bluuebunny/crossref_metadata_2025 huggingface dataset:
Mixed-method study of women’s experiences of Respectful-Disrespectful Maternity Care in Cyprus
Authors: Middleton N , Papairaklidiou I , Kapsou M , Hadjigeorgiou E , Kinni P , Karanikola M , Nicolaou C , Kolokontroni O ,   RESPECT project team
Published: October 2024

Background

Since the WHO reports on Disrespect and Abuse (D&A) in childbirth, there was an increase in studies across Europe exploring women’s experiences. Even though contentious, a 2024 EU Committee report adopts the term obstetric violence. With the highest caesarean section (C/S) in the EU, the birth environment in Cyprus raises questions about informed choices.

Methods

The RESPECT mixed-method study gained insights into the experiences of women in Cyprus with focus groups (N = 6, 28 women) and survey (online and in-person) tapping on Rights for Respectful Maternity Care (RMC), as measured by Person-Centred Maternity Care scale (PCMC), autonomy in decision making (MADM), dignity and respect (MoRi) and mistreatment (MIST).

Results

Among 516 responses (61% first childbirth, 38.5% vaginal, 15% public sector, consistent with official statistics), the 35-item PCMC (range 0-100%) represents a continuum of quality standards deviations (Med=81, IQR=61-92). Lowest scores were recorded for “Communication & Autonomy”, with 28.5% reporting ‘feeling pushed into a decision’, with associations observed with younger age, first-time birth, mode and place of birth, highlighting social inequity. Based on MADM, 23.8%, 14.1% and 14.7% women were classified as having moderate, low or very low autonomy. For mistreatment, 32.0% reported at least one of 11 indicators, most commonly privacy violations and no freedom of movement. Formula feeding against wishes (13.6%), vaginal examinations (11.6%) and episiotomy (7.8%) where most common among 33.7% reporting procedures without consent. Deductive content analysis of narratives according to RMC triangulate findings of weak shared decision-making processes.

Conclusions

Given that C/S reduction was identified as a national priority in Cyprus, the RESPECT findings can widen the conversation about quality improvement and form the basis to engage with local stakeholders in an open-dialogue about RMC, guided by participatory action research principles.

Key messages

• In the medicalized birth environment of Cyprus, women report a range of sub-optimal practices, with ethical implications, primarily affecting the right to autonomy.

• Adopting the Respectful Maternity Care framework, the findings can stimulate and shape quality improvement efforts in a participatory and inclusive process with local stakeholders.
Association between infant feeding behavior and maternal choice of breastfeeding type
Authors: Abonce Bautista K A , Cordero Garcia P , Ruiz Garcia F , Ceballos Vela M C , Viñas Dozal J C , Villegas-Dominguez J E , Lopez Hernandez F , Vázquez Hernández K
Published: October 2024

Introduction

Feeding in infants is a fundamental process influenced by the mother-child relationship during the early months of life. The regulation of feeding behavior, and hunger and satiety cues may be interpreted by the mother, potentially relating to the type of feeding chosen.

Objectives

To determine the association between infant feeding behavior and the type of breastfeeding chosen by the mother.

Methods

A cross-sectional and prospective study was conducted, including mothers with children aged between 6 and 18 months. Those with medical contraindications for immediate postpartum breastfeeding or with suspension of exclusive breastfeeding during the first 6 months of life due to medical prescription were excluded. The Baby Eating Behavior Questionnaire was used to evaluate the baby’s enjoyment of food, appetite response, eating speed, and satiety response.

Results

108 mothers were included, with 87% in agreement with exclusive breastfeeding (EBF), 43.3% using breastfeeding as the primary feeding method, and only 33.3% practicing EBF during the first 6 months. Food response (FR) scored 19.6 (±4.3), enjoyment of food (EF) 17.6 (±2.1), satiety response (SR) 7.1 (±2.0), eating speed (ES) 8.8 (±2.3), and appetite (AP) 4.2 (±0.7). Comparing FR, EF, SR, ES, and AP scores between those who practiced EBF and those who did not showed p > 0.05. sociodemographic characteristics, perinatal factors, stance on EBF, number of hours per day with the child, feeding location, poor technique, breastfeeding pain and lack of medical guidance, all showed p > 0.05 when comparing between those who practiced EBF and those who did not; in contrast to perceiving that the baby wanted to breastfeed (2.5/1.0-6.2), having time to feed (3/1.2-7.2) and having no health problems (10/1.2-78.7) all with p-value <0.05.

Conclusions

The mother’s perception identifying the baby’s desire to breastfeed, having time to feed the baby and not having health problems favor exclusive breastfeeding.

Key messages

• Maternal perception plays an important role in deciding to give SCI, so it is the physician’s job to educate the mother so that she has additional arguments for choosing SCI.

• The infant’s feeding behavior does not have a significant impact on the mother’s behavior in choosing SCI feeding.
Breastfeeding duration, children’s diet and physical activity in immigrant children living in Lisbon
Authors: Loesch R Becker , Banha Alves I , Neto Conceição M , Oliveira Martins M R
Published: October 2024

Background

In 2023, 25% of children born in the Lisbon metropolitan area were from foreign mothers. Children of immigrant parents often face an unbalanced diet and unhealthy lifestyle, preventing them from reaching their full potential. The aim of this study was to analyse the associations between migrant status and breastfeeding duration, fruit and vegetable consumption and physical activity in children living in the Lisbon metropolitan area, Portugal.

Methods

Cross-sequential cohort study in Lisbon Region. Between May 2022 and April 2024, 729 children (49.4% immigrants) born in 2018 and 2020 were enrolled in the study. Data were collected in a face-to-face interview with the parents using a structured questionnaire with information on children’s diet (fruit and vegetable consumption) and physical activity. We used X2, Mann-Whitney U and t-tests to compare immigrant and non-immigrant children. Adjusted odds ratios (aOR) with a 5% level were estimated by logistic regression.

Results

Immigrant children (49.4%) live in socio-economically disadvantaged families. Breastfeeding practices are more common among migrant mothers with a higher median duration of exclusive breastfeeding (6 versus 4 months, p < 0.001) and a higher median duration of breastfeeding (14 versus 8 months, p < 0.001). Parental migration background is associated with the frequency of fruit (p = 0.039) and vegetable (p < 0.01) consumption and with the practice of physical activity (p < 0.01). The odds of consuming three or more portions of fruit are 1.37 times higher for non-immigrant children, and the odds of consuming two portions of vegetables are higher for non-immigrants than immigrants (aOR=2.04, p < 0.01). Practicing sports is most frequent in non-immigrants (aOR =2.25; p < 0.01).

Conclusions

Migrant status was associated with a less healthy lifestyle in childhood for children living in the Lisbon metropolitan area.

Key messages

• Breastfeeding is an essential source of nutrition for children, especially in socio-economically disadvantaged families.

• The migrant status is often associated with inequalities in childhood, challenging immigrant children to achieve their full potential.
Mapping the Out-of-Pocket Healthcare Costs for Terminal Cancer Patients across Europe
Authors: Tur-Sinai A , Bentur N
Published: October 2024

Background

In many countries, including those with universal health insurance, cost-sharing for healthcare is prevalent, resulting in out-of-pocket expenses for cancer patients. However, the proportion of government contribution to national healthcare expenditure varies across countries. This study aims to determine the prevalence and magnitude of out-of-pocket expenditure among cancer decedents in their final year of life and to assess whether decedents’ characteristics or their country’s welfare regime have a greater impact on out-of-pocket expenditure.

Methods

SHARE data was analyzed for individuals aged 50 and above from seven European countries (including Israel) who passed away from cancer. Interviews were conducted with the decedents’ family members to gather information about out-of-pocket expenditure on behalf of their deceased relatives.

Results

The study identified 1,950 cancer decedents with an average age of 74.4 (S.D.=9.39), of which 58.0 percent were male. In their last year of life, 58 percent of the decedents incurred out-of-pocket expenditure on healthcare services. The welfare regime is found to be the primary factor influencing the likelihood of out-of-pocket expenditure, while patients’ characteristics have minimal impact. The proportion of out-of-pocket expenditure varies significantly across welfare regimes, with the highest probability observed in the Continental and Social Democratic regimes and the lowest in the Mediterranean and East European regimes.

Conclusions

A country’s welfare regime plays a crucial role in determining the generosity of its public healthcare spending and its ability to alleviate the financial burden on the households of cancer patients. Increasing public funding for cancer care may reduce patients’ out-of-pocket expenditure in all countries, particularly in those where out-of-pocket expenditure is the highest.

Key messages

• A country’s welfare regime significantly impacts the likelihood and magnitude of out-of-pocket healthcare expenditure for cancer patients in their last year of life.

• Increasing public funding for cancer care may help reduce the financial burden on patients and their families, particularly in countries with high out-of-pocket expenditure.
Main challenges and measures taken by public health institutions in response to war in Kyiv Region
Authors: Rodyna N , Kuzin I , Husovych M , Maiboroda V , Kozolii I , Kupriianova T , Aaronson W , Hasiuk L , Savchuk R , Tomosky A M
Published: October 2024

Background

The establishment of martial law due to Russia’s military aggression against Ukraine led to specific adjustments in the functioning of the Centers for Diseases Control and Prevention (Ð¡DÐ¡). The negative impact of hostilities is determined by the increased morbidity rate of communicable and non-communicable diseases, insufficient supply of safe drinking water and food to damaged sites, inadequate living conditions, etc.

Objectives

The purpose of the work was to create an effective system for responding to biological, chemical and radiation hazards and eliminating the consequences of an emergency situation in the realities of martial law.

Methods

We used the most common methods, namely descriptive, statistical, microbiological and сhemical laboratory tests.

Results

The activities of the CDC under martial law include daily monitoring studies of environmental objects. The epidemic situation of acute intestinal infection (AII) and other communicable diseases (CD) is constantly analyzed. The Kyiv Oblast CDC became the basic institution for the implementation of the ‘pilot project’ in the direction of sanitary and epidemic assessment and monitoring of environmetal objects in 188 de-occupied areas. The main public health risks were identified: providing the population with high-quality drinking water; low immunization rate of the population; sites for the location of internally displaced persons; natural foci of especially dangerous diseases, such as tularemia, leptospirosis, infection fevers, etc. In 2022, the overall level of CD in the Kyiv region decreased by 44.0% from 2021. The most common nosologies were acute respiratory viral infections and influenza (98.9%), AII (42.4%), tuberculosis (15.3%), Lyme disease (15.3%), and viral hepatitis (14.2%).

Conclusions

Based on the research conducted, mechanisms have been developed for responding to hazards of various origins by public health institutions, including risk assessmant and laboratory studies.

Key messages

• The main focus of the Centers for Diseases Control and Prevention is aimed at effective response to hazards of various origins in order to ensure public health under martial law.

• Risk assessment in de-occupied territories has become an important tool for identifying correct approaches to prevent negative consequences for public health.
The importance of healthcare monitoring systems
Authors: Miotti A M , Tikvina S , Calzavara A , Nesoti M , Zilli E
Published: October 2024

Issue

Healthcare evaluation is an important tool of governance in the health sector that reinforces its key components: evidence-based care, effectiveness, programme standards, performance monitoring, quality improvement, risk and incident management and patient-centered care. One of the evaluation systems used by the Veneto Region (north italian region of about 4.8 million inhabitants) consists of the National Outcomes Programme (PNE) developed by the Italian National Agency for Regional Healthcare Services (AGENAS) on behalf of the Health Ministry.

Description

The PNE is an instrument used to measure, analyze, evaluate and monitor clinical and welfare assistance performances of Italian healthcare facilities. The Veneto Region, in particular, utilizes a regional epidemiologic service to periodically monitor 21 performance indicators based on “treemap” methodology. These indicators are used to assess processes, outcomes and volumes. The data used to monitor these practices derive from the hospital discharge documentation (SDO) and tax registry information system. The aim of this monitoring system is to track any critical situation that is not in alignment with national guidelines and to improve the efficacy, efficiency, appropriateness and safety within the healthcare system.

Results

In the Veneto region, over the course of nearly 10 years, this method of management has led to the development of various training courses that guide clinicians to correctly document and code different diagnosis and treatments. The treemap process of analysis has also made possible various clinical audits that have provided significant policy changes regarding risk and overall health management.

Lessons

Having a constant view of healthcare performance has proven to be helpful not only to identify some common gaps in care given from different facilities on a national level, but also guides different regions to develop specific strategies that lead to quality improvement.

Key messages

• Data on healthcare quality can be used as comparative information and for quality improvement.

• Continuous monitoring of specific performance indicators can help identify difficulties in healthcare facilities and create strategies for long term solutions.
How do industry and other actors undermine tobacco control policies post-adoption? A scoping review
Authors: Matthes B K , Hiscock R , Fitzpatrick I , Alaouie H , Gatehouse T , Gilmore ABC
Published: October 2024

Background

Over recent decades, many countries have strengthened their tobacco control policies. To be effective, full implementation is needed. Tobacco industry interference is widely recognised as a key barrier to tobacco control progress and evidence-based models like the policy dystopia model (PDM) list industry strategies, focusing on those avoiding and undermining policy adoption. While prior research highlighted industry activities post-adoption, these have not been captured systematically. This review aimed to map the efforts of industry, front groups and other actors to undermine the implementation of policies, including marketing, packaging, smokefree and flavour measures.

Methods

We searched six literature databases, relevant bibliographies and grey literature, and consulted experts. We included articles describing one or more attempts to undermine adopted policies, including marketing, packaging, smokefree and flavour. The PDM served as starting point for coding; additional strategies were identified inductively. Strategies were charted against aims and policies.

Results

Several aims and strategies were identified which were similar across policies. Following policy adoption efforts to 1) overturn and 2) weaken measures, and 3) delay implementation continued. Legal strategies were utilised and there were attempts to influence stakeholders. In addition, tobacco industry and other actors sought to 4) undermine policy effectiveness by creating confusion, circumventing policies, and noncompliance, and 5) use implementation as an opportunity to enhance industry reputation.

Conclusions

Interference from tobacco industry and other actors threatens effective tobacco control policy implementation. The public health community must continue to monitor, expose and counter industry conduct after policy adoption. More research is needed to enhance our understanding of how industry interferes in policy implementation, and how this can be pre-empted and countered.

Key messages

• The interference from tobacco industry and other actors following policy adoption threatens effective tobacco control, and needs to be monitored, exposed and countered by the public health community.

• Policymakers and civil servants need to be wary of efforts to undermine tobacco control policies and act to ensure effective policy implementation.
Empowering health literacy: Turkiye’s Health Literacy Action Plan 2022-2026
Authors: Soganda S Y , Oztop M B , Uner S , Ornek M , Kerman G
Published: October 2024

Issue/Problem

The ‘Health Literacy Action Plan 2022-2026’ of the Turkish Ministry of Health addresses the critical public health issue of limited health literacy, leading to increased hospital admissions, inappropriate emergency department use, and poor health outcomes. This underscores a significant challenge in individual health self-management and higher healthcare expenditure within the country.

Description of the Problem

The Health Literacy Action Plan aims to tackle disparities in health literacy levels among people. It employs customized teaching schemes, digital communication, and inclusive healthcare practices to reach every demographic group. The plan seeks to enhance health knowledge and empowerment among Turkish people by increasing access to medical information, simplifying clinician instructions, and promoting closer communication between patients and healthcare professionals.

Results

Comparative evaluation of nationwide surveys conducted in 2017 and 2023 with 15,000 participants shows remarkable improvements. Despite delays due to the pandemic, the action plan led to a notable increase in adequate health literacy levels from 31.9% in 2017 to 46.1% in 2023. Additionally, significant improvements were observed in ailment prevention and health promotion, with health literacy levels in disease prevention increasing from 28.4% to 45.7%.

Lessons

The Health Literacy Action Plan plays a crucial role in developing and implementing multifaceted public health strategies based on data and stakeholder participation. These interventions, requiring continuous monitoring and adjustment, are essential steps toward achieving high-level health literacy.

Key messages

• Strategic health literacy interventions are essential for improving health outcomes and optimizing the use of public resources.

• Evidence-based interventions and ongoing evaluation are key to promoting health literacy.
Navigating Crisis: Resilience and Mental Well-being in Post-COVID Cyprus Students
Authors: Magorokosho N , Heraclides A , Prodromou M , Papaleontiou-Louca E
Published: October 2024

Background

The mental health of university students is identified as a major challenge in public health, exacerbated by the COVID-19 pandemic. The pandemic and its aftermath have brought forth several stresses, which have had a substantial influence on university students’ mental health. Understanding how resilience, which is crucial in coping with adversity, influences students’ responses to these difficult circumstances is critical.

Objectives

This study aims to examine the relationship between resilience and mental health outcomes among university students in the Republic of Cyprus after the COVID-19 pandemic.

Methods

Using a parallel embedded mixed methods approach, resilience was measured using the Conner-Davidson Resilience Scale (CD-RISC) while mental health outcomes were assessed using the Symptom Checklist 90-Revised (SCL 90-R) among a preliminary sample of 470 students. The association between the two was assessed by linear regression analysis, adjusting for potential confounders, and also stratifying by gender.

Results

Preliminary findings from this ongoing study revealed a significant inverse relationship between resilience and mental health (beta= -0.58, 95% CI -0.88, -0.29), regardless of gender, age, or socioeconomic status. Stratifying by gender revealed for males, the association between resilience and mental health is (beta= -0.50, 95% CI -0.98, -0.32), whereas for females, it is (beta= -0.63, 95% CI -1.04, -0.22). In short, the influence of resilience on protecting mental health appears to be slightly more prominent in women than in males.

Discussion

This study enriches our understanding of the intricate interplay between the COVID-19 pandemic, resilience, and mental health outcomes among university students. By prioritizing the psychological well-being of this population group, our findings resonate with the World Health Organization’s advocacy for heightened mental health awareness during crises.

Key messages

• Prevalence of mental health issues post pandemic era among university students.

• Resilience as a buffer for mental health crisis in young adults.
Factors predicting a decrease in suicidality among young people (0-28 years old)
Authors: Gijzen M , Van Bergen D , Jeronimus B , Oldehinkel T
Published: October 2024

Background

Suicide, self-harm and suicidal thoughts (i.e., suicidality) are important public health concerns. Most youth that experience suicidality find a way to overcome these affronts. Preventative public health measures require an understanding of factors that can help youth overcome their suicidality.

Methods

Data come from a Dutch prospective birth-cohort study that surveyed youth from age 11 to 28 (measurements 2-3 years apart). We determined the proportion of youth that experienced suicidality across seven waves and focused on changes in suicidality, and factors associated with changes in suicidality using linear discriminant analysis. We examined a mix of individual, family, peer and socio-cultural factors in line with an ecological framework, e.g. the Interpersonal Theory of Suicide.

Results

Between 4-8% of youth experienced suicidal thoughts and between 2-5% experienced self-harm across time points. Most youth (89%-94% across time points) did not experience changes in suicidality, while between 3-6% experienced a decline of suicidal thoughts and between 2-4% a decline in self-harm across time points. Discriminant analyses could correctly identify ≈90% of subgroup per case (decline, increase, stable suicidality). But, the model was not very accurate in predicting which youth belonged to the declining suicidality subgroup. Functions with best predictive ability indicated the importance of interpersonal factors; belonging to peers, parents, classmates, teachers and religion. Also, overall happiness and positive changes in romantic relationships and family had predictive value.

Conclusions

It remains difficult to distinguish youth who experience a decrease in suicidality. Interpersonal factors may play a role in changes in suicidality, but we need to identify new factors related to declines in suicidality. Future prospective birth-cohort study should consider including factors that may be better predictors of decreases in suicidality and mental health in general.

Key messages

• Factors that contribute to decreases in suicidality will enrich suicide prevention strategies, which have until thusfar mostly been informed by a risk perspective.

• Interpersonal factors might play an important role in changes in suicidality among youth, which indicates we need an ecological perspective on suicidality rather than an individual perspective.
Smartphone addiction among medical students in the University of Monastir, Tunisia
Authors: Zemni I , Bennasrallah C , Kacem M , Garrach B , Dhouib W , Ben Fredj M , Abroug H , Zayene O , Bouanene I , Sriha A
Published: October 2024

Background

Smartphone addiction is a global mental health issue with diverse psychological and socioeconomic concerns. The aim of this study was to determine the prevalence of smartphone addiction and its associated factors among medical students in the university of Monastir, Tunisia.

Methods

We conducted a cross-sectional survey among medical students of the faculty of medicine of Monastir in October 2020. The data were collected through a self-administered anonymous questionnaire that included the SAS-SV scale to assess smartphone addiction levels. A multivariate logistic regression model was employed to identify associated factors. The threshold of statistical significance was set at p < 0.05.

Results

A total of 626 medical students participated in this study, with an average age of 21.76 ± 3.12 years and a sex ratio of 0.41. The prevalence of smartphone addiction was 30.2% (95% CI: 26.0% - 33.79%). Associated factors with smartphone addiction included academic repetition(OR = 4.30; 95% CI [1.38 - 13.42]), fast food consumption scores (OR = 1.55; 95% CI [1.21 - 2.00]),addiction to the Facebook social network (OR = 6.36; 95% CI [1.92 - 21.07]), cohabitation with colleagues (OR = 2.13; 95% CI [1.03- 4.43]), cohabitation with family members(OR = 2.10; 95% CI [1.01 - 4.36]) and stress level (OR = 1.13; 95% CI [1.07 - 1.18]).

Conclusions

This study identified associations between smartphone overuse and other behavioral and mental health indicators. Based on these findings, several interventions should be undertaken to address this growing concern.

Key messages

• The prevalence of smartphone addiction among medical students in the University of Monastir was 30.2% (95% CI: 26.0% – 33.79%).

• The main associated factors with smartphone addiction were academic repetition, fast food consumption, addiction to Facebook, cohabitation with colleagues and with family members and stress level.
Bridging gaps: A closer look at the health of sexual and gender minorities in Austria
Authors: Pfabigan J , Pentz R , Teufl L , Winkler R , Gruber G , Gaiswinkler S
Published: October 2024

Austria has long lacked comprehensive data on the health and well-being of sexual and gender minorities (SGMs). The 2022 LGBTIQ+ Health Report addresses this gap by presenting a comprehensive overview of the health status of SGMs in Austria. To contextualize SGM health issues, a review of the literature, health surveys, and action plans across Europe was conducted in the initial project phase. Then a questionnaire was developed in collaboration with an expert group for quantitative data collection. A total of 1,047 individuals participated in the survey; analyses of the quantitative data were enriched by insights from ten qualitative interviews. Detailed findings cover SGMs’ health status and experiences of discrimination as well as access to healthcare and health-promoting factors. Participants rated their health status lower than the average in Austria. A high number reported encountering discrimination in healthcare, especially among intersex and trans participants. While approximately half of the respondents were satisfied with healthcare provision, around 16% expressed dissatisfaction. Finally, a significant proportion of participants reported having foregone healthcare services at least once despite having health issues. Our work underscores the importance of recognizing the diverse needs of distinct groups within the SGM spectrum. It is crucial to avoid oversimplification by grouping them into a single SGM category as this obscures the unique challenges and inequalities faced by each subgroup. The rapid evolution of terms adds complexity to this work. Moreover, attention should be directed towards intersectionality within these groups as some are hard to reach with an online survey. Navigating the seas of public health innovation, our exploration of SGM health in Austria reveals not only the challenges but also the imperative for inclusive and tailored healthcare strategies.

Key messages

• The 2022 LGBTIQ+ Health Report Austria reveils SGM health realities: lower health status, discrimination, and unmet healthcare needs, urging targeted interventions.

• Acknowledging diverse SGM groups and evolving terminologies, our study underscores the need for nuanced, intersectional healthcare approaches.
Smoking, alcohol, substance, technology, and gambling addiction among university students
Authors: Baran A , Sülü M , Kekilli C , Avcu A , Gündoğdu S , Boz G , Genç M
Published: October 2024

Background

University students turn to addictive substances to cope with the anxiety and stress caused by separation from family, adaptation to a new environment, as well as many economic and social problems. This study aimed to examine smoking, alcohol, substance, technology, and gambling addiction among university students.

Methods

The data of this cross-sectional study were collected between February and March 2024. The study population consisted of 23,446 people studying at Ä°nonu University, and the sample size was calculated as 346 based on a smoking rate of 35.6% among university students. A stratified sampling method was adopted according to the faculty of study, and 366 people were approached regarding the study. The independent variables were age, gender, faculty of study, and smoking status, while the dependent variables were alcohol and substance use status. Descriptive data were expressed in numbers and percentages, and a Chi-square test was used in the statistical analysis.

Results

Of the students in the research group, 56.8% were female, 54.4% were 22 years of age or older, 30.1% reported smoking cigarettes, 7.7% reported drinking alcohol in the last 30 days, 39.2% reported using the internet for five hours or more per day, 3% reported playing various casino games on the internet once a week or more, and 1.4% stated that they used substances. There was no statistically significant difference between alcohol and substance use according to smoking status (p > 0.05).

Conclusions

Approximately one-third of the students in the research group reported smoking cigarettes, and one-tenth reported alcohol use, which is quite high. The high percentage of students who use the internet for five hours or more per day and the low rate of online gambling should be considered in relation to these addictions.

Key messages

• Multidimensional interventions and intersectoral cooperation are required to prevent smoking, alcohol, substance use, technology, and gambling addictions among university students.

• In addition, precautions should be taken to protect students against the risks associated with internet addiction and online gaming.
Promoting Equity: Child & Adolescent Health Service
Authors: Bjørnsen H N , Welde B , Lervold T , Manvik M D , Ringås H S , Høyland M M , Riiser K
Published: October 2024

The health and well-being of children and adolescents face significant challenges, particularly in times of social instability. In response to these challenges, the Norwegian government allocated funding in 2021 to establish a national center for Child and Adolescent Health Promotion Services. Situated within the Norwegian Institute of Public Health, this center focuses on enhancing expertise, professional development, and research within municipal maternity and child health clinics, school health services, and youth health clinics. This presentation delves into the crucial role of Universal Health Promoting Services (UHPS) in mitigating the adverse effects of social inequality on child and adolescent health. By leveraging evidence-based practices and identifying knowledge gaps in health promotion and disease prevention in primary care settings, UHPS serve as catalysts for reducing health disparities and enhancing outcomes among expecting parents, children, and adolescents. Moreover, UHPS plays a vital role in addressing the underlying determinants of health inequality, including social network, lifestyle factors, promotion of health literacy and ensuring accessible health care services for all. UHPS empowers individuals and communities to actively participate in health promotion efforts, fostering a culture of health equity and resilience. Through targeted health education programs, early intervention strategies, and community empowerment initiatives the UHPS work both at a systems and individual level to address social inequality in health. This presentation contextualizes UHPS within a broader picture aimed at promoting child and adolescent health while addressing social inequality in health. By highlighting effective approaches and areas requiring further research, it aims to contribute to the ongoing discourse on optimizing health outcomes for young populations.
Don’t pass me by: Tackling vaccine hesitancy among migrants via the RIVER-EU project
Authors: Ganczak M , Schloemer T
Published: October 2024

Literature research has suggested that vaccination hesitancy (VH) has been increasing in recent years across migrant populations. It poses various challenges, including risks of outbreaks, and re-emergence of diseases. Nevertheless, only few studies provide an insight of the interventions successful in tackling VH among these groups. This presentation will describe a multi-country research enterprise that aims to respond to these needs. The “RIVER-EU - Reducing Inequalities in Vaccine uptake in the European Region - Engaging Underserved communities” project (funding from EU’s Horizon 2020, Grant Agreement No. 964353) involves several underserved communities, such as Ukrainian migrants (UMs) in Poland, migrants and refugees in Greece, females with Turkish/Moroccan migration background in the Netherlands and the marginalized Roma communities in Slovakia. The project aims at improving child and adolescent HPV/MMR vaccination among these communities by implementing tailored interventions, suitable for each target country. The focus is on removing health system barriers to vaccination. The data regarding VH are an important by-product of the RIVER-EU project, and shows the connection between perceived access barriers and VH. A project-based approach to combat VH among UMs in Poland will serve as a case study to demonstrate the complex process of development of adequate interventions, that could be used to support this migrant group, with disturbingly low vaccination uptake. However, this presentation will go beyond this case study findings - a review of the existing evidence will help generalize our results. Overall, this presentation will show to how investigating various drivers of under-immunization helps to assess what approaches, strategies and interventions are effective to combat VH among marginalized migrant groups.
Longitudinal association between nonstandard work schedule and depressive symptoms
Authors: Nwaru C , Albani V , McNamara C , Bertilsson M , Bambra C
Published: October 2024

Background

Nonstandard work schedules (NSWSs) have been linked to increased risk of depression, but the evidence is mostly from cross-sectional studies and data on the risk distribution across various groups is lacking. We examined the impact of different NSWSs on depressive symptoms and assessed effect modification by sex, ethnicity, and immigrant status.

Methods

We used five waves of longitudinal data from the Understanding Society, the UK Household Longitudinal Study, which were collected biennially from 2010/11 to 2018/19. The study sample comprised 11371 employed workers aged 16 to 58 years in 2010/11. Generalised estimating equation with logistic regression was used to assess crude and adjusted effects of NSWS types (work time arrangement, work hours, and weekend working) on depressive symptoms. Independent correlation was specified in all the models. Complete-case and multiple imputation analyses were performed.

Results

After adjusting for confounders, only weekend work was associated with depressive symptoms. Workers who worked most/all (OR 1.24; 95%CI 1.13 - 1.37) or some (OR 1.10; 95%CI 1.02 - 1.18) weekends had a higher risk of depressive symptoms than workers who did not work on weekends. Ethnicity modified the association between work hours and depressive symptoms, indicating a higher risk among White workers working > 40 hours/week (OR 1.10; 95%CI 1.02 - 1.20) and Asian workers working <35 hours/week (OR 1.72; 95%CI 1.32 - 2.25) compared to White workers working 35-40 hours/week. No effect modification by sex or immigrant status was observed. The results were the same as those obtained from the imputation model.

Conclusions

Weekend work, long work hours (for White workers), or working < 35 hours/week (for Asian workers) were associated with increased risk of depressive symptoms. These findings indicate the need to review the working conditions of workers exposed to NSWSs, especially those working on weekends and Asian workers who work part-time.

Key messages

• Weekend work schedule is associated with an increased risk of depressive symptoms among employed workers in the UK.

• The effect of work hours on depressive symptoms varies by ethnicity.
Role Play: Practicing EVFAM-BR
Authors: Eshriqui I , de Almeida L Y , de Souza E L , Nascimento V E , de Mendonça JMT , Neto FTP , Rebustini F , de Medeiros E B , de Sousa AAF , Bonfim D
Published: October 2024

This activity will last 20 minutes and will consist in a role Play dynamic, when participants will have the opportunity to experience the Vulnerability Family Scale (EVFAM-BR). Groups of three participants will be formed. In each group, one person will represent the community health worker, another will act as the patient and the third will play the observer role. Half of the groups will receive a case (low family vulnerability) and the other half will receive a second case (high family vulnerability, emphasizing a violence situation occurrence).
Patient-Reported Indicator Surveys (PaRIS): measuring patient reported experiences and outcomes across populations and health systems
Authors: Porter Ian
Published: October 2024

We aimed to develop and test the performance of a questionnaire for adults (aged 45 or older) with one or more chronic conditions who use primary/ambulatory care across populations and health systems in multiple countries. Candidate scales and items were identified through a systematic process supported by international stakeholders (PaRIS Patient Advisory Panel, Technical Advisory Community and Working Party members of participating countries). Four instruments for each domain, covering patient reported outcome measures (PROMs), patient reported experience measures (PREMs), health behaviours, and health and health care capabilities, were shortlisted using predefined criteria and evaluated using the EMPRO method. A modified Delphi supported selecting a core instrument for each domain and additional relevant scales/items. Consultations took place with the stakeholders to confirm the suitability of the proposed questionnaire. The questionnaire was evaluated through cognitive testing and further modified accordingly. The survey was piloted in a Field Trial. Psychometric evaluation was conducted with data from a Field trial on an item level and scale level. Out of 217 instruments, the Delphi resulted in consensus on a core instrument for each main domain and additional questions to ensure comprehensiveness. The cognitive testing of the draft survey (17 languages, 20 countries) confirmed that most questions were interpreted as intended. The version of the survey developed for the field trial included 118 questions. The field trial psychometric evaluation was based on 10,145 patients, across 18 countries. The questionnaire performed well at item level and at scale level. Performance in terms of structure and validity was good overall. A revised version of the patient questionnaire was created with 115 items. A comprehensive questionnaire has been constructed based on the PaRIS survey framework for people living with chronic conditions and following an inclusive approach.
The Impact of Portuguese Community Pharmacies on Influenza Vaccination Accessibility and Coverage
Authors: Teixeira Rodrigues A , Guerreiro J , Romano S , Moura S , Paulino E
Published: October 2024

Background

Vaccination reduces influenza infections. Non-adherence often stems from external barriers like distance to vaccination sites. To counteract the projected coverage decrease for 2023/24, Portugal’s Government expanded free Influenza vaccination to those ≥ 60 and to community pharmacies (CP), enhancing proximity and availability. This study aimed to assess the impact of CP inclusion on the distance to vaccination sites and on Influenza vaccine coverage in the 2023/24 campaign.

Methods

Analytical study, evaluating the average distance (km) from population to the nearest vaccination site per municipality using GPS coordinates from National Health Service (NHS) sites and CP. The Global Human Settlement resident population grid was derived from Eurostat 2011 Census, Corine Land Cover Refined 2006 and European Settlement Map 2016. Scenarios with and without CP were compared. The difference (%) in distances between 2022/23 (NHS sites) and 2023/24 (NHS sites and CP) and the coverage for the top and bottom 10% of municipalities with the highest and lowest distance reductions were calculated.

Results

In the 2023/24 Influenza vaccination campaign, 844 NHS sites and 2487 CP participated. Excluding CP, the average distance to the nearest NHS site was 2.4 km, decreasing to 1.2 km with CP inclusion (-50.5%). As of March 31, 2024, influenza vaccine coverage for those aged ≥65 was 72.1%, decreasing 0.1 percentage points (pp) compared to 2022/23 (72.2%). For the top 10% municipalities with the highest distance reduction (up to 66.5%), coverage increased by 1.3 pp compared to 2022/23. Conversely, the bottom 10% (reduction under 10.3%) experienced a decrease of 4.5 pp.

Conclusions

The inclusion of pharmacies has effectively reduced access barriers, filled geographical gaps, and improved proximity to vaccination. This strategy appears to have a positive impact on influenza vaccination coverage, particularly amid growing hesitancy, with potential for broader public health strategies.

Key messages

• The inclusion of community pharmacies in the 2023/24 Influenza vaccination campaign reduced the average distance to the nearest vaccination site by 50.5%, from 2.4 km to 1.2 km.

• In 2023/24, for the top 10% municipalities with the highest distance reduction (up to 66.5%), coverage increased 1.3 pp compared to 2022/23.
Introduction to the digital health divide
Authors: Pedrós Barnils N
Published: October 2024

This presentation will introduce the concept of digital health divide. It refers to inequalities in accessing and using digital technologies, leading to digital exclusion. Digital inclusion is defined by the United Nations as “equitable, meaningful, and safe access to use, lead, and design of digital technologies, services, and associated opportunities for everyone, everywhere”. Indeed, digitalisation is a worldwide phenomenon that permeates all levels of determinants of health inequities, leading to several populations being more adversely affected. Age, gender, education, and economic status are significant determinants amplifying the digital divide’s impact, with older individuals, women, less educated individuals, and economically disadvantaged populations bearing disproportionate effects. The relationship between the digital divide and health leading to the digital health divide can be direct and indirect. Here, access to the latest advancements in health technologies used along the health span (eHealth, mHealth) - from health prevention to patient care - can directly influence the user’s health. However, the lack of access to or use of existing technologies can also indirectly affect their well-being. A globally informative example of this indirect association is the lack of internet access in rural areas during the hard COVID-19 lockdowns, leading to the loss of a school year for many pupils. Indeed, school attendance and attainment are associated with better physical and mental health. Currently, there is a lack of operationalisation of the digital health divide, making it difficult to measure it accurately. The absence of a standardised evaluation and therefore evidence-based information hinders governments and organizations’ efforts to effectively address digital health divide.
Measures to increase the retention of migrant healthcare professionals in Germany
Authors: Jansen E , Peppler L
Published: October 2024

Background

The shortage of skilled workers in the healthcare sector is a pressing issue in Germany that has been worsening in recent years. It is often compensated by the deployment of specialists from abroad. However, this is accompanied by various challenges. This article synthesizes challenges from nine years of research and proposes approaches to solutions that have proven successful in practice in Germany as well as in international settings.

Methods

The insights presented here condense the results from a total of six research projects (four on physicians and two on nursing). The research projects are based on exploratory qualitative interviews, quantitative questionnaires, mixed-methods designs, and the generation and testing of measures that can help with the integration of foreign skilled workers.

Results

The main challenges for migrated skilled workers are inadequate language and communication skills, lack of knowledge about the national healthcare system, disease and therapy concepts, unfamiliar forms of inter-hierarchical and inter-professional collaboration, a lack of understanding of administrative and bureaucratic processes and social integration. The following measures have proven successful in Germany and abroad: increasing social integration of physicians (e.g. through partner or peer programs), streamlining systems, establishing professional structures for the integration of foreign skilled workers, and creating a positive work environment.

Conclusions

Compared to findings from international studies, in Germany the hurdles of administrative processes, the peculiarities of the healthcare system (e.g. social medicine), and learning the language are considered to be the highest. It is important to counteract these challenges with appropriate measures in order to prevent a migration of healthcare professionals already in Germany to (mostly English-speaking) foreign countries.

Key messages

• In Germany the hurdles of administrative processes, the peculiarities of the German healthcare system (e.g. social medicine), and learning the German language are considered to be the highest.

• It should be considered to no longer leave the migration of healthcare staff to individual integration efforts, but to create appropriate government structures that focus on their social integration.