bluuebunny/crossref_metadata_2025 huggingface dataset:
AI-Enhanced Allergy Diagnostics: Streamlining Healthcare and Reducing Costs
Authors: Łukasiewicz P J
Published: October 2024

Issue/Problem

WHO projects a shortfall of 10 million health workers by 2030. One area particularly lacking technological support is allergy diagnostics. The World Allergy Organization recognizes skin tests as the gold standard for allergy diagnostics, yet these tests are still manually assessed. General practitioners lack the time and tools, leading them to focus on treating the symptoms without addressing the causes.

Description of the problem

Symptomatic treatment of allergy can lead to the development of asthma in 30-40% of patients, increasing healthcare costs and causing lost productivity. The shortage of allergists further exacerbates this issue in many countries.

Results

Research conducted by the Military Institute of Medicine in Warsaw, in collaboration with a company producing automated allergy testing systems, explored a solution for allergy diagnostics, analyzing the entire process from the patient’s initial visit to desensitization therapy. The solution uses AI algorithms to reusable existing patient data and analyze patient history, correlate symptoms, medications, and allergen exposure, streamlining diagnostics and treatment. Patients at high risk undergo a computer-assisted interview to determine allergen panels. The only manual step is applying allergens to the skin, after which AI performs the reading and diagnosis.

Clinical trials involving around 300 patients demonstrated high sensitivity and specificity, along with significant time savings for allergists and other medical staff, averaging 40 minutes per patient. The HTA evidence base will be ready by the end of this year.

Lessons

The integration of this AI-supported diagnostic method can eliminate bottlenecks in allergy diagnostics, improving health outcomes and reducing healthcare costs. However, its effectiveness depends on having at least few years of patient treatment data available. Without access to patient data, the method can be used in part to objectify PRICK test readings.

Key messages

• AI-supported diagnostics streamline allergy testing, reducing time and costs in the healthcare system.

• The most accurate technique currently available for the automated reading of test results is that which evaluates the response to an allergen in the dermis in two spectra.
Applying knowledge translation for an effective use of Burden of Disease
Authors: Hilderink H
Published: October 2024

Burden of disease, expressed in disability-adjusted life years, is a very powerful metric to assess population health. It combines both mortality, i.e. years of life lost, and morbidity, i.e. years lost due to disability and is increasingly used within public health policy making. However, the substantial demand for (good quality) data, the involved methodological choices and the complexity of the concept make it also challenge to calculate Burden of Disease and to have the results properly used, e.g. in the policy making process. The concept of Knowledge translation provides a systematic way of dealing with the synthesis, dissemination, and application of research findings to improve health outcomes and inform policymaking. Understanding the burden of disease is fundamental to effective knowledge translation, as it helps prioritize research efforts, target interventions to address the most significant health challenges, and allocate resources efficiently. The four different models of knowledge translation, i.e. the push, pull exchange and integrated model, provide a sound theoretical basis to strengthen the use of burden of disease in policy making. To have an effective way of knowledge translation, the following basic facets are important: timing of providing results, having policy-relevant results, for whom are the results relevant and in what way to get the results to a potential user. This presentation will focus on how to deal with these different aspects, building on experiences of burden of disease studies throughout Europe.
Using electronic health records in assessing the prevalence of hypertension in Kyrgyzstan
Authors: Arykova A , Laatikainen T , Borubaev M , Duishenalieva M , Altymysheva A , Polupanov A
Published: October 2024

Background

Non-communicable diseases are an increasing challenge in Kyrgyzstan as well as in other parts of Central Asia. However, there is very little epidemiological data on disease burden in the country. The development of electronic health records in primary health care provides an opportunity to assess the disease incidence and prevalence among patient population.

Methods

All patients with hypertension (HT) diagnoses (ICD-10 I10-I15) were identified from electronic health records used in primary health care in Kyrgyzstan from years 2021, 2022 and 2023 from all 7 regions and Bishkek and Osh cities (n = 132621-152743). Each year, all patients diagnosed with HT during that year or in previous years were included, while those who had passed away were excluded. The incidence and prevalence of patients was calculated using as denominator both the patients who had visited the services as well as registered patients.

Results

The prevalence of patients with hypertension calculated using patients with service use as denominator varied by region between 10.2% to 14.0% and was pretty stable during the observed period. The prevalence was the lowest in Chui region and the highest in Bishkek city. When the prevalence was calculated using the registered patient population the prevalence was only between 1.5% to 3.1%.

Conclusions

The observed prevalences were notably lower compared with data from WHO Steps surveys, which have reported a hypertension prevalence more than 40% among individuals aged 25 to 64. It is known that only approximately 25% of the population in Kyrgyzstan utilize primary healthcare services, with maternity care comprising the largest portion. This factor, coupled with cases that go undiagnosed, could potentially account for the observed low prevalence in electronic patient data. However, the electronic patient records provide useful information on diagnostics and disease burden in the country that can be used in developing the services.

Key messages

• Electronic health records have developed quickly in Kyrgyzstan and enable extraction of patient data from primary health care.

• The low use of primary health care services complicates the use of register data in assessing the disease prevalences.
BELCOHORT: towards a population-based cohort for health research and policy support in Belgium
Authors: Smith P , Bruggeman H , Van der Heyden J
Published: October 2024

Background

In the past decades much progress has been made in Belgium in the development and valorisation of population-based data collections which are directly or indirectly related to health. New surveys have been set up and the use of medico-administrative and environmental data for public health research gained momentum. However, no infrastructure is currently in place to link survey data with existing sources in a longitudinal perspective to address research questions directly relevant to health policy. BELCOHORT is a three-year pilot project aimed at developing a population based cohort enriched with these different data sources. The project is considered as a step towards a large population cohort in Belgium.

Methods

A first wave of participant recruitment was organized in February 2024 using the Belgian national register as a sampling frame, and 41,153 households were invited (targeted sample of 5000 individuals aged 18-69). A first baseline survey (online and paper) was organized and an annual follow-up is planned. Linkages procedures will be implemented with administrative data and geospatial data on air pollution and green space. The inclusion of data from physical examinations and biological samples will be explored.

Results

In the first recruitment wave the individual response rate was only 2.5%, leading to a sample of 1,947 participants. The sample showed an under-representation of women (45%), people aged 18-24 years (2%) and low educated people (21%). In total, 23% of participants opted to complete the first baseline questionnaire on paper. Stakeholder meetings have been started to implement the individual and geospatial linkages.

Conclusions

This project generate insights that will assist in methodological choices in the development of a large population cohort in Belgium. In the second recruitment lessons learned from the first data collection will be used to improve the response rate as well as the participation of under-represented groups.

Key messages

• This study provides insights on how existing population-based data collections including administrative and environmental data can be valorized in setting up a population cohort.

• Recruitment strategies for a population cohort should be tested thoroughly and adapted in order to obtain a well-balanced sample composition.
Global health at local level: characterization of tropical diseases in northern Portugal, 2020-2024
Authors: Malcata F , Silva D , Guedes R , Mendes M , Teixeira R , Ferreira A
Published: October 2024

Background

The escalating global prevalence and geographic spread of tropical diseases pose significant global health risks worldwide, with local implications. In Portugal, these diseases require mandatory notification. Concerns were raised following the detection of Aedes albopictus mosquitoes in mainland Portugal in 2017, alongside a Dengue outbreak in Madeira in 2012. Despite Portugal being declared malaria-free, the detection of Anopheles mosquitoes also raises concerns. This study aims at characterizing notified cases of tropical diseases in two cities in Northern Portugal since 2020.

Methods

A retrospective study of Malaria, Dengue, Zika, and Chikungunya cases in the Maia & Valongo’s Public Health Unit included data from the National Epidemiological Surveillance System covering January 2020 to April 2024. Descriptive analysis was conducted using SPSS IBM for iOS® v29. Results are presented as mean ± standard deviation for continuous variables and proportions for categorical ones.

Results

Five malaria cases were reported, predominantly affecting males (80%), with an average age of 34±16.96 years. Four were Portuguese and one Angolan. All cases were imported, mostly from Angola (80%). Etiological analysis revealed two cases of Plasmodium malariae and three of Plasmodium falciparum. All were hospitalized, no deaths. Four dengue cases were documented, 50% in males, averaged 33±24.73 years. Three were Portuguese and one Mozambican. One was hospitalized with no deaths. All cases were imported from Brazil, Cuba, Indonesia, and islands of Saint Martin/Saint-Barthélemy. No Zika or Chikungunya confirmed cases were identified during this period.

Conclusions

The increasing incidence of Dengue and Malaria underscores the critical connection between infectious diseases, vector ecology, and global health security. This study highlights the risk of imported Dengue and Malaria cases, emphasizing the imperative for surveillance and preventive actions to protect public health.

Key messages

• Dengue and Malaria cases in Portugal underline the importance of international collaboration and robust strategies.

• Stepped-up surveillance is key to protecting vulnerable groups from imported infections.
One Health literacy and governance of health leaders across three countries following the pandemic
Authors: De Gani S M , Crimlisk H , Bauer B , Desmedt M , Blankart C R
Published: October 2024

Background

To address health threats and promoting health of all, One Health is an important approach. To foster the implementation of One Health, a framework proposed by Blankart et al. (2024) postulates a reinforcing relationship between One Health literacy and governance after being triggered by an external event. We build on this model and aim to explore how the postulated mechanism differs among health policy and practice leaders across the UK, Germany, and Switzerland after the external triggering event of the COVID-19 pandemic.

Methods

We developed an online survey instrument for each of the 5 elements of the framework and conducted it in April 2024. We targeted mid- and end-career leaders and senior experts from the Sciana network that reported about their personal experiences and perceived changes (scale from -5 to + 5). We performed descriptive and inferential statistics to analyse the data. The survey was complemented by structured interviews to gather contextual information.

Results

Leaders and experts (N = 30, response rate: 30%) increased their One Health literacy (mean: 2.2), increasingly engaged with One Health principles (mean: 1.0), which resulted in more calls for optimized One Health governance (mean: 2.4). The interviewees reported that they adopted and implemented a more consistent One Health governance (mean: 2.6), which led to more familiarity with One Health principles (mean: 2.3). According to the results, the average effect on One Health literacy and Governance was stronger in Germany, followed by Switzerland and the UK.

Conclusions

We have demonstrated that triggering events such as the COVID-19 pandemic have led to improvements in One Health literacy and subsequently One Health governance. We therefore suggest that the postulated framework holds in practice and have showed that there are important differences in uptake between leaders in the three countries. Further research may build on these findings and develop more effective health policy.

Key messages

• We have contributed to the understanding of how pandemics improve One Health literacy and subsequent One Health governance using the example through a survey of leaders in health policy and practice.

• Based on the understanding of triggering events’ effect on One Health literacy and governance specific recommendations for the implementation of One Health in public health can be developed.
Key competencies for global health research: systematic literature review and mapping
Authors: Saint V , Detering B , Franke A , Eger H , Oppenberg J , Rohleder S , Bozorgmehr K
Published: October 2024

Background

Despite a boom in global health programmes and trainings, there is a lack of clarity and standardisation about which competencies are essential for researchers in global health, who stem from diverse disciplines and backgrounds. The objective was to map key competencies for global health research and approaches to progressively develop them in education and training.

Methods

We performed a systematic review in English in PubMed/MEDLINE, Web of Science, and Psychinfo/EBCSO host of literature published since 1 January 2010. 1827 articles were screened in duplicate. Data was extracted from 84 publications about focus in global health, recommended competencies and educational approaches, with two researchers giving a relevancy rating. AI-assisted extraction was conducted on 40 high-relevance publications to garner further information, informing development and application of a coding framework to these articles.

Results

Emerging results point to eight main domains and numerous subdomains related to competencies seen as critical for global health research. In addition to traditionally emphasised cognitive competencies (e.g. methodological), the literature underlined the importance of critical analyse of how systems related to globalisation, political economy and structural injustice shape health at local level. Also highlighted was the need for more focus on affective and practical competencies for conducting global health research in alignment with equity principles, including through innovative pedagogical approaches.

Conclusions

Our review identifies competencies seen as essential for global health researchers, including skills to critically analyse geopolitical, colonial and structural drivers, as well as self-reflexivity, (cultural) humility and other key affective competencies. It also highlights, however, the significant diversity of perspectives, lack of consensus, and ongoing disconnect between principles and practice.

Key messages

• Greater clarity and consensus is needed around the specific competencies required to work as a researcher in global health, taking account of diversity across disciplines, sectors and stages.

• Global health researchers require skills to critically analyse geopolitical, colonial and structural drivers, as well as self-reflexivity, (cultural) humility and other key affective competencies.
Barriers to a sustainable living in Italy: results of a national survey
Authors: Favero B , Miotto E , Smaniotto C , Furmenti M F , Palandri L , Voglino G , Cannone S , Adamo G , Parpinel M , Brunelli L
Published: October 2024

Background

Sustainable living plays a crucial role in creating a fairer society, but various constraints prevent consumers from adopting sustainable behaviours. This study investigated the reasons for non-adoption of sustainable products or behaviours among the Italian population.

Methods

From January to June 2023, we surveyed the Italian population using a 40-question online survey that asked about knowledge, awareness, and attitudes toward sustainable behaviours and products. Participants were asked about the reasons why they did not engage in a certain behaviour or did not use a selected product. Descriptive statistics, t-test and chi-square tests were performed to assess association with participant characteristics.

Results

The 420 participants had a median age of 39 years (interquartile range: 32-56), 66% were female. The largest discrepancy between knowledge of sustainability impacts and implementation was in the personal care (92% knowledge, 31% implementation) and transportation (85% knowledge, 48% implementation) domains. In general, the main reasons for not using the surveyed products were practical complications in everyday life (25%), the difficulty of finding or producing them (23%) and their cost (13%). Specifically, practical complications (42%) were the main reason for not adopting sustainable behaviours in the transport domain. In the personal care domain, low confidence in product quality or ignorance of their existence accounted for only 26% of reasons for non-use, while supply problems, practical complications in everyday life and existence unawareness accounted for 61%.

Conclusions

Targeted measures are needed to address the reasons for non-use or adoption of sustainable products and behaviours. In this way, these actions will help to promote healthy living, protect our planet, support socio-economic development, and ensure global prosperity.

Key messages

• A greater sustainability- implementation awareness gap was found in personal care and transportation domains.

• The main reasons for not implementing sustainable living were practical complications in daily life, supply difficulties and product cost.
Food insecurity is associated with poor mental health and health risk behaviors in Czechia
Authors: Ohno M , Dzúrová D
Published: October 2024

Background

Food insecurity (FI) is one of social determinants of health and a profound public health concern because it leads to malnutrition and hence poor health. COVID-19 impacted people disproportionately and exacerbated preexisting social and health inequalities. The aim of this study was to understand how socioeconomic and health conditions affected one’s FI in Czechia during the pandemic using a representative panel of Czech adults from a longitudinal survey, Life During the Pandemic collected in October 2022 as part of a Czech longitudinal survey.

Methods

A study sample of 1,499 respondents was included in our multiple logistic regression models. Depressive symptoms and anxiety symptoms were assessed using validated questionnaires PHQ-2 and DAG-2.

Results

Approximately one third of the study sample (32.4%) reported being food insecure. In the fully-adjusted model, adults with depressive symptoms (OR 2.37, CI 1.49, 5.02), problems with sleeping (OR 2.20, CI 1.64, 2.96), smoking habit (OR 2.27, CI 1.68, 3.07), lower fruit and vegetable consumption (OR 1.50, CI 1.04, 2.17) had greater odds of experiencing FI. The lowest income group was associated with 6.2 times greater odds of reporting FI as compared to the high-income group (CI 3.96, 9.67). Lower education attainment also had higher odds of experiencing FI (OR 2.15, CI 1.40, 3.31). Anxiety was not a significant predictor for FI.

Conclusions

Our study highlights that food insecurity is associated with depressive symptoms, poor quality of sleep and lower consumption of fruit and vegetables among adults. Food insecurity was also evident among lower income and lower education attainment.

Funding source

This study was supported by The Charles University Grant Agency (GA UK).

Key messages

• Our study suggests that adults with poor mental health and diet quality experience food insecurity.

• Given the established link between a balanced diet and mental well-being, interventions should encompass not only food security but also the quality of dietary intake.
3.A. Round table: Towards a research agenda for burden of disease studies
Authors:   Organised by: EUPHA-ECO, European Burden of Disease Network, OECDChair persons: Vanessa Gorasso (EUPHA-ECO), João Vasco Santos (EUPHA-ECO)
Published: October 2024

What are the most relevant diseases in a country? Which risk factors are the strongest contributors to disease and death? How is the impact of different diseases evolving over time, and how does it compare between countries and within subnational units? As the need for prioritising the use of available resources constantly increases, a timely, sound and comprehensive answer to these fundamental questions is more than ever needed to inform public health decision-making. Driven by the impact of the Global Burden of Disease study, several researchers and national and international health institutes have adopted the burden of disease approach to address these questions. The complexity of the burden of disease approach however resulted in major disparities in research capacity across Europe. Furthermore, the current burden of disease landscape remains scattered, and researchers struggle to translate their findings to decision makers. The European Burden of Disease Network (COST Action CA18218) addresses these challenges by acting as a technical platform for integrating and strengthening capacity in burden of disease assessment across Europe and beyond. The different activities of the Network have helped to improve the quality and comparability of burden of disease estimates and increase their use in policy and practice. However, still many challenges remain. As a way of looking into the future applications of the burden of disease metrics, the European Burden of Disease Network took the initiative of developing a research agenda based on barriers and weaknesses identified within the activities of the network and input from researchers working regularly with burden of disease. As an initial step, a series of systematic literature review was carried to identify barriers and weaknesses in the computation of burden of disease estimates. These highlighted the differences in methodological choices that could hamper the comparability of results. This point was later identified as a key element of future development (abstract one). Secondly, the members of the network were consulted. Online questionnaires and structured consultations led to the identification of four main pillars of the future research agenda: transparency and availability, refining current methods, new applications, and prioritization of topics.

In this workshop, we will present different activities within and outside the Network that correspond to the four pillars above described (abstract 2-4) and start the reflection on the future of burden of disease estimated.

Key messages

• Despite the wide use of the burden of disease approach, many challenges were identified in the replication of the methods and the need for further developments.

• A new research agenda for burden of disease estimates will formalize a way to strengthen methodologies, interpretations and applications.
Implementing patient navigation for cancer prevention among individuals with mentally ill-health
Authors: Bempi V , Radaios V , Karnaki P , Zota D , Gómez Trenado R , Kostyla M , Mancebo Salas N , Zioga I , Schäfer K , Grabovac I
Published: October 2024

Issue

In Europe, over 80 million people experience mental ill-health and there are 4 million new cancer diagnoses each year. Individuals experiencing mental ill-health exhibit higher rates of cancer morbidity and mortality, with this excess attributed to risky health behaviors and obstacles encountered when accessing often fragmented healthcare systems.

Description of the problem

The aim of Co-CAPTAIN is the pilot implementation and evaluation of the Patient Navigation Model (PNM) for the improvement of primary cancer prevention in individuals with mental ill-health, adapted through participatory co-design in the European context. The project will adopt a cohort-based study design, commencing data collection at baseline and succeeded by three follow-ups (6 weeks, 9 months, 18 months). It will utilize a mixed-methods approach, combining quantitative and qualitative methodologies to assess diverse outcomes of PNM, facilitating both exploratory and confirmatory research. Qualitative data will be obtained through semi-structured interviews, while quantitative data will be collected using validated questionnaires and items developed ad hoc. The project will involve four pilot sites in Europe (Austria, Greece, Poland and Spain), where the PNM will be adapted to the specificities of national healthcare and support systems. The implementation phase is expected to begin in June 2024.

Results

During implementation, gathering both quantitative and qualitative data will offer valuable insights into feasibility and effectiveness, establishing a baseline for reshaping health and social care policies for individuals with mental ill-health across Europe.

Lessons

Co-CAPTAIN project aims to reduce health disparities for individuals with mental ill-health by improving overall health and reducing cancer burdens, leading to cost reductions in European health and social care systems.

Key messages

• The project aims to deliver an innovative solution based on the PNM, to address health disparities among individuals with mental ill-health by reducing cancer burden.

• Combination of qualitative and quantitative methodologies to assess diverse outcomes.
Quality of life in people with multiple sclerosis vs general population: differences increase by age
Authors: Fricke L M , Krüger K , Krauth C
Published: October 2024

Background

To enhance health care for chronically ill people, it is crucial to understand the impact of their disease on health-related quality of life (HRQoL). More than 240,000 people in Germany live with multiple sclerosis (PwMS), the most common immune-mediated neurodegenerative disease of the central nervous system. Little is known about HRQoL in PwMS in comparison to the general population and by subgroups.

Methods

In 2021, 6,928 statutorily-insured PwMS aged ≥18 years and living in the federal state of Lower Saxony, Germany, were invited to take part in an online survey. The German EQ-5D-5L value set was used to analyse HRQoL by index values. Descriptive subgroup analyses were conducted (age, sex) and compared to a general German reference population (Grochtdreis et al. 2019, DOI: 10.1007/s10198-019-01054-1). Mann-Whitney-U- or Kruskal-Wallis-tests were performed as appropriate.

Results

Of 1,935 respondents (response rate 27.9%), 1,916 PwMS were included in the current preliminary complete case analysis. HRQoL is reduced in PwMS compared to the general population: Mean (M) 0.67 vs. M 0.88, respectively. While no significant differences by sex were found in PwMS (male: M 0.66 vs. female: M 0.68, p = 0.1), HRQoL decreased with increasing age (p < 0.001). The reduction in HRQoL is more pronounced in PwMS than in the general population (difference between means 0.53 in 18-24 years old to ≥ 75 years old PwMS vs. 0.14 in the reference population, respectively).

Conclusions

PwMS report an overall lower level of HRQoL compared to the general population. Increasing age correlates with a substantial decrease of HRQoL in PwMS. Targeted research is needed to improve HRQoL of this vulnerable population.

Key messages

• The decline in HRQoL with increasing age is more pronounced in PwMS than in the general population in Germany.

• Further research should focus particularly on the extent to which MS-related factors are solely attributable for the considerable decline of HRQoL in PwMS.
The Role of Faith in Medical Decision-Making
Authors: Tur-Sinai A , Neriya-Ben Shahar R , Yuval F
Published: October 2024

Background

Ultra-Orthodox Israeli Jews face complex decisions when their doctors’ instructions contradict their rabbis’ advice. This study examines how their belief system affects their trust and decision-making in such situations, using socio-economic club theory and Gilligan’s listening guide.

Methods

Excerpts from 16 focus groups with 128 ultra-Orthodox Jews were analyzed to understand their perspectives on the relationship between doctors and rabbis. The socio-economic approach of Berman’s club theory was applied to explain their behavior, and Gilligan’s listening guide was used to analyze the focus group results.

Results

The strict behaviors in the relationships between doctors, rabbis, and patients function as social capital, raising the status of ultra-Orthodox Jews as members of an exclusive club. They balance critical health decisions with the social demand to obey religious leaders. However, listening to different voices (‘I,’ ‘we,’ and ‘they’) provides nuanced insights into their decisions, revealing dynamic changes in the community’s perceptions of the doctor-rabbi relationship and varying perspectives within the heterogeneous ultra-Orthodox community.

Conclusions

Combining Berman’s theory with Gilligan’s listening guide is an effective method for conducting in-depth qualitative research on sensitive issues with religiously strict groups. Understanding the belief systems underlying healthcare decisions is essential for providing culturally sensitive medical care to religious communities and training medical staff serving these communities.

Key messages

• Ultra-Orthodox Jews balance complex health decisions with social demands, revealing nuanced perspectives through strict doctor-rabbi relationships.

• Combining theories and qualitative methods effectively studies sensitive issues in religious groups, informing culturally sensitive healthcare.
An Innovative Public Health Solution with European Features for an American Problem
Authors: Maykrantz S , Diriker M
Published: October 2024

Problem

The Eastern Shore of Maryland is a beautiful region that boasts a multicultural community of 455,000 year-round residents. Despite its rural location, the coastal lifestyle attracts retirees, making it the state’s oldest population. Unfortunately, the region also has the highest socioeconomic disparities in the state, which creates difficulties in accessing healthcare. This is a significant public health issue that results in costly barriers to preventive care and timely, accounting for $320 billion in unnecessary healthcare spending.

Description of the problem

Maryland’s healthcare funding formulas favor larger health systems in urban areas, leading to health inequities. To address this, we propose an innovative scenario analysis model partially based on European public health approaches. This model will adjust funding formulas based on each region’s specific needs and challenges, promoting fairness and equity in healthcare funding.

Results

Adopting this population health management approach would have built-in efficiencies: In the United States, healthcare spending tends to be higher among underserved populations due to delayed care, access challenges, missed diagnoses, and limited access to the latest scientific advances as well as proper preventive services.

Lessons

The proposed scenario-based public health funding approach targeting the needs of the underserved population on the Eastern Shore of Maryland could yield significant positive health outcomes and health savings generating a ripple effect across the state, and perhaps even the country. The lessons learned in how other countries handle public health funding could lead to global collaboration.

Key messages

• Our approach aims to provide a practical solution to unnecessary healthcare spending.

• We must adapt to the changing tides to stay on course.
Formalizing the role of community key individuals in Utrecht, the Netherlands
Authors: Hintaran P , Sarolea C , El Loukili M , Bah M
Published: October 2024

Issue

The disconnect between (underserved) communities and governmental bodies in Utrecht, The Netherlands, has led to uneven access to (essential) healthcare services, increasing health inequalities. This gap is often bridged by key community individuals, whose roles have historically been informal. Key individuals are often seen as volunteers who are necessary to gain access to certain communities but are rarely seen as equals in a project team, resulting in mistrust and reduced collaboration on the long term on the side of the key individuals.

Description of the problem

This practice describes the start of a new foundation in Utrecht that formalizes and compensates key individuals’ roles in public (health) projects. The aim was to empower them and to encourage continued participation.

Effects

In 2024, the foundation supported key individuals in three government projects, including a childhood vaccination awareness campaign. Interviews revealed that key individuals felt more empowered and equally valued compared to other project members. They also felt a strong responsibility for project success. However, some noted that formal structures could be restrictive. The government felt more convenience working with a formal foundation.

Lessons

Empowering key individuals is crucial for effective collaboration in public health. There needs to be a balance between formal structures and the flexibility of informal approaches to prevent barriers for key individuals to participate in government projects.

Key messages

• Formalizing key individual roles enhances public health interventions.

• Fair compensation to key individuals fosters sustainable collaboration.
Regional variations in breast cancer screening uptake and its associated factors in Ghana
Authors: Wongnaah F , Aboagye R , Storph R , Seidu A , Adnani O , Ahinkorah B
Published: October 2024

Introduction

Timely identification of breast cancer is critical for successful treatment and prevention, reducing its burden. Despite its significance, breast cancer screening services in Ghana are underutilized, with considerable regional variations in uptake rates. We examined the regional differences in breast cancer screening uptake and its associated factors in Ghana.

Methods

We analyzed data from 15,014 women of reproductive age from the 2022 Ghana Demographic and Health Survey. Spatial mapping illustrated regional variations in screening uptake. Multilevel logistic regression was employed to examine the factors associated with breast cancer screening uptake.

Results

National breast cancer screening prevalence was 18.4%, with regional variations observed across the 16 regions. Eastern, Western, Brong Ahafo, and Greater Accra had the highest screening uptake. The likelihood of breast cancer screening was higher among women aged 45-49 (aOR = 3.59; 95% CI = 12.52, 5.12), Married women (aOR = 1.44; 95% CI = 1.17-1.77), Higher education, employment, health insurance, recent health facility visits, media access, and wealth index (middle: aOR = 1.45, 95% CI = 1.08, 1.94; richest: aOR = 1.91, 95% CI = 1.36, 2.70). Islamic and African Traditional affiliations decrease screening likelihood (aOR = 0.77; 95% CI = 0.63, 0.95; aOR = 0.46; 95% CI = 0.22, 0.97). Rural residence and specific regions (Ashanti, Oti, Savannah, Upper West) reduce odds, while living in North East increases odds (aOR: 1.86; 95% CI = 1.14-3.03).

Conclusions

Cost-effective breast cancer screening services are crucial, particularly in rural areas with geographical disparities. Culturally and religiously sensitive protocols are needed to address regional and religious differences. Expanding Ghana’s national health insurance to cover preventive measures like breast cancer screening is essential. Promoting awareness through conventional and digital platforms is crucial for advocating screening.

Key messages

• Addressing geographical and cultural differences crucial for equitable breast cancer screening in Ghana.

• Expanding health insurance and raising awareness vital to promote screening access and reduce disparities.
Prioritizing health, well-being, active ageing needs in Lithuania: insights from stakeholders
Authors: Domeikiene A , Danuseviciene L , Sileikiene L , Paulauskiene J
Published: October 2024

Background

The rate of aging in Lithuania is faster than the EU average. The number of long-term health problems in older (65+yrs) people increases, posing changes in societal needs. The aim of our study was to identify the most important needs of older people in Lithuania.

Methods

Generic qualitative inquiry employed purposeful sampling of stakeholders in Lithuania: policymakers, administration, academia, civil society, health care, social service, public health, organizations of elderly. 43 experts, engaged in online focus groups, generated a list of needs for health, wellbeing, active ageing in elderly; they deliberated to prioritize top 5; scientific team condensed a list of 10 for voting to determine final 5 national needs. Research was done within project “Roadmap to improve the health and well-being of the ageing population in the Baltic Sea Region (AgeFLAG)”, 2020.

Results

Top needs identified were: shaping healthy lifestyle habits and motivation for change (72%) / age friendly environment and virtual assistive technologies (72%); person centred care (domiciliary care, residential care and nursing, social activities and etc. depending on the needs and wishes of the older person) (58%); increasing and maintaining physical capacity (56%); intersectoral collaboration and integration of social and health services (53%); establishment of positive public attitudes towards elderly people (50%). All stakeholders indicated that “Establishment of positive public attitudes towards elderly people” is the corner stone of all priorities for action to healthy ageing in Lithuania.

Conclusions

The main issue hindering active and healthy ageing in Lithuania - negative image of ageing in the society. Recommendations on the public health actions included promoting intergenerational conversation, reducing stigmas around ageing, strengthening social inclusion, generating age-friendly environments, and creating a safe space for self-realization and development.

Key messages

• The main issue hindering active and healthy ageing in Lithuania – negative image of ageing in the society.

• The change in the population requires the transformation of health care and social care systems building age friendly environments in Lithuania.
Associations between diabesity and mortality over 7 years: a Maltese population-level case study
Authors: Cuschieri S , Grech E , Cuschieri A
Published: October 2024

Introduction

Diabesity presents a growing global epidemic. Demographic and socioeconomic associations have been documented, yet, the literature on mortality risk associated with diabesity is scarce. The aim of this study was to assess whether diabetes and/or diabesity increas the risk of all-cause mortality across a period of 7 years at a population level.

Methods

A nation-wide health examination survey in Malta was conducted between 2014 and 2016. This collected sociodemographic information, bio-anthropometric measurements (waist circumference, body mass index [BMI], body adiposity index [BAI]) and blood samples. Mortality information was acquired in 2021 by cross-referencing with the national mortality register. Statistical analysis was conducted using chi-square tests and Cox proportional hazard models.

Results

A mortality rate of 1.67% was observed (n = 3947), with diabetes and obesity being responsible for 6.06% and 3.03% of deaths, respectively. Examining the deceased individuals alongside their baseline characteristics (2014-2015) revealed that 25.76% (CI95%: 16.75 - 37.44) had diabetes, and 30.30% (CI95%: 20.55 - 42.22) were obese. Diabetes was associated with significant mortality risk (HR: 2.65 CI95%: 1.20 - 5.85; p = 0.02), while diabesity showed borderline significance (p = 0.06). After adjustment for potential confounding factors the mortality risk linked to diabetes remained significant and BAI was the only anthropometric measurement positively associated with mortality.

Conclusions

These findings emphasise the urgency for comprehensive public health policies targeting the concurrent prevention and management of diabetes and obesity at a population level. Our results also indicate that incorporating body adiposity index (BAI) into risk assessment protocols may provide valuable insights into mortality risk prediction and inform tailored interventions.

Key messages

• Diabetes and a high BAI score were significantly associated with mortality in the Maltese population, while diabesity had moderate significance, emphasising the urgency of tackling this epidemic.

• These findings call for broad health policies to address diabesity at a population level and suggest integrating BAI into risk assessment for better mortality prediction and tailored interventions.
Joint Action JACARDI: a context analysis on CVDs and diabetes policies and practices
Authors: Di Girolamo C , Turatto F , Destefanis C , Formenti B , Armocida B , Lionello L , Jehlicka L , Costa G , Savoia C , Onder G
Published: October 2024

Issue/problem

Non-communicable diseases are the leading cause of death and disability in Europe, with 63 million people living with cardiovascular diseases (CVDs) and 32 million with diabetes (DM) in 2019. The EU-co-funded Joint Action on CVDs and diabetes (JACARDI), with 76 partners from 21 countries, aims to reduce CVDs and DM burden at European level through 142 pilot projects.

Description of the problem

For an effective and tailored pilots’ implementation, a preliminary step is to assess the current state of strategies and services for CVDs and DM prevention and management in Europe. We adopt the Gap Analysis methodology aiming to evaluate the gap between the current and the ideal state, the latter defined according to scientific evidence, best-practices, guidelines, and expert’s opinions. For this purpose, 12 questionnaires, one for CVDs and one for DM for six different thematic areas, were developed through a participatory approach that fostered the collaboration between the scientific coordination team and the project members.

Results

Questionnaires were sent to National Focal Points for health covering 29 European countries. We anticipate receiving responses from each country covering aspects related to the legal and strategic framework, the intersectoral and equity-oriented approaches, the funding and the service delivery and capacity for CVDs and DM. This information will be collected across each of the six thematic areas corresponding to six technical Work Packages (WP): health literacy, data, screening, integrated-care pathways, patients self-management, labour participation. The survey will be completed by June 2024, and results by WP and country will be presented.

Lessons

The context analysis, based on the Gap Analysis methodology, allows to identify gaps between the current and ideal state in CVDs and DM prevention and management. This will guide JACARDI’s pilots to address gaps and serve as a roadmap to inform European policy-makers.

Key messages

• The context analysis will provide an invaluable overview of the current European state of CVDs and DM prevention and management.

• The context analysis will support JACARDI’s pilots in addressing identified gaps and policy-makers in shaping public health responses.
Primary prevention of type 2 diabetes in the EU: A systematic review of interventional studies
Authors: Lovas S , Soares Andrade C A , Mahrouseh N , Chamouni G , Shahin B , Wangeshi Njuguna D , Israel F , Awad Mustafa Eltayeb O , Aisul Muhlis A N , Varga O
Published: October 2024

Background

The GBD 2019 study revealed that type 2 diabetes caused over 109.000 deaths and accounted for 5.3 million Disability Adjusted Life Years in the EU, with an estimated annual cost of EUR 300 billion in 2014. Interventions for primary prevention are pivotal in preventing diabetes, providing a structured approach to implementing lifestyle modifications or community-based programs. The objective of this study was to demonstrate the effectiveness of primary prevention interventions to prevent or delay the onset of type 2 diabetes in the EU member states.

Methods

A systematic review on six databases was conducted for relevant interventional studies carried out in the EU-28. The main outcome of the studies was determined by changes in the incidence of type 2 diabetes.

Results

The search yielded 18.885 records, of which 18 met the eligibility criteria. The following studies reported significant incidence reduction in the intervention groups: The Finnish Diabetes Prevention Study by individualised lifestyle intervention (HR: 0.614, 95%CI: 0.478-0.789), the Spanish CORDIOPREV Study through increased plant protein intake (HR: 0.64, 95%CI: 0.43-0.96), the Spanish PreDE trial by promoting healthy diet and physical exercise (RR: 0.68, 95%CI: 0.47-0.99), the Norfolk Diabetes Prevention Study with intensive diet-exercise counselling (OR: 0.57, 95%CI: 0.38-0.87), the Spanish PREDIMED and PREDIMED-Reus trials by mediterranean diet supplemented with extra virgin olive oil or mixed nuts (HR: 0.60, 95%CI: 0.43-0.85; HR: 0.49, 95%CI: 0.25-0.97; HR: 0.48, 95%CI: 0.24-0.96), and the Dutch SLIM Study with advices on diet and physical activity (RR: 0.53, 95%CI: 0.29-0.97).

Conclusions

Significantly decreasing the incidence of diabetes is feasible within primary healthcare settings through intensive lifestyle interventions targeting individuals at high risk. Therefore, it would be beneficial to incorporate these findings into the European guidelines for preventing type 2 diabetes.

Key messages

• Primary care plays an important role in the prevention of type 2 diabetes.

• Well-defined primary lifestyle interventions are capable of slowing the progression from prediabetes to diabetes.