bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistent organic pollutants and developmental trajectories of ADHD symptoms: The Rhea cohort study
Authors: Mouatsou C , Margetaki K , Kampouri M , Psoma S , Roumeliotaki T , Vafeiadi M , Chatzi L , Kogevinas M , Koutra K
Published: October 2024

Background

Prenatal exposure to persistent organic pollutants (POPs) has been linked to elevated symptoms related to attention deficit hyperactivity disorder (ADHD) in a few studies, but findings remain inconclusive. We aimed to explore how prenatal exposure to POPs affects the developmental course of ADHD symptoms from early childhood to adolescence in the Rhea cohort in Crete, Greece.

Methods

We determined concentrations of HCB, DDE, and PCBs in first-trimester maternal serum. Child ADHD symptoms were reported by mothers using the ADHD Test at 4 years and the Conners’ Parent Rating Scale at 6, 11 and 15 years. Group-Based Trajectory Modeling was used to classify 551 participants into 4 distinct groups: Stable low (60.1%), Stable high (9.6%), Low-increasing (14.6%), and High-decreasing (15.7%) symptoms. Adjusted multinomial regression models were applied to assess the risk of being grouped into an adverse developmental trajectory as compared to the reference group (stable low), in relation to prenatal POP exposure in 465 children. The analyses were performed in sex-specific manner.

Results

Prenatal HCB exposure was associated with elevated risk of being grouped in the stable high ADHD symptoms trajectory only in girls (RRR [95%CI]: 2.0 [1.04, 3.82]). Overall, exposure to DDE and sum of PCBs was linked to decreased risk of membership in an adverse ADHD symptoms trajectory. More specifically, in utero exposure to DDE and sum of PCBs was associated with lower risk of being grouped in the low-increasing trajectory for boys (RRR [95%CI]: 0.7 [0.54, 0.95] and 0.5 [0.32, 0.88], respectively) and in the high-decreasing symptoms group for girls (RRR [95%CI]: 0.6 [0.44, 0.84] and 0.5 [0.30, 0.93], respectively).

Conclusions

The findings suggest that prenatal exposure to HCB is linked to increased risk of stable high ADHD symptoms from preschool age and up to adolescence. The association was pronounced only in girls, a group for which less is understood in relation to ADHD.

Key messages

• Prenatal exposure to HCB increases the risk of persistently high ADHD symptoms from preschool age to adolescence.

• The impact of prenatal HCB exposure on ADHD symptoms is evident in girls.
An intergenerational study of mental health among parents and adolescents
Authors: Labriola M , Lund T , Lindholdt L
Published: October 2024

Background

The aim of this study was to examine the association between parents’ mental disorders and adolescents’ self-rated health, using both subjective and objective assessment of parents’ mental health status.

Methods

This cohort study was based on the Danish Future Occupation of Children and Adolescents cohort. Study population 25,891parents (biological parents or registered guardians) linked to 13,067 adolescents. Survey data were merged with register data on parent mental health, and logistic regression was used to analyse association between the register- and self-report data on parents mental health, and self-rated global health among their offspring.

Results

Adolescents’ self-rated health was associated with their parents’ mental disorders, showing an unadjusted OR of 1.5 (95% CI 1.4-1.6) when assessing parental mental disorders using ICD-10 diagnoses and an unadjusted OR of 2.0 (95% CI 1.8-2.2) when using the adolescents’ self-reported measure on the parental mental disorder. Adjustment for adolescents’ sex, adolescents’ mental disorders during childhood, parental education, and parental labour market attachment led to a decreased association between parents’ mental disorders and adolescents’ self-rated health in both analyses with an adjusted OR of 1.2 (95% CI 1.1-1.4) when assessing parents’ mental disorders using ICD-10 diagnoses and an adjusted OR of 1.8 (95% CI 1.6-2.0) when using the adolescents’ self-reported measure on parental mental disorder.

Conclusions

This study documents a clear pattern in mental disorders across generations and that parental labour market attachment as well as mental disorders in earlier life phases are risk factors for developing mental disorders in adolescence. The results point to the importance of public health interventions aimed at the more vulnerable group of adolescents, where mental health problems are observed over two generations.

Key messages

• There is a clear pattern in mental disorders across generations.

• Parental labour market attachment are risk factors for developing mental disorders among their offspring.
Demographic, socioeconomic and lifecourse risk-factors for internalized weight stigma
Authors: Hughes A , Flint S W , Clare K , Kousoulis A A , Rothwell E R , Bould H , Howe L D
Published: October 2024

Background

Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with social factors in a large general population birth cohort study for the first time.

Methods

In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, and sexual orientation using multivariable regression. Using data collected over a 32-year period, we explore the impact of family, peer, and wider social influences in adolescence, and bullying from mid-childhood to adulthood, whilst minimising risk of recall bias.

Results

In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (0.56 S.D. higher, CI:0.50-0.61), sexual minorities (0.17 S.D. higher, CI:0.09-0.24), and less socioeconomically advantaged individuals (0.16 S.D. higher (CI:0.08-0.24) for those whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (0.13 S.D., CI:0.03-0.23), and the media (S.D. 0.17, CI:0.10-0.25), or had experienced bullying (0.25 S.D., CI:0.17-0.33 for bullying at age 23 years).

Conclusions

Internalized weight stigma differs substantially between demographic groups, and this is not explained by differences in BMI. The family environment during adolescence, bullying, and pressure to lose weight from the media may have long-lasting impacts on adult IWS. These may be fruitful avenues for intervention to reduce IWS and its consequences.

Key messages

• Females, sexual minorities, and socioeconomically disadvantaged adults are at greater risk of IWS irrespective of BMI.

• To reduce IWS, interventions should improve the family and social environment.
Workplace health promotion in the German Federal Armed Forces-Economic analysis and health benefits
Authors: Ludwig S , Seeland U , Arnold L , Roehle R , Dickob C , Hauck M , Ucar J , Willich S N , Reinhold T , Roy R
Published: October 2024

Background

In the German Federal Armed Forces (GFAF) workplace health promotion measures (WHPM) are implemented since 2015 to promote the health of military and civilian employees and thus improve the ability to defend state interests. Here the aim is to evaluate the social and health benefits associated with WHPM in relation to expenditures for WHPM.

Methods

Calculations are based on data from departmental reporting (full survey) on WHPM, the number of participants and days of incapacity for work (DIW). Mean indirect costs for the WHPM participation and DIW were calculated as 249.33 Euro per DIW. To assess the costs for the use of health care services and social and health benefits a longitudinal observational study (T0: 06-09/2022; T1: 06-09/2023) was conducted online and paper based. The survey invitation was addressed to 223.967 employees of the GFAF. Statistical analyses were performed using R software.

Results

In departments offering WHPM the chance of DIW is lower (-19%) compared to departments without WHPM offers and in case of DIW, the duration is shorter (-10%). In T0 23.568 (10.5%) and in T1 14.059 (6%) employees participated. 63.9% (T1: 3.070/4.805) reported positive effects of WHPM on their working ability and general health status (T1: 63.0% (3.013/4.782)). Of those participating in WHPM 81% (T0: 5.442/6.716) would recommend the GFAF as an employer. A number of 4.540 employees participated in both surveys, of which 2.249 participated in WHPM. The average costs per employee participating in WHPM compared to employees not participating are 0,4% higher (T0; T1: 3,5%) and thus almost equal.

Conclusions

Although WHPM need expenditures, the total costs per employee participating and not participating in WHPM are comparable. WHPM participants report better self-rated health status, higher working ability and commitment to the employer than non-participants. The chance of DIW is reduced in departments offering WHPM to its employees.

*shared authorship

Key messages

• Although WHPM need expenditures, the total costs per employee participating and not participating in WHPM are comparable.

• Employees participating in workplace health promotion measures report higher working ability and commitment to the employer.
Strategies to advancing digital health equity: perspectives from underserved groups
Authors: Wilson S , Tolley C , Mc Ardle R , Slight R , Hassan N , Slight S
Published: October 2024

Digital Health Technologies (DHTs) are revolutionizing healthcare. However, there is a lack of demonstrable health benefits across all populations. To advance digital health equity, we explored the perspectives of underserved groups on strategies to support digital inclusivity. Participants belonged to two or more CLEARS (Culture (ethnicity, language, religion), Limiting conditions (visual or hearing), low Educational attainment, older Age, Residence (rural, deprived or no fixed address), low Socioeconomic status) groups. This framework encompassed sociodemographic factors associated with digital exclusion and recognizes the role of intersectionality.(1) Twenty-nine individuals participated in focus groups (n = 4) or interviews (n = 11) and shared their perspectives on the barriers to DHTs, innovative ideas to improve inclusivity, and perceived feasibility of implementing changes. An inductive reflective thematic analysis was used to analyze the transcripts, assisted by N-Vivo. Participants experienced fragmented communication with healthcare providers when using DHTs, explaining how they received a no-reply SMS message asking them to confirm an appointment via a link but were unable to access the link. Current solutions to overcoming such barriers included using non-digital routes (e.g., visiting a pharmacy) or calling non-emergency healthcare services. Many participants expressed the need for DHT support services to be implemented to provide educational support and access to devices. However, some participants raised concerns about the financial strain this might place on healthcare systems. Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity.

(1)Wilson et al. (2023). Strategies to develop, design, implement and support digital health equity in key underserved groups: protocol for a systematic review. Alzheimer’s & Dementia.

Key messages

• Strategies to mitigating digital exclusion within healthcare should be designed with underserved groups.

• Future research should evaluate the feasibility of implementing different DHTs support services across different settings to advance digital health equity.
Accessibility engineering in the mhealth industry - A multi-case study
Authors: Hasenlust K , Reinschluessel A V , Rother M
Published: October 2024

Medical apps, i.e. apps that fall under the EU Medical Device Regulation (MDR), are increasingly becoming a relevant part of healthcare in European countries. This is particularly evident in the numerous partnerships between app vendors and insurers as well as in the launches of national reimbursement programs. However, when it comes to enabling as many patients as possible to benefit from the medical advantages associated with the use of these apps, funding is only one part of the equation. It is up to the app vendors to develop barrier-free user interfaces so that people - regardless of individual characteristics such as cognitive abilities, physical limitations or language skills - can interact successfully with the app. Little is known about how these companies approach the topic of accessibility, what challenges they face and how big the impact of medical device legislation and other regulations on accessibility is. Against this background, we are undertaking a case study in several companies offering apps on the German market that are certified as medical devices and targeted at patients. Through interviews with employees with various roles (e.g. business, engineering, design) we are aiming at reconstructing the development processes of the apps with a focus on accessibility. We plan to expand the results by interviews with experts, e.g., in the area of MDR conformity assessment. 20 interviews in four companies have revealed that accessibility only plays a minor role during development. As a result, the topic is not systematically addressed, but only a few features are implemented. The app’s compatibility with screen reader or voice control was not explicitly addressed in any of the companies. There was also no deliberate involvement of people with disabilities in user studies. The preliminary results also indicate that the influence of medical device legislation on the implementation of accessibility is negligible.

Key messages

• User interface accessibility has a very low priority in the mhealth companies we have examined so far.

• The current regulations are not sufficient in enforcing the basic implementation of accessibility features requiring more guidance and detailed regulations, given our sample of companies.
Assessment of digital literacy and user experience in patients with cochlear implants
Authors: Werminghaus M , Thyson S , Schatton D , Richter J G , Klenzner T
Published: October 2024

Introduction

The cochlear implant (CI) is the treatment of choice for people affected by deafness or profound hearing loss. Patients with cochlear implants (PwCIs) can enhance their hearing outcomes using digital hearing training programs (dHTPs). Current technological trends leans towards personalized, AI-driven dHTPs, aiming to optimize user experience (UX) and adherence. This study aims to investigate the digital literacy skills and UX of PwCI before and after testing a prototype of a dHTP with an AI-driven design (TraiCI).

Methods

Two research-specific questionnaires developed by the Hearing Center Düsseldorf (QDL and QUX) were used to assess digital literacy skills and user experience in TraiCI. Additionally, the User Experience Questionnaire (UEQ) was employed to evaluate general user experience. The UEQ assesses software quality across dimensions such as transparency and stimulation using paired opposites.

Results

22 outpatient PwCIs the Hearing Center Düsseldorf with unilateral or bilateral CI (mean age 54 years; SD = 15) were included. In QDL, PmCI demonstrated high levels of digital literacy skills. The majority of PmCI (80.6%) reported prior experience with dHTP. Usage of these programs occurred daily to multiple times per week within the first six months after CI treatment, with session durations predominantly ranging from 10 to 30 minutes. QUX data indicated a smooth initiation process (70.8%) and seamless login experience (95.5%). The UEQ addressed various aspects of user experience, with ‘transparency’ receiving the highest scores (MW = 1.9; SD = 0.6), while ‘stimulation’ received the least positive ratings (MW = 0.0; SD = 2.1).

Conclusions

The results show a high degree of digital literacy among PwCIs. They encountered minimal challenges in operating hardware and software components. Further refinement is necessary to align with PwCI’s expectations and maximize benefits. Early and iterative involvement of PwCIs in future projects could optimize outcomes.

Key messages

• The study highlights the proficient digital literacy skills of cochlear implant patients (PwCIs).

• Further refinement of dHTPs is needed to better align with PwCIs’ expectations and maximize benefits, emphasizing the importance of iterative involvement for optimized outcomes.
Patients’ trust in health information sources as an antecedent of novel healthcare technology usage
Authors: Gur A , Avidar R
Published: October 2024

Background

As professional health information sources, healthcare maintenance organizations (HMOs) need to convince patients of the necessity, efficiency, and reliability of technology-based services to increase and optimize their usage. It raises the question of whether patients’ trust in health information sources shapes the use of technology-based services and, in return, increases their willingness to use novel healthcare services in the future.

Methods

Data were collected through an online close-ended survey among 668 adult Israeli citizens insured with Israeli health insurance (85% of them Jewish, 52.5% female, and in their early 40s, with half holding an academic degree). The survey explored actual use and willingness to use innovative healthcare technologies and the trust respondents attributed to various sources of health information. Data were analyzed by SPSS 28.

Results

Participants generally use healthcare technology primarily to schedule appointments, search for medical information, and make health-related requests. To quite an extent, they are willing to be treated with innovative healthcare technologies (e.g., for radiological purposes and personally tailored medication). Preliminary results suggest that trust in the measured formal health information sources (i.e., formal health providers, HMO, HMO online services) was positively associated with technology-based healthcare services usage (r=.14 - .20, p<.001). A positive association also emerged between the current use of healthcare technology and the willingness to use innovative medical technologies in the future (r=.23, p<.001).

Conclusions

HMOs, as key players, have the power to maximize the usage of advanced health services by establishing trusting relationships with their patients. This will increase the usage of healthcare technology-based services and generate positive patient experiences, which will result in the willingness to experience novel types of health services in the future.

Key messages

• Encouraging patients to use technology-based health services will maximize the potential inherent in the use of innovative health services and treatments in the future.

• Nurturing trusting relationships with patients at any level in the health system will increase their compliance with health providers’ recommendations to use advanced health services.
Debuting an innovative model for integrated child health care in the Southeast region, Bulgaria
Authors: Vankova D , Nikolov D
Published: October 2024

Background

Demographic indicators are fundamental drivers for health policy action. The Southeast Region (SER) is the largest statistical region (NUTS 2) in Bulgaria (BG), distinguished by the highest Infant mortality rates (IMR) and teenage crude fertility rates across the European Union (EU). For instance, the 2022 statistics reveal an IMR of 8.2 per 1000 live births in SER, notably higher than Bulgaria’s average of 4.8 and the EU’s average of 3.3. This disparity highlights the critical need for region-specific health initiatives aimed at curtailing IMR and harmonizing health outcomes throughout the EU territories. This report outlines such an initiative under the project code BG16FFPR003-2.001-012, recently funded by the EU. The novel SER initiative: This is the first presentation of the concept of integrated territory investments (CITI) and the innovative model for integrated child health care in SER, BG. The project impacts child health care across the four districts of SER - Burgas, Sliven, Yambol, Stara Zagora. The municipalities have collaboratively submitted 24 project proposals with educational bodies, NGOs, public institutions, and the Ministry of Health. The theoretical frame of the project’s model is underpinned by three foundational pillars: 1) Prevention in primary healthcare; 2) Child health care in hospitals; 3) Development of human resources, providers of health care. The forthcoming infrastructural, organisational, and capacity-building interventions will remain adaptable yet aligned with the overarching CITI framework.

Conclusions

A current phase of public discourse on the CITI concept and the innovative integrated model in SER is underway. Stakeholders are actively encouraged to provide input either through discussions or by participating in designated online surveys. Community engagement is instrumental in evaluating and prioritizing these initiatives, which aim to fundamentally transform the SER by leveraging its unique territorial potential.

Key messages

• Demographic indicators drive health policy. Project BG16FFPR003-2.001-012 targets EU disparities, lowering IMR and balancing fertility rates.

• This is the first presentation of the “Innovative model for integrated child health care in SER”. The EPH Conference provides an ideal platform for sharing and discussion.
Intergenerational Transmission of Overweight and Obesity among Preschool Children in Sweden
Authors: Kodagoda H , Lindkvist M , Ivarsson A , Silfverdal S-A , Vaezghasemi M
Published: October 2024

Background

Child overweight including obesity (OWOB) has quadrupled globally, since 1975. It affects a third of European children and even higher rates persist among expectant parents. Parental pre-pregnancy body mass index (BMI) and health behaviours are known to influence offspring health. Thus, this study aimed to investigate the link between parental and children’s OWOB, alongside parental socio-economic and other factors.

Methods

This is a population-based repeated cross-sectional study utilized data from the Salut Programme in Västerbotten, Sweden, and Swedish national registers, including 5,937 of 3-year-olds and their parents. Logistic regression analyses were used to examine the association of child BMI with prenatal BMI and other factors. Further, the Relative Excess Risk due to Interaction (RERI) arising from the interplay between parent’s OWOB status in relation to their children’s OWOB was calculated.

Results

OWOB prevalence rates for 3-year-olds, expectant mothers, and their partners were 15.1%, 29.1%, and 53.5%, respectively. Both parent’s OWOB significantly affected children’s BMI (with strongest association for mothers). The Relative Excess Risk due to interaction (RERI) was positive for children’s OWOB if both parents were obese, showing an additive interaction effect of individual parental obesity status. The odds for a child to be OWOB was 2.88 (1.83-4.43) if both parents were obese compared to if none of them were obese.

Conclusions

OWOB among preschool children remain an important public health concern in Sweden. Based on the study findings, Sweden’s regional and national public health initiatives should prioritize targeting parental overweight and obesity as a key strategy to reduce the burden of OWOB among children. Furthermore, the resemblance of these results with comparable studies across the world, emphasizing the importance of initiating interventions with parents before pregnancy or even earlier.

Key messages

• Parental combined obesity status significantly increase the odds of childhood overweight and obesity.

• The importance of initiating interventions with parents before pregnancy for better health outcomes related to child BMI.
Barriers and Facilitators in Implementation of Nutritional Benefit Transfer to Tuberculosis Patients
Authors: Singh M K , Mahapatra A , Kandpal S D , Salah H , Sharma K
Published: October 2024

Background

Malnutrition & Tuberculosis (TB) form a vicious cycle. Nikshay Poshan Yojana (NPY) is a key strategy for a TB free India, that seeks to provide financial assistance for nutritional support to TB patients. The study is a qualitative study to identify operational challenges and facilitators in implementation of NPY

Methods

In Depth Interview (IDI) of 18 Senior Treatment Supervisor (STS) at Tuberculosis Unit (TU) and 19 Tuberculosis Health Visitor (TB HV) at Designated Microscopy Centre’s (DMC) was done. For further insights, the STS, at District Tuberculosis Centre, Lucknow was also interviewed. Informal discussion was done with about 50 Tuberculosis patients. We explored providers perspective on impact of NPY on other duties/services, case load, hours dedicated to NPY, practice protocols, record keeping and data management, compliances, capacity building needs, quality protocols, key enablers, motivating factors, challenges, best practices and beneficiary’s perspectives on quality of life, facilitators and challenges in availing services.

Results

Motivating leadership, supportive staff, good working relationship and seamless communication, teamwork, use of technology, supportive supervision & collaboration and support of NGO for private sector were the key facilitators. Barriers comprised system level barriers (Budget constraints, issues with NIKSHAY software and bank account), provider level barriers (shortage of human resource, nonfunctional tablets) and patient level barriers (stigma and bank account related challenges). The encouraging finding was majority of recipients, responding that they used the incentive to purchase ration, vitamin supplements etc.

Conclusions

NPY is having its intended benefit but there are barriers that need to be resolved for successful roll out. The study yield suggestions for removing barriers and found a set of innovations that can be replicated across other settings with high Tuberculosis burden

Key messages

• Malnutrition and Tuberculosis form a vicious cycle. Nutritional support to TB patients improves treatment outcome and can save lives.

• Operational research on implementation of NPY offers insights for successful roll out of this key initiative across other resource limited settings in developing countries.
Health in Germany – A new panel infrastructure for Public Health Research in Germany: study design
Authors: Öztürk I , Lemcke J , Damerow S , Hintze M , Kuttig T , Heller T , Wetzstein M , Allen J , Schmich P
Published: October 2024

Background

The Robert Koch Institute (RKI) is developing a new panel infrastructure, ‘Health in Germany,’ to enhance public health research through continuous, rapid data collection from questionnaire surveys, measurements, and laboratory analyses. Using online and offline collection methods (CAWI and PAPI), the project aims to have 30,000 registered panelists by Spring 2024.

Methods

The sample of the recruitment study is based on address data from Germany’s local registration offices, whereby a mixed-mode design is used for data collection. Individuals aged 16-69 receive an initial online-only invitation, followed by postal reminders that include a paper questionnaire. For those aged 70 and above, both online and paper options are available from the outset. Incentives include an unconditional €5 cash payment for all invitees and an additional €10 for successful registration into the panel infrastructure.

Results

The initial response rate of the recruitment study is 35%. Of the CAWI participants, approx. 90% expressed willingness to participate again, with approx. 80% completing the online registration. To date, over 42,000 panelists have been recruited. Further detailed results on response rates, non-response bias, and sample composition will be presented at the conference.

Conclusions

RKI’s ‘Health in Germany’ is one of the largest probability panels in public health research, effectively gathering and analyzing data. The recruitment success and strong participant engagement highlight the infrastructure’s efficiency and its significant contribution to epidemiological research in Germany.

Key messages

• Successful recruitment of over 42,000 panelists demonstrates robust engagement and effective implementation.

• The push-to-web strategy (or web-push strategy) underscores the infrastructure’s adaptability and efficiency.
Tobacco Free Advent Calendar: Evaluating innovative strategies in Public Health digital campaigns
Authors: Lotrean D , Sargsyan Z , Bonarrio T , Antinozzi M , Mocanu K , Radu-Loghin C
Published: October 2024

Introduction

Two editions, 2022 and 2023, of the Tobacco Free Advent Calendar (TFAC) built a large network of Organizations, Universities, Institutions, individual experts and medical students across Europe, coordinated by ENSPNext (European Network for Smoking and Tobacco Prevention Youth Group), to advocate for Youth and for Public Health. This study has 2 objectives: 1. Monitor the performance of TFAC 2023 vs TFAC 2022 for 31 days 2. Evaluate improvements in reach and engagement made for TFAC 2023.

Methods

For 24 days, TFAC 2023 featured thematic messages, embedded fact sheets, quizzes, videos and call-to-action buttons. New content was accessible daily starting on the first day of advent, ending on Christmas. TFAC was available in English and Armenian. AI was used to assist for various tasks and challenges during development and research. Comparative and Time Series Analysis were conducted in Excel and IBM SPSS26.

Results

TFAC 2023 was accessed 3764 times (8.8% increase), the doors were opened 1506 times (3.9% decrease), Call to action buttons were clicked 261 times (169% increase). For english version a strong variation in reach was observed, but not in engagement which remained relatively constant. In Armenian version both reach and engagement varied in 2023 vs 2022. A seasonal component was identified for both versions, particularly an increase at weekends and a decrease on weekdays. Similar to 2022, the reach and engagement were higher at the start and lower as time passed, although in 2023 the reach and engagement remained higher and more constant over time. Completion rates of interactive materials ranged between 21.4% to 100% in the English version and from 7.1% to 100% in the Armenian version. No interactive material remained unanswered.

Conclusions

Decrease of translations didn’t lower the reach and engagement of TFAC. Engagement with TFAC 2023 was higher, possibly due to the implication of students organizations and collaboration with influencers.

Key messages

• Targeted dissemination increased the reach and engagement of TFAC 2023 versus TFAC 2022.

• Members of the target group should be recruited for being members in the projects affecting them to increase engagement and impact of the campaign.
How stop smoking outreach works: a co-inquiry informed, complex intervention model
Authors: Mills T , Dawkins L , Dean R , Lewis E , Wills J , Sykes S
Published: October 2024

Background

Across Europe, smoking prevalence is concentrating in underserved communities with high levels of deprivation. And yet, there is little research on how stop smoking services (SSS) can engage these communities. This study presents the findings of a 12-month collaboration involving an external public health research team and staff of an English SSS. Staff worked with community partners (e.g., schools) to raise awareness of the service, which included a newly introduced e-cigarette offer.

Methods

A complex intervention model was developed and refined through 6 facilitated co-inquiry sessions involving 13 SSS staff. Staff also completed 32 reflection forms on outreach events and rapid ethnography was conducted, by the research team, to evaluate staff’s working assumptions. This included 8 observations of outreach events and interviews with 10 SSS staff and 8 community members, from the service target groups. Data were organised into themes.

Findings

The model presents a picture of stop smoking outreach as challenging, unpredictable and resource intensive yet often having great impact. The themes enrich this to highlight 1) the appreciation for yet unpredictability of outreach referrals for people disconnected from health services; 2) the importance of staff adopting a person-centred approach; 3) the challenges and opportunities presented by e-cigarettes; and 4) the role of strategic community partnerships in optimising staff time on outreach.

Conclusions

Stop smoking outreach can generate considerable interest in SSS, particularly when delivered in combination with an e-cigarette offer. Future research should explore the economic and social return on investment in community outreach: while time consuming, referrals generated proactively may become more important for SSS as smoking concentrates in underserved communities.

Key messages

• Stop smoking outreach is an effective way to raise awareness and generate referrals but must be done non-judgementally and via effective community partnerships.

• Staff’s careful discussion of an e-cigarette offer can change the perception of SSS without contributing to recreational normalization.
UROLATAM Project: A multidisciplinary comprehensive care project for prostate cancer
Authors: Viñas Dozal J , Autrán Gómez A M , Mondragon Delgado M J , Palmeros Exome C , Hurtado Capetillo J M , Ruiz Garcia F , Torres Hernandez R M , Hernandez Ojeda H , Ricardez Espinoza A A , Villegas-Dominguez J E
Published: October 2024

Introduction

Prostate Cancer (PCa) represents a health problem in the world and its management is heterogeneous in care, depending on the resources each country has, modifying its effectiveness in prevention, diagnosis, treatment and follow-up.

Methods

The UROLATAM program was implemented based on the Design Thinking quadruple helix innovation model, consisting of the immersion, design, idea and prototype phases, characterized by being multidisciplinary and comprehensive. Teachers and students from different careers at the Universidad Veracruzana participated. Linkages were made with: Local government, government health institutions, colleges of specialist doctors, private institutions and civil society. This program was broadcast on radio, television and social networks inviting the population to participate in education and prevention activities, in addition to participating in diagnosis, treatment and follow-up actions for men over 40 years of age. The duration of the program was 4 days, including educational sessions for doctors, patients, family members and caregivers, as well as determination of prostate-specific antigen, urological consultation and prostate ultrasound, as well as rehabilitation exercises, diagnostic confirmation and treatment. who needed it.

Results

During the sessions, 944 patients aged 60.7 (±15.0) years were treated, 443 (47%) had never received a urological consultation, identifying a prevalence of 11.7% of Cap. The human team present with the patient was 25 specialist doctors, 16 medical residents, 38 undergraduate students, 3 rehabilitators and 6 administrative staff. None of the participants received a salary for participating in this project.

Conclusions

The multidisciplinary UROLATAM linkage project constitutes a useful educational, training and assistance tool for the population, as well as an educational element for the students who are part of the work team.

Key messages

• The UROLATAM project is replicable in countries that require additional support in the prostate cancer approach.

• The structure of the UROLATAM project can be replicated to address other public health problems.
‘Freeze the measles’: how to improve backward tracing with a new digital tool
Authors: Daole A , Giorgi S , Bonaldo L , Cruschelli G , Spagnolo G , Gallo A , Rizzo C
Published: October 2024

Background

A measles outbreak occurred in Tuscany, between January and April 2024. There were 37 cases (Incidence: 40,5 per million) with 32 cases (24 confirmed) in the Health District of Pisa. Even if bidirectional tracing showed a better effectiveness in pandemics, there aren’t ready-to-use standardized tools for backward tracing.

Methods

Pisa Public Health Unit created a digital tool based on a spreadsheet and called “Freeze the measles” which records measles cases and the locations where they passed through (hotspots). These were uploaded on a cloud shared with all the tracers. Hotspots have an expiry date of 21 days. Hotspots and home address case were plotted on a digital map. In a new investigation, tracers could find out if the case visited some hotspots before getting sick and check the distance between home address and hotspots, reducing recall bias. Every case was interviewed about 21 days before rash onset (backward) and plus or minus 4 days of rash onset (forward). The tool matched data to identify contacts and exposure.

Results

Since the index case wasn’t found, the first 5 unrelated cases were considered index cases for this outbreak. Second and third wave involved 17 cases. The tool allows to find an epidemiological link for 16 of them, while 1 case remained unrelated. A super-spreader was identified with 12 secondary cases occurred at hospital emergency room (7), at a near home minimarket (4) and in a large furniture store (1). In second and third waves, tool was able to link 94% of cases. 2 additional cases were imported. When the last hotspot became frozen without new cases occurring, the outbreak was considered ended. The outbreak lasted 33 days.

Conclusions

The “Freeze the measles” tool allows to identify transmission chains through an interactive map built on cases and their mobility.

Key messages

• Contact tracing needs an appropriate backward investigation to be more effective.

• New digital tools as ‘Freeze the measles’ could improve preparedness and management of outbreaks.
Adoption and Utilization of Telemedicine and Digital Health Services among Older Adults in Israel
Authors: Haimi M , Sergienko R
Published: October 2024

Background

As the population ages and the prevalence of long-term diseases rises, telecare is being used increasingly frequently to aid elderly people.

Aims

We aimed to explore the usage and adoption of 3 types of telehealth services among the senior population in Israel- prior, during, and after the COVID-19 pandemic rise in Israel.

Methods

We explored the usage characteristics of older adults (age 65 and above) belonging to ‘Clalit’, in the use of three types of telehealth services: digital services for administrative tasks, synchronous ‘online visits’ with the patient’s personal physician during clinic business hours, and ‘afterhours’ consultations during evenings, nights, and weekends. The data was collected and analyzed throughout three distinct time periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic and following the COVID-19 ‘peak’.

Results

Data of 618850 patients who met the inclusion criteria was extracted. Telehealth services utilized for administrative purposes were the most popular. The older population significantly increased their use of all types of telehealth services during the COVID-19 period, and in the majority of types, this usage decreased after the COVID-19 peak, but to a level that was higher than the baseline level prior to the COVID-19 period. Prior to the COVID-19 period, 23.1% of the study population used ‘online visits’, and 2.2% used ‘afterhours’ consultations, at least once. The percentage of usage for these services increased during the COVID-19 period to 59.2% and 5.0%, and then decreased during the third period to 39.5% and 2.4%, respectively (P < 0.001). Multiple patient variables have been found to be associated with the use of the different telehealth services, in each time-period.

Conclusions

The senior population uses telehealth services, and can increase their consumption, when they are needed. Suitable and straightforward telehealth solutions tailored for this population should be created.

Key messages

• The senior population uses telehealth services, and can increase their consumption, when they are needed.

• Suitable and straightforward telehealth solutions tailored for this population should be created.
User technology for AI-supported objective measurement of Work-related Quality of Life (MI-LQ)
Authors: Schreiber C , Geisler M , Voigt J , Kosakyan H , Hohn J , Hamm A , Mut E , Burkhardt J M , Braumann U D , Militzer-Horstmann C
Published: October 2024

Background

Understanding and enhancing job satisfaction is crucial for improving Work-Related Quality of Life (WrQoL) in today’s office work environments. Our work uses multimodal data collection and analysis techniques to objectively assess WrQoL, thus mitigating respondent bias and survey fatigue. Leveraging machine learning (ML) and automated methods measuring WrQoL presents a promising approach in public health research, particularly concerning stress-related health outcomes.

Methods

Through a systematic literature search of 9,242 publications to identify WrQoL indicators, we selected over 100 publications for data extraction. A base model, including workload, commute, overtime, valence, and arousal was formulated. To amass a wide data set, Objective measurement tools (computers, smartphones, and wearables) complemented by questionnaire data. This data will inform ML algorithms to predict individual WrQoL indicators. Developed as an input/output data platform, an app-prototype will objectively assess WrQoL, facilitating a field study with office workers to refine the model. A mobile app prototype serves as a user interface and data relay for WrQoL metric analysis.

Results

Our research develops instruments for measuring WrQoL using smartphones, wearables, and specialized trackers for heart rate variability (HRV) analysis, alongside a software prototype for keyboard and mouse tracking for workload assessment of valence and arousal. Fitness trackers with photoplethysmography functionality are favored for HRV assessment.

Conclusions

The systematic search identified influences on WrQoL, translated into measurable indicators in a base model. Leveraging user tech for assessment and a ML and mobile app framework, this approach facilitates objective WrQoL determination. By presenting the relationship between digital service use and WrQoL indicators, this methodology promises new insights, informing stress and burnout prevention strategies within public health initiatives.

Key messages

• Progressive approach: ML-driven WrQoL assessment offers promising avenues for stress prevention in workplace health research.

• Methodological Advancement: The novel framework for WrQoL assessment using digital tools contributes to effective workplace health promotion strategies, with potential for tailored interventions.
Leveraging digital adherence technologies to enhance public health: insights from TB care in Ukraine
Authors: Kochanov V , Bogdanov A , Karpiuk K , Rodyna R , Germanovych M , Dravniece G
Published: October 2024

Background

Effective tuberculosis (TB) care is vital for public health, especially in war-affected Ukraine. In response to the complex healthcare delivery landscape, where traditional directly observation treatment methods became impractical, digital adherence technologies (DATs) emerged as a promising solution, offering more autonomy for people, and remote monitoring capabilities for healthcare providers.

Intervention

The PATH-led USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project implemented smart pill boxes in eleven Ukrainian regions. These devices equipped with built-in reminders helped people adhere to their medication regimen, and signaled healthcare providers when the box was opened.

Results

Since April 2022, STBCEU has supported 2,022 people with TB who used smart pill boxes during their treatment, including 489 (24%) with drug-resistant TB (DR-TB). A total of 482 people continue utilizing boxes. Of 1,540 people with TB who completed the use of boxes, 1,207 people (78%) successfully completed TB treatment with an average of 84% treatment adherence rate digitally reported by the technology.

Conclusions

The integration of smart pill boxes in TB management has enhanced people-centered care, ensuring treatment continuity even in challenging circumstances and providing healthcare providers with real-time adherence data. The innovation contributed to TB control efforts and health equity through expanding opportunities for people to choose their treatment model based on their needs, available resources and community support programs. Leveraging digital solutions proved to be essential in strengthening healthcare systems. In the realm of TB management, DATs enhance differentiated care, embodying a harmonious integration of technology automation and provider interventions.

Key messages

• Integration of smart pill boxes enhanced patient-centered care, providing real-time adherence data and empowering individuals to choose personalized treatment models.

• Digital technologies like smart pill boxes transformed TB care, offering tailored support for patients and remote monitoring capabilities for healthcare providers even in challenging circumstances.
International case studies: success and failure factors for digital transformation in healthcare
Authors: Kraft L , Brecher A L , Sgraja S , Amelung V E
Published: October 2024

Background

The digitalization of healthcare systems is expected to lead to improvements in the quality and efficiency of healthcare services. Despite Germany’s leading economic and technological position, the implementation and utilization of digital health solutions is lagging far behind internationally. A look at other countries shows that the digital transformation in healthcare can be successful, and that financial resources and available technologies are not the only determining factors. Rather, it is a matter of political processes, the interests of different stakeholders and the acceptance of patients and HCPs.

Methods

While the impression often arises that the selection of countries in case studies is random, eight international case studies were identified using a scientific method. A systematic and multi-stage process was developed to select the case studies, taking into account various relevant criteria (e.g. degree of digitalization, geography, economy). The implementation and use of various digital health tools will be examined in selected countries and healthcare systems, in which the digitalization of the healthcare system is particularly advanced. Semi-structured interviews will be conducted with experts from the international healthcare systems between fall 2024 and summer 2025. The findings will inform the development of recommendations for actions for policymakers in Germany.

Conclusions

This study aims to provide new insights into the key success and failure factors for the digital transformation of healthcare systems. Recommendations for action, tailored specifically to the German healthcare system and aimed at policymakers, are intended to support decision-makers in setting the course for a successful further transformation towards digital health.

Key messages

• International case studies will be used to identify factors that contribute to the success or failure of digital transformation in healthcare systems.

• Based on the findings of this research, recommendations for action will be developed for policymakers in Germany to set the course for the successful further digitalization of healthcare.