bluuebunny/crossref_metadata_2025 huggingface dataset:
“The Church of Fail”: Learning from Our Mistakes in Co-Creation (part II)
Authors: Ryom K , Agnello D , Jacobsen J S , Laursen M G , McCaffrey L , Vogelsang M , Chastin S
Published: October 2024

For the second activity, participants will be invited to break into smaller facilitated groups for a ‘peer-to-peer’ session where they will share further and discuss lessons learned and how they would do things differently going forward. They will do this by either working with one of their own failure stories/cases, or a predetermined case around critical aspects of co-creation, such as power imbalance or recruitment strategies. The groups will work with a facilitator and a template to discuss some key aspects of learning, such as what do you perceive as the failure, how could you address this, and the changes they could be made moving forward. The second session closes with each group nominating a presenter to share their reflections on the proposed solutions in plenary. The facilitator will close the workshop by inviting participants to sign up to join a collaborative effort to publish examples of failures and lessons learned when addressing complex public health challenges. This has the potential to increase awareness about the importance of embracing the power of failure, and break down the stigma that comes with admitting to your mistakes.

Speakers/Panelists

Sebastien Chastin

Glasgow Caledonian University, Glasgow, UK
Integrating AI in cause-of-death regular statistical production with human and expert system codings
Authors: Zambetta E , Razakamanana N , Robert A , Martin D , Coudin E
Published: October 2024

Background

Cause-of-death (CoD) statistics are key indicators in epidemiology and public health. These statistics are derived from death certificates completed by physicians and are usually coded by official statistics authorities according to the standards of the WHO ICD-10 classification to construct time- and cross-country-comparable statistics. For coding causes of death in free-text format in France according to ICD-10, predictions by deep neural networks (DNNs) are employed in addition to fully automatic batch coding by a rule-based expert system and to interactive coding by the coding team.

Methods

Seq-to-seq DNNs are trained from scratch on previously coded data to ICD-10 code multiple causes and underlying causes of death. Human coding is focused on certificates with a special public health interest or with low confidence in AI prediction quality to maximize the quality of the overall statistics disseminated when human resources are limited. DNNs also directly predict multiple causes and underlying causes of death for part of the certificates. Hence, the coding campaign aims to optimally allocate a coding mode to a given certificate.

Results

For deaths in 2021, 63% of the certificates are automatically batch coded by the expert system, 14% by the coding team, and 23% by DNNs. Compared to a traditional campaign that would have relied on automatic batch coding and manual coding, the present campaign reaches an accuracy of 95.7% for ICD-10 coding of the underlying cause (97.3% at the European shortlist level).

Conclusions

The 3-coding mode approach enables timeliness of dissemination of CoD statistics and may lead in the future to more responsive surveillance.

Key messages

• Deep neural networks trained on already coded data can be integrated into the regular statistical production of the CoD database in a fully controlled way.

• The allocation between the different modes of coding can be optimized to achieve best quality and timeliness under the constraint of limited human resources.
Effects of metaphorical communication on vaccine confidence in the adolescent population
Authors: Nuccetelli F , Gabellone V , Gabrielli E , Lopalco P L
Published: October 2024

Vaccine hesitancy, defined as delay or refusal of vaccination despite the availability of vaccination services, has been included by WHO among the top 10 global health threats. Individual decision-making process can be strongly affected by communication. The use of metaphors is common in public health communication and increased during the COVID19 pandemic. Although some evidence has supported the persuasive potential of metaphorical language over scientific language, further research is needed. Our study aimed at comparing the effects of neutral scientific talk with war and protective metaphors on health communication. An online survey was conducted on a convenience sample of Italian teenagers randomly allocated to three study arms. Each participant was invited to watch a specific version of an informative video on infections and vaccines (group 1: neutral-scientific approach, group 2: metaphorical-war, and group 3: metaphorical-protective approach). After watching the video, each participant responded to an ad-hoc questionnaire. A total of 2681 subjects were randomly allocated to the three groups. No significant differences regarding age, sex and geographical area were detected between groups. Median age of the sample was 17 years (mean 16,8) and 56.8% were girls. The general attitude towards vaccination in group 2 and 3 was largely positive, with the majority agreeing (strongly or tend to agree) on the fact that vaccination is important (group 2: 89%; group 3: 92%), safe (group 2: 91%; group 3: 92,5%), effective (group 2: 85%; group 3: 88%), and does not generate anxiety (group 2: 80%; group 3: 83%). Higher level of distrust against vaccines was found in group 1, where 32% of participating adolescents are strongly or tend to be anxious about getting vaccinated. The results of our survey suggest that emotional involvement evoked through the use of metaphorical language may have, at least in the short run, some positive effect on vaccine confidence.

Key messages

• Use of metaphors can be successfully used in public health communication.

• Messages evoking either war or protecting concepts are more efficacious than plain scientific language.
Artificial intelligence – NPHIs’ role in utilizing its opportunities and addressing the risks
Authors: Habl C , Ottersen T
Published: October 2024

Issue & Problem

National Public Health Institutes (NPHIs) in many countries are at the forefront of action to mitigate the impact of current and future threats to health as well as improving population health and wellbeing. Through research, collaboration, and support, NPHIs can approach these new realities together. One of the many emerging realities that NPHIs will need to engage in is how NPHIs best can utilise the powers of artificial intelligence and deal with the ethical and legal issues that come with it.

Methods

In preparation of IANPHI’s (International Association of National Public Health Institutes) Europe Regional network meeting in April 2024 a survey was conducted among the 42 members. 16 countries replied to questions, around e.g., 1) current applications of (generative) artificial intelligence (AI) in the work of institutes, 2) which experiences were made and 3) which measures NPHIs take to best utilize the possibilities and overcome challenges of AI technologies. Within four weeks 16 replies were shared.

Lessons & Conclusions

Some institutes have not yet adopted AI, while others report multiple applications but the primary areas of application vary considerably among Europe.

Applications include

summarizing and reformatting text; translation; transcribing and documenting meetings; search information in documents or databases; coding; creating visuals; literature review; surveillance of infectious diseases; disease forecasting; analysis of transmission dynamics; vaccine efficacy assessment and development; image recognition; diagnosis and prediction of diseases from medical datasets; text mining; symptom extraction; social listening; prediction of nitrate concentration in groundwater; drug analysis and measuring psychological resilience in social crisis.

Key messages

• AI poses opportunities and risks for public health and work of national public health institutes and capacity building initiatives are essential.

• IANPHI decided to develop a joint framework for the use of AI in its member organisations with a focus on research and responsible use.
Luton, a Marmot town – using a whole-system approach to tackle health equity
Authors: Cartwright S , Egbutah C , Allen J , Ravindrane R , Austin-Croft L , Ali N
Published: October 2024

Issue

Luton has high deprivation and health inequalities. We have a borough-wide vision that no one should live in poverty by 2040, and have become a health equity town - committed to Marmot policy objectives and recommendations across all we do.

Description

Luton is 70th most deprived local authority in England, with stark health inequalities. To deliver the 2040 ambition, 5 pillars have been established, including tackling health inequalities. Luton has become the first Marmot Town in the UK, working with the Institute of Health Equity to develop recommendations and actions relating to the Marmot Policy objectives. Cross-sector system partnership has been key -NHS, businesses, housing, voluntary sector, university. Year 1: we mapped the Marmot recommendations to existing workstreams; completed a mixed-methods evaluation to understand system views of the approach and establish our impact measures. We established steering groups: Children and young people; Housing; Employment and skills; Net zero, they continue to embed recommendations using logic models. We have an overarching strategic approach, alongside smaller scale programmes, to create a movement. Including: grant funding; regular newsletter; training; case studies repository and annual celebration event.

Results

We have established 15 impact measures across Marmot policy areas to review annually. Qualitative evaluation findings built into work plans include: improved governance and accountability; workforce development across the system; use of logic models; Learning from best practice; sharing knowledge and learning.

Lessons

The wider agenda of Luton 2040 has enabled health inequalities to be embedded into strategic discussions; improved evidence base and clear narrative to support priorities is helpful; clear focused recommendations helps move work forwards; shared understanding of how we will measure long term impact is vital, communicating to the system is key, and long-term ism challenging.

Speakers/Panelists

Lee Watson

East of England Public Health Training Programme, Luton, UK

Ramya Ravindrane

East of England Public Health Training Programme, Luton, UK

Chimeme Egbutah

Luton Borough Council, Luton, UK

Nasreen Ali

University of Bedfordshire, Luton, UK
Estimated lifetime impact of a school-based intervention for mental health: A microsimulation study
Authors: Bates S , Saidi Y , Cookson R , Skarda I , Ford T , Hayes R , Ganguli P , Byford S , Brennan A
Published: October 2024

Background

The prevalence of childhood mental health problems is increasing. School-based interventions have the potential to reduce poor mental health and mental health inequalities. Our aim was to estimate the long-term costs and benefits of the Incredible Years Teacher® Classroom Management (IY-TCM) intervention in primary schools compared to no intervention.

Methods

LifeSim, an existing microsimulation model, was used to estimate the lifetime costs and benefits of IY-TCM by linking short-term changes in SDQ based on a previous trial in primary schools (Cluster RCT: 2075 children aged 4-9 years with a 30-month follow-up) to long-term health, social, economic and wellbeing outcomes. Benefits were measured in quality adjusted life years and wellbeing adjusted life years. We examined subgroup based on deprivation, conduct scores and parental depression.

Results

Microsimulation modelling estimated small gains in lifetime outcomes including reduced conduct disorder in adolescence and depression in adulthood. Estimates indicate IY-TCM could be cost-effective with a large amount of uncertainty (Net monetary benefit (NMB)=£21, Estimated CI = -£195, £240). IY-TCM was estimated to be more cost-effective for those with high deprivation (NMB = £231, Estimation CI - -£99, £231) and high conduct problem scores (NMB=£315, Estimated CI = £45, £483). Total net social benefit for a typical year size group was estimated to be £111m.

Conclusions

IY-TCM could be cost-effective compared to no intervention with a large estimated social benefit supporting wider implementation of IY-TCM, but results indicate a large amount of uncertainty. Greater benefits and higher certainty of cost-effectiveness for children with conduct problems and those living in a deprived area suggest IY-TCM has the potential to reduce mental health inequalities and may be more cost-effective for schools with higher deprivation and/or a high prevalence of conduct problems.

Key messages

• The Incredible Years Teacher Classroom Management intervention for mental health in primary schools could be considered cost-effective but there is a large amount of uncertainty.

• Greater benefits for children with conduct problems and those living in a deprived area indicates the intervention has the potential to reduce mental health inequalities.
Exploring support for return-to-work: A comparative analysis of firm and country-level factors
Authors: Leoni T
Published: October 2024

Background

Employers are important stakeholders in efforts to facilitate the return-to-work (RTW) of employees after sick-leave, but the available data reveal large variation in employer support for RTW across European countries and firms. This paper explores in a comparative perspective what factors at the country level and at the firm level can explain these differences.

Methods

Employer support for RTW is examined using microdata covering 31 countries from the Third European Survey of Enterprises on New and Emerging Risks (ESENER), conducted in 2019 (N = 9,775). These data are integrated with country-level indicators to capture national differences in economic incentives and institutional provisions concerning the management of sick-leave. Two-level mixed-effects logit models with random intercepts are used to estimate the impact that different firm characteristics and country-level factors have on the propensity to provide RTW support.

Results

The empty model has an intraclass correlation coefficient (ICC) of 0.345, indicating that a substantial share of the observed variation across European firms is determined at the country level. Larger establishments and those with workplace health risks are more likely to provide RTW support. Including firm-level indicators does however not reduce the observed between-country variance. Institutional differences in the economic costs of sick leave for employers, on the other hand, explain about 15% of this variance. The ICC drops more strongly after including in the model policy indicators that capture activating elements in the social security system and the existence of national policies targeting RTW. The full model explains almost two thirds (62.8%) of the observed between-country variance.

Conclusions

The findings highlight that only in few European countries employers are systematically involved in RTW support and strengthen the case for comprehensive policy strategies to engage employers in worker activation.

Key messages

• Employer characteristics, such as firm size, impact the propensity to provide RTW support, but they do not explain the large between-country variation that we observe across Europe.

• Comprehensive national policy strategies and institutional incentives are crucial to engage employers systematically in RTW efforts.
Cost-effectiveness analysis of screening three-year old for social-emotional problems
Authors: Manzano A , Pulkki-Brännström A-M , Ivarsson A , Vaezghasemi M , Feldman I
Published: October 2024

Aim

To assesses the long-term cost-effectiveness of a population-based screening to detect social-emotional problems at 3-years-old combined with an evidence-based intervention to prevent mental health problems.

Methods

A decision-analytic Markov model compares two alternatives 1) all 3-years-old get screened for social-emotional problems, and parents for children at a high risk receive a generic targeting parenting intervention 2) no screening and no intervention. The cohort of 3-year-old is modeled until they are 19 years old. The screening test is the ASQ:SE and the intervention was given to children with scores that suggest social-emotional problems. The model considered development of anxiety, conduct problems, and ADHD, over the 16 years. The analyses were done from a societal and healthcare perspectives. Health outcomes were assessed with DALYs averted.

Results

Results suggest that the probability of population-based screening for social-emotional problems combined with the parenting intervention to high risk-children being cost-effective is high, adopting a societal and healthcare perspective, 98% and 97% each. From a societal perspective, the likelihood of cost saving is high, 85 %. The combination of screening and intervention strongly dominated the comparator.

Conclusions

The findings align with previous research; prevention aimed at children’s mental health disorders will likely yield high investment returns. Successful implementation of population-based screening for social-emotional problems combined with an effective evidence-based parenting intervention might be an important way to contribute to sustainable and efficient mental health care.

Key messages

• The impact of combining population-based screening with intervention is encouraging when considering a long-term view.

• Prevention aimed at children’s mental health will likely yield high investment return.
The corporate political activity of Portugal’s food industry: enhancing public health transparency
Authors: da Costa S , Mialon M , Graça P , Gregório M J
Published: October 2024

Background

This study in Portugal aims to monitor the Corporate Political Activity (CPA) in the food industry. Portugal provides a compelling case study due to its robust implementation of public health policies.

Methods

A systematic qualitative approach proposed by Mialon et al., a part of the INFORMAS Module 3, was employed. This method is based on the analysis of publicly available information. Key industry actors were selected through expert consultation and market analysis using EuroMonitor data. Information sources included industry, government, and academic materials accessed via websites and news. A thematic qualitative analysis was conducted involving iterative steps: identifying CPA practices based on predefined strategies - Taxonomy of Action Strategies: access and influence policymaking, use the law to obstruct policies, manufacture public support, shape evidence, displace and usurp public health, and manage reputations -, recording methods in a database, and saving evidence. Data collection spanned October 2023 to April 2024, covering materials from 2022 to 2023.

Results

Twenty-five key players were identified, including processed food and non-alcoholic beverage manufacturers, fast food companies, food retailers, and national trade associations. Food retailers, notably Jerónimo Martins, Lidl, Mercadona, and Sonae, showcased a higher prevalence of CPA. Nestlé and Sumol+Compal also emerged as prominent actors. The food industry in Portugal employs diverse strategies and tactics primarily focused on shaping evidence and managing reputations. While instances of displacing public health priorities and manufacturing public support were observed, they were relatively fewer. Only APED and FIPA showed engagement in policymaking influence.

Conclusions

Vigilant monitoring of CPA in the food industry in Portugal reveals dominant tactics of shaping evidence and managing reputations. Understanding these strategies is vital for policymaking to safeguard public health.

Key messages

• The food industry in Portugal employs diverse strategies, primarily shaping evidence and managing reputations, to influence public health policies.

• Monitoring the Corporate Political Activity is key to preserving the integrity of public health policymaking in Portugal’s food industry.
Collaboration between general practice and sickness benefits office - A Scoping Review
Authors: Poulsen A G , van Meerkerk I , Nielsen C P , Rolving N , Jensen L G
Published: October 2024

Background

Effective collaboration among stakeholders is essential in supporting return to work (RTW) processes for individuals on sick leave. Yet sickness benefits office and general practice experience a lack of collaboration. This is echoed by individuals on sick leave. This scoping review aim to map existing literature on collaboration between sickness benefits office and general practice in RTW processes to identify both collaboration activities and underlying conditions influencing the collaboration.

Methods

A systematic search of peer reviewed literature was conducted across five databases in March 2023. Screening and data extraction were conducted by two independent researchers.

Extracted data was mapped and activities and underlying conditions were analyzed following descriptive thematic analysis. Tentative results were discussed with a reference group.

Results

Among the 7471 papers screened, 21 met the inclusion criteria. Certificates was the most common collaboration activity. Of underlying conditions far more barriers compared to facilitators were identified. Barriers encompassed conflicting opinions, opposing roles, communicating via certificates, and time. Facilitators included personal communication and knowledge.

Conclusions

The number of included papers reflects a limited emphasis on this domain within research endeavors. The prevalence of barriers outweighing facilitators underscores the challenges inherent in this collaboration. General practice is depicted as advocating for their patients while the sickness benefits office pushes for return to work. Scarcity of time induces several challenges, impacting e.g., availability for personal communication and delays.

Key messages

• Stereotyping and opposing roles, poor communication and time constraints are major barriers that need to be addressed to enhance future collaboration.

• Meetings and mutual knowledge about working conditions including legislations and procedures benefit the collaboration.
Assessing the return-to-work mode of Dutch precarious workers with mental health issues
Authors: Suijkerbuijk Y , Nieuwenhuijsen K , Jansen L P , Schaafsma F G
Published: October 2024

Background

Mental health issues are highly prevalent among precarious workers, often leading to sickness absence, work disability, and job loss. Return to work (RTW) is more challenging for these workers, as they often lack a job to return to and have limited access to occupational health care. Perceptions and attitudes about RTW are important determinants and can be categorized into three modes within the RTW process: a passive, an ambivalent and an active RTW-mode. To identify the RTW mode, we developed the RE-MODE tool. This study aimed to assess occupational health professionals’ agreement on the RTW-mode of sick-listed precarious workers with mental health issues using RE-MODE.

Methods

In a vignette study, 71 occupational health professionals from a Dutch social security institute viewed six videos of consultations between insurance physicians and precarious workers. They then used RE-MODE to assess the RTW mode and need for RTW-support. They also provided feedback on the tool’s validity and usability. We used a generalized linear mixed model to analyze inter-rater agreement, inter-item consistency, and the contribution level of each item. Additionally, we calculated the content validity index and the system usability scale.

Results

The agreement on the RTW mode with RE-MODE is high (ICC 0.86, 95% CI 0.64-0.95) and on the workers’ need for RTW-support moderate (0.61, 95% CI 0.31-0.84). Furthermore, the content-validity (Scale-CVI 0.83), usability (SUS 0.75), and inter-item consistency (Cronbach’s Alpha 0.70) show favorable results. We are currently analyzing the contribution of each item to the total score. The items with the best overall performance will be included in RE-MODE 2.0.

Conclusions

REMODE is a valuable tool for occupational health professionals to identify precarious workers with mental health issues at risk of long-term disability. Then they can arrange targeted RTW-support. Based on the study results, RE-MODE 2.0 is in development.

Key messages

• RE-MODE is a valuable tool for the assessment of the RTW-mode of precarious workers with mental health issues.

• RE-MODE’s reliability, content-validity and usability is satisfactory.
Impact of motherhood and social support on the wellbeing of UK female police officers and staff
Authors: Illias M , Demou E , Riach K
Published: October 2024

Background

Female officers and staff face gender-specific challenges, particularly, during pregnancy and motherhood. Our study explores whether and how motherhood affects mental health outcomes (e.g., probable depression and anxiety) and return to work following sickness absence (SA), considering mediating role of workplace social support.

Methods

Logistic regression analysed probable depression and anxiety using Airwave Health Monitoring Study (AHMS) data. Cox proportional hazards models assessed return to work after sickness absence, linking AHMS with sickness absence data from 26 police forces. Exposure variables were created by the interaction of motherhood status and social support, while covariates included sociodemographic, lifestyle, and work-related factors.

Results

Mothers with low social support from superiors had higher odds of probable depression (OR = 2.14, 95% CI = 1.81-2.54) and anxiety (OR = 1.86, 95% CI = 1.62-2.14) compared to non-mothers. Moderate and high social support reduced odds of depression (Moderate: OR = 0.97, 95% CI = 0.85-1.11; High: OR = 0.65, 95% CI = 0.57-0.73) and anxiety (Moderate: OR = 1.24, 95% CI = 1.12-1.36; High: OR = 0.82, 95% CI = 0.75-0.9) for mothers, but the impact varied when adjusted for covariates. Mothers with lower levels of social support were less likely to return to work after SA compared to non-mothers, as indicated by the survival analysis (Low social support: HR = 0.83, 95% CI = 0.95-1.13; High social support: HR = 1, 95% CI = 0.96-1.04). These trends persisted across social support sources-colleagues and combined support-emphasising the complex interplay between workplace social support, motherhood, mental health, and sickness absence in policing.

Conclusions

Our study emphasises boosting workplace social support for female police officers and staff, to aid them in navigating motherhood demands. This improvement can lead to better mental health, retention, job satisfaction, and organisational effectiveness, ultimately promoting community safety.

Key messages

• Highlighting the importance of workplace social support for female police officers and staff, informs policy makers and practitioners to prioritize social support initiatives within policing.

• Lower social support was associated with a reduced likelihood of returning to work after sickness absence, particularly among mothers compared to non-mothers.
Sickness absence duration of stress complaints, adaptation disorder or burnout in the Netherlands
Authors: De Rijk A , Van Iperen L , De Witte H , Kok R , Schaufeli W
Published: October 2024

In the Netherlands, occupational physicians can diagnose burnout when employees report sick. Their guideline distinguishes between stress complaints lasting < 3 months, adaptation disorder with complaints lasting 3-6 months and burnout with complaints lasting > 6 months at moment of diagnosis. The Four-Dimensional Symptom Questionnaire (4DSQ) is recommended to assess and monitor. The new Burnout Assessment Tool (BAT) might be an alternative. Research questions were: 1) What are the sickness absence duration, 4DSQ and BAT-scores of absentees diagnosed with stress complaints, adaptation disorder and burnout?; 2) Is the BAT a better predictor of sickness absence duration than the 4DSQ? From 2020-2023, data was collected among all 3,462 employees who were absent due to stress complaints, adaptation disorder or burnout at one large occupational health and safety service via registry data and an employee questionnaire. Results show that two-thirds of those with stress complaints, half of them with adaptation disorder and one third with burnout were absent for less than half a year. 4DSQ and BAT scores differed significantly between the three groups (p<.05). The BAT explained 0.8% of variance in absence duration (p< .001) when controlled for covariates, which explained 1.6% of variance (p< .001). The explanation by BAT was 1.9% within the group with stress complaints (p = 0.002), .4% within the group with adaptation disorder (p=.022) and absent within the group with burnout. Comparable results were found for the 4DSQ. The differences in absence duration between the three groups aligned with the Dutch guidelines. The BAT nor the 4DSQ were clinically relevant predictors of duration of absence for stress-related diagnoses among absentees in the Netherlands. To reduce productivity loss, it seems better to report sick when still in the stage of stress complaints than to wait until a full burnout has developed. The BAT and 4DSQ might help risk assessment in the working population.

Key messages

• The sickness absence duration of Dutch employees diagnosed with burnout is much longer than that of those with adaptation disorder or stress complaints.

• Both the instrument recommended in the guideline and the new instrument have no clinical relevance in predicting sickness absence duration of stress-related diagnoses.
Facilitating subgroup identification: the use of decision trees in breast cancer screening uptake
Authors: Pedrós Barnils N , Schüz B
Published: October 2024

Introduction

Organized breast cancer screening (BCS) programs are effective prevention measures for women aged 50-69 to prevent the sixth cause of death in Germany. It is unclear which sociodemographic factors and potential interactions are associated with never-attendance. Explorative approaches such as decision trees offer an inductive approach to intersectional subgroup identification based on different computational decisions. This study discusses two approaches for estimating the likelihood of not attending BCS in Germany.

Methods

Women aged 50-69 (N = 3,644) were selected from the German 2020 European Health Interview Survey. We estimate the risk of not attending BCS first by employing cross-classification regression analysis utilising known social dimensions and second by leveraging the nodes of the best-performing decision tree as exposure variables.

Results

The first approach, adjusting for age, found that women born in Germany had 1.97 higher odds (p = 0.015) of never attending BCS than high-income women not born in Germany. Conditional Inference Tree (mincriterion= 0.6040046, maxdepth=3) adjusted to optimise sensitivity and the Area Under the Curve (71.43% sensitivity, 63.21% AUC), identified 8 relevant intersectional groups characterised by unique combinations of family status, perceived social support, working situation, experienced physical limitation, and region, with the highest odds of 4.85 (p < 0.001) of not attending BCS for women living with their couple and children or non-conventional household constellations who perceived little, uncertain or a lot of social support.

Conclusions

Using explorative decision trees for subgroup identification, the study provides more detailed insights into women at higher risk of not attending BCS in Germany, aiding, on the one hand, more precise health reporting data and, on the other hand, enhanced preventive public health interventions.

Key messages

• Explorative decision trees for subgroup identification allow for more detailed insights into women at higher risk of not attending BCS in Germany for enhanced preventive public health interventions.

• Women living with their couple and children or non-conventional constellations who perceived little, uncertain or a lot of social support are at the highest odds of never attending BCS in Germany.
COVID-19 impact on childhood vaccination attitudes in pregnant antenatal class attendants in Rome
Authors: Bruno S , Nachira L , Arcaro P , Campo E , Pattavina F , Pascucci D , Damiani G , Carducci B , Lanzone A , Laurenti P
Published: October 2024

Background

The COVID-19 pandemic caused a decrease in vaccination rates, impacting vulnerable populations such as pregnant women (PW), who concern about future children’s immunisations. The aim of this study was to assess whether the pandemic led to changes in childhood vaccination attitudes among PW attending antenatal classes at the Fondazione Policlinico Universitario A. Gemelli in Rome. Specifically, it assessed the impact of the pandemic on the perceived usefulness of information sources, their trust in healthcare workers (HCWs) and the National Health Service (NHS), their perception of the risk of infection and severity of vaccine-preventable diseases (VPDs), and their vaccination intentions.

Methods

A repeated cross-sectional study was conducted across three flu seasons by administering an anonymous questionnaire: one before and two during the pandemic. Intention to vaccinate children was expressed as the percentage of PW who selected each vaccination from the questionnaire. Trust in HCWs and the NHS, and perception of the risk of infection and severity of VPDs were expressed as the percentage of PW who answered “quite” or “very”. For the usefulness of information sources, mean scores were calculated. To assess differences of the three periods a chi-square test was performed (p = 0.05).

Results

Course attendance surged from 105 to 340. Significant shifts in vaccination intentions were noted: 7.5% and 10% decreases for measles (p = 0.02) and pertussis (p = 0.004), respectively, from 2019-20 to 2020-21. Perceived contagion risk decreased, but perceived disease severity increased. A significant reduction in the proportion of PW suspecting economic interest behind NHS workers promoting vaccination, and an increase in the perceived usefulness of non-institutional websites and of the advice from non-NHS physicians were noted.

Conclusions

PW’s attitudes towards vaccinations might have been modified by COVID-19 pandemic, regarding risk perception and trust in NHS HCWs.

Key messages

• Our findings suggests that PW’s attitudes towards childhood vaccinations might be modified by the COVID-19 pandemic, in particular risk perception and trust in NHS healthcare workers.

• These findings could help Public Health to develop evidence-based interventions and communication strategies, to maintain vaccine confidence and mitigate potential adverse effects.
Fighting HAIs by monitoring hand hygiene compliance in the Umberto I teaching Hospital in Rome
Authors: Ceparano M , Covelli A , Baccolini V , Migliara G , Carluccio G , Mattera D , De Vito C , De Giusti M , Marzuillo C , Villari P
Published: October 2024

Background

Healthcare-associated infections (HAIs) are one of the most common preventable complications in hospitalised patients related to increased morbidity and mortality for patients. Proper hand hygiene (HH) can decrease the prevalence of HAIs within care settings. The aim of the study was to evaluate the effects of a monitoring and feedback system on HH compliance (HHC).

Methods

Three monitoring and feedback studies have been carried out in Umberto I teaching hospital of Rome since 2021. Healthcare workers (HCWs), were trained on how to carry out the direct observation on the 5 WHO moments on HH. The data collection lasted two weeks each year. Following data collection, they were analysed and discussed annually with HCWs. A multivariable logistic regression model was constructed to identify predictors of HH compliance.

Results

A total of 15874 HH were observed, of which 40.1% in 2023. The recorded HHC was 71.0% in 2021, 75.4% in 2022 and 71.6% in 2023. Multivariable analyses showed that HHC was positively associated with female sex of observed (aOR:1.3, 95% CI:1.1-1.4), during weekend days or holidays (aOR:1.3 95% CI:1.1-1.4) and all indications with respect to ‘before touching a patient’. Regarding the professional category of the observer, compared to physicians, midwives were more likely to report compliant observations (aOR=2.4, 95% CI: 1.4-4.1). On the other hand, a negative association was found with external ward staff and other HCWs and no-HCWs compared to physicians. Ward area and year of observation did not influence the probability of the outcome.

Conclusions

The results of this study revealed sub-optimal adherence to HH, with the lowest rates observed prior to patient interaction. That, coupled with the variability seen among HCWs, underlines the difficulties in achieving a uniform level of compliance. Therefore, ongoing training to raise awareness among HCWs and to repeat the survey over time identifying any major problems is essential.

Key messages

• Monitoring the reasons for non-adherence to hand hygiene in healthcare institutions in order to formulate strategies to improve HH adherence among hospital staff is essential.

• Hand hygiene (HH) monitoring systems can produce measurable improvements in HH adherence by healthcare personnel, resulting in a reduction in the incidence of healthcare-associated infections.
Forecasting cognitive functioning: an artificial intelligence approach with Dynamic Bayesian Networks
Authors: Etholén A , Roos T , Hänninen M , Bouri I , Kulmala J , Rahkonen O , Kouvonen A , Lallukka T
Published: October 2024

Background

Several potentially modifiable risk factors are associated with subjective cognitive decline (SCD). However, developmental patterns of these risk factors have not been used before to forecast later SCD. Practical tools for the prevention of cognitive decline are needed. We examined multifactorial trajectories of risk factors, and their associations with SCD using an artificial intelligence approach to build a score that forecasts later SCD.

Methods

Five repeated surveys (2000-2022) of the Helsinki Health Study (n = 8960, 79% women, aged 40-60 at Phase 1) were used to build dynamic Bayesian networks (DBN) for estimating the odds of SCD. A score-based approach was implemented for learning DBN using the quotient normalized maximum likelihood criterion. The model was used to predict SCD based on the history of consumption of fruit and vegetables, smoking, alcohol consumption, leisure-time physical activity, body mass index, and insomnia symptoms, adjusting for sociodemographic covariates.

Results

Of the participants, 31-48% reported decline in memory, learning, and concentration in 2022. Physical activity was the strongest predictor of SCD in a 5-year interval, with an odds ratio of 0.76 (95% Bayesian credible interval 0.59-0.99) for physically active compared to inactive participants. Alcohol consumption showed a U-shaped relationship with SCD. Other risk factors had minor effects.

Conclusions

A new online risk score tool was developed that enables individuals to inspect their own risk profiles, as well as explore potential targets for interventions and their estimated contributions to later SCD. Dynamic decision heatmap was presented as a communication tool to be used at healthcare consultations.

Key messages

• Potentially modifiable health-related behaviours such as physical activity can contribute to subjective cognitive decline.

• Artificial intelligence can be applied to discover the complex interactions between risk factors and subjective cognitive decline, to support preventive healthcare at individual and population levels.
Predictors and outcomes of adolescent alcohol and drug use: a scoping review
Authors: Brennan M M , Corrigan C , Mongan D , Doyle A , Galvin B , Nixon E , Zgaga L , Smyth B , Ivers J H , McCarthy N
Published: October 2024

Background

Adolescence is a pivotal life stage marked by educational advancement, entry into the workforce and formation of lasting relationships. Globally, adolescence is also the peak period during which individuals first engage in alcohol and/or drug consumption. This scoping review aimed to summarize existing longitudinal research on factors and outcomes related to adolescent substance use to identify gaps in existing evidence.

Methods

A scoping review was conducted in accordance with the PRISMA extension for scoping reviews. A systematic literature search was conducted on PubMed. Additional studies were identified through hand-searching key reference lists and Google Scholar searches. A narrative synthesis was completed.

Results

123 studies were included; 12 reviews and 111 cohort studies. 60% of cohort studies originated from North America, 29% Europe, 7% Australia/New Zealand, 2% South America and 2% Asia. Factors consistently associated with increased risk of ASU include male sex, increasing age, externalizing disorders, adverse childhood experiences and peer or parental substance use. Few studies considered wider community or neighbourhood factors. Early initiation and higher frequency of adolescent drug use were predictive of later-life substance use patterns, education derailment, contact with the justice system and mental health disorders.

Conclusions

The body of longitudinal evidence on adolescent substance use is rapidly expanding yet significant research gaps exist. Rising levels of cocaine use and its substantial health impacts motivate further research on all potentially important factors associated with cocaine use to guide interventions for prevention and treatment.

Key messages

• There are important gaps in existing research on adolescent substance use.

• These include neighbourhood influences and factors associated with initiation of illicit drugs other than cannabis.
Exploring the state-of-the-art on competencies for policymaking in public health
Authors: Frisina L , Aragón de León E
Published: October 2024

Against the complex backdrop characterizing both the nature of public health challenges and the corresponding skills required to face them, this presentation will introduce the state-of-the-art on scholarship concerned with the definition and/or development of competencies for effective policy making in public health. The presentation will focus especially on presenting findings of a scoping review of the state-of the-art involving: 1) research that develops competency frameworks explicitly designed for policymakers operating in public health; and 2) case studies that explore the application of specific competencies (whether explicitly or implicitly) in different public health contexts. By exploring both bodies of literature, the scoping review will take stock of how each study defines the concept of competencies, enumerates areas of knowledge and demonstrable skills pertaining thereto, and uses evidence to establish their significance in the field of public health leadership. The findings of the scoping review will also be brought into comparative perspective, examining whether and how the categories of existing competency frameworks correspond with one another, as well as reflect the insights of single case studies. The proposed presentation will conclude with an overview of findings of a mapping exercise including all competencies identified in the literature, which can serve the workshop audience as both a synthesis and holistic refinement on the state-of-the-art going forward. The proposed presentation will conclude with an overview of findings of a mapping exercise including all competencies identified in the literature, which can serve the workshop audience as both a synthesis and holistic refinement on the state-of-the-art going forward.

Speakers/Panelists

Anne-Catherine Viso

Santé publique France, Saint Maurice, France

Charlotte Marchandise

EUPHA

Kasia Czabanowska

Maastricht University, Maastricht, Netherlands
Teachers perspectives on positive and inclusive sex education in Dutch secondary schools
Authors: de Looze M , Meijburg S , Vermeulen M , van Ditzhuijzen J
Published: October 2024

Sex education in schools can play an important role in improving young people’s sexual health. Dutch youth are often dissatisfied with the sex education they receive at school; they want more attention to discussing pleasure, consent and diversity. While there have been various calls for positive and inclusive sex education over the past decade, still very few schools provide it. This study examined teachers’ perspectives on positive and inclusive sex education and documents the barriers teachers are confronted with in providing this type of sex education. Based on an online questionnaire survey of 508 sex education teachers, we examined the extent to which teachers possess the knowledge, attitudes and skills that facilitate the delivery of positive and inclusive sex education. We also held focus groups with 25 teachers from 10 schools and explored what they consider to be key barriers and best practices in teaching positive and inclusive sex education. Teachers overall have the knowledge, attitudes and skills that are needed to provide positive and inclusive sex education, but there is room for improvement, for example regarding knowledge on intersex individuals and the clitoris. Teachers experienced barriers at three levels: the personal level (e.g. personal discomfort), the classroom level (e.g., safety in the classroom) and the structural level (e.g. sex education not being part of the national curriculum; lack of time). Structural barriers seem to be at the basis of the barriers at the personal and classroom level. It is advised that positive and inclusive sex education gets a permanent place in the national curriculum. By developing concrete core objectives in the area of relationships, sexuality and diversity, for all grades, and by providing more extensive teacher training, teachers and schools will be facilitated to organize sex education in a more sustainable way.

Key messages

• Sex education teachers in the Netherlands desire better training to provide positive and inclusive sex education in the classroom.

• Integrating sex education in the national curriculum would help teachers to address sexuality in a more sustainable way in the classroom.