bluuebunny/crossref_metadata_2025 huggingface dataset:
A method for interactive collaboration between different actors: theory of change workshops
Authors: Wendt J , Scheller D A , Müller-Stierlin A
Published: October 2024

It is well recognised that the involvement of different actors in health research is crucial to the success of projects and interventions, as it increases the likelihood that they will be relevant, impactful and applicable in practice. However, researchers and policy makers often lack tools for the participatory involvement of actors. One way of actively involving actors is the Theory of Change (ToC) method. A ToC is a model of a change process that describes how and why an intervention leads to the intended change or outcome in a given context. It describes the path along which change is expected to occur and provides a framework for investigating whether and how change takes place. It is a systematic methodology that can be used both prospectively and retrospectively for the planning, implementation and evaluation of interventions. The approach recognises that changes in socio-ecological systems are complex and challenging and that the causal processes are often non-linear and intertwined. A ToC workshop begins with the formulation of a clear vision for the desired change and the long-term goal of the intervention. Starting from the long-term goal, the necessary medium-term and short-term goals are then defined in a backward mapping process. Next, indicators, activities and assumptions are defined for each intermediate goal. The results of a ToC workshop can be visualised in a ToC map, which shows the causal pathways, relationships, and connections between the different components of the ToC. This visual representation helps the actors to understand the logic, connections, and assumptions underlying the ToC. This in turn facilitates a shared understanding, collaboration, and ownership among all actors involved. Overall, successful involvement of actors using the ToC method can not only enrich the research process, but ultimately also increase the health benefits of interventions and health policies.
Leveraging digital platforms to improve Public Health in hospital smart buildings
Authors: Lapão L , Viegas S
Published: October 2024

The integration of digital platforms into hospital infrastructure represents a significant leap forward in public health management. This session explores how smart hospital buildings, equipped with advanced digital technologies, can enhance public health outcomes through more effective disease surveillance, improved environmental controls and enhanced patient care management. Smart hospital buildings utilize a range of new technologies such as IoT sensors, AI-driven analytics and big data solutions to monitor and optimize various aspects of hospital operations and care. These technologies enable real-time data collection on environmental conditions, patient health metrics and resource utilization, creating an ecosystem that not only supports the immediate health needs of patients but also contributes to broader public health goals. The session will address four key areas where digital platforms can make an impact:

-Disease Surveillance and Management: Digital tools can track health data trends and patterns within hospital settings, enabling early detection of infectious outbreaks and more precise tracking of patient outcomes.

-Environmental Monitoring: IoT sensors can continuously assess conditions such as air quality, temperature and humidity, which are critical for preventing hospital-acquired infections and ensuring a safe environment for patients and staff.

-Resource Optimization: AI algorithms can analyse data to optimize resource allocation, ensuring that medical supplies and human resources are used efficiently, which is crucial in health emergencies.

-Patient-Centred Care: Digital platforms can facilitate personalized patient care through real-time health monitoring and data analysis, ensuring timely medical interventions and better health management.

This session will highlight case studies demonstrating successful implementation of digital technologies in smart hospital buildings and discuss the challenges and lessons learned from these initiatives.
8.K. Scientific session: Promoting Healthier and Sustainable Diets – Evidence from the Interdisciplinary MedDietMenus4Campus
Authors:   Organised by: University of Porto (Portugal), Lisbon School of Health Technology (Portugal),   Chair persons: Ada Rocha (Portugal), Marília Prada (Portugal)
Published: October 2024

Food service comprises the production of meals consumed outside the home, including consumers from all age groups and in different sectors. This service sector has evolved through the years, providing an increasing number of meals, which have been drifting away from the Mediterranean Food Pattern. Food service is an important setting for public health interventions, educating consumers and modulating behaviours through the meals provided. Prior research on eating habits has mainly focused on a single stakeholder - typically consumers - and on a narrow set of outcome variables. Although these studies provide important clues about the determinants of adherence to food offer, research has yet to address this issue using an integrative approach of multiple stakeholders (e.g., the consumers, food providers, and decisors) across a set of different variables. Also, intervention initiatives, usually act only on the environment without strategies that efficiently engage all the stakeholders involved. In contrast, to promote behavioral change this research will focus on Social Marketing as it has been acknowledged as an effective strategy to enhance the health and well-being of consumers. Establishing and managing long-term partnerships that include different groups of stakeholders - consumers, government, retailers, and other players - are key elements in the application of mid and upstream social marketing to complex issues. The project’s main ambition is to change the food service paradigm, by creating and implementing a new healthy and sustainable food service concept complying with the Mediterranean diet, as well as solutions that comply with consumers’ new needs, and also developing and implementing strategies that engage all the stakeholders with this concept. We expect to create the reference in terms of food offer that will be demanded by consumers of the next generations and the standpoint to inspire the other food service sectors/ settings to achieve an effective and sustainable food offer change and positively influence food service consumers’ food patterns towards Mediterranean recommendations. In this workshop, the findings of the project will be presented focusing on examining the barriers and facilitators of adherence to the Mediterranean Diet in the menus offered in public high education institutes canteens in Portugal, Turkey, and Croatia. To promote the identification of effective intervention pathways, we take on an interdisciplinary approach, integrating the theoretical and methodological frameworks of Nutrition, Psychology, and Marketing.

Key messages

• Provide an overview of an interdisciplinary approach to promote healthier and more sustainable food offered in university canteens.

• Present the pathway to develop social marketing strategies to engage different stakeholders in effective food behaviour change.
The impact of the tobacco law on tobacco-related hospitalizations in Portugal - a natural experiment
Authors: Santos M , Perleman J , Dionísio J , Vasconcelos R , Peralta-Santos A
Published: October 2024

Introduction

Tobacco is responsible for approximately 8 million deaths annually worldwide, with 1.2 million resulting from passive exposure to smoke, as reported by the WHO. Comprehensive tobacco control policies have been enacted across Europe, yet their impacts are seldom assessed. This study evaluates the effects of the anti-tobacco legislation enacted in Portugal in 2007 on tobacco-related hospitalizations between 2002 and 2018.

Methods

Data from all in-patient admissions in public hospitals throughout the 2002-2018 period were utilized. A quasi-experimental interrupted time series design was employed, treating 2008 as an exogenous shock. The dependent variables include the municipality-based incidence of hospitalizations by year for tobacco-related diseases, namely, Acute Myocardial Infarction, stroke, lower respiratory tract infections, chronic obstructive pulmonary disease, and asthma. The analysis was adjusted for the percentage of women, the percentage of individuals aged over 65, and purchasing power in the municipality. Time trend graphs for each variable were generated, followed by an adjustment using the Poisson regression model to forecast their trends. A comparison was conducted between observed post-law implementation data and projected values from the regression model to ascertain the percentage difference between the two. Expected

Results

The 2007 tobacco law led to significant reductions in tobacco-related disease incidence, with the most notable effects immediately post-implementation. The impact varies across age groups, with younger individuals (30-49 years) showing a sharper decrease. The effect diminished over time, as indicated by negative coefficients in time:law interactions, such as -0.03.

Conclusions

The anti-tobacco laws implemented in Portugal have effectively decreased hospitalizations related to tobacco use, suggesting potential increases in life expectancy and reduction in health system burden.

Key messages

• Public health policies are crucial for the long-term improvement of people’s health.

• Non-exposure to tobacco can bring health gains on several levels.
Transforming systems and improving lives - the social movement of compassion in Wales
Authors: Hopkins J , Blakeborough N , Bromwell J , Hopkins L , Roane B , Brierley Sollis T , Hughes C
Published: October 2024

Wales has embarked on a journey towards becoming an adverse childhood experiences (ACEs) and trauma-informed nation. In 2021 the Welsh government supported the co-creation and co-production of an all age, all of society framework: Trauma- Informed Wales: A Societal Approach to Understanding, Preventing and Supporting the Impacts of Trauma and Adversity (ACE Hub Wales et al 2021). This framework is not just an operating model, it has the ambition to be a social movement to embed and sustain a culture shift that is rooted in tackling the conditions of inequality in our communities and the work we do in organisations in the clinical and community settings that support, and employ, people who have experienced trauma and adversity in their lives. The starting point is that any of us can have these experiences. The trauma and ace informed toolkit sets out a process of readiness, self assessment, action planning and implementation across six domain areas which include governance and leadership, monitoring and evaluation, policy and practice. Resources and guidance are co-created and co-produced by partners already on the journey, developed and tested in environments to look at trauma-informed physical spaces, communications, workforce development, training and inclusion of marginalised voices. Supporting this work is a national community of practice, promoting good practice, sharing ideas and developing a culture of wisdom supported by reflective practice. This dynamic forum is supported by online and in person capacity and is transforming organisations and sectors including housing, education, substance misuse, criminal justice and health. It places people, compassion, kindness and empathy at the heart and is enabling traumatised systems to understand and meet the needs of the workforce and the people they serve.

Key messages

• Systems change is sustained by compassion, kindness and love in a social movement supported by the scaffolding of an operating model.

• Public Health has a key role to play in co-developing social networks and resources to transform traumatised systems into trauma-informed places that improve lives and health outcomes.
Ultra-processed food intake and type 2 diabetes: A dose-response meta-analyses of prospective studies
Authors: Kim Y , Oh H
Published: October 2024

Studies suggested a positive association between ultra-processed food (UPF) intake and risk of type 2 diabetes (T2DM). However, the magnitude of association varies across studies due to differences in population characteristics and methodological issues. It is also unclear about the exact shape of the association and whether the association is independent of diet quality and adiposity. We conducted a dose-response meta-analysis of prospective studies to summarize the association between UPF intake and T2DM risk. PubMed/MEDLINE, Web of Science, and Embase were searched through Jan. 2024 to identify relevant studies. Using random-effects models, summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated for each of the following unit increment in UPF intake: 10% (of total g/d), 100-g/d, and 1-serving/d. A non-linear dose-response meta-analysis was conducted using restricted cubic spline analysis. After screening 569 publications, 12 prospective cohort studies were included in this study. The summary RRs associated with every 10%, 100-g, and 1-serving increment in UPF intake were 1.13 (95% CI = 1.10-1.16), 1.05 (95% CI = 1.03-1.06), and 1.04 (95% CI = 1.03-1.05), respectively. The positive associations remained statistically significant after additional adjustment for diet quality, BMI, and total energy intake. The dose-response curve for g/d of UPF intake suggested evidence of nonlinearity (p-nonlinearity=0.0005), showing a steeper increase in risk at UPF intake >300 g/d. However, evidence for non-linearity was not observed with % and serving/d of UPF intake. The association did not significantly vary by method and timing of UPF assessment. Higher summary RRs were observed among studies from Europe and North America compared with those from other countries (p-heterogeneity=0.048). Our data suggest that higher UPF intake may increase T2DM risk, independent of diet quality and adiposity.

Key messages

• Higher intake of ultra-processed food is positively associated with the risk of type 2 diabetes.

• Public health strategies should encourage healthier dietary choices by emphasizing reduction of UPF intake in dietary guidelines and implementing regulations on manufacturing and labeling of UPF.
Healthcare access for people with disabilities: a scoping review of COVID-19 policies in Europe
Authors: Aguilera Cruz J , Krafft T , Padeiro M
Published: October 2024

Introduction

The COVID-19 pandemic raised healthcare inequalities, affecting the most vulnerable groups. There is limited evidence of whether the COVID-19 measures and the health system’s preparedness for outbreaks among European countries were sufficient to cover the health access needs of PWDs.

Aim

To provide a structured overview of the COVID-19 measures and policies addressing access to primary and specialist health services for PWDs during the COVID-19 pandemic in the European Members States (MS) and the United Kingdom (UK), using ten dimensions of healthcare access by Levesque et al. (2013) and the PoliMap taxonomy.

Methods

This study followed the PRISMA guidelines for Scoping Reviews. A search strategy was employed on PubMed, Embase, Scopus, and Web of Science databases from January 2020 to January 2023. Studies published in peer-reviewed journals in English, Portuguese, and Spanish were included, informing a COVID-19 measure or policy and assessing or providing a rationale with access to primary or special healthcare services.

Results

The final search strategy yielded 2.076 results, 188 studies were reviewed for full-text analysis, and 74 were included in the final analysis. One hundred twenty-one policies or measures addressing primary or specialist care access were identified. Only thirteen target PWDs, focussing on intellectual or mental disability and addressing mental healthcare services. Results revealed that COVID-19 measures for PWDs were oriented to increase health system response capacity and reduce virus transmission, describing a predominantly negative effect on healthcare access for PWDs.

Conclusions

The needs of PWDs in access to primary and specialist care were not fully covered by the policies and measures placed during the COVID-19 pandemic among the MS and the UK. One-size approaches focussing on the attendance of COVID-19 infection with stigmatizing measures overlook the specific health necessities of this population.

Key messages

• Adopting disabled-inclusive measures in the daily healthcare provision and engaging PWDs in the policy cycle is paramount to preparing for the next outbreak and public health crises.

• Additional research focusing on primary and specialized healthcare access during outbreaks for PWDs, especially with sensory and physical disabilities, is crucial to furthering health equity.
Active offer of influenza vaccination during hospitalization: a multicenter study in Sicily (Italy)
Authors: Fallucca A , Anzà D , Pieri A , Costantino C , Genovese C , Squeri R , Casuccio A , Vitale F , Belbruno F , Restivo V
Published: October 2024

Background

Every cold season, the Italian health institutions strongly recommend influenza vaccination for categories at risk of complications, however influenza vaccination coverage is over and over far from the desirable target of 95%. After the pilot experience conducted in Palermo during the 2022-23 influenza season, the ‘Vaccinations in the ward’ project was extended to other Sicilian centers in order to evaluate the impact of the vaccination offer strategy in a broader territorial reality and to analyze the determinants of influenza vaccine acceptance among at risk people.

Methods

The project was conducted at the Umberto I Hospital in Enna and the University Hospitals of Messina and Palermo during the 2023-24 influenza season. A questionnaire was administered to the at risk hospitalized patients to investigate socio-demographic factors, behavioral habits, and clinical condition. Furthermore, influenza vaccination upon discharge was offered. Multivariable logistic regression was performed to identify the determinants of influenza vaccine acceptance.

Results

Overall, 374 patients with a median age of 65 years (IQR: 50-70) were recruited, of whom 36% had been vaccinated for influenza during the 2022-23 season (n = 136). The patients who accepted influenza vaccination in the ward were 57% (n = 214). The determinants of vaccination adherence were: age (OR: 1.03; p = 0.003); having quit smoking (OR: 2.68; p = 0.017); having received advice on vaccination from general practitioner (OR: 4.9; p < 0.001) and hospital healthcare workers (OR: 7.3; p < 0.001).

Conclusions

The offer of vaccination in the ward effectively increased influenza coverage among categories at risk of complications. Furthermore, the adoption of correct behavioral habits and the promotion of influenza vaccination by healthcare personnel have played a decisive role in the vaccine acceptance process. These findings could be useful for planning future influenza vaccination campaigns targeted to at risk people.

Key messages

• Vaccination strategies are needed to increase influenza coverage among at-risk categories. Active offer of influenza vaccine upon discharge can effectively increase vaccination compliance.

• The adoption of correct behavioral habits and the promotion of vaccination by healthcare personnel play a decisive role in the influenza vaccine acceptance process among at risk people.
Health consequences of harmful chemicals in foods: insights from the WHO Global Burden of Foodborne Disease Study
Authors: Jakobsen L S , Al Huthiel M , Al Natour F , Agudo A
Published: October 2024

Foods can be an important source of human exposure to harmful chemicals. Contamination can occur at any stage of the food chain; with chemicals that occur naturally or by anthropogenic pollution in the environment and during production processes from farm level to the kitchen of the consumer. The variety of chemicals in foods is broad and associated with a wide range of adverse health effects. Where toxicological risk assessment of chemicals in foods serves the purpose of protecting populations from exposure levels constituting a health concern, burden of disease methodology provides a quantitative snapshot of the current impact of chemicals on disease occurrence and population health. This allows for the comparison across hazards, health effects and foods and eventually prioritized allocation of resources to maximize health benefits. Following the advice by the World Health Organization Foodborne Disease Burden Epidemiology Reference group (WHO/FERG), WHO published in 2015 the first estimates of the global burden of foodborne disease. More than 400,000 deaths and 33 million disability-adjusted life years were estimated due to unsafe foods in 2010; the largest proportion due to foodborne pathogens, as the contribution of only 3 chemical hazards (dioxins, aflatoxin B1 and cassava cyanide) was included. WHO, once more under the advice by the re-established WHO/FERG (2021-2025), is currently working to update the 2010 estimates. Besides applying updated data and methodological improvements in managing data gaps and time series analysis, WHO’s ambition is to consider a wider range of chemicals and associated health effects for the year of 2020. In this presentation, we will share insights on the WHO estimates of the global burden of foodborne chemicals, and explore the methodological opportunities and challenges that estimating the burden of foodborne chemicals provides for informing policies.
UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and LIfestyle in Children and adolescents through behavIOUral change actionS: the DELICIOUS project
Authors: Grosso G , Abdelkarim O
Published: October 2024

Over the last decades, the abandonment of traditional dietary patterns and engagement in unhealthy lifestyles (including poor physical activity, prolonged screen time, poor sleep behaviours) in children and adolescents has been considered an important threat for the future health of the younger generations living in the Mediterranean area and the safeguard of the environment. The DELICIOUS project aims to promote healthy lifestyles among children and adolescents by implementing activities and tools to increase the adherence to the Mediterranean diet with an attention to the environmental impacts of dietary habits. The DELICIOUS project as a single-arm, uncontrolled behavioral intervention program providing formal and non-formal education activities, development of new snacks and recipe reformulation, web/mobile app development, and physical activities to school children and adolescents in five European countries. Over 2000 families joined a preliminary survey to investigate potential determinants of adherence to a healthy diet. Children and adolescents recruited from schools in the parterns’ countries are now currently being recruited to participate to the intervention activities. A web application for school canteen and a mobile application for parents have been developed to help both schools and families to track and provide healthy and sustainable meals. The project aims to increase awareness of the nutritional benefits and the sustainability aspects of the Mediterranean Diet and to promote consumers’ empowerment through an online platform for sustainable and healthy meal planning in the school canteen.
A cross-sectional study of data linkage and artificial intelligence practices across European countries
Authors: Haneef R , Tolonen H
Published: October 2024

Background

The availability of different data sources is increasing with the possibility to link them with each other. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the use of data linkage and artificial intelligence (AI) in routine public health activities and the constraints to linking different data sources.

Methods

A cross-sectional survey was performed across European countries to explore the current practices applied by national institutes of public health, health information and statistics for innovative use of data sources (i.e., the use of data linkage and/or AI).

Results

In Europe, the use of data linkage and AI at national institutes of public health, health information and statistics varies. The use data linkage in routine by applying a deterministic method or a combination of two types of linkages (i.e., deterministic & probabilistic) for public health surveillance and research purposes is common in majority of European countries. The use of AI to estimate health indicators is not frequent among these institutes. The complex data regulation laws, lack of human resources, skills and problems with data governance, were reported by European countries as main constraints to routine data linkage for public health surveillance and research.

Conclusions

Our study showed that the majority of European countries have integrated data linkage in their routine public health activities but only a few use AI. A sustainable national health information system allowing to link different data sources are essential to contribute to public health research. Moreover, it supports evidence-informed health policy making processes with an overview of various aspects affecting population health and may contribute to European pandemic preparedness.
ProtAct-Us from serious injuries with long-term consequences
Authors: Leitgeb W , Papadakaki M , Johannsen H , Morandi A ,   The ProtAct-Us consortium
Published: October 2024

Battling serious injuries and long-term consequences in road traffic remains one important issue in the overall goal of resilient future road transport and its Vision Zero. Challenges of increasing personal transport in urban areas coupled with autonomous vehicles and shuttles, new mobility devices and the overall need to ensure the safety of vulnerable road users as well as all types of vehicle occupants’ require solid medical background knowledge paired with innovative engineering approaches. EU Horizon Europe is currently funding the ProtAct-Us consortium (2024-2027) that aims at protecting all Road User Groups from serious injury and long-term physical, cognitive and mental health consequences related to road crashes through innovatively interlinked research action between medical and engineering methods and approaches. ProtAct-Us works on the following goals and challenges: i) Medical data correlation, standardisation and classification of long-term consequences of road crashes; ii) Robust and reliable medical, epidemiological and engineering tools like agreed methods to collect information on long-term consequences, upgraded Human Body Models and virtual assessment methods for the extremities, head, neck and face allowing for effective countermeasure development for all road users; iii) Reduction of long-term consequences and related socio-economic cost of road crash related injuries for all road users. The ProtAct-Us solutions will influence new standards in respect of extending current injury codification system with relevant long-term aspects, allowing new physical as well as virtual safety assessment procedures and adaption of rules and regulations to be implemented. Finally, scientifically well-founded suggestion for future implementation into policy, regulatory, and standardization guidelines for an inclusive safety improvement approach for in- as well as post-crash will be provided.
4.Y.2. Building inclusive risk communication, community engagement and infodemic management strategies
Authors:   Organised by: Ludwig Maximilian University (Germany),   Chair persons: Zeliha Öcek (Germany), Dilek Aslan (Türkiye)
Published: October 2024

Public health crises have their most devastating effects on people who are marginalized due to structural vulnerability mechanisms. As a reflection of this phenomenon, the Novel Coronavirus Disease (COVID-19) pandemic as a public health crises has increased the vulnerability of groups such as refugees, asylum-seekers and LGBTQ+ individuals facing discrimination, stigmatisation, displacement, economic instability, risk environments, precarious living and working conditions among others, and health inequities have been further deepened. A critical post-pandemic task is to develop comprehensive crisis response plans that prioritize inclusivity and address diverse needs. Integral to these plans are Risk Communication (RC), Community Engagement (CE), and Infodemic Management (IM) strategies. While international organizations have provided guidelines for RCCE-IM, there is an urgent need to translate these principles into tailored, context-specific strategies that account for the unique circumstances and requirements of diverse groups. The aim of this workshop is to reflect the lessons learned from the COVID-19 pandemic to strengthen the RCCE-IM strategies, using the cases of migrants and LGBTQ+ people, two groups who are intensively influenced by structural vulnerability mechanisms. The first 20 minutes of this workshop will feature four short presentations. First, the concepts of RCCE-IM will be defined, followed by an explanation of why related strategies should differ for vulnerable groups. The second presentation will focus on the issues that LGBTQ+ people faced during the COVID-19 pandemic, as well as their specific RCCE-IM needs. The third and fourth presentations are based on a collective project taking an expert perspective on the RCCE experience with migrants during the COVID-19 pandemic. Firstly, the extent to which the RCCE actions in Munich, Germany, has been able to include asylum-seekers and areas for improvement will be presented. This will be followed by a presentation on recommendations to enhance RCCE of the experts who were working with undocumented migrants, unaccompanied minors, and newly arrived refugees in Malmö, Sweden. In the final part of the workshop, participants will be invited to provide brief recommendations on the operationalization of international RCCE-IM principles across four key thematic areas: 1) Rapid adaptation of RC materials to culture and context, 2) Trust-building in crisis, 3) Navigating sociocultural and linguistic diversity, 4) Addressing LGBTQ+ migrants in RCCE activities.

Key messages

• Addressing vulnerable groups in (public) health and humanitarian crises using RCCE-IM strategies are needed to leave no one behind.

• To conduct inclusive RCCE-IM activities, cities need to address structural vulnerabilities, identify different needs and context-based strategies, and integrate various sectors and perspectives.
How do palliative care clinicians use their emotions during end-of-life encounters?
Authors: Moens K , Bilsen J , Zambrano S
Published: October 2024

Background

Palliative care clinicians are regularly exposed to emotionally laden end-of-life care situations. Until now, the use of their emotions during palliative care consultations has remained understudied. We aimed to develop a theory to understand how palliative care clinicians use their emotions.

Methods

Qualitative data were collected via individual interviews held with different types of palliative care clinicians across the world (countries were selected based on their Quality of Death Index ranking). We used a social constructivist grounded theory approach to analyze the data using a constant comparative method.

Results

We held interviews with 21 palliative care clinicians (5 nurses, 11 physicians, 2 psychologists, and 3 social workers) from 10 different countries. Fourteen were female. Participants’ average age was 46 and they had 14 or more years of palliative care experience. The mean length of the interviews was 52 minutes. The process of using emotions could be characterized as follows: first, a difficult end-of-life encounter (e.g. ethical dilemmas or conflicts) would trigger a strong emotion in clinicians. Second, clinicians become aware of the specific emotion via its physical or psychological cues. Third, an assessment of the appropriateness of the use of the emotion follows, in which facilitators and barriers (e.g. the level of emotion skills, the view on emotions, or the feeling of safety in the team) interplay, influencing the clinician to act upon a specific emotion or not. Finally, with a specific intent (e.g. to build connection, stimulate patients and relatives to express their feelings, or clarify a point of view) the clinician shares, shows, or expresses the emotion.

Conclusions

We found that the strong emotions clinicians experience can be used as a valuable resource to provide palliative care. We also identified key steps to aid clinicians reflect on the appropriateness of using certain emotions in patient care.

Key messages

• Palliative care clinicians’ emotions can be considered as tools to support palliative care provision.

• The developed theory shows potential to explore its applicability in other professions that are also regularly confronted with emotionally charged situations.
Levels of adherence to the Planetary Health Diet of current diets in Italian adults
Authors: Grosso G , Tucci M , Godos J , Martini D
Published: October 2024

Despite the efforts in the direction towards the identification of healthy and sustainable diets, little is known about the environmental impact associated with current diets. The aim of this study was to validate the application of the Planetary Health Diet Index (PHDI) to dietary habits currently adopted in a sample of adults living in southern Italy and background variables associated. Dietary intake from nearly 2000 individuals was assessed through a validated 110-item food frequency questionnaire. The PHDI was applied by considering the energy contribution of 16 different components with a gradual scoring system. For the estimation of the environmental impact, carbon and water footprint data for food commodities were extracted from the SU-EATABLE LIFE database and matched with the FFQ items. An energy-adjusted linear association between the PHDI scores and the majority of food groups included in the analysis was found; when considering the level of food processing, ultra-processed food consumption was inversely associated with PHDI scores. Among nutrients, PHDI scores were directly associated with fiber, antioxidant vitamins, potassium, plant-derived omega-3 poly-unsaturated fats, and inversely with sodium, total, saturated, mono- and poly-unsaturated fats, cholesterol, and protein. A significant difference in carbon and water footprint was observed across quartiles of PHDI scores as well as a linear direct association. After adjustment for potential confounding factors, 1-point increase in the PHDI score was associated with lower likelihood of being overweight or obese (OR = 0.99, 95% CI: 0.98-0.99). A linear inverse association between PHDI scores and waist and hip circumferences and, partially, with BMI but not with body weight was found. In conclusion, the PHDI seems to properly identify an environmentally friendly diet with a good nutritional quality.

Key messages

• An environmental-friendly dietary pattern resulted also having a good nutritional profile.

• Adherence to the Planetary Health Diet is associated with parameters of central obesity.
Establishing a healthy and sustainable diet in diabetes management: a social marketing approach
Authors: Ribeiro R T , Mourre M , Ribeiro L , Nascimento do Ó D , Charvet A , Sequeira M J , Dupont E , Raposo J F
Published: October 2024

Background

In recent years, there has been evidence that diets based on plant-based products have positive results in the management of type 2 diabetes (T2D). However, their adoption remains low.

Objectives

To evaluate and understand food consumption of people with T2D; and to define priority groups for intervention using a social marketing approach.

Methodology

An online questionnaire was developed and applied to 832 adults with T2D living in Portugal and France. The questionnaire included the collection of socio-demographic data, health data, as well as data on food consumption, eating habits, awareness and attitudes towards the consumption of plant-based foods. Finally, hands-on food workshops were organized to convey practical knowledge on plant-based food cooking.

Results

Regarding eating habits, 11% of participants have already excluded or would like to exclude meat products, and 37% would like to consume them in smaller quantities. 35% of the participants intend to increase the intake of plant-based products. The most well-known diets among the participants were the Mediterranean diet (80%) and Low Carb diet (51%). Regarding the Planetary diet, 86% of the participants expressed low or no knowledge. Regarding the consumption of plant-based foods, 61% of participants view them as a desirable and suitable option for people with diabetes. Furthermore, the planetary diet is among the least often recommended by healthcare professionals (1%). The clustering of participants originated five main groups, with two being highlighted as particularly relevant for intervention, namely through knowledge or practical support.

Conclusions

Overall, participants with T2D seem to have a positive attitude towards increasing the consumption of plant-based products and decreasing the consumption of meat products. Social marketing profiling identified specific clusters which constitute priority target groups for support in shifting to healthier and sustainable diets.

Key messages

• Social marketing profiling identified specific clusters which constitute priority target groups to support the shift towards plant-based/planetary diets.

• Hands-on food workshops were shown to be effective in conveying practical knowledge and motivation about plant-based diets.
International survey of young adults’ opinions on tobacco endgame measures & e-cigarette regulations
Authors: Gannon J , Forberger S , Bar-Zeev Y , Cattaruzza M , Kilibarda B , Jongenelis M , Cosgrave E , Sinha N , Gonzalez M , Kabir Z
Published: October 2024

In the last decade, while tobacco consumption has decreased, there has been a significant rise in e-cigarette usage particularly among young people. Tobacco-free generations and other endgame strategies are being considered in several countries, moving from tobacco control towards ending the tobacco epidemic. This online survey of 18-34-year-olds evaluated opinions on potential endgame measures and e-cigarette regulations, to generate evidence to inform policy decisions. The survey was developed with input from the World Federation of Public Health Associations and Tobacco-Free Ireland, asking participants about support (yes/no) for 20 endgame measures in 4 domains and attitudes towards e-cigarettes. Utilising convenience sampling, the survey was distributed through international networks. Of 295 responses in 34 countries, 72% were never smokers and 56% were never e-cigarette users. 31% were aware of tobacco endgame. 68% supported increasing tobacco purchasing age to 21. 70% supported restricting tobacco sales to a limited number of licenced shops. 73% supported reducing nicotine content in cigarettes. 74% supported tobacco companies having to pay for health costs from smoking. 73% would like to see tobacco-free generation legislation in their country, but only 31% expected it would be successful. Regarding e-cigarettes, they were judged as more desirable than cigarettes mostly due to different flavours and visual appearance (both 74%). They were perceived to be an important health risk (82%) and as or more addictive than cigarettes (78%). 65% believed overall harms from e-cigarettes outweigh benefits for society. 86% felt they should be subjected to the same advertising restrictions as cigarettes and 66% supported increasing their cost. There was strong support for various tobacco endgame measures and tobacco-free generation legislation in this 18-34-year-old cohort. The majority recognised health risks of e-cigarettes and favoured stricter regulation of these products.

Key messages

• An international survey of 295 young adults in 34 countries demonstrated strong support for various tobacco endgame measures including tobacco-free generation legislation.

• For e-cigarettes, there was wide acknowledgement of addictiveness and health risk, and support for increased education and warnings, lower nicotine content and reduced advertising and availability.
Consumer Preferences for Health Services Offered by Health Insurance Companies in Germany
Authors: Schilling R , Pavlova M , Karaman A
Published: October 2024

German health insurance companies increasingly strive to position themselves as health partners to their customers to improve customers’ health and contain costs. However, there is uncertainty about customers’ preferences for health services offered by health insurance companies. Therefore, this paper studies consumer preferences for health services that are or could be provided by health insurance companies in Germany. An online survey was conducted using two stated preference techniques to collect and analyze the data (namely, rating and ranking of health services considered by insurance companies). A sample of 880 German health insurance customers between 18 and 65 years old filled out the online questionnaire, of which 860 submitted complete responses. Ordinal logistic regression analysis was used for the rating and ranking. Preliminary examinations, care management, and health programs were the three health services most important to the respondents. The results suggest that people want their health insurance to support them with preventive health services that offer direct therapeutic value and not just informational, economic, access-related, or convenience-related benefits. These preferences for health services are homogeneous for most subgroups of the population, implying that health insurance companies could consider an overall strategy to address these preferences for all clients by focusing on the important health services.

Key messages

• People value health services provided by health insurers that offer direct therapeutic value over those that offer only informational, economic, access or convenience benefits.

• As preferences are homogeneous across the population, insurers could consider an overall strategy by focusing on the important health services.
Diagnoses of mental health disorders among Norwegian youth and young adults with immigrant parents
Authors: Sheikh N S , Straiton M L , Kjøllesdal M K
Published: October 2024

Introduction

Adolescence and early adulthood are associated with an increase in mental health problems. Migration is also a risk factor for mental disorders. Yet, there is a notable gap in research concerning the mental well-being of descendants of immigrants. This study investigates the risk of a diagnosis of a mental health disorder among those aged 16-30 years, born in Norway with at least one immigrant parent.

Methods

Data were sourced from the Medical Birth Registry of Norway, the Norwegian Patient Register, and Statistics Norway. Cox proportional hazard regressions were used to estimate hazard ratios (HR) of being diagnosed with different mental disorders, in total and by parental region of origin, compared to individuals of Norwegian background. Analyses were adjusted for sex, year of birth, and parental education.

Results

Individuals with two immigrant parents had a lower risk of most mental disorder diagnoses, while those of one immigrant parent had a higher risk. With the exception of schizophrenia, individuals with two immigrant parents had a lower risk of most mental disorder diagnoses compared to those with Norwegian-born parents. The HR for the risk of a diagnosis of anxiety for those with two immigrant parents was: 0.79 [95% CI 0.76 - 0.81], with immigrant mother: 1.07 [95% CI 1.04-1.10], with immigrant father: 1.28 [95% CI 1.24 -1.30]. Similarly, for depression, two immigrant parents: 0.85 [95% CI 0.82-0.88], immigrant mother: 1.13 [95% CI 1.09 - 1.17], immigrant father: 1.31 (95% CI 1.28-1.37). Bipolar disorders, two immigrant parents: 0.67 [95% CI 0.60-0.76], immigrant mother: 1.19 [95% CI 1.07 - 1.31], immigrant father: 1.47 [95% CI 1.35-1.61]. The pattern was relatively consistent across parental regions of origin.

Conclusions

Those with one immigrant parent are more likely to use specialist mental health services, while those with two immigrant parents are not. These need special attention in adulthood.

Key messages

• Differences in risk of diagnosis for mental disorders could be due to differences in the utilization of mental health services.

• Early prevention of mental health issues seems to be especially important among children and youth raised in families with one immigrant parent.
Dis-continuity in Continuity-of-Care: a pathway for more equal access to mental health care services?
Authors: Burau V , Buch Mejsner S , Fehsenfeld M
Published: October 2024

Background

Access to healthcare is core to achieving universal health coverage. Reaching and obtaining appropriate health care services requires engagement by health care organizations and users. For people with mental illness, access emerges as a continuous process, reflecting oscillating health conditions. This challenges aspirations of continuity of care (COC), but we know little about the experiences of users.

Methods

We carried out observations of interactions between professionals and users (n = 18) and semi-structured interviews with users, professionals, and managers (n = 33) in the specialised mental health services in Central Denmark Region and FACT-inspired teams in three municipalities. We also conducted 3 focus groups with regional and municipal professionals from these teams. Data was analysed through a qualitative thematic analysis.

Results

From the perspective of users, COC builds on the acknowledgment of their entire life situation. For users, this is about making connections between their past, present and future lives. Past experience affect their present abilities to follow treatment and influence future hopes and expectations. The acknowledgment of these connections often translates into spaces of discontinuity in continuity, where users need occasional breaks from treatment but worry about being excluded from treatment. Crucially, the organization of the FACT-inspired teams allows for flexibility in the intensity of visits and treatment. The norms of professionals also support users’ perspectives on COC, as the norms focus on building trust in the relations between users and professionals.

Conclusions

One important step to achieve more equal access is to integrate the social world of users. This requires organizational and professional approaches that allow for user needs for dis-continuity in COC.

Key messages

• For mental health service users, continuity-of-care includes breaks from treatment (discontinuity).

• More equal health access requires adapting continuity-of-care to needs as perceived by users.