bluuebunny/crossref_metadata_2025 huggingface dataset:
Where you live matters: how degree of urbanization influences healthcare utilization in Portugal
Authors: Martinho J , Leite A
Published: October 2023

Background

The degree of urbanization is a health determinant, causing inequalities in exposure to risk factors, influencing health services’ territorial organization and enabling healthcare utilization. Since Portugal's proportion of population residing in urban areas is higher than the world average, we aimed to estimate the magnitude of the association between the place of residence's degree of urbanization and healthcare utilization in the country.

Methods

A cross-sectional study was conducted, using data from the Portuguese 2019 National Health Survey, a multi-stage clustered stratified sample. All participants, aged over 15, were included. Outcomes assessed included: going to general practitioner (n = 14 360) and specialist consultations (n = 14 334), taking a flu vaccine (n = 5 270), undergoing a colonoscopy (n = 9 075), too-long waiting times (n = 12 009) and waiting for healthcare due to distance/transportation (n = 12 117). Crude and adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated using Poisson regression models.

Results

Compared to urban areas, living in less populated areas was significantly associated with waiting for healthcare due to distance/transportation (aPR=1.54, CI95% 1.06-2.24) and lower colonoscopy utilization (aPR=0.86, CI95% 0.78-0.95). Flu vaccination prevalence ratios were significantly higher for rural (aPR=1.15, CI95% 1.03-1.29) and suburban areas (aPR=1.16, CI95% 1.04-1.30) than urban areas. There was no significant association between degree of urbanization and attending general or specialist consultations nor too-long waiting times.

Conclusions

Healthcare needs are not being met in less populated areas likely due to geographic constraints. Against expectation, flu vaccination might not be optimized in urban areas, which could bring concerns for immunization rates in risk groups. Policies to improve universality and equity in population's access to healthcare are needed.

Key messages

• Differences in healthcare utilization related to place of residence's degree of urbanization show that universal health coverage is yet to be reached.

• Less populated areas are more likely to wait too long to receive healthcare due to distance and mobility hindrances, representing a challenge for health systems which policies should help mitigate.
Psychosocial determinants of adherence to COVID-19 preventive behaviors
Authors: Gali K , Hermanns B , Sabat I , Neumann-Böhme S , Schreyögg J
Published: October 2023

Background

Non-adherence to medical guidelines is associated with suboptimal health outcomes and increased healthcare costs, and yet adherence to preventive therapies is often difficult to achieve. Understanding which factors can improve adherence is a public health priority. In this study, we examined the association of psychosocial factors and adherence of preventive behaviors within the context of the COVID-19 pandemic.

Methods

Panel data from the European COvid Survey (ECOS), a representative sample of residents aged 18+ from Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy collected from April 2020 (wave 1) to May 2022 (wave 10) was used to examine trends and determinants of COVID-19 preventive behaviors (i.e., mask wearing, hand washing).

Results

With a total of 27,095 participants, 53.5% were female, and 15.9% were aged 18-24, 67.9% 25-64, and 16.3% 65+. The trends in adherence decreased over time except in wave 5 where a spike in adherence levels matched wave 1 levels and a surge in reported COVID-19 infections. In multivariable logistic regression models, worry about overloading the health system (OR = 1.26, 95%CI: 1.22-1.31), perceived risk to one's own health (OR = 1.13, 95%CI: 1.08-1.18) and others (OR = 1.16, 95%CI: 1.10-1.22), and trust in institutions (OR = 1.20, 95%CI: 1.12-1.26), traditional news media (OR = 1.05, 95%CI: 1.01-1.10), and health providers (OR = 1.31, 95%CI: 1.26-1.37) increased the likelihood of engaging in COVID-19 preventive behaviors. However, those with high trust in social media were less likely to follow prevention guidelines (OR = 0.78, 95%CI: 0.75-0.80).

Conclusions

Psychosocial factors (risk perceptions, worry, and trust variables) were associated with adhering to COVID-19 prevention guidelines. Findings that high trust in social media was related to low adherence suggests more research is needed to understand how public health can improve health communications via social media, a popular information resource.

Key messages

• Health risk perceptions and worry about overloading the health system were associated with adhering to COVID-19 prevention guidelines.

• Trust in social media was related to low adherence to COVID-19 prevention guidelines.
Examination of the Effectiveness of a Public Health Nurses’ National Call Center for Young Families
Authors: Bord S , Satran C , Odesky G , Ali-Saleh O , Wagman S , Madjar B
Published: October 2023

Background

The Public Health Nurses Call Center (PHNCC) is an innovative, free-of-charge Israeli national pilot aimed at parents of 0-6 years old children. The Center provides information, counseling, and guidance re- issues of health and preventative medicine and is active when the daily Infant-Parent Centers are closed.

Aims

Examining the PHNCC's suitability for the target population's needs and evaluating its effectiveness in locating situations needing intervention, improving patient experience, and promoting the children's and their parent's health.

Methods

Three sub-studies were conducted: (1) a descriptive study using an initial analysis of 6,000 calls received at the Center, as well as a profound analysis of randomly selected 1,500 calls; (2) a comparative study among 201 parents who had called the Center and 232 parents who had not; and (3) a qualitative study which included interviews with 20 parents who had called the Center and six of the PHNCC nurses.

Findings

The PHNCC provides a fast, professional, and accessible response. Caller satisfaction is high, as is that of the Center's nurses. The population of people calling the Center is mainly made up of young parents to first-born children, as well as parents characterized by high levels of parental efficacy perception, social support, and health literacy, as opposed to the population of parents who did not call. There is a direct association between callers’ satisfaction with the PHNCC and their level of trust in the Center nurses.

Conclusions

Both parents and nurses describe an accessible, professional Center and high satisfaction levels. However, the study's findings highlight the need to minimize health-related gaps and make the Center accessible to additional populations, such as parents with lower health literacy.

Key messages

• Both parents and nurses describe an accessible, professional Center suitable for the target population's needs.

• The PHNCC is a service with excellent implementation potential for promoting public health. It should be budgeted accordingly and made accessible to the various populations of Israeli society.
Out-of-pocket expenditure and mortality in the elderly in Europe: a longitudinal analysis, 2006-20
Authors: Palladino R , Mercogliano M , Sorrentino M , Fiorilla C , Esposito F , Triassi M , Hone T
Published: October 2023

Background

European Health Systems are increasingly considering the implementation of cost-sharing policies to compensate cuts in public health spending. However, out-of-pocket expenditure (OOPE) has been associated with delay in seeking care, especially in the elderly population, with negative effects on health. This is the first study to assess the relationship between OOPE and mortality in European Health Systems.

Methods

Longitudinal analysis of 11 European Health Systems between 2006 and 2020 using data from the Survey of Health, Ageing, and Retirement in Europe. Total OOPE, OOPE on medicine, outpatient, and inpatient were the main variables of interest. Covariates included multimorbidity, age, sex, marital status, residential country, educational attainment, and household income. To model the association between OOPE and mortality we employed mixed-effect parametric survival models with Gompertz distribution. Analyses were stratified by income quintiles and sensitivity analyses were conducted with time-varying independent variables.

Results

Study population included 70367 respondents, average age was 65 year (±14.1), 53.7% were female, and average number of chronic disease was 1.6 (±2.6). 60.1% of the sample paid OOPE, 41.2% more than 100 euros in a year. For each 100 euro increase in OOPE we found a 1% increase in mortality over the study period (HR 1.01, 95%CI 1.01-1.01), with little difference when stratifying analyses by income quintiles. The largest effect was found for OOPE on medicine (HR 1.04, 95%CI 1.02-1.06), while the smallest for OOPE on inpatient (HR 1.02, 95%CI 1.01-1.03), although it was much larger when restricting analyses to only those in the lowest income quintile (HR 1.08, 95% 1.92-1.12). Time-varying analyses confirmed main findings.

Conclusions

Cost-sharing policies, especially on medicine, increase the risk of mortality in elderly people in Europe. For certain health services the association might affect especially the most disadvantaged groups.

Key messages

• For each 100 euro increase in OOPE we found a 1% increase in mortality for elderly people in Europe over the study period, with little difference when stratifying analyses by income quintiles.

• The largest effect was found for OOPE on medicine, while the smallest for OOPE on inpatient, although it was much larger when restricting analyses to only those in the lowest income quintile.
Perinatal common mental health disorders among migrant women: a systematic review and meta-analysis
Authors: Stevenson K , Fellmeth G , Edwards S , Calvert C , Bennett P , Campbell OMR , Fuhr D C
Published: October 2023

Background

Pregnant migrants are particularly vulnerable to mental illness because they are exposed to stressors including conflict, poverty, and discrimination. We aimed to assess the global prevalence of perinatal mental health disorders or substance use among migrant women.

Methods

We searched MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in the perinatal period or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal mental health disorders amongst migrant women globally. A random-effects meta-analysis was used to calculate pooled prevalence estimates. PROSPERO: CRD42021226291.

Results

18,650 studies were retrieved, of which 135 studies (comprising data from 621,995 participants) met the inclusion criteria. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all migrant women, 32·5% (1·5-81·6; 98·7%; τ2 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; τ2 0·01) among economic migrants (p < 0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32).

Conclusions

One in four migrant women who are pregnant or postpartum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher amongst forced migrant women compared to economic migrants. These findings highlight the need for community-based perinatal mental health screening and access to interventions that are culturally sensitive.

Key messages

• Women who are forced migrants have a higher prevalence of perinatal depressive disorders compared with women who are economic migrants; forced migrants also experience a high burden of PTSD.

• The findings highlight the need for culturally sensitive mental health screening and care for migrant women who are pregnant or postpartum, particularly for forced migrants.
Temperature around conception and metabolic health in adulthood: Evidence from the UK Biobank
Authors: Münz T , Pradella F , Gerking L , Gabrysch S , van Ewijk R
Published: October 2023

Background

Mice studies and correlational evidence among humans suggest that paternal cold exposure around conception is associated with improved metabolic outcomes among the offspring, which is caused by an increase in their amount of active brown fat. Especially the 2 weeks prior to conception are relevant as epigenetic programming during spermatogenesis takes place. Causal evidence on humans is thus far lacking. We overcome this challenge by exploiting quasi-random temperature variation around conception and studying metabolic health in a large sample.

Methods

We combine daily temperature data with individual-level data from UK Biobank (N = 430,000, birth years 1934 - 1971) and link quasi-random temperature variations around conception to later-life metabolic health outcomes. We do not use actual temperatures, since conceiving during cold months or living in cold areas may be associated with socioeconomic and other characteristics that may affect offspring later-life metabolic health. Instead, we utilize deviations from the temperature that is to be expected for a certain place at a certain time point in a natural experiment framework. Date of conception is estimated from date of birth and our main exposure is temperature variation in the 2 weeks before conception. Since pregnancy length varies, temperatures during several time windows around conception are considered.

Results

Individuals who were conceived when it was one degree Celsius colder than usually have a lower BMI (-0.018; 95% CI -0.033, -0.003), waist circumference (-0.038; 95% CI -0.071, -0.004), as well as lower levels of triglycerides (-0.004; 95% CI -0.007, -0.001) and cholesterol (-0.013; 95% CI -0.017, -0.010).

Conclusions

Comparatively subtle environmental shocks such as temperature variations around conception are causally associated with long-term metabolic health. This study points to the importance of future research on similar potential health externalities of rising global temperatures.

Key messages

• Colder temperatures around conception lead to improved metabolic health outcomes in adulthood, including lower BMI, waist circumference, and levels of triglycerides and cholesterol.

• Subtle environmental factors during the periconceptional period can have long-term health impacts, highlighting the need for further research on potential health externalities of climate change.
Mental health in Swedish adolescents prior to and three years after the Covid-19 outbreak
Authors: Uvhagen L , Söderqvist F
Published: October 2023

Viewing mental health from a two continua perspective, this presentation focuses on results of pooled data from a recurrent cross-sectional survey, carried out in ninth and eleventh grade in lower and upper secondary school of Västmanland county, Sweden, 2020 - weeks prior to the Covid-19 outbreak - and 2023. In total, 7908 students participated of which 50% were girls (2020 N = 3880; 2023 N = 4028; response rate≈72%). A compilation of the results according to the two continua model and the six mental health status groups described in the previous presentation shows that 39.0% are categorized as having Complete Mental Health (CMH), 1.6% as Symptomatic But Content (SBC), 36.7% as Vulnerable (V), and 2.9% as being the Most Vulnerable (MV). Further, 12.8% are categorized as being Troubled (T) and 6.9% as Most Troubled (MT). Statistically significant differences are seen between boys and girls in the categories CMH (boys=47.4%, girls=30.8%), SBC (boys 1.0%, girls 2.1%), T (boys 7.2%, girls 18.3%) and MT (boys 3.7%, girls 10.1%). Significant changes over time, between 2020 and 2023, are seen in SBC (0.9% statistically significant increase) and MV (1.9% statistically significant increase). When divided by sex, significant changes over time are only seen among girls: in CMH (5.3% statistically significant decrease), MV (1.9% statistically significant increase) and SBC (1.3% statistically significant increase). No statistically significant changes are seen over time for boys. The result indicates that only four out of ten adolescents have a CMH. The differences between boys and girls are substantial; almost five out of ten boys and three out of ten girls has CMH. This emphasizes the importance of promoting mental well-being, especially among girls. The result also implies the importance of strengthening well-being in the large group without flourishing mental health since the latter can also provide a buffer against mental illness.
Barriers and facilitators for food systems policy development and implementation in African countries and cities
Authors: Van Dam I , Burgaz C , Vandevijvere S
Published: October 2023

Background

The sustainable food systems policy index (SFS index) was created to evaluate government actions towards healthy diets from sustainable food systems at national and city level. A mapping of policies was conducted across East (Kenya, Tanzania, Uganda) and West (Burkina Faso, Benin, Ivory Coast, Senegal, Togo) African countries and cities. Only few recommended policies were in place. Therefore, this study set out to identify the barriers and facilitators for food systems policy development and implementation within food supply chains and environments at national and city level.

Methods

A total of 64 semi-structured interviews are being conducted (April-July 2023) across aforementioned eight East and West African countries. Per country, four city level and four national stakeholders actively engaged in the design, implementation or evaluation of food systems policies were selected, 36 working on food supply chains, 27 on food environments and one involved in both.

Results

Results of the interviews are expected to highlight common barriers and facilitators to develop and implement policies to obtain healthy diets from sustainable food systems. Moreover, these will contribute to the finalisation of the SFS index.

Conclusions

Understanding barriers and facilitators influencing sustainable food systems policies is key to achieving the sustainable development goals. Moreover, the final SFS index will be useable in countries and cities across the world to map existing policies to obtain healthy diets from sustainable food systems and identify areas of improvement.
Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study
Authors: Sá R , Roquette R , Rebecchi A , Rocha J , Buffoli M , Capolongo S , Ribeiro A I , Nunes B , Dias C , Sousa Uva M
Published: October 2023

Diabetes is responsible for a high burden of disease, yet there is a great potential for prevention. Physical inactivity is one of the major risk factors for type 2 diabetes which can be tackled by increasing area-level walkability. That said, there are still few population-based studies exploring the association between area-level walkability and objective measures of diabetes. The aim of this study is therefore to estimate the association between area-level walkability and individual levels of glycated haemoglobin in the Portuguese adult population. Area-level data required to estimate walkability was obtained from the 2011 census and an updated street map. The walkability index was constructed using measure of residential density, land-use mix and street connectivity. Individual-level health data was obtained from The National Health Examination Survey (INSEF) 2015, a population-based survey representative of Portuguese adult population. We used gamma regression to estimate associations. The regression coefficients showed that living in medium walkable areas reduced the average glycated haemoglobin (Exp(β)=0.906; 95%CI: 0.821, 0.999) in a statistically significant way when compared with least walkable areas. The association was smaller, and not significant, for the third tercile of walkability (Exp(β)=0.919; 95%CI: 0.822, 1.028). Our findings suggest a non-linear protective association of walkability on glycated haemoglobin. These findings could have important policy implications for urban planning, with a goal of preventing diabetes and promoting health by increasing walkability.
Socioeconomic Disparities in Beliefs about Cancer: Irish National Cancer Awareness Survey
Authors: O'Hare C , McCarthy T , Mullen L , Bennett K
Published: October 2023

For most tumour types survival varies according to socioeconomic position (SEP) and stage at diagnosis. The aim of this study was to examine the association between SEP and beliefs about cancer, and the impact of beliefs on symptom awareness and help-seeking. This is important as negative beliefs about cancer may represent a modifiable target in cancer awareness campaigns aimed at adults aged 50+ years. A cross-sectional study of 1,327 adults aged 50+ years was conducted using data from the Irish National Cancer Awareness Survey, 2022. SEP was indexed using educational attainment. Beliefs about cancer were assessed using the Awareness and Beliefs about Cancer measure, symptom awareness using the Cancer Awareness Measure, and help-seeking using the French Cancer Barometer. Latent Clas Analysis (LCA) was used to identify unobserved ‘beliefs about cancer’ subgroups across belief items. Multivariable logistic regression, adjusted for age, sex, smoking status and cancer experience, was then used to identify associations between SEP and belief subgroups, and subsequently between belief subgroups and symptom awareness and anticipated help-seeking. LCA identified two subgroups: n = 1,033 (77.7%) broadly positive and n = 294 (22.3%) broadly negative. Those with primary education or less, and those with secondary education, were more likely to endorse negative beliefs relative to those with tertiary education (aOR 3.20 (95%CI 1.84, 5.53;p<0.001) and aOR 1.88(95%CI 1.32, 2.70;p<0.001) respectively). Compared to the positive beliefs subgroup, the negative subgroup were less aware of persistent cough as a potential cancer symptom (aOR 0.60(95%CI 0.40, 0.88);p=0.01) and less likely to anticipate seeing a doctor first with symptoms (aOR 1.52 (95%CI 1.11, 2.08;p=0.009) ‘other’ vs. ‘doctor’). Negative beliefs about cancer are associated with lower SEP. Negative beliefs about cancer should be targeted in health promotion campaigns seeking to increase awareness and help-seeking behaviour.

Key messages

• There is a need for interventions to increase symptom awareness and encourage timely help-seeking in those with symptoms suggestive of cancer particularly among socioeconomically disadvantaged groups.

• Negative beliefs about cancer should be targeted in health promotion campaigns seeking to increase awareness and help-seeking behaviour.
Improving students’ mental health literacy: evaluation of an adapted school intervention in Germany
Authors: Kirchhoff S , Fretian A , Okan O
Published: October 2023

Background

Mental health problems and mental illness are central concerns for young people's health. As most mental illnesses emerge before the age of 25, young people are considered a key target group for preventive measures. Mental health literacy (MHL) is considered a set of resources and capacities for positive mental health and mental health care. MHL encompasses specific mental health knowledge, positive attitudes towards mental illness, and effective help-seeking behaviors. School-based MHL interventions seem to be promising in reaching young people and educating and empowering them regarding the topic of mental health.

Methods

An evidence-based Canadian MHL school intervention was adapted for German schools and evaluated for its effectiveness in terms of strengthening different dimensions of MHL (mental health knowledge, stigmatizing attitudes, help-seeking efficacy) as well as its acceptability. The evaluation study included a pre-post intervention control group design. Paired sample t-tests were conducted separately for the intervention and control group in order to verify the improvements in the different dimensions of MHL.

Results

The sample comprises 251 students aged Ø 15.6 years, with 9 intervention classes (IC) and 5 control classes (CC). The analysis showed significant improvements in the MHL dimensions knowledge, attitudes towards mental illness (personal stigma) and help-seeking for the IC. In addition, the students’ reception of the intervention was highly positive which reflects high acceptance.

Conclusions

Despite the rather small sample size (due to the COVID-19 pandemic), the evaluation offers insights into the effectiveness in terms of improving the different MHL-dimensions, and applicability of the adapted MHL intervention for students in Germany. Further evaluations are needed to confirm the intervention's effectiveness, especially with regard to long-term effects.
Racial implicit biases among obstetric care providers and associated differential care
Authors: Azria E , Sauvegrain P , Anselem O , Bonnet M P , Deneux-Tharaux C , Fischer C , Rousseau A , Richetin J
Published: October 2023

Background

The mechanisms of disparities in maternal and perinatal health between migrant and native women are multiple and remain poorly understood. One hypothesis is the existence of implicit biases among caregivers through which the women's ethno-racial belonging can influence medical decisions and engender healthcare disparities. Their existence and their role in the generation of non-medically justified differential care is being more and more documented in the United States but remains largely unexplored in Europe.

Objectives

The aims of the BiP research program are to test and quantify the existence of implicit biases toward African migrant women among obstetric care providers and to explore the association between implicit biases and differential care.

Study design

This study is a national web-based survey to which French obstetricians, midwives, and anesthetists were invited to take part by eight professional societies and networks. The potential existence of implicit biases toward African versus French was quantified through Implicit Association Tests (IAT) for valence and strength. The association between implicit biases and clinical decisions was then assessed using six clinical vignettes. For each, the patient's origin, African/French, was suggested by using typical surnames.

Results

The survey was completed by 887 professionals. The IATs showed that caregivers in the three professional categories had strong implicit biases with a preference for French versus African women in terms of valence, while they implicitly tended to attribute more strength to African women. We did not observe any association between Patient's name (French vs. African), caregiver's biases (implicit valence or strength) and the behavioral intention captured through vignettes responses.

Conclusions

This study shows a high level of implicit racial biases among obstetric care providers, but these biases were not associated with differential clinical decisions.

Key messages

• This study shows a high level of racial implicit bias among healthcare providers.

• No association between implicit bias and clinical behavioral intentions were observed.
Empowerment-based intervention and immigrant awareness of biomedical HIV prevention tools in France
Authors: Coulibaly K , Bousmah M-Q , Ravalihasy A , Taéron C , Mbiribindi R , Senne J-N , Gubert F , Gosselin A , Desgrées du Loû A ,   For The Makasi study group
Published: October 2023

Background

Sub-Saharan African immigrants are particularly affected by HIV in France and social hardship is an indirect factor of HIV acquisition. While biomedical HIV prevention tools are available for HIV prevention, evidence suggests a lack of knowledge of these tools among immigrants from Sub-Saharan Africa. We analysed the impact of an empowerment-based intervention on the knowledge of treatment as prevention (TasP), Pre Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) among a population of precarious sub-Saharan African immigrants.

Methods

Data were collected in the Makasi research project. Participants were recruited in public places based on their precarious situations, they were randomised into two groups (intervention and control) followed during six months between 2018 and 2021. We described the knowledge of biomedical HIV prevention tools at each follow-up time (0, 3, 6 months) and used random-effects logistic regression models to analyse the intervention effect on the level of knowledge of these tools.

Results

The majority of the participants were men (77.5%) and almost half of them arrived in France within 2 years prior to inclusion (49.3%). At the time of inclusion, 56% of participants knew about TasP, 6% knew about PEP and 4% knew about PrEP. Receiving the intervention increased the odds of knowing PEP (aOR=2.02 [1.09-3.75]; p < 0.026). Intervention effect were observed for TasP and PrEP only after 6 six months. We observed significant time effect for PEP (at 3 months aOR=4.26 [2.33-7.80]; p < 0.001; at 6 months aOR=18.28 [7.39-45.24]; p < 0.001) and PrEP (at 3 months aOR=4.02 [2.10-7.72]; p < 0.001; at 6 months aOR=28.33 [11.16-71.91]; p < 0.001). This time effect is linked to the associations outreach activities.

Conclusions

Our results suggest that exposure to the Makasi intervention combined with associations activities contributed to increase knowledge of biomedical HIV prevention tools among precarious sub-Saharan African immigrants.

Key messages

• The Makasi intervention improved the knowledge of biomedical HIV prevention tools.

• One-shot empowerment-based intervention shows encouraging result for HIV prevention.
Nutrient values and sustainability of omnivorous, vegetarian and vegan choices in a hospital canteen
Authors: Menis D , Fiori F , Zago D , Cautero P , Lesa L , Scarpis E , Brunelli L , Parpinel M
Published: October 2023

Background

A plant-based diet has a lower environmental impact than an omnivorous diet and, when balanced, may reduce the risk of certain non-communicable diseases. The aim of our work is to evaluate the nutritional profile and sustainability of omnivorous, vegan and vegetarian choices in an Italian hospital canteen.

Methods

We photographed the midday meals of users in the hospital canteen of Palmanova (Italy) for 5 consecutive days in September 2022. We examined the recipes provided by the canteen and divided the meal trays in omnivorous, vegan and vegetarian. For each tray we estimated the carbon and water footprint using the SU-EATABLE LIFE database and the energy and nutrient content using the Italian Food Composition Database for Epidemiological Studies.

Results

We analysed 228 trays (167 omnivorous, 7 vegan, 54 vegetarian). Median energy content was higher (p < 0.05) in the omnivorous trays (942 kcal/tray) than the plant-based trays (813 kcal/tray). The omnivorous trays contained more fats (42 %E) and less carbohydrates (36 %E) than the plant-based trays (fats: 35 %E; carbohydrates: 44 %E) (p < 0.05). The carbon and water footprint were higher (p < 0.05) for the omnivorous meals (1202 gCO2eq/tray, and 1370 LH2O/tray) than for the plant-based meals, which had a median value of 687 gCO2eq/tray and 907 LH2O/tray.

Conclusions

Vegan and vegetarian meals were more in line with the Italian dietary reference values and more sustainable than omnivorous meals. Nutrition education is needed to improve the sustainability and quality of workers’ lunches and to ensure an adequate choice of plant-based meals.

Key messages

• Even if plant-based meals were more sustainable and nutrionally balanced than the omnivorous ones, they were less chosen.

• Improving food choices can help achieve the Sustainable Development Goals.
Pediatric injuries classification using openAI: new opportunities for epidemiological surveillance
Authors: Lorenzoni G , Sciannameo V , Baldan G A , Bressan S , Da Dalt L , Berchialla P
Published: October 2023

Background

The burden of unintentional pediatric injuries remains a significant concern for healthcare systems worldwide. Timely and accurate surveillance is critical for injury prevention and resource allocation. However, the diagnosis reported in the emergency department records is often not coded, and the manual coding of these records is labor-intensive, time-consuming, and prone to errors. To implement an automatic coding system using GPT-based models to extract and classify injury data in the Italian language from pediatric emergency department records.

Methods

The study included 283,468 admission records to the pediatric Emergency Department of Padova University Hospital from 2007 to 2018. Each access is mandatorily registered in an electronic data collection system. For each emergency department access, both coded (administrative and demographic data) and free-text (diagnosis) information are reported. A random subset of 40,030 records underwent classification of free-text diagnosis (as injury or not) by an expert clinician (gold standard). OpenAI was used for the classification task. OpenAI is an extensive language model based on the GPT architecture. Specifically, the GPT-3.5 variant was employed for the present work. openAI was accessed through a public application programming interface (API) using R software.

Results

Preliminary results showed a classification accuracy of 96.2%. The tool's ability to correctly classify the injuries (sensitivity) was 95%, while the specificity was 96.5%.

Conclusions

The performance of the classification task was excellent. The present results demonstrate the feasibility of GPT-based models for processing unstructured free text information from medical records.

Key messages

• OpenAI would represent a promising opportunity to improve pediatric injuries surveillance

• OpenAI would improve the classification of unstructured information from medical records
Climate change and public health: barriers and levers for implementation of climate adaptation in Europe
Authors: Turner G , de’Donato F , Hoeben A , Nordeng Z , Otto I , Stackpole Dahl M , Aunan K , Kovats S
Published: October 2023

Background

Climate adaptation policies (to reduce health impacts from climate change) are being implemented across Europe driven by political action, public support, and more extreme weather. All EU countries have national climate adaptation policies but the the role of addressing public health in implementation varies by country and is often undervalued.

Aim

Identify key issues in climate adaptation implementation by public health professionals in Europe.

Methods

Key informant interviews were undertaken with decision makers in international, national, and local government across 20 European countries. Participants were recruited if working in public or environmental health, and in climate adaptation policy. Interviews addressed these key themes: barriers, health agenda, levers, networks, evidence needs. Interviews were conducted online, recorded, transcribed, and analysed thematically.

Results

32 interviews were completed between June-October 2021; 4 international, 5 national level and 23 city-level stakeholders. Most reported inadequate resources for health adaptation implementation (funding, training, and personnel) and the marginal role of health in climate adaptation policy development. A clear mandate to act was key for adaptation implementation and resource allocation. A reported challenge was departmental cross-collaboration, and city-level stakeholders’ awareness of the public health role in climate policy. European-level stakeholders reported strength in ability to coordinate expertise to national and regional-level governance partners highlighting the importance of interagency collaboration.

Conclusions

Across Europe, there is varied progress in implementation of climate-health adaptation. Providing appropriate resources, inter-departmental collaboration, training, knowledge mobilisation, and multi-level governance support will facilitate climate and health policy implementation.
Stakeholder mapping: regional comparisons in adaptation implementation
Authors: Natukunda J , Turner G , Wright C , Mawanda S , Pagiwa V , Muthoni C , de’Donato F , Hajat S , Kovats S
Published: October 2023

Background

Health adaptation planning is rapidly progressing but implementing actions on key health and climate change priorities is slow. We summarise and compare findings on progress in health adaptation in Europe and East and Southern African regions.

Methods

A desk-review of national health adaptation plans and strategies (NAPs) was conducted in 20 European countries and 14 East and Southern African countries to identify adaptation priorities. Key informant interviews were conducted with government representatives, non-governmental organizations, development partners, and civil society organisations. Participants were identified through partner networks and snowballing. The WHO framework was followed in mapping stakeholders’ interests, knowledge, and influence on health adaptation. Interview responses were transcribed and analysed in Nvivo to identify key themes.

Results

34 NAPs were reviewed (20 in Europe, 14 in Africa). Interviews were conducted with 48 stakeholders (32 in Europe, 16 in Africa). Across Europe, more than half of the countries have policies addressing infectious diseases (12) and heat-related risks (14). In Africa, infectious diseases were a national priority for all countries, but heat management plans were largely absent (only one nation had a heat management plan). In both regions, adaptation action was driven by national policies, high stakeholder interest and knowledge, and the presence of focal points or joint working groups. Key barriers included: limited interagency or institutional collaborations, a need for evidence-based practice-oriented research, and funding for health adaptation activities.

Conclusions

There are similarities in drivers and barriers to health adaptation in Europe and Africa. Progress on implementation is uneven, with heat-health planning largely lacking in East and Southern Africa.
Testing the resilience of the Greek health system faced by a Human Resources in Health (HRH) shock scenario
Authors: Kaitelidou D , Konstantakopoulou O , Panteli D , Vildiridi L
Published: October 2023

Greece holds the highest density per capita of doctors and the lowest density per capita of nurses among the EU countries. There is significant health worker maldistribution leading to understaffing of primary healthcare and an overabundance of specialists. However, there are numerical and geographical imbalances and shortages in specific specialties. A shock event scenario with respect to a sudden shortage of HRH (especially of doctors and nurses) crisis due to hypothetical upcoming changes to legislation regarding pension thresholds, salaries and insurance for health professionals will be piloted in May 2023. The resilience test is based on the resilience testing tool developed by the European Observatory on Health Systems and Policies, the OECD and the European Commission. Participants will include government and MoH representatives, health professionals from the hospital and PHC sector, academics, patient representatives etc. This sudden and massive loss of health workforce scenario entails a significant strain on the healthcare system mainly with regard to governance (e.g., increased need for reliable data and intelligence reporting on the distribution and availability of the remaining healthcare professionals), resource generation (e.g., health units forced to operate under unfavorable and below safety limits staffing ratios), service delivery (e.g., long waiting times for surgeries and hospitalizations and PHC units struggling to meet the demand for visits) and financing (e.g., rising healthcare costs due to the need to purchase services from the private sector).

Expected outcomes refer to highlighting challenges that the Greek health system would encounter during this scenario and good practices that could be implemented to alleviate short- and long-term implications of health workforce shortage and strengthen system's resilience in view of future crises. The presentation will share actual outcomes, which will be available by the time of the conference.
Process evaluation of the Greek nationwide school health education program
Authors: Sakellari E , Prapas Ch , Perifanou D , Chatzicharalampous E , Lagiou A
Published: October 2023

Background

Schools can play a significant role in promoting health of the school community. Process evaluation is always needed to gain valuable insights on how next health promotion interventions could be improved. In Greece, the first effort to organize health education interventions in the schools at national level, was in 2019 by the Ministry of Health. The aim of the current study was to evaluate the process of a national school health education program in Greece.

Methods

The health education interventions took place during school year 2019-2020. They included the following themes: oral health, healthy eating, mental health, sexual health, bullying, and online safety. Multidisciplinary teams co-developed all health education material. A representative sample of teachers and health professionals filled in the structured questionnaires developed for the current study, after their informed consent. Statistical analysis was conducted using SPSS statistical software (version 22.0).

Results

Most teachers evaluated as excellent (83.6%) the cooperation with the school principal and the health education coordinator (77.6%), while the general satisfaction from the intervention was evaluated as excellent by 69.8% of them. In addition, most of the health professionals (90.7%) perceived as excellent the cooperation with the health education coordinator and the other health professionals (86.3%) as well as the cooperation with the school principal (87%).

Conclusions

Even though this was the first effort in Greece to organize school health education interventions at a national level, the results of the process evaluation have been positive. Therefore, the Greek Ministry of Health has adopted this program which is implemented until today.

Key messages

• Process evaluation of school health education interventions is important to improve future initiatives.

• Centrally organized school health education interventions may be the key for their success.
Overview of key findings on CSE status in 4 countries
Authors: Ivanova O
Published: October 2023

We used SERAT to assess the implementation of CSE in four countries. The data collection took place between December 2021 and July 2022. All four countries teach sexuality education, which is supported by adequate legal and policy frameworks, and integrate it into their school curricula. The comprehensiveness of the curriculum, teacher training and learning methods differ across the four countries. The integration of the sexuality education concepts varies across countries. Relationships and values topics are generally more present in the curricula across all age groups. Topics with lesser attention are gender, sexual behavior and sexuality. The content is more comprehensive for the age group 12-15, followed by 15-18 in all countries. All countries integrate learner-centred learning techniques and employ different teaching strategies for sexuality education, including participatory methods. Overall, there is a lack of school-based SRH services and commodities, including contraception. In countries where school-based health services exist, nurses often do not have guidelines or a mandate to provide relevant information. Monitoring and evaluation is one of the weakest components of all programmes in three of the four countries. To conclude, there is a need to enhance the content in all age groups, improve teacher training and provide materials to teachers and students, strengthen links with health services, involve relevant stakeholders in curricula development and introduce measurable monitoring and impact indicators.
6.P. Workshop: Responding to violence and abuse across the life-course
Authors:   Organised by: EUPHA-PMH,   Chair persons: Jutta Lindert (EUPHA-PMH), Anastasia Fadeeva (UK)
Published: October 2023

Much research on the mental health effects of violence focus on domestic violence as experienced in adulthood. The mental health impacts are often gauged using cross-sectional studies and focus on current associations between violence and health. This workshop presents a range of analyses - drawing on data from New Zealand, Germany and the UK - that address the ways in which violence and abuse manifest at different life stages, including in childhood, among working-age adults, and in later life. The presentations highlight differences across the life course, as well as commonalities. They provide evidence of the long-term, even life long, shadow that violence and abuse can cast over people's health, and provide evidence of the extensive costs for society. Health impacts are shown to be broad, not only anxiety and depression, but substance dependence, chronic physical health conditions, and related health risks such as obesity. This workshop comprises four presentations that each consider violence and abuse prevalent at a particular stage of life, and provide evidence to inform the sensitive tailoring of responses from and for families, schools, health and social services, workplace human resource employees, and care and residential homes. The format of the workshop comprises brief presentations, with a focus on extended audience discussions. We invite engagement from people from a range of disciplines interested in how different forms of violence and abuse present at different life stages, the impacts on health, and the ways in which society should respond. This workshop is submitted on behalf of the EUPHA Public Mental Health Section.

Key messages

• Violence occurs across the life course. While its prevalence and form often vary between life stages, at every stage it has major, long-term, and diverse implications for health.

• Interventions need to be tailored to the life course and sensitive to changing context, including domestic, workplace, and care home environments.