bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Impact Assessment in Personalized Prevention: three applications on pharmacogenomic testing
Authors: Valz Gris A , Kannan P , Costa A , de Fátima Silva Lopes M , Cardoso M L , Pezzullo A , Tona D , Perola M , Vicente A M , Boccia S
Published: October 2024

Background

In recent years, literature on the efficacy of genetic and genomic tests has expanded, yet the impact of personalized prevention programs that include such tests remains understudied. Our study aims to test the use of the Health Impact Assessment (HIA) framework, traditionally applied in non-health policy evaluation, to assess the impacts of personalized prevention policies.

Methods

We selected a policy mandating dihydropyrimidine dehydrogenase (DPYD) genetic test use before prescribing fluoropyrimidine for colorectal cancer (CRC) patients. Three HIAs are being conducted in Italy, Portugal, and Finland to assess the applicability across different contexts. The assessment involves literature review, comparative risk modeling, and stakeholder interviews. Three national steering committees, comprising representatives from key interest groups and experts, will evaluate evidence to gauge policy impacts and offer recommendations.

Results

The potential impacts identified include CRC patients’ outcomes, economic, organizational, patient experience, clinician workload, and equity. Preliminary results show a consensus in literature and national guidelines on the ability of the DPYD test to reduce adverse events and enhance the quality of life of CRC patients. However, the assessment reveals context-specific effects regarding equity, influenced by the prevalence of ethnic groups and variations in access to health services across regions. Differences also emerged on organizational aspects like the availability of resources such as laboratories and personnel. A lack of literature was observed on patient acceptability and clinician attitudes towards the test.

Conclusions

The use of HIA in personalized prevention might assist in identifying policy impacts often overlooked through the involvement of key interest groups in the assessment process. Such effort can further emphasize the significance of evaluating these programs while considering the geographical context.

Key messages

• Our study innovatively applies the Health Impact Assessment framework to evaluate personalized prevention programs in pharmacogenomic, addressing a critical research gap.

• Preliminary findings underscore the importance of considering geographical factors in public health policy evaluation, highlighting nuanced context-specific effects.
Future actions and a call for ongoing support
Authors: Quilici S , Czwarno A
Published: October 2024

The EUVABECO project is currently piloting a suite of innovative tools, including decision support systems, targeted screening tools, electronic vaccine leaflets, disease simulators, and cross-border vaccination cards. These tools have shown great promise in transforming vaccination practices within individual healthcare settings, contributing to building vaccine confidence and increasing protection against vaccine-preventable infections across the life course. As EUVABECO progresses to the crucial phase of implementing these pilots, active collaboration and sustained support from the multiple actors of the vaccine ecosystem in the implementing countries are essential. To ensure these tools are effectively adapted across different MS, they must be customised to meet local needs and the specific requirements of diverse healthcare environments. This involves integrating feedback from initial deployments. More than just a technical implementation, this phase is about fostering and maintaining robust partnerships with key stakeholders such as healthcare providers, policymakers, and National Immunization Technical Advisory Groups (NITAGs). The success of the EUVABECO project depends on continuous engagement and the sharing of knowledge and resources among all partners involved. This presentation seeks to reinforce the call for ongoing commitment and collaboration from existing stakeholders and to encourage new partners to join this transformative effort. This will foster a more harmonized approach to vaccination policies. Together, we aim to build a more resilient public health infrastructure, enhancing the preparedness and responsiveness to current and future vaccination challenges, ultimately improving resilience to health threats across the European Union.
Uptake and effectiveness of an Instagram intervention on AMR for undergraduate students
Authors: Parveen S , McHugh P , Vellinga A
Published: October 2024

Background

With the large volume, diversity and amount of information shared on social media, this offers opportunities to deliver and disseminate health interventions through these platforms. Social media campaigns have been found to be effective in raising public awareness of health issues during the COVID-19 pandemic. Social media is however not widely used to raise awareness on antimicrobial prescribing and resistance.

Aim

To study the potential of Instagram as a tool for promoting awareness and understanding of critical health issues such as AMR among undergraduate students.

Methods

A 3-month Instagram-based educational intervention with Instagram posts with messages on AMR was implemented from January to April 2024. The planning phase involved two co-design sessions and two key-informant interviews, which provided valuable insights and guidance for structuring the intervention. The messages on AMR were developed based on the planning phase to ensure relevance and effectiveness. To evaluate the impact of the intervention, pre and post-intervention surveys were conducted to measure the knowledge levels of the participants.

Results

126 students signed up for the intervention by following the instagram account and filling the pre-intervention survey. A total of 36 messages were posted during the intervention with an engagement of 2.5% and a daily engagement of 4.6%. The average likes per post was 14.

Conclusions

Type of message and change in knowledge on AMR will be explored to inform future Instagram AMR awareness campaigns.

Key messages

• Social media interventions can be effective in raising awareness when co-designed with the target audience.

• A good content mix with engaging short format content is key in capturing the attention of the target audience on social media.
Procrastination and risky behaviors: preliminary results among Italian university students
Authors: Bianco A , Licata F , Maruca R , Di Gennaro G , Citrino E A
Published: October 2024

Background

The study aims to investigate if the tendency to procrastinate has a relationship with engaging in risky behaviors among university students.

Methods

A cross-sectional study was conducted at the ‘Magna Græcia’ University of Catanzaro, in the Southern part of Italy, using a stratified random sample technique. Undergraduate students (ages 18 to 30) were provided with an anonymous online survey via the institutional email. The survey comprised five sections to assess procrastination levels, sleep quality, breakfast habits, alcohol and tobacco use, and social and demographic characteristics.

Results

Of the 404 participants, more than half were enrolled in medicine or life science majors. The procrastination mean score was 14.8(IQR 10-20). Poor sleep quality was found in 57.2% of students and women were the most affected part of the sample. The logistic regression model revealed that higher procrastination levels increased the likelihood of engaging in unhealthy behaviors such as breakfast skipping, alcohol abuse, and poor sleep quality. Furthermore, the study found that people who skipped breakfast were more likely to engage in smoking and alcohol abuse, suggesting the interconnectedness nature of unhealthy behaviors.

Conclusions

The study’s findings shed light on the correlation between procrastination and unhealthy habits. Moreover, the results can offer recommendations for how universities might successfully support students by implementing integrated, evidence-based programs to assist students who struggle with procrastination. Indeed, universities can serve as centers for promoting wellness by increasing awareness of the need to change deeply rooted behavioral patterns. Hence, breaking the vicious cycle of procrastination can ultimately lead to improved academic performance and overall well-being for students. This will benefit both individuals’ and the general public’s health.

Key messages

• The novel correlation between procrastination and risky behaviors among university students was shown.

• Targeted interventions must include procrastination tendency to improve academic results and general well-being.
First things first: measuring French Medical schools’ deans motivation to engage in smoke-free campus
Authors: Geindreau D , Girault A , Gallopel-Morvan K
Published: October 2024

Smoke-free campuses (SFC) prohibit smoking and vaping on all university grounds and for all users. Around a hundred of papers was published on that topic revealing how they reduce initiation and increase smoking cessation among students. Whereas it is key for the success of all project, including SFC, very rare research has investigated attitude of high-level leaders of universities toward SFC, their perceived barriers and motivation to adopt it. To fill this gap, we interviewed deans of medical schools in France, where SFC are limited. In-depth individual interviews were conducted on 31 deans and two associate-deans (representing 31 out of 35 French medical schools). Questions rose knowledge of SFC, perception of this measure, self-role to play and other factors influencing implementation. We targeted medical schools because they train future prescribers of smoking cessation, and can act as a model for policy dissemination to other schools. The 23 hours of interviews were analyzed using thematic analysis with Nvivo14. Regarding diffusion in 2023, only one medical school had a SFC, six were implementing it, 23 had no SFC and one abandoned it. 28 held positive attitudes towards SFC, explained by its impact on health and the mission of medical schools. Most of them considered SFC feasible with resources and engagement of students. Identified barriers were competing priority, lack of funding and of support from users and risk of stigmatization of smokers. A majority of deans thought they had a role to play in initiating, promoting and moderating the policy. SFC are recommended by the WHO but there is important room for improvement for their diffusion in France. Yet, a majority of deans we interviewed appeared motivated to adopt it. Solutions to encourage them and overcome barriers must be found.

Key messages

• Diffusion of SFC among medical schools remains limited in France.

• Deans’s positive attitude towards SFC bring hope for a better diffusion of SFC among French universities.
Social prescribing for healthy ageing: insights from older people referral and uptake in Portugal
Authors: Hoffmeister L , Gonçalves B , Gama A , Canas A M , Figueiredo C , Dias S
Published: October 2024

The population ageing presents multifaceted challenges for health systems, with implications for healthcare delivery and health and well-being outcomes. Innovative integrated-care approaches are needed to promote healthy aging and the quality of life of older people. Social Prescribing (SP) has emerged as a promising strategy to address the complex health and social needs of populations, including those older, offering non-medical interventions that encompass social, cultural, and community-based activities. SP has been implemented in Portugal since 2018 and currently target different subgroups, including elderly. This study aims to examine referral and uptake of older people to SP in Portugal. This cross-sectional study analysed sociodemographic, health condition, referral and uptake-related data from older patients (≥65 years) engaged in SP, collected through a survey and registries at primary healthcare units in Lisbon between 2018-2023. Of the 1060 patients referred to SP, 43.9% (n = 465) were aged 65 years or older. Within this age group, 38.1% were 71-80 years old and 36.1% were 81-90 years old; 67.5% were female. Around 48% were referred to SP for social isolation, 40% for social and financial support, and 32.5% for functional dependency. Two thirds had two or more chronic conditions, with cardiovascular disease (59,1%), mental health disorders (29,2%), and obesity (27,1%) being the most frequent. The SP consultations uptake rate was 59.1%, and patients were referred to a range of activities provided by third-sector organisations, as psychosocial support, home care, senior university classes, arts activities, and support in medicine management. The elderly population accounts for a large proportion of SP referrals. Further efforts are needed to identify the factors that influence patients’ acceptability and adherence and to promote the sustainability of SP and the well-being of the population.

Key messages

• Older people referred to SP initiative in Portugal have complex health-social needs, which reinforces the relevance of adopting a holistic centred-care approach to respond to the aging challenges.

• Through SP older people have been integrated in community-based activities that promote their health and wellbeing, thus it is needed to develop tailored strategies to improve patient uptake.
How do communities define “work precarity” and “labour exploitation”? Lessons for research from participatory research in high economic hardship communities in Chicago, Illinois/USA
Authors: Forst L ,   obo Greater Lawndale Healthy Work Council
Published: October 2024

Labour migration has both social and economic drivers that channel workers into jobs that are less desirable to citizens of the receiving countries. Immigrant workers find jobs through contacts from their home countries, including temporary staffing companies. These workers tend to co-locate in segregated communities and coalesce in jobs that entail hard work, low wages, and limited social benefits. As such, labour migration adds a dimension to the structural and social determinants of health (SDOH) that can broaden our understanding of health inequities, and that can point us toward policies and practices to enhance the health and wellbeing of migrant workforces. However, to generate evidence, align interventions with workers’ needs and priorities, and move evidence to action, it is crucial to engage communities. This presentation describes a community-university research partnership that co-investigates the relationship between work and health as experienced at the community level in two high-economic-hardship neighbourhoods in Chicago, Illinois/USA. The academic and practice partners co-developed and tested a conceptual model of the interrelations among migration, work and health, conducted an inventory of local employers, and executed a street-level survey of 497 workers in these two communities. The research findings helped enhance existing models of the structural/social determinants of health and of work precarity, thus informing methodological approaches to measure work precarity, labour exploitation, and their health effects. The community-based participatory research further led to several action-research projects that are ongoing. This presentation will describe the development of the community-university research partnership and its work, the subsequent enhancements made to the worker precarity and SDOH models, and preliminary findings of the partnership’s current action-research projects.
Measuring laypeople’s notions of intersex in the Netherlands and Flanders
Authors: van Ditzhuijzen J , Hessen D J , Motmans J
Published: October 2024

Introduction

In emancipation policy, the ‘I’ is often added to the LGBTI+-acronym. Yet it is still unknown to what extent this term is known and understood by the general population, and what attitudes toward intersex (people) are. In the current study, we describe the construction and development of the Intersex Knowledge and Attitudes Scale (IKAS), as well as the results from this baseline measurement in the Dutch and Flemish population.

Methods

The IKAS was developed after a carefully documented stepped process of literature scan, expert consultations, and pretesting. A representative sample of 2,003 respondents (1,000 Dutch and 1,003 Flemish) participated in the study. To determine the dimensionality of the scale, we performed EFA and CFA with measurement invariance constraints. We also performed a baseline measurement of knowledge and attitudes towards intersex people in the general population, and determined predictors of attitudes toward intersex people in regression analyses.

Results

Two-thirds of the sample had no (correct) knowledge of the term intersex. Even among the intersex respondents, only one person was aware of the term intersex. The average attitude was moderately positive to neutral. Having a female gender or birth sex, an advanced level of education, lower importance of religion, belonging to a minority group, more tolerant gender beliefs, and preexisting knowledge on the topic all resulted in more positive attitudes.

Conclusions

Both in Flanders and the Netherlands there still is room for improvement in terms of knowledge and attitudes towards intersex people. More knowledge may lead to more understanding, so that intersex people can be more open. Second, it is recommended to challenge beliefs of sex and gender as binary categories, because people who have less issues with people who do not entirely fall in these categories, also have more accepting attitudes toward intersex people.

Key messages

• It is vital to include intersex in monitoring studies of population attitudes, to be able to genuinely incorporate the ‘I’ in LGBTI+ in emancipation policies.

• To increase acceptance of intersex people in society, knowledge about intersex in the general population should be expanded, and acceptance of people who do not fit into the binary should be promoted.
Barriers to the application of simulation technologies in the education of health care students
Authors: Usheva N , Bliznakova K , Grancharov D
Published: October 2024

Simulation technologies (ST) in health and medical education are undergoing rapid development due to the undoubted advantages of the methods and forms of simulation used - high quality, significant efficiency, economy, reliability and safety for the patient. At the same time, the application of ST is still underrepresented in the education of health care students. The main aim of this study was to identify the barriers and perspectives for the application of ST in the education of health professional students in Bulgaria from the perspective of the respondents’ expertise. A qualitative study of the expert (n = 17) opinion of those directly involved in the introduction, application, and evaluation of the use of ST in the education of healthcare students was conducted in 2023 in Varna. The questionnaire regarding the barriers and perspectives in the use of ST in the education of undergraduate and postgraduate students in health specialties students was used. The main barriers to the widespread use of ST in the training of students were identified as follows: the lack of adapted curricula that combine traditional practical sessions with patients and those on simulators; the lack of a sufficient number of trained and motivated trainers; the reluctance of trainers to introduce or more widely use ST; lack of or insufficient space to locate a simulation centre or equipment in relevant core units; the high cost of purchasing and maintaining ST and limited financial resources, as well as the large number of students in the groups. According to one of the experts, ‘there are no barriers to the use of ST, but real patient contact and a personalized approach to the patient is impossible to replicate through technology,’ highlighting the importance in combining traditional training with real patients and modern with the use of technology. Ethical issues in training healthcare professionals with simulators appear to be a new aspect of medical education with the application of ST.

Key messages

• In the effort for widespread implementation of ST in the training of health professions students, it is important to achieve a balance with traditional training experienced with real patients.

• Identifying and overcoming barriers is an important prerequisite for the rapid and widespread application of ST in the training of health care students.
Organizational barrier to herpes zoster vaccination uptake in Europe: a systematic review
Authors: Fiorilla C , Sorrentino M , Belpiede A , Stilo I , Mercogliano M , Triassi M , Palladino R
Published: October 2024

Background

The Herpes Zoster virus represents a significant public health threat for unvaccinated frail individuals and older adults, aged 50 or older. Globally, 95% of elderly and frail individuals are susceptible to develop Herpes Zoster as already being exposed to Varicella Zoster Virus. Organizational and logistical barriers, such as cost management, vaccine storage requirements, supply limitation, logistic difficulties, absence of a streamlined collection system, and healthcare system deficiencies might reduce vaccination uptake.

Methods

A systematic review was conducted to identify studies published in the last 10 years, and focused on logistic and organizational barriers for Herpes Zoster vaccination uptake among frail and participants aged 50+ in Europe. Prisma guidelines were followed, and AXIS tool was used to evaluate the risk of bias.

Results

After a thorough analysis, 4 studies were selected from a total of 863 for detailed review. The analysis revealed several barriers to vaccination uptake, including challenges involving healthcare professionals, participant-related obstacles concerning perceptions and knowledge, accessibility issues, structural deficiencies, and social dynamics. A significant barrier identified is the perception among participants that general practitioners either do not support the vaccination or that participants themselves underestimate the risk of developing Herpes Zoster. Additionally, current communication strategies have proven inadequate, indicating a need for more effective and updated approaches to increase public awareness. These factors contribute to hesitancy regarding vaccination.

Conclusions

This study provides a comprehensive examination of the organizational and logistical barriers to the Herpes Zoster vaccination uptake. Tailored interventions are essential to overcome these barriers. Successfully addressing these challenges might enhance vaccination rate and reduce the public health burden associated with Herpes Zoster.

Key messages

• Several logistic and organizational barriers reduce the Herpes Zoster vaccination uptake.

• Further literature is required to understand how to overcome those barriers, and increase vaccination uptake.
Epidemiology of obesity during pregnancy in Europe: a systematic review
Authors: Naughton P , Brennan M M , Cosgrave E , Turner M , O’Higgins A C , Kearney P , Buckley C M
Published: October 2024

Background

Obesity during pregnancy poses inter-generational health risks and places added burden on healthcare systems. Characterising levels of obesity during pregnancy is necessary to guide future research, policy and practice.

Methods

The systematic review was performed according to PRISMA guidelines. PubMed, Embase and Web of Science were searched. Studies published between 2009 and 2023 that report the prevalence of obesity during pregnancy in countries in the World Health Organization (WHO) European region were eligible. The Joanna Briggs Institute Prevalence Critical Appraisal tool was used. Two reviewers screened studies independently. A single reviewer completed data extraction and quality assessments, a second checked 20% of extractions and a third resolved disagreements. Narrative synthesis was completed.

Results

100 studies reporting the prevalence of obesity during pregnancy in the WHO European region were identified. 59% from Western Europe, 36% Northern, 4% Southern and 1% Eastern. Data within the studies was collected between 1950 and 2019. 35% of studies reported national estimates, 65% regional. 39% studies had measured height and weight, 34% did not report how either were ascertained, 6% used self-report for both, 17% had self-reported height but measured weight, 4% a mixture of self-report and measurement. The smallest sample was 157 while the largest was 1,891,097. Estimated prevalence of obesity during pregnancy ranged from 2.3% (Sweden, data collected 1982-1989) to 28.3% (England, 2007).

Conclusions

This review identifies variation in the prevalence of obesity during pregnancy in the WHO European region. This may reflect diverse sociocultural contexts, different methodological approaches and temporal trends. There was limited evidence available for Southern and Eastern Europe.

Key messages

• There are high levels of obesity during pregnancy within the WHO European region.

• Enhanced primary prevention and resourcing of obstetric services is needed.
Economic burden of suicide in Sweden in 2022
Authors: Feldman I , Martínez de Alva P
Published: October 2024

Background

Suicide and suicidal behaviors bring massive human, social and economic impacts. Estimates of the cost of suicide can give some guidance as to where research on developing new interventions might be focused to give the greatest potential gain. The aim of the study is to quantify the economic cost of suicide in Sweden in 2022.

Methods

Incidence of suicide attempts and mortality due to suicide, intentional and undetermined (ICD10 X60-X84 and Y10-Y34) were sourced from the Swedish National Board of Health and Welfare databases for 2022. Cost were estimated from a societal perspective, including costs for inpatient and outpatient care, medication, police and justice activities as well as productivity losses due to early mortality.

Results

In 2022, a total of 1,569 suicide death were registered in Sweden (1,102 men and 467 women). The incidence rate remains stable during the last ten years, 17 death per 100 000. In total, 18,854 patients (10, 359 women and 8,459 men) were treated in inpatient and outpatient hospital care with suicide-related diagnoses, generated 32,843 days in inpatient care and 11,471 outpatient care visits. Direct costs for suicide death including forensic examination, emergency services, police investigation and property damage were estimated as €6,02 million, while indirect costs for productivity losses totaled €690 million. Direct healthcare costs for suicide related treatment were estimated at €54.3 million. Overall, suicide and suicide attempts cost around €750 million per year to society.

Conclusions

Estimates of the economic burden of suicide are needed for the Swedish setting, and these amounted to €60.3 million in direct costs and €690 million in indirect costs in 2022. The cost might be underestimated because the societal cost of suicide bereaved persons was not considered. These cost estimates can provide useful inputs to a cost-effectiveness analysis of a specific preventive intervention, and to its subsequent evaluation.

Key messages

• Economic burden of suicide is substantial for society.

• Public health policies aimed at the prevention of suicide should be increased.
Prevalence of adults with fatigue in Germany: results of the ‘German Health Update 2023’ study
Authors: Ordonez Cruickshank A , Poethko-Müller C , Schaffrath Rosario A , Sarganas G , Scheidt-Nave C , Schlack R
Published: October 2024

Background

Fatigue is a non-specific symptom complex associated with exhaustion, lack of motivation and concentration. It has high public health relevance due to impairments in quality of life and work ability and increased risk of accidents. Fatigue has increasingly gained attention as one of the most common post-acute consequences of SARS-CoV-2 infection. Fatigue is also common among non-infected people and there is a lack of population-based background data. Therefore, we investigated the prevalence and factors associated with fatigue in a population-based epidemiological study in Germany.

Methods

The analyses are part of the national population-based cross-sectional telephone survey ‘German Health Update’ (GEDA 2023) in adults (3/2023-2/2024). Fatigue was surveyed using the Fatigue Assessment Scale (FAS) and dichotomized into yes (at least mild/moderate) versus no fatigue. The FAS is an instrument for mild-to-moderate fatigue, which must be distinguished from chronic fatigue syndrome (CFS). Weighted analyses of the data from 9,766 adults were carried out descriptively and in multivariable Poisson models, considering sociodemographic and health-related determinants.

Results

The prevalence of fatigue in Germany was estimated to be 29.7% (95% CI 28.1-31.2) and was highest in 18- to 29-year-olds at 39.6% (35.0-44.4). The prevalence decreased up to 65- to 79- year-olds (20.6% (18.2-23.3)) and was again higher in people aged 80 and over (33.2% (28.9-37.7)). Women had a higher risk of fatigue than men (aRR 1.19 (1.08-1.32)). Lower education (aRR 1.29 (1.13-1.49)) and medium education (aRR 1.13 (1.01-1.27)) were associated with increased risk of fatigue. There were significant associations between fatigue and chronic illness, depressive symptoms and long COVID.

Conclusions

Fatigue is a common symptom among adults in Germany. Female gender, young and very old adulthood as well as lower education are associated with higher risk of fatigue.

Key messages

• The correlations between fatigue and socio-demographic variables as well as parameters of physical and mental health provide important indications of groups particularly affected by fatigue.

• The fatigue survey in GEDA 2023 is one of the few current European studies that describe the frequency of fatigue in the general population and analyzes health and sociodemographic determinants.
Wastewater-Based Epidemiology of Influenza Viruses: a systematic review
Authors: Viviani L , Pellegrinelli L , Vecchio R , Sandri L , Binda S , Pariani E , Odone A
Published: October 2024

Background

Influenza viruses (IVs) are responsible for annual epidemic outbreaks during the winter months. Beyond conventional surveillance systems, the circulation of these pathogens can be monitored using Wastewater-Based Epidemiology (WBE), an epidemiological tool that describes the health status of an entire community by analyzing the presence of pathogens within wastewater. Systematically reviewing existing experiences in this emerging field is crucial to highlight the best practices to establish a WBE surveillance system providing useful information for public health actions.

Methods

The study protocol for this systematic review has been registered on the PROSPERO website (registration ID: CRD42024532435). Three academic databases (PubMed, Web of Science and Scopus) were accessed to collect studies examining the presence of IVs in wastewater. Studies included were those reporting quantitative measures of viral concentration or detailing molecular/phylogenetic characterization of IVs in wastewater.

Results

Databases were searched on July 8th, 2024. After de-duplication and screening of the 400 remaining records, 42 were included in the review. IVs detection in wastewater was reported in all papers except from one, although with high variability in terms of positivity titers and concentration levels. More than half of the collected papers (52.4%) evaluated association between environmental viral concentration and clinical data, generally showing concordance between the two aspects. Moreover, 28.6% of papers described subtyping of IVs in wastewater through different methods (specific PCR assays being the most used).

Conclusions

WBE is a promising approach for surveilling viral circulation, and IVs represent a high value target for implementing this innovative system. Systematically reviewing previous experiences can be useful to obtain information for the establishment of a novel environmental surveillance system of Influenza Viruses

Key messages

• Nucleic acids belonging to Influenza Virus are detectable in wastewater, even though we report high levels of variability in sampling techniques, laboratory methods and data management systems.

• Association between environmental data and number of clinical cases is reported to be generally strong in collected papers; subtyping of IVs present in wastewater is also feasible.
A methodology to map chains of general practices in the Netherlands
Authors: Jansen L , Timans R , Batenburg R , van Tuyl L
Published: October 2024

Background

Commercial entities are increasingly interested in acquiring Dutch general practices (GPs). They see profitable opportunities in upscaling by forming chains. Chain organizations integrate business processes of GPs within one organizational unit. The governance structure of these chains can be complex, leading to opacity and difficulties to see conflicts of interest and market power. To investigate how this development may have an impact on quality and accessibility of care, it is first needed to establish the ways in which these chains are formed. By mapping the chain structure in a data-driven way, impact monitoring becomes possible. For the Netherlands we investigated how chain structures of GPs can be empirically identified.

Methods

Background data of approximately 4,800 Dutch GPs from the Nivel Healthcare Professional Registries was linked with data from the Chamber of Commerce’s Trade Register. This enabled the determination of the legal form, business location, ownership, and director identification for all GPs. By this data-driven manner, the variation in organizational structures of all Dutch GPs was mapped and analyzed.

Results

Four different chain variants of Dutch GP chains were identified based on three types of relations between the chain organization and their GPs: ownership, location and the composition of the board of directors. Based on ownership, two ‘top-down’ chain variants were identified. Two ‘bottom-up’ chain variants were found based on location and board composition: (1) a chain organization acquires a seat on the board of the GP, and (2) the GP and the chain organization share the same business address. Combining these variants provides a new typology of GP chains in the Netherlands.

Conclusions

Our methodology enables to empirically map chain formation in primary care. By developing a new typology in a systematic way, a foundation is created to monitor organizational developments and their impact on quality and accessibility of care.

Key messages

• A typology of Dutch GP chains was developed based on three relations: the ownership, composition of the board and the establishment location of the chain organization and its practices.

• Our methodology was put into practice to map different chain structures of GPs in the Netherlands, but it is not limited to primary care and can also be applied in other sectors and countries.
Sociodemographic disparities in depression and anxiety symptom severity among young adults in Sweden
Authors: Granvik Saminathen M , Brolin Låftman S , Östberg V
Published: October 2024

Background

Young adults are disproportionately affected by mental health problems such as depression and anxiety. While previous studies have identified sociodemographic predictors using the four-item Patient Health Questionnaire (PHQ-4), differences in symptom severity remain less explored. This study aimed to evaluate the sociodemographic predictors of different levels of depression and anxiety symptoms among young adults in Sweden.

Methods

Survey data from a population-based sample of Swedish adults aged 20-21 (n = 3,226) was used. Symptom severity was categorized into three levels: normal/mild, moderate, and severe, based on established cutoff scores on the PHQ-4. Gender, parental education and birth country, and upper secondary education were assessed through linked registry information. Multinomial logistic regression was used.

Results

Females had a higher risk of moderate (RR = 1.8, 95% CI 1.5, 2.2) and severe (RR = 2.3, 95% CI 1.8, 3.1) symptoms (compared to no or mild symptoms) relative to males. Among males, the risk of moderate symptoms was higher without a secondary degree (RR = 1.9, 95% CI 1.0, 3.4) compared to an academic degree. Males with parents born abroad faced elevated risks of moderate (RR = 1.9, 95% CI 1.3, 2.9) and severe (RR = 2.2, 95% CI 1.3, 3.7) symptoms relative to males with Swedish-born parents. Among females, parental tertiary education was associated with a lower risk of moderate symptoms (RR = 0.7, 95% CI 0.5, 0.9) compared to lower education. Further, females having a vocational (RR = 1.5, 95% CI 1.1, 2.1) or no secondary degree (RR = 3.6, 95% CI 2.1, 6.1) had an increased risk of severe symptoms compared to females with an academic degree.

Conclusions

This study identified sociodemographic predictors for moderate and severe symptoms of depression and anxiety among young men and women in Sweden. Mental health promotion and prevention should specifically target young adults at elevated risk of experiencing moderate to severe symptoms.

Key messages

• Understanding sociodemographic predictors of depression and anxiety symptoms in young adulthood is essential for public health work.

• Mental health promotion and prevention needs to include appropriate interventions for young men and women from diverse socioeconomic and cultural backgrounds.
Fidelity of the Face-it health promotion intervention for women with recent gestational diabetes
Authors: Husted Jensen N , Dahl-Petersen I K , Nielsen K K , Timm A , O’Reilly S , Maindal H T
Published: October 2024

Introduction

According to the 2021 British Medical Research Council 2021 framework, a feasibility study aims to assess intervention-specific progression criteria. Fidelity is a critical criterion because it concerns how an intervention is implemented as intended. Fidelity conceptualisation has expanded beyond intervention adherence to encompass participant engagement, i.e., how well they receive and enact the intervention, but these latter aspects achieve little attention. We aimed to assess the fidelity of the Face-it intervention, a health promotion intervention for women with a history of gestational diabetes mellitus and their families. The intervention consisted of three home visits and health technology delivered by health visitors/coaches. Our fidelity assessment included: i) training of the health visitors/coaches ii) the delivery, iii) receipt, and iv) enactment of the intervention.

Methods

The National Institutes for Behaviour Change Consortium’s (NIHBCC) framework for fidelity was used to assess four elements of fidelity. Data were collected from 150 women using intervention checklists, health technology logs and the virtual climate care questionnaire, which measured autonomy supportiveness from the intervention.

Results

The health visitors/coaches received four training days before the implementation and 16 hours throughout the intervention delivery. 73.3% of women completed three home visits, and 91.3% of women registered as health technology users. The participants perceived the intervention to be autonomy supportive, encourage health behaviour change and provide effective possibilities for health behaviour change, even though the delivery of the health technology varied greatly.

Conclusions

The Face-it intervention was largely implemented as intended. Using the NIHBCC framework, we expanded our fidelity conceptualisation and gained important insight into the feasibility of the intervention and interplay between delivery, receipt, and enactment.
Sex differences in mortality associated with heatwaves: a systematic review and meta-analysis
Authors: Pinho-Gomes A , Mcintosh A , Woodward M
Published: October 2024

Introduction

The existence of sex and gender differences in the mortality associated with heatwaves remains unclear.

Methods

A systematic review and random-effects meta-analysis of population-based studies that investigated the mortality associated with heatwaves and reported results stratified by sex/gender was conducted (PROSPERO registration CRD42023430208). Bibliographic databases Medline and Embase were searched from inception to May 2024 with MESH terms for heatwaves/extreme heat and mortality. This was complemented with hand-searching of reference lists of relevant studies. The methodological quality of eligible studies was assessed using the Joanna Briggs Institute critical appraisal tool.

Results

In total, 931 studies were identified, of which 32 studies were included in the qualitative review and 11 in the meta-analysis. Most studies (20/32) reported a higher risk of heat-related death for women than men even after adjusting for or stratifying by age. Twelve studies showed statistically significant higher risks of death for women than men and 7 studies identified an increased risk of death for women, but the wide confidence intervals precluded making definite conclusions. Two studies reported a higher risk of death for men in comparison to women but only one was statistically significant. The remaining 10 studies found comparable risks for women and men. For the 11 studies included in the meta-analysis, women had an 8% increased risk of death in comparison to men (RR 1.08, 95% CI [1.02 to 1.14]). There was significant heterogeneity (I2=69%, p = 0.001) due to the variability in the definition of exposure, population, and setting. Most studies had a low to moderate risk of bias.

Conclusions

Women appeared to have an increased risk of death associated with heatwaves in comparison to men. Further research is warranted to understand the underlying factors and ensure the health protection response considers the gendered impact of heatwaves.
Methods for projecting health workforce planning in Ireland: a collaborative approach
Authors: Myers C , Segerstrom V , McDonnell A , De Vore-Merriman A , Johnston B
Published: October 2024

Background

Health workforce planning (HWFP) is the process of analysing, forecasting, and planning workforce supply and demand, assessing gaps, and determining target workforce to ensure that health systems are prepared for future demand. HWFP elicits recommendations that are ideally utilised by the health system to support medical workforce over a defined time.

Methods

The objective of this project is to inform intake for medical and surgical specialties in Ireland to reach the necessary consultant workforce by 2038. A literature search was conducted to help inform the methodology for this project. The most common approach was a needs-based model, and additional reviews discussed the integration of medical engagement into the modelling approach.

Results

This project will employ a collaborative approach, combining mathematical modelling and a combination of quantitative and qualitative inputs, including the following phases: 1. The research phase will estimate baseline supply and demand data across medical and surgical specialties in Ireland using statistical models; 2. The presentation phase will include input from clinical leads to allow for more accurate assumptions in the baseline of each model; 3. Review of projections will include feedback from the clinical leads to help clarify and improve the initial model; 4. Presentation of the revised projection will include further collaboration with clinical leads to finalise the model.

Conclusions

The robust methodology for this HWFP project will ideally inform medical and surgical specialities in Ireland through 2038. Specific and extensive predictions of health workforce supply and demand will enhance strategic preparation, which is a key priority for the Health Service Executive in Ireland.

Key messages

• A collaborative approach to HWFP is essential for health service preparation and improvement.

• The project will be finalised by the end of 2024, and the methodology for conducting similar HWFP projects can be adapted by other EU states.
Training for outbreak response through the Global Outbreak Alert and Response Network
Authors: Karo B
Published: October 2024

The WHO designated the Information Centre for International Health Protection (INIG/ZIG 1) at the Robert Koch Institute as the first WHO Collaborating Centre for Global Outbreak Alert and Response (WHO CC GOARN). Its mandate is to aid WHO’s efforts in improving the detection of public health events and enhancing preparedness, readiness, and capabilities for alerts and rapid responses. The main focus of WHO CC GOARN at RKI include supporting WHO in the development and implementation of the GOARN training programme on international outbreak alert and response, as well as facilitating knowledge exchange and information dissemination. GOARN’s extensive engagement in international public health response underscores the need to complement technical expertise with human-centred competencies like effective communication and teamwork, while respecting diversity. On 18 -22 September 2023, WHO CC GOARN at RKI hosted the first “GOARN Outbreak Response Leadership Training Programme”, inviting 24 public health leaders plus highly experienced mentors from all WHO. The training was designed to enhance leadership mind-sets and practices, including advanced interpersonal and situational awareness, managing polarised tension, establishing trusted relationships with stakeholders, and influencing collective decision-making. Alongside expert facilitators and experienced mentors from various fields, participants engaged in open discussion, shared experiences and reflected on lessons from the COVID-19 pandemic and other recent outbreaks. This course provided an opportunity to engage with diverse, experienced and highly regarded leaders, sharing their views and personal experiences on what it means to practise leadership in health emergency response. This training also aimed to build a network of diverse, well-trained and interconnected public health leaders, upholding the principles of diversity, equity and inclusion to ensure that our response efforts resonate with the communities we serve.
Impact of loneliness and social support on leisure physical activity in adolescents in Luxembourg
Authors: Lopes Ferreira J , Mendes F G , Catunda C
Published: October 2024

Background

Healthy lifestyle includes a regular practice of vigorous physical activity in adolescents’ leisure time. Engaging in physical activity (PA) depends on individual, social and environmental factors. Previous literature has showed that social support and loneliness can influence the practice of PA. The study aims to analyse the relation between PA during leisure time and social support and loneliness among adolescents in Luxembourg.

Methods

The study includes 7049 adolescents from the Health Behaviours in School-aged Children (HBSC) Luxembourg 2022 survey. PA in leisure time was categorised according to WHO recommendations for vigorous physical activity. Perceived social support (friends, family, teacher, and classmate) was dichotomised in high support and in low/medium and loneliness in feel often lonely and not feel often lonely. It was executed a binomial logistic regression to analyse the PA levels in leisure time by loneliness and social support, controlling by age, migration background, perceived wealth, and family structure, split by gender.

Results

In Luxembourg, boys who perceived high support from most of the sources and didn’t feel often lonely had higher chances to reach WHO recommendations for PA during leisure time (e.g. loneliness: OR = 1.38, CI95%[1.11-1.74]; family support: OR = 1.31, CI 95%[1.10-1.56]), except for teacher support (OR = 0.79, CI95%[0.67-0.93]). In contrast, girls who only perceived high support from classmates (OR = 1.21, CI95%[1.05-1.4]) and teachers (OR = 1.19, CI95%[1.01-1.38]) had higher chances to be physically active.

Conclusions

This is the first study to investigate the impact of social support and loneliness among adolescents in Luxembourg. Future research should investigate social-related barriers and facilitators of PA during leisure time.

Key messages

• Understanding adolescents social support can guide towards effective strategies that promote physical activity during leisure time.

• Boys benefit from several social support sources, while girls thrive with encouragement from classmates and teachers to stay physically active in leisure time.