bluuebunny/crossref_metadata_2025 huggingface dataset:
11.E. Workshop: Healthy Buildings: interdisciplinary perspectives
Authors:   Organised by: EUPHA-URB, EUPHA-MEN, EUPHA-ENV,   Chair persons: Stefano Capolongo (EUPHA-URB), Jutta Lindert (EUPHA-PMH)
Published: October 2023

The Workshop titled “Healthy Buildings: interdisciplinary perspectives” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), policy/decision makers and buildings’ users, to establish a multidisciplinary approach for understanding together how to create and manage healthy living indoor environments (both housing and complex constructions/public buildings). The Workshops mainly address both the “Climate emergency / Environment and health / Urban health” and the “Mental health” EPH23 conference topics. The Workshops purpose is to explore the relationship between housing conditions, Indoor Environmental Quality, and Mental Health implications on human well-being. In fact, time spent at home and in the indoor environment increased due to the recent COVID-19 lockdown period, and social-sanitary emergencies are expected to grow due to the urbanization phenomenon. Thus, the role of the physical environment in which we live, study, and work, has become of crucial importance, as the literature has recently highlighted. The Workshops program include inputs which they argue current experiences, emerging practices and scientific outcomes related to the Urban Health discipline. From Sustainable Development Goals framework, in “Urban environment, unhealthy buildings as a root of inequalities and importance of SDGs”, to Indoor Environmental Quality implications, in “Can housing conditions and features affect well-being? A review through Indoor Environmental Quality aspects and Mental Health implications”. From experience-based works related to specific functions, in “Can the built environment impact on the health and well-being of people with dementia? Evidence from Literature and Stakeholders Involvement”, to Indoor Air Quality emerging issue, in “Buildings, air quality and mental health conditions: a review of intervention studies”.

Key messages

• Explore the relationship between housing conditions, Indoor Environmental Quality, and Mental Health implications on users well-being.

• Establish a multidisciplinary approach for understanding together how to create and manage healthy living indoor environments (both housing and complex constructions/public buildings).
Buildings, air quality and mental health conditions: a review of intervention studies
Authors: Lindert J
Published: October 2023

In high-income countries, people spend most time inside buildings, and the quality of the building including indoor air quality (e.g. particulate matter and gasses such as carbon monoxide, carbon dioxide, nitrogen oxide, nitrogen dioxide, and ozone) can contribute mental health conditions. Additionally, buildings are home. “Home” is associated with sense of security and belonging. However, there has been comparatively little research into the ways in which both, housing and indoor air quality, and feelings of security and belonging may contribute to mental health conditions. To provide 1) an update of relevant studies on housing and air quality and mental health conditions in urban men and women, with a special focus on intervention studies before and after retrofit of buildings and to 2) identify gaps in research. To respond to aim one Intervention studies before and after retrofit of buildings were reviewed. To respond to aim two qualitative studies on home and belonging were reviewed. Results suggests that pollutant concentrations and ventilation vary widely across buildings. After retrofit pollutant concentrations decreased significantly. Building characteristics, such as ventilation and pollution from combustion is related to mental health conditions. The negative impacts of low-quality housing, however, fall inequitably. Women and older persons who stay longer inside buildings in buildings are more exposed than those who stay less time inside buildings. The feeling of home and security have been neglected and may provide inside into effect moderation and modification of the association between buildings and mental health conditions. Housing is a critical social, and environmental determinant of health and mental health. Despite evidence on aspects of the overall effectiveness of improved housing this study adds to the identify gaps in research and calls for interdisciplinary research including Public Health, humanities and architecture.
Health examination surveys for policy formulation
Authors: Rakovac I , Galea G , Fedkina N
Published: October 2023

Health examination surveys (HES) are one of the key data sources for health policy formulation and evaluation as well as monitoring of several health related Sustainable Development Goals (SDG) and other internationally agreed indicators for NCDs. The presentation will 1) highlight importance of health examination surveys in reporting accurately SDG and other internationally agreed NCD indicators; 2) Identify internationally agreed NCD indicators for which HES is used as data source; 3) give an overview of current levels of implementation of HES in the WHO European Region; and 4) Briefly describe available WHO tools related to HES.
Adaptation of the Digital Health Literacy Instrument and testing with German school-aged children
Authors: Rangnow P , Fischer L , Hartmann A , Renninger D , Stauch L , Dadaczynski K , Okan O
Published: October 2023

Background

Children and adolescents in particular navigate in the digital space intensively and use the Internet, social media, and apps to seek health related information. From a public health perspective, the increasing amount of online-based information requires them to possess the abilities to find, understand, evaluate, and apply health information, making digital health literacy more and more important. The Digital Health Literacy Instruments (DHLI) is a psychometrically tested instrument for assessing digital health literacy in adults, which has been adapted for children and adolescents in the United States, using cognitive interviews. However, this version has not yet been adapted for Germany. Hence, the aim of this study is to adapt and test a German version of DHLI for secondary schoolchildren.

Methods

The pretest tool was translated into German by three native speakers. To test the translated version of the DHLI adapted for secondary schoolchildren, cognitive pretests were conducted with N = 12 children and adolescents aged 10-17 years. The thinking aloud method and probing questions were used during the pretests. The aim of the evaluation was to maximize usability and comprehensibility of the adapted version for schoolchildren in Germany.

Results

In order to adapt the instrument for a German target group, preferred synonyms were identified during the pretests, as well as a preferred word collocation for health information, namely ‘information about health,’ which was used consistently for all items. Furthermore, two explanations were added in one instruction and one item.

Conclusions

Based on the results of the pretest analysis, a German version of the DHLI for children and adolescents is now available. Psychometric properties and the methodological quality of the schoolchildren's version of the DHLI have been analyzed in a representative quantitative study, shown in the subsequent presentation.
Sociodemographic differences in digital health literacy of schoolchildren: a representative study
Authors: Stauch L , Renninger D , Fischer L , Hartmann A , Rangnow P , Dadaczynski K , Okan O
Published: October 2023

Background

The increasing amount, availability, and use of digital health information through the Internet, social media, and apps highlights the relevance of digital health literacy in schoolchildren. Children and youth need digital health literacy in order to find, understand, and appraise health information and to make health decisions in everyday live. However, there is only limited to none evidence available on child and youth digital health literacy. This study aims at investigating digital health literacy of schoolchildren in Germany and explore associations with sociodemographic differences.

Methods

Data were collected from a representative sample of N = 1,448 secondary schoolchildren employing a face-to-face survey (CAPI) (Oct-Nov 2022). In addition to sociodemographic information (age, gender, migration, family affluence, education level), digital health literacy was measured using an adapted and translated self-report tool for secondary schoolchildren in Germany. Descriptive statistics, chi-square tests, and internal consistency were calculated using SPSS.

Results

Cronbach's alpha indicated a good internal consistency (α=.82) for the overall scale and an acceptable-to-good reliability for the subscales (α=.735-.866). Digital health literacy was low in more than half of the participants (52.9%). While no differences were found for gender (X2 (1)=0.25, p=.618) and migration background (X2 (2)=2.34, p=.31), lower digital health literacy was more frequent among younger children aged 9-11 years (X2 (2)=34.69, p = <.001), children with low family affluence (X2 (4)=24.16, p = <.001), and lower parental education (X2 (2)=8.26, p=.016).

Conclusions

The results of the first study of its kind in Europe suggests an elevated need to promote digital health literacy in schoolchildren. Public health and education policies and interventions are needed that pay attention particularly to younger children's needs, to those from lower family affluence, and lower parental education.
Teaching digital health literacy skills in schools: A quantitative study among teachers
Authors: Rangnow P , Fischer L , Hartmann A , Renninger D , Stauch L , Dadaczynski K , Okan O
Published: October 2023

Background

In societies increasingly characterized by media and information diversity, digital health literacy (DHL) is an essential key competence for public health. Due to their educational mandate, schools are an important setting for the promotion of DHL, with teachers playing an important facilitating role. While there are findings available on generic health literacy of teachers, evidence is lacking regarding their DHL and the level of teaching DHL in schools.

Methods

An online survey using a non-probability sample of school teachers in Germany was carried out (N = 1,600). DHL was measured using a translated version of the adult Digital Health Literacy Instrument (DHLI) tool. The level of teaching DHL was assessed using self-developed items based on the seven DHLI dimensions. Descriptive analyses and chi-square tests were conducted in SPSS.

Results

A large number of teachers reported the level of teaching DHL to be problematic (45,5%) or even inadequate (22,2%). While operational skills, e.g., using a keyboard, are the most likely to be taught in the context of seeking health information, 31% of teachers reported that these skills were not or hardly addressed at their school. Adding self-generated health content, e.g., how to create health-related messages on social media, is the least taught skill, 81% reported that this is taught hardly or not at all. The degree to which DHL is taught is associated with their age (p < .048), school position (p < .001), and own DHL (p < .001), which was found to be low for 44% of teachers.

Conclusions

The results show that hardly any DHL content is taught in German schools. However, as teaching of DHL in school plays a significant role in student DHL, it should be integrated more often into teaching and learning situations. The links between teacher DHL and the degree to which DHL is taught suggest that teachers’ DHL should be systematically promoted. Education policies in Germany should support incorporating DHL into the curriculum.
Costs and control strategies of healthcare-associated infections in an Italian university hospital
Authors: Mosconi C , De Santo C , Ciccacci F , Carestia M , Guarente L , Di Giovanni D , Morlino G , Moramarco S , Cicala M , Orlando S
Published: October 2023

Backgrounds

Healthcare-associated infections (HAIs) increase morbidity, mortality, and costs, necessitating effective prevention strategies. This study estimates the additional costs of HAIs in a university hospital in Rome, Italy Policlinico Tor Vergata (PTV), to inform policymakers, healthcare professionals, and researchers.

Methods

We conducted a retrospective cohort study, including all patients admitted or discharged in 2018. We applied propensity score matching (PSM) to balance study groups and then we analysed cost differences using the average treatment effect on the treated (ATT) approach. Costs were calculated using the Diagnosis Related Groups (DRGs) system. Outcome measures included the real reimbursement cost in euros and the relative cost increment using adjusted logarithmic transformation.

Results

12,033 patients were included: 6,653(55%) female, 5,380 (45%) male, with a median age of 67. In total, 1,212 (10.1%) infected patients were compared to 10,821 (89.9%) non-infected patients. Predominant infections were urinary tract infections (UTI) (48.8%) and blood stream infections (BSI) (34.4%), while Staphylococcus spp. (37.5%) and Enterococcus spp. (36.4%) were the most common pathogens. The propensity score analysis showed a 59.7% (95% CI: 48.8% to 71.3%) cost increase for infected patients. They incurred an additional €4,988 (95% CI: €4,173 to €5,804) in costs. Subgroup analyses revealed cost variations across infection sites and pathogens, with Klebsiella P. having the greatest economic impact at €7,586 (95% CI: €5,301 to €9,871) and BSI also at €9,719 (95% CI: €8,137 to €11,307).

Conclusions

This study highlights the significant additional cost burden of HAIs in the PTV. Interventions with an equal or lower cost per HAI averted can be considered cost-effective. Public health actions, including enhancing infection prevention, developing or revising policies, and strengthening surveillance systems, should be prioritised to address ongoing HAI challenges.

Key messages

• Our study reveals a significant 59.7% cost increase (€4,988in our hospital) for HAI patients, highlighting the need for cost-effective prevention strategies in healthcare settings.

• Findings emphasise the importance of enhancing infection prevention measures, policy development, and strengthening surveillance systems to reduce HAI-associated costs.
Suicide attempts among Swedish healthcare workers – a population-based cohort study
Authors: Nevriana A , Brulin E , Almroth M , Pan K-Y , Bodin T , Kjellberg K , Hemmingsson T , Falkstedt D
Published: October 2023

Background

While there are abundant studies on healthcare workers’ (HCWs’) suicide risk, studies on HCWs’ suicide attempts are rarer. Most previous studies on HCWs’ suicide attempts were based on cross-sectional self-reported information among selected occupations, i.e., physicians, and did not consider potential multiple attempts. This study aimed to determine the risk of suicide attempts among a wide range of healthcare professions using information from Swedish nationwide population registers.

Methods

This population-based cohort study included 4.9 million Swedish workers aged 20 years and above residing in Sweden in 2005 who were followed until their death, emigration, age 65, or 31 December 2020. The suicide attempts rates (number of secondary care visits with ICD-10 codes X60-84 and Y10-34 during follow-up) among HCWs were identified and compared with the general working population. The following occupations were included: physicians, nurses, dentists and dental hygienists, psychologists, psychotherapists, counsellors, pharmacists and prescriptionists, therapists and other allied health professionals, assistant nurses, and healthcare administrators. Adjusted rate ratios (aRRs) were estimated using Poisson regression controlling for demographics, socioeconomic, and health status.

Results

Most HCWs have an increased risk of suicide attempts compared to other workers. The highest risk was observed among nurses (aRR 1.48, 95% CI 1.42-1.56) and assistant nurses (aRR 1.33, 95% CI 1.30-1.35). The association was stronger in males (aRR nurses 1.56, 95% CI 1.35-1.81) than in females (aRR nurses 1.41, 95% CI 1.34-1.48). The risks were similar over the age at follow-up and calendar year.

Conclusions

Many HCWs were at increased risk of suicide attempts. Unlike patterns observed in the general population, male HCWs might have a higher increase in suicide attempt risk. Preventive efforts for suicide attempts within the healthcare system might need to be improved.

Key messages

• Healthcare workers were at increased risk for suicide attempts, and the risk might be stronger in male than female HCWs.

• The risk for suicide attempts among healthcare workers was similar throughout age and calendar year.
Sibling complexity and psychiatric disorders in late adolescence among the Finnish 2000 birth cohort
Authors: Junna L , Remes H , Martikainen P
Published: October 2023

Background

Due to the increasing family instability and multipartner fertility in Western countries, more children have half- and stepsiblings. While numerous studies link family instability and complexity with mental health problems, the focus has typically been on the parents while a small but growing literature suggest that sibling constellations with half- and stepsiblings may also be important for adolescent mental health.

Methods

This study is based on administrative register data of all children born in Finland in 2000 and residing there at ages 0 − 15 (n = 56,372). We identified the biological parents, their cohabiting partners, and any full, half and step siblings that the index child has from birth to age 15. We used Cox proportional-hazards models to compare differences in psychiatric disorders from age 16 to 19 for boys and girls by different sibling constellations. Psychiatric disorders were identified as any disorders treated in specialized outpatient or hospital care (n = 7,999).

Results

Almost one in five children in the birth cohort had a cohabiting half sibling and almost 4% had a step sibling. Psychiatric disorders in late adolescence were more prevalent among children in different sibling compositions with half or step siblings. For example, the preliminary results show that adjusting for confounders such as socioeconomic status and living with both biological parents or not, boys and girls with an older half sibling had a 44% (95% confidence interval 34-55) higher risk of psychiatric disorders when compared to children with biological siblings only. The corresponding difference in risk for those with younger half siblings was 24% (11-55).

Conclusions

Psychiatric disorders were more prevalent in late adolescence among children with half and/or step siblings. Future studies on family complexity are likely to benefit from including information on sibling characteristics in addition to those of the parents.

Key messages

• Adolescents growing up with half or stepsiblings had a higher prevalence of psychiatric disorders in late adolescence.

• More studies on sibling composition and adolescent psychiatric disorders are needed to inform the type of supportive measures that may benefit children living with half and stepsiblings.
Evaluation of a school health promotion program using the holistic WHO approach
Authors: Kien C , Klingenstein P , Pell A , Griebler U
Published: October 2023

Background

A school health promotion program guided by the WHO approach is implemented in approximately 40% of public secondary schools in Lower Austria. Program advisors support participating schools in developing a systematic plan for the promotion of health and wellbeing of all students and teachers. This study aimed to evaluate the effectiveness of the program and identify potential areas for program optimization.

Methods

We applied a non-randomized controlled cluster trial with pre- and post-measurements (T0: October 2021 and T1: June 2022). We invited students, teachers and school principals of 30 program schools (PS) and 29 non-program schools (NPS) to fill in an online-questionnaire. We analyzed data of 2706 students, 451 teachers and 47 principals.

Results

The study showed that PS had established more favorable structures for school health promotion (HP) than NPS (e.g., established HP-team, financial resources setting objectives). Although PS implemented more HP activities than NPS (8.5 versus 6.3 activities), they merely took place as one-time events. At student level, an advantage for the PS over time was shown with respect to two out of 19 endpoints (subjective health status [b = 0.19, p < 0.001] and uptake of additionally offered physical activity lessons [b = 0.09; p = 0.04]). In two out of 19 endpoints, an advantage was also shown for the NPS (opportunities for physical activity during lessons and breaks [b = 0.06; p = 0.001], opportunities for participation [b = 0.20; p = 0.001]). At teacher level, in five out of 25 endpoints, the teachers of PS reported more favorable results than NPS’ teachers.

Conclusions

A supportive structure for school health promotion may be helpful for implementing more health promoting activities in schools. However, these activities do not seem to be profound enough to have an impact on the students. Teachers would need more support in implementing HP activities.

Key messages

• Structures for implementing health promoting activities are in place.

• However, the implemented activities did only show limited effect on students.
11.P. Workshop: Inequities in physical and mental health, and health care utilization for LGBTQ groups across Europe
Authors:   Organised by: EUPHA-SGMH,   Chair persons: Corina Lelutiu-Weinberger (USA), Arjan van der Star (EUPHA-SGMH)
Published: October 2023

Compared to heterosexual cisgender-identified individuals, lesbian, gay, bisexual, and transgender and queer (LGBTQ) individuals evidence pronounced poor mental and physical health outcomes, as well as sub-optimal healthcare access and utilization. Yet, most of the evidence documenting these disparities comes from a small group of Western countries. This limited knowledge across health conditions and geographical regions leaves multiple important questions unanswered. In particular, it remains unknown to what degree these disparities may be generalizable to contexts that have not yet been studied. This workshop includes novel reports on disparities in health, wellbeing, and healthcare access between LGBTQ groups and their heterosexual cisgender counterparts across several European countries where such data were not previously available. Through these four presentations, we explore health inequalities across Europe in physical and mental health, as well as healthcare utilization. Findings emphasize a continued need for attention to systems that can be modified (e.g., trainings of healthcare cadre, resource allocation) to reduce health disparities that uniquely burden LGBTQ groups. Andreas Pfister (Zurich University of Applied Sciences, Switzerland) will present the first national systematically documented psychosocial burden and healthcare access disparities for LGBTQ individuals compared to their heterosexual cisgender counterparts in Switzerland. Sladjana Baros (Centre for Disease Prevention and Control, Department for HIV, Hepatitis, Sexually Transmitted Infections and Tuberculosis, Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut’, Republic of Serbia) will present findings from the HIV testing cascade among men who have sex with men at high risk for HIV. Michal Pitonak (Center for Epidemiological and Clinical Research of Drug Abuse and Dependence, National Institute of Mental Health, Klecany, Czech Republic) will present data on disproportionate rates of psychological distress reported by lesbian, gay and bisexual individuals compared to heterosexual individuals in the Czech Republic. Lastly, Luis Roxo (Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden) will present population-based data on differences in mental health services and unmet mental health needs based on sexual orientation among Swedish young adults.

Key messages

• Despite being the first of such evidence, findings from these four European countries are consistent with reports from other global regions, signalling that these disparities are universal.

• A clear need emerges for structural changes to increase access to and expertise in affirmative LGBTQ healthcare to reduce disproportionate morbidity rates for LGBTQ people in Europe.
Health inequalities of LGBT persons in Switzerland – Results from the first national LGBT health study
Authors: Pfister A , Krüger P , Eder M
Published: October 2023

Background

Internationally, there is evidence that lesbian, gay, bisexual and transgender persons (LGBT persons) have poorer health outcomes than the heterosexual or cisgender population. In addition, LGBT populations face more frequent and unique healthcare access barriers. Barriers to healthcare among LGBT persons in Switzerland remained undocumented until recently, when the Swiss Federal Council mandated a report describing the health and healthcare access of LGBT persons, and related health inequalities.

Methods

Two data sets were included in analyses: (1) two waves of the representative Swiss Health Survey (SHS 2012, 2017) n = 29,793, ages 16 to 74, including 858 LGB persons, and (2) data from a non-representative national online survey (May to July 2021), including 1,542 LGB cisgender and 522 transgender persons, ages 15 to 81. Data were analyzed using descriptive and inferential statistics (e.g. binary logistic regression), controlling for potential confounding factors (e.g. year of study, age), using the Health Equity Promotion Model as a conceptual framework.

Results

The most significant areas of health inequalities across the groups of interest were mental health, experienced discrimination and violence, healthcare access barriers, substance use, and sexual health. For example, LGB persons experienced significantly higher rates of depression (16.0% vs. 7.4%; p<.001) and suicide attempts (11.0% vs. 3.3%; p<.001) compared to the heterosexual population. Additionally, LGB persons abstained from seeking medical care significantly more often than heterosexual persons (16.2% vs. 6.9%, respectively) due to a lack of trust in the healthcare system.

Conclusions

Besides targeted action in the identified (health) areas, a Health in All Policies Approach is needed to improve the lives and health of LGBT people in Switzerland by diminishing stigmatization and discrimination, and by implementing LGBT inclusive and specific protocols in healthcare and other settings.
Inadequate nutrient intake in people with disabilities: National representative sample in Korea
Authors: Park J E , Kim S Y , Park J H
Published: October 2023

Background

Individuals with disabilities often face significant issues related to nutrition such as food insecurity. However, only few studies have investigated whether people with disabilities have relatively poorer nutritional status than those without disabilities.

Methods

To compare the differences in the nutritional adequacy of diets between people with and without disabilities, 5296 adults aged ≥19 years from the 2013 Korea National Health and Nutrition Examination Survey were included in the analysis. Diet adequacy was assessed with the nutrient adequacy ratio (NAR) for 10 nutrients and the corresponding mean adequacy ratio (MAR). A multivariate logistic regression model was used to assess the likelihood of having nutrient inadequacy in people with disabilities.

Results

NAR for energy, protein, vitamin B2, niacin, calcium, and phosphorus, excluding vitamin A, B1, C, and iron, was significantly lower in people with disabilities compared to in those without disabilities (all P < 0.05). MAR of 10 nutrients was also lower in people with disabilities (P = 0.003). The proportion of overall nutrient inadequacy, defined as having a MAR below 0.75, was 40.6% in people with disabilities versus 27.5% in those without disabilities (P < 0.001). In a multivariate logistic regression model, people with disabilities had a higher odds of having nutrient inadequacy than people without disabilities (odds ratio = 1.53, 95% confidence interval = 1.11-2.11).

Conclusions

People with disabilities are more likely to not meet nutritional adequacy. Therefore, it is necessary to develop a nutrition assistance policy to comprehensively support people with disabilities who have poor nutritional status.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2021R1C1C2008683) and the Ministry of Education (No. 2019R1I1A1A01063639).

Key messages

• People with disabilities had a higher prevalence of nutrient inadequacy than those without disabilities.

• A support system to improve the access of people with disabilities to safe and healthy food must be ensured.
Tackling breast cancer where almost no care is available. A Europe-Africa partnership
Authors: Gajewski J , Pittalis C , Mwandira R , Schouten E , Brugha R
Published: October 2023

Background

African and European societies share similar challenges, such as the growing cancer burden, and are committed to equity and women's health, as highlighted at the 2022 EU - African Union summit. Breast cancer - the most common cancer worldwide and the leading cause of cancer death among women - disproportionately affects individuals in low-resource settings such as Malawi, where only 9.5% of patients survive beyond 18 months. Early detection and treatment could bring hope and extend the healthy lives of these women. The Akazi project, a collaboration between partners from Ireland and Malawi, is implementing a health systems platform to achieve this goal.

Methods

Based on the six WHO health systems building blocks framework, a mixed methods health systems capacity assessment was done in Malawi in 2022 to inform the development of a national breast cancer strategy.

Results

Major gaps were identified in all building blocks, critically in human resources, as no training in breast health was available in the country, and the number of trained health workers was critically low. Only five breast surgeons, five oncologists and one pathologist practice nationwide. In response, a breast health course was developed, tested and implemented with endorsement from MoH. Two cohorts of frontline workers have been trained (n = 37). Local health authorities have designed and implemented community breast care awareness activities.

Conclusions

This simple intervention provides the basis for critical improvements in national breast cancer services in Malawi. Akazi-funded breast health training needs to be rolled out country-wide by the Ministry of Health and significant infrastructure and human resources investments. Technical and financial support from the global North is essential to ensure progress towards Universal Health Care in Africa.

Key messages

• Bridging inequities in breast cancer outcomes requires systematic health systems strengthening.

• EU-Africa research collaborations can fill critical knowledge gaps through systems analyses to guide national cancer control strategies.
Impact of health education on sexual safety among Hungarian adolescents
Authors: Major D , Szabó K , Fazekas-Pongor V , Arva D , Falus M , Eörsi D , Terebessy A
Published: October 2023

Background

The aim of sexual health education is to raise awareness of sexual safety, i.e., to prevent unwanted pregnancies, sexually transmitted infections, and emotionally harmful experiences. The Balassagyarmat Health Education Program (BEP) is a comprehensive health education program covering different areas of health, including sexual health, targeting all high school students of a Hungarian town. The goal of our study is to measure the impact of BEP on adolescents' knowledge of sexual safety.

Methods

Tenth-grade students from three academic years (2018-2020) were included in our analysis. Since the class of 2018 received no intervention, it was considered as the control group. Tenth-grade classes of 2019 and 2020 each took part in the health education program (2 out of 10 sessions on sexual safety). After the intervention, students filled out an online questionnaire regarding their sexual attitudes and health behaviors. Open-ended questions were evaluated with quantitative content analysis done by two independent coders. Participants were asked to identify the safest form of protection, and those who offered an appropriate explanation were considered as “conscious” students. Proportions of answers within each academic year were compared with Chi-squared tests.

Results

768 students completed our questionnaire (group 2018: 315; group 2019: 274; group 2020: 179). Compared to the control group, a significantly higher proportion of students in the intervention groups considered the condom to be the safest protection method (76.2%; 90.9%; 81.0% respectively) and fewer considered the same for contraceptives (21.6%; 7.7%; 16.8%). The intervention groups also exhibited a significantly higher proportion of conscious students compared to the controls (21.6%; 49.8%; 30.3%).

Conclusions

Even though our study confirmed that adolescents' knowledge of sexual safety can be improved, a relatively low proportion of students is aware of the purpose of protection.

Key messages

• Health education programs are effectively able to improve knowledge of sexual health and safe sex practices with a higher proportion of health-conscious individuals as a result of the intervention.

• Since better knowledge is associated with more health-conscious behaviors, the purpose of protection should be emphasized more as students were not always able to explain their choice of protection.
Health literacy and health behaviors 3E 2S of Medical Profession
Authors: Mayod N
Published: October 2023

Background

Health literacy (HL) and health behaviors (HB) include skills needed to make appropriate health decisions and successfully navigate the health care system. However, the survey of HL and health behaviors of medical professionals is limited. This cross-sectional study aimed to assess the level of HL and health behaviors 3E 2S of the medical profession, Rajavithi hospital, and their association.

Methods

Two hundred and eighty-eight medical doctors were recruited and completed three parts of a self-administered questionnaire: demographics, HL, and health behavior 3E 2S scale of Thai adults (2018-revised edition). This HL questionnaire has six components with scoring criteria, and interpretation is designed by the Health Education Section, Health Service Support Department, and Ministry of Public Health. Pearson correlation coefficient was performed. The ethics committee Rajavithi Hospital approved this study.

Results

Of 288 medical doctors, 59% were female, and the mean age was 30.11±5.77 years. Most had overall HL at good and upper level 54.7%: cognitive skills 70.8%, access to health information 76.7%, health decision making 61.3%, media literacy 66%, and self-management 55.9%. A moderate level of health communication was 35.4%. Most subjects had a poor level of health behavior at 60.8%. HL was positively associated with health behavior (r = 0.483, p < 0.001). Single status significantly related to HL (p = 0.002) and HB (p = 0.011).

Conclusions

Health literacy was at a good level. Health communication requires improvement. Health behaviors 3E 2S were poor. The organization should formulate a policy. A role model and health program should be proposed to develop health literacy skills best suited for the target group.

Key messages

• Health literacy can help us prevent health problems, protect our health, and better manage health problems when they arise.

• Improved health literacy skills are something that anyone can benefit from, especially if you are dealing with a chronic condition or illness.
Evaluation of a nutrition education program at the Dutch out-of-school care during summer holidays
Authors: Battjes-Fries MCE , Hoefnagels F A
Published: October 2023

Background

School-based nutrition education has increasingly been used to teach children about nutrition. With over half a million children attending out-of-school care in the Netherlands, this might be a suitable setting for nutrition education as well. The aim of this study was to evaluate the implementation of the program ‘Spoony's Gezonde Smikkelweken’ for out-of-school care among staff and parents.

Methods

The program consists of 4 cooking, play and eating activities, a home-workbook and an online platform to promote vegetable consumption during the holidays. In July 2022, 585 out-of-school care locations for 4-12 year-olds across the Netherlands implemented the program. All locations received digital questionnaires to be distributed among the staff and parents on appropriateness, implementation, appreciation and perceived effects. Also semi-structured interviews were conducted with 11 employees for more detailed feedback.

Results

The questionnaire was filled out by 410 employees before the program and by 327 employees and 79 parents after the program. The 4 activities were implemented by 77%-96% of the locations. The staff was generally positive about the program; easy to fit into their daily routine (90%), suitable for the children (82%), well-organised (92%) and willing to implement it again (99%). Besides, they reported a higher number of children willing to taste vegetables after the program than before (57% vs. 37%) and vegetables eaten more often as a snack and at lunch (+17%). A majority of the children took the workbook home (82%) and did one or more activities from it (84%). Parents were generally positive about the program (4.6±0.8) and the attention to healthy eating at this setting (99%).

Conclusions

This program has been successfully received by staff and parents as a suitable form of nutrition education at out-of-school care. Despite a low response rate among parents, it appeared promising to also reach children's home situation.

Key messages

• Nutrition education provided by out-of-school care seems suitable, similar as provided at schools.

• Spoony’s ‘Gezonde Smikkelweken’ appeared a suitable program for Dutch out-of-school care.
Prevalence of major noncommunicable diseases and their associated risk factors in Afghanistan
Authors: Noormal A S , Winkler V , Busari S , Horstick O , Louis V R , Deckert A , Antia K , Elkhoury Z , Dambach P
Published: October 2023

Objective

Afghanistan is dealing with a double burden of diseases and yet there has been no evidence synthesis of the scientific literature on noncommunicable disease (NCDs), thus this study fills the gap by systematically analysing the prevalence of four major NCDs and the associated risk factors.

Methods

We performed a systematic review and meta-analysis of the studies published since 2000, reporting the prevalence of diabetes, chronic respiratory diseases (CRDs), cardiovascular disease (CVDs) or cancer, and their risk factors in Afghanistan. Four online databases (PubMed, Web of Science, Cochrane, and Google Scholar) and two local peer reviewed journals in Afghanistan were systematically searched using the predefined keywords. Two reviewers independently screened and appraised the quality of the papers. Data extraction and data synthesis were carried out using tabulated template. Stata 13 was used to perform the meta-analysis.

Results

58 articles included in this review of which 13 focused on cancer, 10 on diabetes, 7 on CVDs, 5 on CRDs, and 23 on any of the risk factors as primary outcome. Very few articles reported the prevalence of 4 NCDs in general population where cancer was reported 0.15%, asthma ranged between 12.5% to 17.3% and no evidence on CVDs. The pooled prevalence for diabetes, hypertension, and overweight were 12%, 31%, and 35% respectively. Central obesity was almost twice prevalent in females (76% vs 40%). Similarly, the pooled prevalence of smoking and snuff use were 14% and 25% in males, and 2% and 3% in females respectively.

Conclusions

Less evidence is available on the prevalence of major NCDs in Afghanistan, however, the risk factors for NCDs are prevalent across the country. The quality of the available data specially those of the local resources are poor, therefore, further research should be conducted to generate reliable evidences to inform the policy makers on prioritization of the interventions for the control of NCDs in Afghanistan.

Key messages

• The prevalence of NCDs is escalating in Afghanistan, and the local data show higher estimates of NCDs and their associated risk factors.

• Prevalence of NCD risk factors is relatively high in Afghanistan, and considering the political emergency situation, if preventive measures are not taken properly, the burden of NCDs may increase.
The burden of breast cancer attributable to modifiable risk factors
Authors: Todorovic J , Santric-Milicevic M , Stevanovic A , Devleesschauwer B , Stoisavljevic S , Bjegovic- Mikanovic V , Terzic-Supic Z , Stamenkovic Z , Vojvodic K
Published: October 2023

Introduction

Breast cancer (BC) is a preventable non-communicable disease and the most common cancer among women of reproductive age. Although largely associated with non-modifiable risk factors, the prevention of modifiable risk factors for BC (smoking, alcohol use, physical inactivity, and dietary risks) can help decrease society's burden. The aim of this study was to examine the BC burden among women of reproductive age attributable to these risk factors in the ten leading countries in the World Health Organization (WHO) European region, in order to describe the potential burden which can be avoided.

Methods

Within the EU CA 18218, we analyzed Disability-Adjusted Life-Years (DALY) rates of BC per 100,000 among women aged 15-49 years attributable to the four modifiable risk factors: smoking, alcohol use, physical inactivity and dietary risks. Estimates were taken from the Global Burden of Disease Study 2019, for ten countries with the highest DALY rates of BC in WHO European region in 2019: Monaco, Georgia, Bulgaria, Montenegro, Ukraine, North Macedonia, Armenia, Serbia, Greece and Romania.

Results

The highest DALY rate for BC was in Monaco (758.37) and Georgia (708.99). The highest DALY rate attributable to the four modifiable risk factors combined was in Monaco (178.89) and Bulgaria (171.68). The highest attributable DALY rate to smoking was in Bulgaria (49.04), and Monaco (44.67). The highest attributable DALY rate to alcohol use was in Ukraine (87.24) and Bulgaria (83.25). The highest attributable DALY rate to physical inactivity was in Monaco (9.88), followed by Bulgaria (3.49), as was the DALY rate attributable to dietary risks (48.51, and 35.90, respectively).

Conclusions

The variable burden of BC attributable to the modifiable risk factors between the examined countries calls for strengthening regional activities. The proportion of BC burden attributable to these risk factors is non-negligible, given its impact on the total burden of the disease.

Key messages

• A combination of four modifiable risk factors significantly contributes to the burden of breast cancer.

• Regional collaboration on risk factors is needed to prevent the burden of breast cancer.
National Health Index shows an increase and marked regional differences in diabetes burden in Finland
Authors: Jousilahti P , Lindström J , Koponen P , Lindell E , Sarnola K , Luoto R , Koskinen S
Published: October 2023

Background

The National Health Index contributes to the data bases needed for monitoring population health and development of health promotion policy and social and healthcare services. It includes a Morbidity Index and a Work Ability Index. The Morbidity Index is built on seven sub-indexes estimating the prevalence of the main components of the overall disease burden. The aim of this study is to describe the five-year time trend and regional differences in diabetes burden in Finland.

Methods

Diabetes index is based on four register data sources: (1) diagnosis in out-patient care, (ICD-codes), (2) hospital discharge diagnosis (ICD-codes), (3) purchase of diabetes medication (ATC-codes), and (4) special reimbursement for diabetes medication. Both non-standardized and age-standardized indexes were calculated. The time trend analysis is based on three three-year periods: 2017-2019, 2018-2020 and 2019-2021 for the whole country and separately for 22 regions. Index value 100 represents the average national level in the last period.

Results

National diabetes index increased from 94.9 in the first to 100 in the last follow-up period. The age-standardized values were 96,7 and 100, respectively. In 2019-2021 Åland region had the lowest index value (64.2) followed by Helsinki city (72.6). The highest index value (134.5) was observed in South Savo region. Age-standardization reduced the differences between regions which, nevertheless, remained remarkable: 63.2, 84.8 and 106.7, respectively. Furthermore, the highest age-standardized index value (117,5) was observed in South Ostrobothnia region.

Conclusions

Diabetes burden is still increasing in Finland, and there are marked differences between regions. The increase and regional differences are partly explained by changes and differences in age-structure but also other (preventable) factors play an important role. In general, diabetes burden is highest in eastern and northern parts of the country.

Key messages

• Diabetes burden is still increasing in Finland, and there are marked differences between regions.

• The increase and regional differences are partly explained by changes and differences in age-structure but also other (preventable) factors play an important role.