bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaccination in the post pandemic era - a qualitative study of the experiences of Somali immigrants
Authors: Gleditsch R N , Ofitserova T S , Winje B A , Sheikh N S , Skogheim T S , Hansen B T
Published: October 2024

Background

The Somali population is the largest non-European immigrant group in Norway and past studies have indicated lower coverage for both childhood vaccines and COVID-19. However, little is known about views and experiences of vaccination among this group and how their experiences might impact their vaccination decision-making process. This study explored views and experiences with vaccination among Somali immigrants in Norway.

Methods

We conducted semi-structured interviews with 15 participants in the fall of 2022. To better understand the participants’ perceptions of vaccine information, the data was inductively analyzed using a reflexive thematic analysis.

Results

Based on the thematic analysis, we focused on four sub themes: 1) the impact of COVID-19 on views of vaccines; 2) new versus old vaccines; 3) childhood vaccination; 4) trust in vaccines. The study found that the participants’ experiences during the pandemic have impacted their views on vaccination in general. Many of the participants expressed positive views and high levels of trust in the Norwegian health authorities and their vaccination recommendations. It was found that having sufficient information and trust in vaccination recommendations contributed to higher vaccine readiness. Viewing vaccines as new and insufficiently tested or researched, as well as lacking information about potential side-effects, increased participants’ hesitancy when faced with vaccination decisions. Among the parents in this study, postponing the measles-mumps-rubella-vaccine due to fear of autism was a common occurrence.

Conclusions

The current study fills an important gap in knowledge about views, experiences, and vaccination decisions among the Somali population in Norway. Knowledge from this study can help adapt better vaccine information and further improve the prevention of infectious diseases in Norway in general and for under-vaccinated groups in particular.

Key messages

• Having sufficient information and trust in vaccination recommendations contributed to higher vaccine readiness.

• Viewing vaccines as new and insufficiently tested/researched, as well as lacking information about potential side-effects, increased participants’ vaccine hesitancy.
Satisfaction with maternity care among immigrant women compared to non-immigrant women
Authors: Seidel V , Teschemacher L , Breckenkamp J , Borde T , David M , Abou-Dakn M , Henrich W
Published: October 2024

Introduction

Migration is a worldwide phenomenon leading to challenges for the health care system. There is conflicting evidence on the effect of migration on the satisfaction with obstetric care. Our hypothesis was that satisfaction with obstetric care was lower in immigrant women with and without self-defined (sd) refugee status than in non-immigrant women.

Methods

In the Pregnancy and Obstetric Care for Refugees (PROREF)-study between June 2020 and April 2022 in Berlin women were interviewed 1-3 days after giving birth with the Migrant Friendly Maternity Care Questionnaire (MFMCQ). The interview data was linked to the routine perinatal data of the hospital charts. Descriptive analysis and logistic regression analysis were performed to identify factors influencing satisfaction with obstetric care.

Results

A total of 3420 women (Frauen (247 with sd refugee status, 1356 immigrant women und 1817 non-immigrant women) could be included in the study, with an overall response rate of 77.5%. Satisfaction measured generally high with over 80% of women being satisfied with obstetric care at all three time points: during pregnancy, during labor and birth and after giving birth. We identified two factors associated with an increased chance of being satisfied with obstetric care: sd refugee status (OR 2.57, 95% Cl 1.48 - 4.44, p-value 0.0008) and being multipara (OR 1.40, 95% Ci 1.18 - 1.67, p-value 0.000).

Conclusions

Efforts on improving birth experience should focus on primipara. Among the reasons for non-immigrant women being less satisfied with care than women with sd refugee status might be different expectations and the timing of data collection.

Key messages

• Refugee women might have different expectations regarding birth experience than other immigrant women and non-immigrant women.

• Satisfaction with obstetric care in Berlin is generally high among immigrant women and non-immigrant women.
Self-help groups for people with migration experience
Authors: Weigl M , Ecker Sandra
Published: October 2024

Background

Self-help groups as voluntary associations of people to jointly cope with illnesses or psychological problems are sometimes regarded as the fourth pillar of the health care system. Still, so far people with migration experience do not resp. less participate in self-help groups in Austria. The project aimed therefore on identifying related obstacles and solutions.

Methods

A mixed-methods approach was chosen: a systematic literature search; interviews, focus groups and workshops; including people with migration experience and experts. A concept for self-help groups was delevoped in a participatory way, piloted in Vienna and evaluated.

Results

The study confirmed, that the concept of self-help groups as they are usually implemented in Austria is not known among people with migration experience. But there is a great need for exchange among those with a chronic illness or their relatives. Success factors and obstacles are mainly related to the access to people with a migration experience and the way how such self-help groups are set up. Much time needs to be invested in developing a common understanding of the concept of a self-help group and in maintaining contacts. However, despite the of the personal benefit, the often stressful life situation of people with migration experience is an obstacle for continuous participation or even initiating a self-help group oneself.

Conclusions

The project showed, that, although the concept of self-help groups is often not known, people with a migration experience can benefit from it. But more support is needed than is usually provided by the established self-help organisations. A change in the understanding of self-help groups on the one hand and integrating such activities in services/associations working with migrants on the other hand could improve the access for people with migration experience to this important pillar of the health care system.

Key messages

• Several obstacles hinder people with migration experience in participating in self-help groups in Austria, e.g. the concept itself is unknown to them.

• Implementing a specific concept for self-help groups with support by professionals can facilitate the access of this population group to an important part of the health care system.
Co-producing COVID-19 health education resources with ethnic minority communities in the UK
Authors: Paudyal P , Majeed-Hajaj S , Khapangi Magar N , Hughes L , Keeling D , Armes J , Kulasabanathan K , Sharp R , Cassell J
Published: October 2024

Background

Effective communication of relevant health information is challenging in elderly minority ethnic groups due to language barriers and cultural differences. During the COVID-19 pandemic, much of the public health guidance around COVID-19 was in dominant languages, lacking cultural nuance. This study aimed to co-produce culturally, linguistically, and age-appropriate health education resources in COVID-19, tailored to the needs of older adults from ethnic minority backgrounds.

Methods

This study involved three stages: 1) Semi-structured interviews with Indian and Nepalese older adults (≥65 years), their families (≥18 years) and healthcare professionals (HCPs) (≥18 years) engaging with these communities; 2) Co-production of COVID-19 information resource, and c) Implementation of co-produced resources among the communities.

Results

24 participants took part in the study. There was wide variation in participants’ knowledge of COVID-19; some were knowledgeable, while others had limited information. Participants highlighted the need for information in multiple formats and languages and discussed the importance of culturally avenues for information dissemination. Drawing on these findings and two co-production workshops held with the stakeholders, culturally sensitive information leaflets (electronic and paper) were co-prodcued in Hindi and Nepalese using age-appropriate images and infographics. The leaflets were distributed widely to the Nepalese and Indian communities, healthcare trusts and local authorities using the networks of community members, HCPs, and religious leaders.

Conclusions

The project highlights the significance of participatory methods in the development of culturally relevant public health interventions applicable to the cultural practices of ethnic minority groups. The co-production approach in this study could influence information provision for future public health campaigns for other marginalised groups.

Key messages

• Health information should be co-produced with a representative sample of the community members and relevant stakeholders.

• There is a need on an ongoing basis to identify and fill the information gaps, address misinformation and develop targeted messages.
Determinants of health among Ukrainian refugees in Germany: comparison with other refugee groups
Authors: Biddle L , Marchitto A , Zinn S
Published: October 2024

Background

6.5 million Ukrainian refugees have been displaced globally since 2022, with 1 million seeking asylum in Germany. Little is known about the health determinants for this group, limiting the evidence base for policy intervention.

Methods

We use a nationally representative survey of adult Ukrainian refugees in Germany (IAB-BiB/FReDA-BAMF-SOEP study; n = 5943), conducted in 2023, to analyse the effect of sociodemographic, pre-migration (experienced war intensity, traumatic experiences) and post-migration factors (time since arrival, accommodation, social networks) on self-rated health using multiple logistic regression. We contrast these findings with estimates of identical models obtained from a subset of the IAB-BAMF-SOEP-sample of non-Ukrainian refugees within one year of arrival (n = 1195).

Results

In the Ukrainian sample, post-migration factors are particularly critical for health, with those experiencing discrimination (OR 1.83; 95%CI: 1.51,2.21) and social isolation (OR: 2.70; 95%CI: 2.23, 3.28) affected by ill health, while those with high German proficiency (OR 0.34; 95%CI: 0.18, 0.64) and contact with Germans (OR: 0.66; 95%CI: 0.53,0.83) are protected. Pre-migration factors do not affect self-rated health. Among refugees from other countries of origin, post-migration factors are not associated with health within the first year of arrival, with exception of social isolation (OR: 2.03; 95%CI: 1.32,3.13).

Discussion

Despite the EU Temporary Protection Directive, the health of Ukrainian refugees in Germany is shaped by adverse post-migration circumstances. While other refugee groups may have had riskier escape journeys and worse arrival conditions, this is unrelated to self-rated health in the first year. This underscores the importance of considering pre-migration contexts when evaluating subjective health. Outreach services, communication campaigns and the expansion of medical interpreting services are needed to ensure access to the health system.

Key messages

• Despite the EU Temporary Protection Directive, the health of Ukrainian refugees in Germany is shaped by adverse post-migration circumstances.

• Outreach services, communication campaigns and the expansion of medical interpreting services are needed to ensure access to the health system.
Gestational diabetes and pregnancy outcome in Kurdish, Somali and general population in Finland
Authors: Tähkäpää S , Mohamed F , Pallasmaa N , Grénman S , Mäkikallio K , Lehtoranta L
Published: October 2024

Gestational diabetes (GDM) increases the risk of type II diabetes and cardiovascular morbidity later in life but GDM incidence in women from different cultural backgrounds varies. This study aims to examine treatment of GDM and pregnancy outcomes in Somali, Kurdish and general population women. Patient data of 312 Kurdish, 254 Somali and 508 general population women was collected from Turku University Hospital records from 2008 to 2019. The general population was selected by randomization with matching year, BMI, age, and parity. Singleton deliveries after 34th gestational week with no prior diabetes mellitus were included. Descriptive and comparison analyses (SPSS, version 29.0) were used to identify associations between ethnic background and pregnancy outcomes in women with GDM. The incidence of GDM was 22 % (CI 95 % 17-27) in Somali, 36 % (CI 95 % 31-42) in Kurdish, and 16 % (CI 95 % 13-19) in the general population women. Kurdish women had medication for GDM more often (43 % CI 95 % 34-53) than the Somali (22 % CI 95 % 11-33) and general population women (18 % CI 95 % 9-26). Metformin was more commonly used among Kurdish (30 % CI 95 % 22-39) compared to the general population (12 % CI 95 % 4-18) and Somali women (13 % CI 95 % 4-22). There was no difference in insulin or combined metformin and insulin treatment between the groups. In GDM group, vaginal deliveries were more common in general population (89 % CI % 81-95) than in Somali women (67 % CI % 64-81). Induction of labour (indication GDM or other) and instrumental vaginal delivery rates were similar between the groups. Newborns of all Somali women had a lower weight (SD -0.3 CI 95 % -0.7 - -0.2) compared to the general population (SD 0 CI 95 % -0.1 - 0.3). The prevalence of GDM was increased and dietary treatment decreased in Kurdish women compared to the general population in Finland. In the future, the treatment of GDM should be adjusted to better optimize the care for different cultural background women.

Key messages

• Kurdish women have increased incidence of GDM and less dietary treatment compared to the general population with similar risk factors. The pregnancy outcomes remain good in all groups.

• With Somali women, the birth weight of the child is lower despite GDM status. This might direct clinicians to underestimate the effect of GDM when considering individual treatment.
A framework to guide the commissioning of healthcare services for people seeking asylum in England
Authors: Al-Sharabi I , Deal A , Mackey K , Rangel N , Joseph A , Davies L , Bryant L , Carter J , Knights F , Hargreaves S
Published: October 2024

The increasing number of people seeking asylum (PSA) in England, compounded by delays in processing their cases, has led to an urgent need for tailored practices to overcome barriers to healthcare access. While local examples of excellence in healthcare provision for PSA exist, a national framework to guide healthcare for these groups is lacking, leading to fragmentation and inconsistency in service provision. This collaborative research project with the British Red Cross took a co-production approach, involving three peer researchers with lived experience from the outset. From a literature review of case studies on improving access to healthcare for PSA, a preliminary framework of good practice was developed and explored with participants with lived experience of seeking asylum during three in-person workshops refined this. Finally, two focus groups with policymakers and healthcare professionals (HCPs) explored challenges in commissioning services, ensuring final framework relevance to the policy context. In total, 60 participants with lived experience attended three workshops and 19 policymakers and HCPs attended focus groups. Workshop participants emphasised the critical role of improving communication in healthcare settings and educating HCPs and PSA on entitlements and the NHS system. Policymakers highlighted the importance of robust leadership and a standardised national approach that can be adapted locally. Capacity constraints within the NHS and primary care system were highlighted as barriers to good quality care provision. Findings were collated into a practical framework, describing five pillars of good practice; 1)Working in partnership; 2) Upskilling the healthcare workforce; 3) Including lived experience voices; 4) Improving data on local needs; and 5) Strengthening pathways into healthcare. The framework provides guidance to enhance the accessibility, consistency and quality of healthcare services for PSA, addressing critical gaps in the current system.

Key messages

• A novel framework to guide commissioning and provision of healthcare for people seeking asylum has been developed, drawing from existing pockets of excellence to aid a consistent national approach.

• The framework presents five pillars of systemic good practice, highlighting the importance of strategic partnerships, workforce training and data collection in providing good quality care.
Solutions for reducing the severe economic burden of musculoskeletal diseases
Authors: Sedlak S , Jelenc M
Published: October 2024

Issue

In Slovenia the big group of over 150 musculoskeletal and connective tissue diseases (MSCTD) constitute a serious public health problem, a major burden on health systems and society as a whole. Patients with these diseases have a poorer quality of life and often retire early. Any early retirement that could have been prevented represents a loss of human capital, which is a major social and economic cost to society. The aim of this study was to analyze the economic burden of the six most common MSCTD in Slovenia for the period from 2020 to 2022, to contribute to a better understanding of this problem and suggest solutions.

Methods

At the Slovenian National Institute of Public Health, in collaboration with the Faculty of Economics at the University of Ljubljana, we calculated the burden of six most common MSCTD for the period 2020-2022. We used the National Transfer Accounts (NTA) methodology to calculate the indirect costs; direct costs were calculated based on the national routine health data.

Results

The calculated economic burden of the six most common diagnoses of MSCTD represents 5% of total health expenditure or 0.4% of Slovenian gross domestic product on average. Direct costs amounted to 2% of total health expenditure (hospitalizations 22.5%, costs for medicines 9.3%, first curative visits at the primary level and visits to the outpatient clinic at the secondary level 2.7%). Indirect costs amounted to 3% of total health expenditure.

Conclusions

Despite the reduced access to the health system due to COVID-19 the economic burden of MSCTD is high in Slovenia and would be significantly higher considering all diagnoses from this group of diseases. The research requires interdisciplinary cooperation between medicine and economics regarding demanding NTA methodology which is innovative in our country.

Key messages

• One of the main public health priorities in Slovenia should be to raise awareness of MSCTD.

• In the light of the aging population prevention activities with focus on MSCTD should be intensified as soon as possible.
The burden of executive dysfunction after ischemic stroke (Bulgaria, 2019-2021)
Authors: Veleva I , Valkova M , Chumpalova-Tumbeva P
Published: October 2024

Background

Executive dysfunctions have great impact on behavior and quality of life in elderly. They also play important role for post-stroke functional outcome. The aim of our study was to examine the frequency, severity and types of executive dysfunctions at the third month after the ischemic stroke.

Methods

We examined 108 patients 3 months after ischemic stroke (66.67±9.03 years old, 66 males and 42 females) via 128-Wisconsin Card Sorting Test (WCST). WCST is a standardized instrument for detecting various executive dysfunctions. It is applicable for patients after stroke, because the test doesn’t require preserved arm motor functions. It measures global executive functioning (GEF), inhibitory control system (ICS), executive attention (EA), cognitive flexibility (CF) and working memory (WM). Our patients’ results were compared to the normal population test results. SPSS 24 was used for statistical analysis.

Results

Impaired GEF were found in 46% of our patients, most of them had mild or moderate impairment. One fourth of them showed impaired ICS, although the impairment in most of the cases was mild. EA deficits were found in 43% of our cases (17% had mild, 15% mild to moderate, 7% moderate and 4% severe impairment). WM dysfunction was found in 1/3 of them (the average result was about 27 percentiles; 29% had mild and 5% had mild to moderate deficits) and about ¼ of our patients had borderline results. CF was impaired in 68% of our patients (11% had mild, 28% mild to moderate, 16% moderate and 13% severe impairment).

Conclusions

GEF impairment is frequent after stroke. Patients had problems in ICS, EA, CF and WM. However, in most of the cases the dysfunction is mild or moderate and can be found only if it is actively searched and accessed. The most impaired functions were CF and EA. Patients with executive dysfunction require cognitive rehabilitation and specific social support.

Key messages

• Executive dysfunctions are frequent after ischemic stroke. The impairment is mild or moderate, but however it impacts the quality of life, behavior, prognosis and outcome of post-stroke survivors.

• Patients with executive dysfunctions require specific cognitive rehabilitation and social support.
Functioning in Older Adults: Prevalence and Implications for Policy and Digital Services
Authors: Sääksjärvi K , Holm M , Koskinen S , Aalto A , Pennanen M , Ilmarinen K , Hammar T , Sainio P
Published: October 2024

Background

Actions maintaining and promoting functioning, and proactively preparing for the surge in demand for services in near future, are needed as the population is aging. Policy actions need to base on up-to-date picture of the situation. We examined the prevalence of limitations in different dimensions of functioning in the older population.

Methods

Data consisted of participants aged 75 years or older (n = 9,686) in the nationally representative Healthy Finland Survey in 2022. The questionnaire included questions on various aspects of functioning (physical, cognitive, psychosocial, need and use of help), quality of life, internet use and digital competence. Weighted prevalence of functional limitations by age (75-79, 80-84, 85-89, ≥90 years) was analyzed for men and women using logistic regression, sampling design and non-response acknowledged.

Results

Difficulties in most aspects of functioning increased rapidly with age. In ≥ 90-year-olds, one third experienced major difficulties in activities of daily living (vs. 4% in 75-79-year-olds), and 30% of men and 45% women aged 90 or over experienced major difficulties in getting out of their home (vs. 4% in 75-79-year-olds). The prevalence of loneliness doubled by age, from 9% in the youngest to 21% in oldest age group. The corresponding increase in psychological distress was from 9% to 15%. Need for help increased dramatically with age, but the unmet need among those needing help did not, being around 20% in all age groups. In ≥ 90-year-olds, 83% of men 92% of women reported little or no internet skills (vs. 40% in 75-79-year-olds), and 55% of men and 75% women did not use digital services at all, i.e. neither independently nor with help from others (vs. 25-28% in 75-79-year-olds).

Conclusions

Difficulties in functioning and need of help were common among the oldest age groups which underlines the urgency to ensure sufficient resources for elderly care.

Key messages

• While developing health and social care services, equal access to services must be ensured even for those not able to use digital services.

• Functioning must be supported not only by measures aimed at the individual, but also by improving the environment so that people with a lower level of functioning can cope with their everyday lives.
Prevalence and accumulation of metabolic risk factors of cardiovascular disease in Finland
Authors: Lehtoranta L , Santalahti A , Ikonen J , Parikka S , Jääskeläinen T , Sääksjärvi K , Lahti J , Männistö S , Jousilahti P , Lundqvist A
Published: October 2024

Background

Cardiovascular disease (CVD) remains the leading cause of death and disability in the world. We aimed to examine the prevalence of metabolic risk factors of CVD and their accumulation in the Finnish working-age population.

Materials and methods

The data consisted of individuals aged 20 to 69 who participated in the population-based Healthy Finland health examination survey in 2023 (n = 4375; participation rate 56%). We studied the accumulation of four risk factors: hypertension, hypercholesterolemia, diabetes and central obesity. The information was collected using health examination measurements and blood samples. Information on medical conditions and medication use was collected using questionnaires and national register data. All analyses utilized weighting coefficients. Adjusted results (age, sex) were calculated via logistic regression.

Results

The most common CVD risk factor was hypercholesterolemia (male= 69%, female= 63%), followed by central obesity (m = 41%, f = 44%), hypertension (m = 44%, f = 34%) and diabetes (m = 11%, f = 6%). At least three risk factors were present in 26% in male and 23% in female participants, while 17% of males and 22% of females had no risk factors. The prevalence and accumulation of metabolic risk factors became more common with age. Of those aged 60-69, more than 10% had all four risk factors and almost half had at least three. Central obesity increased the risk of hypertension (OR 3.11; 95% CI 2.61-3.71), diabetes (OR 3.97; 95% CI 2.86-5.52) and hypercholesterolemia (OR 1.75; 95% CI 1.48-2.07) compared to those without central obesity.

Conclusions

81% of all participants had at least one metabolic risk factor for CVD and 50% had at least two. High prevalence and accumulation of CVD risk factors remains a major threat to future morbidity, mortality, and increased healthcare costs in the Finnish working-age population. It is particularly important to identify those individuals with several simultaneous risk factors.

Key messages

• Metabolic risk factors for CVD are common in the Finnish working-age population, with high prevalence especially hypercholesterolemia and central obesity.

• If the increasing prevalence of risk factors is not addressed, morbidity, mortality and health care costs can be expected to increase in the future as the population ages.
Exploring non-smokers’ attitudes toward e-smoking: results from the Minerva Project Europe
Authors: Gregori D , Khan N M , Ocagli H , Azzolina D , Martinato M , Lorenzoni G
Published: October 2024

Background

In the shifting paradigm of tobacco use, the attitudes of non-smokers toward e-cigarettes are crucial for public health planning, as in the literature it has been suggested that non-smokers who use e-cigarettes could be more prone to switch to tobacco. This multi-center study investigates the interplay between traditional smoking and the potential benefits of transitioning to e-smoking, through a comprehensive examination of smoking behaviors, dietary, and lifestyle practices.

Methods

MINERVA (My changINg lifEstyles, our Research, and eVeryone’s heAlth) is an ongoing prospective international cohort study aimed at investigating the association between smoking habits and dietary and lifestyle habits among the study participants. The secondary objective pertains to the assessment of subjects’ willingness to try e-cigarettes. We implemented an univariable logistic regression analysis on a dataset comprising 2367 nonsmokers to identify factors influencing their willingness to smoke e-cigarettes.

Results

Employment significantly predicted willingness, with employed non-smokers showing a higher likelihood to consider e-smoking (OR 2.5, p = 0.002). Household dynamics, specifically the presence of children, also affected the decision, indicating a protective effect against adopting e-smoking (OR 1.26, p < 0.001). Lifestyle choices, particularly fitness and dietary habits, played a discernible role. Surprisingly, age inversely correlated with the willingness to try e-smoking, as younger non-smokers were more likely to consider it (OR 0.97 per year increase, p < 0.001), suggesting that this openness could increase their risk of future tobacco use, which carries important public health consequences.

Conclusions

The study’s outcomes underscore the impact of socio-economic and lifestyle factors on non-smokers’ openness to e-cigarettes. These insights are pivotal for devising culturally competent educational campaigns and regulatory policies.

Key messages

• In the shifting paradigm of tobacco use, the attitudes of non-smokers toward e-cigarettes are crucial for public health planning.

• By thoroughly analyzing smoking habits, diet, and lifestyle choices, the Minerva Project research aims to shed light on the complex dynamics between health behaviors and smoking.
Lifestyle habits and openness to alternative tobacco products: insights from the Minerva Project
Authors: Gregori D , Khan N M , Ocagli H , Azzolina D , Martinato M , Lorenzoni G
Published: October 2024

Background

Recent studies have suggested that the use of alternative tobacco products (ATPs) is a significant predictor of cigarette smoking, particularly among young individuals. The present study evaluates the association between dietary patterns, specifically junk food consumption, and the willingness to try ATPs among non-smokers.

Methods

MINERVA (My changINg lifEstyles, our Research, and eVeryone’s heAlth) is an ongoing prospective international cohort study primarily focused on investigating the link between smoking habits and the dietary and lifestyle habits of participants. Subjects are given a web-based survey to report socio-demographic characteristics, dietary and lifestyle habits, smoking habits, and attitudes towards ATPs. This analysis concentrates on respondents from Italy who do not smoke traditional tobacco products.

Results

The survey included 7,535 respondents from Italy; of these, 40% (2,992 subjects) were non-smokers. Among the non-smokers, 219 (7%) were identified as fast-food consumers (defined as consuming fast-food at least once a week). Fast-food consumers were significantly more likely to consume junk food as snacks (87% vs. 62%) and were less likely to report daily consumption of fruits and vegetables. Notably, fast-food consumers were 2.5 times more likely to be willing to try ATPs compared to those who do not consume junk food (Odds Ratio [OR] 2.55, 95% Confidence Interval [CI] 1.68-3.88).

Conclusions

Junk food consumption has been identified as being associated with an increased willingness to use ATPs among non-smokers. This finding is significant from a public health standpoint, highlighting the crucial influence of unhealthy eating habits in fostering an interest in ATP use.

Key messages

• The Minerva study evaluates the association between dietary patterns, specifically junk food consumption, and the willingness to try alternative tobacco products among non-smokers.

• The study underscores the public health importance of addressing dietary patterns alongside smoking habits.
Foregone care in the Italian elderly population: a new challenge for the National Health System
Authors: Contoli B , Asta F , Possenti V , Gallo R , Marotta D , Pettinicchio V , Minardi V , Masocco M
Published: October 2024

Background

The avoidance of medical care among the elderly in Italy has been exacerbated during the COVID-19 pandemic and today, according to data from the Passi d’Argento surveillance, it involves over 3 million elders. The study analyzes the medical care avoidance among the elderly in Italy, the motivations behind it and the changes over time.

Methods

Passi d’Argento surveillance system, coordinated by the Italian National Institute of Health and conducted by Local Health Units, continuously collects information on health and lifestyles, as well as care and assistance needs, of the population aged over 65 residing in Italy, through interviews with representative samples by gender and age.

Results

Between 2021 and 2022, 1 in 4 individuals over the age of 65 (24%) reported avoiding, in the 12 months before the interview, a medical visit or diagnostic test they needed. The phenomenon is higher among those reporting significant economic difficulties (37%). Among those who have waived, 31% said they did so for fear of Sarsv-Cov-2 infection; 22% due to suspension of service and/or closure of the practice because of the restrictions imposed by the COVID-19 pandemic; 36% declared that the avoidance reason was due to long waiting lists; 7% due to difficulty reaching the facility. With the end of the pandemic, this phenomenon has decreased overall (from 34% in 2020 to 23% in 2022), however, there is an increase of individuals who report renouncing due to long waiting lists or difficulties accessing services.

Conclusions

Data clearly highlights the difficulties of National Health System in meeting the health needs of elderly citizens, which persist even after the pandemic. It is important to preserve the right and the access to prevention and care for the elderly, for which timeliness is crucial. In this perspective, these data can provide important guidance for action at both national and regional levels.

Key messages

• Having national data on foregone care allows to see the burden of the phenomenon.

• Even after the pandemic, the phenomenon of medical care avoidance among the elderly continues to be observed.
Assessing progress towards viral hepatitis B and C elimination in prisons in the European region
Authors: Fondelli S , Pisetta R , Mazzilli S , Montanari M L , Seyler T , Azevedo e Silva F , Tavoschi L
Published: October 2024

Background

In 2016 the WHO launched the global health sector strategy for the elimination of viral hepatitis, alongside a dedicated monitoring&evaluation (M&E) framework to assess progress at national, regional and global levels. Despite being a priority setting for viral hepatitis elimination in Europe, prisons are rarely integrated into national monitoring efforts. Besides, prisons are particular contexts with a high viral hepatitis prevalence, where it is possible to utilize adequate micro-elimination strategies.

Objectives

We aimed to assess available metrics of viral hepatitis burden and coverage of prevention and control interventions in prison settings in Europe using routine sources of data.

Methods

We adapted the WHO M&E framework for viral hepatitis elimination to the prison context. The resulting M&E framework has 49 indicators of which 10 are defined as core. Data were sourced from available European prison surveillance systems at European level, namely: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and WHO Health in Prisons European Database (HIPED).

Results

In total 38 countries in the European region provided data to either data sources for 2020. For WHO-HIPED, among core indicators, 3 out of 10 could be calculated for HCV, and covered prevalence, HCV treatment availability and treatment outcome. Concerning HBV, 3 core indicators out of 10 could be calculated and covered prevalence, screening availability and treatment coverage in prison. With EMCDDA surveillance system we could calculate 4 HCV core indicators and 6 HBV core indicators.

Lessons

Availability of health data from prison settings is scarce, hampering the current capacity to monitor the progress in the viral hepatitis elimination within prisons contexts strategies and its relative contribution to global health goals achievement. A coordinated and standardised M&E framework tailored to this specific setting is needed to foster data collection and systematic monitoring.

Key messages

• Micro-elimination strategies in prison context contribute to the global health goals achievement.

• A coordinated and standardized M&V framework, adapted to the prison context, is needed to foster data collection and monitoring of the viral hepatitis elimination strategy.
Passing the hot potato: a multinational study on public trust in the health policy process
Authors: Zavattaro F , Gille F , von Wyl V
Published: October 2024

Background

Health data-sharing initiatives are central to European and national e-health strategies, aiming to improve healthcare quality, inform policymaking, and drive research. Public trust is crucial for their success, influencing public participation and policymakers’ legitimacy. This study investigates the role of public trust in the health policy process at both the European level and in Italy, France, and Switzerland to determine 1) if a common conceptual understanding of public trust across different countries and policy stages exists, and 2) if policymakers explicitly discuss and implement trust-building measures in their legislative work

Methods

A total of 60 interviews were conducted with 16 European, 15 Italian, 14 French, and 15 Swiss policymakers from the World Health Organization, the Council, Parliament, and Commission at the European level, along with representatives from the Ministry of Health, Parliament, regional councils, local health authorities, frontline staff, and relevant agencies at the national levels

Results

Preliminary results reveal that a common definition of public trust in health data sharing is missing. Associations to public trust are observed at the European level with citizens’ reassurance about their sensitive data being shared, and in Switzerland with data security. In France, public trust is connected to public engagement, while no distinct patterns were identified in Italy. Findings also reveal a consensus among interviewees on the central role public trust plays in health data-sharing initiatives; yet public trust is perceived as a vague concept, often addressed implicitly without a clear strategy

Conclusions

The study reveals widespread ambiguity among policymakers regarding the definition of public trust and its translation into policy. Practical guidance is crucial to effectively integrate elements of public trust into policymaking, thereby actively reinforcing trust in health data sharing through legislative efforts

Key messages

• While policymakers recognize the importance of public trust for data-driven health initiatives, they lack a common conceptual understanding on what trust is and how to build it.

• Guidance is needed to help policymakers actively contributing building trust in health data sharing through their legislative work.
Reception of health data using the Australian Burden of Disease study as an example
Authors: Anton A , Gourley M , Kirkland L , Chapman A M
Published: October 2024

Background

Health data, especially on Burden of Disease (BoD), are vital for evidence-based health promotion and effective dissemination is crucial due to resource intensiveness. Germany’s national BoD study is currently transitioning to permanence. Analysing the Australian Institute of Health and Welfare’s (AIHW) well-established collaboration with stakeholders and their reception of health data at national and regional level offers insights for improved knowledge translation.

Methods

To follow the path of stakeholder engagement, this 3-month project involved scientific exchanges with the AIHW and Department of Health, Western Australia. It compiled communication strategy examples and documents stating examples of BoD data use. A quantitative online survey accompanied by a series of 18 qualitative 45-minute interviews was conducted. The survey implemented via Swift Digital has been running for 20+ days. Interview partners originated from the fields of health research, politics, planning and advocacy for patients or population groups. Results were analysed, illustrated digitally as a booklet and refined in a participatory workshop.

Results

Communication strategies such as embargoed press and stakeholder releases as well as regular online formats were identified. The survey and interviews displayed the required technical and content-detail level from key facts to raw data and visualisation needs. Noteworthy are the demand to link data to economic aspects like disease expenditure, trends and future scenarios. It elucidated how diverse target groups utilize data to place disease significance and preventive public health measures, aiding dissemination. Alongside, it shows examples of knowledge translation by emphasizing impact over indicators when targeting communities.

Conclusions

Prioritizing target group identification and employing tailored communication strategies regarding data format and detail level are essential when utilizing new data.

Key messages

• Analyzing a well-established collaboration with stakeholders offers insights for improved knowledge translation and reveals leveraging engagement strategies for others.

• Understanding stakeholder needs is essential for promoting broader health data use in policy and practice, fostering evidence-based decision-making, and enhancing public health outcomes.
Mapping the Public Health and Health Promotion Capacity in Oman
Authors: Al Riyami H
Published: October 2024

Background

An essential condition to enabling people to increase control over their health is to have sufficient capacity for public health (PH) and health promotion (HP). Despite the recognition of its importance, a comprehensive view of the PH and HP capacity in the sultanate of Oman is not yet available. This study provides a mapping of the country’s PH and HP capacity at national, governorate and district levels.

Methods

An online quantitative survey was performed amongst 70 health policy maker and experts in PH and HP using a questionnaire based on the PH capacity framework of Aluttis et al., yielding data on the country specific context with relevance for PH and 6 PH capacity domains, each divided in subdomains: leadership and governance; organizational structures, workforce, financial resources, partnerships, and knowledge development. Internal consistencies of the scales measuring the capacity subdomains ranged from .75 to .99.

Results

The survey revealed relatively low scores, representing partial development of capacities, for most of the public health capacity domains. The highest levels of capacity were observed for knowledge development (health information and monitoring systems, reporting systems and knowledge infrastructure), organizational structures (institutional capacity, program delivery structures, PH within health services, and response emergencies) and partnerships (formal consortia, informal partnerships and multisectoral coordination). In contrast, leadership and governance, workforce development, and financial resources score lower.

Conclusions

Mapping the strengths and weaknesses of PH and HP capacity in Oman allows to make recommendations for improving population health. Whereas all domains of PH and HP capacity are partially developed, there is a need to further improve capacity in all domains.

Key messages

• PH and HP capacities are partially developed in Oman.

• Mapping the PH and HP capacity allows to identify strengths and weaknesses and make recommendations for improving public health.
Exploring Burden of Disease Metrics in EU legislation: A Systematic Analysis
Authors: Chen-Xu J , Grad D A , Mahrouseh N , Cuschieri S , Gazzelloni F , Mechili E A , Riva S , Santos J V , Varga O , Viegas S
Published: October 2024

Background

The burden of disease (BoD) methodology is a valuable tool for evidence-based policymaking. However, there is currently no systematic analysis available regarding its use in the European Union (EU) legislation framework. This study aims to describe the implementation of BoD methodology in EU legislation.

Methods

A search was conducted on EUR-Lex, the official and most comprehensive platform to access EU legal documents. The main inclusion criteria in the analyses were date of publication (between 2004 and 2023, accounting for EU-25) and inclusion of BoD metrics (years of life lost - YLL, years lived with disability - YLD or disability-adjusted life years - DALY). Descriptive and network analysis were conducted to analyse the legislation content.

Results

Out of 2592 documents, 191 met the set criteria. Ten were legally binding, and 69% were published after 2018. The European Commission (n = 152) was the most regular issuing institution. BoD was mainly used as an argument (n = 93) and for impact assessment (n = 50). The metrics were commonly presented in the main text (n = 122) and in the annex (n = 48). EuroVoc domains like environment and social questions prevailed. The most frequent EuroVoc terms were climate change policy (n = 45), EU environmental policy (n = 32) and pollution control measures (n = 32).

Discussion

Despite the growing recognition of BoD metrics in supporting policymaking, only 191 documents published over the past 20 years within the EU legislation make reference to this methodology. Greater efforts in knowledge dissemination and directing research towards specific policy uptake may increase the application of BoD studies in EU policies. By advocating for increased awareness, promoting collaboration between researchers and policymakers, and targeting research efforts towards specific policy needs, a more comprehensive integration of BoD methodologies into EU legislation can be achieved, contributing for evidence-informed policies.

Key messages

• There were only 191 documents of the EU legislative documents published in the past 20 years mention burden of disease metrics, mainly addressing environmental and social issues.

• There is a need to increase EU policy uptake from BoD studies, by conducting policy-oriented research, and building capacity among researchers and policymakers on BoD methodology.
Outcomes of integrated knowledge translation: A comparative, multi-country case study
Authors: Sell K , Rehfuess E A , Osuret J , Pfadenhauer L M
Published: October 2024

Background

Integrated knowledge translation (IKT) seeks to establish continuous relationships between researchers and knowledge users, in particular decision-makers, to enhance evidence-informed decision-making in public health and healthcare. IKT is, however, difficult to evaluate and outcome evaluations remain scarce. The German-African Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) undertook research on IKT and non-communicable diseases in Ethiopia, Malawi, Rwanda, South Africa, and Uganda. Over six years, we implemented an IKT approach and evaluated it according to a pre-defined programme theory.

Methods

We conducted qualitative interviews and surveys with CEBHA+ researchers and their decision-making partners at two stages (3/2020-2/2021; 9/2022-5/2023) and collected IKT-related documents (see protocol: https://rdcu.be/dyfBP). Transcripts and documents were analysed using qualitative content analysis and surveys were analysed descriptively, with subsequent integration, cross-case analysis, and revision of the programme theory.

Results

We collected 92 IKT-related documents; and 55 researchers and decision-makers participated in surveys, focus groups or interviews. Proximal outcomes were collaborative research; capacity-building related to research skills and evidence use; and relationship-building, establishing trust and partnerships. Intermediate outcomes were changes in attitudes and knowledge; decision-makers became attuned to research and researchers increased their understanding of the decision-making context, and developed a vision for research impact. Distal outcomes were the production of applicable research and the consideration of evidence by decision-makers. High opportunity costs associated with IKT implementation constituted unintended effects.

Conclusions

Our study presents rich, theory-informed insights into IKT outcomes, based in particular on the experience of researchers implementing the CEBHA+ IKT approach.

Key messages

• A multi-country research collaboration offered an opportunity to examine IKT implementation and investigate proximal, intermediate, and distal IKT outcomes based on a pre-defined programme theory.

• Beyond our initial conceptualisation, the IKT approach was linked to researchers developing a vision for ‘research impact’ and gaining a better understanding of the decision-making context.