bluuebunny/crossref_metadata_2025 huggingface dataset:
7.L. Practice session: Is there an investment case for health at older ages?
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Jonathan Cylus (WHO)
Published: October 2024

The global demographic landscape is undergoing significant transformation due to increases in longevity and declining birth rates. According to the United Nations, the world’s population aged 65 and over is projected to more than double, reaching over 1.5 billion by 2050, while global fertility rates are expected to decline to 2.4 births per woman by 2030 and continue decreasing to 2.2 births per woman by 2050. Ageing populations have frequently concerned decision-makers due to the potential implications of changes in population age-mix for labour markets and the economy, as well as for the sustainability of public programs and spending, particularly the health sector. For example, as the share of the population at older age increases, there are concerns over how to cope with the possible economic implications of having a smaller share of people at traditional working age (with potentially more people obtaining income security through both public and private pensions) and how to respond to greater health and long-term care needs. Without appropriate policy responses, there are worries that demographic changes will have inevitable consequences for households, public finances and possibly for economic growth and development. To support policy decisions related to population ageing it is important to have informative evidence and modelling tools that allow policymakers to better understand both the implications of population ageing as well as the consequences of policy action or inaction. To this end, this session presents three recently developed modelling tools that aim to address a number of policy relevant questions related to ageing:

1) How does ageing affect health financing and are health systems unsustainable?

2) How does ageing affect economic objectives and does health at older ages matter?

3) Can we develop economically relevant measures of health at older ages if older people do not have formal ties to the labour force?

Using data and analyses from a range of European countries, we will demonstrate empirically that the way ageing affects health financing systems, economies, and societies more broadly reflects policy choices and is not an inevitable consequence of demographic changes.

Key messages

• Policymakers must prioritize informed policies to comprehensively understand the impact of aging on health financing and economies, facilitating the development of sustainable solutions.

• Immediate action is imperative to address the implications of aging on labor markets and public spending, ensuring future economic stability and safeguarding societal well-being.
Health, an ageing labour force, and the economy: Does health moderate the relationship between population age-structure and economic growth?
Authors: Cylus J
Published: October 2024

Research often suggests that population ageing will be detrimental for the economy due to increased labour market exits and lost productivity, however the role of population health and disability at older ages is not well established. Identifying whether the health of older people affects economic outcomes is challenging due to methodological issues. Using country-level panel data, we estimate the relationship between the size of the older working age population (aged 55-69) and economic growth across 180 countries from 1990 to 2017. We run models using annual data and 5-year moving averages of real per capita GDP growth as dependent variables. This enables us to quantify the gains in real per capita GDP growth associated with a healthy older working-age population on a country-by-country basis. The initial models confirm an inverse-U or hump-shaped relationship between population age groups and economic growth. In the 5 year average GDP growth model, the coefficient for the inverse of YLDs among 55-69 year olds is positive and significant at p < 0.01. The interaction term is significant at p < 0.001 in the same model. Across all countries, a 5% improvement in YLDs is associated with at minimum 0.3% predicted additional annual real per capita GDP growth. While a larger share of the older working-age population at ages 55-69 has historically been associated with slower real per capita GDP growth, low levels of disability in this age group can reduce or even eliminate these adverse economic effects. We consistently find a significant positive interaction between disability and the share of the population at ages 55-69, suggesting that adverse economic effects are amenable to policy intervention.
Equity and diversity maturity matrix for structured diversity inclusion in the EU JACARDI project
Authors: Skogberg N , Spadea T , Armocida B , Zaletel J , Formenti B , Di Girolamo C , Onder G , Osborne R
Published: October 2024

Issue

There is increasing awareness on the importance of integration of cultural and ethnic diversity perspectives to reduce prevailing health inequities effectively and sustainably. There is, however, limited experience and practical tools for systematic integration of these perspectives in public health.

Description of the problem

The EU Joint Action for Cardiovascular Diseases and Diabetes (JACARDI) project, conducted 11/2023-10/2027 has developed a structured and systematic approach for integrating equity and diversity perspectives in all its 142 pilots across 21 European countries.

Results

Equity and diversity perspectives are embedded in the harmonized stepwise methodology for pilots, supported with a practical Equity and diversity maturity matrix. The maturity matrix is based on the JACARDI 4Cs Equity and diversity explanatory framework (Critical reflection; Context and data; Co-design; inclusive and accessible Communications). The content of the matrix is divided into concrete steps related to pilot’s planning and implementation, each with three levels of maturity that aim at gauging how equity and diversity perspectives are applied in practice: Approaching, Meeting, Exceeding. Pilots are encouraged to strive for any of these three levels, considering their available resources and previous experiences in diversity inclusion.

Lessons

Effective and sustainable change toward more equitable and diversity inclusive practice requires seamless integration of these perspectives in other routine activities. Training and continued practical and motivational support are key for adherence to novel approaches. In addition to being a practical tool, the Equity and diversity matrix acts as a structured self-evaluation tool to monitor how equity and diversity principles are translated into practice.
Key requirements for achieving EU-wide programme change
Authors: Osborne R
Published: October 2024

Issue

Across the world, thousands of projects aim for equitable improvement in health for people who are experiencing ongoing avoidable stigma, discrimination and disadvantage however very little change is often achieved.

Description of the problem

In this presentation we explore key requirements for project-level change to ensure EU-wide programme change is achieved.

Results

The two most common causes of project failure are a) the innovation is not suitable, needed or wanted (also called theory failure) or b) implementation failure. This presentation shares strategies to mitigate risks of project failure through co-design processes and communication, drawing from 30 years of experience from the entire implementation process from ideation to scale up. These experiences include projects from over 30 countries, including partnerships with the World Health Organization, governments and industry focused on health literacy, self-management, care pathways, workplace health, hospital services redesign, First Nations health and migrant health. Common success factors include balancing top-down needs with co-designed inputs and with previous preferred or good practice (which may have come from controlled trial evidence generated in different contexts). The intervention must co-implemented to serve stakeholder’s needs at all levels, from citizens to decision makers.

Lessons

The United Nations (UN) and private sector apply system-wide approaches to affect large scale change. This knowledge is valuable for large public health programmes aiming to integrate equity and diversity in project processes to minimize implementation failure.
The EU-funded action to strengthen health information systems
Authors: de Barros J
Published: October 2024

The European Commission initiative to build a European Health Union recognizes the need to address in a coordinated fashion the effects of the pandemic in health and social sectors and to strengthen the resilience, accessibility and effectiveness of health systems through co-operation, best practice exchange, training schemes, technical support and improved data and knowledge management. To make the most of the potential of health data, the European Health Data Space (EHDS) is being established as one of the central building blocks of a strong European Health Union. The EHDS sets out rules, common standards, infrastructures and a governance framework for the use of electronic health data for healthcare, research, innovation and policy making. In line with these policy goals, the European Commission is funding the Action ‘Supporting Member States in the WHO European Region in strengthening health information systems and boosting health data governance’. This Action will be implemented by WHO Regional Office for Europe and aims to boost the use and reuse of health data, including by promoting, where possible, the principles and solutions developed and implemented for the EHDS. It will also contribute to the objectives of the EU Global Health Strategy to improve global health security and deliver better health for all in a changing world. In addition, the Action is designed to strengthen countries’ capacity across critical programmatic areas of health data and digital health such as data quality (including appropriate data management and analytics) and digital health literacy across the 53 Member States in the WHO European region. The main objectives of the Action are to establish a Health Information Network for strategic guidance; and develop and implement tools and capacities to strengthen health information systems, health data governance, data quality and interoperability in countries.
8.C. Scientific session: Health system resilience: A Planetary Health perspective
Authors:   Organised by: EUPHA-ENV,   Chair persons: Andrea Schmidt (Austria), Angelique Mavrodaris (UK)
Published: October 2024

Planetary Health is a collective and unifying approach to balance the interlinkages between human health, political, economic and social systems as well as the natural systems of our planet, the importance of which is growing in the context of climate change in European countries and beyond. Yet, there is a dearth of of research linking Planetary Health to health systems’ resilience, particularly from a public health lens. With the number of studies growing regarding impacts of climate change on health, the question remains how health systems need to be prepared, focusing for example on the emergence of infectious diseases as well as the triple crises of biodiversity loss, pollution and climate change. In addition, tools to assess climate-related risks developed at international level, such as the vulnerability, adaptation and capacity assessment developed by the World Health Organization (WHO) have rarely been piloted in European countries. In this workshop, firstly evidence is presented on the status quo of how climate change impacts health and emerging infections in Europe and at global level. Secondly, the workshop provides insights into how tools to assess vulnerability and resilience of health systems in the context of climate change may be used in the European context. Thirdly, resilience is assessed against evidence emerging from the triple environmental crises of biodiversity loss, pollution and climate change.

Key messages

• In a planetary health lens, using mixed methods to consider climate change vulnerability of different population groups and adaptation potentials are key to address current complex health challenges.

• Synergistic solutions and joint working across climate and health offer opportunities for greater health system resilience and population health impact.
Climate change and emerging infections: Risks, adaptation and response
Authors: Mavrodaris A
Published: October 2024

Background

Weather and changing climate are key drivers of the emergence, re-emergence and spread of infectious diseases globally. However, approaches to emerging infections and climate strategies are still largely being developed separately missing the opportunities for integrated climate adaptation actions to address infectious diseases.

Description

To inform the development of the UK national emerging infectious diseases plan, a literature review of the current and projected risks from extreme weather events and climate change on emerging infections in the UK is currently underway. This will support further work examining and co-designing adaptation options in the context of preparedness and response to emerging infections.

Results

Key preliminary findings from the literature review have indicated risks predominantly from evolving patterns of vector borne diseases as climatic conditions and habitat suitability of pathogens change. Changing temperatures and hotter summer temperatures have been associated with changing food-borne infection patterns. Further risks driven by extreme weather, including flooding and droughts, could perpetuate changes in water-borne infection patterns. Adaptation actions focussed on these infectious disease groups are currently under review and will cover risk assessment, data and surveillance, preparedness and response.

Lessons

This work integrates climate action with action on emerging infectious diseases. By examining the evidence on climate sensitive infections and co-designing solutions across teams, awareness is being raised and relationships and infrastructures built to better prepare and respond to both fundamental global public health challenges.
Climate change and health vulnerability assessments to increase regional climate resilience
Authors: Durstmueller F , Horváth I , Brugger K , Schmidt A E
Published: October 2024

Background

The impacts of climate change on health and healthcare systems exhibit complex interrelationships, varying across time and space. Population groups already disadvantaged due to their demographics, health, socioeconomic status, or geographical location tend to be particularly vulnerable to climate-related health risks. Our work aims to develop a method for a systematic quantitative vulnerability assessment to make regional vulnerabilities comparatively measurable.

Methods

Building on the WHO framework on Climate Change and Health Vulnerability and Adaptation Assessment (2021) a data mapping process was carried out to identify and validate vulnerability factors and quantitative indicators on a small-scale spatial resolution for the five dimensions: demographic, socioeconomic, biological/health, sociopolitical, and geographic/climate. Regional vulnerability scores for each indicator were calculated and visualized as geographic maps and circular barplots to allow for easily understandable interpretation.

Results

A set of 25 quantitative vulnerability indicators from a multitude of data sources - combining register data, survey data, and geospatial data - was compiled. Main challenges were the identification of sociopolitical vulnerability factors suitable for Austria and data availability on a small-scale level. The indicator set was used to identify regions that are particularly vulnerable due to their population composition, disease burden, and geographical location (e.g. regions in Eastern Austria with high shares of persons < 65 years of age, unemployment, and heat days).

Conclusions

Systematically assessing vulnerabilities in key dimensions is central to identifying regionally specific pressure points, allowing for a quantitative baseline to derive adequate and tailored climate change adaptation measures to sustain future health. Systematic assessment provides essential insights for policymakers, public health officials, and disaster management agencies.
Whole of prison approach to vaccination: co-development of information materials for people living in prison
Authors: Plugge E , Laryea-Adekimi F , Harper J , Gleave M , Harriott P
Published: October 2024

Enhancing vaccination literacy is pivotal in addressing hesitancy, especially among incarcerated populations who may lack regular access to health information, thus ensuring health equity. Supported by the European Union, the RISE-Vac project endeavours to bolster vaccine literacy, accessibility, and uptake within European prisons. To discern vaccination knowledge gaps and preferences for information dissemination, consultations were conducted with incarcerated individuals in the United Kingdom (via the Prisoner Policy Network), France, and Moldova. A total of 344 responses were garnered: 224 from the UK, 70 from France, and 50 from Moldova. In addition a focus group was conducted in the UK. The key themes that emerged were common across the 3 participating countries: views of vaccination, prior knowledge about vaccines, areas of appetite for learning, availability of reliable information, and preferred mechanism for information sharing. Participants were particularly interested in learning about the effectiveness, side effects, and manufacturing of vaccines. Their invaluable input informed the creation of educational materials, notably a brochure slated for pilot testing in European prisons and a video clip. Notably, individuals with lived prison experience were actively engaged at every phase of this initiative, ensuring its relevance and efficacy.
Introducing vaccination services in prison settings: case study from Moldova
Authors: Barbiros I , Busmachiu V , Doltu S , Jignea Suveica L
Published: October 2024

Introducing vaccination services within prison settings presents a multifaceted challenge and opportunity, particularly evident in the case of Moldova. This Eastern European nation grapples with various socio-economic and healthcare disparities, with its prison population often experiencing heightened health vulnerabilities. Amidst such complexities, the implementation of vaccination services emerges as a crucial strategy not only to safeguard the health of incarcerated individuals but also to contribute to broader public health goals. Moldova’s journey in this regard reflects a commitment to advancing preventive healthcare within its correctional facilities. The introduction of vaccination services in prisons necessitated a comprehensive approach, encompassing policy development, infrastructure enhancement, staff training, and community engagement. Infrastructure enhancement was imperative to ensure the provision of vaccination services in a safe, efficient, and dignified manner within prison settings. This involved the establishment of designated vaccination areas equipped with the necessary medical supplies and equipment. Staff training emerged as a cornerstone of the initiative, empowering healthcare professionals working within prisons with the knowledge, skills, and confidence to deliver vaccination services effectively. Training programs encompassed various aspects, including vaccine administration, adverse event management, and communication strategies tailored to the specific needs of incarcerated individuals. Collaboration with people living in prison facilitated the dissemination of accurate information, addressed concerns, and encouraged participation in vaccination programs. During the period 2021-2023 7454 doses of antiCOVID-19, 1298 doses of anti-Flu vaccine, 3083 doses of anti-HBV vaccines were administered.
Advancing Public Health Equity through Expanded Vaccination Services in prison: case studies from Italy and France
Authors: Cocco N , Ranieri R , Polidoro M , Murauer E , Meauset A , Meroueh F
Published: October 2024

In Montpellier prison in France and San Vittore remand house in Italy, the provision of expanded, age-appropriate, coercion-free, and tailored vaccination services to PLP has emerged as a cornerstone in improving health outcomes within prison settings. The implementation of life course vaccination programs required the full integration of prison health into public health systems building on existing vaccination services covering HBV, flu and COVID-19. In San Vittore, a vaccination clinic aimed at people living in prison was set-up. Universal vaccination status assessment and vaccination catch-up was introduced targeting people admitted into prison. The vaccination clinic-related activities included information and awareness sessions on vaccination and health literacy offered regularly to PLP: increased vaccination knowledge is effective to enhance uptake. The vaccination clinic team consisted of infectious diseases physicians and a health assistant with an anthropological background, who ran the information and awareness sessions combining and adapting core content on vaccination with individual and community social and cultural contexts. Besides seasonal flu vaccination and anti-SARS-CoV-2 immunisation campaigns, vaccinations against pneumococcal pneumonia and herpes zoster were also offered to older and fragile individuals as per national immunization plan. One of the priority objectives of the vaccination clinic was the increase in vaccination coverage against HBV and HPV, not only as a tool for the prevention of infectious diseases, but as an innovative and effective tool of cancer prevention. As part of a more ambitious program to protect sexual health in prison and related to updated screening tools for the early diagnosis of lesions due to HPV infection, vaccination against HPV was also offered as part of a health empowerment project tailored to women in detention, with the aim of building self-awareness of their own health needs.
8.E. Skills building seminar: Methods for measuring the true health cost of pollution
Authors:   Organised by: BEST-COST, EUPHA-PHMR, -ECO,   Chair persons: Brecht Devleesschauwer (Belgium), Hanna Tolonen (EUPHA-PHMR)
Published: October 2024

Healthy environments are essential for physical and mental wellbeing. Air pollution is considered to be one of the most significant environmental risk factors for ill health and premature death within the European Union. Poor air and noise quality have been linked to the exacerbation of symptoms, hospital admissions, and even premature deaths, especially for those with cardiorespiratory diseases. The associated medical costs and productivity losses therefore also impose a large economic cost. Exposure to environmental stressors disproportionately affects socially disadvantaged groups, and therefore contributes to the large socioeconomic inequities in health observed persistently in Europe. The EU has prioritised action on causes of pollution. For example, its Green Deal outlines ambitious plans to address climate challenges such as pollution and align air quality ambitions closer to the World Health Organization guidelines. Likewise, the European Environmental Agency routinely monitors the mortality burden associated with air pollution, while the impact of environmental noise on European citizens is examined through the Environmental Noise Directive. While in the political scene there is interest to advance the reduction of pollution, efforts are hindered by the lack of an harmonized methodology to quantify the socioeconomic cost of environmental stressors. Currently, researchers working with the burden of disease framework face many challenges in its application in the context of environmental stressors. Among others, these challenges include unmet data needs and major lack of transparency in methodological developments. In this skills-building seminar, we will outline an integrated approach for measuring the true health cost of pollution. This approach is currently being trialled in the EU-funded BEST-COST project, which sets out to improve methodologies for understanding the socioeconomic cost of environmental stressors, focusing on air and noise pollution. The project brings together a consortium of 17 partners from Europe and the USA, and is led by Sciensano, the Belgian institute for health. Through a synergy of theoretical outlines and real-life examples, seminar participants will gain methodological insights in the three key components of this integrated approach - i.e., the quantification of the health burden of environmental stressors via comparative risk assessment, the monetization of Disability-Adjusted Life Years to assess economic impact, and the quantification of environmental health inequalities via a novel area-level based framework.

Key messages

• There are significant unmet needs with respect to both data and methodologies for quantifying the socioeconomic cost of environmental stressors.

• We outline an integrated approach for measuring the true health cost of pollution, combining health burden, economic burden, and environmental health inequalities.
The German National Cohort (NAKO): Current state and further follow-up data collection
Authors: Greiser K , Hilger-Kolb J , Bohn B , Palm L , Panreck L , Breunig E , Lieb W , Pischon T , Schikowski T , Völzke H
Published: October 2024

The German National Cohort (NAKO) is a multidisciplinary, population-based cohort study that aims to investigate the development and aetiology of diseases, identify risk factors and enhance early detection and prevention of diseases. Between 2014 and 2019, a total of 205,415 subjects aged 20 -74 years were recruited and examined at 18 study centres across Germany. The baseline assessment included a face-to-face interview, self-administered questionnaires, a wide range of biomedical examinations and the collection of various bio samples. Furthermore, whole-body magnetic resonance imaging (MRI) was performed on 30,861 participants at 5 of the18 study centres. The first re-examination of study participants started in October 2018, and will be completed end of July 2024 aiming for at least 135, 000 participants. Until April 2024 134,428 participants completed their second examination, including 18,707 participants with additional MRI examination. The second re-examination will start in May 2024 and will last until April 2028 aiming to examine at least 85,000 participants for a third time. Besides the examinations at the study centres, participants receive written health questionnaires (GEFUs) 2-3 years after their last examination to get additional information on incident diseases and changes in exposures. The first GEFU questionnaire (GEFU-1) was conducted between October 2017 and May 2023 and was filled in by 171,181 participants. Since the start of GEFU-2 in March 2023 65,624 participants have answered the GEFU-2 questionnaire. Due to the longitudinal design, the large sample size and the broad examination programme, NAKO provides information on determinants of population health and disease. Thus, it is a valuable resource for researchers from different disciplines.
8.H. Scientific session: Coordinated actions to improve our response to Long COVID at EU and national levels
Authors:   Organised by: DG SANTE European Commission, NIVEL (Netherlands), EUPHA-HSR,   Chair persons: Stefan Schreck (Luxembourg), Johan Hansen (EUPHA-HSR)
Published: October 2024

The COVID-19 pandemic still has very real and far-reaching consequences for European citizens, healthcare systems and economies. It has been estimated that approximately 10%-20% of people that were infected by SARS-CoV-2, develop Long COVID. Countries within the European Union and elsewhere have been responding to Long COVID in various ways. Some countries initiated a more extensive response to Long COVID, including the creation of multidisciplinary Long COVID clinics. In other counties, Long COVID should be addressed within existing infrastructures within the health care system, which can be hampered by the siloed approach of how services for people with chronic conditions is organised. Moreover, a coordinated and uniform response to Long COVID is complicated by the fact that there is a large variety of terms and definitions of Long COVID and the fact that long COVID symptom are often similar to symptoms of other diseases, thus hampering specific characterisation of patients. While substantial progress has been made in understanding Long COVID we still need more answers about its causes and the most effective treatments. It is also important to understand the impact that Long COVID has on individual lives of those who are being affected - and their families - as well as on societies as a whole. The session aims to take stock of a number of recent insights relating to Long COVID, also with the purpose to identify opportunities for a more coordinated and harmonized approach towards Long COVID at national and international levels. The session will provide room for discussions and engagement with the audience, allowing to help inform future policy agendas. As such, better ways to understand and address Long COVID can also be beneficial for health systems as a whole, given the parallels with how services are provided and policies are set up to address other chronic (non-communicable) diseases.

Key messages

• Long COVID is still poorly understood, in part relating to the complexity of the condition, also having considerable impacts on individuals and societies.

• A more harmonised response can help improve the manners to address it, this to support those still suffering from this long term impact of the COVID-19 pandemic.
Smoke-Free Policies and Cigarette Consumption Impact on Myocardial Infarction Mortality in Europe
Authors: Pastorino R , Sassano M , Mariani M , Boccia S
Published: October 2024

Background

Limited evidence exists on the association between smoke-free policies and per-capita cigarette consumption and mortality due to acute myocardial infarction (AMI) in Europe. Therefore, our study aimed to assess this association and evaluate influencing factors.

Methods

We conducted an interrupted time series analysis involving 27 European Union member states and the UK, examining per-capita cigarette consumption and AMI mortality. A multivariate meta-regression assessed potential influencing factors.

Results

Approximately half of introduced smoke-free policies were associated with level or slope changes, or both, in per-capita cigarette consumption and AMI mortality (17 of 35). Notably, the smoking ban in Poland in 2010 resulted in the most substantial level reduction in cigarette consumption (rate ratio (RR): 0.47; 95% CI: 0.41, 0.53), while the intervention in Bulgaria in 2012 led to the largest level reduction in AMI mortality (RR: 0.38; 95% CI: 0.34, 0.42). More recent policies or those from countries with lower human development indices were linked to greater decreases in cigarette consumption. Furthermore, smoking bans encompassing bars exhibited a stronger inverse association with both cigarette consumption and AMI mortality.

Conclusions

Our findings indicate the effectiveness of smoke-free policies in reducing per-capita cigarette consumption and AMI mortality. Continued monitoring and data collection on tobacco, prevalence, and consumption are crucial for concerted efforts to address its health impacts.

Key messages

• Smoke-free policies lower cigarette consumption, reducing heart attack deaths in Europe.

• Monitoring tobacco data crucial for health efforts: Study shows smoke-free policies save lives.
Sociodemographic, work- and health-factors predict rejection of vocational rehabilitation in Finland
Authors: Louhimo R , Hautamäki H , Airila A
Published: October 2024

Background

Vocational rehabilitation (VR) decreases the number of premature retirements. Pension insurance companies operate private sector employees’ VR in Finland. In 2022, some 15,500 individuals received rehabilitation in this earnings-related pension system. However, the rejection rate was 46%. Similar systems exist throughout OECD. VR facilitates finding suitable work despite an illness. A person is eligible if a threat of disability exists within the next few years and non-medical requirements are met. Currently VR is underused. Thus, it is important to understand which sociodemographic, work- and health-related factors predict a VR rejection.

Methods

We had full application data from a Finnish insurer for 2015-20. Our data cover roughly 40% of the 2.7M person Finnish working population. We excluded applicants with preceding VR and only included under 58-year-old applicants rejected due to ‘no risk for disability’. Our data comprised age, region of residence, salary, doctor’s assessment grades, diagnosis, industry, and data on preceding sickness, unemployment and rehabilitation benefits. For analysis, we used logistic regression.

Results

After adjustment, younger age and mental disorders showed largest effects on rejection. Features associated with a less severe medical condition as well as decreased employment were significantly connected to rejection. Industry and place of residence showed no effect. Of note, stable employment and higher pay predict entry possibly due to more possible rehabilitation options and better health in general. Interestingly, people with multiple diagnoses are more likely to be rejected.

Conclusions

The work-ability of aging European populations could benefit from vocational rehabilitation that better suits mental disorders and younger people.

Key messages

• Vocational rehabilitation (VR) is an underused method to maintain work ability.

• Our study identified groups that could benefit from tailored solutions in VR that decrease barriers to entry.
Innovative approaches to measuring and promoting employee vitality and sustainable employability
Authors: Houkes I , Hazelzet E , De Rijk A , Bosma H , Koep N
Published: October 2024

Background

Employers find it difficult to develop interventions for vitality and sustainable employability (SE), particularly for employees in low-skilled jobs. Measures based on the employee perspective on SE that would give direction to interventions fall short, and effective programs to improve vitality and SE in this group are lacking. This study aims (1) to get insight into the effect and implementation of an innovative organizational, dialogue-based approach ‘Healthy HR’ (HHR)* to promote job control and SE, and (2) to refine and further validate the Maastricht Instrument for SE (MAISE)-Easy (an HHR tool for needs assessment).

Methods

(1) An effect evaluation with a pretest-posttest design with a 1 year follow up (N = 71), and a mixed-methods process evaluation were conducted. Data were collected using questionnaires, interviews with employees and employers (N = 26), focus groups (N = 4) and logbooks. (2) A questionnaire containing the MAISE-Easy-items, proxy variables (health and vitality) and demographics was answered by 1223 employees from 7 organizations. Construct validity, reliability and criterion validity were tested through PCA, CFA, Cronbach’s alpha and correlations.

Results

(1) A higher dose of HHR resulted in better job control and SE (n.s.). HHR had a positive impact on the awareness level of vitality and healthy workplaces of all stakeholders. (2) Reliability, construct and criterion validity of the MAISE-Easy were good, and MAISE-Easy 2.0 was constructed. This tool consists of 8 scales and 20 items divided over 4 areas: (1) Level of SE; (2) Factors affecting my SE; (3) Overall responsibility for SE; and (4) Responsibility for factors affecting my SE.

Conclusions

MAISE-Easy 2.0 is a valuable, valid and reliable tool in HHR which serves as a needs assessment for SE interventions. The innovative participatory approach HHR can improve job control and SE of employees in low-skilled jobs by giving them an active voice.

*doi.org/10.1186/s12889-021-11278-7

Key messages

• Healthy HR (HHR) is an effective, organisational dialogue-based approach (online toolkit) to promote job control, vitality and sustainable employability (SE) of employees in low-skilled jobs.

• MAISE-Easy-2.0 (Maastricht Instrument for SE) is a new and thoroughly validated HHR tool for needs assessment, which measures SE and the responsibility for SE from the employee perspective.
Substance use and risk behaviour patterns among people who inject drugs
Authors: Jakubauskiene M , Pridotkiene E , Rasimaite B
Published: October 2024

Background

Substance use and injecting drug use in particular are related to health damages, reduced quality of life and life expectancy. Injecting drug use is a risk factor for acquiring infectious diseases among people who inject drugs (PWID). The aim of the study was to assess the risk behavior related to the use of intravenous psychoactive substances among PWID in Lithuania.

Methods

In 2023 a cross sectional study using respondent driven sampling (RDS) of active intravenous drug users (n = 370) was conducted in 5 different sites across Lithuania. RDS is a sampling methodology based on peer-referral in underserved populations that cannot be sampled randomly. Descriptive statistical and regression analyses were conducted using SPSS 23.0.

Results

78% of the sample were males, 22% - females. Age mean is 40.6 years, SD-7.7. The first injecting drug was used at the age of 18 (mode). 69% of PWID received drug dependance treatment at least once in life. 70% of the PWID in harm reduction services are also in the substitution therapy programmes. Fentanyl is the main substance for every second respondent which is injected 3 times a day and commonly used with alcohol (64%). 79% of PWID during the last injection used sterile needles and syringes. 45% of respondents reported overdosing during the last 12 months and half of all PWID had naloxone for death prevention. Nearly 70% were tested for TB and syphilis during the last 12 months.

Conclusions

PWID are mainly males who began injecting drugs at 18 years. Unsafe injecting behaviour (frequency and mode), using alcohol were related to lower participation in health care services for PWID.

Main messages

• Lower participation in health care services is related to behavioural risk factors.

• Ongoing research is needed to assess the factors determining engagement into healthcare of PWID.
Transferability of vaccination interventions from a community perspective: One size does not fit all
Authors: Schloemer T , Hecht H , Papaevgeniou N , Karnaki P , de Zeuw J , Ganczak M , Filakovska Bobakova D , Horstman K
Published: October 2024

Background

Removing health system barriers to childhood vaccination is an urgent matter in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. The objective of this study was to select and adapt potentially transferable evidence-based interventions for HPV and MMR vaccine uptake in partnership with the underserved communities.

Methods

Using a participatory approach, we assessed transferability of six pre-selected interventions with the Population, Intervention, Environment and Transfer (PIET-T) models: All countries investigated two interventions with trained community members to support vaccination as health promoters. Greece and the Netherlands included a school-based vaccination program. The Netherlands added two interventions addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention.

Results

We identified barriers and facilitators for successful intervention transfer in each of the target contexts. The transferability analysis showed that an intervention with health promoters is potentially transferable with adaptations in all countries. Principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost are transferable key elements in all contexts. Adaptations refer to the intervention elements that need to be tailored to specific contextual needs. School-based vaccination was nowhere transferable. Health provider training needs to be culturally sensitive and adapted to the Dutch system. The multilevel intervention in Slovakia is not fully transferable.

Conclusions

Participatory transferability analysis was essential for decision-making and intervention adaptation. All countries independently selected a health promoter intervention as having potential to remove the identified health system barriers in the respective context.
Skills and competences of sexuality educators. Evidences from a qualitative research in Italy
Authors: Ubbiali M , Mortari L , Paparatto G
Published: October 2024

Background

The scientific literature recognizes the strategic role of educators in sexuality education projects in schools. If, however, there is often a discussion about the most effective professional figure (teachers, school experts or external experts), there is a little attention to the skills and competences that an educator should possess and to which he or she must be trained. Adopting a Comprehensive Sexuality Education (CSE) approach, which is evaluated as the most effective, it is necessary to consider a skill set for educators that should not be limited to the knowledge in the area of sexual health promotion and risk prevention.

Methods

In order to build evidence-based competencies and skills, a qualitative study was conducted. A total of 72 educators involved in school-based CSE interventions in 4 Italian Regions, in 24 middle and secondary schools (68 classes), during 2 consecutive school years were enrolled. Before, during, and after the activities in the classrooms, qualitative feedback was collected, through reflective journals written by educators themselves. These data were analyzed through a qualitative approach, according to the principles of empirical phenomenology.

Results

The phenomenological evidences confirm the need to overcome the conception of educator as instructor equipped only with knowledge in the field of sexual health. It is considered fundamental to possess and develop pedagogical competences and skills, such as: caring attitude, teaching skills, theoretical awareness, capacity to manage the unexpected. Moreover, educators reported the necessity of an initial and continuous training on these dimensions considered as the most challenging.

Conclusions

The research confirms the complexity of the competency profile of CSE educators. Therefore, their professional development should include tailored designed multi-disciplinary training programs, with particular attention to the pedagogical dimension.

Key messages

• Comprehensive sexuality education requires an adequate professional figure intended not as an instructor aimed only at risk prevention and health promotion, but as a real caring educator.

• Pedagogical skills and competences should be included in the training processes for sex educator, through adequate activities.
Individual fluidity of sexual identity in Stockholm County, 2010 to 2021
Authors: Zhang G , Tynelius P , Mathur M B , Brandén G , Liljeros F , Kosidou K
Published: October 2024

Background

Sexual fluidity is key to understanding the size of sexual minority populations and analyzing the socioeconomic disparities these populations face. This study explores the stability and changes in sexual identity over time, and identifies key demographic factors that predict shifts in sexual identity.

Methods

We analyzed longitudinal data from the Stockholm Public Health Cohort, following 36,398 participants from 2010 to 2021. Sexual identity was measured using a self-administered questionnaire in 2010, 2014, and 2021. Demographic data from 2010 were collected from the Swedish national registers. Multivariate Poisson regression with robust variance estimators was used to identify demographic factors that predicted identity changes. Results were presented as proportion or risk ratio (RR) with 95% confidence interval (CI).

Results

Overall, 12.1% (95% CI 11.8%-12.5%) changed sexual identity at least once in 2010-2021, including 10.4% (10.0%-10.7%) among those initially identifying as heterosexual in 2010, 41.3% (37.1%-45.6%) as homosexual, 59.6% (55.0%-64.0%) as bisexual, and 65.0% (59.4%-70.3%) as uncertain. Multivariate analyses showed that sexual minorities (homosexual: RR 5.00, 95% CI 4.45-5.61; bisexual: 6.68, 6.04-7.38; uncertain: 3.88, 3.30-4.55), females (1.28, 1.21-1.35), younger (18-29 years: 1.49, 1.30-1.70) and older ( > =60 years: 2.07, 1.92-2.22) ages, born outside Sweden (Europe: 1.21, 1.11-1.32; Outside Europe: 2.90, 2.62-3.21), and lower education ( < =9 years: 2.14, 1.98-2.31; 10-12 years: 1.43, 1.34-1.53) and income (100 SEK/year) ( < =2,500: 1.83, 1.66-2.02; (2,500, 3,500]: 1.32, 1.19-1.46) independently predicted a higher probability of identity changes.

Conclusions

This study provides the first insights into sexual identity fluidity in a large general population sample in Sweden, highlighting its fluid nature. Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity.

Key messages

• This study provides the first insights into sexual identity fluidity in Sweden, highlighting its fluid nature.

• Future research is needed to unravel the intricate mechanisms underlying the demographic disparities in sexual identity fluidity.
Defining child maltreatment for research and surveillance: a Delphi study in 34 countries
Authors: Hurt L , Cowley L E , Lamela D , Drabarek K , Rodrigues L B , Laajasalo T , Naughton A , Ntinapogias A , Nurmatov U
Published: October 2024

Background

Child maltreatment is a complex public health issue that has consequences across the life-course. Studies to measure child maltreatment and identify interventions and services are constrained by a lack of uniform definitions across sectors and countries. We conducted a Delphi study to reach consensus on types and characteristics of child maltreatment for use in surveillance and research in Europe.

Methods

Statements were developed following a scoping review and identification of key concepts by an international expert team (n = 19). A multidisciplinary expert panel (n = 70) from 34 countries participated in three rounds of online data collection. We defined consensus as ≥ 70% agreement or disagreement with each statement after the final round.

Results

Consensus was reached on 26/31 statements, with a participant retention rate of 94%. The definition states that child maltreatment is a subtype of violence against children. The perpetrator can be an adult or minor, but must be in a position of power over the child. To define an act or omission as child maltreatment, it must cause harm or have the potential to cause harm, regardless of intention, severity, chronicity, or the traditional/cultural beliefs of the perpetrator. In addition, the broad umbrella term encompassing emotional, behavioural or cognitive maltreatment should be “psychological”, and psychological maltreatment should be split into sub-types of psychological abuse and psychological neglect. “Neglect” is a broad type of child maltreatment within which there are subtypes that can all be characterised as “failure to provide” or “failure to supervise”.

Conclusions

This is the first study to demonstrate consensus on the types and key characteristics of child maltreatment across multiple sectors and countries, providing a unified definition of child maltreatment to improve consistency of measurement and surveillance in Europe. This abstract is submitted on behalf of Working Group 1 COST Action 19106.

Key messages

• A standardised definition is essential for monitoring child maltreatment.

• We propose a consensus-based definition that can be used to improve child maltreatment measurement in research and surveillance.