bluuebunny/crossref_metadata_2025 huggingface dataset:
Resilience in Syrian refugee youth
Authors: Dangmann C , Solberg Ø , Myhrene Steffenak AK , Høye S , Andersen PN
Published: October 2022

Background

The importance of resilience factors in the positive adaptation of refugee youth is widely recognised. However, their actual mechanism of impact remains under-researched. The aim of this study was therefore to explore protective and promotive resilience mechanisms on both negative and positive mental health outcomes. Promotive resilience is seen as a direct main effect and protective resilience as a moderating effect.

Methods

Cross-sectional study with 160 Syrian youth aged 13-24 years, who recently resettled in Norway. A multi-dimensional measure for resilience was used to explore the potential impact of resilience factors on pathways between potentially traumatic events from war and flight (PTE), post-migration stress, mental distress and health-related quality of life (HRQoL). Analyses included regression, moderation and moderated mediation using the PROCESS macro for SPSS.

Results

A direct main effect of resilience factors (promotive resilience mechanism) was found for HRQoL and general mental distress, but not for post-traumatic stress disorder (PTSD). No moderating effects of resilience factors (protective resilience mechanism) were found. Post-migration stressors mediated the effects of PTE, and this indirect effect was present at all levels of resilience. Relational and environmental level resilience factors and combined amounts had more impact than individual level factors.

Conclusions

Despite high risk exposure and mental distress, resilience was also high. The direct main effect of resilience factors and less impact on PTSD, suggests universal resilience building interventions may be beneficial, compared to exclusively targeting groups with high symptom levels. These interventions should target relational and environmental resilience factors as well as individual coping techniques. Additionally, reducing current stress and symptoms could increase the efficacy of resilience factors already present.

Key messages

• Refugee youth may have both high levels of risk and high resilience.

• Universal resilience interventions should focus on relational and environmental support, as well as individual resilience.
Redistribution down under—dealing with ill-defined deaths in the Australian Burden of Disease Study
Authors: Dunford M , Ho W , Bishop K , Gourley M , Juckes R
Published: October 2022

Burden of disease analyses measure the healthy years of life lost due to living with and dying prematurely from disease and injury. It is now the global standard for comparable policy-relevant evidence on the impact of disease, injuries, and risks on a population. The Australian Burden of Disease Study (ABDS), undertaken by the Australian Institute of Health and Welfare, uses Australian-specific data and methods (based on the Global Burden of Disease Study, adjusted to suit the Australian context) to quantify disease burden for Australia. Despite the high quality of deaths registration data in Australia, in burden of disease analyses not all coded causes of death are considered appropriate or valid to estimate years of life lost (YLL). Therefore, these ‘ill-defined deaths’ are redistributed to one or more diseases on the ABDS disease list according to a more probable underlying cause of death. In the latest ABDS, almost 1 in 10 deaths in 2018 was an ill-defined death. Most of these were redistributed to other diseases using one of three methods developed for the Study:

1) direct evidence on more plausible causes of death from data linkage studies or other sources

2) redistribution algorithms based on the distribution of underlying causes of death where the ill-defined cause was recorded as an associated cause of death

3) reassignment of deaths across a specified range of target diseases according to patterns of causes of death observed in the mortality data for the ABDS disease list.

Expert advice was also received on the redistribution of deaths from septicaemia and deaths coded to ICD-10 code X59 Exposure to unspecified factor. Overall, 8.5% of the years of life lost for Australia in 2018 came from ill-defined deaths. These deaths generally followed age-specific all-cause mortality patterns. It is important to consider methods and target diseases when redistributing ill-defined deaths to appropriately quantify their contribution to disease-specific burden.
Redistributing ill-defined deaths in the German Burden of Disease study BURDEN 2020
Authors: Wengler A , von der Lippe E
Published: October 2022

Having valid information on mortality within a country is of great importance for public health planning. This includes knowing the causes of death (CoD) within a population. However, these data are not always suitable for Burden of Disease calculations from the start and hence, need some realignment in advance. The CoD statistics in Germany include a relatively high share (26% in 2017) of ill-defined deaths (IDD) - using the definition of the Global Burden of Disease Study. Additionally, only the underlying CoD is included in the national statistics and no multicausal data are available yet. As part of the German Burden of Disease project BURDEN 2020 we redistributed IDD to valid CoD using a process of proportional redistribution. To do so, we made use of the distribution of the valid ICD-codes in the data. In the proposed presentation, we use examples of stroke, diabetes, and heart failure to illustrate how IDD were reallocated. After redistribution, the largest increases for both women and men were seen for lower respiratory infections, diabetes mellitus, and stroke. The numbers of deaths for these causes more than doubled after redistribution. Within this project, we carried out the first comprehensive redistribution of IDD for German CoD statistics.
10.D. Workshop: Injury Severity Classification and burden of disability measurement
Authors:   Organised by: EUPHA-INJ, EUPHA-EPI, EUPHA-PHMR, EUPHA-ECO,   Chair persons: Maria Papadakaki (EUPHA-INJ), João Vasco Santos (EUPHA-ECO)
Published: October 2022

Globally, injuries cause over 4.3 million deaths per year with incalculable costs for the health, legal, and social systems. Burden of disease analyses are being conducted across the world in order to map the health status of injured population, run comparisons and enable prioritization of preventive and interventional measures. Metrics of injury burden are therefore important indicators of population health that are increasingly being incorporated into national and international health information systems. To prevent injuries and their disabling health consequences, and to effectively reduce injury burden, it is essential to provide policy makers and health system planners with detailed measurements and assessments that allow them to focus resources where they are most needed and areas where more targeted policy attention might be required. However, efforts to fully understand the health outcomes of trauma patients remain inconsistent and insufficient, specifically for certain injury populations and health outcome domains. A wide variety of measures are available to track outcomes after injury in various health domains. Reaching consensus is an important step in benchmarking of outcomes across institutions and injury types to improve quality and advance the field of injury care. Modern, validated measures that are feasible and usable in both research and clinical contexts are needed to facilitate the improvement of quality and comparability of research. The workshop aims to discuss trends and variation of injury burden, which is critical to health system planning. The high human and societal costs as well as inequalities of injury mortality and burden will be highlighted based on comparisons with long-term trends. The workshop will discuss the latest developments in injury severity classification and disability measurement. The most efficient measures to calculate the valid burden of injuries will be presented and comparative measurements across EU countries will be promoted. Limitations of injury classifications and factors introducing uncertainty and potential bias in estimation of disability, will be identified. The workshop will contribute to the identification of evidence-informed tools and measurements of injury burden.

Key messages

• Some injury outcomes are responsible for huge individual and societal burden but are still difficult to measure.

• Multiple measures are developed to assess severity and outcomes: e.g. AIS/ ISS/New ISS/ ICD-10. Efficient prevention and quality care requires validated and easy to use measures.
Quantification the cost of injuries
Authors: Haagsma J
Published: October 2022

The population health impact of injuries can be measured with a range of metrics. ranging from incidence and mortality to disability adjusted life years and cost-of-illness. Cost of illness gives insight into the societal burden of injury, and factors and characteristics that are associated with higher costs. Assessment of the economic burden of health care is important, because this information allows us to understand main cost drivers of health care and to monitor the impact of injury prevention and interventions. However, comparability of cost-of-illness is hampered by differences in included and excluded health care resources, the perspective and time horizon that is applied in the cost-of-illness studies and inclusion or exclusion of productivity costs. Productivity costs refer to that are caused by work absence. In our injury cost of injuries studies, we found that, among working age injury patients, productivity costs are a significant contributor to the total costs related to injury. We also found that there is a lot of variety in the health care and productivity costs in injury patients, and these costs are not solely dependent on injury severity. In this presentation, we will discuss data sources that can be used to assess the cost of illness of injuries, methodological choices that can be made and risk factors for high health care and high productivity costs.
A novel stream of collaborative National portals to enhance preparedness and informed choices
Authors: Carinci F , Vicario C , Zamperini N , La Valle F , Rocchi L , Veltro G , Siccardi G , Mantoan D
Published: October 2022

Issue/problem

AGENAS supports the implementation of health policies in direct collaboration with Italian Regions and Autonomous Provinces. To improve public reporting, we aimed to complement the production of technical reports with new forms of timely communication, using National Portals.

Description of the problem

Between October-December 2020, we designed and implemented the Covid-19 National Portal, including a suite of targeted indicators, fully automated via ad hoc scripts written in php and R on top of a relational database using internal and external data sources. Targeted information was widely communicated and continuously updated. Dedicated sections on forecasting and resilience were delivered in collaboration with specialised academic institutions. In 2021, we deployed the Portal for the Transparency of Health Services, broadly oriented towards health issues, the location of services and performance indicators.

Results

Pre-post comparisons of web analytics for Jan-Apr 2020-2022 showed clear advantages of Covid-19 Portal. By Apr 2020, Italy had introduced national lockdown, while AGENAS covered the topic traditionally, recording 48,122 users overall, with daily peaks below 5,000 sessions. In 2021-2022, the number of users skyrocketed at 436,280, with daily peaks of 100,000 sessions, and 421,123 respectively, with daily peaks of 150,000 sessions. Visits to the Transparency Portal were considerably more limited.

Lessons

To be widely used, public health information needs to be relevant (responding to personal need close to home), understandable, accurate and timely. National Portals can gain efficiency through the mediation of search engines, enhanced by: targeted naming (url), coherent semantic perimeter (third level domain in a highly referenced institutional website), continuous updating, and impact factor (linked by authoritative websites). The Transparency Portal will take stock of these lessons to succeed in a new funded program of NextGenerationEU.

Key messages

• Relevant, understandable, accurate and timely dissemination for different types of audience may be effectively organised through National Portals.

• Productive collaboration between health specialists and communication experts can enhance usability and actionability of National Portals for public health.
Mortality among internal and international migrants in the 100 Million Brazilian Cohort
Authors: Pescarini JM , Goes E , Scaff P , Schindler B , Rodrigues LC , Brickley EB , Smeeth L , Barreto ML
Published: October 2022

Background

There is limited evidence on the health of migrant populations in low and middle-income countries (LMICs). Here, we investigated the patterns of mortality risk in migrants and non-migrants in women and men over the life course.

Methods

We linked socioeconomic and mortality data from 1st Jan 2011 to 31st Dec 2018 in the 100 Million Brazilian Cohort. We calculated all-cause and cause-specific age-standardised mortality rates according to individuals’ migration status. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., people born in Brazil but living in a different Brazilian state to their state of birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals.

Results

We followed 45,051,476 individuals, of whom 6,057,814 were internal migrants and 277,230 were international migrants. Internal migrants had a similar overall risk of all-cause mortality compared to Brazilian non-migrants (aHR=0.99, 95%CI=0.98-0.99), with lower mortality from some causes but higher mortality for some non-communicable diseases (NCDs). Compared to Brazilian-born individuals, international migrants had a lower risk of all-cause mortality (aHR=0.82, 95%CI=0.80-0.84), with up to 50% lower risk of death attributed to interpersonal violence among international migrant men (aHR=0.50, 95%CI=0.40-0.64), but a markedly higher risk of death by avoidable causes related to maternal health among young migrant women (aHR=2.17, 95%CI=1.17-4.05).

Conclusions

Overall, internal migration was not associated with excess all-cause mortality, while international migration into Brazil was associated with lower all-cause mortality. Mortality patterns among migrant populations in Brazil show marked variation for specific causes of death, and risks varied by age and sex.

Key messages

• Non-communicable diseases and maternal mortality are disproportionally higher among internal and international migrants, respectively.

• Further investigation of the underlying factors associated with higher maternal mortality among international migrant women is key to informing the targeting of social and health interventions.
Inequalities in adverse birth outcomes and survival in early childhood: birth cohort in South Korea
Authors: Jo M , Chung H
Published: October 2022

Background

Adverse birth outcomes (ABOs) are considered the most common factor of deaths in early childhood. Inequalities in child mortality occur due to interactions between intrinsic and socio-environmental factors related to socioeconomic disadvantage. There are, however, few studies investigating the impact of ABOs on mortality in terms of parental SEP.

Methods

Using the Under-5 Infant Birth-Death Cohort Data in Korea, a pooled retrospective birth cohort of all children born in 2012-2014 was built (N = 1,356,584). We analyzed neonatal, post-neonatal, and childhood mortality by ABOs and with the interaction of parental SEP using the Cox proportional hazard regression model for survival analyses. We further stratified the analysis both by parental SEP and child age. Multiple logistic regression was performed to confirm the social inequalities in ABO itself.

Results

After adjusting for covariates, children born with ABOs presented higher risk of mortality for all periods. For post-neonatal period, lower maternal education showed significant interaction effect with LBW (HR = 0.57; 95% CI = [0.39-0.85]), PTB (HR = 0.53; 95% CI = [0.33-0.86]), LBW & PTB ([HR = 0.67; 95% CI = [0.54-0.83]) while lower paternal education (HR = 0.67; 95% CI = [0.54-0.82]) and maternal unemployment (HR = 0.80; 95% CI = [0.63-0.99]) showed significance for babies with LBW & PTB. However, stratification analyses suggested that the impact of ABOs on mortality was greater for children born to lower parental SEP in neonatal period. Meanwhile apparent social inequalities in ABOs were suggested from regression analyses.

Conclusions

We confirmed social inequalities in the incidence of ABOs as well as mortalities from ABOs. However, the difference in mortality between babies with and without ABOs was greater for advantaged children. Policies to reduce the mortality of children with ABOs as well as those of healthy children among socioeconomically disadvantaged families are required.

Key messages

• Social inequalities in mortality from ABOs were apparent especially in the neonatal period while the incidence of ABOs itself was greater among children from disadvantaged families.

• Disadvantaged children are more likely to die not only from ABOs but also from other socio-environmental determinants, especially in the post-neonatal period than their counterparts.
The COVID-19 pandemic as an disruptive event in school health promotion. Survey results from Germany
Authors: Dadaczynski K , Messer M , Okan O
Published: October 2022

Background

This study examines the extent to which schools implement activities on health promotion and prevention during the COVID-19 pandemic. Moreover, potential differences with regard to demographic variables, school type, state, and participation in state public health and health promotion initiatives are determined.

Methods

As part of the international COVID-Health Literacy Research Network, an online-based cross-sectional study was conducted from March to April 2021 with 2,186 school principals from three German federal states. The implementation status of COVID-19 related school health promotion was assessed using a self-developed instrument. After examining the factorial structure of the instrument, univariate and bivariate data analyses were performed.

Results

Three dimensions of implementing school health promotion can be identified (1. COVID-19- related support for pupils, 2. Health promoting design of teaching, learning and working conditions, 3. Principles of Health Promoting School). A low level of implementation can be observed for aspects of teaching, learning and working conditions (31%) as well as for participation (52%) and cooperation with community stakeholders (42%). Significant differences can be determined with female, older and primary school principals reporting a higher implementation status while for federal state mixed results are found. Stratified by participation in state health promotion initiatives, only schools with a certificate in health promotion show a higher level of implementation.

Conclusions

The results indicate that the COVID-19 pandemic is a disruptive event for schools, impeding the implementation of holistic activities on health promotion and prevention. In addition to systematic support for school principals in the area of health promotion and prevention, it should be ensured that existing initiatives are provided with sufficient resources, especially in times of crisis.
School health promotion during the COVID-19 pandemic: Associations with school leaders’ health literacy
Authors: Betschart S , Sandmeier A , Skedsmo G
Published: October 2022

Background

School leaders are credited with an important role when it comes to school health promotion. During the COVID-19 pandemic, much health-related information was available and had to be interpreted and acted upon by school leaders. Therefore, it is crucial that they have sufficient health literacy as the ability to gain access to, understand and use health-related information. A study in Germany showed that limited health literacy among school principals was associated with low levels of health promotion activities. This paper explores the association between school leaders’ health literacy and school health promotion in Switzerland, addressing the following questions: 1. What is the relationship between health literacy of school leaders and the implementation of school health promotion? 2. Does health literacy explain variance above and beyond other antecedents, such as principals individual mental health and attitudes?

Methods

The quantitative analysis is based on an online survey conducted among school leaders in the German- and French speaking parts of Switzerland in June 2021 as part of the project “COVID-19 health literacy school principals survey”. The final sample comprised N = 339 school leaders. The data were analyzed using stepwise regression with health literacy, stress, wellbeing and attitudes toward school health promotion as antecedents and COVID-19 related school health promotion as the outcome.

Results

The results show that health literacy of school principals has played an important role in the implementation of school health promotion during the COVID-19 pandemic. It explains additional variance beyond other antecedents.

Conclusions

One way to promote implementation of school health promotion is to strengthen the health literacy of school leaders.
Impact of booster vaccination on COVID-19 outcomes in Portuguese population aged 80 or more years old
Authors: Kislaya I , Rodrigues AP , Silva S , Santos AJ , Matias Dias C , Nunes B , Machado A
Published: October 2022

Background

Vaccination is essential to control SARS-CoV-2 transmission and complications. The study aimed to estimate the number of SARS-CoV-2 infections, COVID-19 hospitalizations and deaths averted by booster vaccination in Portuguese population aged 80 or more years old.

Methods

We developed an ecological study for the period of the Omicron variant of concern predominance (week 2 to week 16, 2022). Data on vaccine coverage and effectiveness, and number of events of different severity reported to the national COVID-19 surveillance system were used to estimate the number of averted events, prevented fraction and number needed to vaccinate. Uncertainty intervals (UI) were obtained using Monte Carlo simulations.

Results

By week 2 2022, vaccination coverage in the target population reached 91.2%. Booster vaccine effectiveness was 4.1% (CI95%: -0.1 to 9.0), 87.5% (CI95%: 84.9 to 89.7) and 83.2 (CI95%: 80.3 to 85.7) against infection, hospitalization and death, respectively. During the study period, 70862 SARS-CoV-2 infections, 2697 COVID-19 hospitalizations and 2106 deaths were reported. Booster vaccination averted 2731 (UI95%: -298 to 5838) infections, 10629 (UI95%: 9173 to 12127) hospitalizations and 6608 (UI95%: 5725 to 7546) COVID-19 related deaths among individuals aged 80 years or more resident in Portugal. Prevented fractions were 3.7% (UI95%: 0 to 7.6%), 79.7% (UI95%: 77.3 to 81.7%) and 75.8% (UI95%: 73.2 to 78.1%), respectively. It would require to vaccinate 59 individuals (UI95%: 52 to 69) to prevent one hospitalization and 94 individuals (UI95%: 82 to 109) to prevent one death in the target population.

Conclusions

The booster vaccination strategy had considerable impact on preventing severe outcomes in the Portuguese population aged 80 and more years old.

Key messages

• High vaccine coverage combined with high vaccine effectiveness resulted in considerable reduction of severe COVID-19 outcomes.

• Information on number of outcomes of different severity levels averted by COVID-19 booster vaccination allows to strength public health communication.
Suicide attempts in LGBTQ+ youth in Switzerland: Qualitative insights in school-based risk factors
Authors: Bomolo NJ , Koschmieder N , Gavin A , Kupferschmid S , Bourquin C , Michaud L , Pfister A
Published: October 2022

Background

Studies show that the LGBTQ+ population is particularly vulnerable to suicidal thoughts and behavior. This vulnerability is even more pronounced in the younger population. However, in Switzerland, qualitative studies on this topic are missing. Our study investigates the processual dynamics and background of suicide attempts of LGBTQ+ youths while looking into their subjective meaning. Here, behaviors of help-seeking are also from interest. In addition, the burdens and resources associated with being LGBTQ+ are explored. By better understanding the process of suicide attempts, we can identify relevant contexts of the respondents’ experiences and illustrate how to enhance suicide prevention strategies. We are referring here to the school context.

Methods

From 2021 until 2024, we interview LGBTQ+ youths in the German- and French-speaking parts of Switzerland who have tried to end their lives between the ages of 14 to 25 (max. three attempts). Applying a multi-perspective approach, we interview persons from their social environment if agreed. Recruitment is based on ‘theoretical sampling’. Data collection and analysis follow the grounded theory methodology. As of July 2022, the sample consists of 18 persons: 3 bisexual women, 1 lesbian woman, 2 gay men, 7 transgender persons, and 5 persons with fluid identities.

Results

Through preliminary analysis, the school context could be identified as one relevant burdening context in the respondents’ experience and suicide attempt process. In this respect, respondents experienced complicated social relationships: e.g., bullying, social exclusion, and pressure to conform. Moreover, the school environment was experienced by some as LGBTQ+ hostile.

Conclusions

Our current findings support the necessity to integrate schools as important stakeholders in suicide prevention but highlight a need for LGBTQ-specific and LGBTQ-sensitive orientations to suicide prevention strategies.
Meso-level ambulatory care and ambulatory care sensitive hospitalizations in Germany
Authors: Schüttig W , Sundmacher L
Published: October 2022

Ambulatory care sensitive hospitalizations are widely considered as important measures of access to as well as quality and performance of primary care. In our study, we investigate the impact of spending, process quality and continuity of care in the ambulatory care sector on ambulatory care sensitive hospitalizations in patients with type 2 diabetes. We used observational data from Germany's major association of insurance companies from 2012 to 2014 with 55,924 patients, as well as data from additional regional data sources. We conducted negative binomial regression analyses with random effects at the district level. To control for potential endogeneity of spending and physician density in the ambulatory care sector, we used an instrumental variable approach. In doing so, we adjust for a number of known risk factors for hospitalizations among this patient group. We undertook a Shorrocks-Shapley decomposition to investigate the relative contribution of groups of regressors to the pseudo R2. The results of our analysis suggest that spending in the ambulatory care sector has weak negative effects on ambulatory care sensitive hospitalizations. We also found that continuity of care was negatively associated with hospital admissions. Patients with type 2 diabetes are at increased risk of hospitalization resulting from ambulatory care sensitive conditions. The results of the decomposition analysis for groups of variables indicate that ambulatory care characteristics account for 9.8% of the pseudo R2, morbidity of patients (including gender and age groups) for about 85.5%, and system-related factors of health provision for 4.7%. Our study provides some evidence that meso-level factors such as increased spending and improved continuity of care while controlling for process quality in the ambulatory care sector may be effective ways to reduce the rate of potentially avoidable hospitalizations among patients with type 2 diabetes.
Geographic variation in COVID-19 hospital admissions in France: a population-based study
Authors: Mercier G , Georgescu V , Baehr C , Riedel C
Published: October 2022

The impact of various environmental, socio-economic, and epidemiological factors on COVID-19 transmission and severity is well-known. However, there is little evidence about the respective role of these factors at the population-level at a national scale. The objective was to identify the environmental and contextual factors that influenced the spread and the severity of COVID-19 at the French department level during the first national lockdown. We performed a national, population-based, retrospective analysis. The cumulative rate of patients admitted for COVID-19 to any public or private acute care hospital from March 31st, 2020 to May 25, 2020 was modelled at the ‘departement’ (hereafter county) level. We used spatial regression models to quantify the aggregated effect of population health status, air pollution, meteorological, and socioeconomic factors. 57,356 patients were admitted to an acute care facility for COVID-19 over the period of interest. At the county level, the age and sex-standardized rate of admission ranged from 0.07 to 3.24 admissions per 1,000 people. After adjustment on the pre-lockdown COVID-19 hospital admission rate, the standardized cumulative rate hospital admission for COVID-19 during the period of interest was significantly and positively associated with the prevalence of diabetes, with the prevalence of mental conditions, and with high cumulative exposure to atmospheric ozone values. It was significantly and negatively associated with high cumulative exposure to ultraviolet radiation. These results suggest that several population-based epidemiological and meteorological factors could have played a role in COVID-19 spread in France. They provide potentially useful insights to design and implement geographically differentiated public health policies.
The path to evidence-based guidelines for food insecurity during pregnancy
Authors: McKay F , van der Pligt P , Zinga J , Lindberg R , Dickson A
Published: October 2022

Background

Food insecurity has negative health implications during and after pregnancy, however, identifying and then assisting women who are food insecure is complex. Successful screening programs are often embedded in practice guidelines that include referral and treatment guidance. Screening for food insecurity is vital to address food insecurity, however, it is not present in Australia, nor are there any guidelines for healthcare settings. This presentation will describe the steps taken to gather evidence to inform the development of practice guidelines.

Methods

The creation of practice guidelines for screening and responding to the needs of food insecure pregnant women was informed by 1) qualitative interviews with food insecure pregnant women, and 2) qualitative interviews with clinicians about their experiences of assisting hungry and food insecure pregnant women, 3) quantitative research with a cross-section of pregnant women about their experiences managing their food supply, 4) a systematic review describing the existing interventions addressing food insecurity during pregnancy, and 5) a modified Delphi to gather the opinions of experts on the best ways to address food insecurity in pregnancy.

Results

This work highlight the potential effectiveness of a food insecurity screening tool in the antenatal setting, the readiness of clinicians to respond to this need, the breadth and depth of current interventions to address food insecurity, and the opinions of experts on how this issue needs to be addressed. The combined impact of these 5 studies is the identification of a number of responces to food insecurity and hunger during pregnancy.

Conclusions

Given the lack of screening, standard care, and treatment of food insecurity in a clinical setting in Australia, it is essentail that guidelines are created that standardise patient care and control costs through efficient use of health care resources.

Key messages

• Food insecurity during pregnancy has significant implications for both mother and baby.

• Creating supportive evidence-based mechanisms to address food insecurity will lead to positive outcomes.
Bridging Epidemiological Data with Features of the Urban Context: An experience of Urban Public Health within the City of Milan, Italy
Authors: Rebecchi A , Johnson AA , Brambilla A , Buffoli M , Russo AG , Capolongo S
Published: October 2022

Referring to the Research Project “Enhancing Healthcare and Well-Being Through the Potential of Big Data: An Integration of Survey, Administrative, and Open Data to Assess Health Risk in the City of Milan with Data Science” the Authors present preliminary results regarding a survey distributed to a sample of citizens across all neighborhoods of Milano city. This survey sought to collect data regarding health risk factors of this population, including both individual (e.g. socio-demographic characteristics, behaviors, etc.) and community (e.g. environmental/morphological features, available social services, etc.) data. A digital survey was designed to collect information on the health conditions, risk factors, and lifestyle characteristics of a representative sample of the Milanese population at the neighborhood level, with reference to the census tracts and Local Identity Units (NIL). Collected survey data are entered into a system containing corresponding individual health information acquired from the Local Health Authority databases, creating a synthesized information profile with each respondent's state of health, including existing conditions, health services used, and drug therapies. The disseminated survey was developed from comparisons with similar experiences at the national/international level and divided into 60 multiple choice questions (6 for Sociodemographic profile; 8 for Context of residence; 12 for Functional limitations; 25 for Behaviors and lifestyles; 9 for Access to health services). The data from urban analysis conducted on the NIL of the City of Milan are assessed with particular reference to the theme of bicycle-pedestrian accessibility (Walkability) in the urban context and repercussions on the adoption of Healthy Lifestyles. The models developed through this research are expected to provide critical insight for designing health promotion, health protection, and disease prevention interventions aimed both at individual and community level.
Foreign-born people and covid-19 in Sweden - the effect of co-morbidity
Authors: Akhavavn S
Published: October 2022

Foreign-born people who live in Sweden, especially those who were born in low- and middle-income countries, were at higher risk of developing severe covid-19. It has previously been found that morbidity and mortality in covid-19 were associated with country of birth, level of education, income and type of housing. The aim of this study was to map differences between foreign and Swedish-born (18 years and older) with severe covid-19 regarding co-morbidity. This was a register -base study. Register data were gathered from the Patient Register, the Swedish Intensive Care Register, the Cause of Death Register and information on socio-economic variables from Statistics Sweden. Results shows that co-morbidity with severe covid-19 was generally higher for Swedish-born than foreign-born. On the other hand, co-morbidity with diabe-tes and obesity was slightly higher for foreign-born than for Swedish-born. The results also indicate that a higher risk of developing severe covid-19 remains despite the fact that we have controlled a number of factors that affect the relationships such as residential region, demography and socioeconomics. The conclusion of this study is that there is a need for strengthening public health surveillance systems for information such as diagnoses from primary care, the stage at which a person who has become infected has sought care, how the possible differences were in care seekers between foreign and Swedish-born and what the care chain looked like from the time the patient received first symptoms until she/he ended up in inpatient or intensive care.

Key messages

• Co-morbidity with severe covid-19 was generally higher for Swedish-born than foreign-born.

• There is a need for strengthening public health surveillance systems in primary health care for explaining the reasons of higher risk of developing severe covid-19 among foreign-born people in Sweden.
Inclusive governance: Enhance health literacy to reduce vaccine hesitancy
Authors: Bjegovic-Mikanovic V
Published: October 2022

Background

The COVID-19 pandemic placed a call for action worldwide. Based on scientific investigation, governments need to assess strategic priorities. Health system capacity constraints and failures in response to the pandemic have social, medical, productivity, and economic implications. It compounds health equity issues and confronts with excess mortality, higher chronic disease prevalence, and risk factors. Despite initial progress in vaccination against COVID-19 and attempts to speed up vaccination, the Western Balkan lags behind. Infodemic and low trust in institutions are among the main factors associated with low success and adverse effects on other vaccination programs. This presentation aims to shed light on the importance of health literacy in resilient communities supported by inclusive governance.

Methods

A narrative review based on literature on inclusive governance, health literacy, and resilient communities during COVID-19 and other emergencies. Primary sources are databases, scientific articles, Health System Response Monitor, and observations by ECDC and OECD.

Results

Results show that characteristics of resilient communities in possessing knowledge and ability to assess risk, manage an emergency, monitor change, and address threats stand out. Many studies highlight the interconnectedness of community members with the wider external environment and their participation in decision-making to improve health services. Examples include interventions for developing future vaccination programs in program planning, conducting sound evaluations, transferring results to those who need to know, and receiving feedback. The key to this success is enhancing digital and health literacy.

Conclusions

COVID-19 requires cross-sectional strategies to reinforce collaborative gains and build resilient communities, ready to apply population strategies for prevention. Inclusive governance and a bottom-up approach will be essential to optimize the response to future challenges.
School-based sexuality Education in Europe and Central Asia
Authors: Marquardt J
Published: October 2022

Introduction

In 2016, the BZgA and the European Network of the International Planned Parenthood Federation initiated an extensive survey regarding the development and current status of sexuality education (SE) in Europe and Central Asia, which included 25 selected countries of the European WHO Region. Since 2000, remarkable progress has been made in the region in developing and integrating SE curricula in school settings. The majority of the surveyed countries teach basic elements of SE in schools. Yet, in about half of the countries, there is still some reticence in understanding the benefits of SE for the health and well-being of young people. In countries with fully developed comprehensive SE programmes, the school is the main source of information on sexuality for young people. In the other countries young people tend to rely on information from friends or peers and the internet. The findings also showed a gap in teacher training on sexuality education.

Methods

The Survey included a detailed questionnaire, among member associations of IPPF EN and government agencies responsible for SE. A random sample was drawn from the 50 states of the region which is considered representative for the entire region. All 25 IPPF EN members and 16 of the 25 government agencies responded.

Results and discussion

Remarkable progress has been made in developing and integrating SE in formal school curricula. In 11 of the 21 countries, SE is a mandatory teaching subject, and in six additional countries it is partly mandatory. In four additional countries it is optional. Despite the progress, there are still shortcomings and gaps in providing the full spectrum of SE.

Conclusions

If provided, SE tends to focus primarily on the biological aspects and prevention of HIV/STIs and unwanted pregnancy. There is a need to broaden the spectrum of topics that are addressed to include gender equality, sexuality, violence and sexual abuse, human rights and empowerment.
Establishing Covid-19 Research in UK Care Homes – Infrastructure Challenges for Trial Design
Authors: Leighton P , Sprange K , Robinson K , Rick C
Published: October 2022

Background

The Covid-19 pandemic brought into sharp relief the role that long-term care facilities play in health and social care of an aging population. It also cast a spotlight upon the need for high-quality research to assess the effectiveness of any care home interventions. The Prophylactic Therapies in Care Homes (PROTECT-CH) trial was one such study (funded by the UK National Institute for Health and Care Research). PROTECT-CH was designed to collect data in 200 care homes (approximately 6,400 residents), and whilst the changing epidemiology of Covid-19 in the UK (due to vaccination take-up) made this unfeasible other insights were gained about establishing large-scale research in care homes.

Methods

An iterative process evaluation of the set-up phase of a large, platform trial testing prophylactic measures in long-term care facilities. Including a documentary review of the PROTECT-CH working groups and an online survey of working group members.

Results

Documents were reviewed from 24 working groups, which in a hub and spoke model represented the PROTECT-CH trial infrastructure; representative of 20 of these groups completed an online survey about their organisation and working. Data demonstrated the number and organisation of individuals required to set up a large-scale care-home trial - 91 individuals representing a mix of academic, clinical, and methodological contributions from 25 organisations. Data demonstrated working groups specific to care home research, and activities designed to address the specific challenges of researching in care homes. PROTECT-CH produced dedicated training materials and reporting templates for care home research. PROTECT-CH established novel mechanisms for prescribing and clinical oversight in care home research.

Conclusions

PROTECT-CH has highlighted the complexity of establishing large, scale RCT research in long-term care facilities. It has produced resources which might be of use in subsequent care home research.

Key messages

• Infrastructure is required to support high quality research in long-term care facilities.

• RCTs in long-term care facilities pose specific challenged to researchers.
Diffusion of smoke-free policies at outdoor sports clubs in the Netherlands
Authors: Garritsen HH , Kunst AE
Published: October 2022

Background

Although outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, the majority of sports clubs are not smoke-free. This study aims to assess diffusion patterns of outdoor SFPs at sports clubs in the Netherlands, which may inform national strategies aimed at making all outdoor sports clubs smoke-free.

Methods

Using a retrospective, registry-based design, an inventory was made of football, field hockey, tennis, and korfball clubs that became smoke-free between 2016-2020. We determined the type of sports, number of members, and proportion of youth members. The degree of urbanization and density of smoke-free sports clubs were measured at the municipality level. The association between sports clubs’ characteristics, degree of urbanization, and SFP adoption was analysed using multilevel regression analysis. Horizontal diffusion was tested by analysing the association between the density and annual incidence of smoke-free sports clubs.

Results

Since 2016, the number of sports clubs with an outdoor SFP increased from 0.3% to 26.4%. Field hockey [OR compared to football 6.00 95% CI 4.46-8.07] and korfball clubs [OR 6.65 95% CI 4.98-8.87] and clubs with many (youth) members [OR 8.75 95% CI 6.20-2.35] were more likely to be smoke-free. SFPs spread from the most urbanized to less urbanized municipalities, which could mostly be attributed to sports clubs’ characteristics. A higher density of smoke-free sports clubs within municipalities was associated with an increased incidence of new SFPs in the following year.

Conclusions

Outdoor SFPs at sports clubs in the Netherlands diffused across horizontal and hierarchical lines. National strategies for smoke-free sports should monitor clubs that are more likely to stay behind, such as football and tennis clubs, smaller clubs, and clubs in less urbanized areas.
Implementing a smoking cessation training for lower socioeconomic groups into local policy in Amsterdam, the Netherlands: Identifying preconditions and barriers among multiple stakeholder groups
Authors: Harting J , Kuipers MAG
Published: October 2022

Background

Socioeconomic inequalities in smoking prevalence are high, partly because smoking cessation programs are insufficiently accessible and suitable for smokers with a lower socioeconomic position (SEP). To make it easier for this target group to access suitable smoking cessation programs, it is necessary to structurally implement such programs into local policies. The study aims to identify preconditions and barriers for the implementation of smoking cessation programs for people with low SEP from the perspective of key stakeholders.

Methods

The Feel Free! Smoking cessation rolling group training has been previously developed for people from lower socio-economic groups and was implemented in Amsterdam Noord. Semi-structured interviews were held with 25 stakeholders consisting of participants, trainers, professionals in the neighbourhood and stakeholders of the municipality. The interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach. The Implementation Framework of Fleuren will be used to structure the presentation.

Results

The main preconditions found are effective recruitment of participants by local professionals, having a central coordinator for implementation within the neighbourhood network, and offering a smoking cessation program with a clear added value for participants. The main barriers found are challenges in setting up a sustainable financial structure, allocation of organizational tasks, and high participant absences and dropout. More results will be presented in detail.

Conclusions

This study shows that action is required from various stakeholders to facilitate the implementation process. These findings can inform policy makers and implementers to choose strategies to implement suitable smoking cessation programs into local policy.