bluuebunny/crossref_metadata_2025 huggingface dataset:
Community-centred yet little community health: The paradoxes of the German health system
Authors: Cassens M
Published: October 2023

Due to its history of development since the middle of the 19th century, the German health care system is almost exclusively dominated by pathogenesis and the resulting reactive treatment. Insiders dub it “repair medicine”. The situation of community health in Germany is very heterogeneous: On the one hand, the community is referred to as the ‘mother of all settings’. In health services research, it is also referred to as the third pillar of the health care system, alongside inpatient and outpatient care. On the other hand, it cannot and must not be ignored that public budget cuts hit public health structures very hard. Ultimately, the COVID-19 pandemic exposed the deficits caused by thirty years of consistent austerity policies. National surveys shows that the already weak public image of the community health structures has once again suffered a massive loss of confidence among the population during this period. The OECD points out that the health behaviour of the population in Germany deteriorated significantly more during the pandemic than was the case in countries which have had strong health promotion structures for decades. The municipality as the ‘mother of all settings’ could and should have intervened here - but did not. In the context of the ‘Public Health Service Pact’ the German government is currently implementing nationwide so-called ‘health stores’ with a focus on socio-economic hotspots in large cities. Concerned here are low-threshold offerings across the entire spectrum of health promotion and prevention. In this regard, we are also currently involved in an Erasmus KA 203 project with the title ‘Family Health Advisor’. From the German perspective, the project sustainability will depend on the extent to which we manage to transfer the project contents into community health structures, which the ‘Public Health Service Pact’ will bring with it in the next few years.
Evaluation of a city-region initiative to galvanise a community response to gambling-related harms
Authors: Jenkins C , Mills T
Published: October 2023

Background

Community interventions have an important role in public health strategy for gambling harms yet many interventions are shaped by stigmatising notions of individual responsibility. This presentation describes a process evaluation of an intervention for galvanising community-level innovation, administered by a city-region government. The intervention comprised 12 community projects, a Lived Experience Advisory Panel and a Community of Practice.

Methods

The process evaluation focused on refining a coproduced logic model. Data collection consisted of n-42 qualitative interviews and a short survey (n-21) with stakeholders, including commissioner-facilitators, project leads and people with Lived Experience, during intervention delivery. Thematic analysis and complex intervention modelling were carried out with the outputs of this refined through consensus discussion.

Results

The modelling exercise revealed a highly complex intervention that was suited to the poorly understood, hidden and stigmatised issue of gambling-related harms. The Community of Practice fostered group identity, collaboration and learning, with commissioner-facilitators expanding this to support the sustainability of the community projects. The Lived Experience Advisory Panel helped develop project outputs and non-stigmatising health messages although impact on the community projects varied. Stigma and commercially-driven gambling normalisation presented challenges to projects with the greatest impact evident on skill development among professionals and community actors. The city-region government adapted its gambling harms strategy based on learning generated.

Conclusions

The findings suggest the combination of a Community of Practice, Lived Experience and commissioner-facilitation effectively galvanised a community response to gambling harms, generating vital learning for the field. Public health actors should explore applying the approach for other emerging and contested public health issues.
Community Health Workers in Spain: a missing strategy to tackle hepatitis in migrant populations
Authors: Picchio C , Nicolàs A
Published: October 2023

Community health workers (CHWs) are health care providers which live and serve in the community and are responsible for the provision of health education to their communities, promoting healthy habits and lifestyles, diagnosing common illnesses, and encouraging the use of health services by linking people to health services. CHW programmes have been formally included as part of national health systems in many low- and middle-income countries (e.g., Ethiopia or Brazil), along with some high-income countries (e.g., Canada). Despite the major contribution CHWs have proven to make in health systems globally, Spain has yet to introduce a law acknowledging their role in the health system. The introduction of CHWs allows for the decentralization of health services and their extension beyond the regular forms of health service delivery (e.g. primary health centres or hospitals) as additional strategies for equity and person-centred care. CHWs have the capacity to reach underserved and vulnerable populations, including marginalized populations, which often encounter barriers to engage with their health systems. Migrant communities in Spain are an example of communities which are often marginalized and struggle to have their health needs met through their host health system. For instance, studies have reported a significantly higher prevalence of chronic infection of Hepatitis B virus (HBV) among migrants in comparison to the general Spanish population and late presentation to care in this population has been reported. CHWs have the potential to reach these underserved communities and provide culturally and linguistically appropriate health information, emphasizing the importance of HBV prevention, management and treatment, and vaccination. Ultimately, CHWs can offer decentralized and accessible health care and lead in co-creation processes for effective viral hepatitis - including HBV vaccination- services in community spaces and facilitate linkage to higher levels of care.
Self-endangering work behaviour of Polish school principals during the COVID-19 pandemic
Authors: Leksy K , Gawron G
Published: October 2023

Background

During the COVID-19 pandemic, the work-related demands of school principals grew incredibly, and many experienced overwork and stress. This study focuses on three self-endangering work behaviour (SEWB) subscales - work extensification (EW), intensification (IW), and quality reduction (QR) - among Polish school principals during COVID-19 and its association with respondents’ well-being (WHO), exhaustion (EXH), and psychosomatic complaints (PC). Taking care of the health of school principals and teachers is particularly important in the context of European public health as they are crucial models of health attitudes for students as future citizens.

Methods

The results come from an online survey among school principals in Poland. The survey was conducted in 8 provinces in Poland between June 2021 and December 2021. 1899 school principals participated in the survey, of which 928 completed the questionnaire. Descriptive statistics, Kendall's Tau correlation, and regression models were conducted. Sociodemographic characteristics (gender, age, and type of school) were considered the control variables.

Results

The study confirmed increasing respondents’ EW (62.6%) and IW (52.5%) during the COVID-19 pandemic. The rise in EW was associated with lower WHO (τ = -0.25), greater EXH (τ = 0.29), and PCs (τ = 0.23). The more respondents intensified their work, the lower well-being declared (τ = -0.36). With the increase in IW and QR, WHO decreased, and the level of EXH and PC grew. Male and older school principals less frequently felt PC.

Conclusions

The study suggests that SEWB presented by Polish school principals during the COVID-19 pandemic was associated with respondents’ WHO, EXH, and PC. These findings could be a baseline for policymakers for multidimensional interventions to reduce school principals’ SEWB and prevent overwork and burnout in Polish school principals.
School principals stress, wellbeing, and health literacy during the Pandemic
Authors: Meyer M , Dadaczynski K , Messer M , Okan O
Published: October 2023

Background

Mental health of school principals is poorly researched in public health, despite principals being critical to the success of sustainable school development. They are the key agents enabling and leading the implementation of school health promotion, which elevates the importance of their mental health state. Evidence shows that principals are more likely to suffer from work-related stress and psychological strain, but given the additional stress during the Covid-19 pandemic, their mental health was more at risk. Health literacy could be an asset in the interplay of mental health and stress. The aim of this study is to examine the associations between principals’ corona-specific health literacy and their perceived stress, wellbeing, and psychosomatic complaints.

Methods

As part of the international COVID-HL school principal survey, an online study among German school principals in four federal states was conducted during the third infection wave (Mar-Apr 2021). Health literacy, perceived stress, wellbeing, and psychosomatic complaints were measured using self-report tools. Descriptive statistics, variance with subsequent post-hoc analyses and effect sizes were computed.

Results

A total of N = 2186 principals completed the survey, with 60.5% showing an adequate, 31.4% a problematic and 8.1% an inadequate health literacy level. Welch's ANOVA indicated significant differences between the health literacy levels and perceived stress (F(2, 423.734) = 69.51, p < 0.001; η2 = 0.06) as well as wellbeing (F(2, 407.343) = 33.463, p < 0.001; η2 = 0.034). One-way ANOVA showed significant differences between health literacy and psychosomatic complaints (F(2, 1775) = 15.94, p < 0.001; η2 = 0.018).

Conclusions

The findings emphasize that health literacy could be an asset for principals’ mental health, suggesting to include health literacy more frequently to public mental health promotion interventions. This will require an acknowledgment from public health and educational policies.
Risk-benefit assessment of foods – status, challenges, and opportunities
Authors: Thomsen S T
Published: October 2023

Evaluation of tradeoffs between toxicological and microbiological risks and nutritional risks and benefits associated with food consumption is a relatively new research field. Several initiatives have been taken to develop and harmonize approaches to assess health risks and benefits of foods in an integrated assessment - risk-benefit assessment. Today, the pool of published risk-benefit assessments of foods is still very heterogeneous with respect to e.g. evaluation of weight of evidence, methodology and degree of quantification and integration of risk and benefits. It is a research area in continuous development and has the potential to support decision making in food safety and nutrition. This presentation will set the scene for the workshop by introducing the concepts of RBA of foods and provide an overview of different methods to make such assessments based on examples of previous studies and ongoing research within the field. Emphasis will be put on the various measures of health risk-benefit balance, ranging from qualitative to quantitative approaches, and their individual strengths and weaknesses. The presentation will round off with a discussion of current challenges in RBA and highlight opportunities for further developments in the field.
Holistic approaches for risk-benefit assessment
Authors: De Matteu Monteiro C
Published: October 2023

Moving towards holistic approaches that assess trade-offs among health, sustainability, and economics is imperative to minimize emergent risks and drivers of environmental degradation associated with food systems. Health risk-benefit assessments provide informative outputs to support decision-making within the public health domain. However, integrating indicators from different dimensions requires tailoring current risk-benefit methods. In this context, multicriteria decision analysis methodologies can be relevant to account for different factors and weighing trade-offs of real-life scenarios of changes in food systems. In addition, further research building on initiatives attempting to integrate frameworks within health (e.g., risk analysis) and environment (e.g., Life-Cycle Assessment and linear programming) or health and economics (e.g., cost-benefit and cost of illness), is needed to establish a holistic risk-benefit assessment framework. This presentation will introduce current efforts in the development of holistic assessment methods that evaluate impacts beyond the health risk and benefits perspective. In addition, the presentation will highlight the potential gains of such methods in policymaking.
The impact of COVID-19 on the demand of arthroplasty
Authors: Guarducci G , Dragoni L , Golinelli D , Messina G , Nante N , Carbone S
Published: October 2023

Background

Nowadays healthcare systems are affected both by a growing demand for prosthetic surgery, and by an increase of patients’ migration who are seeking a place of care more suited to their needs. This study aims to evaluate the impact of COVID-19 on patients’ migration for lower limb arthroplasty in Italy's regional healthcare systems.

Methods

We conducted a cross sectional study on Hospital Discharge Cards provided by the Italian Ministry of Health from 2015 to 2020. We considered hospitalizations for lower limb arthroplasty (Diagnosis Related Groups 544; 545 and 471). We analyzed the interregional patients’ migration, comparing the average number of admissions in the years 2015-2019 with that of 2020. Regional data of Residents, Attractions and Escapes, were graphically represented through Gandy's Nomogram (GN).

Results

In years 2015-2019, the GN shows that all regions satisfied care needs of their Residents, except for Basilicata, for which the number of Escapes is greater than the number of residents hospitalized in their own region. However, only Piedmont, Lombardy, Veneto, E.Romagna, Tuscany, Abruzzo, and the Autonomous Province (A.P.) of Bolzano showed an Attractions minus Escapes positive balance. However, A.P. of Bolzano had a negative balance in 2020, while in Liguria and Molise, the number of Escapes exceeded the admission of residents to regional hospitals. During studied period, Attractions increased for Piedmont, A.P. of Trento, Veneto, Friuli V.G., E.Romagna, Marche, Apulia, and Calabria, while Escapes decreased for Piedmont, A.P. of Trento, E. Romagna, Tuscany, Marche, Lazio, Abruzzo, Campania, Apulia, Calabria, Sicily, and Sardinia.

Conclusions

Hospitalization for lower limb arthroplasty decreased in most of the regions during the COVID-19 pandemic. Piedmont, A.P. of Trento, E.Romagna, Marche, Apulia, and Calabria showed to be the most “resilient” regions, increasing the Attractions, and decreasing the Escapes at the same time.

Key messages

• Mapping flows by type of healthcare service is essential to identify the lack of supply so as to strengthen it in critical areas.

• Italian Regions have responded to the impact of COVID-19 pandemic on hospital activity in different ways.
The impact of the covid-19 pandemic on the subjective well-being of the Belgian population
Authors: Claes S , Vandepitte S , Annemans L
Published: October 2023

Background

Data from European studies suggest that well-being declined during the first year of the COVID-19 pandemic. However, the pandemic's consequences on an overall nations’ well-being remains inadequately explored, especially over time. This study aims to map the long-term impact of the pandemic on the subjective well-being (SWB) of Belgian citizens.

Methods

Using a repeated cross-sectional study design, data were collected in representative samples of the Belgian population at 5 different time points during the period from February 2020 until December 2022. Life evaluation was measured with the Cantril ladder. Positive and negative affect were assessed with the short version of the Positive and Negative Affect Schedule. ANOVA were used to evaluate the evolution in SWB. Moderation analyses were performed to investigate the differential impact of the pandemic for different age categories.

Results

Our results show that the pandemic negatively impacted the SWB of the Belgian population. Life evaluation (F(4,7605)=18.12, p<.001) and positive affect (F(4,7605)=16.83, p<.001) significantly decreased during the second wave and after the fourth wave compared to before the pandemic with a decline of .52 and .37 points respectively for life evaluation and a decline of .18 and .42 points respectively for positive affect (both on a scale between 0 and 10). No statistically significant differences in negative affect were found (F(4,7605)=1.08, p = 0.363). Citizens over the age of 50 appeared to be more resilient than younger citizens as the negative impact of the pandemic was either smaller or delayed in this group for all SWB indicators.

Conclusions

The COVID-19 pandemic clearly impacted the SWB of the Belgian population, and particularly the well-being of younger individuals suffered. We urge policymakers to consider all aspects of health during pandemics and to attend in particular the mental health needs of younger members of their society.

Key messages

• The COVID-19 pandemic and its related measures negatively impacted the well-being of the Belgian population, with younger individuals being more susceptible to the negative effects of the pandemic.

• We urge policymakers and governments to consider all aspects of health during pandemics and to attend in particular the mental health needs of younger members of their society.
Problems in accessing health care and child survival in 49 low- and middle-income countries
Authors: Kim J , Kim R
Published: October 2023

Background

Access to health care remains suboptimal in many LMICs and continues to hinder children's survival. We aimed to systematically assess the association between problems accessing health care (PAHC) and U5M at the global-, regional-, and country level.

Methods

Data came from the latest Demographic and Health Surveys of 49 LMICs (2013-2021). Child mortality data were available on 721,658 live births born to mothers aged 15-49 years within the five years preceding the survey. Three domains of PAHC were defined for women who identified the following reasons as PAHC for themselves when they are sick: “money needed for treatment” (economic), “distance to health facility” (physical), “getting permission” or “not wanting to go alone” (socio-cultural). Multivariable logistic regression models were used to estimate the association between PAHC (any and by each type) and U5M.

Results

In our pooled sample, 4.7% of children died before age of five and 58.4% of mothers reported experiencing PAHC (ranging from 43.2% in Europe & Central Asia to 71.0% in Latin America & Caribbean). Economic PAHC was the most prevalent (42.7%), followed by physical (36.9%) and socio-cultural (35.2%). After adjusting for a comprehensive set of covariates, children of mothers with any PAHC had higher odds of U5M (OR: 1.05, 95% CI: 1.01, 1.08), and this association was especially significant in Sub-Saharan Africa. Of the different domains of PAHC, socio-cultural PAHC was found to have the strongest association with U5M.

Conclusions

Our findings suggest the need to improve access to health care in LMICs by expanding health care coverage, building health facilities, and focusing more on context-specific socio-cultural barriers to encompass marginalised populations.

Key messages

• More than half of mothers in low-and middle-income countries had problems accessing health care, and it was associated with increased risk of under-five mortality in children.

• To improve child survival in low-and middle-income countries, economic, physical, and socio-cultural barriers to health care should be improved.
Challenges Related to Recruitment and Involvement of Frail Older People in Service Development
Authors: Langergaard S , Overgaard C , Petersen K S , Andreasen J
Published: October 2023

Background

Involving relevant stakeholders in development or improvement of community health services is rapidly increasing and found to be of pivotal importance for the success of the service. Involvement can help identify priorities, understand the problem, and find solutions. However, frail older people are often hard to reach, and can be an underrepresented group in terms of involvement in community health services. If community health services targeted frail older people, are expected to benefit their health and well-being, the voices of this group need to be heard and taken into consideration.

The objective was to involve frail older people in the development of a health service offered in municipal senior centers, aiming to improve frail older peoples’ possibilities of accessing the social communities of senior center and thereby improve their health and well-being.

Methods

The involvement was carried out as continuous panel meetings throughout the development process with a panel consisting of five senior center users, recruited through a senior center staff member functioning as gatekeeper. One researcher facilitated the panel meetings.

Results

The involvement brought forth important knowledge about the need of frail older people, when wanting to become part of a social community. Nevertheless, two main challenges emerged during the involvement period: 1) Recruiting frail older people proved difficult albeit a gatekeeper being used and 2) Facilitation of, and the methods used for, the panel meetings should be appropriate for involvement of the specific target group, in this case frail older people, to allow for all participants to be heard.

Conclusions

Considerations about the involvement concepts, methods and facilitation are crucial in order for challenges linked to involvement to be minimized, making it possible for the needs of frail older people to be heard and met in the development or improvement of community health services.
The Added Value and Unintended Negative Consequences of Involvement Processes
Authors: Petersen K S , Pedersen J F , Egilstrød B , Overgaard C
Published: October 2023

Background

Public involvement is widely considered a way to improve health and quality of health services. The research literature reveals ambiguities concerning the added value and the unintended negative consequences of public involvement processes. The aim of this study was to identify, synthesize and present an overview of added value and unintended negative consequences of public involvement processes in the planning, development, and implementation of community health services.

Methods

36 peer-reviewed articles retrieved from a systematic search (published in a review article) in the CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, ProQuest, and Scopus databases in 2021 were coded and extracted according to the aim of the study. A thematic synthesis was conducted involving (1) line-by-line text coding, (2) developing descriptive themes and (3) generating analytical themes.

Results

Two main themes with corresponding subthemes were identified providing an overview of the added value of public involvement processes (theme 1) at individual, service, and political levels. Unintended negative consequences (theme 2) show how individual resources is required, and uncertainty about the effect of involvement on services and power differences among providers and the public revealed.

Conclusions

The added value of public involvement processes is primarily reported on an individual and service level and often accompanied by unintended negative consequences. Professional facilitators and recruitment of a wider group of participants representing vulnerable groups is important to promote equality in public involvement.
International Comparison of Professional Competency Frameworks for Advanced Practice Nurses
Authors: Wit R F , Noorland S A , de Veer AJE , Batenburg R S , Francke A L
Published: October 2023

Background

Advanced Practice Nurses (APNs) have become established professionals in many healthcare systems. APNs combine nursing with medical expertise, bridging the boundaries of traditional professions in nursing and medicine. This study focuses on the content of professional competency frameworks for APNs in different countries to determine (1) how these frameworks define the competencies of APNs and (2) address the division of tasks between APNs and physicians.

Methods

An inductive content analysis is conducted of the competency frameworks for APNs in Belgium, Canada, the Netherlands, the United Kingdom, and the United States.

Results

In Belgium, the Netherlands and the US, the framework is based on an existing model, while in Canada and UK, frameworks do not refer to a model. The analysis revealed twelve generic competency domains for APNs: 1. Clinical Care in Practice, 2. Independent Practitioner, 3. Professional Attitude, 4. Scientific Research & Evidence-Based Practice Care, 5. Leadership, 6. Health Promotion and Public Healthcare, 7. Communication and Collaboration, 8. Organisation of Care and Policy, 9. Support of Self-Management and Patient Empowerment, 10. Quality and Safety of Care, 11. Teaching and (continuing) Education, 12. Technology and E-Health. There are some differences in explicitly to which high-risk procedures are described per country. The frameworks provide limited descriptions of task division and delegation from physicians to APNs, except for the frameworks from Belgium and the Netherlands.

Conclusions

Despite variations in the basis of professional competency frameworks per country and country-specific influences, twelve generic competency domains with similar competencies were identified. It is recommended to stimulate the development of a global standardised competency framework for APNs, including clear descriptions of task division and delegation, to optimise their role in delivering high-quality healthcare services.

Key messages

• Similar APN competency expectations suggest the need for an international competency framework, including roles and tasks for APNs, to function as a basis for individual country frameworks.

• Nursing associations can use this study to learn from other countries and enhance their development of country-specific competency frameworks for advanced practice nurses.
Assessing examination equipment accessibility for the disabled using non-fidelity of checkup items
Authors: Park B , Park J , Kim S
Published: October 2023

Background

Even after arriving at the hospital for a health checkup, access to equipment of the disabled is often limited. However, there is a lack of investigation on accessibility of health examination equipment due to difficulty in appropriate evaluation.

Methods

The Korean national health information database was analyzed to assess the non-fidelity of health checkup screening items for the disabled and non-disabled. Health checkup items included height, weight, BMI, visual acuity, audiometry, blood pressure, urinary protein, hemoglobin and chest X-ray. To analyze the non-fidelity of health checkup items according to the characteristics of the disabled, a chi-square analysis was conducted. Logistic regression analysis was performed to non-fidelity the influencing factors for non-fidelity of each health checkup item for the disabled and non-disabled.

Results

Among all health checkup participants, women's non-fidelity rate of checkup items was twice higher than men's (OR 2.20, 95% CI 2.18-2.21). The disabled were more twice times higher non-fidelity rate than the non-disabled(OR 2.49, 95% CI 2.47-2.52). It was evident in the case of women disabled, severely disabled or elderly disabled(<.001).

Conclusions

The non-fidelity rate of the disabled was high, especially for women disabled, severly disabled or elderly disabled. Even if the disabled visit a hospital for health checkup, access to the equipment may be limited. To increase accessibility to diagnostic equipment and improve access to essential health services, it is important to monitor and support the non-fidelity of each checkup item.

Key messages

• The disabled are more than twice as likely to have higher non-fidelity rates of health checkup items than the non-disabled.

• Especially it was high among women disabled, severely disabled or elderly disabled.
The impact of compliance with health literacy principles in Facebook posts on user engagement
Authors: Wei M , Chen C
Published: October 2023

Background

Addressing health literacy in designing health messages can improve understanding and application of health information by the audience. However, the impact of health literacy-compliant social media posts on user engagement remains unclear. The aim of this study was to investigate the relationship between compliance with health literacy principles in Facebook posts and user engagement by governmental and non-governmental health organizations in Taiwan.

Methods

A total of 3,305 Facebook posts were collected from two governmental and four non-governmental health organizations. Using a proportional sampling method, 600 posts were selected for analysis. A quantitative content analysis was conducted. Compliance with health literacy principles was assessed using a Chinese tool adapted from the US CDC Clear Communication Index, which provided health literacy scores for the text and visual components of each post. User engagement was measured by the number of likes, shares, and comments. Non-parametric statistical methods were used for analysis.

Results

The use of pictures had a positive impact on the number of likes (z = 4.77, p < .001) and shares (z = 2.45, p = .014) received. Posts with higher health literacy scores in their text and visual components received more likes (Spearman's r = .21, p < .001 for text; r = .25, p < .001 for visual), shares (r = .24, p < .001; r = .24, p < .001), and comments (r = .12, p = .002; r = .13, p = .002). Posts with text components that fully corresponded to health literacy indicators received more likes (z = 3.78, p < .001), shares (z = 4.05, p < .001) and comments (z = 2.21, p = .027) than those that only partially corresponded to. The same trend was found in visual components (z = 4.95, p < .001 for likes; z = 4.92, p < .001 for shares; z = 2.73, p = .006 for comments).

Conclusions

Compliance with health literacy principles and/or using pictures in Facebook posts positively affects user engagement for health organizations.

Key messages

• Health organizations should consider health literacy principles when creating social media posts to improve user engagement.

• Applying visual aids on Facebook posts enhances user engagement for health organizations.
Physical activity in leisure time and motivation among citizens with chronic disease in in Denmark
Authors: Toxvaerd C , Aadahl M , Groenkjaer M , Eliasen M , Andreasen A , Elsborg P
Published: October 2023

Background

Physical activity (PA) has a preventive effect on chronic disease, but PA also promotes health among citizens with chronic disease. However, the presence of chronic disease may be a barrier for PA engagement. The aim of this study was to examine the difference between citizens with various chronic diseases and all citizens in The Capital Region of Denmark in terms of the proportion who reports low PA levels in their leisure time, wants to be more physically active, and has been advised to exercise by their doctor.

Methods

Information from national registers on hospital diagnoses and medical treatment was used to identify citizens with chronic diseases. Data from “The Danish Capital Region Health Survey” among citizens (≥16 years) in The Capital Region in 2021 (N = 56,245, response rate=54.9%) were used to obtain information about citizens’ movement behaviour in leisure time, their motivation to become more physically active and whether they have been advised by their doctor to exercise. Results for several diseases will be presented but heart disease is used as example in this abstract.

Results

Preliminary results show that the proportion in 2021 who has reported low PA levels in their leisure time is almost twice as high among citizens with heart disease (35%) compared with all citizens in The Capital Region (18%). Less citizens with heart disease (62%) are motivated to become more physically active compared with all citizens in The Capital Region (73%). The proportion who has been advised to exercise by their doctor is not significantly different among citizens with heart disease (31%) and all citizens in The Capital Region (28%).

Conclusions

Among citizens with heart disease low PA levels in leisure time are more prevalent, they are less motivated to become more physically active and, despite their chronic illness, they receive advice from their doctor to the same extent. For citizens with chronic disease, it is important to engage in PA.

Key messages

• Among citizens with chronic diseases low PA levels in leisure time are more prevalent and they are less motivated to become physically active compared with all citizens in The Capital region in DK.

• Despite their illness, they receive advice from their doctor about exercising to the same extent as all citizens in The Capital Region of Denmark.
Assessing and projecting the burden of diabetes mellitus in the European Union by 2030
Authors: Mahrouseh N , Kovacs N , Andrade C , Varga O
Published: October 2023

Background

Although the upward trend in diabetes mellitus (DM) is known in many countries, there are considerable uncertainties in the forecasts. This study provides valuable insights into the potential development of DM in the European Union (EU) member states through past trends and future projections.

Methods

European Health Interview Survey (EHIS) 2015 and 2019 microdata from 27 EU countries were used. Finite mix model (fmm) was applied to identify subgroups within the population and obtain probability of risk factors within each group. Time indicator as interaction was added to obtain the developing trend of heterogeneous effects with socioeconomic and lifestyle risk factors that were included in the model. Forecasting was used to project probability of risk factors within each group up to 2030.

Results

Data included 500,840 participants (274,016 from 2015 and 226,824 from 2019). Fmm and forecasting results showed DM prevalence was 7.4% in 2015 and 8.4% in 2019 and expected to increase to 11.15% in 2030. High- and low-risk subgroups were identified. Most risk factors and lifestyle categories increased in the high-risk group in comparison to the low-risk group between 2015 and 2019. However, within the high risk group, the probability of living rural areas has decreased 2.7% 2015 vs. 2019 and is expected to further decrease by 10.2% up to 2030. Additionally, within the high-risk group, the likelihood of living in towns and suburbs, having a tertiary education and eating fruit and vegetables 1-6 times a week have increased by (3%, 5%, 1.7%, 4.4%) compared to other categories for each risk factor and are expected to be higher in 2030 by (11.6%, 18.6%, 5%, 16.3%).

Conclusions

According to EHIS data, from 2015 to 2030, the number of people with diabetes in the EU will change and increase by 3.8 %. This increase will vary by subgroup.More data on risk factors are needed to obtain more accurate estimates.

Key messages

• The future health and economic burden of diabetes on society, health systems and the national economy is expected to increase in the EU.

• Implementing effective prevention strategies on a large scale can reduce the future burden of diabetes.
Mini-ethnography for medical students. Inquiry-based learning to foster transcultural competences
Authors: Ziegler S , Bozorgmehr K
Published: October 2023

Background

Transcultural competences are important for health professionals in plural societies. But if ‘culture’ is addressed in medical curricula, the underlying concepts are often not up to date with constructivist approaches of social sciences. Instead of teaching multiple definitions and complex theory, medical students can be familiarized with the perspective of these sciences through a methodologically structured exposure.

Objectives

An ethnographic field exercise was included in a clinical elective on refugee health care for medical students at a German university between 2016 and 2023. An anthropologist introduced the scientific perspective as well as participant-observation as qualitative method. Evaluations after introducing the task were analysed and a qualitative content analysis after completion was done to discern if learning goals were reached.

Results

130 students participated in the ethnographic exercise. Perceived relevancy for medical education varied (4-p; M = 2,6; SD = 0,7; n = 81); 47% of students regarded written reflection as enhancing competencies (5-p; M = 3,3; SD = 1,2; n = 107). Many considered the exercise as demanding, but interesting. The field protocols show it sharpened perception, ‘culture’ became one of many factors impacting on interactions. Learning to separate description from interpretation, students were able to reflect on own thoughts, evaluations, stereotypes and emotions. Awareness of context-dependency and structural embeddedness of medical encounters, critical assessment of power-dynamics, political issues, service quality and professional ethics in a resource constrained setting were fostered.

Conclusions

An anthropological approach and self-experience as participant observer can provide medical students with the opportunity to cultivate situational awareness and a holistic, multi-layered, structurally sensitive perception that may be more helpful in dealing with the challenges of diversity than presumed knowledge about ‘cultures'.

Key messages

• Ethnographic exercises linked with exposure to refugee settings help to foster transcultural and structural competences of medical students without the need for an extensive study of culture theory.

• Essentialist culture concepts within medical education can be countered by short theoretical updates and inquiry-based learning within contexts characterised by diversity and exclusion.
Access and utilization of health services improved by trained posyandu cadres in rural Indonesia
Authors: Yani F , Shah M , Retno W , Luqman P
Published: October 2023

Posyandu stands for ‘Pos Pelayanan Terpadu’ in Bahasa, meaning ‘Integrated Service Post,’ a community-based health center to provide a range of services for mothers and under five children in Indonesia. Each Posyandu center s served by five posyandu cadres who are community-based health workers and responsible to deliver essential health services and counseling to their communities. In Central Lombok district, Indonesia, we facilitated building capacity and skill of posyandu cadres for counseling and health education and to encourage the community to attend Posyandu center as well as to seek care from nearby Puskesmas and Polindes (other community based static health facilities). During January - August 2022, we trained 1100 posyandu cadres and equipped them with pictorial cards with health education and counseling messages. We retrieved monthly attendance and care seeking data from Puskesmas, Polindes and Posyandu centers through routine health management information system for January 2022 to February 2023 and we compared pre-training (January-August 2022) and post-training (September 2022-February 2023) data. Monthly average number of pregnant women and sick children who were brought to nearby Puskesmas and Polindes for care during pre-training period was 1553 which was significantly increased to 1844 during post-training period (p < 0.001). We also observed statistically significant ((p < 0.001) increase in average monthly attendance of mothers and children at Posyandu centres (from 12,751 in pre-training period to 14,677 in post-training period). This incremental attendance at Posyandu centers and increased care seeking from Puskesmas and Polindes can potentially be attributable to counseling-education session by trained and skilled posyandu cadres and it reconfirms the worthiness of additional investment for capacity and skill building of posyandu cadres to improve community health in rural Indonesia.

Key messages

• Posyandu cadres have potential strength to make significant improvement in community health care service delivery by educating and counseling communities in rural Indonesia.

• Investment on capacity building and training of posyandu cadres can pay off by improving access and utilization of health care services by pregnant women and children.
Rapidly increasing multimorbidity results in increase of health care costs
Authors: Wikström K , Linna M , Reissell E , Laatikainen T
Published: October 2023

Background

Ageing of the population increases the prevalence and co-existence of many chronic diseases, i.e. multimorbidity. In Finland, information on the significance of multimorbidity and its relation to healthcare capacity is scarce. We aimed to study the prevalence of multimorbidity, the transitions between patient groups with and without multiple diseases and associated healthcare cost in 2017-2019.

Methods

The study cohort includes all adults (≥18 yrs) who used Finnish primary or specialized healthcare services in 2017. Multimorbidity status (non-multimorbid, multimorbid or multimorbid at risk) at baseline was determined based on the recordings of a diagnosis of interest using Finnish Care Register data from the year's 2015-2017. The costs were calculated using the care related patient grouping and national standard prices. Transition plots were drawn to observe the transition of patients and costs between different multimorbidity categories during two-year follow-up.

Results

Of 3,201,276 patients, 59% were non-multimorbid, 25% multimorbid and 16% multimorbid at risk in 2017. During the follow-up, we found a considerable number of patients moving from non-multimorbid group both to multimorbid and multimorbid at risk -groups. In 2019, 38% of patients were non-multimorbid, 31% were multimorbid, and 28% were multimorbid at risk of poor outcomes, and 3% had died. The proportion of multimorbid patients at risk increased the most in two years. The healthcare cost depended on the severity of multimorbidity. The total healthcare costs were the lowest among non-multimorbid patients and the highest among multimorbid patients at risk, costing 5660 million euros and accounting for 66,8% of total healthcare cost of this patient cohort in 2019.

Discussion

Multimorbidity, especially multimorbid patients at risk, is causing a heavy burden and costs for Finnish healthcare. The estimates on its effect on health care usage and costs should be used to guide healthcare planning.

Key messages

• The number of multimorbid patients, especially those at risk, is increasing fast.

• Interventions for improving the prevention and care of multimorbidity are urgently needed.
Knowledge and attitudes towards vaccination in the Croatian adolescent population
Authors: Miskulin I , Pavic Z , Miskulin M , Matic Licanin M , Lanc Curdinjakovic V , Zukanovic G , Pavlovic O
Published: October 2023

Background

Adolescents are a large and vulnerable group for infectious and other diseases. A good insight into their specific needs and their understanding of disease and prevention is necessary to adapt vaccination strategies for this population subgroup characterized by constant change and evolution. This study aimed to explore knowledge and attitudes about vaccination among the Croatian adolescent population.

Methods

This online cross-sectional questionnaire study was conducted from January 2021 to April 2021 in a convenient sample of adolescents from the northwestern part of Croatia. The knowledge was assessed through a specially designed validated questionnaire. The Vaccination Attitudes Examination Scale (VAX) was used to assess attitudes towards vaccination in the study population, where the higher scores on the VAX scale reflect more negative attitudes toward vaccination.

Results

The study included 1012 adolescents (29.2% males and 70.8% females). The median age of all subjects was 17.0 (interquartile range 17.0 - 18.0) years. According to the knowledge, there were 29.5% of students with poor, 53.9% of students with average and 16.6% of students with good knowledge about vaccination. The median VAX scale score was 50.0 (interquartile range 43.0-59.0). Male adolescents more frequently had poor knowledge about vaccination (P = 0.028), while female adolescents had more negative attitudes towards vaccination (P = 0.001). The study revealed that there was a positive correlation between poor knowledge and more negative attitudes towards vaccination in the studied population (P < 0.001; rs = 0.260).

Conclusions

The study showed that a large proportion of Croatian adolescents have poor knowledge about vaccination and negative attitudes toward vaccination. Public health programs specially designed for this vulnerable population subgroup are needed to successfully tackle observed negative indicators.

Key messages

• Public health interventions directed towards the suppression of negative attitudes about vaccination must involve younger population subgroups, such as adolescents.

• Positive attitudes as well as better knowledge about vaccination among adolescents are crucial preconditions for adequate vaccination coverage.
Impacts of climate change and environmental pollution: a public health foresight study
Authors: Staatsen B , Betgen C , Strak M , Houthuijs D , Limaheluw J , Hall L , Mulder Y
Published: October 2023

Background

In the Netherlands, the National Public Health Foresight Study (PHF) is published every 4 years, as starting point for national and local public health policy development. A priority topic in the PHF2024 is climate change and living environment. The important transitions (energy, food, mobility, housing) that are required all require space and thus pose a societal challenge for the future quality of the living environment.

Approach

We use a mixed method approach to identify main trends and impacts on public health:

- analysis of Demographic, Economic, Socio-cultural, Technological, Ecological and Political developments (DESTEP) based on a literature review and expert consultation;

-organization of focus group discussions with young people (N = 41);

-analysis of mortality data in relation to temperature;

-evaluation of trend-scenarios.

Results

Direct and indirect health impacts of climate change will become more visible in the next 30 years. These need not all be negative. For example, an earlier edition of the PHF already showed that the increase in temperature may lead to less deaths in winter but more deaths in summer. In the PHF we will focus not only on adverse health consequences, but also identify opportunities for health improvement through climate mitigation and adaptation. Similarly we will look into related developments like energy and mobility transitions, that may (partly) result in health gains, depending on how they will be implemented and who will be affected. For example, we will look into possible improvement of air quality and its impact on health. The preliminary findings of our focus group study suggest, however, that young people are mostly pessimistic regarding developments in our living environment. This is particularly the case for climate change; young people fear that this may cause severe events. Nevertheless, they have high expectations regarding technological advancement in the energy sector.

Key messages

• Foresight studies should not focus on risk alone but also identify possible health promoting developments in the living environment.

• Expert views and views of lay people, in particular youth, may not necessarily be identical. Both need to be addressed in foresight studies.