bluuebunny/crossref_metadata_2025 huggingface dataset:
Sars-CoV2 in wastewater: 2021-2023 surveillance in three provinces of Lombardia region (Italy)
Authors: Bertasi B , Galuppini E , Mangeri L , Tilola M , Righi F , Losio M N ,   Lombardia network for Sars-CoV2 wastewater surveillance
Published: October 2023

Background

Sars-CoV2 pandemic has shown the importance of wastewater surveillance to monitor virus diffusion and its environmental permanence; WHO experts highlighted the importance of wastewater controls as early detection system to individuate Sars-CoV2 and other viruses which could potentially spread to the population. The aim of this work was to investigate the presence of Sars-CoV2 in wastewater from Brescia, Cremona and Bergamo cities during 2021-2023 years after pandemic event.

Methods

From the end of 2021 until now, 341 wastewater samples were collected and analyzed at Food Control department to detect Sars-CoV2. After the inactivation at 56 °C for 30 minutes, samples were centrifugated and extracted by eGENE-UP® system (bioMérieux). Virus detection was based on three genes amplification: ORF, N1 and N3. Quantification in genome copies/µL (cg/µL) was performed.

Results

Almost all samples were positive for virus presence; in particular ORF gene was detected in 94% of samples (IC95% 91,6 - 96,7%); the other genes N1 and N3 were detected respectively in 91% (IC95% 87,2 - 93,6) and 98% (IC95% 95 - 99%). In only three samples all genes simultaneously were not detected. ORF and N1 were quantified between 103 and 104 cg/µL without differences among seasons. N3 was quantified at higher values than the other genes (104 in 57% of samples; IC95% 51,4 - 62,2%).

Conclusions

The pandemic has run out with the safety measures applied, but wastewater surveillance has highlighted virus circulation, even if at lower, constant levels than in pandemic period. Virus quantity in wastewater followed and sometime preceded epidemic trend. Wastewater control could support competent authorities in epidemic event management.

Environmental surveillance, as already demonstrated during pandemic period, could represent an alert system for Sars-Cov2 and oral fecal route virus spreading

Key messages

• Wastewater surveillance is an important tool to control Sars-CoV2 mutation and spreading.

• Environmental viruses’ surveillance can support competent authorities in decisions regarding public health.
Sentiment towards vaccinations in healthcare workers of five European countries after the pandemic
Authors: Regazzi L , Cadeddu C , Valz Gris A , Lomazzi M
Published: October 2023

Background

Health care workers (HCWs) are a trusted source of vaccine information for patients and communities. Our aim is to evaluate the impact of the COVID-19 pandemic on European HCWs’ sentiment towards vaccination (STV), focusing on COVID-19 and influenza.

Methods

We designed a multilingual Knowledge-Attitudes-Practice web-survey with 4-point Likert items addressed to HCWs in 11 countries and spread through national Public Health Associations. We present a preliminary analysis of responses from France (n = 206), Germany (n = 376), Italy (n = 394), Spain (n = 549) and the United Kingdom (n = 172, UK).

Results

The completion rate is 81% (1,374/1,697). Respondents are mostly female (66%), with a median age of 45, mainly employed as physicians (44%). HCWs agree on the effectiveness (92%), safety (89%) and necessity (91%) of vaccinations in general, but many think that their side effects are downplayed by pharmaceutical companies (46%) and health authorities (39%). The majority received 3+ doses of COVID-19 vaccines (72%) and agree that these vaccines are effective (88%) and have a favorable benefit-risk ratio (83%). However, many have concerns about their administration in pregnancy (76%). Most HCWs agree with mandatory COVID-19 vaccine for their category (59%) and are ready to accept a further COVID-19 booster vaccination if recommended (72%). The majority agree that the pandemic increased their attention to update their vaccination schedule (62%) and their confidence in vaccines safety (53%). Accordingly, only 50% received regular influenza vaccination prior to the pandemic, whereas 67% got vaccinated in the last season and 65% plan to do so in the next one. Overall, STV is more positive in Italy and Spain, less marked in Italy has the lowest scores in Germany.

Conclusions

Despite persisting doubts about COVID-19 vaccines and differences among countries, the sentiment towards vaccinations in European HCWs is generally positive and has improved after the pandemic.

Key messages

• European healthcare workers have generally positive sentiment towards vaccination, including COVID-19 and influenza, despite concerns about side effects and about administration during pregnancy.

• The COVID-19 pandemic increased European HCWs’ attention to update their vaccination schedules, with the majority agreeing on the effectiveness, safety, and necessity of vaccinations in general.
Comparison of progress in CSE in Moldova measured by SERAT - from 2017 to 2022
Authors: Sirbu L , Lesco G , Gherciu C
Published: October 2023

In recent years in the Republic of Moldova, many actions have been carried out to develop health education programmes that integrate sexuality education, in both the compulsory and optional school curricula. Sexuality education is not a stand alone subject and was integrated mainly in two mandatory courses Biology and Personal Development. To assess the quality of school-based sexuality education in the country, UNFPA in the Republic of Moldova in partnership with the Ministry of Education and Research (MER), under a regional initiative supported by the UNFPA Eastern Europe and Central Asia Regional Office and the BZgA, conducted in 2021-2022 a national assessment of the compulsory curriculum by applying SERAT. To observe the progress over the last years, a comparative analysis was performed with the results from SERAT analysis conducted in Moldova in 2017. Overall, the results of the current assessment demonstrate a significant progress in the development of sexuality education programs since 2017, achieving a much higher score of compliance with the international standards for CSE in 2021/2022 - 54 per cent average score for all components compared to 34 per cent in 2017. The government is committed to increase the level of sexuality education integration in schools, as the legal framework provides strong support for the right to sexuality education for adolescents and youth.
Asian American & Pacific Islander SGM Emerging Adult Mental Health: Current Trends and Next Steps
Authors: Zhou S , Abelson S , Stojanovski K
Published: October 2023

Background

Asian American and Pacific Islander (AAPI) sexual and gender minority (SGM) young and emerging adults are an especially high-risk group to consider in mental health research, holding multiple marginalized identities & report discrimination based on race/ethnicity & immigration status at double the rate of overall SGM youth. There is a need for extensive national studies that capture the experience of AAPI SGM youth to comprehensively elucidate the mental health burden on this often-overlooked population in the COVID-19 era. This study aims to describe the national landscape of AAPI SGM university student mental health & treatment usage.

Methods

We data from the Healthy Minds Study, conducted between September 2021-May 2022 (n = 89,255) across 133 campuses in the United States. We used bivariate analyses & cross-sectional logistic regression models to evaluate mental health symptoms, risk/protective factors, & treatment utilization across AAPI SGM students.

Results

Preliminary findings indicate that 78% of AAPI SGM respondents report the presence of one or more positive screens for depression, anxiety, eating disorder, suicidal ideation, or non-suicidal self-injury. Among these students, approximately 57% report utilizing therapy or psychotropic medication. Experiences of discrimination & financial stress were the strongest correlates of mental health symptoms. Self-reported experiences of discrimination based on race, culture, & sexual orientation were associated with higher odds of treatment utilization for AAPI SGM domestic students but not for international students.

Conclusions

The data underscore the need to consider the adequacy of current approaches in supporting AAPI SGM mental health, as well as unique ways to foster protective institutional & intrapersonal factors & increase investments to culturally responsive, gender-affirming treatment & prevention programs that address mental health disparities already looming in minoritized communities.
Sustainalibity elements of the Best-ReMaP Joint Action
Authors: Silano M , Tonello S , Sienkiewicz D , Gabrijelčič M , Robnik Levart M , De Cosmi V
Published: October 2023

To enable sustainabile and effective uptake of recommended actions, key policy-relevant messages are conveyed: (1) enable the implementation of processed food monitoring and reformulation by ensuring personnel and resources for institutionalized actions at governmental level; re-establish platforms at European level like former HLG on nutrition and PA to facilitate knowledge exchange; (2) reduce the marketing of unhealthy foods to children via adoption of government-led regulatory approaches; policies cover the reduction, preferably the removal of marketing of unhealthy foods in a broad set of marketing types and techniques; raise the age threshold for marketing regulations to 18 years; define the foods and drink products to be restricted from marketing through a strict government-led NPM, based on the WHO Europe NPM, as outlined in the revised 2018 AVMSD; enforce a national food marketing code by an assigned national administrative body, and ensure financial and human resources to cover the workload related to food marketing monitoring; (3) support actions in public food procurement policies by the involvement of inter-sectoral collaboration in MSs; facilitate the policies in this field by collaboration with an EU public food procurement network to share knowledge and experiences among MSs; align the implementation of the public food procurement legislation for MSs; guarantee a sufficient budget for public food procurement and cooperate on the interventions with relevant sectors and stakeholders, such as the parents, communities. A Food System Sustainability Scoreboard was proposed as a mean of how to insert a monitoring mechanisms of the food system sustainability in the European Semester. DG JRC has elaborated on the FABLE testing branded foods EU open database. MSs are indicating the overall expressed need for re-establishing the high level collaboration in the areas of nutrition, physical activity and obesity at the EU level.
Enhancing the reuse of health data for research purposes: laws and regulations as pillars of trust
Authors: Verheij R , Van Veen E B
Published: October 2023

Background

Routinely recorded health data are increasingly used for research purposes and indispensable to stimulating appropriate and sustainable health care. In many countries access to data has proven to be a challenge. Trust by researchers, organisations and the general public is key, and adherence to the rule of law is one of the key elements determining that trust. We investigated the laws and regulations regarding the reuse of health data and how they work out practically for researchers.

Methods

Our study focuses on France, Finland, Denmark, Germany, England and The Netherlands. We investigated consent mechanisms, the possibilities of record linkage, and how the sharing of data for research purposes was organised, with a combination of desk research and interviews with researchers in these countries.

Results

All countries investigated except England are subject to the General Data Protection Regulation. However, explicit consent is the default in Germany and the Netherlands, while other countries maintain an opt-out system or even a system of neither consent nor opt-out. A central data access authority is in place in all countries investigated except Germany and the Netherlands. The nature and level of detail of data varies widely.

Conclusions

GDPR does not dictate a specific modality for the reuse of data. In terms of the reuse of health data, Germany and the Netherlands are lagging. The Netherlands seems to be the only country with continuing discussions about consent modalities. A broader societal debate about the balance between trust and the reuse of health data is needed, also against the background of a European Health Data Space. In the Netherlands, widespread government distrust is one of the challenges. Options to counteract this distrust will be discussed.

Key messages

• European countries vary in the way routine health data are accessible for research purposes.

• This will affect the feasibility of a uniform European Health Data Space.
Adopting population health management in PHC. Bridging needs and response
Authors: Cerezo Cerezo J
Published: October 2023

Population health management can substantially contribute to realizing some of PHC's central attributes, including person-centeredness; accessibility; comprehensiveness; attention to health problems in their physical, mental, social, cultural and existential dimensions; continuity; coordination and community orientation. It can do this by supporting PHC providers in:

• moving from a one-size-fits-all approach to targeted and tailored approaches that account for the needs of different groups within local catchment populations or population clusters with similar needs or health conditions;

• moving from passive and reactive to proactive care, ensuring that people with different risks are identified and have their care anticipated;

• moving from a narrow focus on clinical needs to a holistic approach focusing also on psychosocial needs and the social determinants of health; and

• moving from fragmented and poorly coordinated care to better coordination and integration with secondary and tertiary care and partnership with other sectors and actors in the community.

Although moving towards system-wide implementation of population health management requires several years of development work and takes time to achieve impact, population health management can promote improvements in PHC even before the full benefits of population health management are realized. Key and common success factors to enable population health management in PHC are described here as system (such as information governance arrangements that promote information sharing within and outside the health system, data stewardship capacity and skills or support of regulatory agencies); organizational (multidisciplinary and networked PHC models and integration and close collaboration with public health and social care agencies); and clinical-level factors (such as comprehensive and systematic data collection in PHC or patient and community engagement).
I used to think... now i think...
Authors: Shimocomaqui G
Published: October 2023

This activity will last 20 minutes, aiming to support the consolidation of the new learning. The method Thinking routine, developed by the Project Zero from Harvard Graduate School of Education will be used. Participants will be informed that the activity aims to support them to in reflecting on their thinking about the topic “Access to Health Care” and exploring how and why their thinking has changed. The panelist will guide participants with the following instructions: I. When we started this workshop about access to mental health care, you had some pre-thoughts about this topic. Take a minute to recall what you used to think about the topic and write a few sentences using the sentence starter, “I used to think...”. II. Now, think about whether and how your ideas about this topic have changed as result of what we discussed during the Access Game. Again, in just a few sentences, write what you think now about Access to mental Health Care. Start your sentences with, ‘Now, I think...’”. III. Sitting in a large circle, participants will be invited to share their thoughts and thus visualize the lessons learned from the workshop.
Participatory transferability analysis of vaccination interventions with underserved communities
Authors: Schloemer T , Hecht H , Horstman K
Published: October 2023

Background

The Horizon 2020 project RIVER-EU will remove health system barriers to childhood vaccination in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. In order to identify transferable vaccination interventions for HPV and MMR, our aim was to establish a collaboration with various stakeholders from these communities.

Methods

For the transferability analysis, we used the participatory action approach (PAR) to stimulate meaningful participation of different key stakeholder groups in discussing evidence-based interventions and the specific contextual conditions of the underserved communities. Based on the PIET-T models, we collaboratively explored characteristics of the populations (P), interventions (I), environments (E) as well as options for intervention transfer (T) to understand transferability (T), need for intervention adaptations or new interventions.

Results

Six interventions were pre-selected for decision-making. These addressed elements of involving community members to support vaccination, education in schools, providers’ vaccine communication, and educational videos. All partners co-created knowledge through their expertise: Community members contributed through their experiences with vaccination services, provided valuable arguments for or against interventions, as well as ideas for improvement. Country coordinators in each context were mediators for knowledge-co-creation between all partners involved. Transferability researchers guided the process and analysed the results of discussions through workshops, interviews and focus groups.

Conclusions

Establishing trust between partners was a key issue in all contexts. Participatory transferability analysis required the consideration of a complex interplay between understanding content of interventions, context, and the specific characteristics and contributions of stakeholders.
Pandemic-time mental health surveillance among the French population using survey and routine data
Authors: du Roscoät E , Forgeot C
Published: October 2023

Alerted by the scientific community about a possible negative impact of the COVID-19 epidemic on population's mental health, Santé publique France (the French public health agency) started a reactive surveillance in March 2020. From a crisis management perspective, the objective was to closely monitor mental health developments during the pandemic and to collect necessary information to implement preventive and protective interventions for the population. The population mental health surveillance was mainly based on two data sources: first, the Coviprev survey, a declarative internet-based survey among the adult population ran weekly and then monthly during the pandemic, and second, the OSCOUR® database, developed after the heat wave of summer 2003 in France, which has been collecting daily emergency department (ED) data for almost 20 years. 94% of French ED visits are collected by the system. The main indicators monitored were mood disorders, anxiety disorders, suicidal ideation and behaviors. This surveillance confirmed, from the start and throughout the epidemic, the negative impact of the health crisis on the population's mental health and suggested that adolescents (aged 11 to 17 years) and young adults (aged 18 to 24 years) have been more affected than the rest of the population. In comparison to previous years, significant increases of mood disorders and suicidal behaviors were observed in both data sources in the beginning of 2021 and are still observed in 2023 for some indicators. The results of the work carried out showed the importance of a continuous surveillance of mental health during a crisis situation based on reactive data sources which are essential tools for steering preventive responses and advocating for the strengthening of mental health prevention and promotion policies. Strengths and limitations of the implemented surveillance system integrating two different data sources will be discussed.
8.C. Workshop: Female leadership in times of crisis – fostering a sustainable future for humanity
Authors:   Organised by: Women in Global Health (WGH) European Chapters, EUPHA-MIG,   Chair persons: Bernadette Kumar (EUPHA-MIG), Peggy Maguire (Ireland)
Published: October 2023

Women in Global Health (WGH) is a global movement with the largest network of women and allies working to challenge power and privilege for gender equity in health. It has grown to include over 50,000 supporters in 90 countries and has 41 official chapters. The WGH European network is an established hub of the global WGH movement focusing on gender equality in Europe Some of the WGH European Chapters have been engaged in the work with Ukrainian migrants.The workshop will start with a brief introduction to the WGH network and European hub. Following these opening remarks, the session will review the ongoing conflict in Ukraine through a gender equity lens, exploring what the crisis has taught us and how these experiences can help improve gender equity interventions in the future. The session will focus on two topics. 1) exploring the daily realities of women living in the conflict situation in Ukraine and 2) the situation of Ukrainian female refugees in European Member States. We will hear personal stories and accounts from Ukrainian women themselves and from professionals working with them both in-country and in European Member States. The inputs will be moderated in an interview style by one of the WGH European Chapter leads. The interviews will be followed by an interactive section where discussions will be facilitated with the audience in small groups. These discussions will centre on the accounts heard in the session and draw on any personal experience audience members may have of working with women in/from conflict situations, in Ukraine or elsewhere. In the plenary, we will then ask the small for feedback on their conversations. with the aim of discussing what the WGH movement can learn from these experiences with respect to applying them to interventions in gender equity in migrant health in the future. A final input from a female health leader will reflect on the session content and summarise its conclusions.

Key messages

• Gender equity can bring about transformative change in times of crisis.

• Gender equity is not merely the ethical way to advance, but an operational necessity in time of crisis.

Speakers/Panelists

Sabine Ludwig

Charité - Universitätsmedizin Berlin, Berlin, Germany

Halyna Skipalska

Ukrainian Foundation for Public Health, Kyiv, Ukraine

Paloma Cuchi

WHO, Poland
The German National Cohort (NAKO): Design, current state, and further follow-up data collection
Authors: Greiser K H , Bohn B , Hilger-Kolb J , Panreck L , Breunig E , Lieb W , Pischon T , Schikowski T , Völzke H
Published: October 2023

The German National Cohort (NAKO) is the largest population-based cohort study in Germany and provides a central resource for epidemiologic research. NAKO aims to investigate the development and aetiology of diseases, and to identify risk factors and enhance early detection and prevention of diseases with a focus on diabetes, cancer, cardiovascular, pulmonary, neurological, psychiatric, and infectious diseases. Between 2014 and 2019, overall 205,415 participants aged 20-74 years were recruited and examined at 18 study centres across Germany. During their visit to the study centre, they participated in an extensive examination programme including a face-to-face interview, self-administered, computer-based questionnaires, broad biomedical examinations (e.g., blood pressure, electrocardiograms, oral glucose tolerance tests) and provision of bio-samples (blood, urine, stool, saliva, nasal swabs). In addition, a subgroup of 30,861 participants received whole-body Magnet Resonance Imaging (MRI) with a focus on brain, heart, the musculoskeletal system, and body fat distribution. All study participants are re-invited for examinations at the study centres at 4-5 year intervals. The programme of the first re-examination is similar to the baseline programme in order to detect changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function. By 31.03.23, 100,822 participants were re-examined, including 14,950 with MRI re-examination. A third examination will start in 2024. Data collection is standardized, and central quality control and data cleaning is performed. For more complex data (e.g., echocardiography, accelerometry), competence units process the data and derive variables on exposure, functions, and disease. Due to its large sample size, the in-depth examination programme and the longitudinal design, NAKO provides an excellent source for better understanding of determinants for health and disease at the population level.
Environmental exposure assessment in the German National Cohort (NAKO)
Authors: Wolf K , Schikowski T , Dallavalle M , Niedermayer F , Bolte G , Lakes T , Moebus S , Schneider A , Peters A , Hoffmann B
Published: October 2023

Background

The environment plays a major role in human health and wellbeing. Air pollution, non-optimal temperatures, noise and lack of greenspace have been identified as the main external drivers, but their interplay is not well understood. Moreover, negative impacts are expected to increase in the coming decades due to population growth and climate change, especially in urban areas. Therefore, we aimed to assess the exposure to multiple environmental indicators and compare the spatial variation across NAKO participants to lay the foundation for subsequent health analyses.

Methods

We collected German-wide data from different sources for the following environmental indicators: short- and long-term air pollution (particulate matter, nitrogen dioxide, ozone), short- and long-term meteorology (air temperature, relative humidity), noise and greenness. All exposures were assigned to the NAKO participants based on their baseline residential addresses.

Results

The NAKO study regions ranged from highly urbanized areas (Berlin, Hamburg) with up to 4,123 inhabitants/km2 to rural regions (Neubrandenburg) with 732 inhabitants/km2. This large variation is reflected in the individual environmental exposures. PM2.5 and NO2 levels ranged from 7.7-16.2 and 4.2-32.6 µg/m3, respectively. Annual mean temperature for 2017 ranged between 8.1-11.7 °C. Noise data were available only for 22% of participants, of which 42% fell into the lowest and 1.9% into the highest category of Lden 55-59 and Lden >75 dB(A), respectively. Greenness also showed considerable contrasts (Normalized Difference Vegetation Index between 0.09-0.82).

Conclusions

An extensive population-based data set with high-quality environmental indicators is available for the first time across Germany. Expanding the database by adding innovative indicators (e.g. light pollution, walkability) as well as socioeconomic factors (e.g. unemployment rate, deprivation) will further increase its impact on science and public health.
Building up public health resilience to tackle climate change in an urban context
Authors: Schmidt A , Lampl C , Aigner E , Haas W
Published: October 2023

Background

By 2050, about 70% of the global population will be living in cities. At the same time the health burden due to climate change is increasing in urban areas e.g. as heat waves become more frequent and prolonged and the socio-economic inequalities increase. Also, health systems are faced with multiple stress tests due to multimorbidity, lack of health personnel, and the direct and indirect health impacts of the climate crisis, falling disproportionately on disadvantaged populations. Gaining a better understanding of the climate-health-equity nexus represents huge potential for health policy to contribute to climate change mitigation and for climate policy to reduce disease burden while tackling socio-economic inequalities and health inequity.

Objective

Building on a systematic literature review, this paper presents a framework of the interdependencies between the climate crisis, public health, and social aspects and applies it to urban areas. It then links the domains identified with data requirements at the European level and highlights potential pitfalls for European health information systems, and all six building blocks of health systems following WHO's framework on climate resilience, from governance to health workforce to early warning systems.

Results

The review showcases risks associated with acting in “policy-silos”, neglecting the interactions between climate, health and inequality, compounding negative consequences both for planetary health and human health. Our data framework shows that the interdependencies described open up various opportunities for a European research infrastructure, in the aftermath of the COVID-19 pandemic and in a transformation towards more health promotion.

Conclusions

A European Green Deal with a strengthened focus on public health would have the potential to address these challenges, in cities and beyond. All health system building blocks need to contribute to such a climate-health pact at the European level.
Case report Montenegro
Authors: Obradović A
Published: October 2023

Montenegro is an upper-middle income country, with an estimated population of 620,739 (Eurostat, 2021). A national strategy for sustainable development until 2030 was adopted in July 2016, taking into account the implementation results of the Action Plan from the previous strategic document. Data for the period 2016-2021 are showing changes in a certain number of indicators, but also that Montenegro continued to face a large number of challenges (especially in No poverty and Gender equality goals), which became even more complex during the COVID-19 pandemic. Montenegro is reporting 69 out of 248 SDGs indicators. Indicators are not reported at all for 3 goals. Data similar to those required exist for some indicators, so a rough picture of trends in individual SDG goals can be obtained. For the remaining 14 goals, the median percentage of reported indicators is 31% (Range: 14%−58%). Some indicators are reported periodically, as part of research. Also, the UN methodology is not followed for all the reported indicators. For example, for the assessment of the first goal, 13 indicators were determined, and none of them are monitored by the UN methodology. However, since 2013, the Statistical Office of Montenegro has been calculating some indicators (based on the EU-SILC survey) that can be used for the same purpose. For SDG 3; Good health and well-being, there are improvements in certain segments: reduction in the infant mortality rate (2.8/1,000 from 2020) and mortality rate among children under 5 (3.7/1,000 from 2020) and reduction in the tuberculosis and malaria incidence. Numerous challenges are mainly reflected in the inequality of access and quality of health services, the high prevalence of current tobacco use among those over 15 years, and low air quality. Existing information system in healthcare is incomplete, fragmented and insufficiently interoperable to provide satisfactory data for monitoring the progress of indicators in this area.
Learning from experience: Integrating patient experience survey responses with other key metrics to understand and improve care quality and patient safety
Authors: Martin J , McDonnell T , O'Dowd M , Hogan E , Cosgrove G , Foley C , Healy O
Published: October 2023

Issue

The Irish National Care Experience Programme (NCEP) collects rich qualitative and quantitative data on patient and service-user experiences of healthcare. These survey data are not routinely triangulated with other quality and safety datasets for patient safety surveillance.

Description of the problem

The Irish Health Service Executive has commenced development of a quality and patient safety surveillance system called Quality and Safety Signals (QS Signals). This programme seeks to optimise the use of existing data to reduce variability in quality and safety of services, identify risks and signals of concern, as well as learnings from signals of excellence. Patient experience data is a rich source of insight into quality and safety of care but currently, it is not routinely considered alongside other quality and safety measures.

Results

As a proof of concept, the Quality and Safety Signals programme is collaborating with the National Women and Infants Health Programme (NWIHP) to develop a composite profile of quality and safety for maternity and neonatal services. A Clinical Advisory Group (CAG) has been established with multi-disciplinary clinical representation from Ireland's six Maternity Networks. To reach agreement amongst the CAG on the indicators relevant to the measurement of quality and safety, a series of interviews, workshops and a Delphi Survey are being conducted. The co-design process seeks consensus on the themes and classification structure appropriate for a composite profile of quality and safety.

Lessons

The implementation of a patient safety surveillance system challenges the Irish health system to reflect on how available data can best be harnessed. Person-centredness is a core domain of healthcare quality. Capturing the person's experience of care through the NCEP surveys is vital to ensuring the development of a comprehensive profile and guiding quality improvements.
The commercial determinants of health practices: a short introduction
Authors: Makhoul J
Published: October 2023

The field of study around the commercial determinants of health or commercial determinants of ill-health, corporate determinants, health harming commodities/industries, commercial drivers of NCDs, is a decade old. It encompasses the systems, practices, and pathways through which commercial actors drive health and equity (Gilmore et al, 2023) as well as sophisticated strategies that are designed to protect and promote commercial interests, at the expense of public health, the environment, and democracy (Lacy-Nicols et al, 2022). These strategies are common across varying types of industries and constitute unethical/illegal political, scientific, and business practices, such as manipulation, hiding the truth, coercion, exploitation, violation of workers’ rights, secrecy, deliberate exposure of the public to harm, and many more. This presentation will provide an overview of the commercial determinants, their playbook and illustrations from examples around the world to set the stage for exemplars of industry strategies and tactics of the tobacco, alcohol and fossil fuel industries.
Promoting Achievable Goals to Increase Physical Activity
Authors: Booth L , Jongenelis M , Hasking P , Hastings G , Pettigrew S
Published: October 2023

Background

Physical inactivity is a leading contributor to the development of non-communicable diseases including cardiovascular disease, diabetes, and cancer. Public health messages that advocate activity guidelines with specific duration thresholds (e.g., 30 minutes per day) have had limited success. This approach may risk an ‘all or nothing’ mindset whereby people feel exercise is not worthwhile unless they can meet recommended guidelines. World Health Organization guidelines recognise that any activity is better than none. In line with this, the present study aimed to test the effectiveness of two messages that referred to relative rather than absolute increases in physical activity: ‘Sit less, move more’ and ‘Add 2000 steps to your day’.

Methods

A representative sample of 7995 Australian adults responded to three surveys over six-weeks, with random assignment to a control condition (non-physical activity message) or one of two physical activity message conditions: Sit less, move more or Add 2000 steps to your day at each time point. At all three time points, respondents were exposed to their allocated message and reported their frequency of enacting the recommended behaviours. To account for attrition over the surveys, an intention-to-treat approach was adopted. Two generalised estimating equations models were run to examine time-by-condition interactions for the enactment of each message.

Results

Compared to control, respondents in the Add 2000 steps to your day condition significantly increased their enactment of adding 2000 steps to their day over time (B=.161, p=.011). Those in the Sit less, move more condition did not significantly differ from control in the frequency of enacting this message.

Conclusions

Promoting a specific physical activity goal that was relative to baseline activity increased the enactment of the recommended behaviour. Messages seeking to promote physical activity may be more effective if they include goals that are clear and feasible.

Key messages

• A message encouraging people to add 2000 steps to their day successfully increased physical activity.

• Promoting achievable goals in physical activity messages might be a useful public health strategy.
Health Literacy, lifestyles, and socio-economic factors in the Italian population: a national survey
Authors: Marcozzi B , Rosano A , Unim B , De Castro P , Cadeddu C , Lorini C , Donfrancesco C , Bonaccorsi G , Galeone D , Palmieri L
Published: October 2023

Introduction

Health literacy (HL) entails people's knowledge and abilities to find, understand and use health information to make health-related decisions. This study aims to evaluate HL association with lifestyles in the Italian adult population.

Methods

In 2021, in the framework of the Italian participation in the WHO network Measuring Population and Organizational Health Literacy M-POHL, a survey was conducted on a representative sample of the Italian population aged 18+ years (n = 3,500). A validated 47-item questionnaire was used to collect core HL information, plus 31 items for correlate information, including lifestyles. For each HL-item, a 4-point Likert scale was applied: very easy/easy/difficult/very difficult. The HL index (percentage of very easy/easy), was stratified in Inadequate (0%−50%), Problematic (51%−66%), Sufficient (67%−80%), Excellent (81%−100%). Inadequate/Problematic were merged into “Limiting”, Sufficient/Excellent in “Not limiting”. Multivariate logistic regression analysis was implemented to assess the association between dichotomous HL and obesity (BMI > =30 Kg/m2), physical activity-PA (intense (5-7 days a week)/not intense (0-4 days a week)), fruit and vegetable diet-FVD (daily/not daily), smoking habit (yes/no), adjusted by sex, age, region, education-ED, financial deprivation-FD.

Results

Prevalence of Limiting HL is 64.6%. In Limiting HL, obesity is significantly higher than in Not limiting HL (14.6% vs 12.0%), similarly not intense PA (82.3% vs 75.7%), not daily FVD (54.0% vs 47.7%), low ED (22.3% vs 18.0%), severe FD (20.8% vs 9.1%); the opposite for smokers (30.2% vs 34.7%). Significant association with Limiting HL was found for not intense PA (Odds Ratio-OR=1.48), not daily FVD (OR = 1.24), low ED (OR = 1.39), severe FD (OR = 3.33).

Conclusions

Results show that persons with not intense PA and those with not daily FVD need targeted support to improve HL, as well as those with a lower level of education and problematic financial situation.

Key messages

• This study aims to evaluate Health literacy association with lifestyles and socio-economic factors in the Italian adult population.

• Intense physical activity and a regular fruit and vegetable diet lifestyles are associated with ‘Not limiting’ Health Literacy, as well as high educational level and low financial deprivation.
Evidence-based infographics and visual communication as powerful tools to improve health outcomes
Authors: Chanzu A , Wells M , Vitkin N , Nersesian S
Published: October 2023

Background

Anemia can double the risk of death in pregnancy, with women in developing countries being the most at risk. Adherence to an iron supplementation regimen can markedly improve overall health outcomes for those who are affected by iron deficiency anemia. Still, most adherence-boosting programs require significant counseling time with a primary care provider, a resource that is becoming increasingly scarce. In our review of the literature, we explored infographics and other visual science communication tools for their ability to improve medication adherence, with a special focus on low literacy populations in the developing world. With the results of this review being favourable, we conducted a subsequent literature search on factors that can amplify the useful effect of infographics.

Methods

We conducted a literature search on PubMed, Ovid MEDLINE, CINAHL, Web of Science, and PsycInfo to identify literature on effective visual science communication techniques. Techniques from the literature were then compiled and sorted into the categories of “DOs” or “DON’Ts” of developing impactful infographics. These guidelines were then utilized to develop an infographic depicting an iron supplementation regimen for pregnant women.

Results

27 recommendations on developing effective and impactful infographics were identified from the literature. These included, but were not limited to, the following: utilize accompanying text that is understandable at a low literacy level to prevent misinterpretation of the message depicted through pictogram(s), and use a culturally-sensitive lens to design images that would be easily relatable among the target cultural demographic. These recommendations were adapted to develop an evidence-based infographic.

Conclusions

Our review of effective visual science communication techniques supports the importance of using evidence-based methods to develop infographics that are effective among a range of demographics and medical conditions.

Key messages

• Evidence-based infographics and visual science communication tools can amplify the effectiveness of science and health communication.

• Infographics and visual science communication tools can be applied to a variety of literacy levels and medical conditions to improve patient outcomes.
Self-perceived and calculated health literacy score in long-term unemployed people
Authors: Singh H , Hübner W , Samkange-Zeeb F , Lakeberg M , Randles K , Kolschen J , Brand T , Zeeb H , Schüz B
Published: October 2023

Introduction

Recent studies show that low levels of health literacy are widespread in Germany, especially among socioeconomically disadvantaged groups such as long-term unemployed individuals. At the same time, it is unclear to what extent commonly used health literacy tools are tailored to the needs and literacy skills of socioeconomically disadvantaged populations. Therefore, we examined to what extent self-perceived and calculated health literacy scores of long-term unemployed people in Germany correlate.

Methods

We conducted 171 semi-structured interviews between November 2022 and February 2023 with long-term unemployed people in 11 occupational reintegration settings in Bremen, Germany. Health literacy was measured by the HLS-EU-Q16 (self-report health literacy score) and the Newest Vital Sign (calculated health literacy score). Descriptive and correlation analyses were performed with R.

Results

According to HLS-EU-Q16, 37% of the 171 participants (male=112, female=59) had sufficient health literacy, according to NVS only 29%. An inadequate health literacy score was shown by 19% according to HLS-EU-Q16, and by 48% according to NVS. The applied tools did not show a statistically significant correlation (r = 0.105, p = 0.17).

Conclusions

Self-reported health literacy data (e.g., measured by the HLS-EU-Q16) could underestimate deficits in health literacy and may be insufficient as a sole assessment tool to determine health literacy among low-literate populations as long-term unemployed people.

Key messages

• Various tools exist to measure health literacy. Not all measures might be suitable for all population groups. Literate skills should be considered while applying different health literacy measures.

• More health literacy data on low-literate populations is needed in the literature. Health literacy tools applied in these population groups should be short and easy to understand.
Regional Health Coordination: An evaluation of the first pilot training program in Lower Austria
Authors: Griebler U , Klingenstein P , Grillich L , Moick S
Published: October 2023

Background

Starting from 2018, the University of Krems and ‘Tut gut!’ Gesundheitsvorsorge GmbH have jointly implemented the two-year academic program ‘Regional Health Coordination’, which trains students to become a Regional Health Coordinator (RHC). It is funded by the Lower Austrian Health and Social Fund. We evaluated the pilot-program and the work of the RHC in the first two years after graduation. The objectives of the evaluation were to provide 1) a basis for further development of the academic program and 2) an assessment of the achievement of the program objectives.

Methods

The evaluation ran from 2018 to 2022 and followed a mixed-methods approach. Qualitative interviews and focus groups with stakeholders, document analyses of annual RHC activity reports and repeated written community surveys in 13 municipalities were conducted.

Results

The evaluation showed that RHCs already bundled health promotion (HP) activities and worked on their HP network within the municipalities during the practical training period. HP was given a higher priority in some municipal administrations. The pilot program was consistently rated positively, and the curriculum was optimized. In the first two years after graduation, the RHCs developed and implemented HP measures and endeavoured to engage citizens. However, genuine involvement was rare. The results showed that future HP interventions should especially target older people, less educated and male citizens. RHCs were seldomly involved in health policy decisions, although they often worked with mayors. Personal characteristics, an existing network in the community and support from the local government were success factors for the work of the RHCs.

Conclusions

RHCs play an important role in the coordination of community HP but should be stronger included in local policy decision-making. Citizens should be more involved in planning and implementing HP measures.

Key messages

• An academic training program for regional health coordination helped to improve community health promotion.

• An existing network and the involvement in the local government facilitated the work of graduated regional health coordinators.