bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 vaccine hesitancy in five Western Balkan countries
Authors: Matovic Miljanovic S , Cvjetkovic S , Jeremic-Stojkovic V , Mandic-Rajcevic S
Published: October 2022

Background

The vaccine hesitancy is a matter of global concern with inadequate global uptake postponing the moment of reaching herd immunity and bringing the COVID-19 pandemics under control. Countries in the Western Balkans struggle with vaccine hesitancy, trying to bring vaccine acceptance and ways to improve it into the focus.

Methods

A cross-sectional study on vaccine hesitancy was conducted from July to September 2021 and included adult population from Albania, Bosnia and Herzegovina, North Macedonia, Montenegro and Serbia (1605 individuals). Convenience sampling was applied using anonymized online questionnaire (shared through social media) measuring, among others, trust in societal factors, social responsibility and, the credibility of information sources about COVID-19 vaccines.

Results

The highest degree of trust in societal factors was found in North Macedonia (M = 3.65, SD = 1.06), followed by Montenegro (M = 3.50, SD = 1.19) and Serbia (M = 3.24, SD = 1.26). In Albania 44.7% respondents believed in reluctance of pharmaceutical companies to publish detailed research reports on the risks of adverse reactions to COVID-19 vaccines. The view that the health authorities when they encourage vaccination do so with the best intentions supported 66,3% respondents in North Macedonia and 49% in Albania and Serbia. The highest level of social responsibility (M = 4.12, SD = 1.09) was revealed in North Macedonia. Primary care physicians, health professionals in media, webpages of public health institutions, and scientific literature are the most trusted sources of information about COVID-19 in all countries.

Conclusions

The study demonstrated moderate trust in societal factors and moderately high level of social responsibility in all countries. The health professionals enjoy the greatest trust, which implies that medical doctors, especially physicians in primary health care should have a pivotal role in promoting vaccination and educating the general public in the Western Balkans.
Implementing a school-based comprehensive sexual health education intervention in Italy: experiences from the field
Authors: Martinelli D , Galipò R , Meli P , Farinella M , Chinelli A , Palamara AT , Suligoi B , Oldrini M , Colaprico L , Tavoschi L
Published: October 2022

Introduction

This study describes the preliminary results of a School-based sexuality education (SBSE) pilot activity developed and implemented within EduForIST project, funded by the Italian Ministry of Health.

Methods

The pilot activity (5 modules of 2 hours each delivered per classroom) targeted lower secondary schools students. A total of 20 schools located in 4 different Italian regions participated. The educators were staff of several HIV/AIDS civil society organisations operating in Italy. A 2-days intensive workshop for educators was performed. Pre and post tests were conducted.

Results

At the time of submission, pre-test results were available from 14 classrooms of 5 schools within 2 Italian Regions, for a total of 266 students. Among these, 37,4% were unsure that personal identity is built through social comparison; 21,8% reported that emotions don't get more intense during adolescence, while 18,1% were unsure about the response; 42,1% reported a higher level of uncertainty concerning the definitions of gender identity, sexual orientation and stereotype. The highest level of uncertainty were reported for STIs symptoms (58,7%), impact of treatment on HIV+ people (61,9%) and efficacy of contraceptive pills in preventing STIs (43,4%). The post-test results were available for 153 students. Pre/post analysis showed an increase of correct answers (p < 0.05) for 12 of 15 items investigated. A total of 102 students responded to the satisfaction questionnaire, with preliminary positive results.

Conclusions

Since activities are ongoing, further data will be soon available for more exhaustive analyses. Early pre/post evaluations suggested that the pilot experience was effective in enhancing knowledge and decreasing uncertainty in the different domains addressed in the pilot. Evidence collected through this study shall raise awareness among decision makers on the urgency of introducing CSE in Italian school curricula and inform future policy options.
How to evaluate a sexual health education intervention: experience from an Italian pilot project
Authors: Ubbiali M , Mortari L
Published: October 2022

Introduction

Evaluation is an essential dimension of every educational activity, however it is a very crucial and problematic aspect to be considered. It is necessary to focus on some fundamental concepts: the idea of ‘measurement’, the definition of expected goals for the educational activity, whether they are measurable, and if not, how they can be evaluated. Finally, effectiveness may be assessed only after longer periods of time and by adopting coherent instruments. Outcomes of educational activities on sensitive themes such as sexuality education, are challenging to evaluate through causal relationships. So a fundamental question is: what is really possible to evaluate in the field of sexuality education (SE)?

Methods

A desk review was carried out to collect information about national policies, international literature and guidelines on SE evaluation. A literature review was performed to collect and collate reported field experience and evaluation data.

Results and discussion

In literature it is possible to find a consistent number of studies aimed at evaluating SE programs (in particular inspired by the models ‘abstinence-only’ and ‘abstinence-plus'), whose goal is to understand their impact on adolescents sexual health. Most of the studies reported limited evidences on SE efficacy on sexual health-related outcomes. This may be attributed to two different causes: methodological - evaluation instruments are epistemologically difficult to develop; and theoretical - the underlying philosophical frameworks they refer to may not fully reflect the complexity of sexuality education for adolescents.

Conclusions

Based on the findings, evaluation instruments were developed to collect experiences from educators performing school-based sexuality education within the context of EduforIST project funded by the Italian Ministry of Health. Analysis of the collected data were still ongoing at the time of submission.
A capital-based approach to understand health inequalities: empirical explorations
Authors: Qi Y , Vrooman JC , Almansa J , Ots P , Brouwer S , Reijneveld SA
Published: October 2022

Background

The persistence of health inequalities may not be merely driven by education and income, but also by other economic and non-economic factors. In this study we investigated how the association between single-dimensional health and socioeconomic status (SES) changes when including health-related person capital, economic capital, social capital, cultural capital and non-health related person capital.

Methods

The present study proposes a capital-based approach to understand health inequalities. It presumes intertwined relationships between a wide notion of health (‘health-related person capital’) and embodied resources (‘non-health related person capital’) on the one hand, and non-person capital, i.e. economic, social, and cultural resources on the other. We used cross-sectional data on 152,592 participants from the Dutch Lifelines cohort study. Correlations between capital constructs were estimated using partial least squares structural equation modelling.

Results

The correlation between health-related person capital and SES (r = 0.15) was higher than the correlations between single-dimensional health (physical and mental health) and SES (r = 0.12, r = 0.04, respectively). Non-person capital, combining economic, social and cultural capital, showed a correlation of 0.34 with health-related person capital. This was higher than the correlation between health-related person capital and economic capital alone (r = 0.19). Lastly, the correlation between health-related person capital and non-person capital increased when non-health (personality and attractiveness) and health related person capital were combined into person capital construct (from r = 0.34 to r = 0.49).

Conclusions

This exploratory observational study shows the empirical interconnectedness of various types of resources. Our findings corroborate the idea of considering health as a multidimensional concept, and to extend conventional SES indicators to a broader measurement of economic and non-economic resources.

Key messages
Assessment of needs-based usefulness of interventions to address system barriers to HPV vaccination
Authors: Schloemer T , Hecht H , Horstman K
Published: October 2022

Background

Adolescents of underserved communities face multiple health system barriers to access HPV vaccination. The Horizon 2020 project RIVER-EU will implement interventions to address these barriers in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian community in Poland and the Roma community in Slovakia. The objective of this study was to identify promising evidence-based interventions that potentially meet the specific contextual needs of the target groups, as a basis for assessing their transferability.

Methods

Based on the PIET-T models of transferability, we developed a methodology to assess the needs-based usefulness of an intervention for a target context. Criteria of intervention usefulness addressed specific aspects of the health issue, population, intervention content, outcomes, up-to-datedness, applicability, quality and usefulness of the evidence-base. Guided by methodological workshops, country members with their local advisory boards performed a rating of 32 interventions identified from a systematic literature search.

Results

Through independent assessment in each country, 5 of 32 interventions were selected as useful, with overlap: 2 interventions were selected by all countries, and 1 by 2 countries. In all countries, trained community members to support HPV vaccination were seen as promising. In Greece and the Netherlands, an educational programme in schools was included. Further, the Netherlands chose an intervention addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention.

Discussion

The feedback of the country members on the assessment emphasised the structured way to face complexity of understanding the potential usefulness of an intervention from the perspective of the target country. Critical discussions on the interventions enabled to specify needs for further clarification, for adaptations, and alternatives to consider for transferability analyses.

Key messages
The positive impact of a care–physical activity initiative for people with low socioeconomic status
Authors: Mulderij LS , Verkooijen KT , Groenewoud AS , Koelen MA , Wagemakers MAE
Published: October 2022

Background

Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care-physical activity (care-PA) initiatives may lower overweight and obesity rates. A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. We answered the research question: what are the short- and long-term outcomes of participation in X-Fittt 2.0 in terms of health, quality of life and societal participation?

Methods

Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), 1 year (t2) and 2 years (t3). We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3). Continuous variables were analysed using linear mixed-model analysis, while we used descriptive statistics for the categorical variables. Qualitative data were analysed using thematic analysis.

Results

Body weight was significantly lower at all three post-initiative time points compared with t0, with a maximum of 3.8 kg difference at t2 (p < 0.05). BMI, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks (p < 0.05). A positive trend regarding paid work was observed, participants reported increased PA levels (including sports) and a few stopped smoking or drinking alcohol. Participants felt healthier and more energetic, reported improved self-esteem and stress levels, and had become more socially active. However, barriers to being physically active included a lack of money or time, or physical or mental health problems.

Conclusions

X-Fittt 2.0 improved the physical health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results.

Key messages
European studies to evaluate COVID-19 vaccine effectiveness in HCWs: results from Italian hospitals
Authors: Agodi A , Rapisarda V , Bonfanti P , Rossi M , De Gaetano Donati K , Murri R , Barchitta M
Published: October 2022

Background

Evaluating COVID-19 vaccine coverage and risk factors is useful to develop public health strategies against COVID-19 pandemic. In the framework of two studies commissioned by the European Centre for Disease Prevention and Control (ECDC) and coordinated by Epiconcept, France, we reported findings about incidence and seroprevalence among healthcare workers (HCWs) enrolled from three Italian hospitals.

Methods

From July 2021 to date, the AOUP “G. Rodolico-San Marco” (Catania), the San Gerardo Hospital (Monza) and the Policlinico Gemelli (Rome) participated in the ECDC study to measure COVID-19 vaccine effectiveness. Catania and Rome also participated to the ECDC study of nosocomial transmission. HCWs were asked to complete a weekly questionnaire to report changes in health status and professional/personal exposures. At recruitment, a nasopharyngeal swab for RT-PCR and a blood sample for serology test were collected. Moreover, HCWs were followed-up with a weekly or bimonthly nasopharyngeal or saliva swabs. Blood samples were collected every one or two months.

Results

A total of 226 HCWs was enrolled from Catania, 330 from Rome and 132 from Monza in the COVID-19 vaccine effectiveness study. As of February 2022, PCR tests performed were 2270 in Catania, 5475 in Rome and 891 in Monza sites. Moreover, the serological tests performed were 845 in Catania, 760 in Rome and 395 in Monza sites. A total of 6 SARS-CoV-2 infections were identified in Catania, 34 in Rome and 4 in Monza sites. Interestingly, the study of nosocomial transmission reported the highest incidence rate in Catania (4 per 10,000 person-day), while 0.7 per 10,000 person-day in Rome. During the study period seroprevalence declined by 17% among HWCs enrolled in Catania.

Conclusions

Our findings revealed low number of COVID-19 infections, with high COVID-19 vaccine coverage among HCWs. However, further analyses are needed to provide more robust estimates of vaccine effectiveness.

Key messages
Gateways not gatekeepers – reaching seldom-heard groups to gather public health community insights
Authors: Lie M , Visram S , Cheetham M , Christie A , Hodgson P , Jasperse J , Logan M
Published: October 2022

Background

Each local authority in England must develop a Health and Wellbeing Strategy (HWS) in collaboration with NHS partners to plan and support delivery of local improvements in health and wellbeing. HWSs often draw on diverse sources but few are informed by consultative exercises involving citizens. South Tyneside Council in Northern England sought to ensure their new HWS was community-informed, specifically including seldom-heard groups and individuals. Specific objectives of this community insights research were to:

1.Target sampling and recruitment activities at typically marginalized, vulnerable or otherwise underrepresented groups

2.Explore the health and wellbeing-related views and priorities of these groups to address health inequalities

Methods

A mapping exercise was undertaken to identify organisations who might act as gatekeepers to accessing participants from underrepresented groups. Focus groups were held in settings-based venues where members would be comfortable and known to one another. Representatives of voluntary and community sector (VCS) organisations often helped to co-facilitate the discussions.

Results

119 participants took part in 16 group discussions. Three were held online, two were outdoors, while 11 involved community venues where the groups regularly met. We reached older and younger people, minority ethnic groups, and vulnerable men and women, including residents who had experienced homelessness, mental health issues, substance misuse, offending, domestic violence and learning disabilities. Participants were largely concerned with the wider determinants of health (such as poverty, employment, and leisure spaces), shifting the narrative away from individual lifestyle factors that tend to be the focus of much public health discourse.

Conclusions

Gatekeepers from the VCS were essentially gateways, enabling us to include underrepresented voices in local consultation processes and generate new insights to inform the South Tyneside HWS.

Key messages
Early adolescents’ sexual and reproductive health literacy in Lao PDR
Authors: Lee HK , Yang YS , Kim SK , Vongxay V , Lee YM
Published: October 2022

Background

Sexual and reproductive health literacy (SRHL) refers to the ability to access, understand, appraise, and apply information for decision-making related to sexual and reproductive health. The low level of SRHL in adolescents increases their sexually risky behaviors and endangers sexual health. Although early adolescence is a critical development period for forming initial views on sexuality and is often a time for attempting risky behaviors, studies on SRHL for early adolescents are fairly limited in Las PDR. As an initial step for the development of a global health project between Lao PDR and South Korea, this study assessed the level of SRHL and the differences in gender among early adolescents in Lao PDR.

Methods

Participants were 235 students conveniently recruited from one junior high school each in two provinces in Lao PDR. SRHL was measured using the 39-item Teen Pregnancy Health Literacy scale consisting of 4 subscales of finding, understanding, appraisal, and application. The scores were classified into inadequate, problematic, sufficient, and excellent using the SRHL index formula. The mean differences in gender were compared using t-test.

Results

The mean of the SRHL scores of the participants was 19.07 (±10.57). The mean score was significantly lower for girls, at 17.67 (±11.22) than for boys, at 21.37 (±9.05) (p = .006). Significant differences were further identified in all four sub-domains of SRHL: finding (p = .025), understanding (p = .005), appraisal (p = .041), and application (p = .029). The majority of participants (91.7%) were categorized as having an ‘inadequate’ or ‘problematic’ level of SRHL.

Conclusions

The level of SRHL among most early adolescents was found to be inadequate. The level of SRHL among girls was much lower than that among boys. The findings suggest a gender-specific approach to developing health education programs to improve SRHL among early adolescents and prevent future sexually risky behaviors in Lao PDR.

Key messages
Overview of national strategies for the prevention and management of non-communicable diseases
Authors: Reinsperger I , Gassner L , Zechmeister-Koss I
Published: October 2022

Background

Several countries have developed national strategies or policies for preventing and managing non-communicable diseases (NCDs) which are the leading cause of death worldwide. We aim to provide an overview of these strategies from selected countries and their implementation, focusing on chronic respiratory and cardiovascular diseases, diabetes and depression.

Methods

Using a comprehensive structured hand search, strategies from 8 countries (Germany, Switzerland, Netherlands, Finland, Ireland, United Kingdom, Canada, Australia) were identified and information on the main characteristics and implementation process of the strategies was extracted.

Results

A total of 18 strategies were included. Most of the strategies formulate rather broad overarching aims or visions (e.g., “stay healthy” or “living healthier lives”) as well as more specific targets that differ across strategies, e.g. focusing on improving quality of life and health literacy, reducing health inequalities or strengthening integrated care. The level of detail of information on implementation, monitoring and evaluation processes as well as financing is very heterogeneous. All strategies provide information on activities to achieve their aims, e.g. in the areas of health promotion/primary prevention, self-management, screening, integrated care, measures for specific risk groups or activities outside the health sector. Only a few strategies mention specific, already implemented (and evaluated) interventions, such as prevention or disease management programmes.

Conclusions

The included NCD strategies differ considerably in terms of level of detail, structure and implementation. We focused on interventions within the health sector and on adults as a target group. However, for the prevention and management of NCDs, it is important to start in early childhood and to adequately address the social determinants of health with a ‘Health in All Policies’ approach.

Key messages
A systematic review of multimorbidity patterns: social determinants and classification methods
Authors: Ramos-Fiol B , Ortega-Martin ME , Carretero-Bravo J , Suarez-Lledo V , Alvarez-Galvez J
Published: October 2022

Background

Governments and healthcare systems are facing multimorbidity (MM) as a major challenge due to the difficulties related to its proper identification and clinical management. Despite growing research on MM, its epidemiology is poorly understood due to the great complexity of underlying patterns of chronicity. The present review aims to identify the most frequent MM profiles and their social determinants.

Methods

A systematic review following the PRISMA statement was conducted. The search strategy was performed by combining three sets of keywords (MM, inequalities and patterns) that were searched in Pubmed, Scopus, Web of Science, OVID, CINAHL Complete, and PsycINFO. Primary studies analysing MM patterns and their relationship with social determinants were included. The quality of the studies was assessed using the Axis tool quality assessment.

Results

After the review process, 96 studies were selected from the 46,726 identified. The main methods used to identify MM patterns fell into five categories: latent class analysis (38.54%), cluster techniques (23.96%), factor analysis (19.79%), and machine learning (10.42%), and expert knowledge (7.29%). Latent class analysis was widely used, although in recent years the use of techniques based on machine learning has increased. The main patterns were cardiometabolic, cardiovascular, mental, musculoskeletal, complex MM, and respiratory diseases. Some MM profiles were more prevalent among lower-SES groups. In particular, patterns of mental multimorbidity were more prevalent among women and complex patterns were associated with low income.

Conclusions

Results show different disease combinations among disparate social determinants such as gender, age, education, and socio-economic status. Our results suggest that more and better designed studies are needed to improve clinical practice and health policies with the aim of enhancing the quality of patients with MM and their relationship to health system use and care.

Key messages
Dual task test: Screening procedure for early detection of cognitive impairment among healthy adults
Authors: Simi H , Guggenberger B , Holler P , Christova M , Pilz R , Staubmann W
Published: October 2022

Background

Early detection of cognitive impairment can slow progression to dementia when using appropriate therapy. For early detection of dementia dual task combining cognitive tasks and walking might be suitable, since individuals with cognitive impairment have shown greater changes in gait specific parameters on dual task test (DT) compared to single task test (ST). This study investigates whether these changes correlate with poorer cognitive function in healthy older adults.

Methods

In a cross-sectional study 174 healthy adults (66,48±4,26years; 40%female) completed the Cognitive Functions Dementia Test (CFD), with a lower CFD index indicating lower cognitive function. Participants performed ST (walking 20m) and DT (walking 20m & counting backwards), in which step frequency, stride length and gait speed were monitored by Pablo sensors. Cognitive cost (CC) was determined for each gait variable. CC represents a change score between SD & DT and quantifies cognitive demands, with higher CC indicating poorer cognitive function. Pearson correlations and stepwise linear regression adjusted for age and gender were applied to analyze the association between CFD Index (dependent variable) and CC gate variables (predictors) (α = 5%).

Results

Significant correlations were observed between CFD Index and CC step frequency (p=.014, r=-.187), CC stride length (p=.037, r=-.160) and CC gait speed (p=.002, r=-.232). Since gait variables were intercorrelated (multicollinearity), only gait speed was significant predictor for CFD Index (ß = -.243, p<.001, R2 = .053) in a stepwise adjusted regression model.

Conclusions

Changes in gait speed might be sensitive enough to indicate differences of cognitive performance among older individuals. Therefore, DT could be included in screening procedures as alert for potential cognitive decline.

Key messages
The role of public health services in implementing heat health action plans in Germany
Authors: Geffert K , Rehfuess E , Rechel B
Published: October 2022

Background

The rise in extreme heat periods is a major public health challenge of climate change and the World Health Organization therefore recommends the implementation of heat health action plans (HHAPs). In Germany, HHAPs are not implemented in a comprehensive manner nor nationwide. Public health authorities have been identified as key actors with regards to heat and health. This study aims at assessing the role of public health services in the implementation of HHAPs in Germany.

Methods

First, a review of the scientific and grey literature on the role of public health services in heat adaptation in Europe was conducted. Second, a policy document analysis of the legislation of Germany's federal states for public health services and their potential role in the implementation of HHAPs was carried out. Finally, semi-structured interviews with selected experts from multiple sectors at the local, federal and national level on their perception of the role of public health services in the implementation of HHAPs in Germany were undertaken.

Results

Preliminary findings show that the legal framework for public health services in the different federal states addresses environmental health and civil protection to varying extents, but that climate change-specific health risks are barely mentioned. The expert interviews revealed perceived barriers for the public health services to implement HHAPs, notably with regards to personnel (e.g. competencies, time), organizational structures (e.g. financial resources, administrative structures, legal mandates) and competing other tasks (e.g. COVID-19 response). Facilitators included motivated individuals, funding opportunities for cross-sectoral collaboration and political support.

Conclusions

The role of public health services in HHAP implementation in Germany varies widely between the different geographic settings and is influenced by several factors at the individual, organizational and political level.

Key messages
Mediation of behavioural and socioeconomic risk factors associated with malaria in children in Ghana
Authors: Habermann T , Lorenz E , Puradiredja DI
Published: October 2022

Background and objectives

Malaria remains a major global public health concern and a leading cause of morbidity and mortality especially among children <5 years in Ghana. While an association between poverty and malaria has long been recognised, evidence on the causal pathways between socioeconomic position (SEP) and malaria is scarce. Our study contributes to addressing this gap by investigating the association whilst taking mediation through potential behavioural and socioeconomic factors into account. This can help to identify more specific targets for interventions on a structural level.

Methods

Using data of 3,004 children from the Malaria Indicator Survey of the Demographic and Health Surveys Program conducted in Ghana in 2019, a household wealth index (quintiles) was derived using principal component analysis based on household assets. Causal multiple mediation analyses investigated mediating effects of treatment-seeking, bed net (LLIN) use, educational attainment, and housing conditions on the association between socioeconomic position and children's malaria fever events.

Results

Higher maternal educational attainment and housing conditions jointly mediate 18% of the association between socioeconomic position and malaria fever events (OR = 0.98; 95%CI = 0.96-0.99). Maternal educational attainment and seeking formal prenatal health care jointly mediate 20% of the total effect (OR = 0.98; 95%CI = 0.95-1.00), in presence of a lower socioeconomic position. No strong mediation was found for educational attainment jointly with the use of LLINs between malaria and socioeconomic position in this study (OR = 0.99; 95%CI = 0.97-1.01).

Conclusions

As shown by the proportions mediated between malaria and socioeconomic position, findings suggest that current malaria control efforts could be strengthened by investments at the structural levels, such as increased (female) education, targeted improvements in housing, and stronger integration of informal health care.

Key messages
Protection against invasive meningococcal disease and vaccination policy in the Netherlands
Authors: Ohm M , Knol M , Sanders E , Berbers G
Published: October 2022

Background

A rise in serogroup C invasive meningococcal disease (IMD-C) led to introduction of MenC vaccination in 2002 in the Netherlands at 14 months of age, accompanied by a mass-campaign for all children between 1 and 18 years (coverage 94%). Due to an IMD-W outbreak in 2016-17, the MenC vaccine was replaced by a MenACWY vaccine and an adolescent booster at 14 years was introduced next to a mass campaign for 14-18 year-olds in 2018.

Aim/methods

We explored meningococcal antibody status in the Netherlands across the population in 2006-07, 2016-17 and 2020 in consecutive cross-sectional serosurveillance studies. Furthermore, we assessed the vaccine impact and effectiveness of the recent MenACWY vaccination campaign. We determined long-term protection in both adolescents and adults after a MenACWY vaccination and investigated sex-related differences in the vaccine response in adolescents.

Results

MenC antibody levels were low in 2016-17, except in recently vaccinated toddlers and individuals who were vaccinated as teenagers in 2002. We demonstrated waning of MenC immunity 15 years after the mass campaign and highlighted the lack of meningococcal AWY immunity across the population, which underlined the importance of the recently introduced MenACWY (booster) vaccination. The MenACWY vaccination program was effective in preventing IMD-W in the target population. Long-term protection was achieved for MenC, MenW, and MenY in 94-96% of adolescents five years postvaccination, but in adults only in 32%, 65% and 71% for MenC, W and Y. Adolescent antibody responses were higher in girls than in boys for all serogroups at most timepoints after MenACWY vaccination. The differences in average titers were however small and the percentage of participants with protective titers was very high for both sexes.

Conclusions

The current meningococcal vaccination policy in the Netherlands provides protection across the population against IMD-ACWY and seems sufficient on the long-term.

Key messages
Analysing hospital travel times in central Athens using Google Maps services
Authors: Xifaras NC , Roubou E , Altsitzioglou P
Published: October 2022

Introduction

The importance of timely care is well documented for numerous emergency conditions, including STEMI and ischemic stroke, where low symptom-to-balloon/symptom-to-needle times are crucial for mortality and disability. The study of all potential delays helps us understand the constraints we have to work under. Here, we use Google Maps services to map the travel times from central Athens areas to on-duty hospitals

Methods

We built our code in the Python programming language, using the Google Maps Distance Matrix API to perform real-time trip duration calculations based on real-life data. As reference points, we used a set of Athens neighbourhoods provided by the Municipality as open data; we considered only public secondary and tertiary health facilities as valid destinations, and based our calculations based on the available daily duty schedules.

Results

Our algorithm collected 43,200 data points in total over two weeks, using 144 starting points. The average trip durations to reach an on-duty department formed a right-skewed distribution (-0.424), with a mean of 19.55 minutes and a median of 19.95 minutes. The maximum average time was 26.78 minutes, and the overall maximum was 44 minutes. Average travel times to cardiology, general surgery, neurology and internal medicine ERs, which experience a heavy patient load, were higher than the total mean (20.60/22.06/21.31/20.51 mins respectively). We found no correlation between the average travel time and average distance from a hospital or the geographical location, but we were able to create a map with hotspots of high/low travel times.

Conclusions

Our approach to collecting accurate trip data has shown the impact of time-of-day and location on trips to hospitals, even for patients within the same larger area. As acute care can be time-sensitive, similar wide-scale modelling could be used to create systemic solutions, e.g. data-guided spatial distribution of facilities or transportation.

Key messages
Fostering mental health and chronic diseases self-management among professional truck drivers
Authors: Desrosier D , Carrière ME , Chartrand S , Gaudet MV , Jbilou J
Published: October 2022

Most passengers and goods in Canada travel by road. The trucking industry is the backbone of the tangible goods economy. However, the health and well-being of this aging workforce is in jeopardy. Recent data reveals that 86% of the truckers’ community are 50 years old and over, 4% are female and 5% are immigrants. Moreover, 75% of the male truckers self-reported one or more health condition (54% obesity, 19% hyperlipidemia, 18 % high blood pressure, 11 % type II diabetes). Despite, the high prevalence of risk factors (e.g. stress, depression/anxiety, lower level of education, social isolation and financial challenges) and preventable chronic diseases among truckers, in New Brunswick and elsewhere in Canada, there is a lack of on-the-road accessible lifestyle change programs. Therefore, tailored interventions are needed to appropriately support them adopt healthy behaviors. Using the Re-AIM Framework, we carried out 23 semi-structured interviews to inform the development of tailored educational material. The aims were: to describe the needs and challenges and to design a truckers-sensitive educational intervention. The theoretical foundation of this qualitative study is articulated around concepts extracted from cognitive and behavioural theories (transtheoretical model of behaviour change). Qualitative analysis of verbatims identified four major themes: Lifestyle challenges, Social and individual representation of healthy behaviors, Health education strategies and communication and Motivational and engagement strategies. Drawing upon these findings we developed tailored educational material and pre-validated them with a small group of professional truck drivers. Our findings informed the development of an educational intervention to support truckers manage and improve their mental health and self-management of chronic diseases. The next step is to implement a randomized clinical trial to test and assess acceptability, feasibility, and effectiveness of our intervention.

Key messages
Participation in prevention measures during the corona pandemic in Germany in 2020/21
Authors: Jordan S , Kuhnert R , Schmid-Küpke N , Starker A
Published: October 2022

Background

The availability and use of preventive measures such as diet courses, sports groups, and counselling services were hindered by containment measures set by the German government and local authorities to reduce the spread of the COVID-19 pandemic. Regulations on contact restriction, closure of sport and leisure facilities made it difficult to use prevention programs in 2020 and 2021. So far, no information is available to what extent the participation of the population in prevention programs has changed as a result of the pandemic and whether there are group differences regarding socio-demographic characteristics.

Methods

We used standardized telephone interviews of the adult German-speaking population to ask for changes in the participation in prevention measures in the last 12 months as a result of the corona pandemic. The data were collected between 17.3.2021 and 18.08.2021 in four cross-sectional surveys and is representative of the population aged 18 years and older in Germany. Analyses of the weighted and pooled data were conducted for n = 3,998 individuals by gender, age and education.

Results

Almost one third of the respondents reported a lower use of programs (28.3%). An unchanged use of the programs was stated by 6.5%, a higher use by 2.1%. 63.2% said they did not use such programs. More women (33.6%) than men (22.7%) reported reduced pandemic-related use (p < 0.0001). For women, we observed a difference between age and education groups, but not for men: Lower participation was reported by a higher proportion of older than younger women (p < 0.0001). More women with high education reported an increased use than ones with low education (p = 0.003) (preliminary results).

Conclusions

The observed differences indicate to different barriers to use prevention measures during the pandemic, especially for women. To promote equal opportunities, resilient structures of prevention and health promotion should be built for future crises in advance.

Key messages
Physical activity change across retirement by device measured work-related and commuting activity
Authors: Pasanen S , Halonen JI , Suorsa K , Leskinen T , Kestens Y , Thierry B , Pentti J , Vahtera J , Stenholm S
Published: October 2022

Background

Work-related and commuting physical activity before retirement may contribute to changes in physical activity and sedentary time after retirement, and the aim of this study was to examine these associations.

Methods

Study population consisted of participants of the Finnish Retirement and Aging study (n = 119). Activity behaviour was measured with GPS and accelerometer devices. The participants provided 637 measurement days before and 557 days after retirement. Work-related physical activity was defined as physical activity accumulated at workplace. Commuting activity was dichotomised based on the speed of trips between home and workplace to active (<20 km/h) and passive (≥20 km/h) commute. Participants were divided into four groups: non-active workers and commuters, non-active workers but active commuters, active workers but non-active commuters, and active workers and commuters. Linear regression analysis with generalized estimating equations were used for statistical analysis.

Results

The change in physical activity during retirement transition markedly varied by the activity group. Lower work-related activity was associated with an increase in light physical activity and a decrease in sedentary time. Conversely, higher work-related activity was associated with a decrease in light physical activity and an increase in sedentary time, except among those active workers who were active commuters. Particularly the active workers but non-active commuters increased their sedentary time (48 min, 95% Cl 20 to 76) and decreased their light physical activity (54 min, 95% Cl -80 to -29). No statistically significant changes in moderate-to-vigorous physical activity were observed.

Conclusions

Our results suggest that work-related physical activity is associated with changes in physical activity behavior when retiring. Special attention should be targeted to active workers who are non-active commuters to maintain physical activity and decrease sedentary time after retirement.

Key messages
Development and early results of a comprehensive sexuality education experience in Italian schools
Authors: Chinelli A , Torri E , Martinelli D , Farinella M , Rancilio L , Galipò R , Meli P , Ubbiali M , Suligoi B , Tavoschi L
Published: October 2022

Background

Comprehensive sexuality education (CSE) is an integrated approach to sexual health and wellbeing promotion, especially effective when performed in school settings, but it is not included in Italian school curricula. This study describes the creation and early results of a pilot experience targeting students attending 20 lower secondary schools (LSS) in 4 Italian regions within EduForIST project, funded by the Ministry of Health.

Methods

A literature review and a national survey were used to collect guidelines and best practices in the field of sexuality education (SE), along with focus groups and multisectorial expert consultations. The results informed the development of 4 modules of 2 hours each, addressing: changes in adolescence; emotions and relationships; sexual identities and diversity; sexual consent, pregnancy and sexually transmitted infection (STI) prevention, sexual health services. A final session was dedicated to evaluation.

Results

The pre-test results referred to 14 classrooms of 5 schools within 2 Regions, for a total of 266 students. A high level of uncertainty was reported, regarding the topics of personal identity development (37,4%), experiencing intense emotions during adolescence (18,1%), the definitions of gender identity, sexual orientation and stereotype (42,1%), STI symptoms (58,7%) and prevention (43,4%). The post-test results were available for 153 students. Pre/post analysis showed an increase of correct answers (p<.05) for 12/15 items investigated. A total of 102 students responded to the satisfaction questionnaire, with positive results.

Conclusions

Preliminary results revealed knowledge gaps and high levels of uncertainty among LSS students. Early pre/post evaluation suggested that the pilot activity was effective in enhancing knowledge and decreasing uncertainty in all domains. Evidence collected through this study will foster awareness among policy makers on the value and urgency of introducing CSE in Italian school curricula.

Key messages
Implementation gaps of the Portuguese National Health Plan: a stakeholders’ perception analysis
Authors: Costa A , Rosa A , Costa L , Mexia R , Dias CM , de Almeida T Caldas
Published: October 2022

Background

The Portuguese National Health Plan (PNS) 2012-2016, extended to 2020, was the strategic health document shaping the direction of intervention within the Health System. The National Institute of Health Doutor Ricardo Jorge (INSA) is the institution responsible for carrying out its final evaluation. To underpin PNS final evaluation a multistep process was designed.

Methods

A mixed methods study using a convenience sample was implemented to assess stakeholders’ perception about five PNS dimensions: dissemination, communication, implementation, impact, and evaluation. For this purpose, two different tools were used. Semi-structured interviews with former health policy managers were conducted. In addition, an online survey was designed and widely distributed to additional stakeholders. From October 2019 to February 2020, data was collected using two separate instruments. Integral transcriptions of the interviews were made. Qualitative content analysis and quantitative descriptive analysis were used.

Results

A total of 12 interviews and 179 valid surveys were obtained. Regarding stakeholders’ perception about PNS implementation process, there was an overall positive recognition about the strategic and operational relevance of the PNS, as a common dialogue platform and a tool for health improvements both for health status and health system function in Portugal. Among pointed implementation barriers, management was mentioned as the major constraint, mainly due to shortage of human and financial resources to carry out the recommended interventions within the PNS timeline.

Conclusions

As part of the evaluation process the research team found relevant gain knowledge of the wider context in which PNS was developed and implemented, based on stakeholders’ perception. Their considerations are important not only to support the definition of the questions and criteria for PNS final evaluation, but also to highlight key issues for the future policy cycle.

Key messages
The Italian Roma, Sinti and Travellers Health Project for equity in access to care
Authors: Diodati A , Proietti MC , Eugeni E , del Gaudio R , Sisti LG , Curtale F
Published: October 2022

Issue

In 2015, Italy approved the National Action Plan for Health for and with Roma, Sinti and Travellers (RSC); however, it is still not fully applied at a local level. The INMP (funded by the National Operational Programme for Social Inclusion), implemented the “Health Project - Promotion of strategies and tools for equity in access to health care for RSC”, aimed to support the implementation of the Plan by Local Health Authorities (ASL).

Description

The project lasted from March 2019 to December 2021. INMP worked with 7 ASL to design interventions and develop tools to address RSC health needs. The SODA (Strategic Options Development and Analysis) method as a participatory process aimed at identifying strategies and models for the execution of the Plan among relevant stakeholders was used. Moreover, RSC communities’ engagement strategies and a community-based Proximity Public Health (PPS) approach were adopted in designing and developing health promotion interventions.

Results

INMP performed 38 interviews with ASL health operators highlighting barriers and strategies in the local implementation of the Plan. Tools orienting to social and health services and health education materials for hard-to-reach groups were produced. A training course for 14 RSC facilitators and 5 training courses attended by over 200 NHS operators have been organized. ASL were supported in developing health promotion initiatives, based on the engagement of both local RSC communities and third sector entities.

Lessons

The project has enabled the ASL to develop local protocols for the implementation of the Action Plan. In line with this capacity-building activity, the project trained both health operators and RSC facilitators fostering the dissemination of the PPS culture in designing and providing care for hard-to-reach groups. Given the positive results obtained, INMP is still collaborating with both ASL and the Third Sector on additional activities related to the Project in 2022.

Key messages