bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors linked to future care conversations with others in Ireland: Age and gender differences
Authors: Pilch M , Wards M , Doyle F , Thomas S , Kenny R A , May P , Hayes C
Published: October 2023

Background

Ireland needs evidence-based strategies for meaningful engagement in ACP activities. This study aimed to identify factors associated with conversations with trusted others among older adults in Ireland.

Methods

Data from the Irish Longitudinal Study on Ageing (TILDA), a nationally representative study of community-dwellers (≥50 years old), was used. Participants who consistently reported ACP conversations with trusted others at Waves 4 and 6 (n = 2764) were included. Binary logistic regression was carried out using these conversations as a dependent variable (categorised as engagement/non-engagement). The results of a mixed-research synthesis informed selection of explanatory variables; including age, gender, education, health literacy, pain, making a will, religiosity, wish to die, and marital status. Data were stratified by gender and aged groups.

Results

Although men (n = 1242) were 58% less likely to engage in conversations with trusted others, there was a 4% increase in odds of their engagement per year older. Younger participants (≤64) who made a will were 99% more likely to report ACP conversations. Those who were ≤74 years old and reported pain were 42% more likely to engage. Men and younger participants (50-64) who ever experienced a wish to die were over twice as likely to report ACP. Similarly, men and those >74 years old with a third level education were twice as likely to engage. For every additional score on the health literacy scale, women were 56% more likely to report ACP. Younger participants (50-64) for whom religion was somewhat important were 36% less likely to engage. While single women were 49% less likely to engage, separated, divorced, or widowed women were 43% more likely to report ACP.

Conclusions

This study identified theoretically important factors associated with ACP conversations with loved ones in Ireland and highlighted gender and age groups differentials. These findings will inform policy and ACP intervention development.

Key messages

• Increasing age, female gender, third level education, health literacy, having a will, pain, and a wish to die facilitate ACP conversations. Religiosity and being single impede these conversations.

• The findings should inform the design of local ACP interventions. They suggest the need to tailor future ACP strategies to the requirements of specific gender and age groups.
Leisure activities and mental well-being among adolescents across Norwegian municipalities
Authors: Myhr A , Haugan T
Published: October 2023

Background

Engagement in organized leisure activities (OLAs) may benefit health and well-being in adolescents. The social inequalities in OLA participation, and growing share of non-participants, is a public health concern in Norway. Thus, the present study aims to examine the association between OLA participation and mental health outcomes, and the interaction effect of overall share of adolescents participating in OLAs at municipal level.

Methods

This study, based on the nationwide Ungdata survey, includes 342,161 adolescents attending lower and upper secondary education in 276 municipalities in Norway between 2019 and 2022. A series of two-level random intercept models were fitted to distinguish the individual and municipality sources of variation in adolescents’ mental well-being measured by depression symptom scores and quality of life.

Results

Adolescents’ participation in OLAs varied considerably between Norwegian municipalities from lowest 33 % to highest 88 %. Being female, increase in age and decrease in family affluence level was negatively associated with both OLA participation and mental wellbeing. Overall, and particularly among girls and the least affluence adolescents, participation in OLAs was associated with higher quality of life and lower depressive symptoms. Among girls, the positive association between OLA participation (at individual level) and mental well-being was most evident in municipalities with high share of adolescents participating in OLAs. The overall share of OLA participants in municipality of residence had no or little impact on boys’ mental wellbeing.

Conclusions

Both the personal leisure involvement and the overall share of individuals participating in OLAs at local community level may impact adolescents mental well-being. Ensuring that all adolescents, regardless of family affluence level and gender, are able to participate in OLAs may promote adolescent's mental well-being that benefits the local public health.

Key messages

• Participation in leisure activities was associated with higher mental well-being in boys and girls, and across the socioeconomic spectrum.

• In girls, highest mental wellbeing was observed among individuals living in municipalities with high share of leisure activity participating, and particularly for those who participates themselves.
Quarantweens - the impact of COVID-19 restrictions on preteen health and wellbeing in Ireland
Authors: McGuire F , Reynolds C , Codd M
Published: October 2023

Background

The COVID-19 pandemic has been dubbed the “biggest public health crisis since the Second World War”. In Ireland, schools were closed for 141 days, dramatically altering the day to day lives of children in Ireland. This research aimed to evaluate the overall wellbeing of schoolchildren in Ireland and capture the prevalence and factors contributing to poor mental health.

Methods

A cross-sectional study was performed based on data from the Growing Up in Ireland COVID-19 web survey of the ’08 Infant cohort. Mental Health Inventory-5 scores were used to assess children at risk of mental health disorders. Logistic regression examined associations between various demographic and psychosocial factors and risk of mental health disorders.

Results

This study included 2,867 primary caregiver- child dyads. Almost 25% of 12/13-year-olds were at risk of mental health disorders (MHDs). An adjusted logistic regression model found associations between being at higher risk of MHDs and factors such as reduced physical activity levels (OR 1.35, 95% CI 1.10-1.66), spending less time outdoors (OR 1.48, 95% CI 1.18-1.85), increased screen-time (OR 1.35, 95% CI 1.09-1.67) and increased arguments with PCGs (OR 3.44, 95% CI 2.78-4.27). Having a trusted adult confidante reduced the risk of MHD (OR 0.25, 95% CI 0.14-0.45).

Conclusions

The prevalence of 12/13-year olds at elevated risk of MHD was high, indicating an urgent need for enhancement of child and adolescent mental health services in Ireland. Physical activity, time outdoors and supportive relationships with primary caregivers were positively associated with reduced MHD risk.

Key messages

• Children were impacted by the COVID-19 restriction measures in a way that was disproportionate to their risk.

• To reduce the risk of poor mental health outcomes for a generation of “quarantweens” we need to place children front-andcentre of our response as we recover from COVID-19.
Childhood BMI trajectories predict cardiometabolic risk and stress at age 13 years. The STARS cohort
Authors: Chen Y , Dangardt F , Friberg P
Published: October 2023

Background

Research on BMI trajectory focuses mainly on childhood and adolescence, missing birth and infancy, which are also relevant in the development of cardiometabolic disease. We aimed to identify trajectories of BMI from birth throughout childhood, and to examine whether BMI trajectories predict health at age13 years; and, if so, whether differences exist among trajectories regarding timeframes during which early life BMI influences health.

Methods

Participants from Western Sweden (n = 1902, 44% males, 13.5±0.4 years) completed questionnaires assessing perceived stress and psychosomatic symptoms and examined for waist circumference (WC), systolic blood pressure (SBP), pulse wave velocity, and white blood cell counts (WBC). They had at least 5 retrospective measures of weight and height covering birth, infancy, childhood to early adolescence. We used group-based trajectory modeling to identify BMI trajectories and linear regression to assess associations, which are presented as estimated mean differences with 95% CI between trajectories.

Results

We identified three BMI trajectories: normal, moderate, and excessive gain. Differences distinguishing these trajectories were established before 2 years of age. After adjusting for sex, age, migrant background, and parental income, adolescents with excessive gain had higher WC (19.2 [18.4-20.0} cm), SBP (3.6 [2.4-4.4] mmHg), WBC (0.7 [0.4-0.9] x109/L) and stress (1.1 [0.2-1.9]) than adolescents with normal gain. Increased levels of WC (6.4 [5.8-6.9] cm), SBP (1.8 [1.0-2.5] mmHg) and stress (0.7 [0.1-1.2]) were found in adolescents with moderate gain. The observed significant positive correlation of early life BMI with SBP started approximately at age 6 years for participants with excessive gain, much earlier than for participants with normal and moderate gain, for which it started at age 12 years.

Conclusions

Excessive gain BMI trajectory from birth predicts cardiometabolic risk and stress in adolescents before age 13 years.

Key messages

• Differences distinguishing childhood BMI trajectories were established before age 2 years.

• In excessive gain group, influence of early life BMI on SBP started already around age 6 years.
Health and safety of labor migrants in food industries during Covid-19: Germany, Netherlands and USA
Authors: Gottlieb N , de Lange T , Mantu S , Jungwirth I , Glassner M , Forst L
Published: October 2023

During the Covid-19 pandemic, migrant workers in the food supply chain (FSC) were deemed an essential workforce. At the same time, they were particularly exposed to risks as shown by Covid-19 outbreaks, for example in meat-processing plants. The pandemic has thus highlighted preexisting inequities related to precarious migrant labor in the FSC. We use the Covid-19 pandemic as a showcase to comparatively examine occupational safety and health (OSH) protection gaps for migrant workers in agriculture and meat-processing in Illinois/USA, the Netherlands, and North-Rhine Westphalia/Germany. We conducted harmonized policy analyses of OSH policies for migrant workers generally, and of pandemic measures specifically. The policy analysis was complemented by expert consultations. The Covid-19 syndemic has prompted OSH measures in horticulture and meat-processing. However, our analysis demonstrates the reliance of FSC industries on various precariously employed worker groups. Intersecting health-, work- and migration-related factors led to poor adaptation of policies for some of these groups, including instances where protective measures excluded them or exacerbated their marginalization. Our analysis shows how influence peddling prevents better protection of workers in some contexts. But it also identifies positive policy changes; for instance the prohibition of subcontracting in meat-processing in Germany. Across different contexts, agriculture remains problematic, with major evidence gaps on migrant workers’ conditions. Comprehensive improvements in the social and health protection of migrant workers in FSC industries will require tackling the structural causes of migrant workers’ exploitability, including low visibility, racial capitalism and cronyism; intersectoral action on OSH; stronger enforcement; and firewalling data exchange between OSH and immigration agencies.
9.A. Round table: From science to reality: the potential of food environments as a gamechanger
Authors:   Organised by: EPHA,   Chair persons: Amandine Garde (EUPHA-LAW), Milka Sokolovic (Belgium)
Published: October 2023

Food environments have the potential to shift our food system towards a health-oriented system that puts the health of people and planet at its core. Today, however, food systems and dietary patterns are unsustainable, as unhealthy diets have become the leading cause of non-communicable diseases (NCDs) and premature deaths in the European Union (EU). The over-reliance of the EU on individual consumer responsibility, expecting them to make healthy and sustainable food choices in an environment where unhealthy food is ubiquitous and heavily promoted, particularly to children, has proven largely ineffective to shift diets at population level. Consumers are constantly influenced by the context in which they purchase food and which shapes their choices towards calory-dense and high in fat, sugar and salt foods (HFSS). Understood as the “physical, economic, political and socio-cultural context in which consumers engage with the food system to make their decisions about acquiring, preparing and consuming food” (HLPE, 2017), food environments should be reconfigured so that healthy and sustainable choices become easier and more likely. This will not only promote better health for all, but also contribute to the transition towards a greener economy, offering opportunities within the food system. This workshop aims to explore the potential of food environments as a gamechanger for promoting better health for all and thereby assess the potential of the EU's Farm to Fork Strategy (2020) and Europe's Beating Cancer Plan (2021) as they relate to the prevention of obesity and other-diet related diseases. The first presentation will consider the implications of the commercial determinants of health in the degradation of food environments, highlighting that the European Union and its Member States can no longer delegate the responsibility to promote health for all to private sector actors. The second presentation will reflect on the scientific research on food environments and consumer behaviour. The third presentation will provide a compendium of public policies that, together, could contribute to the promotion of healthier food environments. The fourth presentation will consider specifically the regulation of food marketing to children to protect them from its established harmful impact. It will conclude with a roundtable discussion

Key messages

• Food environments should be shaped in a way that the sustainable and healthy food choice is the most affordable, accessible, and attractive, especially for children and vulnerable groups.

• Food environments have the potential to prevent NCDs and create sustainable and healthy diets. Governments should assume their regulatory duties and offer protection from vested interests and CDoH.

Speakers/Panelists

Stefanie Vandevijvere

Sciensano, Brussels, Belgium

Alba Gil

European Public Health Alliance, Brussels, Belgium

Emma Calvert

BEUC, Brussels, Belgium
Malaria asymptomatic carriage in the Sahelian region: the challenge associated to young adults
Authors: Legendre E , Ndiaye A , Sougou N M , L’Ollivier C , Mehadji M , Gaudart J , Ba E H , Ridde V , Sagara I , Landier J
Published: October 2023

Background

Mali and Senegal have made important efforts to control malaria. After a period of decline, the number of cases has remained stable for several years. Asymptomatic carriage acting as a reservoir could explain malaria persistence despite malaria control. Mass drug administration (MDA) is a candidate intervention that could help to accelerate the decreasing of malaria transmission if favourable epidemiologic context and good adherence are met. We aimed to update asymptomatic reservoir description along a Sahelian ecological gradient and study MDA acceptability.

Methods

We conducted an open cohort in 8 villages in Mali and Senegal including all household members sampled aged >6 months. We measured P. falciparum infections prevalence by qPCR in 4 surveys: 2 in dry season 2021, 1 in rainy season 2021 and 1 in dry season 2022. We measured prospective acceptability of MDA in cohort aged ≥15 years in Senegal by questionnaire. We explored risk factors associated to asymptomatic infections and acceptability score with multilevel logistic and linear models.

Results

We included 168 households and 1428 participants in at least 1 survey. In preliminary results, prevalence of P. falciparum infections was 11% in dry season 2021 in Senegal, 20% in central Mali and 60% in Northern Mali. Young adults between 15 to 24 years old were more likely to carry asymptomatic infections in dry season compared to children <5 years old (OR = 5.74 [2.99;11.04]). MDA presented a good acceptability with a mean score of 3.5 (score between -7 and 7). Young adults had lower acceptability compared to older participants (β=−1.07 [-1.82,-0.32]).

Conclusions

Young adults were important asymptomatic carriers in Senegal and Mali but were less likely to accept to participate in MDA.

Key messages

• Young adults represent a public health challenge that need to be address to reach malaria elimination.

• Specific sensibilization could be implement to improve adherence to malaria control interventions.
Community and local partner: ‘Must-to-Have’ elements for achieving immunization target in Somalia
Authors: Shah M , Hussein M , Ali A
Published: October 2023

We have been working on a community-based project aiming to improve access to quality Immunization by strengthening the capacity of health structures and communities with identified immunization gaps in the Galgaduud and Jubaland states in Somalia. The project is delivered in partnership with Ministry of Health, UNICEF (strategic partner), Acasus (for data management using digital platform), and two local implementing organization WASDA and WRRS as local implementing agencies. Owing to the varying levels of insecurity in the regions targeted, to deliver to ensure optimal immunization services to communities without delay, we operationalized a rapid and intensive scale-up of immunization services in 27 health facilities and sites following a phased approach. The project also supported the set-up and strengthening of community-driven immunization systems as well as district-level immunization management systems to promote ownership of the immunization programs within the target locations. To achieve this the project is anchored on four pillars namely capacity strengthening (at community, facility, and district/regional level), immunization logistics and supply chain strengthening, use of data for decision making and scaling-up innovative approaches. The project efforts achieved most of its targets throughout the implementation period, more so in the second and third year. Between April 2021 and February 2022, supportive supervision was increased from 54% to 100% of facilities and the average number of monthly fixed and outreach immunization sessions increased by 54% and 31%, respectively. We found the number of Penta3 doses delivered was more than double while we compared data for 2021 and 2022. These encouraging results suggest critical importance of local community engagement in planning and monitoring plus having local community-based organizations for implementing the project in similar remote rural areas with high security risks in Somalia.

Key messages

• Without having intensive community engagement efforts, immunization project implementation in high security risk areas in Somalia is almost impossible.

• Local community-based organizations as implementing partner is the other critical mass for success in achieving immunization target in similar high security risk areas like Somalia.
Preventable premature mortality in Northern Dimension partnership countries 2003-2021
Authors: Jousilahti P , Harald K , Vienonen M
Published: October 2023

Background

Potential Years Life Lost (PYLL) is an established method to measure, follow trends and compare disease burden within and between countries. Northern Dimension Partnership in Health and Social wellbeing (NDPHS) network was established in 2003 and includes the following countries in same geographic area but considerable differences in social and economic development: Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Poland, Russia, and Sweden. Due to the Russian invasion to Ukraine, Russia is now excluded from the collaboration.

Aims

To study total and cause-specific premature mortality and mortality trends in NDPHS countries from 2003 to 2021.

Methods

Premature mortality is defined as a death before the age of 70 years. PYLL-rates per 100,000 population are presented in six cause of deaths categories: total mortality, external causes, vascular diseases, cancers, alcohol-related deaths and suicides. Data are obtained from Eurostat and analyses are standardized to EU standard population.

Results

PYLL-rates declined from 2003 to 2017 in all countries and in most causes of death sub-groups. In 2017 PYLL rates, in men and women respectively, were lowest in Norway, 3001 and 1921, and highest in Russia, 14267 and 5363. Most premature losses were due to malignant neoplasms (1122), followed by vascular diseases (947) and external causes (902). Difference between countries was largest in vascular diseases (316 vs. 2845), external causes (478 vs. 2845) and alcohol related causes (62 vs. 842). The new data until 2021 are available in May and updated results will be presented in the EPH Conference.

Conclusions

The number of years lost due to premature preventable mortality have declined markedly in all NDPHS countries in last decades. However, in 2017 there were remarkable differences in PYLL-rates between countries. The updated analysis will show whether the positive trend continues and whether differences between countries are diminishing.

Key messages

• The number of years lost due to premature preventable mortality have declined markedly in all NDPHS countries in last decades.

• In 2017 there were remarkable differences in PYLL-rates between NDPHS countries.
Applying behavioural insights to tackle obesity
Authors: Nagyova I
Published: October 2023

Issue/Problem

Obesity has grown into a global epidemic and represents a major challenge for public health, with rates of related comorbidities, healthcare, and societal costs continuing to rise. Current approaches to obesity prevention and management have had limited success, highlighting the need for new innovative strategies.

Description

The narrative surrounding obesity often assumes that a lack of individual's knowledge and willpower is at the root of the problem. However, behavioural insights suggest that the problem is more complex and that people's behaviour is often irrational and influenced by many factors, such as environment, habits, emotions, or social norms. These insights can be used to design interventions that nudge people towards healthier behaviours.

Results

Behavioural interventions have been shown to be effective in promoting healthier behaviours and reducing obesity rates in various settings. For example, digital weight loss programmes that incorporated behavioural strategies, such as goal-setting and self-monitoring, or GPS and physical activity trackers and video or exer-games can be used with success as vehicles for delivering such behavioural-informed interventions. Also, nudge interventions that include subtle changes either in our environment or in incentive-provision have proven to be effective.

Lessons

The use of behavioural insights in obesity prevention and management has the potential to improve the effectiveness and efficiency of public health policies. However, to ensure the success of these interventions, policymakers need to consider the context and target population, as well as the ethical implications of nudging people towards certain behaviours. More research is also needed to determine the long-term effects and cost-effectiveness of these interventions. Overall, incorporating behavioural insights into public health policy can lead to more effective and sustainable solutions to the obesity epidemic.
Developing healthy and sustainable school food systems: A collaborative practice in the city of Madrid
Authors: Franco M , Vidal I , Diez J , Fajó M , Gutiérrez S , García S , López E , Vázquez B , Esteban A , Hernández P
Published: October 2023

Problem

Eating habits and lifestyle during childhood and adolescence are key to achieving an adequate health status in adulthood. Malnutrition, in the forms of overweight and obesity, disproportionately occurs among vulnerable communities. The question is: How can cities develop strategies and policies to stablish and maintain healthy and sustainable school food systems? In Madrid, the Healthy and Sustainable Food Strategy started in 2018-22 with a revised phase 2022-25 for the promotion of healthy and sustainable policies. Within the public nursery system, local NGOs, food and nutrition researchers, the education department and city officials collaborated to develop healthy and sustainable menus and public food procurement. This collaborative practice can be useful to other European cities.

Objective

To describe the example of Madrid developing collaborative policies (e.g. public food procurement standards) and activities between city administration, civil society and academia (e.g. creation of school based Food Driving Groups) towards healthy and sustainable school food systems.

Results

We will share two specific sets of results: 1) Creation of school-based Food Driving Groups. 2) Establishment of public food procurement criteria. More results will be presented at the conference.

Lessons

Regarding school food procurement criteria, it is necessary to improve the knowledge of the different socio-environmental variables of food. The development of school-based Food Driving Groups as a fruitful and sustained collaboration is only possible with the education department leadership.
Public health monitoring of behavioural risk factors in USA: An exploratory study
Authors: Kaur J , Sahu K , Oetomo A , Chauhan V , Morita P
Published: October 2023

Background

The COVID-19 pandemic's restrictions had a significant impact on behavioural markers such as physical, sedentary and sleep activity. The Behavioral Risk Factor Surveillance System is a key data source for public health surveillance in the USA but is limited by subjectivity and data quality, and new-generation data sources like Fitbits face challenges with battery life and data access. This research study aims to use zero-effort technology and IoT-based big data to evaluate the impact of the COVID-19 pandemic on population-level behavioural changes in USA.

Methods

The study used a proposed methodology to analyze data from 470 households in New Mexico, USA, using the DYD dataset from Donate your Data initiative by ecobee (a smart thermostat company). The Microsoft Azure data lake is used for the storage of raw data and the Azure databricks is used for data pre-processing, processing, and analysis. The Gaussian mixture model is used to identify sleep parameters by segmenting the sleep cycle records into different clusters. The quantity of sleep is measured by a motion sensor based on the absence of movement, and an increase in sensor activation indicates longer duration of household occupancy.

Results

The findings show significant changes at the household and population level for the selected behavioural health indicators (sleep-time, wake-up time, time spent indoors, time spent outdoors) during COVID-19 pandemic, which could be attributed to the policy changes implemented to curb the spread of COVID-19. The study findings are shown by 1) heatmap visualizations at the household level showing trends for the selected indicators during the Covid-19 pandemic; and 2) statistical analysis indicating a significant difference in selected behavioural health indicators before and during the pandemic.

Conclusions

These innovative data analytics have the potential to provide real-time insights and alert system activation to monitor, promote, and improve public health.

Key messages

• Sleep health analysis using IoT data is a novel method of measuring public health indicators objectively using zero effort technology.

• The available evidence from this study can further offer surveillance systems with near-real-time behavioral markers; alert system activation; and measure short- and long-term impact policy changes.
Interactive dashboard development for Irish general practices to visualise and compare patient data
Authors: Garzon-Orjuela N , Vornhagen H , Stasiewicz K , Garcia Pereira A , Vellinga A
Published: October 2023

Background

Health information technology has increased worldwide, transforming health and healthcare programs in which information visualisation and visual analytics processes are central. However, aggregating and comparing patient data remains challenging. Therefore, a dashboard was developed with and for Irish general practitioners (GPs) to improve their understanding of their patient population, disease management and prescribing. This paper describes the design and development process of the CARA dashboard.

Methods

The design and development of the CARA dashboard used an Action Design Research approach, which consists of (1) problem formulation, (2) building, intervention and evaluation, (3) reflection and learning and (4) formalisation of learning. The process included interviews, to explore what type of information GPs need, as well as iterative testing of the CARA dashboard prototype.

Results

Key challenges identified from the interviews (Context, Sense-making, Audits, Relevancy, Action, Engagement and Ease of Use) formed the basis for the development of the CARA dashboard prototype. The first exemplar dashboard focused on antibiotic prescribing to develop and showcase the proposed platform, including automated audit reports, filters (within practice) and between-practice comparisons as well as a visual overview of practice demographics.

Conclusions

User involvement in the design and development of the CARA dashboard is crucial to ensure GPs are enabled and supported to visually access and monitor their patients’ data. Next steps will include an exploratory study on dashboard engagement and the development of additional dashboards for topics such as chronic disease and mental health.

Key messages

• Good knowledge of operating systems, effective use of data, user interaction and context factors are required to design and implement an interactive dashboard.

• Crucial components to make sense of the information provided in dashboards include the context, transparency about the data transformation processes and adherence to design principles.
How do health authorities inform about general practitioner selection? Analysis of Italian Websites
Authors: Vinci A , Pirrotta L , Vainieri M
Published: October 2023

Background

The Next Generation EU and Italian Recovery and Resilience Plan share the common goal of supporting digital transformation. In health, adequate digitalization and web communication strategies are essential to achieve adequate population health outcomes. This work describes the level of digitalization and information of a fundamental primary care service: the choice or change of the General Practitioner (GP).

Methods

The analysis was conducted by consulting websites of Italian Local Health Authorities (LHAs). First, we explored digitalization levels of 105 websites through the Primary Care Digital Information (PCDI) composite index. It comprises four dimensions: informativeness, accessibility, inclusiveness, and adaptability, scoring from 0-5 (low-high digitalization). Second, we conducted a readability analysis of websites. Text quality was measured using the Gulpease and READ-IT indexes and New Basic Italian Vocabulary (NBIV) was used for lexical complexity.

Results

We found a national average of 2,48 for the PCDI (Min 0 - Max 4,38). Nationally, the best performing dimension was adaptability, while the worst was inclusiveness. Half of the LHAs provided several digital alternatives to choose or change the GP, while the remaining provided limited or no options. Most LHAs (70%) displayed directly on their home page a reference on how citizens can choose or change GP. However, 70% lacked specific information for non-residents citizens. Regarding readability, the national average was 48,78 for READ-IT (Min 32 - Max 62), on a scale from 0-100 (good-bad readability).

Conclusions

Overall, our findings depict variable and fragmented digitalization and information levels of a key health service. Despite best practices, several areas require monitoring and intervention. Moreover, some barriers characterize Italian health communication strategies, notably the variability of information across and within regions and on average low website readability.

Key messages

• There are significant digitalization discrepancies in Italy with respect to the primary care service observed. The PCDI scores highlight a fragmented scenario and opportunities for improvement.

• The aspects related to the readability of information remain to be monitored. This study highlights the need to invest more in fostering efficient service comprehension and clarity.
Quantifying the health impacts of alternative urban development scenarios using the HAUS tool
Authors: Hunt A , Eaton E
Published: October 2023

Local authorities face a capacity challenge to balance policy considerations when master-planning an area for redevelopment. Effects of redevelopment on residents’ health comprise one competing priority alongside financial viability, sustainability and employment provision. The challenge is not a lack of data, but a lack of accessible tools to help LAs synthesise and interpret complex information about health effects. We address this by creating a health-economic valuation model which allows the user to understand health trade-offs entailed in alternative scenarios and relative to other costs and benefits. The model applies evidence to quantify and monetise the potential impact on health outcomes related to characteristics of the urban environment. The model is driven by a set of 200+ environment-health impact pathways supported by systematic reviews of evidence relating to building design, natural environment, community infrastructure and transport. We estimate the societal value of changes to health using a database of economic values for 70+ physical and mental health outcomes. Values include costs of treatment, productivity loss and pain & suffering associated with ill health, and are disaggregated according to who bears the costs, e.g. NHS, police. Values are modelled for a synthetic population which can be tailored to local contexts, allowing for aggregation. We apply the model to a regeneration site in Bristol, UK, identifying health outcomes resulting from alternative land use scenarios for the site. Model outputs were used to inform the process of developing a Spatial Regeneration Framework and preferred land use scenarios within the regeneration site. Our research helped to widen out the number of health impacts considered by the design team, and to build a strong case for healthy policy options such as enhanced green space within the strategic framework, ensuring that health data can be built into negotiations with developers in the implementation phase.

Key messages

• Economic valuation of health impacts of urban environment leads to better public health decision-making.

• The HAUS model allows better-informed trade-offs between health and urban investment to be made.
9.H. Workshop: Applying the Supersetting-approach to tackle health inequities in disadvantaged settings
Authors:   Organised by: Health Promotion Research, Steno Diabetes Center Copenhagen (Denmark),   Chair persons: Maria Stougaard (Denmark)
Published: October 2023

Inequity in health remains a major urgent global public health challenge, not least concerning noncommunicable diseases (NCDs) including type 2 diabetes (T2D). Peoples’ abilities to live long healthy lives is linked to their social and economic situation and living in disadvantaged neighbourhoods is associated with increased health risk across the life course and increased risk of T2D in adulthood. The risk of ill health is thus deeply rooted in the complex social contexts of people's everyday lives. Thus, addressing the social determinants of health by incorporating a variety of strategies and interventions in the settings where people live is imperative to tackle health inequities. Evidence suggests that multilevel-multicomponent interventions can have a positive impact on a range of health and behavioural outcomes. Moreover, studies show that bottom-up approaches in community interventions constitute important drivers of collaborative action and sustainable solutions to inequity in health at a community level. This workshop presents the Supersetting approach - an intervention strategy for comprehensive community interventions - as one solution to tackle growing health inequities in disadvantaged urban settings focusing on T2D. The approach strives to attain synergistic effects through coordinated engagement of multiple stakeholders in multiple settings to mobilize local resources and strengthen social networks for collective community action. The Supersetting approach has recently gained international recognition as a “a whole-of-society endeavor” approach to health promotion by welcoming complexity at all levels of the intervention. The workshop uses Tingbjerg Changing Diabetes (TCD) a long-term community-based initiative, as a case to unfold the complexity and width of the Supersetting approach (www.tingbjergchangingdiabetes.dk). Beginning with an introduction and conceptualization of the Supersetting approach and characterization of the urban area of Tingbjerg focusing on T2D, we hereafter present three integrated TCD initiatives. These illustrate how the Supersetting approach can be applied in practice as well as how to explore and measure its different impacts through different methodological approaches. The workshop aims to present and discuss the potentials and challenges of using a Supersetting approach to tackle inequalities in health in disadvantaged urban settings.

Key messages

• The rising challenge of inequity in health calls for complex systems approaches.

• The Supersetting approach is presented as a sustainable complex systems approach to tackle growing health inequities in disadvantaged neighborhoods.
Intersectoral health governance during floods: a qualitative case-study into the Dutch 2021 flood
Authors: van Vuuren K , Borst RAJ , de Graaff B , Bal R A
Published: October 2023

Background

With the planetary crisis comes an increasing risk of flooding events. As shown during the 2021 floodings in Limburg, these can have disastrous consequences for the public health system and healthcare organisations. Historically flooding events are often treated as either affecting public health or acute care, but the 2021 events showed the necessity of an intersectoral governance approach. In this study, we investigated how governance actors from different domains collaborate and perform shared sensemaking processes to ensure patient safety continuity of (public health) care.

Methods

For the past months, we conducted a qualitative case-study in the Dutch region of Limburg where we interviewed governance actors from public health, acute healthcare, water management, and safety and crisis management. We also observed and analysed crisis exercises and hospital crisis management meetings, including relevant paper trails. All data were abductively coded and thematically analysed.

Results

Our analysis shows that during and after the flooding event, actors were confronted with numerous vulnerabilities about decisions to evacuate hospitals, care homes, or even villages. These include decisions about what are public health risks, and what are not. To curb such uncertainties, intersectoral sensemaking proofed essential with a central role for the public health crisis system. In our presentation we highlight how such sensemaking was done in practice.

Conclusions

To deal with the effects of the planetary crisis on healthcare, events such as floodings must be approached intersectorally. The public health system plays a central role in perceiving the vulnerabilities in a crisis from all angles.

Key messages

• Floodings are more likely to affect the public health and healthcare system.

• Highly complex crises, such as floodings, require an intersectoral governance response with the public health system in a central role.
Self-care behaviour among arterial hypertension patients: role of a general practitioner in Latvia
Authors: Kursite M , Springe L , Villerusa A
Published: October 2023

Background

Engagement in self-care behaviours is a crucial part of arterial hypertension (AH) management. Yet, now patients practice self-care selectively and with low adherence. This study aimed to determine the association between patients’ experience with a general practitioner (GP) and positive self-care behaviours among people with arterial hypertension in Latvia.

Methods

A cross-sectional study of 950 participants aged 15-74 (median 62, 38.7% male) with AH from a population survey in Latvia in 2022 was conducted. Logistic regression was used to determine respondents’ experience with a GP (overall attitude, providing information and counselling on a lifestyle change) in relation to having positive self-care behaviour (use of medication, weight loss, physical activity (PA), salt intake, smoking cessation) adjusting for age, sex and education.

Results

Most of the participants reported being satisfied with their GP (94.1%) and the information provided about their disease (84.8-89.4%). Regular use of AH medications was reported by 83.6%, and lifestyle change attempts by 5.2-16.1%. Regular medication use increased by receiving information about complications of AH (aOR=4.43, p ≤ 0.001), and being satisfied with the provided information about the treatment plan (aOR=1.91, p = 0.011), and alternative treatment methods (aOR=2.21, p ≤ 0.001). Receiving advice to change eating habits increased adhering to a diet for weight loss (aOR=4.16, p ≤ 0.001), reducing salt intake (aOR=4.64, p ≤ 0.001), and increasing PA (aOR=4.33, p ≤ 0.001). Similarly, advice to increase PA or reduce weight was statistically significantly associated with other self-care behaviours. None of the factors had a statistically significant impact on smoking cessation.

Conclusions

Patients’ experiences with a GP are important factors in determining engagement in positive self-care behaviour regarding medication use, PA, and changes in eating habits. The GP's role in smoking cessation requires to be strengthened.

Key messages

• Arterial hypertension patients are more engaged in self-care when supported by a general practitioner. Yet patients are more focused on medication use than lifestyle change.

• Strengthening the communication skills of general practitioners is crucial for improving the disease-related health literacy of arterial hypertension patients and their ability to practice self-care.
General population knowledge, attitudes, and behaviors (KAB) on hepatitis c screening, Latium, Italy
Authors: Bongiovanni A , Santolini G , Abbondanzieri A , Mantia F E , Ambrosone C , Flammini A M , Marfurt C , De Angelis F , Perra A
Published: October 2023

Background

In 2022, a free-of-charge screening to eliminate the HCV virus circulation was offered countrywide to the citizens born from 1969 to 1989. Recent studies reported low adherence rates to HCV screening campaigns, highlighting the need for policy makers to know the determinants of adherence, aimed to set up more effective communication campaigns.

Methods

A target population random sample answered by phone a questionnaire based on the Health Belief Model (HBF), containing 4 sections on perceived HCV susceptibility and severity, screening benefits and barriers. Each interviewed was finally invited to adhere to the screening. Prevalence was estimated using a 95% C.I., and association between sociodemographic characteristics, HBF attitudes, and screening adherence following the interview were assessed.

Results

Survey involved 641 participants. HCV susceptibility was perceived by 4.8% (C.I.95% 3,23-6,57) and HCV severity by 69,4% (I.C.95% 65,83-72,97), 95% (C.I.95% 93,3-96,6) acknowledged screening benefits and 88% (85,4-90,5) perceived no obstacles. It was found that 49.0% (C.I.95% 45,1-52,8) received no information. Perception of screening barriers was associated with low education level (OR 1.83, P = 0.02). In the 2 months following the interview, 17.6% (C.I.95% 14,6-20,5) carried out the HCV screening. Severity (OR 1.74, P = 0.03) and no barriers perception (OR 2.63, P = 0.01) were associated factors to post phone call adherence to UCV screening.

Conclusions

Insufficient communication campaign toward target population results in poor knowledge of HCV susceptibility and gravity and low adherence to HCV screening. Target population needs to acquire better awareness about HCV and HCV screening, through targeted and effective messages especially focusing on the susceptibility and gravity of HCV infection.

Key messages

• Target population does not feel susceptible to hepatitis c and has poor perception of severity.

• It is necessary to improve communication through effective messages.
Enhancing help-seeking efficacy in a sustainable and adaptive digital environment
Authors: Wright M , Hochgatterer L , Reitegger F , Gasteiger-Klicpera B , Patias I , Peras I , Veldin M , Vidmar M
Published: October 2023

Background

Help-seeking efficacy is directly related to Mental Health Literacy (MHL) as one of its four important components and has been successfully addressed in digital mental health interventions for youth. However, these interventions are often not sustainable and not sufficiently diversity-sensitive. The 3-year Erasmus+ project me_HeLi-D (mental health literacy and diversity) aims to develop a digital, adaptable, diversity-sensitive tool to promote mental health and MHL among youth (12-15 years).

Methods

The tool-development is based on two pillars: thorough literature reviews and the voices of young people. Through a participatory research process, the design and content of the modules are co-created with the target group. The tool is implemented in Moodle to ensure high accessibility and flexibility and to allow updates and monitoring by the IT-department, which guarantees sustainability beyond the project duration. A total of 27 mental health interventions were systematically reviewed for the module addressing help-seeking efficacy, and three of them reported effective improvement in help-seeking behavior. Among these, an app using character vignettes resulted in greater increases in well-being and help-seeking intentions in the intervention group.

Results

Based on these findings and feedback from the participatory activities, an activity promoting help-seeking behavior was developed for the tool using a narrative format. The help-seeking activity, its content, and its goals are presented. In addition, the digital implementation is discussed, addressing issues of adaptability and sustainability in relation to the deployment plan in Moodle.

Conclusions

The importance of a participatory, evidence-based approach and consideration of diversity-sensitivity and digital sustainability in the development of a digital mental health tool was emphasized.