bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental health literacy of students: evaluation of school-based intervention in Germany
Authors: Fretian A , Kirchhoff S , Okan O
Published: October 2023

Background

Low mental health literacy, which encompasses a set of skills related to recognizing, managing, and preventing mental disorders, has been identified as a crucial cause for low rates of mental health help-seeking, especially among young people. Thus, a strategy for strengthening the mental health literacy of youth is through provision of universal school interventions. In order to add to the evidence-base of the effectiveness of such interventions, an already existing program (“Mental Health and High School Curriculum Guide”) was translated into German and carried out in schools.

Methods

A non-randomized pretest-posttest control group design was chosen to verify whether mental health knowledge, stigmatizing attitudes, help-seeking efficacy (as central indicators for mental health literacy) improved after the implementation of the program. A pen and paper survey was conducted in schools to gather data from participating students. Statistical analysis was conducted through paired sample t-tests for the intervention and control group individually.

Results

Nine classes with 169 students (Ø 15.7 years old) participated as intervention group, while five classes with 82 students (Ø 15.3 years old) served as a control group. Statistically significant improvements were observed after participating in the program for mental health knowledge, stigmatizing attitudes and help-seeking efficacy in the intervention group.

Conclusions

This study shows that a mental health literacy resource could be successfully adapted and used in the German school context and was able to improve relevant indicators of mental health literacy. More data needs to be collected in order to inform on the stability of the results in time and to verify whether effectiveness varies with characteristics related to school environment or socio-demographics of participating youth. Further, comprehensive nationwide roll-outs of the intervention can be implemented as a public mental health strategy.
20 years of declining hospital length-of-stay in different European healthcare models and systems
Authors: Golinelli D , Sanmarchi F , Toscano F , Bucci A , Nante N
Published: October 2023

Background

Hospital length of stay (LOS) is an important indicator of healthcare systems’ performance. Several factors are closely related to LOS, which is characterized by high heterogeneity among countries. This study aims to investigate the 20-year time-trends of LOS and their association with different healthcare systems’ and reimbursement models among 25 European countries.

Methods

We conducted a 20-year time-trend analysis (2000-2019) using a Weighted Least Squares model for panel data to investigate the association between LOS, healthcare systems’ models (National Health Service, NHS, National Health Insurance, NHI, Social Health Insurance, SHI, and Etatist Social Health Insurance, ESH), reimbursement schemes (Prospective Global Budget, PGB, Diagnosis Related Groups, DRG, and Procedure Service Payment, PSP), and several control variables. Data were extracted from the Eurostat and GBD study databases.

Results

The analysis showed a generalized reduction of LOS across the 25 countries, ranging from 9.20 days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to the reference category (NHS) (b=−0.6327, p < 0.05). Both DRG (b = 1.2399, p < 0.05) and PSP (b = 1.1677, p < 0.05) reimbursement models were positively associated with LOS when compared to PGB.

Conclusions

Our results confirmed the downward trend of LOS in the last 20 years among European countries, highlighting the strong influence of the healthcare system model. The results of this study offer insight into the factors influencing healthcare utilization and can inform the design of more efficient and sustainable healthcare systems.

Key messages

• This study investigated the relationship between HS models, financing, regulation, service provision, reimbursement schemes, and LOS, across 25 European countries in the last 20 years.

• This study found a dominant influence of the HS models on LOS. SHI models were associated with shorter LOS compared to National Health Systems, after accounting for several factors.
A roadmap out of medical deserts into supportive health workforce initiatives and policies, results from the ROUTE-HWF study
Authors: Flinterman L
Published: October 2023

Background

Medical deserts are coined as a specific term for areas dealing with low levels of health workers and health services. Health-underserved areas are a Europe wide problem, but still there is a lack of understanding on the different types and causes of medical ‘desertification’. In absence of a clear definition and categorization, countries acknowledge the severity of medical desert problems and take action. But they do so without taking opportunities to learn from each other, in terms of finding the rationale underlying the appropriate choice of policies and measures.

Aims and Objectives

The aim of the ROUTE-HWF project that will be presented is to develop an elaborated taxonomy on medical deserts that supports country comparison, and improves the matching of different policy initiatives with different types of medical deserts. This includes guidelines on how to monitor and measure medical deserts, and solutions like task shifting and retention of health workers.

Methods

The ROUTE-HWF project is based on a systematic literature review, a survey among European countries, and workshops with case studies among a selected number of countries. During each stage of the project the taxonomy and a roadmap ‘out of medical deserts’ is further developed.

Results

We present the ROUTE-HWF taxonomy and roadmap with guidelines for monitoring and measuring medical deserts. Three main distinctive types of medical deserts are defined: medical deserts mainly caused by problems with the accessibility of health workers and facilities, medical deserts mainly caused by problems with population needs in area, and medical deserts with (cumulation) of problems both at the demand and supply side of the local health system. We show that this categorization is useful to tailor health policy measures to the distinctive causes and solutions for medical deserts, enabling mutual or cluster country learning within Europe.
OASES project: promoting evidence-based reforms on medical deserts
Authors: Vitello F
Published: October 2023

The OASES project aims to strengthen the capacity of public health authorities to reform their health systems and address all the key issues to successfully deal with the challenges posed by medical deserts. The project has adopted a broad definition of “medical desert”: it encompasses any situation in which critical issues arise in the meeting of health needs, demand and supply of health care, i.e. not only the simple shortage of health professionals and services, but also poor quality and low accessibility of health care.

The project has developed:

• a set of indicators to assess medical desertification, in terms of availability, quality and accessibility of health workers and services;

• an analysis of the main causes of the phenomena and possible solutions or mitigation actions, through the literature review;

• pilot studies in seven European countries consisting in measuring medical deserts and discussing the antecedents and possible solutions with local stakeholders (consensus building exercise).

So far, the project has completed the activities related to the measurement methodology. Currently, pilot studies have been launched, with the aim to:

• provide a national overview of medical deserts in the participating countries (Cyprus, Finland, France, Hungary, Italy, Republic of Moldova and Romania);

• assess and characterise the medical desert at national and/or regional level, and the mitigation strategies in place and/or planned;

• facilitate consensus on medical deserts mitigation strategies among national/local stakeholders;

• provide evidence-based recommendations to mitigate medical deserts in the seven participating countries.

The results of the project will provide a proposal for policy actions and solutions against medical desertification for all the EU Member States.
Evaluation of a digital intervention for depression among Lebanese&Syrian refugees in Lebanon
Authors: Abi Ramia J , Khoury S , Cuijper P , Heim E , Burchert S , Cornelisz I , van Klaveren C , van’t Hof E , Sijbrandij M , El Chammay R
Published: October 2023

Background

Lebanon is a low-to-middle-income country, hosting more than 1.1 million Syrian refugees, with 90% mental health treatment gap. The National Mental Health Programme (NMHP) in Lebanon along with the World Health Organization (WHO) launched the Step-by-Step (SbS) e-mental health intervention for adults with depression. Step-by-Step is a 5-sessions, self-help, minimally guided digital program for adults with depression. Two Randomized Controlled Trials (RCTs) assessed its effectiveness and cost-effectiveness in the local setting.

Methods

Participants (n = 569 Syr, n = 680 Leb) were recruited online and randomly allocated to Step-by-Step (n = 283 Syr, n = 331), or Enhanced Care as Usual (n = 286 Syr, n = 349). The ECAU group received one-page psychoeducation and a referral list to services. Online assessments were administered at baseline, post-assessments at eight weeks after enrolment, and follow-up assessments at 20 weeks after enrolment. Primary outcomes were the Patient Health Questionnaire-9 and World Health Organization Disability Assessment Scale 2.0 scores at all post-assessments.

Results

Intention-to-treat analyses showed significant effects on depression scores (standardized mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97 for Lebanese, and SMD: 0.48; 95% CI: 0.26; 0.70 for Syrians). Significant results were maintained on all secondary outcomes and at follow-up assessments.

Conclusions

SbS proved effective for depressive and functionality symptoms. Subsequently, it was adopted by MoPH as an official, free-of-charge, and first-line service for depression. A global version of SbS is currently being developed by WHO to be replicated and used in several settings worldwide.

Key messages

• This landmark study provided unique evidence on the effectiveness of guided-e-mental health interventions for the Lebanese and Syrian refugees affected by adversity in Lebanon.

• This study guided the scaled-up of SbS into a widely accessible service among the general population.
Epidemiological Profile of Tuberculosis in Tunisia
Authors: Mansouri A , Bouguerra H , Belkahla M , Gzara A
Published: October 2023

Introduction

Tuberculosis (TB) is still a public health problem causing significant morbidity in several countries. In 2020, TB was the second global leading cause of death from an infectious disease, behind COVID-19. Despite the continuous efforts of the national tuberculosis control program, Tunisia remains a country with intermediate tuberculosis endemicity. The objective of this study was to describe the incidence of tuberculosis from 2018 to 2021 and its epidemiological profile in Tunisia.

Methods

This is a descriptive study of the national tuberculosis surveillance data within the framework of the national tuberculosis control programme. All new confirmed cases notified and registered for treatment were included. Data was entered through a registration and notification platform (WEB TBS), which is available in all governorates. Data collected included age, gender, governorate, clinical form. Data analysis was using SPSS-21.

Results

The incidence rate decreased from 28/100,000 inhabitants in 2018 to 22.46/100,000 inhabitants in 2021. In 2021, 2647 new cases were recorded. The majority were aged between 15 and 64 years old (80.4%). More than half were females (52.4%). There was an increasing trend of extra-pulmonary tuberculosis. It affected 64.6% of cases in 2021, mainly lymph node forms (68.5%). The incidence varied considerably by region; from 59.3/ 100,000 inhabitants in Ariana to 7.3/ 100,000 inhabitants in Monastir (2021). The number of reported cases of co-infection (TB-HIV) increased from 0.09 to 0.14/100,000 inhabitants.

Conclusions

Despite the overall decline, there is still a long way to go to reach the target of ending TB by 2030. More adherence to control activities is needed in the most affected regions, including early case detection, patient monitoring and epidemiological investigations. There is also an urgent need to develop an effective strategy to control lymph node tuberculosis, which becomes an increasing burden on the national program.

Key messages

• From 2018 to 2021, there was a national decline in TB incidence, but some regions remain highly endemic.

• With the increase of extra-pulmonary tuberculosis, appropriate preventive and control measures should be taken.
Challenges and opportunities for continued access to effective antibiotics - what role for the EU?
Authors: Anderson M , Panteli D , Mossialos E
Published: October 2023

Large pharmaceutical companies have withdrawn from antibiotic R&D because of the high risk of failure and because antibiotics are less profitable than other areas; small and medium-sized enterprises (SMEs), which now drive antibiotic R&D, face difficulty securing funding for preclinical and early clinical trials, and risk significant economic losses when launching new antibiotics. To reinvigorate the antibiotic pipeline, a holistic package of aligned incentives is required, which takes into account public health factors, improves return of investment while supporting SMEs, and considers operational feasibility including potential political, regulatory, legislative, industry and financial hurdles. This presentation will highlight the main options in this area. Improving access to effective antibiotics requires both short- and longer-term measures. Reducing regulatory administrative hurdles, engaging in good procurement practice, increasing joint purchasing efforts, and considering payment models that de-link revenue from sales can keep older (but effective) antibiotics on the market by ensuring their economic viability. Strengthening the mapping of production capacities and product availability can improve transparency and identify options for action, while stockpiling and strengthening manufacturing capacities within and outside of the EU can boost the supply chain itself. Concrete measures and their feasibility will be briefly presented. The EU has a major role to play by supporting antibiotic R&D and engaging with other international efforts to promote optimal deployment of incentives, by ensuring that the lack of access to appropriate and effective antibiotics is recognized as a threat to global health security, and by building on its relationships with international institutions to act as a facilitator in the global space towards ensuring synergies among existing structures, communicating the cost of inaction, and supporting national and regional initiatives.

Speakers/Panelists

Danilo Lo Fo Wong

Division of Country Health Programmes, WHO/Europe, Copenhagen, Denmark

Malin Grape

Ministry of Health and Social Affairs, Stockholm, Sweden

Lieven De Raedt

Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
Pharmacist care in hypertension management: systematic review of randomized controlled trials
Authors: Gastens V , Tancredi S , Kiszio B , Del Giovane C , Tsuyuki R , Paradis G , Chiolero A , Santschi V
Published: October 2023

Background

Hypertension management remains a major public health challenge in primary care. Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management. Our objective was to systematically review the evidence of the impact of pharmacist care alone, or in collaboration, on blood pressure (BP) amongst hypertensive outpatients compared with usual care. One major focus was to assess the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting.

Methods

A systematic literature search was conducted for any article published up to 05.12.2022 in MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, and Trip databases. Randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients were included. Results were synthesized descriptively and, where appropriate, pooled across studies to perform meta-analysis. We have previously published the study protocol in BMJ Open and registered in PROSPERO (CRD42021279751).

Results

2048 study records were identified by electronic database searching. After removal of duplicates, 2006 were independently screened based on title and abstract by two authors (VG, ST), and 253 full texts were evaluated. A total of 90 studies with 33425 patients were included for data extraction. These studies were published between 1973 and 2022 and conducted in different regions (North America: n = 45, Europe: n = 17, other: n = 28). The preliminary random-effects summary estimate of the effect of pharmacist intervention is -6.6 mmHg (95% CI: -8.0 to -5.2) for systolic BP and -3.2 mmHG (95% CI: -4.1 to -2.2) for diastolic BP. Further results on the heterogeneity in the effects are in preparation.

Conclusions

This systematic review provides updated evidence on the effect of pharmacist intervention on hypertension management. Pharmacist-directed or -collaborative interventions improve hypertension management.

Key messages

• Pharmacist-directed or -collaborative interventions improve hypertension management.

• This systematic review provides updated evidence on the effect of pharmacist interventions on hypertension management.
Adherence behaviours in breast cancer patients at risk of cardiovascular disease
Authors: Artignan J , Goussault-Capmas P , Panjo H , Constantinou P , Pelletier-Fleury N
Published: October 2023

Background

High rates of discontinuation undermine the effectiveness of adjuvant endocrine therapy (AET) among hormone-receptive breast cancer patients. Patient prognosis also relies on the management of cardiovascular (CV) risk, which affects a high proportion of postmenopausal women. As with AET, adherence with CV drugs is suboptimal. We examined whether patient adherence with CV drugs was associated with AET discontinuation in a French nationwide claims database linked with hospitalisation data.

Methods

Women aged over 50 starting AET between 01/01/2016 and 31/12/2020 and taking at least two antihypertensive and/or lipid-lowering drugs were followed for 5 years or until AET discontinuation, 31/12/2021, death or cancer recurrence. Women were categorised as fully adherent, partially adherent or fully non-adherent with their CV drug regimen in the year before starting AET. The primary outcome was AET discontinuation, defined as a 90-day gap in treatment availability. Cumulative incidence curves were used to estimate time to discontinuation according to CV drug adherence and accounting for competing risks of death and cancer recurrence. Multivariate Cox and Fine-and-Gray regressions were used to assess the relative hazards of AET discontinuation while adjusting for potential confounders.

Results

32,072 women fit the inclusion criteria. Fully adherent women had the lowest cumulative incidence of AET discontinuation at any point over the follow-up period. Partial adherence and full non-adherence with CV drugs were predictors of AET discontinuation in both models (cause-specific hazard ratios 1.15 [95% CI: 1.15-1.25] and 1.49[95% CI: 1.42-1.63]; subdistribution hazard ratios 1.15[95% CI: 1.09-1.21] and 1.47[95% CI: 1.38-1.57]).

Conclusions

Patients who do not adhere with their CV drug regimen are more likely to discontinue AET. Appropriate support should be brought to these patients as they may be at heightened risk of both cardiovascular and cancer-related events.

Key messages

• Concurrent management of cardiovascular health and breast cancer is essential and clinicians should know that patients with low adherence to cardiovascular drugs are more likely to discontinue AET.

• Patients with suboptimal adherence across their drug regimen should be brought appropriate support as they may be at heightened risk of both cardiovascular and cancer-related events.
Disease burden in Belgium in 2040: Methodological considerations
Authors: De Pauw R , Gorasso V , Guariguata L , Devleesschauwer B
Published: October 2023

Non-communicable diseases (NCDs) are responsible for a significant proportion of global morbidity and mortality, placing a substantial burden on individuals, communities, and healthcare systems. To effectively plan and allocate resources for prevention and treatment, it is crucial to understand the future burden of NCDs. Projections of prevalence of NCDs can provide valuable insights into the future burden of disease and inform policy decisions and resource allocation. These projections can include various factors such as changes in demographics, health determinants, and healthcare access. By predicting future trends in disease prevalence, policymakers can better anticipate the demand for health services, identify areas where prevention efforts can be targeted, and allocate resources more effectively. For example, projections can help policymakers understand the potential impact of interventions such as increased physical activity, improved diet, or increased access to healthcare services. Several methods can be used to project future NCD prevalence, such as generalised linear models, age-period-cohort models, and microsimulation models. Each of these methods come with advantages and disadvantages. Based on our current projections using generalised linear models within a Bayesian framework, the burden of most NCDs will increase by 2040. In this presentation, the thought-process will be addressed to implement future projections in Belgium for NCDs. We will also present the initial results of the projections based on generalised linear models. These projections can help to reduce the burden of NCDs on individuals and society, and ultimately improve public health outcomes.
The role of health literacy in evaluation of health promotion and prevention interventions
Authors: von Rueden U
Published: October 2023

One specific contribution to the workshop is the consideration of the role of health literacy in the evaluation of health promotion and prevention interventions both as an outcome variable and as a determinant of health-related behaviour. Health literacy has a detectable impact on health status and quality of life and is a necessary prerequisite for health-promoting behaviour. Health promotion should therefore address the determinants of health literacy. The causal relationships reported in the literature between the determinants of health literacy and the dimensions of health literacy (finding health information, understanding, evaluating, implementing) and outcomes can be illustrated in impact models. By using them it becomes clear that health literacy programmes should aim to improve situational determinants as well as individual determinants. It also highlights the central importance of the availability of accessible, understandable and trustworthy health information. Health literacy outcomes are only relevant when they lead to health-related decisions and related actions of individuals. Therefore, measuring health literacy is essential, especially at the decision-making level.
Gender gap in life expectancy in Europe and the United Kingdom in 2019
Authors: Kabir Z , Curtin B
Published: October 2023

Background

Life expectancy (LE) is an important metric for overall population health and well-being. The gender gap in LE can be used as a population health metric to capture progress and monitor health inequality in a specific setting. Health inequality is an expression of universal health care coverage and unequal access to health care and the quality of health care - otherwise known as ‘amenable’ mortality.

Methods

The Global Burden of Disease (GBD) Study- a comprehensive global epidemiologic database has developed and validated two population health metrics across 200+ countries- the Universal Health Coverage (UHC) Index (0-100) and the Healthcare Access and Quality (HAQ) Index (0-100) to monitor progress in these two specific domains for each country. We set out to examine the association of gender gap in LE with UHC and HAQ indices across 27 EU countries and the UK combined for year 2019 employing correlation and linear regression analyses.

Results

Overall, LE ranged from 73.3 years in Bulgaria to 83.1 years in Italy; UHC index was worst in Bulgaria (62.6), while Luxembourg (91.5) was the best performing nation; HAQ index had the highest score in the Netherlands (91.1), while Bulgaria had the lowest score (64.9). Lithuania had the largest gender gap in LE (9.2 years; M:71.5; F: 80.7), while the Netherlands had the narrowest gender gap (3.4 years; M:80.0; F: 83.4). On multivariable linear regression, gender gaps in LE were significantly associated with both HAQ (beta: -0.17; R2=0.66), and UHC (beta: -0.14; R2=0.52) across 27 EU countries and the UK combined.

Conclusions

Gender gap in LE can be a proxy measure to monitor progress in health inequality in terms of universal health care coverage, as well as health care access and quality of health care for a specific population setting. The findings suggest that gender gap in LE can be significantly reduced through expansion of universal health care and improving both access and quality of health care in the EU.

Key messages

• Gender gap in life expectancy can be a good proxy to monitor progress in health inequality for EU countries and the UK combined, which has 5.5 years of gender gap in life expectancy on average in 2019.

• A 10% increase in both universal health care coverage and health care access and quality, can reduce gender gap in life expectancy by 1.4 and 1.7 years, respectively, across EU and the UK combined.
The state of community health practice in the Czech Republic: Saste Roma project
Authors: Volevach E
Published: October 2023

A central public health objectives of the Czech government is to reduce health inequalities for community members living in deprived areas of Czechia, where Roma are the most frequent inhabitants. This is achieved through Community Health Workers (CHWs) and subsidies for NGOs. However, they often lack the necessary training in health promotion. Developing more systematic intervention tools could help tackle this challenge, thus improving community health practices and decreasing the burden on the health system. The Saste Roma project responded to the lack of systematic community health practices. It aimed to improve secondary prevention in Roma by developing several interventional tools. Socio-culturally appropriate printed materials are to be used by CHW, as well as by doctors and community members; e-learning is intended for implementation as a part of the school curriculum. These tools have the potential to lower the burden on the health care system to improve community health as they act as communication channels between health professionals and the community. The development of the above tools was carried out with the help of governmental and non-governmental organizations, CHWs, and community members. During the development of the project, some shortcomings of Czech community health services were identified. They include the low competence of CHW, the unwillingness of different sectors to cooperate, refusal of schools to participate due to poor school attendance and workload from other projects. Thus, despite the large government investments in the policy of reducing health inequality, at the local level, it often does not work as it was officially stated. Moreover, despite a 20-year Roma-oriented policy, no evaluation has yet been carried out. Intervention tools from the Saste Roma project can be a first step to get community health practice more systematic in Czechia. The Randomized-control-trial to evaluate the efficacy of developed tools will follow.
Low-dose CT for lung cancer early-detection in China: Findings from a screening program in Shanghai
Authors: Teng J Y , Yao W Y , Li J , Xu H L , Xu W H
Published: October 2023

Background

Low-dose computed tomography (LDCT) has been recommended for lung cancer screening in high-risk populations. This study is aimed to evaluate the effects of LDCT screening for lung cancer in Chinese populations.

Methods

A total of 26124 subjects aged over 40 years were enrolled from the Minhang District of Shanghai, China, 2013-2017. The detection of lung cancer and the survival status of cases up to Dec 31,2018 were obtained. Standardized incidence ratio (SIR) was calculated for the screened populations relative to the local general population. Three-year survival rates and proportion of early-stage (stage 0-I) cancer were estimated for all cases from general population and for screen-detected cases. For 12184 high-risk individuals in the screened population, a total of 12184 matched controls without LDCT were identified using propensity score matching (PSM), lung cancer mortality and all-cause mortality were calculated and compared between groups.

Results

The crude incidence of lung cancer in the screened population was 426.6 (95%CI: 387.4-470.2) per 100000 person-years, with an overall SIR of 2.3 (95%CI: 2.0-2.5). The SIR decreased with the highest level in the first year [3.8 (95%CI: 3.3-4.3)], and a lower level over 3 years [0.6 (95%:CI: 0.5-0.7)]. Early-stage lung cancer accounted for 26.3% of screen-detected cases, significantly higher than 15.3% in all cases during the same period. The 3-year survival rate was also higher in screen-detected cases (60.4%) than all cases (50.9%). Compared with the matched control group, the screened group had a 32.0% (95%CI: 0.47- 0.99) reduced lung cancer mortality and a 56% (95%CI: 0.37-0.52) decreased all-cause mortality. The proportion of early-stage lung cancer was also higher in cases screened-detected than in non-screened (28.9% vs 11.8%, p < 0.05).

Conclusions

Our results prove the benefits of LDCT screening and its great potential in reducing the disease burden of lung cancer in Chinese populations.

Key messages

• LDCT screening improved the detection of lung cancer in Chinese populations, and increased the proportion of early-stage cancer and 3-year survival rate of detected lung cancer cases.

• LDCT screening decreased 32% of lung cancer mortality and 56% of all-cause mortality in Chinese populations.
Joint trajectories of physical activity, self-rated health and income in Finnish statutory retirees
Authors: Lallukka T , Kolmonen P , Rahkonen O , Lahelma E , Lahti J
Published: October 2023

Background

Health behaviours, health and socioeconomic position, particularly income, are known to change during ageing. However, no previous study has examined how they develop together over statutory retirement transition. We aimed to examine this joint development and to identify determinants of distinct groups.

Methods

We examined former employees of the City of Helsinki, Finland, who retired statutorily 2000-2022 (n = 4384, 79% women). We used five repeated questionnaire surveys to examine the joint developmental patterns in key indicators of healthy ageing and wellbeing: self-rated health, leisure-time physical activity and household income. We used joint group-based trajectory analysis to identify latent developmental groups and average marginal effects to examine determinants of the trajectory group membership.

Results

We found four distinct groups describing the joint developmental patterns. Group 1 (23%) had consistently poor health, little physical activity, and low, although slightly increasing income levels. Group 2 (34%) had first good but then declining health, average physical activity, and low but slightly increasing income. Group 3 (13%) had good health and very high level of physical activity, but average and fluctuating income. Group 4 (30%) had first good but then declining health, stable rather low physical activity and sharply increasing and high income. People with obesity had 23% (95% CI 22-26) higher likelihood of belonging to the Group 1 as compared to people with normal weight. They were also more likely with low education.

Conclusions

Over a follow-up of more than 20 years, we identified distinct groups among statutory retirees regarding their development of physical activity, self-rated health and income. Public health interventions to improve well-being and narrow health inequalities during ageing need to consider this heterogeneity and target policies considering people with different developmental patterns in their well-being.

Key messages

• Changes in income did not develop jointly with changes in health. Most statutory retirees had relatively good health, despite the development in leisure-time physical activity and household income.

• Decline in physical activity could reflect decreasing intensity. Social and health-related factors show associations with the trajectory memberships, reflecting the known inequalities in health.
Turnover Intention determinants of EU hospital doctors and nurses: results from the METEOR survey
Authors: Enea M , Maniscalco L , Boone A , Lavreysen O , Godderis L , de Vries N , de Winter P , Kowalska M , Szemik S , Matranga D
Published: October 2023

Background

To contrast effectively the shortage of healthcare workers in the EU, it is essential to find the determinants of the intention to leave the hospital (ITL) by analyzing the role of burnout (BO), job satisfaction (JS), and other individual characteristics and working-related variables. This study aims to estimate the prevalence of ITL for physicians and nurses in Europe, to investigate the determinants of ITL, and to suggest possible job retention policies.

Methods

The METEOR survey is a cross-sectional study on 8 hospitals of Belgium, The Netherlands, Italy, and Poland. Data collection was from May to September 2022. The theoretical model was the Job demands-resources model and validated questionnaires were used. ITL was assessed as agreement with the sentence “I intend to leave my current hospital for another one in the near future” and the response items were scored on a 5-point Likert scale. Two multivariable logistic models for ITL were estimated for both physicians and nurses, including JS, BO, and workers’ individual and hospital characteristics as covariates.

Results

The study included 381 physicians, and 1351 nurses. Physicians and nurses who agreed with ITL were 17% and 9%, respectively. Logistic models for physicians showed that by increasing JS (OR = 0.31, p < 0.001) as well as age (OR = 0.91, p < 0.001), and living with partner (vs alone) (OR = 0.56, p < 0.039), the odds of ITL decreased. For nurses, the model revealed that by increasing JS (OR = 0.27, p < 0.001), as well as age (OR = 0.97, p < 0.001), and equipment (OR = 0.56, p < 0.039), the odds of ITL decreased.

Conclusions

Our survey showed high prevalence of ITL for both nurses and physicians. Recruitment and retention policies, at the micro/meso/macro-levels are needed. It is strategic to support healthcare workers’ categories at higher risk of ITL, such as the younger physicians and nurses.

Key messages

• Our survey found significant individual and work environment characteristics playing a role to explain ITL.

• We provide an estimate of ITL prevalence of hospital physicians and nurses in EU.
HIV testing cascade among men who have sex with men at higher HIV risk in Serbia
Authors: Baros S , Simic D
Published: October 2023

Background

Successful HIV prevention requires motivation, access, and effective use by priority populations. Accessible and non-stigmatizing HIV voluntary counseling and testing (VCT) is the first step towards timely diagnosis. In Serbia, there is a concentrated HIV epidemic among men who have sex with men (MSM), with 49.2% of new diagnoses being detected late in 2021, based on initial CD4 cell count. We examined key aspects related to HIV testing among a high-risk sample of Serbian MSM to improve national HIV prevention guidelines.

Methods

A bio-behavioral cross-sectional respondent-driven sampling study among MSM in 4 cities in Serbia was conducted in 2021 (N = 1,300). We analyzed HIV testing among MSM who had unprotected anal sexual intercourse (UAI) in the last 12 months. The motivation pillar was operationalized as adequate knowledge of where VCT services can be obtained, the access pillar was operationalized as having ever had HIV testing, and the effective use of the VCT service pillar was operationalized as HIV testing in the last 6 months.

Results

Of all MSM reached, 63.8% had practiced UAI in the last 12 months, of whom 66.47% knew where to access VCT services. Of these, 88.9% had even been tested for HIV, yet only a quarter (25.5%) had been tested in the last 6 months. Therefore, only 15.1% of MSM who practiced UAI in the last 12 months had been recently tested for HIV.

Conclusions

HIV testing rate is high among Serbian MSM if they have adequate knowledge of where VCT services can be obtained. However, even though community-based VCT among MSM is subsidized by the Ministry of Health of the Republic of Serbia, the effective use of the VCT services is very low among high-risk MSM. This suggests that VCT service promotion must be transformed to be both visible and culturally sensitive to the Serbian MSM community. VCT protocols should also encourage regular testing (at least every 6 months) for those most at risk for HIV acquisition.
Enhancing men's awareness of testicular diseases: A feasibility trial and process evaluation
Authors: McCarthy M , Hegarty J , Davoren M , Dahly D , Shiely F , Harrington J , Shorter G , Murphy D , Cooke E , Saab M M
Published: October 2023

Background

Testicular cancer is the most common cancer in men aged 18 to 44 years. Symptoms of testicular cancer can mimic those of benign diseases like epididymitis and torsion. Men's awareness of testicular diseases is often lacking and their intention to seek help for testicular symptoms is sub-optimal. Athletes involved in field games like hurling are at risk for testicular trauma and diseases. The aim of the enhancing men's awareness of testicular diseases (E-MAT) study was to explore the feasibility of conducting a definitive trial to test the effect of E-MATVR (intervention; virtual reality [VR] game) compared to information delivered electronically E-MATE (control; information in PDF format) on testicular knowledge and self-examination among athletes.

Methods

In total, 74 participants were recruited from nine Gaelic Athletics Association (GAA) sports clubs in County Cork in Ireland using social media posts and posters. Participants were individually randomised to either E-MATVR or E-MATE. Outcomes were measured at T0 (baseline), T1 (immediately post-test) and T2 (3 months post-test).

Results

Testicular awareness increased significantly between T0 and T1 (p = 0.01) in both groups. Testicular awareness further increased at T2 for E-MATE participants. All participants in E-MATVR (n = 37, 100%) agreed that the VR headset was easy to use and that they were engaged to learn, while almost all E-MATE participants (n = 33, 89%) agreed with these statements. Most participants in both arms agreed that the time it took to complete the intervention was reasonable (p = 0.036). All participants were either extremely satisfied or somewhat satisfied with their overall experience of participating in the study.

Conclusions

VR may be effective in enhancing men's awareness of and help-seeking intentions for testicular diseases. A future definite trial is warranted to test the effect of E-MATVR.

Key messages

• VR may be effective in promoting the wellbeing of hard-to-reach populations, particularly among young men, to help raise awareness and promote testicular self-examination and early help-seeking.

• VR may help detect testicular diseases early, reduce treatment costs, and improve overall health outcomes.
Determinants of infectious disease-related knowledge among adolescents in Armenia
Authors: Sargsyan Z , Grigoryan Z , Harutyunyan T
Published: October 2023

Background

Adolescence is an important period of life, characterized by increasing level of responsibility and independent decision-making, hence it is crucial to explore the infectious disease (ID) related knowledge, which may affect lifelong healthy behavior and control over own health in adulthood. We assessed the level of knowledge for common IDs and explored associated factors among 15-17 years old adolescents in Armenia.

Methods

We conducted a survey among adolescents from three public and one private high schools from capital Yerevan and an adjacent province in 2023. The instrument included items on measles, HIV, TB, influenza, HPV, and socio-demographics. Summative scores were calculated for each ID knowledge, and the scores were combined for measles, HIV, and TB. Univariate and multivariable regression explored socio-demographics associated with each of the scores.

Results

Overall, 368 students completed the survey, most of them being females (64.4%). Nearly 85% have heard about measles and half of them knew that vaccination is the most effective preventive measure (44.5%). About 89%, 78%, and 29% of the adolescents heard about HIV, TB and HPV, respectively, and even few of them identified the correct paths for their transmission and prevention. Almost all (96.5%) heard about influenza, yet 44.1 % reported antibiotics being effective against it. The percent knowledge scores for measles-HIV-TB, influenza, and HPV were 39.7%, 56.3%, and 10.3%, respectively. In the adjusted analysis across all socio-demographics, only the private school type was associated with higher mean score for measles-HIV-TB (p < 0.001), while no differences were found in relation other ID scores.

Conclusions

There is substantial lack of awareness about the most common infectious diseases among adolescents in Armenia. Targeted interventions should address the knowledge gaps among adolescents and promote safe infectious disease-related behaviors.

Key messages

• There is substantial lack of awareness about the most common infectious diseases (measles, HIV, TB, HPV, influenza) among adolescents in Armenia.

• Targeted interventions should address the infectious disease knowledge gaps among adolescents and promote safe infectious disease-related behaviors.
Parental oral health knowledge and plaque index of their children in rural communities of Armenia
Authors: Atanyan A , Muradyan D , Mkrtchyan M , Karbouian K , Paranjkhoo P , Yeretzian S T , Lylozian H , Demirchyan A
Published: October 2023

Background

While the prevalence of oral diseases in high-income countries is decreasing, the opposite is true in low and middle-income countries. Parental awareness about oral health has been shown to be an important contributor to children's oral health. This study evaluated the association between parental oral health knowledge and the oral health status of their children aged 6-10 years in two rural communities of Armenia.

Methods

This cross-sectional study included two main components: telephone survey among parents measuring sociodemographic, oral health knowledge, and behavioral variables, and clinical examination of children's oral health. Multivariable linear regression was used to identify the adjusted association between parental oral health knowledge score and children's oral health measured by plaque index.

Results

A total of 400 pairs of parents and children participated in the study. The mean plaque index among children was 3.1 (out of the maximum 5.0), demonstrating abundant coverage of teeth with plaque. The mean parental knowledge score was 6.9 (out of the maximum 9.0), indicating above-average oral health awareness. The items with the lowest proportion of correct responses were the belief that caries is preventable, the importance of daily flossing, and using fluoride-added toothpaste/water for preventing caries, with 75.1%, 60.4%, and 59.9% of correct answers respectively. The multivariable analysis found negative association between parental oral health knowledge score and children's plaque index (B= -0.24, p = 0.039), when controlling for other significant variables.

Conclusions

The study confirmed the importance of parental oral health knowledge for the oral health of their children and highlighted the knowledge gaps that should be addressed. The high prevalence of dental plaque among the children emphasized the need for complex interventions, including educational activities, preventive clinical procedures, and improved access to dental care.

Key messages

• In two rural communities of Armenia, there was a clear link between parental oral health knowledge and oral health status of their primary schoolchildren measured by plaque index.

• Well-focused educational interventions targeting parents of primary schoolchildren combined with children’s better access to dental care are recommended for improving their oral health.
Comprehensive Sexuality Education in Italy: results from a pilot activity, April 2023
Authors: Chinelli A , Galipò R , Meli P , Bellini S , Catucci N , Farinella M , Paparatto G , Musco A , Martinelli D , Tavoschi L
Published: October 2023

Background

Comprehensive Sexuality Education (CSE) is a key strategy to promote adolescents’ sexual and reproductive health (SRH) in school context. However, CSE is not part of Italian school curricula. This study, funded by the Ministry of Health, describes the preliminary results of a CSE pilot activity in upper secondary schools (USS), in 4/20 Italian regions, started in February 2023.

Methods

The pilot activity has been developed by an interdisciplinary team of academics, public health professionals and civil society organisations (CSOs) with expertise in SRH promotion in schools. It consisted of 5 interventions on the following topics: 1) adolescence and healthy relationships; 2) sexual identity and diversity; 3) sexual consent and contraception; 4) sexually transmitted infections (STIs) prevention and sexual health services; 5) insights into topics chosen by the students. The evaluation consisted of pre-post tests on knowledge and satisfaction.

Results

The results refer to preliminary analysis of 551 pre-tests, 443 post-tests and 329 satisfaction questionnaires. Knowledge significantly increased in 13/15 items investigated. Highest increment of correct answers was found in items related to HIV/AIDS treatment (+41.1%) and STIs symptoms (+37.5%). No increment was observed in items asking the meaning of empathy and stereotype. Among the pre/post-test open questions, “What is sexuality?” showed broader texts and less uncertainty in the post-test answers compared to the pre-test (9.1% vs 1.7%). 90% of students appreciated “very much” talking about STIs and 72% liked the possibility to talk to adults other than teachers.

Conclusions

This study represents one of the first attempts to provide evidence-based data to promote CSE in Italy. Early results reveal short-term positive outcomes (e.g. increased knowledge and decreased uncertainty). However, more data and advocacy are needed to support the introduction of CSE in Italian school curricula.

Key messages

• Comprehensive sexuality education is fundamental to promote sexual health among young people, especially in school context.

• Italy needs to develop and implement a standardised, evidence-based, comprehensive sexuality education intervention to be included in school's curricula.