bluuebunny/crossref_metadata_2025 huggingface dataset:
10.A. Round table: Transforming public health systems at large scale: no pain, no gain
Authors:   Organised by: WHO/Europe,   Chair persons: Natasha Azzopardi Muscat (WHO/Europe), Emilia Aragon De Leon (WHO/Europe)
Published: October 2024

The COVID-19 pandemic, acceleration of climate change, and geopolitical turmoil have triggered discussions about how public health systems in Europe need to transform to be adequately equipped for the so-called “permacrisis”. The challenges to policy makers, health institutions and health services have become so multifaceted, that single solutions from the health sector alone no longer work. Yet, despite the complexity, countries seek to get its own house in order whilst building on inter-sectoral and European approaches in parallel. Germany, Ireland, and Ukraine have all embarked upon ambitious public health services and institutional reforms, leading to transformative change in public health systems. WHO has been accompanying these reforms. The workshop will provide a platform to draw insights and lessons on transforming public health systems from all three countries, although their population size, their socioeconomic and political situation and their public health system design is so different. As the smallest of the three countries in population, Ireland created coherence and is aligning public health actors within “Healthy Ireland” and the Sláintecaire and the Crowe Horwath public health reforms. Germany’s “Pact for the Public Health Services” has been one of the greatest public health investment programs in Europe that was initiated following lessons from the COVID-19 pandemic. And Ukraine has undertaken important legal steps to adopt a Public Health System Law, in the middle of a war of aggression on its territory. The workshop will exhibit the process of large-scale public health system transformation in each of the three countries. The purpose is to identify the enablers that make large scale system transformation possible and addressing some of the pains and gains. The workshop will have three parts. Part one consists of three presentations on large scale system reforms from each of the participating countries. Part two consists of a moderated Q&A session. Part three will focus on the synthesis of enablers for large scale public health system reforms through interaction with the workshop participants, using a digital white board.

Key messages

• Disruptive times can create enabling conditions for large scale public health system transformation.

• Designing and implementing large scale public health system reforms is complex, requiring passion, resilience, and collaborative leadership.
Targeted initiatives to tackle health inequalities, integrating the Leeds Health and Care Workforce
Authors: Gates C
Published: October 2024

Deprivation and poor health are significant challenges in Leeds, with the poverty gap growing in parts of the city. The Leeds One Workforce approach to narrowing inequalities (NI) was co-designed in 2021 building on the innovative partnership approach already visible in the city. Its phased approach has seen interventions put in place to boost the opportunities for people from marginalised communities to develop their skills and remove barriers to careers in health and care and has global relevance for other localities experiencing high deprivation. The overall NI approach is supported by a long-term and wide-reaching evaluation plan which mobilises our partner organisations and intends to amplify best practice in getting people into careers and supporting this group to develop within the health and care workforce. We will present findings from embedded evaluations of initiatives across the city, and individual case studies, from those who have accessed NI interventions in Leeds. These will explore the relationships and contributions of partnership organisations and presence of any unexpected barriers or facilitators to these interventions. Linking with third-sector organisations and creating accessible pre-employment opportunities to develop core working skills is a vital part of the Leeds approach to recruiting people from priority wards. Additionally, supporting people into careers in health and care which suit their values, interests and personal circumstances, in addition to employing organisations with flexibility and openness towards their employees at their core is a strong factor in recruiting and retaining from areas of deprivation. Partnership working is essential to tackling health inequalities in places of high deprivation to address individual and systemic barriers to securing employment, ensure the best chance of success for community outreach programmes, and maximise efficiencies by combining the efforts of local organisations.

Key messages

• Leeds, UK is transforming approaches to narrowing health inequalities through partnership working across health and social care education and employment.

• Current and future best practice will be explored to demonstrate transferable NI approaches.
A school-based intervention to foster adherence to the Mediterranean diet in adolescents: the PROMEDLIFE project
Authors: Franchini C , Degli Innocenti P , Biasini B , Fontana L , Endrizzi I , Gasperi F , Bontempo L , Rosi A , Scazzina F
Published: October 2024

The need to maintain the production of local foods characterized by a high nutritional index, update traditional food production methodologies by developing attractive tech-based approaches, promote healthy eating habits that meet consumers’ preferences and acceptability, as well as reducing the complexity of supply chains (Farm to Fork) must be addressed to ensure food and nutrition security. This is especially true in Mediterranean countries undergoing dietary and nutritional changes that affect their inhabitants’ health while creating many socio-economic and environmental challenges. PROMEDLIFE aims to increase adherence to the Mediterranean diet through a multi-actor approach by encouraging the adoption of a healthy eating lifestyle while decreasing the environmental and economic impact of food production and processing. It also aims to attain optimal food communication and education through training programs that target primary and secondary students as well as their families, from children to older adults. A 4-week nutritional and sensory educational intervention in high school students involves frontal lessons, a web-app for families enrolled, and games on nutrients, food groups, balanced meals and various eating occasions, healthy and sustainable diets. In addition, adherence to the Mediterranean diet, nutritional knowledge, sociodemographic and lifestyle data, picky eating, and food neophobia are investigated. Including nutritional lectures in the school curriculum of high schools promotes knowledge acquisition about healthy diet. However, a period longer than 4 weeks may be necessary to translate this knowledge into improved eating habits. The project is still ongoing, and follow-up data collection will be performed. Final analysis, including data on picky eating and food neophobia, as well as overall eating behavior at follow-up, will allow an evaluation of possible long-term changes.
10.K. Skills building seminar: Practical and methodological guidance for conducting online qualitative surveys in public health
Authors:   Organised by: Institute for Health Transformation Deakin University (Australia), Health Promotion International,   Chair persons: Samantha Thomas (Australia)
Published: October 2024

Online qualitative surveys are surveys which prioritise qualitative (open text) questions in data collection. Researchers have stated that these types surveys have rich potential for qualitative researchers. They are able to collect rapid insights into new or emerging areas of health, and are an effective way of reaching populations who may not otherwise engage in qualitative interview studies or focus groups. Although these types of surveys are increasingly used by public health and health promotion researchers, there is very limited discussion in the research literature to guide researchers about the practical and methodological aspects of such surveys. This creates some challenges for qualitative researchers - as well as funders, and peer reviewers - in assessing the rigour and robustness of these studies. Using data from a range of online qualitative surveys that we have conducted with youth and adults relating to gambling, alcohol, climate change, and the commercial determinants of health, we describe the processes associated with developing, implementing, interpreting, and writing up online qualitative survey data. In this practical and interactive multimedia workshop and developing on the work of Braun, Clarke and colleagues, with a focus on Big Q interpretivist qualitative approaches. We will provide:

1. Practical examples, and lessons learned from our own studies about survey design, question development, the importance of rigorous piloting strategies, the use of novel techniques to prompt detailed responses from participants, and the decisions that are made about data cleaning.

2. Examples of the types of responses that can be expected in different types of surveys, and how decisions are made about the quality of responses to questions.

3. Guidance about how to analyse the volume of qualitative data that is generated from such surveys, including developing robust mechanisms to ensure trustworthiness of decision making and data interpretation.

4. Tips based on our role as journal editors about how to present qualitative survey data, and how to respond to challenging reviewer comments.

Participants will be provided with a booklet containing survey templates, question examples, tips and examples of how to respond to reviewer comments.

Key messages

• Online qualitative surveys have rich potential for collecting insights about emerging public health issues.

• This workshop will provide practical and methodological guidance for researchers who are interested in using these surveys.

Speakers/Panelists

Hannah Pitt

Deakin University, Burwood, Australia

Simone McCarthy

Deakin University, Armadale, Australia

Samantha Thomas

Deakin University, Geelong, Australia
JA ImpleMENTAL Implementing the Belgian Best Practice on Community Mental Health system Reform
Authors: Konte V , Peppou L E , Stamou M , Belorgey N , Lora A , Štimac Grbić D , Lindert J , Bolinski F , Bulyovszky B ,   JA ImpleMENTAL
Published: October 2024

Mental health challenges affect more than one in six people across the EU. In order to support Member States to proceed with mental health care system transformation and suicide prevention JA ImpleMENTAL, was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Program. The JA consists of 39 organizations from 21 countries, more than 180 persons are working. Two advisory bodies support the consortium and provide their insights and expertise, a stakeholder forum with 10 key European Organizations in Mental Health including EUPHA Mental Health Section and WHO Europe and OECD, and the Member State Policy Committee which ensures the involvement of ministries and enables the practices to be embedded in health systems. Within the 11 countries implementing pilots under the Belgium model using a common Implementation Strategy, a total 163 activities are implemented under the 5 following key areas: 62 on structural measures needed for the establishment of local networks promoting a user’s centered, human’s right based recovery approach, 43 for the development and/or transformation of mental health services, 22 on training & capacity building in support of the reform and cultural change, 22 on continuous communication, information and awareness raising, and 13 on data collection, monitoring and evaluation. An analysis of MS pilot action plans shows that most service transformation efforts have concentrated on: defining care pathways for people at risk and for those with mild to severe mental health conditions including smooth transition from child and adolescent to Adult Mental Health services, as well as from inpatient to community services, the nomination of case managers for assisting individuals to their recovery process the development of individual service plans, the Involvement of users in various layers of service delivery including peer support and the provision of assertive treatment through mobile units.
Integrity and accountability in academic publishing: trends and implications of paper retractions and journal delistings
Authors: Valz Gris A , Cristiano A , Pezzullo A M
Published: October 2024

In the context of academic publishing, ‘retraction’ refers to the withdrawal of a published article from the scientific record due to issues such as significant errors, plagiarism, fraudulent data, or unethical research practices. Retractions play a critical role in maintaining the integrity of scientific literature. Retraction Watch, a blog that tracks retractions of scientific papers, lists more than 48,000 retractions in its database, with increasing trend over time (from 450 reported retractions in 2008 to a staggering 7327 retractions in 2023). The extent to which this indicates a heightened vigilance in identifying problematic research or an increased tendency in committing research misconduct or errors is unclear. Retractions can have lasting consequences beyond the retracted paper itself for authors, editors, publishers and the scientific community at large. However, not all retractions are the same, and self-reporting errors might come with minimal effects, suggesting a recognition of accountability and corrective actions. Delisting of a journal from a scientific database such as Scopus and Web of Science refers to the removal of the journal from the database’s index. This can happen for various reasons, including quality concerns and ethical issues. Although this phenomenon is not necessarily correlated with the quality, integrity, or reliability of individual papers published in the delisted journal, it might still have significant impacts on the work and careers of researchers. For instance, articles in delisted journals might suffer from decreased visibility or authors might not be able to use it for promotions. The curated list of sources from Scopus is publicly available and lists around 800 discountinued sources due to quality concerns, while Web of Science made the news in 2023 for the delisting of several journals for editorial reasons, including the MDPI’s giant, International Journal of Environmental Research and Public Health.
Effect on comprehension of an AI patient-friendly hospital discharge letter: a quasi-RCT
Authors: Conrado F , Rosset L , Lo Moro G , Scaioli G , Consoli D , Bert F , Siliquini R
Published: October 2024

Background

During transition from hospital to home care, discharge letters serve as a bridge of information between hospital physicians, general practitioners, and patients. However, the complexity of these letters often hinders patient comprehension, leading to medication errors and adverse outcomes. We assessed the effect on patients’ comprehension and satisfaction of using AI to transform discharge letters into patient-friendly versions.

Methods

An online quasi-randomized controlled parallel-group trial was conducted in Italy. A synthetic discharge letter for a chronic obstructive pulmonary disease patient was drafted. GPT-4 rephrased the letter into an easier-to-understand version. Participants were assigned to receive either the original or AI-generated letter and completed comprehension assessments and satisfaction survey.

Results

Out of 460, 166 participants received the original letter, and 175 the AI version. The AI group showed significantly higher comprehension scores (median 4;IQR 2-4 vs. 2; IQR1-2, p < 0.001) and outperformed the control group in understanding diagnosis, medications, and antibiotic instructions. Perceived satisfaction was higher in the AI group across all measures (p < 0.001). Health literacy was a good predictor of comprehension in both arms (p = 0.013; p = 0.015). Subgroup analysis revealed the AI letter nearly bridged the comprehension gap between non-healthcare individuals and healthcare professionals receiving the original letter.

Conclusions

AI-optimized discharge letters improved patient understanding, and satisfaction compared to traditional letters. The study underscores the influence of sociodemographic factors like healthcare experience and health literacy on comprehension, advocating for adaptive communication strategies. These findings contribute to discussions about integrating AI in healthcare to develop patient-centered communication approaches.

Key messages

• AI-generated patient-friendly discharge letters significantly improved comprehension and satisfaction compared to traditional letters.

• Integrating AI in healthcare communication can help bridge comprehension gaps and promote patient-centered care.
Applications of AI in public health: Improving access to high-quality evidence syntheses
Authors: Dobbins M , Rogers K , Miller A , Kostopoulos A , Husson H
Published: October 2024

Issue

Using the best available evidence is crucial for effective public health practice. Health Evidence™ provides access to high-quality synthesis evidence relevant to public health. As the volume of peer-reviewed published literature grows, maintaining a database of this magnitude is increasingly resource-intensive. Artificial intelligence (AI) can be used to reduce the maintenance burden thereby ensuring decision makers can easily access high-quality synthesized public health evidence. These innovative strategies may be transferable to enhance efficient maintenance of large curated databases of published literature.

Description of the problem

In 2020, The Health Evidence™ team conducted extensive training and testing of a supervised machine learning application to explore the accuracy of AI-assisted reference de-duplication and relevance screening. Finding promising results, the team implemented these AI-assisted strategies in August 2020. To assess the impact on the overall screening burden and time saved, implementation data was analyzed between November 2020 to 2023.

Results

For these 3+ years, AI assisted de-duplication and relevance screening was applied to 394,903 search results. The AI assisted de-duplication application removed 31% (n = 123,903) of references as duplicates. From the remaining reference sets (n = 272,253), the AI assisted screening application removed 70% (n = 190,966) of references as not relevant. Quality assurance spot testing found minimal classification errors (n = 1). In total, AI assisted approaches reduced the need for manual screening by 80%, saving approximately 626 hours of manual screening time over three years (or approximately 17 hours/month).

Lessons

With the reality of limited public health resources, continued access to high-quality synthesis evidence is critical. Innovative strategies using AI-assisted applications improves the feasibility of maintaining a large database of quality-appraised public health synthesis evidence.

Key messages

• Access to high quality synthesis evidence is critical for evidence-informed decision making.

• Artificial Intelligence can be used to efficiently identify evidence syntheses relevant for public health.
An integrated work health intervention among cleaners in Denmark
Authors: Mortensen O S
Published: October 2024

Introduction

Work-related diseases are increasing and considered a global health challenge. Meanwhile, work-related risk factors and diseases are not equally distributed across occupational groups. Previous work health interventions have not succeeded in reducing the prevalence of work-related diseases. Therefore, integrated approaches combining prevention of disease and promotion of health in work health interventions have been developed. The aim of the Integrated Approach to Health, Wellbeing, and Productivity at Work (ITASPA) intervention was to prevent work-related injuries and diseases and promote the health, safety and wellbeing of cleaners.

Methods

The ITASPA intervention was implemented at two Danish workplaces among cleaners. At each workplace a committee of employees was established to develop their own initiatives to promote the health of the workers. By use of the British Medical research Council’s framework, a process evaluation was conducted. Qualitative data (focus group interview and field notes) and quantitative data (questionnaires) of participants evaluated the implementation.

Results

A total of 91 cleaners participated in health checks, and three workshops were held at each workplace. The development and implementation of activities was affected by mechanisms, such as lack of information about the intervention, new power dynamics, and lack of motivation for behavior changes, and contextual factors, such as many replacements, time pressure and absence of managers.

Conclusions

Integrated approaches in work health interventions among employees with short or no education may positively impact employees’ health, wellbeing and safety if comprehensively implemented. However, attention should be drawn to interventions that adapt a participatory design, as unintended power dynamics may occur when employees are given the tasks of implementing behavior changes among colleagues. The role of managers to obtain successful implementation should be highlighted.
11.D. Scientific session: Participatory approaches and co-creation in complex interventions to reduce inequity in health
Authors:   Organised by: SItI Working group of Community mental health (Italy), EUPHA-URB,   Chair persons: Giuseppe Di Martino (Italy), Laurent Chambaud (France)
Published: October 2024

The escalating challenges posed by climate change and rapid urbanization demand an integrated understanding of how our natural and built environments influence health outcomes. This workshop aims to dissect the complex associations between the environment-both natural and constructed-and physical and mental health. The urgency and breadth of these issues necessitate a multidisciplinary approach, leveraging insights from environmental science, public health, and urban planning. The primary objective of this workshop is to elucidate the multifaceted relationships between environmental conditions and health, identifying actionable strategies to mitigate adverse health outcomes and enhance well-being. Specific goals include: i) to assess the current scientific evidence linking various environmental factors with health, highlighting the role of climate change; ii) to explore innovative methodologies for studying environmental impacts on health; and iii) to foster collaboration among researchers, policymakers, and practitioners for integrated health and environmental planning. Organizing this workshop presents several unique added values. First, it serves as a platform for experts from diverse fields to share findings and refine research methodologies. Second, by synthesizing current knowledge, the workshop will inform more coherent and science-based public health and urban policy. Lastly, it could facilitate networking among stakeholders, fostering collaborations that bridge gaps between research and policy implementation. The workshop is structured to ensure thematic coherence and maximally beneficial interactions among participants. Presentations will be grouped into four thematic blocks: 1. effects of climate change on health; 2. healthy design and public mental health; 3. Planetary health challenges to human health; 4. Climate change perception and mental health.

During the workshop, each speech will be built on the previous one in a sequential way. At the end of the workshop, audience members could join the discussion offering their point of view and directly interacting with the speakers. This workshop stands as a crucial endeavor to integrate diverse perspectives on how environmental conditions impact health and to catalyze significant strides in public health and urban planning. It promises to not only advance scientific understanding but also to translate this knowledge into practical, scalable solutions for health resilience in our communities.

Key messages

• Urban health is foundational for sustainable cities, integrating health into all policies ensures inclusive, safe, resilient communities as outlined in SDG 11.

• Public health influenced by environmental and local government strategies highlights the need for multidisciplinary approaches to adapt urban planning and health policies.
Meal timing and risk of metabolic syndrome in the prospective French NutriNet-Santé biobank
Authors: Obeid E , Le Folcalvez X , Ezzedine K , Palomar-Cros A , Péneau S , Bellicha A , Deschasaux-Tanguy M , Touvier M , Andreeva V A , Srour B
Published: October 2024

Background

Circadian rhythm disruption has been associated with higher risks of cardiometabolic diseases and several cancers. Mistimed eating patterns can desynchronize circadian rhythms, and could therefore influence metabolic health. However, long-term associations between meal timing and the metabolic syndrome remain unclear. The aim of this study was to evaluate the prospective associations between meal timing and the risk of developing metabolic syndrome.

Methods

We used measured biological and clinical data from 16 353 adults (51 years ± 13.72) in the NutriNet-Santé biobank (2011-2014), and examined the associations between meal timing, assessed with repeated 24-hour dietary records during the first two years of follow-up (starting 2009), and the risk of metabolic syndrome, using modified Poisson regression models, adjusted for main confounders.

Results

At the end of follow-up (mean 2.1 years (SD = 1.2)), a later timing of the first meal of the day was associated with a moderately higher risk of metabolic syndrome (1,788 cases; RR per 1-hour delay = 1.05; 95% CI: 1.00-1.10). However, after adjusting for overall diet quality, this association was attenuated (RR: 1.04; 95% CI: 0.99-1.09). Overall, we found no evidence of an association between the occurrence of metabolic syndrome and the time of the last meal (RR: 0.99; 95% CI: 0.95-1.05), the number of eating occasions (RR: 1.00; 95% CI: 0.98 - 1.03), or night-time fasting duration (RR: 1.03; 95% CI: 0.99 1.07).

Conclusions

In this large prospective study, timing of the first meal showed modest associations with metabolic syndrome. Further investigations using a longer follow-up are needed to elucidate how meal timing influences metabolic health.

Key messages

• Beyond the nutritional quality of meals, meal timing, particularly time of first meal, may be an accessible prevention strategy for metabolic health.

• More largescale prospective and intervention studies are needed to better understand the links between meal timing and metabolic health.
Impact of the COVID-19 pandemic on food choices among the working-age adult residents of Lithuania
Authors: Arlauskas R , Austys D , Stukas R
Published: October 2024

Background

The COVID-19 pandemic affected the nutrition of various populations. Assuming that the majority of the population of working-age residents of Lithuania know healthy nutrition recommendations and that food selection criteria might serve as an indicator of the following them, we aimed to assess the food selection criteria during and after the COVID-19 pandemic among working-age adult residents of Lithuania.

Materials and methods

Three cross-sectional surveys among working-age adult residents of Lithuania were carried out: in 2019 (before the pandemic), in 2021 (during the pandemic), and in 2022 (after the pandemic). In 2019, this study included 1007 residents, 1600 residents were surveyed in 2021, also, 1600 residents were surveyed in 2022. Distribution of the respondents by food selection criteria was compared between the samples according to gender, age, marital status, education level, place of residence, employment, income.

Results

The COVID-19 pandemic affected the food choices of Lithuanian residents (p < 0.05). In 2019, products’ benefits for health criterion was in the third place when choosing foods. It was indicated by 22% of the respondents. In 2019, the most prevalent criterion for selecting foods was taste. It was indicated by 37% of the respondents. The second most prevalent food selection criterion was the price. It was indicated by 24% of the sample. In 2021 selection of foods because of products’ health benefits became the most prevalent and accounted for 31% of the sample. In 2022, it returned back to the prepandemic level and accounted for 19% of the sample. In all social and demographic groups changes in food selection criteria remained as well (p < 0.05).

Conclusions

The COVID-19 pandemic had a positive impact on the food choices of working-age adult residents of Lithuanian. Changes of food selection criteria were observed within the different groups of gender, age, marital status, education level, place of residence, employment, income.

Key messages

• The COVID-19 pandemic had a positive impact on the food choices of working-age adult residents of Lithuanian.

• Less than a year after the pandemic food selection according to its health benefits rapidly decreased and returned back to the prepandemic level.
11.H. Round table: Making the case for public investment in health
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Rebecca Forman (UK), Jonathan Cylus (WHO)
Published: October 2024

Across the European Union (EU), public budgets are facing pressures and policy makers are becoming increasingly concerned about how to adequately and sustainably fund their health systems to keep up with need and demand. In recognition of this, in 2022 a Technical Support Instrument (TSI) project funded by the Directorate-General for Structural Reform Support (DG REFORM) was launched together with three European Union (EU) Member States with the goal of strengthening capacity to make the case for public investments in health. To support these efforts, the European Observatory on Health Systems and Policies (OBS) conducted an exercise to map relevant analytical approaches and tools for making the case for public investment in health. As a contribution to this workshop, OBS will present the key results from this exercise, including a framework that has been designed to support health policy makers, advisors and advocates by providing five key lines of argument and selected examples of tools, data, indicators and methods that can be used to successfully make the case for public funding for health. This will be complemented by two presentations on country experiences (in Austria and Malta) of navigating negotiations between health and finance and securing public funding for health. These will highlight both successes and challenges in practice. By looking at examples from MS on making the case for public investment in health, these presentations will frame the panel discussion that follows. The chairs will facilitate a discussion closely engaging the audience on how to build better narratives and exchanges which facilitate trust and alignment between health and finance stakeholders in the pursuit of strengthening the capacity to make the case for public investment in health. The workshop will highlight five lines of argument and practical examples of tools, data, indicators and methods that can be used to support the case for public investment in health. It will also focus on the important enablers (e.g. cooperation, communication, transparency, accountability, trust) for successful budget negotiations and discuss how these can be facilitated.

Key messages

• Budget cases for public funds for health tend to be most successful when they align well with the goals and objectives of finance stakeholders, and certain narratives and arrangements can foster this.

• Data and evidence can help steer decision makers to make good choices (or at least avoid bad ones), but other factors serve as the fuel to push the budget case for health forward successfully.

Speakers/Panelists

Rebecca Forman

European Observatory on Health Systems and Policies, London, UK

Jonathan Cylus

European Observatory on Health Systems and Policies, London, UK

Stefan Eichwalder

Ministry of Health, Vienna, Austria

Neville Calleja

Department of Health Information and Research, G’Mangia, Malta
The 2021-2023 Italian influenza pandemic plan: a critical evaluation of its regional implementation
Authors: Riccio M , Migliara G , Baccolini V , Amicosante AMV , Eugeni E , Guglielmi E , De Vito C , Baglio G
Published: October 2024

Background

Influenza pandemic preparedness plans should be adopted, regularly updated in every country, and comply with international guidelines to ensure proper management of public health emergencies. In Italy, each region develops its pandemic plan based on a National Plan. This study, conducted within a project funded by the Italian Ministry of Health, aims to assess the level of compliance of these plans with the national guidelines.

Methods

The assessment was based on a checklist of 192 items reporting the actions prescribed by the national plan. The items were divided into macro-areas by pandemic phase: general, alert, inter-pandemic, pandemic, and transition. The compliance regarding the presence and contextualization of each item in the regional plans was evaluated. Each macro-area was further assessed for easy identification of actions, congruence with the National Plan, and contextualization in the regional healthcare system. Some analyses grouped the regions into North, Centre, and South/Islands.

Results

Some macro-areas, such as ‘Communication’ and ‘Prevention and Control measures,’ showed some weaknesses in all phases, especially in the northern regions, which reached levels of full compliance below 50%. Central regions were highly compliant in almost all macro-areas, especially in ‘Strategy/Governance’ (100%), ‘Supplying’ (75-100%), and ‘Surveillance’ (75-100%). Overall, contextualization was the weakest aspect in all phases, while easy identification and congruence were mainly better achieved. Only three regions fully met all the assessed parameters.

Conclusions

A strict surveillance and monitoring process of planned activities is necessary to strengthen the country’s preparedness. This study identified critical issues and key areas for improvement at the regional level. This might allow us to verify the correct implementation of national guidelines and define the best strategies for improving readiness for public health emergencies in the future.

Key messages

• Implementation of the Italian influenza pandemic plan was uneven across regions.

• Identification of lacking areas of the regional implementation is essential to improving national preparedness.
Empirically exploring the association of health literacy with schoolchildren’s health behaviours
Authors: Marchant E , Davies N , James M , Brophy S , Crick T
Published: October 2024

Background

Health literacy (HL) is a modifiable factor contributing to the promotion and maintenance of health and well-being throughout an individual’s life. Identified as a priority in Wales, UK in 2010, progress has since stalled despite health and education as national policy priorities and international policy growth. There is a gap in understanding of children in Wales’ HL needs, particularly below adolescent age ( < =11 years).

Methods

This study aimed to scope a measure of children’s HL to be integrated into the existing HAPPEN Cohort Study survey, which collects self-reported health behaviours of children aged 8-11. A review identified the Health Literacy of School-Aged Children (HLSAC) tool which conceptualises health literacy as a learning outcome. A convenience sample of n = 15 primary schools were recruited in April 2023 through HAPPEN and n = 669 school children n = 669 completed the online survey between May-June 2023.

Results

Preliminary data using sum HLSAC scores show a proportion of children with low (20.5%), moderate (52.8%) and high HL (26.8%). Independent samples t-tests comparing mean HLSAC scores with binary self-reported health behaviours show higher HL scores for weekly behaviours (p < 0.05); feeling less tired (0-4 days: 15.1+-4.1, > =5 days 14.5+-3.4), can concentrate (0-4 days: 14.3+-3.6, > =5 days: 15.5+-4.0) and consume less fizzy drinks (0-4 days: 15.0+-3.9, > =5 days: 14.0+-3.8). Further, for can ride a bike (no: 14.3+-4.0, yes: 15.0+-3.9), can swim 25m (no: 14.6+-3.7, yes: 15.1+-4.0), someone active in the household (no: 14.3+-3.8, yes: 15.2+-4.0) and higher health well-being (<7/10: 13.9+-3.5, > =7/10: 15.3+-3.9). This preliminary data will be strengthened with further analyses including regression.

Conclusions

Associations appear between various important health behaviours spanning physical activity, nutrition, cognition and wellbeing. Capturing children’s HL and health behaviour needs enables targeted health promotion and education activities.
Parental leave benefit levels and postpartum maternal mental health: a Swedish cohort study
Authors: Heshmati A , Honkaniemi H , Fritzell S , Juárez S P
Published: October 2024

Background

While generous parental leave benefits are protective for postpartum maternal mental health, not all mothers qualify for these benefits due to strong work requirements. Sweden offers paid parental leave to all residents, but the benefit level depends on their salary and labour market attachment.

Objectives

To evaluate the association between parental leave benefit levels and maternal mental health in the postpartum period.

Methods

Using total population register data, we studied 210 800 first-time mothers, aged 18-52 years, who gave birth to a live singleton offspring in Sweden between January 1, 2007 and December 31, 2011. We performed multivariable logistic regression to compare odds of mental health outcomes from different levels of severity (prescribed anti-depressants or anxiolytics, specialist outpatient care and hospitalisation) between mothers receiving higher-level benefits (i.e., qualified for earnings-related benefits) and those with basic benefits (i.e., a low flat-rate level). We also performed decomposition analyses using the Karlson-Holm-Breen method, and subgroup analyses by region of birth.

Results

Mothers receiving basic benefits had increased odds of prescribed antidepressants or anxiolytics (OR 1.44 95% CI 1.37-1.51), specialist outpatient care (OR 2.27 95% CI 2.13-2.44), and hospitalisations (OR 2.47 95% CI 2.97) compared with mothers receiving higher-level benefits. Increased odds remained after adjustment for pre-existing mental health. After further adjustment for income and employment status, the odds remained elevated for specialist outpatient care (OR 1.13, 95%CI 1.02-1.24) and hospitalisation (OR 1.34, 95%CI 1.03-1.76).

Conclusions

Mothers with basic benefits are more likely to experience moderate-to-severe mental disorders compared to mothers with higher-level benefits, independent of pre-existing mental health, income and employment status.

Key messages

• Labour market attachment prior to childbirth affects parental leave benefit levels and plays an important role in determining mental health outcomes in the postpartum period.

• The work requirements for more generous parental leave benefits may prevent mothers from benefiting from the protective mental health advantages of parental leave.
The role of mental health-related healthcare use in employment and benefits use after unemployment
Authors: Salonen L , Leinonen T , Solovieva S
Published: October 2024

Background

Mental health problems are common among unemployed job-seekers and they further hinder successful re-employment. Previous studies investigating the role of mental health problems on labour market participation after unemployment have largely focused on a single outcome. However, many have subsequent unemployment or receive different types of benefits. To understand these complex pathways a more comprehensive approach is needed. In this study, we examine how mental health-related healthcare use among the unemployed affects their employment and benefit use trajectories.

Methods

We use a 90% population sample of individuals who were residing in Finland at the end of 2010, who were 25-59 years old and unemployed between 2014-2016 (n = 596,323). We use multistate trajectory models to analyse their employment and benefits use development three years after the onset of unemployment. We will further use multinominal regression analysis to investigate how mental health-based healthcare use is associated with these trajectories and how this association varies between different sociodemographic groups.

Results

Around half of the unemployed job-seekers received some type of benefit after the onset of unemployment. Almost 25 % received sickness allowance (especially women), a little less social assistance (especially young and low educated), or unemployment benefits (especially men), and around 10 % received disability pension (especially among those with healthcare visits due to mental disorders). Next, we will conduct a trajectory analysis to get a more comprehensive picture of the employment and benefits trajectories.

Conclusions

Unemployment is followed by complex employment and benefits trajectories which further differ by sociodemographic groups and mental health-related healthcare use. Knowledge on the factors influencing these trajectories will help direct employment-promoting interventions towards different groups of unemployed.

Key messages

• Many unemployed job-seekers receive some type of social or sickness benefit after unemployment.

• The employment and benefits trajectories after unemployment differ between those who had mental health-related healthcare use and those who did not, and further by sociodemographic factors.
Maternal pre-gestational and gestational diabetes and risk of offspring epilepsy: A cohort study
Authors: Hossin M Z , Persson M , Bjørk M H , Stephansson O , Razaz N
Published: October 2024

Background

Despite growing evidence linking maternal diabetes to impaired brain physiology and neurodevelopment in offspring, evidence on its effect on epilepsy remains scarce. This study aims to determine if intrauterine exposure to maternal pre-existing and gestational diabetes mellitus is associated with risk of offspring epilepsy.

Methods

We studied >2.3 million singletons live-born in Sweden between 1998 and 2021, with final follow up until October 31, 2023. The Swedish Medical Birth Register was linked to the National Patient Register to identify gestational diabetes (GDM), maternal pre-gestational type 1 (T1DM) and type 2 diabetes (T2DM), and offspring epilepsy. The incidence of epilepsy, comparing offspring of mothers with versus without diabetes, was calculated as hazard ratios (HR), adjusting for maternal education, smoking, body mass index, hypertension, epilepsy and other important confounders. Paternal T1DM and T2DM were additionally analysed as negative control exposures to assess genetic confounding.

Results

Of the 2,335,245 offspring analysed (48.9% female), 13,883 (0.6%) were exposed to maternal T1DM, 4477 (0.2%) to T2DM, and 37,253 (1.6%) to GDM. During a median follow up of 13 years (range 0-26 years), 18,732 offspring were diagnosed with epilepsy. Maternal T1DM (HR 1.27, 95% confidence intervals [CI] 1.08-1.49) and T2DM (HR 1.34, 95% CI 1.00-1.49) were associated with higher hazards of epilepsy in offspring, compared with no exposure to maternal diabetes. Preterm birth and birth-asphyxia jointly mediated 63% and 39% of these associations, respectively. No association was found between maternal GDM and epilepsy. Paternal T1DM and T2DM did not show association with epilepsy.

Conclusions

In this nationwide population-based cohort study, children of mothers with T1DM or T2DM showed an elevated risk of epilepsy. The results from paternal comparison and mediation analyses suggest a key role of the intrauterine environment in the aetiology of epilepsy.

Key messages

• Maternal pre-existing T1DM and T2DM might be risk factors for epilepsy in offspring and are likely to influence the risk through the intrauterine environment independent of genetic mechanisms.

• In the context of a globally rising prevalence of diabetes in women who get pregnant, it is crucial that the diabetes is well-regulated and birth complications associated with diabetes are prevented.
Housing tenure and acute lower respiratory tract infection admissions in two Scottish birth cohorts
Authors: Hart C , Hardelid P , De Stavola B , Hajna S , Cunningham S , Taylor J , Cruz J
Published: October 2024

Introduction

Early-life acute lower respiratory tract infections (LRTI) have been associated with increased morbidity and mortality. Despite young children spending much of their time at home, the contribution of home ownership status, on LRTI hospital admissions is unknown.

Objectives

To estimate the association between housing tenure and the odds of LRTI hospitalization in children <2 years in two birth cohorts.

Methods

De-identified Scottish birth records were linked to maternal Census data (2001 and 2011) and to hospital admission data to construct two birth cohorts (Cohort 1 (C1), born 2000-2002; Cohort 2 (C2), 2010-2012). Using logistic regression we estimated the association of housing tenure (owned, social rented, private rented, rent-free) with the odds of LRTI hospital admission, before and after adjustment for maternal age, residential area, and maternal qualification level.

Results

Over the 2-year follow-up, there were 14,833 LRTI admissions in 12,527 children (10,832 children had 1 LRTI admission and 1,695 >1 LRTI admission). 75.6 % of all LRTI admissions were due to bronchiolitis. In C1 and C2, 4.0% and 5.3% children, respectively, had one or more LRTI admission. Compared to children living in owned housing, the odds of LRTI admission were higher in children living in social rented housing (C1: Odds ratio=1.40, 95% confidence interval: 1.31-1.49; C2: 1.23, 1.16-1.31), private rented (C1:1.24, 1.11,1.39; C2: 1.14, 1.06-1.21), and rent-free housing (C1: 1.53, 1.35,1.74; C2: 1.04, 0.80-1.36) after confounder adjustment.

Conclusions

We found an association between non-owned housing and higher odds of LRTI admission which was more marked in C1 than in C2. Further research is warranted to unpick the mechanisms underlying the association between housing tenure and LRTI admission. Interventions to prevent LRTI admissions could usefully target children living in non-owned housing.

Key messages

• This study demonstrates the value of administrative and health data linkage in improving our understanding of how socio-environmental factors might impact children’s respiratory health.

• Children living in social and private rented housing (compared to owned housing) have a higher risk of LRTI hospital admission and could benefit the most from LRTI-lowering interventions.