bluuebunny/crossref_metadata_2025 huggingface dataset:
Italian translation and cultural adaptation of health literate organisation self-assessment tool
Authors: Paladini A , Ancona A , Unim B , Lombardo C , Cadeddu C , Cacciuttolo M G , Specchia M L , De Castro P , Palmieri L
Published: October 2023

Background

The International Working Group Health Promoting Hospitals and Health Literate Healthcare Organizations has developed an English-language self-assessment tool for Organizational Health Literacy of Hospitals, designed to quality managers of healthcare organizations. It aims to diagnose strengths and weaknesses of the organization's health literacy, and our goal is to translate and culturally adapt it for Italy.

Methods

We have been following the Translation, Review, Adjudication, Pretesting, and Documentation team model for cross-cultural translation of questionnaires. Initially, two separate teams of translators worked independently to translate the tool from English to Italian. Next, the national coordinator organised six meetings to discuss, integrate, and unify the two versions, and any translation difficulties and suggested solutions were reported in the supporting tool that will be sent along with final agreed version of the tool to the International Coordination Centre. Finally, two experts will review the translation for the cultural adaptation.

Results

Difficulties related to comprehension in translation can arise from ambiguity in word choice, the need for contextual precision, and a lack of cultural appropriateness. The translation of English words that have become part of Italian language (e.g. ‘feedback', ‘stakeholder', ‘management', ‘standard') was also hugely discussed between the teams. Finally, to categorize the information entered into the supporting tool, 50% pertains to adaptation to context, 30% to simplification or clarification, and 20% to non-applicable items.

Conclusions

Cultural adaptation will improve the translation by reducing ambiguities, providing contextual clarifications, and rephrasing items to make them more appropriate for Italy. The Italian version of the tool will be piloted in local hospitals to support healthcare operators, patients, and the community in better managing the complexities of healthcare organizations.

Key messages

• Translation of health literacy self-assessment tool for Italian hospitals, aiming to reduce ambiguity and increase appropriateness for local context.

• Culturally adapted tool to diagnose organizational health literacy in Italian hospitals will help healthcare organizations deal with complexity of healthcare and improve patient outcomes.
Addiction prevention & mental health support in Hungarian elementary schools: a mixed-methods study
Authors: Árva D , Vokó Z , Sápi M , Cselkó Z , Rákosy Z
Published: October 2023

Substance and behavioural addictions are growing problems of children and adolescents, and prevention requires reducing risk factors and strengthening protective factors, such as mental health support (MHS). The current Hungarian policy emphasises the role of schools in addiction prevention (AP), but few data exist on school-level implementation. This was a mixed-methods study supported by the Scientific Foundations of Education Research Program of the Hungarian Academy of Sciences, investigating the implementation of AP and MHS in Hungarian elementary schools (N = 2892) with a nationwide cross-sectional survey-based study and by focus groups on teachers’ views about such programmes and ways to improve them (37 teachers from 21 schools). Schools covered the topics of tobacco (74%), drugs (71%), alcohol (62%), and electronic devices (61%) most commonly. Of schools, 55% had regular MHS programmes, and this differed significantly by school type and size. More addiction-, and mental health-related topics were covered with greater diversity of implementers (p < 0.001). A school environment conducive of MHS was more prevalent with higher frequency of community building within the teaching staff (p < 0.001). Logistic regression revealed that school type, support for teachers’ work, and diversity of implementers were significantly associated with the quality of implementation of AP and MHS. Six themes emerged from the focus groups: development of addictions and mental health, health education, role of teachers in addiction prevention, cooperation, factors hindering addiction prevention at schools, and factors supporting it. Teachers claimed that they can do the most for children's health at school, but they need support for effective implementation. Our results indicate the importance of school characteristics in AP implementation and call for the support and empowerment of teachers and greater organisational capacity to ensure the effectiveness of school-based AP and MHS.

Key messages

• Multistakeholder engagement approaches are necessary to address a wider, more diverse range of addiction-related topics in the school curricula.

• The training and mental health support of teachers and their collectives are important intervention points that should be invested in to increase the effectiveness of addiction prevention.
Value and roles of qualitative methods in natural experimental evaluations
Authors: Green J
Published: October 2023

Background

For natural experimental evaluations that estimate effect sizes of population health interventions, qualitative evidence contributes multiple benefits. Incorporating qualitative methods strengthens natural experimental evaluations, particularly when studying interventions in complex systems, and contributes to minimising evaluation design weaknesses.

Methods

Guidance was developed from three international workshops and an online consultation with researchers, journal editors and end users of natural experimental evaluations. The project team comprised researchers with expertise in natural experimental evaluations. The project included an oversight group and an advisory group of independent experts, including researchers, a journal editor, and scientific and public health advisors on central and local government.

Results

The guidance recommends that most evaluations of natural experiments will require the inclusion of qualitative evidence. Qualitative methods are valuable when describing the natural experiment intervention, the system and context it exists within, and theories of change. Qualitative work can help appropriately define exposed and unexposed groups, investigate causal mechanisms, facilitate meaningful selection of outcomes, and understand stakeholder perspectives on the intervention and its effects.

Conclusions

Gaining an understanding of the value and application of qualitative evidence will help producers and users of natural experimental evaluations conduct and identify robust evaluations. To fully benefit the evaluation, qualitative methods should be integrated throughout.
Schools: First Promoters of a Good Visual Health
Authors: El Harrak Y
Published: October 2023

Vision plays an important role in the physical, cognitive and social development of children. Uncorrected vision problems can harm a child's development and interfere with learning. Visual functioning is a strong predictor of academic performance in school-aged children. Early detection and treatment are essential. The objective of our work is to establish the prevalence of visual disorders in children and to investigate the motivations for a consultation. This is a descriptive study carried out at the Vision Clinic of Tetouan-Morocco, including all pediatric patients (<16 years old) who presented to the consultation of the same doctor, between July 2022 and December 2022. All patients underwent a complete ophthalmological examination with measurement of refraction after cycloplegia. The study involved 450 children, including 254 girls and 196 boys. The average age was 9 years old. One of two children was consulting for the first time in ophthalmology. The average age at the first consultation is 8.5 years. The ophthalmological examination was requested by the school in 46% of the cases. In 34%, it is requested following observations made by the parents. In 10%, it is the child who reports the visual disturbance (these children were all over 8 years old). In 3% of cases, the ophthalmological examination is requested by the attending physician. 93% of these children required optical correction after measurement of refraction under cycloplegia and 45% had amblyopia of variable importance. One out of three amblyopic children was over 10 years old when the visual impairment was diagnosed. This work highlights the essential role of schools in the detection of visual impairment in children. Routine vision screening and eye exams are critical to detect vision problems before a child's development is compromised. Schools and teachers are the first and essential actors in a solid public health approach to children's vision and eye health.

Key messages

• Systematic screening for ametropia in children of school age & Awareness of parents for the recognition of visual disorders.

• A child who does not complain is not necessarily in good visual health.
FGM experience and training needs of Italian Gyn&Obs medical staff: results from a pilot study
Authors: Sisti L G , Pacillo C , Farina A , Marino C , Ricciardi M L , Giovannini C , Moscato U , Malorni W
Published: October 2023

Background

Female genital mutilation (FGM) includes removal or other injuries of the external female genitalia for non-medical reasons. The practice roots in cultural customs and is reported in over 90 countries. It is performed in the child and adolescent age and can cause physical and psychological consequences. In Italy, 60-80,000 are estimated to be affected and despite guidelines on FGM care in place since 2007, Gyn&Obs’ perspective has not yet been adequately analysed.

Methods

Based on literature review and focus groups, a questionnaire targeting Gyn&Obs’ FGM clinical experience (e.g. patients’ features; FGM complications; barriers in relating with patients; defibulation requests, etc.) and training needs was conceived followed by content and clarity validation by experts and a pre-test assessing its reliability. A web survey using the tool was launched in 2022 via Gyn&Obs’ associations.

Results

129 Gyn&Obs participated in the survey. 86.8% stated to have visited FGM patients, in particular from Sub- Saharan Africa and aged 18-34 yo. Type II and I (58.9 and 52.7%) are the most frequently observed and urinary issues and dyspareunia are the symptoms most commonly reported. 57.3% had difficulty relating to patients mainly for cultural and linguistic issues, and 56.6% had perceived patients’ difficulties in relating also for fear to be judged. 27.1% received defibulation requests and 25.7% found the referral challenging for lack or unknowing devoted facilities or professionals. 67.4% consider Gyn&Obs’ training inadequate and 79.8% that residency is the optimal time to deliver it.

Conclusions

Results highlighted Gyn&Obs’ difficulties in relating to FGM patients and in providing adequate referral. Moreover, FGM training is strongly perceived as inadequate. The survey offered hints to inform a large-scale study among Italian Gyn&Obs and other health professionals aiming to detect gaps and improve FGM patients’ care through training and health services strengthening.

Key messages

• Italian Gyn&Obs’ training on FGM seems to be inadequate.

• Language and cultural barriers are perceived as the main barriers to interacting with FGM patients.
Loneliness among the elderly in Baltic nations during the beginning of the Covid-19 pandemic
Authors: Pasupathy R , Sazevari R , Queen C
Published: October 2023

Background

The population in the Baltic states of Estonia, Latvia, and Lithuania is ageing rapidly. Loneliness is one of the most disruptive transformations facing older adults. Loneliness implies a lack of meaningful social relations or absence of human contact, and adversely impacts the health and quality of life of older adults. Loneliness is associated with an increased risk of premature death, dementia, heart disease, depression anxiety and suicide. This study is based on the Cacioppo Evolutionary Theory of Loneliness (ETL), that posits, that an individual's perception of loneliness triggers nonconscious evolutionary behavior that may have long term deleterious consequences. There is evidence of the heritability of loneliness as a population parameter.

Research Objectives

To determine the nature of loneliness experienced by older adults in Baltic states, specifically is loneliness among older adults the same across countries, genders, age and employment status.

Study Design

Data from Wave 9, COVID-19 Survey 2 (Summer 2021) of the of the cross-national panel dataset of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of 6303 adults over 50 years old from Latvia, Lithuania and Estonia. Analysis: Nonparametric one-way ANOVA (Kruskal-Wallis test) was performed to test the null hypothesis that the rate of loneliness is equal across gender, age, and country in Baltic states.

Principal Findings

There was a statistically significant difference in the loneliness reported by country. The indicate that country is a significant factor [χ2= 77.14, df = 2; p< .001], and the rate of loneliness varies significantly by gender [χ2= 93.94, df = 1; p< .001, and age [χ2= 187.80, df = 6; p< .001].

Conclusions

These finding suggest that age and gender are significant predictors of loneliness. Implications for Policy and Practice: Care of older adults should aim at alleviating loneliness difficulties faced by this population.

Key messages

• Age and gender was a significant predictor of loneliness among the elderly in Baltic states at the beginning of the Covid-19 pandemic.

• Policy initiatives that aim to alleviate loneliness among older adults should address age and gender factors.
Intermarriage and health: Mortality among Finnish migrants in Sweden by spousal country of birth
Authors: Östergren O , Korhonen K , Cederström A , Martikainen P
Published: October 2023

Background

Finnish migrants in Sweden experience a mortality disadvantage relative to the native population in part due to health behaviours. Interaction between migrants and natives may lead to a convergence of health behaviours and thereby mortality between the groups. Finnish migrants who are married to a native Swede may thus have mortality rates that are more similar to the Swedish population compared to those married to fellow Finns. Conversely, mortality rates of migrants married to a fellow Finn may more closely resemble those of the population in Finland.

Methods

We use register data to identify all Finnish migrants aged 40-64 in Sweden in 1999 who were married to a native Swede or a fellow Finn. We identify reference groups in both Sweden and Finland, using a combination of inverse probability weighting and direct matching to adjust for differences in sociodemographic characteristics between the groups. We analyse mortality from all causes, CVD, alcohol and smoking related causes during 2000-2017.

Results

Compared to Finnish migrant men married to a fellow Finn, migrant men who are married to a native Swede have lower mortality rates, closer to that of the native population of Sweden. This difference is largely explained by sociodemographic characteristics, although lower levels of all-cause and CVD mortality remain after adjustment. By contrast, migrant women married to a native Swede have higher smoking-related mortality, closer to that of native Swedish women. Migrant women married to a fellow Finn have lower smoking-related mortality, closer to that of Finnish-born women in Finland. This pattern is especially pronounced when adjusting for sociodemographic characteristics.

Conclusions

Being married to a native is associated with lower all-cause and CVD mortality for migrant men and higher smoking-related mortality for migrant women. Depending on gender and risk factor intermarriage can be either protective or detrimental for migrant health.

Key messages

• The mortality risk of Finnish migrants in Sweden vary by spousal country of birth but if intermarriage is protective or detrimental for health depends on gender and risk factor.

• Being married to a native Swede is associated with lower CVD mortality for Finnish migrant men and higher smoking-related mortality for Finnish migrant women.
Population size estimation of survivors of violence against women and girls in Tirana
Authors: Ylli A , Sant Fruchtman C , Shahu S , Sota M , Revenga Becedas R , Wallenborn J , Cobos Munoz D
Published: October 2023

Survivors of violence against women and girls (VAWG) are often stigmatized, resulting in unreported cases and missed opportunities for support services. In this analysis we aimed to estimate the real size of VAWG in Tirana district between 2019-2022. Size estimation was based on capture-recapture methodologies using two independent databases; from the Counselling Line for Women and Girls (CLWG), a non-governmental agency providing counselling to survivors of VAWG, and the Registry of Violence in Albania (REVALB), the official registry of VAWG. There were 155 and 895 cases respectively in CLWG and REVALB. 48 women were found in both registries. The first points of contact for survivors of VAWG were Police, Court/Judge and Municipality services while none of the women recorded in REVALB reported accessing health, education or NGO services. The estimated number of reportable VAWG cases in Tirana district between January 2019- August 2022 was 2890 (95% CI:2218-3562). The estimation is highest for 2021 with 1418 cases (95% CI:766-2069) and lowest for 2020 with 251 cases (95% CI:101-400). Real number of reportable survivors and victims of VAWG is at least 3 times higher than the cases officially registered in the national database in Tirana. The estimation for 2020 is highly affected by an important decrease in registration of cases during first year of COVID-19 pandemic. More efforts should be made, especially by the health services, to identify and refer as needed potential cases of VAWG.

Key messages

• Real number of reportable survivors and victims of VAWG is at least 3 times higher than the cases officially registered in the national database in Tirana

• ore efforts should be made, especially by the health services, to identify and refer as needed potential cases of VAWG.
Sudan: from a food basket to a pesticide sink
Authors: Noory B , Nuwayhid I , Habib R R
Published: October 2023

Background

Sudan, a country once referred to as ‘a food basket', had an agricultural sector employing 53% of the workforce (21.8% of the GDP) in 2019. However, intensive agricultural schemes and excessive use of pesticides have plagued this sector since colonial times, resulting in negative environmental health impacts. We analyzed relevant policies to identify deficiencies and improvement opportunities.

Methods

The National Pesticides and Pest Control Products Act (NPPCPA 1994), Environmental Health Act (EHA 2009), and the National Occupational Health Act (NOHA 1966) were analyzed.

Results

The laws governing pesticide handling and use are outdated. The NPPCPA (1994) does not capture recent regulations specified in international conventions. The EHA (2009) regulates the storage of vector-control pesticides, without referring to agricultural pesticides. NOHA was promulgated in 1966, yet the occupational health (OH) functions were formalized within the Federal Ministry of Health (FMOH) in 1968. The OH unit and functions in FMOH were fully dismantled in 1993-1994 and NOHA clauses were reduced to an administrative section in the 1997 Federal Labor Act with no specific mention of pesticide exposure. The NPPCPA 1994 act stipulates the development of a multi-stakeholder national committee, yet it works in a fragmented manner and conducts pesticide analysis on an ad hoc basis. The lack of a national agricultural policy for the safe use of pesticides, and the absence of an oversight agency to monitor, inspect, and enforce safety measures, have led to unsafe exposures and high residues in crops.

Conclusions

Laws and policies governing pesticide use are outdated and deficient in Sudan. They fail to regulate the use of pesticides and protect workers and consumers. Evidence-based and context-specific policies and regulations are needed. A successful implementation of regulations requires revisiting governance structures, in tandem with widescale capacity-building efforts.

Key messages

• Sudan’s economy relies heavily on agriculture, yet the laws governing this sector are outdated and deficient.

• There is a need for a national agricultural policy for the safe handling and use of pesticides.
Out-of-pocket expenditure at end-of-life among decedents from cardiovascular disease
Authors: Tur-Sinai A , Bentur N
Published: October 2023

Background

Most people who develop chronic diseases, including cardiovascular disease (CVD), live in their homes in the community in their last year of life. Since cost-sharing is common in most countries, including those with universal health insurance, these people incur out-of-pocket expenditures (OOPE). The study aims to identify the prevalence and measure the size of OOPE among CVD decedents at end-of-life (EOL) explore differences among countries in OOPE, and examine whether the decedents’ characteristics or their countries’ health policy affects OOPE more.

Methods

SHARE data among people aged 50+ from seven European countries (including Israel) who died from CVD are analyzed. Decedents’ family members are interviewed to learn about OOPE on their relatives’ accounts.

Results

We identified 1,335 individuals who had died from CVD (average age 80.8 years, 54% men). More than half of CVD-decedent people spend OOPE on community services at EOL and their expenditure varies widely among countries. About one-third of people in France and Spain had OOPE, rising to around two-thirds in Israel and Italy and almost all in Greece. The average OOPE is € 369.3, with wide variance across countries. Significant odds of OOPE exist in the country variable only, and significant differences exist in the amount of OOPE among countries and ages.

Conclusions

Since improving CVD care efficiency and effectiveness are key aims, healthcare policymakers should consider expanding public funding for community services in order to mitigate OOPE, alleviate the economic burden on households, mitigate forgoing of community services due to price, and reduce rehospitalization. The expansion of public funding of CVD community care may lower their OOP expenditure, mitigate the non-use of community services due to cost, and reduce hospital readmissions. This is important in all countries included in the study and especially so in those where OOP expenditure is highest.

Key messages

• More than half of CVD decedents spent out of pocket on community services in their last year of life.

• The expansion of public funding of CVD community care may reduce hospital readmissions.
A role of National Cancer Control Programme during COVID-19 pandemics - experience from Slovenia
Authors: Tomsic S , Duratovic Konjevic A , Plantosar K , Zadnik V
Published: October 2023

Issue

Cancer is a major public health issue. Countries should tackle it with setting up National Cancer Control Programmes (NCCP), which are especially important during extreme circumstances. In Slovenia, during the COVID-19 pandemic, we managed to follow the direction set out in the NCCP.

Description of the problem

Slovenia has had a NCCP since 2010. The program's activities are already yielding results at a national level. During the COVID-19 pandemic, oncology services in Slovenia were designated as an exception that should not be interrupted. However, the functioning of primary care level has been modified due to COVID-19 management. This reflected in the drop of new cancer diagnoses and temporary stop of cancer screening programmes.

Results

During pandemics timely monitoring of cancer care has been set up by Slovenian Cancer Registry. During the first wave more than 30% drop in new cancer diagnoses has been observed. The results have been presented to policy makers and general public. Appeals to the policy makers to resume cancer screening as soon as possible, communication campaigns urging people to see a doctor, if they notice any signs of cancer, and support for all providers to maintain cancer care uninterrupted have been initiated by the NCCP. These activities resulted in only 3 months stop of the three national cancer screening programmes, and enhanced activities after their restart; the cancer awareness was raised in the next COVID-19 waves, since the drop in the new cancer diagnoses during following waves (autumn 2020- spring 2021) reached to “only” 10%. And institutions related to cancer care have remained dedicated to cancer throughout the whole pandemic period.

Lessons

Coordinated national cancer strategy can have important influence on policy makers and general population, raising awareness and preventing major disruptions. Coordinated support for cancer care was crucial to avoid worse long-term cancer outcomes.

Key messages

• Strategic framework of activities through NCCP have important impacts on the provision of cancer care, especially during extreme circumstances, such was COVID-19, which diminish health care delivery.

• Strategic framework of activities through NCCP have important impacts on the provision of cancer care, especially during extreme circumstances, such was COVID-19, which diminish health care delivery.
From health in all policies to health for all policies with a focus on older people - climate, health and equity
Authors: Schmidt A , Lampl C , Aigner E , Haas W
Published: October 2023

Background

The climate crisis constitutes the largest threat to public health in the 21st century, from which severe health risks emerge that hit older age groups disproportionately. In addition, the health sector itself contributes to the climate crisis (up to 10% of national carbon emissions) and health inequity. We use the Health for all Policies paradigm and apply it to the links between equity, climate, and health in old-age. The paper develops a conceptual framework for strengthening interdisciplinary approaches toward a climate-resilient future for all age groups.

Methods

We conducted a systematic literature review for the analysis of the links between health, climate, and equity, by considering a health for all Policies (HfaP) paradigm and highlight results focusing on the living situation of vulnerable subgroups of older people in this presentation.

Results

The climate crisis with its pending health threats has multiple links with HfaP, and can be applied to an analysis for specific subgroups of older people, vulnerable due to intersectional and overlapping challenges related to their health status, economic situation, gender or race, specific living or family situation. An in-depth understanding of the equity-climate-health nexus helps avoid a low-carbon shift may become that is too narrow in its scope, compounding vulnerable groups's situations. At the interlinkages between health, climate and inequality multiple co-benefits (e. g. inclusive infrastructure for active mobility) can be achieved and trade-offs avoided.

Conclusions

Policymakers worldwide and in the EU take up the challenge to substantially reduce greenhouse gas emissions, but the complex interconnection of climate, health and equity has found very little attention, even less so applied to older people. Vulnerable subgroups of older people have limited resources for dealing with the severe impacts of climate change on health, calling for adaptation measures to be planned with an equity lens.
The ‘FFAB’ project: Lessons learned from an early health intervention for male sports bettors
Authors: Biggar B , Reith G , Wardle H
Published: October 2023

Background

Sports betting is a growth area for the gambling industry with football fans becoming a key target of advertising. This demographic is also one at elevated risk from gambling harm. This paper reflects on the NIHR-funded Football Fans and Betting project (FFAB) - an innovative early health intervention with football fans (aged 18-55) who gamble regularly to reduce their betting.

Methods

We will present findings from interviews and observations to reflect on the delivery of our 8-week intervention delivered by 4 clubs’ Community Trust Coaches - Leicester, Preston North End, Accrington Stanley, and Blackpool. Planned as a feasibility study and pilot RCT, FFAB's feasibility learnings led to the development of a different model than originally proposed.

Results

Preliminary findings suggest (1) there is a clear need for an early health intervention for men looking to reduce their betting. (2) Overcoming shame and stigma are significant barriers to recruitment in a study like this. (3) Conducting independent research with football clubs, given their complex sponsorship arrangements, presents multiple challenges. (4) relatedly, while recruitment was easier in smaller more locally rooted clubs, they faced more challenges for resources which led to difficulties with retention on the programme.

Conclusions

FFAB is the first intervention of its kind and has lessons for interventions with underserved groups more widely. We identified the need for more focused pre-recruitment work on changing understandings of gambling through public health-focused education. We believe more recognition and visibility of a public health approach to gambling in the wider population would help to de-stigmatise language and discussion of gambling and lessen the challenges of engaging our target group. We recommend a more grassroots, localised approach to future early health interventions of this nature. In doing so, we believe that we could minimise many of the challenges we faced in delivery.

Key messages

• There is a clear need for community-based interventions that aim to reduce gambling harm amongst the high-risk population of male sports bettors.

• Feasibility work suggests that refinements to our initial model, utilising more localised, grassroots approaches, are required to successfully engage with this target population.
Why is it important to address organisational vaccine literacy?
Authors: Aloise I
Published: October 2023

Starting with a quick recall from the definition of organizational HL and HL responsiveness, the concept of vaccine literacy will be unpacked. Individual vaccine literacy and organizational VL will be presented. In particular the new concept of organizational VL will be explained and opportunities for its application to the prison settings and to tailored healthcare approaches for migrant's health. We will remark that the suggested strategy by the two projects is provision of vaccine services, programs and information in ways that promote equitable access and engagement, that meet the diverse vaccine literacy needs and preferences of individuals, families and communities, and that support people to participate in decisions regarding their health. We need to move towards an organisation that takes charge of the complexity of needs and delivers the right performance/service not on the basis of differing accessibility (often determined by socio-economic variables that add discrimination and inequality to more or less well-expressed health needs), but on the correct assessment of the real socio-medical burden and, in so doing, contributes to reducing the gap that determinants such as citizenship or deprivation of liberty can so deeply produce.
Building a European One Health workforce for prevention and preparedness to health threats
Authors: Robbiati C , Milano A , Declich S , Riccardo F , Mancini L , Di Domenico Kevin , Scavia G , Dente M G
Published: October 2023

Background

The Quadripartite has elaborated the One Health Joint Plan of Action (2022-2026) (OH JPA) to promote health sustainably and prevent the next pandemic through the One Health (OH) approach. One of the action track of the OH JPA is to create a training program for environment, medical and veterinary sector professionals.

Objectives

The Italian National Institute of Health is developing a training curriculum about OH prevention and preparedness to health threats within the European Region to promote the OH workforce capacities and capabilities and to support the OH JPA execution. The training curriculum would be developed through a literature review and a stakeholder consultation process, validated by a steering committee and presented during a workshop.

Results

A modular training curriculum about OH prevention and preparedness to health threats within the European Region is developed and it includes modules to strengthen soft and hard skills around 5 OH domains (OH thinking, OH design, OH implementation, OH evaluation, OH cross-cutting competences) with case studies encompassing different threats. The curriculum would be further developed into a training hybrid course for National Public Health Institutes, decision and policy-makers at all level, International and European organizations and agencies, Academia, professionals working in the area of environmental and agricultural sciences, social sciences, human and animal health.

Conclusions

The training curriculum would contribute to build a European OH workforce by strengthening OH prevention and preparedness skills and competences and networking opportunities. It would support OH action and practice at national, regional and global level and the execution of the OH JPA.

Key messages

• A training curriculum for OH prevention and preparedness to health threats within Europe has been elaborated.

• The OH workforce, OH action, and the OH JPA execution are strengthened and supported.
Promoting primary healthcare services resilience with chronic disease management digitalization: a foresight study in the Lisbon health region
Authors: Peyroteo M , Maia M , Velez Lapão L
Published: October 2023

Background

Due to the pressure on health systems, the COVID-19 Pandemic forced administrators to rapidly harness and integrate existing technology to manage access of patients with chronic diseases to Primary Health Care (PHC) in Portugal. Studies show that one of the most important areas for improvement is the sustainability of artefacts after the implementation phase, which depends on the successful implementation of digital transformation. As such, this study aims to assess the impact and influence of digitalization of PHC to settle a set of actions to be taken so that implementation is carried out more effectively and to support evidence-based policy-making in a PHC Unit located in the peripheral area of Lisbon.

Methods

This study followed a collaborative foresight approach using a scenario development methodology proposed by Lapão and Thore, divided into three stages: understanding the context, developing scenarios, and their analysis. These steps were achieved by conducting focus groups using the thematic brainstorming approach to analyse strategic and operational scenarios within ten years (between 2022 and 2032).

Results

Considering the influence of digitalization of PHC in the next ten years, three relevant and plausible scenarios were developed: ‘Digital PHC and active patients’, ‘NHS transition’ and ‘Climate exigency’. Combining innovation skills to establish digital services with improved governance policies has shown significant benefits toward the goals of more patient-centred care.

Conclusions

The collaborative reflection process throughout the study made the different stakeholders identify and understand the impact of the essential measures to be taken in different scenarios, allowing the digitalization of PHCs to be implemented more effectively, enabling the sustainability of the National Health Service in the Lisbon region, which has only been discussed so far at a limited and theoretical level.
Co-creation of an Escape Game on University students’ mental health
Authors: Montagni I , Vié C , Thellier D , Labrosse D
Published: October 2023

University students’ mental health has been strongly impacted by the health crisis linked to Covid-19, with increased levels of stress, anxiety and depression in this population. During the pandemic and afterwards, there was the urgent need to implement interventions to promote students’ well-being and help them cope with these stressful conditions. Gamification - defined as the use of game features in serious contexts - can increase knowledge on health-related topics using a learning-by-doing approach. Studies have proved its effectiveness in promoting players’ health literacy. For this, a team of researchers and a start-up worked together to create an Escape Game (called EscapeCovid) addressed to students on their mental health during the Covid-19 series of lockdowns and curfews. Through playing, students could improve their mental health literacy, destigmatize mental illnesses and learn how to tackle psychological problems. The aim of this study was to describe the preliminary steps of the co-creation of EscapeCovid by researchers, industrials and students. Starting from a prototype, 45 students tested the game and provided their comments through mixed-methods data collection. All players completed a questionnaire before and after the game. They were asked about their knowledge and mental health status to observe a modification due to the game. Satisfaction questions were also asked concerning the design and contents of the game. In addition, semi-structured interviews were conducted with 10 students for in-depth opinions. According to the results of the evaluation, participant appreciated the Escape Game as an innovative tool for health promotion. Especially because of its ability to transmit knowledge and increase skills through gamification. University students seemed very receptive to this type of tool. In order to guarantee its effectiveness, it was clear that the game must be adapted to the target audience and meet its expectations.

Key messages

• Escape Games are innovative tools in health promotion and disease prevention which can be well received by young people.

• It is essential to test an intervention with end-users before deploying it in order to ensure its effectiveness.
5.O. Workshop: Best Practices against child obesity
Authors:   Organised by: Health4EUKids,   Chair persons: Apostolos Vantarakis (Greece), George Karidas (Greece)
Published: October 2023

European countries in the field of health promotion and prevention of non-communicable diseases, indicating best practices and specific risk factors from research results on child obesity that have already developed from previous research actions. The overall goal of the JA is to implement two best practices Grunau Moves established in Germany and Smart Family established in Finland in different MS. The implementation process will include the knowledge transfer between best practice owners (Smart Family and Grunau Moves) and partner organisations from the Member States through the implementation of actions, the cooperation and exchange of knowledge between member states, the organisation of meetings, and related technical support. Also important part of the project is to produce policy developments to foster public health investments at community level in each country member on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases. Scope of the project will be to promote to participating member states healthy lifestyles in families with children to prevent childhood obesity, to increase physical activity and healthy diet in children,families and communities with a focus on social norms, recognition and self-esteem in deprived districts in member states. Also, to study the different prerequisites for member states to implement either Grunau Moves or Smart Family. Finally, to prepare the sustainability of these best practices and transfer to other member states based on the acquired knowledge and experience. The expected results focus on the identification of concrete challenges in the prevention of non-communicable diseases and policy solutions in the form of best practices and innovative solutions for collective action between the Member States and the Commission, to tackle the main public health challenges

Key messages

• To strengthen a cooperative approach in tackling childhood obesity.

• To improve the planning and development of the policies to tackle childhood obesity.
An intervention to improve self-care among people with diabetes mellitus: A quasi-experimental study
Authors: Kumar Gupta S , Lakshmi P , Rastogi A , Malhotra S , Kaur M
Published: October 2023

Background

An increased self-efficacy promotes better diabetes self-care behaviours, which help in achieving glycemic targets among patients with diabetes mellitus.

Methods

A quasi-experimental study was conducted among patients with T2DM living in rural areas of Punjab, North India. A total of 283 in the intervention and 291 in the control arms were participated at baseline, and a total of 242 in the intervention and 237 in the control arms at endline assessments. Summary of diabetes self-care activities and diabetes management self-efficacy questionnaires were used at baseline and endline (after 6 months) surveys. Outcomes were net changes in proportion of population having diabetes self-management self-efficacy, overall diabetes self-care activities (health dietary habits, physical activity, adequate foot care, medication adherence and blood glucose monitoring) and net mean change in HbA1c. Data were analysed using per protocol analysis principle. Difference in difference analysis (DiD) using Generalized Estimating Equation model was done to adjust for confounders. p < 0.05 was considered as significant.

Results

There was a significant net increase in participants proportion (39%; 95% CI: 25% -52%, p < 0.001) on diabetes management self-efficacy scale. At the baseline assessment for overall self-care behaviours, only 4% of participants in the intervention arm were in the action stage and 12% were in the preparation stage; however, at the post intervention assessment, this proportion increased to 24% for action stage and 67% for preparation stage. There was a significant net increase in participants proportion (49%, 95%CI 37% -60%, p < 0.001) engaged in optimal diabetes self-care. There was a significant net decrease in mean HbA1c (-1.06%; 95%CI: -1.62 - -0.50, p < 0.001) at post intervention phase.

Conclusions

Diabetes self-care intervention was successful in promoting self-efficacy and self-care practices among patients with T2DM of rural areas.

Key messages

• Self-efficacy theory-based diabetes self-care intervention successfully improves the diabetes related self-care practices.

• There is a need for a structured diabetes self-care management education programme to improve the ability of patients with T2DM who live in rural areas.
Adaptation to heat and concomitant environmental risks in Europe: a GAP Analysis
Authors: Mazzalai E , De Sario M , Turner G , Natukunda J , Nordeng Z , Aunan K , Kovats S , de’Donato F
Published: October 2023

Background

Climate change is increasing the frequency and intensity of extreme events like heatwaves, wildfires and droughts. Within the ENBEL project, a GAP analysis was carried out to provide evidence on vulnerability factors of concomitant environmental risks during heat waves and promote the implementation of public health response.

Aim

To assess the level of implementation of heat wave and co-exposures (air pollution, wildfires and drought) response actions and to identify gaps and needs for public health adaptation in Europe.

Methods

A scoping review was performed to identify clinical and social vulnerabilities to heatwaves and concomitant exposures and prevention measures in place. Interviews with key stakeholders will provide additional information on response measures addressed to vulnerable groups as well as identifying needs and gaps for adaptation. Furthermore, an assessment of how Covid-19 recovery plans and funding in Europe are supporting climate adaptation and health care resilience was carried out.

Results

From the literature review interventions mainly focused on outdoor workers and athletes, include guidance, plans and actions on hydration, rest in the shade, cooling clothes and food, as well as acclimatization procedures. The elderly are among those consistently targeted in heat prevention plans, with health and social care surveillance, tele-medicine and awareness campaigns carried out during summer in several high-income countries. Regarding multiple environmental exposures, studies on preventive measures are scarce, and stakeholders reported the need for further research, sharing of knowledge and evaluation of measures to enhance action.

Conclusions

Although Covid-19 recovery funding is providing marginal benefits for health systems resilience, key barriers to climate adaptation still remain in terms of limited resources, personnel capacity; governance constraints and unclear policy remit.
Transforming perioperative patient safety clinical guidelines recommendations into measurable standards: insights from the SAFEST project
Authors: Valli C
Published: October 2023

Adopting evidence-based practices can improve the safety outcomes of surgical care. However, translating evidence into practice is slow in the healthcare field; an effort should be made to overcome this challenge. One approach could be to develop measurable standards to allow the evaluation and prioritization of healthcare improvements. The SAFEST project aimed to transform a list of prioritized clinical guidelines recommendations for adults’ perioperative care into measurable standardized practices (or standards) for hospitals to implement along the perioperative patient journey. Based on a previous systematic review of guidelines and an international expert panel review, we transformed recommendations into standards through an iterative and consensus qualitative approach. First, recommendations were classified according to the perioperative period (pre, intra or post) and based on predefined clinical areas. Second, one or more recommendations were transformed into one standard. Third, for each standard, measurable elements were developed to highlight in practical terms what needs to be implemented and measured, and the source of information and responsible stakeholder were identified. The overall transformation was performed by independent reviewers and the list of measurable standards was approved and finalized through discussion. From an initial list of 101 prioritized clinical practices recommendations, we developed 103 standards with 164 measurable elements. The standards with the related measurable elements, classified based on the perioperative period, were grouped in 12 different areas based on specific topic (e.g., complications preventions). Overall, these measurable standards can enhance dissemination and implementation of patient safety standardized practices in the continuum of care for adults’ patients undergoing surgery.