bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic and health literacy inequalities in patient-reported experiences of cancer care
Authors: Jolidon V , Eicher M , Peytremann-Bridevaux I , Arditi C
Published: October 2023

Background

Patients’ economic status and level of health literacy may influence their experiences with healthcare services. However, few studies have examined how these factors shape inequalities in patient-reported experiences measures (PREMs), particularly in cancer care. Thus, we investigated whether experiences of cancer care differed according to patients’ economic status and level of health literacy.

Methods

We used data from 3,220 adult patients diagnosed with cancer collected by the Swiss Cancer Patient Experiences (SCAPE) study in eight Swiss hospitals from September 2021 to February 2022. Logistic regressions were used to investigate the association between patients’ economic status and health literacy and 30 different outcomes, in separate models for each outcome. The outcomes covered eight different areas of cancer care experiences. Models were adjusted for patients’ age, gender, education level and self-rated health. Since hospitals were located in two different linguistic regions of Switzerland, we tested interaction effects between the regions and economic status and health literacy.

Results

In the sample, 30.6% of patients experienced economic hardship and 25.7% had a low health literacy. Patients with low economic status and low health literacy had worse experiences of cancer care for 21 outcomes and 24 outcomes, respectively, compared to patients reporting higher economic status and higher health literacy. No differences were found between linguistic regions in the effects of these two predictors. Discussion: Our study showed that economic and health literacy factors generated inequalities in patients’ experiences of cancer care: patients with lower economic status and health literacy were negatively affected in their cancer care experiences. Hence, disadvantaged patients may require specific attention in order to enhance their experiences with healthcare services, and promote a more equal treatment of patients in cancer care.

Key messages

• Few studies have investigated inequalities in patients’ experiences with cancer care, while factors such as economic status and health literacy may affect care experiences.

• Patients who face economic hardship and with low health literacy showed a worse cancer care experience. These disadvantaged patients may require specific attention to improve their care experience.
Health & healthcare needs among refugees from Ukraine arriving in Norway during 2022
Authors: Hansen T M , Skogheim T S , Helland Y
Published: October 2023

The full-scale invasion of Ukraine has led to a surge in refugees coming to Norway. Systematic information about the health and healthcare needs of the group, which may differ significantly from that of other refugees, is lacking. This study aimed to measure self-reported health and healthcare needs in a sample of adult refugees from Ukraine. Data were collected via a digital questionnaire (UKR-R survey, n = 731) in a cross-sectional study design between 28.10.22-31.01.23, via multiple physical contact points, including asylum reception centres, municipalities, non-profit organisations, as well as Facebook groups for refugees in Norway. Several survey items were from existing Norwegian population surveys, such as a short version of the Hopkins Symptom Checklist (HSCL-5). Data from these surveys (NOR surveys, n = 256 920) formed a comparison group. Results were weighted by age and sex against all Ukrainian refugees registered with collective protection in Norway. Respondents were 83% female, 65% aged 30-49 years, and 69% with higher education. Fewer in UKR-R survey rated their overall health as good or very good compared to NOR surveys (48% vs. 73%, p < 0.001). Fewer in UKR-R survey rated their dental health as good or very good compared to NOR surveys (31% vs. 74%, p < 0.001). More UKR-R survey respondents reported long-term illnesses or health problems compared to NOR surveys (58% vs. 44%, p < 0.001). UKR-R respondents had a mean weighted HSCL-5 score of 2.24 (95% CI: 2.18, 2.29), compared to 1.60 (95% CI: 1.595, 1.601) in NOR surveys, indicating psychological distress. Refugees from Ukraine arrived thus far, compared to the Norwegian general population, rate their overall health and dental health poorer, and report higher levels of psychological distress. These findings may help to inform planning of health services and information to refugees from Ukraine, especially in municipalities and areas receiving large numbers of refugees.
From policy to practice: What factors influence GP's provision of health assessments to Ukrainian refugees in Denmark?
Authors: Castaner M , Vereshchakina V , Iserlohe M , Norredam M
Published: October 2023

Denmark has received over 30,000 displaced people from Ukraine since February 2022 and has implemented certain accommodations specific for this population. Not bound by the EU Temporary Protection Directive, a special Act has been introduced, whereby Ukrainians have been offered streamlined access to temporary resident permits with faster access to health services than what is granted in the asylum-seeking population, for whom parallel systems often exist to provide care. While other refugee groups receive health screenings in the asylum centers during the asylum process, Ukrainian have received quick access to general practitioners (GP's) in the public system. Danish health authorities have recommended that GPs provide a detailed examination of chronic diseases, vaccination status, infectious diseases, and mental health for Ukrainian refugees. Provision of this recommendation is necessary to meet the health needs of Ukrainian refugees. However, how these recommendations have been received and implemented remains unknown. We will present results from a survey sent to 3000 general practitioners in Denmark (expected response rate 30%) investigating how GPs implement the health assessment recommendations and what factors influenced the provision (or not) of health assessment to newly arrived Ukrainian refugees. The survey, which has been developed after conducting a review of the guidelines and conducting interviews with GPs and refugees (n = 11), examines knowledge of the health recommendations; implementation of guidelines; structural (i.e. time, interpretation) and individual factors (i.e. experience with war exposed patients) affecting health assessments and care; and cooperation among different parts of the health system. This presentation will shed light on how, in the context of large numbers of refugees entering EU countries, health policies are translated to practice and what factors affect the provision of adequate care for Ukrainian refugees in Denmark.
The World Health Organization endeavours to put forward Integrated Approaches to Food and Diet Risk-Benefit Assessment
Authors: Oliveira Mota J
Published: October 2023

WHO has identified five pathways that outline how food systems can impact health, including unhealthy diets and food insecurity, zoonotic pathogens and antimicrobial resistance, unsafe and adulterated foods, environmental contamination and degradation, and occupational hazards. The WHO carried out studies on the global burden of foodborne illnesses in 2015, indicating that vulnerable people, particularly those in developing nations, are the most concerned. Unhealthy diet and malnutrition remain at the top ten of the identified risk factors for the global diseased burden. WHO provides science-based food safety risk assessments and evidence-based guidelines on foodborne hazards and nutrient requirements throughout life stages. WHO is currently developing food-based guidelines, covering meat, dairy, and fish intake, as well as scientific opinions on food processing levels. However, the issue of how to combine all of the guidelines into global recommendations for a healthy and sustainable diet remains unanswered. There is a need to develop a more integrated approach to risk and benefit that takes into account the wide range of the populations concerned as well as the new and future foods and food production systems. In this regard, WHO is focusing on developing integrated methodologies and frameworks based on the most recent advances in the risk-benefit assessment for foods and diets, as well as other advancements in decision-making and communication models.
11.H. Round table: Moving the agenda forward on the Commercial Determinants of Health
Authors:   Organised by: WHO/Europe,   Chair persons: Carina Ferreira-Borges (WHO EURO)
Published: October 2023

Commercial actors play a vital role in society, yet there is growing evidence that they are responsible for escalating levels of avoidable ill health, planetary damage and social and health inequity. These problems are increasingly referred to as the ‘commercial determinants of health’ (CDOH). A recent Lancet Series on CDOH brought together a global intergenerational and multidisciplinary team of researchers and thought leaders to help consolidate thinking around the CDOH. It defined the CDOH as “the systems, practices and pathways through which commercial actors drive health and equity”. This workshop brings together one of the three lead authors from the CDOH Lancet series, with leading members of the civil society and intergovernmental organisations (including the WHO CDOH Lead and WHO European lead for NCDs) to discuss and engage with the audience on this complex and urgent issue. By bringing together these experts, this workshop explores the role that different agencies can play in tackling the CDOH. The workshop will consist of a presentation based on the lessons from the Lancet Series on Commercial Determinants of Health followed by a panel discussion among participants enabled by the workshop chair who will encourage audience discussion and participation. Discussants will be asked to comment on challenges and considerations for addressing CDOH in the WHO European Region, the role of civil society in the EU policy making context and the way forward in a global agenda. By convening these experts, the workshop aims to engage the audience in a discussion that builds their understanding of the CDOH and what they can do to respond to this problem. While much of the Lancet series is quite conceptual in its approach to CDOH, this workshop supports the public health community to move beyond simply understanding the systematic nature of the CDOH. In particular, the workshop aims to support researchers, practitioners, and policy makers to collaboratively develop possible solutions to CDOH and practical next steps to drive the CDOH agenda forward in the European Region. We recognise that this is a large amount of content to discuss in this workshop; however, we see this workshop (and the lancet CDOH series) as initiating a larger and ongoing conversation within the public health community.

Key messages

• CDOH is a complex and systematic issue that is hurting the health of people in Europe with low awareness of how they manifest and impact public health issues.

• Despite the complexity of CDOH, there are practical measures that the public health community can implement at local, national, regional, and global level to tackle them.

Speakers/Panelists

Anna Gilmore

University of Bath, Bath, UK

Gauden Galea

WHO, Beijing, China

Monika Kosinska

WHO, Guildford, UK

Florence Berteletti

EuroCare, Brussels, Belgium
Defining key indicators for migrant health outcomes and health policy: a suite of systematic reviews
Authors: Seedat F , Bouaddi O , Maatoug T , Elafef E , Edries H , Ouahchi A , Abdellatifi M , Evangelidou S , Requena Mendez A , Hargreaves S
Published: October 2023

Background

46 million migrants reside in the Middle East and North Africa (MENA) region, a proportion of whom will transit to Europe. Yet little is known about policy and practice in relation to data collection and healthcare provision. We synthesised evidence on health indicators, policies, and provision for migrants in the MENA to inform the development of a new tool to strengthen data collection around key diseases.

Methods

We did 12 systematic reviews (18 countries) to explore the burden, clinical outcomes, policies, and access for the following disease areas in migrants: TB, HIV and hep B/C, malaria and neglected tropical diseases, non-communicable diseases (NCDs) and mental health, maternal and neonatal health, and vaccine-preventable diseases. We searched electronic databases (PubMed/Embase) from 2000 to April 2023, with no exclusion criteria. Migrants were defined as persons who move away from their place of residence within or across a country.

Preliminary results

Most studies on migrants in the MENA are descriptive or cross-sectional, focus on disease burden, and few have counterfactual host population groups. We found data on multiple outbreaks of vaccine-preventable diseases in migrant populations, particularly in conflict-stricken areas. Data show that prevalence for TB may be higher among migrants in certain contexts, which is largely due to reactivation of latent TB potentially due to poor living conditions. Diabetes and hypertension are the most common NCDs in migrant populations. There is a paucity of data on clinical outcomes in migrants, and on the coverage and uptake of interventions. Of the studies that do report interventions, majority assess acceptability, perceptions, or knowledge.

Conclusions

This suite of systematic reviews syntheses evidence from across the MENA to address key evidence gaps. We found there is a need to strengthen data and surveillance around migrant health as an urgent next step to informing policy for disease elimination.

Key messages

• Migrants in the Middle East and North Africa may be at an increased risk of communicable and non-communicable diseases compared with host populations.

• To better inform public health policy, stronger and more comprehensive surveillance on migrant populations and more robust research is needed.
Effects of restrictive asylum-seeker healthcare policies: systematic review of evidence from Germany
Authors: Gottlieb N , Gold A W , Nutsch N , Duwendag S , Bozorgmehr K
Published: October 2023

Background

Asylum-seekers’ entitlements to healthcare vary within and across European countries, over time, and between different nationalities. Within Germany, healthcare policies for asylum-seekers range from restrictions of both scope and access to healthcare to full health entitlements, depending on a person's legal status, duration of stay, country of origin, and place of residence. We seized these variations to study the effects of restrictive vs. inclusive healthcare policies on health status, health system outcomes (incl. health equity), healthcare provision, healthcare utilization, and efficiency.

Methods

We conducted a systematic review in five databases (PubMed, Web of Science, SCOPUS, LIVIVO, Google Scholar) to identify and analyse empirical studies on the effects of healthcare policies for asylum-seekers in Germany. Out of 1159 initial hits, 66 records were assessed for quality and included in the narrative synthesis.

Results

The synthesised evidence shows that more inclusive policies facilitate needs-based health care utilization, incl. broader utilization of ambulatory services and lower use of emergency services. They reduce complexity, fragmentation and bureaucracy for healthcare users and providers by simplifying authorisation and reimbursement. Evidence suggests that inclusive policies contribute to better subjective and mental health among asylum-seekers. We found no evidence for access restrictions being associated with cost savings or other health system benefits.

Conclusions

Restrictive healthcare policies are often justified with the need to protect fiscal resources and health systems. Yet, evidence from Germany shows that more inclusive healthcare policies for asylum-seekers hold benefits in terms of health system outcomes, while not entailing higher costs. Inclusive policies are thus not only normatively preferable to restrictive policy options; they also yield better performance from a health systems perspective.

Key messages

• Germany is a pertinent test-case for analyzing the effects of restrictive vs. inclusive healthcare policies for asylum-seekers.

• Inclusive healthcare policies hold benefits in terms of health outcomes and health system performance, while restrictions fail to show advantages in fiscal or other domains of performance.
Increasing incidence of ovarian cancer in young women in England, 1985-2019
Authors: Ikram H , Taylor-Gallardo E , Salari Y , Memon A
Published: October 2023

Background

Ovarian cancer is the 6th most common cancer in women in the UK, accounting for about 7,500 new cases and 4,100 deaths each year. Genetic predisposition and obesity are the two most important risk factors. We conducted a retrospective population-based cohort study to ascertain trends in incidence of ovarian cancer in England from 1985-2019.

Methods

Individual level data for women diagnosed with ovarian cancer, and the corresponding national population (denominator) data were obtained from ONS/PHE. Average annual incidence rates (AAIR) were calculated for 2 age categories (0-49 and 50+ years) and for the 7 five-year time periods (1985-89 to 2015-19).

Results

During the 35-year study period, a total of 192,791 women with ovarian cancer were registered in England. The large majority of the cases (83%) were diagnosed in women aged 50+ years. In women aged 0-49 years, there was a steady increase in the AAIRs from 4.9/100,000 in 1985-89 to 6.3/100,000 in 2015-19 (+28.6%). Whereas in older women (aged 50+ years), the AAIRs initially increased from 47.9/100,000 (1985-89) to 54.4/100,000 (2000-04), and then steadily declined to 44.6/100,000 in 2015-19. As for the stage at diagnosis, the majority of younger women (72%) were diagnosed at Stage 1 or 2, whereas the majority of older women (65%) were diagnosed at Stage 3 or 4. There was also a dichotomy with regards to socioeconomic status - in younger women the disease was relatively more commonly diagnosed in the most deprived groups, whereas in older women the disease was more commonly diagnosed in the most affluent groups.

Conclusions

This study shows that from 2000 onwards, there has been a steady decline in the incidence of ovarian cancer among women aged 50+ years in England. On the other hand, the incidence rates have been steadily increasing in women aged 0-49 years during the past 35 years. The reasons for this increasing trend in the incidence of ovarian cancer in young women needs further investigation.

Key messages

• The increasing incidence of ovarian cancer in young women (aged 0-49 years) is consistent with the increasing prevalence of obesity in England.

• The declining trend in incidence of ovarian cancer in women aged 50+ years needs to be examined in light of the increasing trend in incidence of HRT prescriptions for menopausal women.
Joint associations of leisure time physical activity and sitting time with sickness absence
Authors: Sarttila K , Pohjola V , Kuusela M , Hautala A , Lahti J , Lundqvist A
Published: October 2023

Background

Physical inactivity and prolonged sitting are risk factors for non-communicable diseases and threaten public health. The aim of this study was to examine the joint associations of leisure time physical activity and sitting time with sickness absence among Finnish adult population.

Methods

Randomly selected adults (N = 10 300, response rate 70,5 %) were asked to fill in questionnaire of the FinHealth 2017 population survey. The survey data were linked to the Finnish Social Insurance Institution's register data on sickness benefit periods (over 10 working days), including diagnoses (follow-up 2,9 years). Self-reported leisure time physical activity was classified into three groups: inactive, moderately active, and active and screen sitting time into two groups: ≤3hrs hours or less and over three hours a day, yielding a six-category variable for the joint analyses. The analytical sample were restricted to working age (18-63 years), which included 5183 participants. Associations were examined by using logistic regression analysis adjusting for key covariates with SPSS 29.

Results

Those who were inactive and spend a lot of time sitting in front of a screen (< 3h) during leisure had a higher risk for sickness absence due to mental disorders (OR = 2,07 95% CI 1,03-4,18) than physically active low sedentary group. Also, the inactive and low sedentary group (OR = 1,69 95% CI 1,12-2,55) and the moderately active and high sedentary group (OR = 2.06, 95% CI 1.15-3.67) had a higher risk. No significant differences were found for associations due to all-cause and musculoskeletal disorders sickness absence.

Conclusions

Alongside increasing leisure-time physical activity, reducing sedentary behavior can have a positive impact on the risk of sickness absence for mental health reasons. A reduction in sedentary behavior and an increase physical activity should be encouraged.

Key messages

• Sedentary behavior in leisure was associated to a higher occurrence of mental health sickness absence.

• Attention should be paid to reducing sitting time and increasing physical activity.
Conceptualisation of co-creation and co-production
Authors: Egilstrød B , Wegener C , Henriksen L S , Petersen K S
Published: October 2023

Background

Creating and producing welfare with citizens has been trendy governmental rhetoric for the last decades, involving partnerships between municipalities, civil societies, and the citizens, aimed to mobilize citizens’ and civil societies’ resources. Co-creation and co-production are topical approaches to involve citizens in improving municipal health services or contributing to service production to balance scarce municipal resources and better target services to citizens’ needs. However, challenging in applicating the concept in practice has resulted in several new definitions being applied within Health and Social Care research. This has led to studies failing to define the concept or to involve citizens in the process. Thus, we aim to clarify the co-creation and co-production concepts to underpin their applicability when involving older people in community health services.

Methods

We draw on theoretical knowledge of co-creation and co-production based on Brandt and Honnigh (2018) conceptualization, combined with results from a scoping review, which explored co-production within health services among older people. We searched six databases across health and social science, 22 studies met the inclusion criteria.

Results

A theoretical agreement exists on how to conceptualize co-creation and co-production. However, the scoping review found that co-production is randomly applied across different theoretical concepts, such as public involvement, co-creation, and co-production. Co-production was applied in 1) intervention and service development, 2) service provision, and 3) the design and process of research.

Conclusions

Contributing to disseminating the concepts may help qualify the applicability within community health services among older people. There remains an unexplored potential in activating resources and involving citizens through co-creation and co-production. However, concept clarity is needed to underpin co-creation and co-production processes.
A first intervention to support the mental health of transgender individuals in Eastern Europe
Authors: Lelutiu-Weinberger C , Pachankis J E , Filimon M , Dogaru B , Braila P , Ichim S , Pana E , Pruneau C
Published: October 2023

Background

Transgender and gender-diverse (TGD) people in Romania experience high discrimination and related dysphoria, while gender-affirmation resources are scant. TGD Romanians report significant emotional distress and no access to competent mental health care. This pilot tested the feasibility, acceptability, and early efficacy of the first evidence-based mental health intervention implemented in Eastern Europe, using cognitive behavioral therapy within an identity-affirming framework.

Methods

Eligible TGD individuals (e.g., ≥ 18 years old, symptoms of past-90-day depression and/or anxiety) were recruited through community outreach. Participants completed a baseline (BL) assessment, were assigned to one of two trained psychologists, attended up to 16 1-hr virtual counseling sessions, and completed a 5-month follow-up assessment. Participants reported demographics, mental health (e.g., anxiety, depression), and identity-related psychosocial experiences (e.g., gender identity congruence). Analyses were conducted using paired sample t-tests and Wilcoxon rank sum tests to compare pre-post intervention scores.

Results

Of 24 participants enrolled (40% transgender female, 43% transgender male, 17% non-binary; M age=25.1, SD = 6.53), 22 were retained at follow-up. Significant reductions occurred from BL to follow-up in depression, anxiety, and psychological distress (p < 0.001), alcohol-related problems, gender identify rumination and difficulties with emotion regulation (p = 0.05). Satisfaction with the intervention was high. There were no changes in suicidal ideation, assertiveness, transgender congruence, gender identity acceptance, and emotion regulation.

Conclusions

This first intervention to support TGD Romanian's mental health shows promise and can be further studied in a randomized controlled trial. Its implementation across similar high-stigma, low-resource countries can provide critical mental health support in settings lacking such resources.
Mothers' decisions regarding treating their children with attention deficit hyperactivity disorder
Authors: Shehadeh Sheeny A , Goldblatt H , Baron Epel O
Published: October 2023

Background

The use of medication for attention deficit hyperactivity disorder (ADHD) differs globally, depending on ethnic group. Stimulant prescriptions for ADHD among Israeli Jewish children are four times higher than among Arab children. Ethnical differences may affect parents' perceptions and attitudes towards diagnosing and treating ADHD. This qualitative study aimed to identify mothers and teachers' attitudes regarding ADHD and what affects mothers' decisions on whether to medicate their child diagnosed with ADHD.

Methods

In-depth interviews were conducted with 23 Arab and Jewish mothers of children diagnosed with ADHD and 12 elementary school teachers. Data were analyzed using thematic analysis.

Results

Four themes were revealed, describing different perceptions of ADHD in the two ethnic groups: (1) medicalization of ADHD; (2) between guilt and sympathy: Mothers' feelings towards ADHD; (3) social pressure and social norms; (4) stigmatization. Jewish mothers and teachers tended to perceive ADHD as a medical problem, whereas Arab mothers and teachers perceived it more as a childhood social behavior. Arab mothers reported guilt feelings relating to ADHD, whereas Jewish mothers felt sympathy towards their child. The social environment influenced Arab mothers more than Jewish mothers. Stigmatization was reported only by Arab mothers.

Conclusions

Ethnic differences in ADHD perception may explain the differences in diagnosis and treatment. Educators and school psychologists should consider cultural factors when advising parents and planning educational programs for children with ADHD.

Key messages

• Social and cultural factors are vital for understanding trends in ADHD diagnosis and treatment because cultural beliefs play a key role in determining parents’ perceptions and attitudes.

• School managers, school psychologists, counseling staff and teachers should be aware of cultural factors when advising parents and planning educational programs for children with ADHD.
Health behaviour and cardiovascular risk in women living in a disadvantaged region in Hungary
Authors: Rucska A , Kiss-Tóth E , Lakatos C , Gyulai A
Published: October 2023

Background

The risk factors for non-communicable diseases more prevalent among socioeconomically disadvantaged (SED) adults. The aim of our study was to investigate monitored health status and health behaviour, including risk factors for cardiovascular disease, among women living in disadvantaged regions of Hungary.

Methods

In the monitored study, nutritional status was measured by a medical body composition analyser and vascular status by the arterial stiffness parameter (PWVao) measured by arteriograph (ARG), supplemented by a health questionnaire. Descriptive statistical analyses were performed to analyse the database, within a 95% confidence interval (CI). Pearson's χ2 test and analysis of variance (ANOVA) were used to test assumptions. The source population of the study was women living in the Abaúj region, the most disadvantaged regions of Hungary. A total of 150 SED adult women constituted the target population.

Results

The average age of the study participants was 52.8 (SD:15.9) years. More than half of the participants had at completed 8 years of primary education or less (52.3%; 95% CI: 44-61). They were overweight in terms of Body Mass Index (mean BMI=28.7 SD:6.6), and mean systolic blood pressure was 139 mmHg (SD:21.43). The mean PWVao measured in the population was 10.51m/s (SD:6.9). Elevated BMI was significantly (ANOVA p < 0.011) associated with higher PWVao. 36.2% (95% CI: 48-64) of the target group smoked daily. More than half of smokers (55%; 95%CI:38-76) smoked 11-20 cigarettes per day. Smokers scored an average of 4.82 (SD = 2.3) on the Fagerström Test for Nicotine Dependence (FTND) scale of moderate dependence. Lower educational attainment status (χ2 p < 0.001) significantly increase the proportion of smokers in the sample.

Conclusions

Obesity, smoking and elevated PWVao, are associated with higher circulatory and vascular risk and higher atherosclerotic organ damage, which may contribute to higher premature mortality among disadvantaged women.

Key messages

• Examining the association between heath behaviour and cardivascular risk of socioeconomically disadvantaged individuals can enhance the development of interventions to decrease health inequalities.

• Targeted community health promotion for disadvantaged women is a priority, because their health behaviour determines the health of their children and families.
Cervical cancer screening attendance related factors among women in Latvia
Authors: Springe L , Kivite-Urtane A , Kursite M , Curkste A , Zodzika J , Parna K , Uuskula A
Published: October 2023

Cervical cancer is the second leading cause of death in Latvia among women aged 15-44. Since 2009 organized cancer screening has been available, but responsiveness from the target population was still not optimal - only half of the invited persons participated in screening in 2022. Our study aimed to analyse sociodemographic factors and knowledge about screening concerning participation in the screening procedure. Data from a cross-sectional population survey conducted in 2021-2022 were analysed (n = 1313). The survey was part of the project “Towards elimination of cervical cancer: intelligent and personalized solutions for cancer screening” (EMP416). A multivariate model was adjusted for independent variables found to be statistically significantly associated with the outcome in univariate analysis. The dependent variable was participation in cervical cancer screening. Independent variables - knowledge about screening, age, education, marital status, and employment

81 % (n = 1063) of respondents participated in cervical cancer screening. The odds of screening attendance were higher among women aged 30-39 (aOR=3.6, p < 0.001), 40-49 (aOR=2.8, p = 0.005), 50-59 (aOR=12.3, p = 0.001) in comparison to women aged 25-29 years. Secondary (aOR=5.9, p < 0.001) and university (OR = 13.1, p < 0.001) education in comparison to primary education and being married (OR = 3.7, p < 0.001) to being single, as well as being employed (OR = 2.0, p = 0.085) and economically inactive (OR = 3.1, p < 0.05) in comparison to unemployment was associated with cervical cancer screening attendance. Knowledge about screening was associated with higher odds of participation (OR = 4.1, p = 0.001). Knowledge about screening is positively related to attendance. Differences were observed across various sociodemographic groups emphasizing the importance of providing targeted information for vulnerable social groups such as the elderly, single and unemployed women, and women with lower education to promote cervical cancer screening.

Key messages

• Cervical cancer screening is important, but target group responsiveness to it is still not optimal. Targeted public health activities are needed to improve cervical cancer screening attendance.

• Equity in cervical cancer screening attendance could be ensured by targeting vulnerable social groups, specifically, the elderly, single and unemployed women, and women with lower education.
Health Impact Assessment (HIA) of a daily physical education lesson in Austrian schools
Authors: Fuchs-Neuhold B , Movia M , Macher S , Simi H , Antony G , Zeuschner V , Wamprechtsamer G , delle Grazie J
Published: October 2023

Background

Encouraging physical activity among school children is vital for their overall health and well-being. This study aims to evaluate the potential impact of implementing a daily physical activity unit in Austrian schools and to identify areas for optimization of the implementation plan to ensure maximum health benefits.

Methods

The HIA systematically followed several stages including screening and scoping, appraisal and formulation of recommendations. The study included a review of literature, an online survey (n = 712), four online focus group discussions, and two online appraisal workshops with stakeholders.

Results

The HIA identified several considerations for implementing the daily physical activity unit model, including promoting equity, ensuring high-quality implementation, and integrating five additional units of physical activity per week into the Austrian school curriculum. Results show that 62% of the respondents are in favor of integrating sports clubs more strongly into everyday school life in the future. Regarding additional personal effort of the pedagogical staff, 45% of the participants of the online survey indicated neutral or no effects, 30% (very) positive effects and 20% suspected (very) negative effects.

Conclusions

The results suggest that the daily physical activity unit model has overall positive effects on individual student health, social and community networks, living and working conditions in the school environment, and the system level. Promoting equal opportunities and supporting disadvantaged children and schools is important. Additionally, organizational, and structural differences of the respective school types and regions, availability of sufficient infrastructure, and appropriate selection of pilot regions must be considered. The binding nature/voluntariness of the physical activity units as well as high-quality implementation, training of teachers and coaches, and focusing on the elementary/kindergarten level are recommended.

Key messages

• Recommendations for implementation include ensuring equal opportunity and support for disadvantaged children and schools.

• The integration of five additional physical activity classes per week and a greater focus on the elementary/kindergarten level were identified as important.
National and subnational analysis of diabetes and health inequalities in European Union countries
Authors: Andrade C , Kovacs N , Mahrouseh N , Varga O
Published: October 2023

Background

Diabetes mellitus (DM) has been a major public health concern with increased epidemiologic and economic burden in the European Union (EU) member states. We aimed to estimate national and subnational DM prevalence in individuals aged 50 years or over in 13 EU member states between 2010 and 2019.

Methods

The present study extracted microdata from waves 4 - 2010/2011, 5 - 2013, 6 - 2015, and 8 - 2019 of the Survey of Health, Ageing and Retirement in Europe (SHARE) database. The analysis was carried out at national and subnational levels from 13 EU member states. Socioeconomic risk factors such as urbanization, income, and educational level were involved in the analysis. Gini coefficient (GC) and concentration Index (CI) were used to evaluate health inequalities.

Results

Prevalence of DM in EU between waves 4 and 8 ranged from 12% to 13.9%, respectively. GC for DM prevalence in EU was 0.140±0.028 (p = 0.00) in wave 4 and 0.141±0.024 (p = 0.00) in wave 8. The highest prevalence was 21.4% in Czechia (wave 8) and the lowest was 6.7% in Switzerland (wave 4). The EU member state with highest GC was Denmark with 0.336±0.085 (p = 0.00) in wave 4 and the lowest was found in Slovenia with 0.001±0.001 (p = 0.04) in wave 5. Urbanization showed the highest CIs, ranging from -0.062±0.030 (p = 0.04) in Italy (wave 8) to 0.079±0.024 (p = 0.00) in France (wave 5). Income ranged from -0.275±0.033 (p = 0.00) in Denmark (wave 5) to -0.007±0.035 (p = 0.85) in Slovenia (wave 4) and educational level from -0.249±0.042 (p = 0.00) in Denmark (wave 4) to -0.028±0.036 (p = 0.43) in Switzerland (wave 5).

Conclusions

In the EU, there are inequalities in the increasing prevalence of DM at national and sub-national levels, with higher rates among those living in non-urban areas, with low educational levels and low income. To tackle such level of health inequalities, the EU and its member states should create prevention programs and policies that prioritize vulnerable groups.

Key messages

• Our research highlights inequalities in DM prevalence between and within member states of EU.

• The study underlines the need for tailored actions addressing specific regions and vulnerable population.
An overview of reviews: what do we know about task shifting and skill mix change in healthcare?
Authors: Meda F , Cantarelli P , Vainieri M
Published: October 2023

Task shifting is a globally recognized strategy to respond to healthcare challenges (WHO, 2008; Simms et al., 2019). This research contributes to the academic debate on task shifting by providing a comprehensive overview of the current knowledge and interpreting the results through the theoretical framework by Sibbald et al. (2004), describing task shifting as enhancement (extending roles of a workers group); substitution/delegation (exchanging tasks between groups of workers); innovation (creating new jobs by introducing new skills or technological innovation). The study is a systematic review of reviews (Smith et al., 2011). The search was performed on Scopus, completed in February 2023, confined to English published article reviews, from 2004 onwards, coherently with publication year of Sibbald et al. (2004). The search keywords defined: type of publication (review), health personnel (doctor/physician, nurse, technician, therapist, social/community worker) and focus of the article (task shifting or skill mix). Of the 692 publications identified, 37 met the inclusion criteria: 23 systematic reviews, 8 non-systematic/narrative, 3 scoping and 3 meta-analyses. In total, 815 papers are reviewed by the studies. 19 are focused on developing countries, 2 on developed and 16 do not specify it. 8 are focused on non-communicable diseases, 7 on surgery/acute care, 6 on HIV, 6 on primary care, 10 studies do not indicate it. Task shifting is not only of doctors and nurses: mental health specialists, surgeons, general practitioners, midwives, technicians, therapists, community workers, volunteers are examples of professionals considered. 31 reviews conceive task shifting as substitution; 4 as enhancement; 1 as innovation. Task shifting is mostly intended as tasks exchange from qualified to less-qualified workers, mainly to respond to staff shortages. It can be performed by different categories of professionals, being applicable to different contexts, services and treatments.

Key messages

• Task shifting is a globally recognized strategy to respond to healthcare challenges. This research contributes to the academic providing a comprehensive overview of the current knowledge on the topic.

• Task shifting can be performed by different categories of professionals, being applicable to many care services. It should be designed according to the specific context and professionals involved.
Workers needed: a needed assessment of the workforce in local public health services in Portugal
Authors: Vasconcelos R
Published: October 2023

Background

Portugal is planning to reform its public health services, which have been struggling with a shortage of professionals, even after hiring more staff during the COVID-19 pandemic. Meanwhile, in 2023, new local health units will be created to reorganize the local public health services (LPHS). Therefore, it is essential to examine and discuss how many and where the professionals in LPHS are in Portugal.

Methods

A cross-sectional descriptive analysis was conducted using hiring data, in the second trimester of 2023. The number of professionals in LPHS in mainland Portugal was described and compared between the 55 LPHS and the 5 health regions. They were classified into categories, with a special attention given to medical specialists, nurses, and environmental health technicians, who have specific regulations.

Results

More than 20 different professions can be found in the different LPHS. The total number of professionals in public health services in mainland Portugal was 1720, of which 380 (22.1%) were medical specialists, 304 (17.7%) were nurses, 443 (25.8%) were environmental health technicians. The highest number of professionals was found in ACES Baixo Vouga with 70. The health region with the highest number of professionals was ARS Norte with 635. When considering full-time equivalents, only 18 (32,7%) LPHS have the legally recommended ratio of one medical specialist per 25 000 inhabitants, the ratio of one nurse per 30 000 inhabitants is attained in 18 (32,7%) LPHS, and only 12 (21,8%) have the indicated one environmental health technician per 15 000 inhabitants.

Conclusions

This study provides a comprehensive overview of the number and distribution of professionals in LPHS in mainland Portugal, at a time of change, with concerning results. These can be useful to plan and evaluate policies and interventions regarding public health personnel recruitment and organization, considering impending the reforms.

Key messages

• There is a lack of professionals in local public health services in Portugal, with few meeting the legally recommended ratios of medical specialists, nurses, and environmental health technicians.

• The incoming changes in public health services organizations are a good opportunity to reorganize and invest in their workforce, which is essential to improve public health in Portugal.
MicroDoc: Developing a guide for managing infections in Zambian rural low-resource health settings
Authors: Gannon J , Greenan K , Takenoshita M , Hettle D , Duffy O , Nygren D , Lynch R , Buttigieg S , Phiri J , Margetts Ben
Published: October 2023

Lack of access to diagnostic tests and guidelines that are inappropriate for poorly resourced facilities can result in incorrect and excessive prescribing of antimicrobial therapy in rural healthcare settings.

On Call Africa (OCA) and Virtual Doctors (VD) are two non-governmental organisations that work in healthcare in Zambia. Volunteers and staff from OCA and VD have collaborated with the Zambian Ministry of Health and local healthcare providers to design a guide to support decisions around management of infections specifically in rural primary healthcare settings in Zambia. Local staff were initially surveyed for their attitudes towards treatment of infections, the content they would like capacity building in, and preferred modes of learning. The team, comprising public health and infectious disease doctors and GPs from Ireland and the UK with experience working in Zambia, have created a guide called MicroDoc which encompasses workshops, PDFs, flowcharts and modules relating to management of infections and antimicrobial prescribing. All the content can be downloaded and accessed offline. The Zambian Standard Treatment Guidelines were consulted for antimicrobial choice, supplemented by NICE and WHO where necessary. Red flags for urgent hospital referral are also incorporated, as well as modules about risks of antimicrobial resistance. Early versions of the guide have been distributed to a range of facilities in Zambia's Southern Province, with promising feedback from healthcare providers. In collaboration with local partners and input from facility staff, MicroDoc will be finalised and rolled out to more health posts and health centres in the region, with a view to eventually expanding to other regions. The OCA team has been conducting clinical audits of prescribing practices in two rural health posts and it is hoped that the MicroDoc guide will contribute to improved antimicrobial stewardship as well as better outcomes for patients.

Key messages

• Management of infectious presentations is particularly challenging in rural low-resource primary healthcare settings in Sub-Saharan countries such as Zambia.

• A team from On Call Africa and Virtual Doctors has created a guide called MicroDoc, in collaboration with Zambian health authorities, to support decision making in managing infections in primary care.
Effect of prenatal passive tobacco smoke exposure on full-term birth weight of born neonates:SR
Authors: Niranjan V , Manat A , Stokes D
Published: October 2023

Prenatal smoking increases the risks of pre-term birth, stillbirth, neonatal death, and perinatal death as well as neurodevelopmental disorders in children. However, there is a lack of consistency in research published about association/impacts of passive smoking and low birth weight (LBW). Hence, we carried out this systematic review to determine whether or not there is a relation between prenatal tobacco smoke exposure and full-term LBW infants. Following PRISMA guidelines, we carried out systematic searches with PubMed, CINAHL, PsycInfo, and Embase for cohort case-control studies the 31-year period from 1991 - 2022. Of the 2,877 articles identified, 835 duplicates were removed. Title screening was done for 2,126 articles. 25 articles met the inclusion criteria that were Peer reviewed full-text articles in the English language and related to LBW due to passive smoking only. We found 20/25 articles showed a significant relationship with an OR ranging between 2.14 and 54.9 respectively between exposure to environmental tobacco smoke (ETS) and LBW infants at term and 5 articles showed no association with an OR ranging between 0.48 and 1.51. A significant difference found between the sample size among the studies included influencing the outcome of the study (ranging from smallest (n = 208) and largest (n = 17412). Mean age of mother was 29.6±3.8 and mean birth weight was 3,212±467.1. Nicotine level > 4.1 ng/mL or duration of exposure 24.4 hours/week gives strong evidence of prevalence of LBW among SHS exposed mothers. Compiled evidence suggests that, there is a significant association between prenatal passive smoke exposure and neonatal birth-weight at full term. There is a need for health researchers and public health experts to design and implement targeted programmes to reduce LBW due to passive smoke in our societies.

Key messages

• Exposure to ETS from domestic sources has a substantial influence on birth weight.

• Combining educational programmes and legislative interventions is required to eliminate infants’ contact with tobacco smoke in utero and throughout childhood.