bluuebunny/crossref_metadata_2025 huggingface dataset:
Public food procurement as a tool for more sustainable and high quality food offer in public institutions
Authors: Gabrijelčič M , Fras N , Ožbolt P
Published: October 2023

As children spend almost a third of their day in kindergarten or school and consume a large part of their daily energy intake in educational environments, those environments are important factors in the development of healthy eating habits at one hand or unhealthy ones with possible consequence of childhood obesity on the other. Strong evidence of the importance of access to healthy and balanced nutrition in schools for children's health is available, and a nutritionally regulated school environment is associated with a lower risk of childhood obesity, which can also be facilitated by a transparent and quality-oriented procurement system. JRC has estimated the value of the European social food service market as sizeable in both reach and force of €82 billion. Progressive and targeted public procurement of food for health can reward food business operators who provide nutritionally balanced meals. According to the EU AP on childhood obesity 2014-2020, action such as use of nutritional criteria in food service procurement should be required in schools and kindergartens. JA Best-ReMaP situation analyses showed that current implementation of public food procurement across EU Member States differs substantially. Project activities aimed to support the establishment of the intersectoral working mechanisms (groups) for the public procurement of foods in participating MSs, to increase the understanding, knowledge and skills regarding public procurement of food/food products in public health and other selected public institutions, to pilot Slovene best practice tool for PFP as optional approach for implementation of the sustainable and high quality PFP procedures and to recommend further institutionalised implementation of the public procurement procedure for foods, based on quality standards, in the Member States and propose minimum criteria for sustainable public procurement, in line with the developments at the European Commission level.
Uptake of flu vaccination in Denmark: A comparison between Danish and migrant populations, 2015-2021
Authors: Deal A , Hayward S E , Langholz Kristensen K , Holm Petersen J , Valentiner-Branth P , Friedland J S , Hargreaves S , Norredam M
Published: October 2023

WHO's Immunisation Agenda 2030 emphasises vaccination across the life course, including among migrants who may be at-risk in terms of access and uptake. Despite availability of a vaccine, influenza remains a key contributor to winter excess mortality in Europe. We analysed national Danish Registry Data to determine how flu vaccine uptake varies by migration status. We carried out a retrospective cohort study (2015-2020) to determine flu vaccine uptake among migrants ≥65 years matched 1:6 on age and gender to Danish-born. We used a multivariate logistic regression model (in R v4.2.1), controlling for migrant status, time in Denmark and other socio-demographic variables (age, gender, nationality, urban/rural residence), to identify factors associated with uptake. 81,644 individuals were included in the analyses. The flu vaccine uptake across 6 flu seasons in Danish-born was 44.7%, compared with 34.7% in the migrants. Migrants were statistically significantly (OR:0.64; 95% CI:0.62-0.65) less likely to receive a flu vaccine across all seasons; the gap widened from 2015 (OR:0.76; 95% CI:0.72-0.80) to 2020 (OR:0.49; 95% CI:0.47-0.51). Those who arrived as family-reunified to Danish citizens (OR:0.51, 95% CI:0.45-0.58) or to immigrants (OR: 0.58, 95% CI:0.47-0.71) were statistically significantly less likely to receive the vaccine across the study period than asylum seekers and refugees. In 2015-2017 seasons, those residing in Denmark >10 years were more likely (2015 OR:2.06, 95% CI:1.56-2.73; 2016 OR:2.35, 95% CI:1.75-3.15); 2017 OR:1.92, 95% CI:1.41-2.61) to receive a vaccine than those more recently arrived. Our data show that flu vaccine uptake was poor in all groups but that migrant groups have consistently lower uptake rates, particularly among family-reunified migrants and those more recently arrived. Migrant flu vaccination rates in migrants fell over a 6-year period. Going forward, developing tailored interventions in collaboration with communities will be key.

Key messages

• Migrant groups have consistently lower uptake rates of flu vaccination than Danish born.

• Newly arrived migrants are significantly less likely to get vaccinated, suggested targeted interventions may be needed.
The assessment of determinants of vaccine-related conspiracy beliefs in Polish society
Authors: Duplaga M , Wilk M , Zwierczyk U , Kowalska-Duplaga K
Published: October 2023

Background

The COVID-19 pandemic showed that health denialism and conspiracy beliefs may influence adherence to preventive measures. Many variables have been considered as determinants of conspiracist attitudes. This study aims to assess the determinants of conspiracy beliefs related to vaccination (Vaccine Conspiracy Beliefs Score, VCBS) in Polish society during the COVID-19 pandemic.

Methods

The analysis was based on data from the online survey conducted in November 2021 in a representative sample of adult Internet users. Uni- (ULR) and multivariable linear regression (MLR) models were developed for VCBS. The relationships of health literacy (HL), e-health literacy (eHL), future anxiety (FA), Internet (IU) and social media use (SMU), self-assessed health status (SAHS), and prevalence of chronic disease (CD) with VCBS were assessed after adjusting for sociodemographic variables and political sympathies. B coefficient (B) and 95% confidential intervals (95%CI) are reported here for MLR.

Results

The study sample of 2189 comprised 51.2% of women and 26.1% of persons with a University education. The mean age (standard deviation, SD) of respondents was 44.1 (15.25) years; VCBS - 3.77 (1.52), eHL score - 28.91 (10.63), and FA score 4.75 (1.27). MLR revealed that VCBS was significantly associated with HL but not eHL. VCBS was higher in persons with inadequate HL than those with sufficient HL (B; 95%CI: 0.66; 0.36 - 0.95). Greater FA was also associated with higher VCBS (0.08; 0.03 - 0.13). Interestingly, less duration of IU (the lowest vs. the highest use: 0.47; 0.08 - 0.85) but more intense SMU (frequent vs. infrequent use: 0.31; 0.11 - 0.51) predicted higher levels of VCBS. Finally, SAHS and CD were not significant predictors.

Conclusions

Health literacy remains a key modifiable determinant of the prevalence of conspiracy beliefs related to vaccination. Effective measures counteracting conspiracy beliefs should be considered in future public health challenges.

Key messages

• Developing adequate health literacy may be an efficient measure counteracting unfavorable impact of conspiracist thinking on the acceptance of vaccinations.

• Health denialism manifesting with conspiracy beliefs should be treated as a target for public health interventions during pandemics.
Methodological challenges in collecting and analysing data on child unintentional injuries: Insights from the CHILD Vigilance project (CHIVI) on parents’ attitudes and practices
Authors: Alves T , Papadakaki M , Silva S , Braz P , Vagionaki K
Published: October 2023

Injuries are among the top ten conditions affecting children according to WHO's latest evidence on years lived with disability. Despite this fact, EU countries are still missing strong information systems for enabling efficient response to the problem. Data on child unintentional injuries are still inconsistently collected in Europe due to substantial deficiencies in injury surveillance data as well as differences in coding systems and legal policies on reporting requirements. Apart from specific countries (e.g. Norway) there is no population-based monitoring of child unintentional injuries in Europe, while initiatives to collect EU-wide information on child unintentional injuries such as the Eurosafe study, seems to be scarce. Improving data availability will require greater investments in country health information systems, vital statistics systems, and household survey programmes. Technical advisory groups indicate the need to develop standard data collection procedures and ensure that indicators are harmonised across global initiatives. Building country capacity in collecting, analysing and increasing the use of child injury data for decision making at global, regional, and national levels, is important. The current presentation will discuss the methodological challenges identified in collecting and analysing data on child unintentional injuries based on the CHILD Vigilance project (CHIVI), which is being conducted in two countries (Portugal, Greece) under the umbrella of EUPHA INJ and aims at assessing parenting attitudes and supervision practices in children aged 0-14 years. Based on 577 valid responses, involving 890 children (53.1% male; 46.8% female) the study revealed major challenges in defining child unintentional injuries, identifying validated tools to accurately measure injuries and their impact on children as well as the challenges in defining the most appropriate determinants of child unintentional injuries.
Compositional analysis
Authors: McKinley J
Published: October 2023

Health outcomes are often multi-faceted as many environmental variables have synergistic impacts. By integrating data on chemical agents from the lithosphere, hydrosphere, and atmosphere, it will be possible to note the roles each play, and which are having the most demonstrable effect on long term cognitive health outcomes. This presentation will showcase an integrated and compositional approach taken to model the effects that chemical agents in each sphere are having on long term cognitive health outcomes. Firstly, chemical agent data will be extracted using circular buffers. Secondly, the relationships that chemical agents share across the environmental spheres are validated through correlation (complex heatmap/clustering) and dimension reduction (PCA) techniques. Thirdly, cognitive health outcome variables are integrated into this framework, to note which chemical agents and health variables show correlations. Lastly, a forward-selection algorithm like selbal is demonstrated to indicate the level of significance that each health outcome shares with each chemical agent(s). Through the integration of these techniques, it will be notable which chemical agents and environmental sphere is having the most significant effect on long term cognitive health outcomes.
Can applying behaviour change principles make public health policies more impactful and sustainable?
Authors: Bacon S
Published: October 2023

Issue/problem

The incorporation of evidence-based recommendations into policy documents and health guidance often does not lead to measurable changes in public health outcomes.

Description of the problem

All the preventative measures of COVID-19 were behavioural in nature, e.g., getting vaccinated, wearing masks, physically and socially distancing, getting tested, etc. However, most government policies did not consider behavioural science or behaviour change frameworks when crafting them. This led to a significant reduction in trust in governments and a resistance to the evolving policies.

Results

Through the international iCARE study (www.icarestudy.com), we captured data throughout the pandemic on people's capabilities, opportunities, and motivation to engage in COVID-19 prevention behaviours, as well as their actual behaviours. This data has led to key insights into how policies could have been crafted to actively engage individuals in the varying measures that they needed to undertake to reduce the impact of COVID-19.

Lessons learned

The incorporation of behaviour change principles in the development and implementation of policies has the potential to engage more shareholders and drive behaviour change. However, more evidence is needed to determine the optimal way to do so, and to assess the effectiveness of these efforts in improving public health outcomes. To achieve this, a rigorous monitoring plan is necessary to evaluate the impact of policy changes and health guidance on public health outcomes.
7.L. Round table: Population health management in PHC: a proactive approach to improve health and well-being
Authors:   Organised by: WHO European Centre for PHC,   Chair persons: Natasha Azzopardi Muscat (WHO/Europe)
Published: October 2023

Population Health Management (PHM) can play a critical role in strengthening Primary Health Care (PHC) by providing a data-driven, people-centred, and proactive approach to managing the health and well-being of a defined population. It entails data-driven assessment of the health status of a specific population followed by prediction of health outcomes and anticipating the resources needed to proactively address these. By identifying subgroups with similar characteristics and needs, PHM can enable PHC providers to move from a one-size-fits-all approach to targeted and tailored interventions that account for the needs of different groups. Moreover, by focusing on the social determinants of health and psychosocial needs, PHM can help PHC providers adopt a more holistic approach. PHM can provide a pragmatic framework to help PHC providers in operationalizing several essential public health functions, which are at the core of PHC. It can also help PHC deploy a proportionate universalism approach to address health inequalities at community level. By showcasing practical examples of how PHM is being used in PHC across Europe; discussing enabling factors for adopting a PHM approach; and presenting pragmatic policy recommendations; the workshop will inspire the public health community and help countries move towards the adoption of a PHM approach in PHC. The workshop will consist of an actively moderated panel discussion, short presentations by panelists and Q&A sessions.

Key messages

• Population health management rooted in PHC can help improve health outcomes for populations, reduce health inequalities, and strengthen health systems.

• The relationship between PHM and PHC can be described as a virtuous circle; PHM helps make PHC more effective, and many elements of a strong PHC model are essential for effective PHM.
Implementing population health management in England. A GP perspective
Authors: Alton D
Published: October 2023

PHC professionals often already have deep understanding of the population that they serve, their needs and the wider determinants of their health. A data-driven population health management approach does not replace this understanding but rather complements it, quantifies it, enables even deeper understanding and, at times, can challenge pre-existing assumptions. PHC professionals’ understanding of their community (in which they often live) naturally facilitates population health management as an effective approach within PHC. There are resultant benefits when clinicians participate in leading this transformational change, even though most of the day-to-day work required is often not done by the clinicians themselves and, in fact, often reduces their workload. This presentation will describe the implementation of a PHM approach in Berkshire West (England) and will provide examples of their practical applications before, during and in the wake of the COVID-19 pandemic.
Risk stratification tools in primary care in Europe
Authors: De Manuel-Keenoy E
Published: October 2023

Risk stratification is an intentional, planned and proactive process that predicts the probability of adverse events occurring and assigns an individual a risk status or score. Based on individual risk assessment, patients are typically classified into high-, medium- (rising-) and low-risk groups. Risk levels should correspond to the likelihood that patients experience negative health outcomes and/or higher rates of unnecessary or preventable health care utilization. This allows targeting effective interventions to prevent them and promotes resource utilization based on individual and population needs rather than demand. Risk stratification is essential for PHC practices to be proactive and reach out to individuals based on their risk profile even if they do not present to PHC facilities and to tailor PHC service delivery accordingly. Even if risk stratification (especially as it becomes more sophisticated) is not done at the PHC level, the results can be made available to PHC professionals, often through integrated electronic health record systems, so they can benefit from it in their daily practice. Risk stratification may be carried out in PHC settings with varying degrees of complexity depending on local resources and with different purposes depending on the context. This presentation will discuss the different risk stratification tools used in country across the European region, and provide practical examples on their uses in PHC. The presentation will discuss enabling factors for advanced risk stratification that accounts for multimorbidity and social complexity.
How 2008 financial crisis legacies impacted future health workforce resilience – a realist review
Authors: Fleming P
Published: October 2023

The 2008 financial crisis and subsequent recession led many Governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks. A realist review identified legacies associated with austerity, with a particular focus on workforce resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007- May’21), followed by additional theory-driven searches. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of Context, Mechanism, Outcomes Configurations (CMOCs), alongside stakeholder engagement to confirm, refine or refute emerging results. CMOCs revealed how: 1) priorities influenced by outside agents (e.g. Troika, governmental departments) led to a focus on external transparency and distrust in policy agenda, compounded by poor communication; 2) efficiency driven culture and performance monitoring meant professionals could not recognise their interests and values leading to sense of powerlessness, detachment and professional dissonance; 3) sustained restrictive economic policies that impacted patient care, eroded values, leading to a diminished view of profession; 4) health professionals maintained control by circumventing policy to deliver care - further isolating decision makers; and 5) street-level bureaucracy eventually leads to moral distress resulting in apathy and burn-out. Austerity challenged health system resilience but lessons can be leveraged by policy-makers and management to develop resilient strategies that protect and promote sustainable outcomes for the health workforce. This review reveals the importance of transparent, open communication, in addition to co-produced and value-driven policies.
Using crises to leverage change and build resilience: Legacies and learnings from shocks
Authors: Farsaci L
Published: October 2023

Background

The economic crisis of 2008 and the Covid-19 pandemic acted as profound shocks on health systems around the world. During the financial crisis, Ireland was one of five European countries to receive a bailout from the Troika. The loss of sovereignty in governance and six austerity budgets created a huge challenge for the Irish health system and its ability to be resilient in the face of long-lasting shock. These constraints on resources and a shift in governance meant that Ireland's health infrastructure was weak going into the Covid-19 pandemic. Furthermore, the depletion of workforce numbers and low morale also presented challenges.

Methods

Semi-structured interviews were conducted with seven senior stakeholders as part of the wider RESTORE research project, following ethical approval from the research Institution. Nvivo software was used to conduct thematic analysis independently by three researchers.

Results

The financial crisis deeply impacted the Irish health system throughout the years of austerity. Due to these legacy issues, the system was in a relatively weak position when faced with the Covid-19 pandemic. Furthermore, a lack of long-term planning was evident during the recovery period and the system was unable to reverse many of the negative impacts brought on during austerity. However, the system proved adaptive and innovative in response to Covid-19, and the pandemic proved to be a catalyst for positive change, providing opportunities for long-term reform, alongside an immediate response to the crisis. This was facilitated by increased funding and a devolution in decision-making structures.

Conclusions

The findings raise the question of whether health systems are entering a state of permacrisis and if so what can be done to promote resilience and prepare for future shocks. Furthermore, it asks whether health systems should put resources into acute shocks or everyday crises and explores the relationship between these two foci and resilience.
Record Linkage of secondary data in the NAKO: Overview of data sources with focus on health insurance claims data
Authors: Ahrens W , Pigeot I , Stallmann C , Swart E
Published: October 2023

Background

The collected primary data are enriched with secondary and registry data from different data owners to support morbidity follow-up and to obtain important exposure and progression data that could not be obtained otherwise.

Goal

A sophisticated data protection procedure had to be developed and agreed upon with hundreds of data owners. The outlines of this procedure and the various data bodies to be linked are presented, and consent behavior is described. Furthermore, it is discussed which hurdles still have to be overcome for a successful implementation of record linkage in Germany.

Methods

Study participants were asked for informed written consent to link their secondary and registry data. Confidentiality was ensured, among other things, by means of a complex pseudonymization procedure by an independent trust center. Legal and technical requirements for annual transmission and long-term use of their data were established with the data owners.

Results

At baseline, a total of 205,000 study participants were screened and interviewed in 18 study centers distributed across Germany starting in 2014. A second study wave followed from 2019, with a third starting in 2024. A high willingness to consent of 90.5% to use health insurance data was achieved. Willingness to consent is higher in the west than in the east of Germany, with 88.1% of consenters insured by one of the 113 statutory health insurance providers and 11.9% insured by one of the 46 private health insurance providers.

Conclusions

Large-scale record linkage of secondary data is a novelty in Germany. In addition to the identification of incident diseases, an almost complete medication history can be collected for the majority of study participants, independent of health insurance. However, linking is associated with a high administrative and technical effort, and some of the required data protection regulations will have a negative impact on data quality if improvements are not made here.
Health Smart City towards improving Public Health and Citizen Engagement
Authors: Lapão L
Published: October 2023

Climate change is modifying weather patterns, producing far-reaching effects on the environment, the economy and society as a whole, endangering global livelihoods, health, food and energy security, and water resources. Europe will not escape its effects, aggravating risks and threats to public health (PH). Today cities are leading the effort to tackle climate change. Cities are embracing digitalization and establishing smart cities (SC). SC should address people mobility, but also the impact of extreme weather phenomena. The degradation of the environment will foreseeably create security and health crisis that could benefit with digital technologies. The development of urban policies should be guided by evidence-based PH practices. The inclusion of PH into the pillars of the SC will contribute toward mitigating PH crises, such as the COVID-19 pandemic. Design Science Research Methodology was used to elicit a Smart Public Health City (SPHEC) framework. A set of PH and SC experts participated in the process, using diabetes as a case study. The European Green Deal served as a blueprint toward a healthier and more sustainable city. The SPHEC framework was defined by elucidating the PH functions within a SC, with the identification of a set of digital PH services that are required to support the SPHEC framework. This allows to assess the benefits obtained with the digital PH services, and provides evidence for guiding decision-making. The role of digital PH services emerges from the analysis of the framework, through the development of proper digital PH services, strengthening capacity and resilience in future climate emergencies, and motivating policy makers to endorse this challenge. Climate change is a serious threat with impact in PH and cities need to be prepared to tackle it. The use of the SPHEC framework enable to understand the role of both digitalization and the green deal in supporting public policies to tackle chronic diseases like diabetes.
Case report Germany
Authors: Sarganas G , Tetzlaff F , Buchmann M , Neuhauser H , Scheidt-Nave C
Published: October 2023

Health data in Germany is collected through official statistics, registries, health insurance and population-based health information surveys. These data are used for monitoring progress of the Sustainable Development Goal on Good Health and Well-being (SDG3). According to the Sustainable Development Report 2022, Germany has achieved an overall high-performance score; however, there are still two health indicators which are stagnating or back-warding: “Gap in self-reported health status by income” and “Gap in life expectancy at birth among regions”. In order to illustrate regional inequalities in health, the Robert Koch Institute has developed the German Index of Socioeconomic Deprivation, which merges the dimensions of education, employment and income. It has been estimated that life expectancy between the least and most deprived district in Germany in 2017 differed by 6.0 years among men and by 3.2 years among women. In addition, data on all-cause premature mortality in Germany between 1992 and 2016 showed that while 13% of women and 27% of men from the lowest income group died before reaching the age of 65, this was the case for 8% of women and 14% of men from the highest income group. Self-rated health (SRH) according to income showed in Germany 2019 the largest gap (31% points) compared to other high-income OECD countries. Data from the German Health Update 2019/2020 also showed differences in SRH according to educational background. These differences were more pronounced among women (54% vs. 82%) than men (64% vs. 81%) and largely persisted across all age groups. Unfavorable SRH is an indicator known to be associated with increased morbidity and health-related limitations in daily life as well as a predictor of premature mortality. In Germany progress towards achieving SDG3 has been made; however, it is important to identify vulnerable groups and health inequalities in order to develop target-oriented interventions.
Adapting to changing healthcare landscapes: international trends and practices in inpatient experience surveys
Authors: Kennedy L A , Boland T , Ruiz-O'sullivan G , Foley C , O'Carroll T , Flynn R
Published: October 2023

Background

The National Inpatient Experience Survey was first implemented in Ireland in 2017. After five iterations, an international review was conducted to identify current practices and trends in inpatient surveys in other jurisdictions, as part of a broader review to ensure the survey remains fit for purpose and responsive to the needs of stakeholders.

Methods

Nine surveys were included in the review, based on a desktop search of jurisdictions that had implemented new, or revised existing, inpatient experience surveys. Documentary analysis of relevant reports and other sources from included jurisdictions was undertaken, in addition to detailed discussions with key personnel from organisations in these jurisdictions.

Results

All included surveys have been subject to a review process or are currently undergoing a review. Most jurisdictions are seeking to reduce or eliminate reliance on postal surveys due to increasing postal costs, the burden of data entry and transcription of qualitative responses, and are moving towards the use of online or digital modes of administration. Trends toward more frequent administration and shorter surveys were also noted. More frequent data collection is useful for quality improvement within hospital settings, as it aids in the attribution of results to current, rather than historic, healthcare practices. Shorter surveys may increase response rates. Various attempts to increase participation of hard-to-reach groups have been made, including targeted surveys for particular minority groups, translation of surveys, and ‘easy-read’ options.

Conclusions

The findings indicate the importance and relevance of patient experience surveys to the wide range of stakeholders in each jurisdiction. Reviewing survey methods and methodologies is essential in responding to new priorities, changes to the healthcare landscape including modes of healthcare delivery and policies, public expectations, and to exploit advances in technology.
8.H. Workshop: The commercial determinants of health strategies and tactics: cases from 3 health harming industries
Authors:   Organised by: American University of Beirut (Lebanon),   Chair persons: Jihad Makhoul (Lebanon)
Published: October 2023

The social determinants of health framework and the socioecological model have established the strong influence of the physical and wider social contexts on health and health inequities globally, although the circumstances where people live, work and grow up have been documented for a long time. These determinants can have health promoting and health damaging effects on population, environmental and planetary health. Recent scholarship on the commercial determinants of health focusing specifically on commercial actors, has exponentially proliferated and draws attention to for-profit industries, actors and strategies that promote products and choices which are detrimental to health. The recent Lancet series provides frameworks to better understand and regulate CDH, and has been endorsed by the WHO. This workshop aims to present the unethical health harming strategies and tactics of the for-profit sector with cases from three industries: the tobacco/vaping, the alcohol, and fossil fuel industries. The workshop begins with an overview of the commercial determinants, their multiple influences on people's well-being and their surroundings globally, and the strategies of action they use to market their products, influencing and threatening public health. The first case discusses how the vape industry advertises its Electronic Nicotine Delivery Systems to youth, particularly targeting the young LGBTQ+ population. The second presentation describes the alcohol industry strategies, such as introducing beverages which have confusing definitions to indirectly advertise for alcohol brands where alcohol advertising is restricted, as well as undermining science and purging alliances with policy makers. The last presenter discusses further unethical efforts of the fossil fuel industry to hide evidence of the harms from benzene over more than half a century, promote false data and influence legislation. Implications for global policy and practice are offered.

Key messages

• Commercial determinants of health endanger one health and this require concerted global efforts.

• Commercial actors influence public health though unethical strategies to promote their businesses.
Changes in active commuting and changes in health
Authors: Gluschkoff K , Haukka E , Kalliolahti E , Lanki T , Jussila J J , Halonen J I , Salo P , Oksanen T , Ervasti J
Published: October 2023

Background

Previous studies have shown that regular physical activity through active commuting, such as walking or cycling, is positively associated with physical and mental health. However, because longitudinal within-individual studies on the association between active commuting and health are scarce, the results may have been biased due to unmeasured confounding. Additionally, information about commute length has rarely been included in studies on within-individual change in active commuting. A better understanding of the association between active commuting and health could inform public health policies and interventions to promote active transportation.

Methods

Using two waves (2020, T1 and 2022, T2) of self-report data from of the Finnish Public Sector study (N = 16881), we examined the association between within-individual changes in active commuting and health. Active commuting was measured by kilometers/week (i.e., by multiplying the number of walking or cycling days/week with the daily commute distance). The primary outcome, self-rated health, was measured with a single item (scale from 1=poor to 5=good) at T1 and T2. The secondary outcomes, psychological distress and sleep problems were measured only at T2 and were therefore analyzed with a between-individual model.

Results

After adjustment for potential time-varying confounders such as socioeconomic factors, BMI, and health behaviors, an increase of 10 additional active commuting kilometers per week was associated with a slight improvement in self-rated health (unstandardized B = 0.01, p = 0.001). No associations were observed between changes in active commuting and psychological distress or sleep problems.

Conclusions

This study provides evidence supporting a modest causal association between active commuting and improved health. Promoting walking or cycling to work may have potential benefits for public health, but further intervention research is needed to better understand the extent of these benefits.

Key messages

• The study provides evidence supporting a modest causal association between active commuting and improved self-rated health.

• Promoting walking or cycling to work may have potential benefits for public health.
A mixed method study to explore knowledge, attitudes, behaviour and experience of introducing solids
Authors: Kolokotroni O , Koutrouba A , Economou M , Kouis P , Rubinsohn C , Enayati Zadeh P , Derlagen A , Philippou E , Quattrocchi A , Mosquera M
Published: October 2023

Background

Infancy is a critical time for establishing dietary habits. EARLY START aims to build an intervention for reducing early life obesogenic behaviours. Using participatory action research, the exploratory phase investigates mothers’ knowledge, attitudes, behavioural intent and experience of introducing to solids

Methods

A mixed methods approach was used. Knowledge, attitudes and behavioural intent about infant feeding were investigated amongst mothers using the Infant Feeding Education Questionnaire (IFEQ). A subgroup participated in a focus group discussion of their experience of introducing solids. Data were analyzed using Descriptive and Thematic Content methods.

Results

One hundred and three mothers participated (mean age 33 y.o., tertiary education 94.3%, in employment 98.9%). Advice from health care professionals (HCP) was the most influential factors for when to start solids. Despite a relatively high total IFEQ score (39, min -56, max 56), learning needs were identified in areas, such as putting baby to sleep with bottle and recommended size of food pieces and breastfeeding duration. Maternal characteristics did not influence the IFEQ score. Mother's confidence on when to wean was associated with higher IFEQ score (β coeff.: -2.9, CI -5.4, -0.4, per change to a lower confidence category). Qualitative analysis showed that mother consider introduction to solids a ritual process that is challenging, emotional and requires guidance. It is compared to a “dance” between mother and baby with HCPs positively influencing coordination. Mothers express the need for timely and continuous information beyond the weaning phase that takes into consideration baby's behavioural development and self-contained needs.

Conclusions

Mother's confidence on weaning is influenced by knowledge, attitudes and behavioural intent. New interventions should build confidence by focusing on challenges and addressing mother's emotional and baby's developmental and specific needs.

Key messages

• Knowledge, attitudes and behavioural intent of introducing solids affects a mother's confidence whilst infant feeding is considered a complex and emotional process requiring guidance on evolving needs.

• Future interventions should focus on building confidence by addressing mother's challenges and emotions whilst taking into consideration the baby's developmental and self-contained needs.
Using single case design and mixed methodology to evaluate a community-based befriending intervention for older Irish adults
Authors: McHugh-Power J
Published: October 2023

This presentation will describe the design and results of a mix method study of a community-embedded befriending intervention in Dublin, Ireland. There is mixed evidence regarding the impact of befriending interventions on loneliness. However, befriending interventions may instead yield an impact on health-related quality of life of older adults. We explored this hypothesis and additionally whether such an intervention might buffer the negative impact of loneliness on health-related quality of life of older adults. A single-case experimental design approach was used with new users (n = 86) between 2018 and 2021. Generalised additive modelling was used to analyse the intensive longitudinal data. Furthermore, dyadic qualitative interviews were used with befriending service users and volunteer partners to explore potential mechanisms through which befriending might impact the health of older adults. The befriending intervention yielded a therapeutic effect on health-related quality of life of older adults, and buffered the negative effect of loneliness on health-related quality of life. Dyadic interviews revealed five key mechanisms through which befriending services might impact health, including via health behaviour support and cognitive stimulation. In conclusion, the results suggest that befriending services are beneficial for maintaining the health of older adults, and that they ought to be advised in this respect, rather than as solutions to loneliness. In this presentation, results will be discussed in the context of policy and service recommendations we developed during this research.
Internalized social stigma and its determinants among drug-sensitive tuberculosis patients in Armenia
Authors: Demirchyan A , Petrosyan V
Published: October 2023

Background

Internalized social stigma (ISS) is still an issue among tuberculosis (TB) patients, exacerbating their suffering and affecting their treatment compliance. Quantitative studies of TB-related ISS are scarce. This study sought to measure ISS and identify its predictors among primary drug-sensitive TB patients in Armenia.

Methods

All patients throughout Armenia diagnosed with drug-sensitive TB from Apr, 2019 through Feb, 2021 were targeted for baseline and follow-up interviews at the start of their TB treatment and shortly after completing it, respectively. The instrument included domains on patient's social support, TB knowledge, health, and stigma. ISS was measured via a 10-item scale previously used in Armenia, with the total score ranging from 10 to 50. Fitted linear regression models identified predictors of ISS at each assessment.

Results

Overall, 401 patients were interviewed at the baseline and 285 at the follow-up. Between the assessments, patient's ISS score decreased from 27.4 to 23.8 (p < 0.01). Factors related to higher stigma at the baseline included age (B = 0.13, p < 0.01), rural residence (B = 1.56, p < 0.05), depression (B = 2.46, p < 0.01), frequent alcohol use (B = 2.67, p < 0.01), and higher stigma in the family (B = 0.55, p < 0.01), while socioeconomic status score was protective against ISS (B = (-0.74), p < 0.01). The fitted model explained 33.4% of the ISS score variance. Age and depression were related to higher ISS score at the follow-up as well, while quality of life score (B = (-5.27), p < 0.01), family support score (B = (-0.53), p < 0.01), and receiving psychological counseling/education (B = (-2.04), p < 0.05) were protective against ISS.

Conclusions

This study found rather high levels of ISS both at the time of TB diagnosis and after the treatment course. It also pointed out several factors that could be targeted to reduce ISS, including educating TB patients and their family members, providing them timely psychological counseling and financial support.

Key messages

• During TB treatment, ISS decreased significantly. Modifiable factors protective against ISS included more support in the family and family's satisfactory financial status.

• After the treatment, ISS score was significantly lower among those patients who received psychological counseling and education on TB at the treatment start compared to those who did not receive it.
Healing Obesity with health-promoting environments – can interventions in Urban Policies bring health benefits?
Authors: Jevtic M , Matković V , Savin M , Bouland C
Published: October 2023

Obesity is a complex chronic disease associated with numerous health and social consequences. In 90% of cases, obesity is multifactorial, with a basis in a discrepancy between energy intake and consumption, but also caused by endocrine, psychological factors, environment, improper diet, physical inactivity, and lifestyle. The environment where people live and work must provide opportunity for enough physical activity to prevent obesity. The availability of fitness parks, bike paths, and publicly accessible swimming pools are the many possibilities that a positive and encouraging environment could provide. Urban areas demand publicly accessible places for physical activity. At the same time, it is important to motivate citizens in urban areas to increase their physical activity, because of a predominantly sedentary lifestyle. If the city's urban and health policies promote a healthy lifestyle, for example encouraging cycling and walking by providing infrastructure that will allow for a greater percentage of people to engage daily in physical activity. A healthy-behaviors-promoting environment is important to combat obesity (walkable neighborhood, green space, safe cycling, healthy food availability). A variety of policy strategies are available to create an active and safe environment: 1) increasing green and blue areas in urban settings: to promote recreation and relaxation; 2) promoting cycling and walking as a form of active mobility; 3) reducing or banning of public advertising of unhealthy food, while promoting healthy nutrition and increase of markets with healthy food; 4) encouraging socialization through sport, etc. Providing a healthy and safe environment is necessary to curb the obesity epidemic. Numerous interventions aimed at implementing a plan to change the environment and create a safe and stimulating environment for children and adults are needed.
The English health inequalities strategy: A time-trend study of mortality rate disparities at 65
Authors: Bennett N , Kingston A , Norman P , Bambra C
Published: October 2023

Background

Rapid population ageing is common in many Global North countries, with the UK being a prime example (with 18.6% aged 65 and over in 2021). Despite this, life expectancy in the UK began to stall around 2011, and the gap between the least and most deprived has been widening. To address these inequalities, a ‘levelling up’ programme was announced by the current Conservative government. Previously, a national health inequalities strategy was implemented (2000 to 2010) by the then Labour government, with many of the interventions targeting older age groups. To provide evidence on the effects of national health inequalities strategies on life expectancy later in life, we assessed the impact of the English health inequalities strategy on inequalities in mortality rate at age 65 by area deprivation.

Methods

Using ecological mortality and population data for Middle Super Output and Local Authority areas, we calculated life expectancy for individuals aged 65 and over in England from 1991 to 2016. We applied time-trend analyses methods with marginal spline terms to evaluate how mortality rate trends at age 65 changed before, during and after the strategy period. We also conducted a series of robustness analyses to considering varying cut points, deprivation levels and geographical scales.

Results

Prior to the programme (1991-1998), there was no change in the absolute difference in mortality rate between the 20% most deprived areas and the rest. During the programme, inequalities decreased at a rate of -0.0000936 (95% CI -0.0001281to -0.0000592) each year. However, after the strategy period (2011-2016) inequalities widened at an annual rate of 0.000078 (95% CI 0.0000166 to 0.0001395).

Conclusions

This study provides evidence of an association between the national health inequalities strategy and a narrowing of inequalities in mortality rate at age 65. Future strategies to address inequalities in ageing populations may benefit from adopting a similar approach.

Key messages

• The national health inequalities strategy (2000 to 2010) was associated with a narrowing of inequalities in mortality rate at age 65.

• Future national strategies which aim to reduce inequalities in life expectancy in older age groups may benefit from adopting a similar approach.
Decreasing trust in health institutions in EU during COVID-19: A Spatio-temporal analysis
Authors: Yaddanapudi L , Hahn J , Ladikas M
Published: October 2023

Background

Public trust is essential for easier acceptance of scientific, technological and policy interventions during crises. COVID-19 pandemic witnessed varied public responses to safety measures, highlighting the need for detailed public trust studies, especially in the health sector. Research shows considerable variation in trust in neighbouring regions to countries which is useful to understand in order to respond better to future pandemics.

Objectives

To analyze public trust in health institutions within the EU, to identify spatial clusters of the same at the beginning of the COVID-19 pandemic to the present, and understand factors contributing to decreasing trust.

Methods

Data from the Standard Eurobarometer surveys between 2020 to 2022 was used to perform spatio-temporal analysis of trust in health institutions & medical staff.

Results

Data shows that trust in health institutions and medical staff decreased in most EU countries from 2020 to 2022. Mapping these values showed clear geographical clusters of varying trust. At the beginning of the COVID-19 pandemic, Eastern Europe (52-66%) trusted less in health institutions and medical staff compared to Central (66-85%) or Western Europe (85-97%). By 2022, although Eastern Europe maintained their tendency to not trust, the percentage of people who trusted health institutions reduced in Western and Central Europe. Interestingly, socio-demographic factors such as age, gender, education and income were found to not be associated with trust. However, several factors of perception such as life going in the right direction and difficulty in paying bills were identified to be significantly associated with trust.

Conclusions

It is essential to understand the reasons for this decrease in trust, whether pandemic responses of health institutions or by policy is what contributed to this pattern. Understanding these changes can enable better policy responses towards supporting trust in health institutions.

Key messages

• There is clear geographical clustering of public trust in the EU - Eastern European countries tended to not trust health institutions during the pandemic.

• Socio-demographics showed no significant association with public trust. Interestingly, factors of perception were significantly associated.