bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of tuberculosis site among 1035 cases in Frankfurt, 2008-2023: does lineage matter?
Authors: Rachwal N , Idris R , Dreyer V , Richter E , Wichelhaus T , Wetzstein N , Götsch U
Published: October 2024

Extrapulmonary tuberculosis (EPTB) presents with nonspecific symptoms which can pose a diagnostic challenge. Currently, there are no clear predictors for EPTB. We aimed to identify these factors for better diagnosis and disease control. We included tuberculosis cases reported in Frankfurt from 2008-2023, with available clinical and whole genome sequencing data. According to WHO criteria, cases with pulmonary or combined pulmonary and extrapulmonary symptoms were categorised as pulmonary tuberculosis, while exclusively extrapulmonary symptoms were categorised as extrapulmonary tuberculosis. We assessed the association between EPTB and M. tuberculosis lineage, comorbidities and demographic characteristics using logistic regression, calculating crude and adjusted odds ratios (aOR). Of the 1035 reported tuberculosis cases, 272 had exclusively extrapulmonary disease and 136 had both pulmonary and extrapulmonary disease. In the univariable analysis, lineages 1 and 3 were significantly associated with extrapulmonary disease compared to lineage 4. However, this association was not observed in the multivariable analysis. In the final regression model, females were more likely to develop EPTB than men (aOR: 1.65, CI: 1.19-2.27). The odds of developing extrapulmonary disease were higher among patients born in the South-East Asian (aOR: 6.48, CI: 3.72-11.43) and Eastern Mediterranean (aOR: 5.54, CI: 3.41-9.11) than in other regions. Among the comorbidities, diabetes was found to be negatively associated with extrapulmonary disease (aOR: 0.50, CI: 0.26-0.91). Our results indicate that host factors such as geographic origin and sex are stronger predictors for extrapulmonary presentation of tuberculosis than a specific lineage. We recommend increasing physicians’ awareness of the nonspecific presentation of EPTB and adapting screening programmes, particularly for patients from South-East Asian and Eastern Mediterranean regions to foster more effective tuberculosis control measures.

Key messages

• Our study highlights the importance of considering host factors in predicting extrapulmonary tuberculosis, indicating their stronger influence compared to specific M. tuberculosis lineages.

• Increased physicians’ awareness of the nonspecific symptoms of EPTB and targeted screening programs for high-risk populations are crucial for enhancing tuberculosis control measures.
Relationship of serum vitamin D levels with atrial fibrillation incidence: The HUNT Study
Authors: Jiang L , Sun Y Q , Malmo V , Mai X M
Published: October 2024

Background

Evidence on the association between serum vitamin D levels and incidence of atrial fibrillation (AF) was inconclusive. To elucidate the nature of the association, we studied the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and AF incidence in the Norwegian Trøndelag Health (HUNT) Study using both conventional observational and Mendelian Randomization (MR) approaches.

Methods

3394 adult participants without AF diagnoses were followed up from HUNT3 (2006-2008) to 2021 in a prospective cohort. Average serum 25(OH)D levels over ten years between HUNT2 (1995-1997) and HUNT3 were calculated and categorized into <50 and ≥50 nmol/L as exposure. AF diagnoses were retrieved from hospital registers and validated by medical doctors. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Furthermore, a one-sample MR was conducted among 36,554 adults who participated in both HUNT2 and HUNT3. An externally weighted genetic risk score based on 19 vitamin D-related genetic variants, chosen for their clear biological functions in serum vitamin D transport, synthesis and metabolism, was used as instrument. We applied the Wald ratio method to assess the causal effect.

Results

During a median 13-year follow-up, 303 AF cases were diagnosed in the prospective cohort. Serum 25(OH)D level <50.0 nmol/L was associated with a 26% reduced incidence of AF (HR 0.74, 95% CI 0.58 to 0.95), compared to serum 25(OH)D ≥50 nmol/L after adjustment for confounders. Genetically determined 10 nmol/L decrease in serum 25(OH)D level was associated with a 7% reduced incidence of AF (HR 0.93, 95% CI 0.86 to 1.00) in the MR analysis. Sensitivity analyses supported this positive association.

Conclusions

We found a consistent positive association between serum 25(OH)D level and AF incidence in the Norwegian HUNT population using both observational and MR approaches.

Key messages

• Serum vitamin D levels appeared to be positively associated with the incidence of AF.

• Vitamin D supplementation should be prescribed with caution, especially for people at high risk for AF.
The state of pandemic preparedness in four European countries
Authors: Forjaz M , Hocevar A , Rodríguez Blázquez C , Falcón M , Romay-Barja M , Sinko M , Murphy R , Deegan A , van Dijk M , Sanders J
Published: October 2024

One of the lessons learned from the COVID-19 pandemic is that monitoring determinants and behaviour can improve policy and communication strategies. To improve countries’ capacity to respond in a hot phase of a pandemic and build a resilient society, suitable monitoring in a cold phase of various behaviours and determinants that could become important in future pandemics is key. In March 2024 we launched the first round of the Pandemic Preparedness and Behaviour (PPb) survey in four European member states: Spain, Slovenia, Ireland and The Netherlands (N = ∼1000 per country). In this presentation we start by showing key findings. For example, we found that overall, approximately one third of participants believe their government is prepared if a new pandemic would occur next month. Next, we discuss similarities. For example, we find that in all four countries, perceived preparedness of self is higher than perceived preparedness of one’s government. We also address key differences, such as distinct patterns in perceived risk of a highly contagious outbreak in the next 5 years (whereas in Spain 26% perceives of participants an outbreak as probable, this is 43% in Slovenia) or differences in self-reported adherence to hygiene behaviours (i.e. handwashing after coughing or sneezing in elbow is markedly higher in the Slovenian sample than in the Netherlands). Next, we explore which determinants of these patterns are generalisable, and which are specific to two of the four countries: Spain and Slovenia. We follow up by comparing insights for policy and practice in their given contexts, as well as lessons learned with respect to use and development of the monitor. We conclude that monitoring individual behaviours and its determinants helps to develop joint efforts in developing effective public health policies across Europe regarding pandemic preparedness.
A scenario study on disaster preparedness behaviours
Authors: Kuehnhanss C , Nohlen H
Published: October 2024

Europe has faced several crises over recent years, including the COVID-19 pandemic and the war in Ukraine. Additionally, the climate crisis has led to an increase in the occurrence of extreme weather events and natural disasters. Getting citizens on board when it comes to being prepared for the changing risk landscape in the EU is essential in building societal resilience. The importance of the population’s preparedness to deal with disasters has also been underlined by the Commission’s identification of the Union Disaster Resilience Goals (2023/C 56/01). One of these goals focuses on increasing risk awareness and the adoption of risk prevention and preparedness measures among the population. Research has shown that simply advising people of potential risks in their region is not necessarily sufficient to motivate them to prepare. Yet, preparation is key to an adequate responses in emergency situations and improving preparedness may thus be a powerful tool to support the population’s ability to respond in times of crisis. The EC JRC’s Competence Centre on Behavioural Insights will present a study conducted in five member states (N = ∼1000 per country), which investigates the effect of envisioning a disaster situation, and therefore explicitly eliciting personal affectedness, on individuals’ self-reported preparedness intentions and preparedness behaviours. The study uses multiple measures for intentions and preparedness behaviours, including click-through to external information and an incentivised preparedness game.
WHO Regional Office for Europe Behavioural and Cultural Insights Unit qualitative studies with refugees from Ukraine, May 2022-September 2023
Authors: Scherzer M , Habersaat K , Alpatova P , Zub T , Mazhnaia A
Published: October 2024

The Russian invasion of Ukraine led to the movement of millions of people. As neighbouring countries opened their borders and made services available to those fleeing war, it became imperative to understand the refugee perspective. To gain insights into refugees’ health-service access, needs and behaviours, the WHO Regional Office for Europe Behavioural and Cultural Insights (BCI) Unit conducted qualitative interviews with Ukrainian refugees residing in Czechia, Poland, Romania, Slovakia and Slovenia. Ukrainian researchers interviewed refugees online, recruiting participants through social media channels and outreach activities. The findings were discussed in high-level meetings, stakeholder workshops and webinars, and informed action by partners, governments and WHO. As examples, refugee clinics were initiated in Czechia, Poland and Romania. Cultural mediators were engaged in Romania to support health-care access at local level, and nongovernmental organizations were supported in providing tailored assistance. In Poland, the telephone hotline for Ukrainian health workers was expanded to include a line for general information, and Slovakia extended health coverage for all refugees under the age of 18.
Co-producing research on universal health system reform in the context of COVID-19
Authors: Crowley P , Burke S , Parker S , Schulmann K , Bruen C
Published: October 2024

Issue

How to co-produce and embed research into universal health system reform implementation in the context of COVID-19. In many respects the pandemic revolutionised the use of data and research, with near real-time data informing key health policy and system decisions. This was evident in the production of publicly available data sets tracking COVID-19 infection as well as health system dashboard tracking activity in real-time and influencing day-to-day decisions made. How can this use of data and research evidence become the norm for all health system reform and policy decisions?

Results

The Foundations’ research project is a partnership project in place since Autumn 2019. Initially focused on producing evidence to inform the design and implementation of new regional areas with the Department of Health Sláintecare Reform Office and the Irish national Health Service Executive as partners. When COVID-19 occurred all work on the regions was paused the research pivoted to harness the learnings form the COVID-19 response to inform universal health system reform. The partnership applied research nature of the programme allowed research to be coproduced and co-designed with health system leaders, meant the researchers understood if and when it was possible to engage with partners and how to feed result into the health system at the earliest opportunity.

Lessons

Trust and pre-existing working relationships with partners allowed the research to pivot and to continue during the pandemic. The applied partnership nature of the research meant that at times the health system was very engaged in the research and at other times (eg during COVID waves and surges or the cyber-attack) there was limited engagement. The co-production nature of the research allowed a dynamic, ongoing, two-way learning between the health system and the research team. It is extremely difficult to measure impact of research on health system and reform decisions.
Youth mental health and exposome
Authors: Lindert J , Olariu E , Lopes I
Published: October 2024

Mental health is a complex Public Health challenge, especially youth. A better understanding of factors that contribute to youth mental health and reduce the burden of youth mental health conditions such as executive and emotional functioning is needed to develop primary and secondary prevention interventions. One of the main challenges for better understanding mental health of youth is the complexity and diversity of exposures that individuals experience throughout their lifetime. There is a wide range of factors in the environment, and individuals are exposed to different combinations of external factors depending on their location, occupation, and lifestyles. These factors include physical (e.g., noise and indoor and outdoor air), chemical and social factors (e.g., neglect and abuse, relationship conflicts) based on the exposome framework. The exposome is a guiding framework for the multi-country study EARLY involving Albania, Belgium, Germany, Israel, Moldova, Portugal, Romania, Serbia, Spain, and Switzerland. EARLY is one of the first projects to theoretically explore and empirically investigate youth mental health in line with the exposome framework. We aim to identify factors influencing youth mental health with validated exposure measures. An exploratory list of measures was collected in Albania, Belgium, Germany, Israel, Moldova, Portugal, Romania, Serbia, Spain, and Switzerland. The measures vary widely. Besides the variation, there is still a lack of standardized methods for measuring environmental exposures. Limitations of measures affect reliability and validity. Therefore, an overview of available assessment methods and steps toward improving measures will be discussed in this talk.

Speakers/Panelists

Karin Boode

GGD GHOR Nederland, Utrecht, Netherlands

Peter Van Den Hazel

INCHES, Ellecom, Netherlands
Health loss after road transport injury – new perspectives
Authors: Friberg E
Published: October 2024

Background

Health loss in the road transport system is a major public health problem. Globally, about a fifth of all fatalities within the road transport system are represented by pedestrians, and bicyclists are the group with the highest number of severe injuries in the EU. Here we strive to add new perspectives of health loss in different road user groups examining sickness absence (SA) and disability pension (DP) and in the case of injuries after car crashes also relating them to permanent medical impairment (PMI).

Methods

Several register-based studies were conducted, based on microdata linked at individual level from several Swedish nationwide registers. In one study information about PMI from the insurance company Folksam was also used. In the main analyses we included all working individuals aged 20-59 years injured in a road traffic accident (pedestrians, bicyclists, car occupants, and other road users) in 2015 in Sweden and population-based matched references without any traffic-related injury. Diagnosis specific SA and DP were assessed during 1 year before and 4 years following the accident.

Results

A third of the traffic-related accidents involved bicyclists, 31% car occupants, 16% pedestrian, and 19% were other accidents. The excess SA days/year was elevated for all road user groups the whole study period. Excess SA due to injury diagnoses was 15-35 days/year during the first year following the accident. Among individuals injured in a car crash that reported the injury to Folksam, 2% had a new DP 2 years after the crash, and 8% had injuries resulting in PMI. A distinct trend showed that the proportion granted DP increased with increasing PMI grade.

Conclusions

Sickness absence is a common outcome among individuals injured in the road transport system. Together, these studies highlight the importance of preventing not only fatalities in the road transport system but also non-fatal injuries.
Public-Private Partnerships: A model for injury prevention and safety promotion – Benefitting communities and NGOs
Authors: Vaagland E
Published: October 2024

Injuries are a leading cause of death up to 45years, and 12% of all hospital beds in Norway are dedicated to accident-related treatments. Addressing injuries poses a significant public health challenge, and preventing accidents is crucial for saving money and resources. The Norwegian Act of Public Health mandates that municipalities promote the population’s health and well-being, contribute to favourable environmental conditions, and prevent mental and somatic illnesses and injuries. This is echoed in various laws and regulations, providing a supportive framework for injury prevention and safety promotion. However, translating these laws and regulations into effective policies and preventive activities necessitates collaboration across sectors and levels. To meet these demands, a public-private partnership for safety has been established through five-year cooperation agreements between the Ministry of Health, Finance Norway (Association for financial and insurance industry in Norway), and the Norwegian Safety Forum (NSF). As a non-profit organization, NSF is a national advocate for safety, specializing in home and leisure injury prevention, road safety and Safe Community initiatives in Norway.

Program Description

The collaboration aims to reduce accidents and injuries. The agreement secures basic financing for NSF and serves as a platform for knowledge sharing and competence building across sectors. It facilitates seminars and meetings to promote learning among different professions, benefiting municipalities and the public. The collaboration leverages the Ministry’s resources, insurance companies’ data and knowledge, and NSF’s expertise to develop injury prevention programs through dialogue with communities and organizations. This model brings together private-public and NGO perspectives. It also provides enhanced possibilities for coordination on both national and community level, enhancing data and knowledge availability and strengthening capacity for safety promotion.
K-HEALTHinAIR Open Access Platform: exploring user-profiles
Authors: Costa Ruiz B , Perez L , Ferri M , Mediavilla Martinez C , Acebes A
Published: October 2024

Background

There is a lack of awareness and accessible knowledge of IAQ effects on citizens’ health. The K-HEALTHinAIR project is working to provide a one-stop-shop for IAQ knowledge. With this aim, partners are co-designing with representatives of the quadruple helix a unique platform to allocate data, information, and relevant resources to research and foster IAQ in Europe. This platform is envisioned to store in an accessible and friendly manner datasets of concentrations of key indoor air pollutants and health parameters, standardized Key Performance Indicators, indoor location characterization information, IAQ recommendations and regulations and analytical models.

Methods

First, a stakeholders mapping was performed in all project pilot sites to identify the platform potential users. Second, partners identified with stakeholders which information, data and resources of the project would be of interest and how to present them. Findings were summarized in user-profiles according to the quadruple helix (academia, public administration, industry, and general society).

Results

A set of resources had been identified for each user profile. Each of them will be adapted and formatted according to the users’ needs before uploading it to the platform. The platform will allow users to access information according to their interest in an accessible a friendly manner. In this sense, a dashboard will be included in the website of the project for accessing the different modules of the platform: data management module and knowledge sharing module. The platform is being co-designed and will be tested in the project scenarios with representatives of the quadruple helix.

Conclusions

The K-HEALTHinAIR Open Access platform aims to be the one-stop-shop for IAQ knowledge.
Mental health and resilience of students with a refugee background in Greece.RaRE project findings
Authors: Stathopoulou T , Adamopoulou E , Cavounidis J , Bourazas K , Spyropoulou N , Zirganou-Kazolea L , Hatzinikolaou K
Published: October 2024

Background

Research highlights the mental health challenges faced by children and adolescents from refugee backgrounds due to various risk factors encountered during migration, including exposure to violence, family disruptions, insecure legal status, and educational interruptions. These factors increase the risk of psychological issues and academic difficulties. This study investigates the relationship between mental health and resilience in refugee adolescents in Greece.

Methods

The study focuses on refugee adolescents aged 12-18 from Syria, Iraq, Afghanistan, Somalia, and Ukraine, the countries with the highest numbers of school-age refugees in Greece. Data were collected from 37 refugee children, 37 teachers, 4 parents, and 19 guardians using Poisson sampling. Results are based on responses to the Strengths and Difficulties Questionnaire (SDQ) and the Child Youth Resilience Measure (CYRM), with triangulation of self-completed questionnaires from students, parents/legal guardians, and teachers. Pearson correlation coefficient was employed for analysis.

Results

We present the pairwise Pearson correlation coefficients of students’ responses to psychometric tests in relation to those of teachers, along with the corresponding p-values for a two-tailed test of significance. Specifically, cor(SDQst,SDQt)=0.443 (p-value=0.006), cor(SDQst,CYRMt)=-0.341 (p-value=0.039), cor(CYRMst,SDQt)=-0.333, (p-value=0.006), cor(CYRMst,CYRMt)=0.323 (p-value=0.051). All p-values are below 0.05 or very close to it, so we reject (or we are close to) the null hypothesis of no association at 5% significance level for every case. On the contrary, we note that the corresponding coefficients between students and parents/legal guardians are all statistically non-different from 0 at 5% significance level.

Conclusions

Educators exhibit a solid understanding of students’ challenges and resilience compared to parents and guardians. These promising findings support further research.
Evidence for AI in healthcare
Authors: Ghafur S , Patel M , Popescu M , Jangam S , Conroy D , Fontana G
Published: October 2024

In healthcare, novel AI solutions are being created to address some of the biggest challenges in the prognosis, diagnosis, and treatment of disease, as well as clinician workflows and service improvement. The emergence of generative AI presents a compelling opportunity to revolutionize diagnostics, treatment planning, medical research, and patient engagement. The hypothesized uses of generative AI are broad, ranging from medical education, providing information to patients, generating synthetic patient data for the validation of AI tools, to the analysis of continuous data from wearables to detect early signs of disease. Adoption of digital solutions and AI in healthcare is slower than in other industries. The majority of clinicians don’t have direct experience with AI technologies, only a quarter have recommended a digital therapeutic, and less than a fifth have prescribed one. Safety, quality and confidence can be built through appropriate governance, testing, careful implementation and appropriate clinical use. There is a responsibility for AI developers, health systems and providers, as well as regulators, to create clear expectations for evidence and solutions. AI solutions require unique model evidence (evidence for the underlying algorithm) and solution evidence (evidence for the product in which the algorithm is embedded). Models will need validation first on internal and then on external datasets (internal and external validation). This will indicate how accurate and reliable the model is, but will be limited to the dataset that a client has access to. By examining ways to evaluate evidence for AI in healthcare, we can develop a better understanding of how best to use AI to its most appropriate advantages.
Health Promotion and the case of social prescription of laughter
Authors: Vital P , Silvestri F , Saboga-Nunes L
Published: October 2024

Introduction

The use of laughter to change lifestyle and promote active and successful ageing is an area of interest within the scope of health promotion. The positive effects of laughter practices occur throughout the life cycle. That is why “laughing” has been identified and indicated as a human activity of social prescription promoting healthy lifestyles. This communication aims to (1) identify the benefits for health, health promotion, well-being, and healthy lifestyle of using laughter activities and practices, (2) identify “laughing” as a social prescription activity that promotes a healthy lifestyle.

Methods

This work is structured in a narrative review of the literature and the authors’ lived experience as professionals in the well-being area.

Results

Studies show that laughing and using laughter-inducing approaches have immediate effects on the person who experiences them (e.g. increased general well-being, reduced cortisol levels) with benefits for the immune system and cardiovascular health. Daily practices that are structured and systematic interventions that induce laughter were revealed to have lasting and durable effects. Studies also highlighted the effectiveness of laughter and its important role in improving communication in healthcare professional-patient encounters.

Discussion

Several behaviors are associated with well-being, happiness and positive affect, but the one that is accessible to all people and with the most immediate effects is laughter. Daily practices, structured and systematic interventions that induce laughter are part of non-pharmacological approaches that promote health and well-being. The principles underlying laughter practices are aligned with the Sustainable Development Goals, namely goal 3 (Health), goal 4 (Education) and goal 16 (Peace).
9.X.1. Protecting the mental health of healthcare workers: evidence, policy and implementation challenges
Authors:   Organised by: EUPHA-HCW, WHO Collaborating Center for Health Workforce Policies and Planning, European Observatory on Health Systems and Policies, WHO/Europe,   Chair persons: Ellen Kuhlmann (EUPHA-HCW), Tiago Correia (Portugal)
Published: October 2024

Background

There is growing evidence that highlights increasing stress levels and declining mental health among the global healthcare workforce, exacerbated by challenges within workplace environments, labour market and policy frameworks. These conditions place additional strain on an already vulnerable healthcare workforce and consequently threaten the stability of health systems as a whole, given the escalating challenges in retaining, recruiting and reactivating healthcare workers. Although the problems are evident, awareness is increasing and international organisations such as the WHO have advanced policy recommendations, comprehensive and context-specific interventions effectively addressing these problems at varying levels are missing.

Objectives

This innovative workshop offers a platform for bridging the gap between research evidence and policy interventions, stimulating policy learning and knowledge exchange across countries. The session provides an overview of existing knowledge and engages representatives of academia as well as national policymaking, and international organisations to critically discuss challenges as well as good practice experiences with a focus on implementation and problem-solving. The following major questions will be explored: What evidence is available regarding the mental health and wellbeing needs of the healthcare workforce? How are different countries responding to these needs and supporting healthcare workers more effectively? What are some best practice cases focusing on improving mental health support for healthcare workers across various groups, considering diverse needs, gender-inclusiveness, and minority groups? Finally, how can evidence-based policymaking be improved, and how can the implementation of these policies be advanced in a more effective manner? Thesession will encourage critical debate and identify major policy recommendations, focusing on governance and implementation strategies. In the second half of the session, the panel will engage the audience in an interactive discussion to explore novel solutions that prioritise the wellbeing of healthcare workers and effectively address the healthcare workforce crisis in a more person-centred and ‘humanised’ manner. The workshop supports cross-country learning and networking opportunities.

Key messages

• Mental health and wellbeing of the healthcare workforce is crucial for health system resilience and needs stronger advocacy for coordinated multi-level governance action.

• Establish a health system and governance approach together with comprehensive monitoring and qualitative comparative workforce studies to identify transformational policies in contextual settings.
Transitions in heating systems and impact on perceived wellbeing: a qualitative study
Authors: Barlin H
Published: October 2024

Background

as part of the larger European WELLBASED project an urban program focusing on transitions in heating to tackle energy poverty, is implemented in 4 disadvantaged, predominantly Roma neighborhoods of Edirne, Türkiye. These neighborhoods have high levels of vulnerability, aid dependency, and energy poverty. This study investigated the impact on perceived wellbeing of implementing the heating system transition.

Methods

A qualitative methodology was applied; data was collected through semi-structured in-depth interviews among participants in the intervention group of the larger WELLBASED evaluation study. Diversity was ensured regarding gender, age, education level, and working status. Participants were 13 individuals from 13 households in which energy-efficient heating systems were installed. Interviews were audio-recorded, transcript verbatim and coded; thematic analysis was conducted.

Results

3 main themes and 7 sub-themes (st) emerged in the preliminary analysis with regard to impact on well-being: perceived changes in living conditions (st: physical changes, financial implications, domestic burden), perceived effects on health (st. mental health, physical health), and expectations versus reality (st. insulation, efficiency). Experiences differed as per housing condition, type of energy used, usage proficiency, and income level.

Conclusions

Energy efficient heating system transition to tackle energy poverty at homes may not be sufficient to realize impact on perceived wellbeing. Housing conditions (ie. insulation), supported energy sources and management of expectations need to be considered as part of the program.
Harnessing technology for co-creation: maximizing the collaborative potential
Authors: Loisel Quentin
Published: October 2024

Quentin will introduce the role of enabling technologies in maximizing hybrid intelligence for effective co-creation. This presentation sheds light on how technological advancements, particularly artificial intelligence, shape the co-creation landscape, emphasizing their pivotal contribution to enhancing collaboration. Through Quentin’s insights, delegates will understand how technology can optimize the co-creation process, facilitating communication, data integration, and collective problem-solving. Explore the transformative power of technology in driving innovative co-creation initiatives and unlocking new possibilities for collaboration in addressing complex challenges.
Assessment of adults’ misconceptions for Human papilloma virus through development of an instrument
Authors: Golbasi Koc S D , Oktar D , Salis E , Metintas S , Onsuz M F
Published: October 2024

Background

Misconceptions, myths, and conspiracy theories surrounding Human papilloma virus (HPV) are prevalent and diverse. To comprehensively address these misconceptions about HPV, the HPV Misconceptions Scale (HPV-MS) was developed and implemented, which supports public health initiatives aimed at combating HPV-related diseases.

Methods

This methodological and cross-sectional study collected data from May 2 to June 28, 2022, involving two sequential participant groups, starting with 150 and expanding to 471 individuals. The survey, which collected demographic data, HPV-MS responses, variables thought to be associated with HPV-MS scores, and knowledge levels using the HPV Knowledge Scale (HPV-KS), was distributed via social networks and analyzed using SPSS and JASP.

Results

The HPV-MS, which includes 26 items and explains 46.8% of the variance, demonstrated substantial reliability with a Cronbach’s alpha of 0.691. The scores ranged from 2 to 20, with a median score of 14. Higher HPV-MS scores, indicating fewer misconceptions, were associated with younger age, higher education levels, absence of a family history of cervical cancer, and greater knowledge about HPV. Analysis revealed that HPV-KS scores were significant predictors of HPV-MS outcomes, even when controlling for other variables.

Conclusions

HPV-KS scores significantly predicted HPV-MS outcomes, highlighting the importance of knowledge in reducing misconceptions. Additionally, the HPV-MS effectively identifies widespread misconceptions about HPV, which is crucial for designing targeted educational measures. The wider use of this tool could help refine strategies to address HPV-related misconceptions across diverse populations.

Key messages

• HPV-KS scores were significant predictors of HPV-MS outcomes, even when controlling for other variables, highlighting the importance of knowledge in reducing misconceptions about HPV.

• The HPV-MS effectively identifies widespread misconceptions about HPV, which is important for designing targeted educational measures.
Incentives to attract and retain physicians to underserved areas - a case study from Portugal
Authors: Alidina S , Fronteira I , Cortes J
Published: October 2024

Issue

Physician shortages in underserved areas are a common challenge for governments and policymakers worldwide, including in Europe. Meanwhile, a knowledge gap exists on effective measures to address the issue.

Description

According to WHO Europe, one of ten actions to strengthen the healthcare workforce is to develop strategies to attract and retain health workers in rural and remote areas. Portugal faces geographical asymmetries in the distribution of physicians, and difficulties in retaining them in certain areas of the country. This case study seeks to describe and analyse the impact of an incentives package introduced in 2015 that aimed to attract and retain physicians in underserved areas. Financial incentives data was gathered via a national health human resources information system. Non-financial incentives data was reported by health institutions through an online form. Document analysis was conducted to understand the scope of the incentives package and its amendments.

Results

The incentives package implemented in Portugal effectively deployed physicians to underserved areas, since it led to a fourteen-fold increase in physicians settling in underserved areas. In terms of retention, an average of 59% of the physicians that took up the incentives package are still practicing in the same underserved area. However, the difference between the retention levels of physicians under the incentives package and those not covered is minimal. To further reduce health inequities and achieve universal health coverage, a need exists to review the financial and non-financial incentives to better suit physicians’ needs and expectations, as well as those of the National Health Service.

Lessons

The incentives package introduced in Portugal makes it clear that flexibility in the design of attraction and retention measures is crucial. It requires a long-term commitment and a recognition that each intervention should be assessed and adapted to local circumstances and context.

Key messages

• The incentives package introduced in Portugal attracted physicians to underserved areas and led to a fourteen-fold increase in physicians settling in underserved areas.

• More than half of the physicians are still practicing in the same underserved health institution but the difference in retention against those not covered by the incentives package is minimal.
Achieving integrated care through clusters of co-occurring diseases for people with multimorbidity
Authors: Beaney T , Clarke J , Woodcock T , Barahona M , Majeed A , Aylin P
Published: October 2024

Background

People with multimorbidity are often seen in many different specialist health services, resulting in fragmented care. Conventional services are designed around specialties based on anatomical systems, rather than diseases that occur together. We examined whether organising services around clusters of co-occurring diseases would lead to fewer interactions with unique services and so improve integrated care.

Methods

We used the Clinical Practice Research Datalink, a nationally representative sample of primary care data in England, including all patients registered on 1st January 2015 with multimorbidity (two or more of 212 long-term conditions (LTCs)). We used the assignment of 212 LTCs to 15 clusters of co-occurring diseases, derived from our earlier work. For each patient, we calculated the number of interactions with different specialists, under both the existing specialty-based model, and the hypothetical cluster-based model, under the assumption that a patient required review for each LTC.

Results

Of 6,200,973 patients with multimorbidity, the mean age was 53 years, with a median (interquartile range) of 8 (5 - 11) LTCs per person. There was considerable variation in the assignment of diseases comparing 15 clusters versus 15 specialties. Under the existing model, 409,708 (6.6%) patients interacted with only one specialty, and under the hypothetical cluster model, 584,446 (9.4%) patients interacted with only one cluster. On average, patients interacted with 3.66 specialties versus 3.30 hypothetical clusters (p < 0.001 for difference).

Conclusions

Health services designed around clusters of co-occurring diseases might lead patients to interact with fewer different services and so experience less fragmented care. Further work is needed to understand which specialties collaborating, and how, would have the greatest impact on improving integrated care.

Key messages

• Health services designed around clusters of co-occurring diseases led to a small reduction in the number of interactions with different services per year.

• Designing services around clusters of co-occurring diseases might reduce fragmented care for people with multimorbidity.
The association between traffic noise and self-rated health within the German National Cohort (NAKO)
Authors: Slesinski S , Wolf K , Zhuang S , Lakes T , Bolte G , Peters A , Schneider A
Published: October 2024

Objectives

Traffic noise can cause stress and disturb sleep, impacting health in many ways. However, few large studies on this topic exist. We investigated the association between traffic noise and self-rated health (SRH) within the German National Cohort (NAKO).

Methods

NAKO enrolled >200,000 adults ages 20-74 at 18 sites in Germany. We used logistic regression to test whether 1) annual mean 24-hour ambient traffic noise levels at or above 55 dB(A) within a 10-meter residential buffer and 2) subjectively reported nighttime traffic noise annoyance were associated with higher odds of reporting fair/poor SRH. We calculated these associations within the full sample, stratified by sex, and stratified by age group (≤39 years, 40-59 years, ≥60 years). We adjusted for study site, age, sex, marital status, education level, and migration background.

Results

Among participants without missing data (n = 121,232), moderate annoyance was associated with 1.27 higher odds (95% CI 1.21-1.32) and strong annoyance with 1.75 higher odds (95% CI 1.65-1.84) of fair/poor SRH, while annual mean noise ≥55 dB(A) was associated with 1.07 higher odds (95% CI 1.03-1.12). Females who reported strong annoyance had especially high odds of fair/poor SRH (OR 1.81, 95% CI 1.69-1.95), as did those aged 40-59 years who reported high annoyance (OR 1.78, 95% CI 1.66-1.92). Those 39 and under had no significant increase in odds of fair/poor SRH if they reported moderate annoyance or if they were exposed to ≥ 55 dB(A) annual mean noise. In single exposure models, noise annoyance and objectively measured noise were both significantly associated with higher odds of reporting fair/poor SRH, but in combined models, the effect of objectively measured noise became insignificant while the effect of annoyance remained strongly significant.

Conclusions

These findings confirm that traffic noise is an important public health issue. Further analyses on most affected populations should inform noise protection policies.

Key messages

• Higher levels of traffic noise are associated with worse self-rated health.

• Ambient noise is an important public health issue for which more research is needed.
Knowledge, behaviours, practices, and expectations on climate change among French health workers
Authors: Guihenneuc J , Cambien G , Blanc-Petitjean P , Bernard N , Jourdain B , Barcos I , Saez C , Dupuis A , Ayraud-Thevenot S , Migeot V
Published: October 2024

Introduction

Hospitals face a dual challenge with climate change (CC): reducing emissions and preparing for its impacts. The main objective of this study was to evaluate the knowledge, behaviours, and practices (KBP) of health workers (HWs) in French hospitals regarding CC and environmental sustainability (ES). The secondary objectives were to understand their expectations and identify associated factors with the KBP of HWs.

Methods

A multicenter cross-sectional KBP study was carried out among HWs of six French hospitals from June 2021 to December 2022. A structured questionnaire was designed and consisted of five parts: i) participant characteristics, ii) CC knowledge and perceptions, iii) behaviours, iv) practices concerning ES actions, and v) expectations. A multilevel logistic regression model assessed associations between HWs’ KBP and both individual and hospital characteristics.

Results

Out of 57034 HWs, 4552 (8.0%) participated in the study. Only 15.4% identified the activities with the greatest environmental impact. On a scale of 1 (Not a priority) to 10 (High priority), the average median rating attributed to commitment to ecological transformation in their hospitals was 5.0/10. Among the participants, 1079 (23.7%) had already initiated at least one ES action. To implement ES-related projects, main barriers were reported including lack of dedicated time (40.4%), hierarchical support (32.5%), methodological support (28.9%), and training access (23.7%). The presence of a sustainable development steering committee, especially active for over 5 years, positively correlated with better information for HWs (ORa=1.78 [1.29-2.45]), better knowledge (ORa=1.83 [1.32-2.53]), and more ES actions initiated (ORa=1.74 [1.33-2.29]).

Conclusions

French HWs demonstrate a commitment to making their hospitals more environmentally sustainable. Some drivers and barriers were identified to further support these essential transformations.

Key messages

• First national study on knowledge, behaviours, practices, and expectations on climate change and environmental sustainability among French health workers.

• Among the drivers to strengthen dynamics within hospitals, the need for training among French health workers and institutional support has been identified.
Scanning the horizon- environmental health indicator surveillance
Authors: O’Connell A , Casey M , Cosgrove B
Published: October 2024

Aim

This work aimed to conduct a comprehensive literature review with narrative synthesis of evidence in relation to the surveillance of environmental health indicators by Public Health agencies internationally. This will strengthen the All-Hazards approach to Health Protection in Ireland.

Methods

The project proposal was registered on PROSPERO. Preferred Reporting Systems for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. A systematic search was conducted across five databases. In addition, relevant websites, reference lists and the grey literature were searched. Data were extracted following TIDieR-PHP guidelines. Risk of bias was considered and quality appraisal was performed using SANRA and AGREE-HS tools. A narrative synthesis of the evidence was completed.

Results

12 papers were included in the final review. Four were narrative review articles describing European and worldwide initiatives and the remaining eight described a single health system. Only three papers were deemed high quality. The number of indicators monitored varied widely from one in Italy to over 400 in the USA. The most established programmes described the use of a framework such as Drivers-Pressures-States-Exposures-Effects-Actions (DPSEEA) and indicator selection criteria were applied. The papers described a variety of public health actions arising from the surveillance of environmental health indicators. The knowledge provided by this review can inform the implementation process. Establishment of a project team, and beginning with monitoring one domain is suggested. Air quality is the most frequently monitored domain internationally. The DPSEEA framework is recommended, and Briggs’ indicator selection criteria should be applied to any indicator under consideration. The system should measure both hazard and outcome measures. Finally, meaningful public health action should result from the monitoring.

Key messages

• Environmental health indicator surveillance is essential to all-hazards health protection.

• Few public health agencies internationally are systematically monitoring environmental health outcomes.