). E-mental health has potential to help with waiting lists, rising health care costs and work pressure. To reach the desired effects, participants need to use the technology as intended. Non-usage though is a common problem. Research question is: what elements obstruct the intention to use e-mental Health interventions, plus what are barriers to bridging the intention-behaviour gap?

Methods

In a qualitative study, semi-structured interviews were conducted (interview guide). We recruited patients who were invited for an e-mental health intervention in a Dutch general practice but did not start the intervention. Data saturation occurred with 11 patients. Open, axial and selective coding was done on the transcribed interviews using the software ATLAS.ti.

Results

Five main themes were associated with non-use: 1) ‘Expectations about the eHealth in general’ were neutral to positive. 2) ‘thresholds to start e-mental health’ were: negative expectations about the content, lacking mental capacity due to mental problems, missing personal contact, the therapy with the mental health professional in general did not fit their needs or aversion towards more screen time. 3) ‘lack of planning’. 4) lacking encouragement from mental health professional 5) ‘Expectations from therapy in general’. (a.o. face-to-face contact and tailoring)

Conclusions

Embedding the e-mental health more into regular therapy has potential to overcome non-usage. The mental health care professional has social influence to increase usage, by a clear and convincing introduction plus joint review of the exercises during consultations. This study needs to be repeated in other clinical settings. Future research should also include age (computer use) and disease prognosis to define when e-mental health is a suitable solution for patients.

Key messages

• E-mental health interventions have potential to help with waiting lists, rising health care costs and workload, but non usage is a problem.

• Embedding the e-mental health more into regular therapy has potential to overcome non-usage.
Changes in TB contact tracing during the COVID-19 pandemic. An Irish single centre experience
Authors: Casey K , Fennessy S , Wallace C , Lyng P , O’Beirne S
Published: October 2024

Contact tracing following the diagnosis of tuberculosis (TB) is a crucial process in the identification and treatment of both secondary TB cases and also infected contacts who may require treatment for latent TB infection. During the COVID-19 pandemic, Public Health and Respiratory teams in the St Vincent’s University Hospital (SVUH) TB clinic in Dublin, Ireland, noted anecdotally that there appeared to be fewer contacts screened by public health services per index active TB case identified. To investigate this, we performed a retrospective review of the TB contact tracing service in SVUH, examining and comparing contact tracing of active TB cases in the 3 years prior to the pandemic (2017-2019) and four years thereafter (2020-2023). Results from 2017-2019 calendar years, prior to the COVID-19 pandemic noted an average of 4.77 contacts per index TB case (total 107 index cases and 510 contacts). In comparison, our data from 2020-2022 noted an average of 3.03 contacts per index TB case (total 59 index cases and 179 contacts). As pandemic restrictions were lifted again, we found our 2023 data to be more comparable to that of pre-pandemic times, noting 4.54 contacts per index case (total 22 index cases and 100 contacts). The reduction in TB contacts per index cases noted during the COVID-19 pandemic may reflect work and lifestyle changes over that time, particularly an increase in remote work but also social distancing. It is interesting that as the population emerged from the isolation measures of the pandemic, contact numbers returned quickly to pre-pandemic levels. In line with global concerns, our data highlights the ongoing workload of TB contact tracing locally and the importance of resource allocation for these services.

Key messages

• Our Irish centre experienced a notable but temporary reduction in contacts requiring screening by public health services, per index active TB case, during the COVID-19 pandemic.

• In line with global concerns, our data highlights the ongoing workload of TB contact tracing locally and the importance of resource allocation for these services.
Arts and Mental health
Authors: Lindert J
Published: October 2024

Art includes performing arts, visual arts, literature, culture, and online/digital products. Its interventions are multimodal, combining a variety of activities, such as evoking emotions, emotional and cognitive stimulation, and imagination. Depending on the type of art, they may also involve social interaction, physical activity and communication. There is a large body of research suggesting that art engagement can enhance different dimensions of mental well-being (eudaimonic well-being, life satisfaction, evaluative well - and positive emotions). Some or all of these benefits have been found in individuals who participate in art activities. Based on these findings, art on prescription has been used in some European countries, including the United Kingdom, and Scandinavian countries. Art on prescription is mostly delivered in partnership with art organizations. The aim of this talk is give an overview on art on prescription in different countries in Europe and enhance understanding of the mechanism for whom art on prescription is a promising intervention in the field of mental health. Building on the mapping and review of reviews challenges of art interventions will be discussed such as study design or evaluating effectiveness and identifying population groups for whom art interventions work best.
Exploring the Relationship Between Health Literacy and Alcohol Consumption Patterns in Tuscany
Authors: Zanobini P , Parsa N , Bonaccorsi G , Minardi V , Possenti V , Masocco M , Garofalo G , Mereu G , Cecconi R , Lorini C
Published: October 2024

Introduction

Alcohol consumption is a prevalent aspect of social and cultural life worldwide. However, high and binge consumption has become a significant public health concern. Inadequate health literacy (HL) may contribute to poor awareness and/or knowledge regarding the risks of alcohol-related behaviors. However, to date, only a few studies have examined the relationship between HL and different types of alcohol consumption. This study aimed to investigate the relationship between HL, other sociodemographic determinants, and their influence on high and binge consumption among the general population aged 18-69 in Tuscany.

Methods

The study analyzed data from 2017 to 2022 from a Tuscan population subsample in the Italian Behavioral Risk Factor Surveillance System PASSI. HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6).

Results

Among the 12,953 interviewees, binge drinking was reported by 8.3%, while high consumption by 3.6% of the entire sample. In the multivariate logistic regression, participants aged between 50 and 69 years with problematic or inadequate HL levels had an increased adjusted odds ratio for high alcohol consumption. Instead, females, individuals older than 34 years, and those of foreign nationality had a reduced odds ratio for binge drinking. Low HL was a predictor of high alcohol consumption but not of binge drinking.

Discussion

As expected, young males are more likely to engage in binge drinking, while older individuals are more likely to have high consumption. In a challenging period for healthcare system sustainability, it is mandatory to use economic resources efficiently and target the right population with tailored interventions: given that HL impacts on high consumption, research and policy should focus HL interventions specifically on high alcohol consumers. Conversely, educational campaigns aimed at increasing HL in binge drinkers risk to have a lesser impact.

Key messages

• Health literacy does not influence binge drinking.

• Inadequate levels of health literacy predict high alcohol consumption.
Living with Dementia: exploring the challenges and needs of informal Dementia caregivers in Portugal
Authors: Lopes H , Hermenegildo C
Published: October 2024

Background

Dementia profoundly impacts not only those diagnosed but also their informal caregivers. The Nova Center for Global Health at NOVA-IMS, in collaboration with the Alzheimer Portugal Association, embarked on a comprehensive study to explore the various aspects of daily life that affect informal caregivers of people with dementia in Portugal. Understanding these impacts is important for developing targeted interventions that address the caregivers’ needs effectively, particularly given the current lack of research on informal dementia caregivers.

Methods

The study utilized a crafted survey developed through initial scripting on key topics identified by informal caregivers and validated by experts on dementia. This phase was followed by a series of in-depth interviews with professionals in neurology, psychology, and social work, as well as with the caregivers themselves. The final survey was distributed among members of the Alzheimer Portugal Association and other volunteers, resulting in 305 valid responses.

Results

Preliminary findings reveal significant emotional, physical, and financial challenges faced by caregivers, underlining the diverse needs across 14 key areas of their lives. The study highlights specific areas where support is lacking, providing a grounded basis for developing more effective support mechanisms.

Conclusions

The ‘Living with Dementia’ project underscores the complex reality faced by informal caregivers. It calls for innovative, practical solutions that can alleviate the burden on these caregivers and improve their quality of life. By addressing the specific needs identified through this research, policy-makers and support organizations can better tailor their interventions to help those at the front lines of caregiving in dementia.

Key messages

• Informal caregivers of people with dementia face challenges that necessitate a comprehensive understanding to tailor effective support systems.

• Interventions are needed that address the emotional, physical, and financial hardships caregivers face, improving their overall well-being and capacity to care.
Health and well-being during the pandemic: views and support needs of older adults who lived alone
Authors: Besselink D , Schaap F , Geleen SJG , van der Lucht F , Sealy M J , Jager-Wittenaar H , Finnema E J
Published: October 2024

Background

Physical and social distancing measures during the COVID-19 pandemic had the potential to jeopardize health and well-being of older adults. Especially older adults who lived alone faced challenges due to restrictive COVID-19 measures. In this study, we explored views and support needs to maintain health and well-being of older adults living in a single household during the COVID-19 pandemic.

Methods

We employed an interpretative phenomenological analysis, including twenty semi-structured interviews with older adults (≥65 years old) living in single households during the pandemic. Interviews were conducted between June and September 2021, audio-recorded and lasted approximately one hour. Data analysis was guided by the heuristic framework of Smith et al. Trustworthiness of the study was enhanced through bracketing and multiple interdisciplinary moments of revision of the data analysis.

Results

The views and support needs of participants to maintain health and well-being during the pandemic were captured in three overarching themes: ‘A lingering search for connectedness’, ‘Dealing with a discouraging situation to stay well’, and ‘Leaning on lessons learned during life’. Important resources that enabled participants to maintain health and well-being were: experiences of social connectedness, acceptance of the situation, and (re)gaining a sense of control. Participants described how they leaned on lessons learned from life-experiences when facing situations that challenged their health and well-being.

Conclusions

Our study points out that views and support needs of older adults to maintain health and well-being during the pandemic were diverse and rooted in various coping mechanisms. During future situations similar to the pandemic, public health policies should include strategies to promote social connectedness among older adults who live alone, to prevent adverse health outcomes.

Key messages

• Experiences of social connectedness, acceptance, and (re)gaining a sense of control were coping mechanisms that enabled older adults to maintain health and well-being during the COVID-19 pandemic.

• Public health policies should include strategies to promote social connectedness among older adults who live alone, to prevent adverse health outcomes during future pandemics.
Caffeine intake, chronotype, and student sleep quality at Polytechnic of Leiria
Authors: Dias S S , Leal M , Capitão I , Gomes J , Ferreira M
Published: October 2024

Introduction

Higher education students ingest very high doses of caffeine, on average twice the recommended safe dose. This excessive consumption can become problematic, ultimately affecting sleep quality and, consequently, academic performance. The aim of this work is to describe caffeine consumption, sleep quality and to characterize the chronotype and academic performance of students at Polytechnic of Leiria.

Methods

An online self-completion questionnaire was developed, consisting of several instruments: The Caffeine Consumption Questionnaire; Horne and Ostberg morningness-eveningness Questionnaire; Pittsburgh Sleep Quality Index (PSQI), to describe caffeine consumption, characterize chronotype and assess sleep quality, respectively. The mean, standard deviation, minimum and maximum values were calculated for the quantitative variables. Absolute and relative frequencies were calculated for the qualitative variables. Parametric tests were used to compare groups; when this was not possible, non-parametric tests were used. P < 0.05 was considered statistically significant.

Results

Of the 261 students (mean age: 23.26 ± 6.60 years), 64.2% had poor sleep quality and 45.3% reported an afternoon chronotype. It was found that men consumed more coffee and energy drinks than women, although women consumed more caffeine-containing food products. The average academic score was 14.56 ± 1.61. There was a statistically significant association (p < 0.01) between the afternoon chronotype and poor sleep quality and between the consumption of coffee and chocolate drinks and poor sleep quality.

Conclusions

Students at Polytechnic of Leiria tend to have poor sleep quality and an intermediate chronotype. Those with an afternoon chronotype or who drink coffee and chocolate drinks have poor sleep quality.

Key messages

• Accurately assessing the situation is essential for crafting suitable solutions.

• Higher students should adjust their coffee consumption to achieve better sleep quality.
Factors influencing emigration decisions among Bulgarian health professionals
Authors: Georgieva I
Published: October 2024

Background

Migration patterns of health professionals are influenced by a variety of factors, including personal, economic, social, political, and cultural ones. This study aims to investigate the factors that influence the emigration decisions of both Bulgarian health professionals who have been abroad and those without such experience.

Methods

A cross-sectional study was conducted in 2022 using an online questionnaire among 447 health workers in Bulgaria. The influence of factors on health professionals’ decision to migrate was measured on a 4-point scale (from “no influence” to “very strong influence”). The factors were grouped into three levels - macro (country and health system), meso (health facility) and micro (individual). Mann-Whitney U test was used to examine differences between the two groups of health professionals at a 0.05 significance level.

Results

At macro level, a higher standard of living in the destination country was the primary factor influencing the emigration decisions of the individuals who have been abroad (n = 109), with a mean value of 3.62 (p < 0.001). Conversely, the opportunity to work in a better-organized health system was the predominant motivator for those without such experience (3.36, p < 0.035). At meso level, remuneration received (3.70, p < 0.001) was the most significant driver for the individuals with a migration background, while better working conditions (3.31, p < 0.006) had the strongest influence for the other group. At micro level, both groups agreed on the importance of enhanced recognition of the medical profession abroad (3.69 vs. 3.49, p < 0.013) as a key determinant.

Conclusions

On the whole, health professionals with no migration experience exhibited lower mean values for the observed factors. Furthermore, economic drivers appeared to be more significant for respondents with a migration background, while the other group attached greater importance to the motives related to the health system and the profession.

Key messages

• Health workers migrate for a variety of reasons with economic motives playing a pivotal role in shaping migration decisions.

• Recognizing the motives that predominantly impact migration attitudes is a crucial step in the development of appropriate retention policies.
Working conditions in OOH-PC centres in Romania: an interview study with healthcare professionals
Authors: Ciotlăuș S , Ungureanu I M , Oprescu F
Published: October 2024

Considering the amplifying primary care workforce shortage, the existing knowledge gaps in out-of-hours primary care delivery (OOH-PC) in Romania, as well as the extreme county-to-county variation in the number of functioning OOH-PC centers across the country, from 0 to 32, we set out to document health workers’ perspectives on existing challenges in after hours primary care. Using a qualitative study design, we conducted semi-structured interviews with a purposive sample of 20 healthcare professionals (HCPs): family doctors and nurses providing clinical services in urban and rural OOH-PC centres, family doctors with coordinating and administrative roles, representatives of professional associations and health authorities, as well as emergency doctors and paediatricians. We examined interview transcripts employing thematic analysis. The data collected and analysed revealed several challenges in the provision of care, including physician shortages, increasing workload, low payments, and an organisational model that lacks coordination with other levels of care and services. The analysis of the interview data identified five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH centre premises (rest space, security), and insufficient financial compensation for after-hours health service provision. Working conditions in OOH-PC centers in Romania constitute a drawback to after hours primary care service provision. Health workers shortage and extreme variation in the number of functioning centres across the country suggest inconsistencies in the governance of OOH-PC. Improving working conditions to recruit and retain health professionals in OOH-PC, combined with targeted policies to optimise organisation and coordination of OOH-PC with other levels of care are as timely as ever to ensure equitable services to the population.

Key messages

• Current working conditions in OOH-PC Romania impact negatively the health workforce and lead to uneven access for the population.

• Improvements in working conditions, service integration, and organisation model are timely for the alleviation of OOH-PC provision.
Factors associated with perception of harassment in interns, trainees and residents of Veracruz
Authors: Villegas Dominguez J , Suárez Hernández N , Teczon Castellanos C O , Andrade Martínez M , Ruiz Garcia F , Duarte Cruz V , Viñas Dozal J C , Sosa Gonzalez Y R
Published: October 2024

Background

Harassment among resident physicians remains prevalent, with reports of abuse at 20% in Mexico, potentially creating a hostile learning environment that does not foster comprehensive learning for students.

Objectives

To determine the factors associated with harassment among interns, medical interns, and residents in Veracruz.

Methods

This is a prospective cross-sectional study, including interns, social service interns, and residents in the state of Veracruz, excluding those diagnosed with oppositional defiant disorder or mythomania. Workplace harassment was assessed using the Cisneros scale (Cronbach’s alpha 0.98), in addition to perceptions of workplace, psychological, and sexual harassment. Within the statistical analysis, the association was determined using chi-square test, odds ratio, and 95% confidence interval (OR/CI95%).

Results

A total of 81 participants were included, with a perception of workplace harassment in 42% and sexual harassment in 51.9%; the Cisneros scale shows 2.5% of subjects free from any harassment behavior. Female gender showed association with workplace harassment (0.7/0.01-0.2); meanwhile, attending a public university (OR: 0.22 / CI: 0.07-0.6) and being a pregraduate intern (OR:2.6/CI:1.03-6.6) were associated with perception of psychological harassment. Furthermore, being female (OR:9.28/CI:3.3-25.4), bisexual (OR:11.8/CI:1.4-97.8), a pregraduate intern (OR:3.44/CI:1.32-8.97), an R1 resident (OR:0.09/CI:0.01-0.79), and being affiliated with Veracruz (OR:2.6/CI:1.05-6.58) or Xalapa (OR:0.1-CI:0.05-0.7) were identified with association for experiencing sexual harassment (p < 0.05).

Conclusions

Gender and level of education are the main factors associated with harassment, while the type of university of origin plays an important role in psychological harassment, warranting further study of these interactions while considering the limitations of this research.

Key messages

• The results of this research show that the roles of violence within hospital medical education are still maintained despite the social evolution with respect to gender roles and equality.

• It is necessary to promote the culture of denunciation and offer courses to eliminate abuse and promote equality and respect among hospital staff.
The influence of education on antenatal care and nutrition of newborns in Croatia
Authors: Maric-Bajs M , Puljak A , Bajs D
Published: October 2024

Background

Previous studies indicate differences in the nutrition of newborns. Great efforts are invests in public health education of expectant mothers in order to improve the health of their offspring.

Methods

An analytical study of data on the influence of social factors and the level of education of mothers on the nutrition of newborns, habits of pregnant women and antenatal care in the City of Zagreb was conduct in 2022. The paper shows analytical results expressed in percentages of the prevalence and 95% confidence interval (CI).

Results

The survey covered 6,358 women giving birth in the City of Zagreb in 2022. Most mothers fed their newborns in the hospital with breast milk (48.6%) or a combination of breast milk and artificial nutrition (45.8%), and only 1.4% with artificial nutrition. The share of mothers who fed their newborns exclusively with breast milk is slightly higher among highly educated women (52.4%). The majority of women had their newborn’s first feeding within one hour (81.4%), also more often in highly educated women. The first breastfeeding is most often ten (10.1%) or 15 minutes after birth (8.2%). Only 1.1% of pregnant women smoked during pregnancy, of which the largest share was women with a high school diploma (62.1%). With the increase in education, the share of women with 5 or less antenatal checks decreases (completed college 3.3%, higher school 4.6%, secondary school 6.6%, primary school 12.7%). The largest share of pregnant women who had their first antenatal examination only after 10 weeks of pregnancy is among women with a high school diploma (11.3%).

Conclusions

The education of pregnant women influenced their adoption of positive lifestyle habits, the need for timely and regular antenatal care and the benefits of feeding newborns with breast milk. Additional education through public health campaigns aimed at pregnant women and future parents as well as breastfeeding support groups need to be continuously implement.

Key messages

• The education of pregnant women influenced their adoption of positive lifestyle habits, the need for timely and regular antenatal care and the benefits of feeding newborns with breast milk.

• Additional education through public health campaigns aimed at pregnant women and future parents as well as breastfeeding support groups need to be continuously implement.
It must not be dangerous to talk about it! Parents views of communication with schoolnurses on weight
Authors: Skantze C , Almqvist-Tangen G , Nyholm M , Karlsson S
Published: October 2024

Background

The study aimed to describe parents’ experiences of communication with school nurses concerning the growth data and weight development of their children aged 8 and 10 years old in Sweden.

Methods

The design was descriptive and qualitative. 15 women and 3 men in south Sweden were included, with children who had performed health visits in the School Health Service (SHS). Data were collected through in - person semi structured interviews. Qualitative content analysis was used.

Results

The results illustrated the health visit’s purpose as unclear with need for improved dialogue and lacking feedback from the SHS. “To be able to get guidelines of what is the normal growth and what is a normal deviation and maybe a bit more about diet and lifestyle and movement.” The need for an improved channel for receiving information from SHS, and access to their child’s growth data. “Couldn’t they have a school nurse site or information page, where you get information about your child from the day they enroll in school until they leave.” Parents experienced a lack of a child-centered perspective, described the child’s context as not in focus, and desired collaboration. “I think that it is very important that children feel good in their bodies, and that is a really important task for health care.”

Conclusions

(a) Initiating a discussion regarding the preventive health work of school nurses and the main assignment of SHS. (b) Development of a child-centered perspective towards parents and children with focus on the child’s entire social context. (c) Implementation of evidence-based methods for communicating growth data and weight development between SHS and parents.

Key messages

• An increased dialogue between parents and SHS was requested, with a reachable way of communication via a digital platform.

• A holistic view of the child, with positive professional attitudes seem essential to meet the needs of the child.
Health status, healthcare use and prevention in Travellers in Nouvelle Aquitaine, France, 2019-2022
Authors: Mondeilh A , Brabant G , Haidar S , Saboni L , Ruello M , Lesieur S , Castor C , Autes-Treand E , Le Strat Y , Vandentorren S
Published: October 2024

Background

The poor health status of underserved populations is compounded by low vaccination uptake, leading to a greater risk of epidemics. On October 2017, a measles outbreak started in the southwest of France among under-vaccinated social groups, including Travellers. We aimed to describe the health status, healthcare use and child measles-mumps-rubella (MMR) vaccination coverage in Travellers according to their environmental and living conditions.

Methods

A cross-sectional study with a three-stage random sample design was conducted between October 2019 and March 2022 in the Nouvelle-Aquitaine region in France. Trained social workers administered face-to-face questionnaires to collect data on adults and children. Anthropometric measurements, vaccination records, and data using an environmental exposure questionnaire were also collected.

Results

The participation rate was high (73.6%), with 1030 adults and 337 children included. Concerning the adults, 36.6% had obesity, 14.4% reported diabetes, 24.7% hypertension, and 14.4% major depression. The prevalence of major depression was significantly higher in adults living in precarious and unauthorized housing than in those with adequate housing (19.8 vs. 14.7%, p = 0.03). The unmet health care needs in the last 12 months was 48.4%. With regard to children, 45.3% had full (i.e., 2-dose) MMR vaccination coverage at 24 months and 17.9% had obesity. Finally, 74.5% of the households experienced housing insecurity, and 22.2% did not have a supply of drinking water.

Conclusions

Traveller children and adults faced deleterious environmental and living conditions potentially affecting their health, healthcare use, and vaccination coverage. These results demonstrate the need for urgent interventions for underserved populations which take into account their difficult living conditions.

Key messages

• Travellers have a greater burden of chronic diseases than the general French population and measles-mumps-rubella vaccination coverage among Traveller children is lower than in the general population.

• The more precarious the housing, the more likely Travellers are to report having a chronic disease (social exclusion gradient).
Preventing dementia is possible. The fraction of cases attributable to modifiable factors in Italy
Authors: Masocco M , Minardi V , Contoli B , Asta F , Gallo R , Possenti V , Lombardo F , Vanacore N
Published: October 2024

Background

Worldwide, approximately 50 million people live with dementia. The Lancet Commission, in its latest report in 2020, identifies 12 ‘modifiable’ risk factors associated with dementia, estimating that they account for about 40% of overall dementia cases. The study aimed to estimate the population attributable fraction (PAF) of dementia cases in Italy due to these factors.

Methods

Relative risks (RR) of each factor and formulas for estimating PAF are derived from the Lancet Commission’s report. Prevalence data were obtained from the Italian surveillance systems PASSI and PASSI d’Argento (PdA), which provide information on 11 of the 12 identified risk factors. The total sample 2017-19 included 86,494 individuals aged 18-64 and 48,516 individuals aged over 65. The Communality, used for ‘weighted’ estimates of PAFs, was calculated via principal components analysis of the inter-risk-factor tetrachoric correlation matrix, using data derived from the overall PASSI and PdA sample.

Results

In Italy, it is estimated that 39.5% of dementia cases are attributable to 11 of the 12 modifiable risk factors, equivalent to 445,150 out of 1,126,961 estimated cases as of January 1, 2023. Among the risk factors with the greatest impact are hypertension before the age of 65 (weighted PAF=6.3%); sedentariness after the age of 65 (weighted PAF=5.9%); low education in youth (weighted PAF = 5%); depression and social isolation after the age of 65 (weighted PAF=4.5% and 4.4%), as well as diabetes (weighted PAF=3.9%) and smoking (weighted PAF=2.4%).

Conclusions

Although it is necessary to to gather further evidence on the role and mechanisms of action of each factor, the importance of prevention and promotion of health and social well-being in the field of dementia is now evident.

Key messages

• Having an overall national sample of adults and elderly people is a unique tool that allows an estimation of dementia cases attributable to modifiable risk factors.

• Dementia prevention may also be possible by acting on modifiable risk factors.