bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the perceived dynamic system driving inequities in the community obesogenic environment
Authors: D’Hooghe S , Inaç Y , Dury S , Deforche B , De Ridder K , Vandevijvere S , Van Dyck D , Van de Weghe N , Guariguata L 
Published: October 2024

Abstract

Introduction
Persons in socioeconomically disadvantaged situations (PSEDS) are more susceptible and disproportionally exposed to obesogenic environments, resulting in poorer dietary outcomes and lower levels of physical activity. This study aimed to map the complex dynamic system within the community obesogenic environment driving unhealthy eating and insufficient physical activity among PSEDS in Flanders, and to identify potential local actions.

Methods
Participatory group model building (GMB), a qualitative system dynamics method, was used to engage PSEDS (n = 7), local decision makers (n = 7) and local stakeholders (n = 5) in two Flemish municipalities. A two-day GMB session was held in each municipality during which a causal loop diagram (CLD) was created and potential local actions were identified by considering causal pathways and reinforcing loops in the system.

Results
The CLD was designed around two main variables (i) healthy eating and (ii) physical activity among PSEDS. Seven sub-systems could be identified: 1) social environment, 2) facilities and activities, 3) mobility options, 4) information, 5) affordability, 6) safety (specifically for physical activity), and 7) industry and advertisement (specifically for eating behaviour). Several actions to improve the local environment to promote eating behaviour and physical activity among PSEDS were identified.

Conclusions
The CLD illustrates the complex interactions between individual and environmental determinants contributing to inequalities in eating behaviour and physical activity by including multiple perspectives of community members in socioeconomically disadvantaged situations, local decision makers and local stakeholders. Both the participatory GMB approach and the final CLD visualization can provide the basis for planning local actions for promoting healthy eating behaviour and physical activity among PSEDS.

Key messages
• Group model building is an effective approach to explore and understand a dynamic complex system through a shared understanding among diverse stakeholders.
• A systems approach is valuable to provide a more comprehensive and context-specific understanding of the perceived factors contributing to inequities in the obesogenic environment.
Promoting sexual health in schools: a systematic review of the European studies
Authors: Abrams R , Nordmyr J , Forsman A K 
Published: October 2024

Abstract

Background
Sexual ill-health causes a high health burden. There is, therefore, a need for more effective sexual health promotion interventions. Previous research has focused on preventive sexual health interventions and the limited evidence concerning school-based sexual health promotion interventions has not been synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in European schools.

Methods
A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and a narrative synthesis of the included studies was performed, highlighting the collective results.

Results
The review included 17 records, reporting 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All qualitative studies described positive effects as experienced by the participants, and ten of the quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest.

Conclusions
The findings indicate good evidence for the effectiveness of interventions with a health promotion approach, underscoring the importance of sexual health resources such as respect, communication skills, and attitudes. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas, e.g., sexual health literacy is less studied and can be recommended to be included in future research.

Key messages
• The synthesized evidence sheds light on the lack of evaluated interventions employing holistic and positive, resource-focused sexual health promotion interventions targeting European adolescents.
• The included school-based sexual health promotion studies, although limited in number, show evidence of promising effects on sexual health outcomes among participants.
Understanding labour exploitation as a social determinant of health in migrant populations – insights from the Danish population-based registers
Authors: Lau K 
Published: October 2024

Abstract
Despite recent global events such as the COVID-19 pandemic and the Qatar world cup drawing attention to the significant loss of human lives of labour migrants in precarious working conditions, evidence on the comparative mortality of migrant workers remains sparse and inconsistent. Studying the comparative mortality of migrant workers with local workers is challenging for several reasons. Data on migrants’ employment conditions and health outcomes are often incomplete, and when available captured in separate databases. In addition, there is a need to disentangle the healthy migrant effect from the healthy worker effect, which presents challenges in the selection of reference populations and temporality when studying mortality of migrants. In view of such challenges, Denmark provides an ideal context to study labour migration and mortality. The Danish population-based registers offer linked longitudinal data on migrants’ employment history and mortality outcomes. Denmark’s migrant integration policy also has a history of weaving immigration and labour policies, and migrants in Denmark continue to be prone to labour exploitation in high-risk industries such as construction and agriculture. This presentation shall use Denmark as a case study to compare the mortality outcomes of migrant workers with Danish workers to better understand labour exploitation as a social determinant of health.
Sporting clubs’ perceptions about harmful industry sponsorship: Lessons from gambling research
Authors: McCarthy S , Thomas S , Pitt H , Arnot G , Randle M , Daube M 
Published: October 2024

Abstract

Background
Unlike tobacco, there are no restrictions relating to gambling sponsorship in Australian sports. While some sporting teams have voluntarily refused sponsorship deals with gambling companies and other harmful industries, many are still actively entering into or renewing such deals. There is limited understanding of why, despite widespread public concern, sporting organisations continue to engage in commercial partnerships with gambling companies and venues. This study aimed to qualitatively explore the ethical and related practical issues associated with gambling sponsorship.

Methods
In-depth interviews were held with 24 key decision makers in Australian community sporting organisations. Participants were asked questions relating to attitudes towards gambling, decisions about gambling sponsorship within their clubs, and issues relating to alternative sponsors and sponsorship disparities. Data was analysed using reflexive thematic analysis.

Results
Interviews revealed the difficulty for sporting organisations to avoid harmful industry sponsorship. When deciding to align with gambling companies, sporting organisations had to consider their own values and the reputational impact of such deals, and balance this with the financial viability of the sporting organisation. Despite sporting organisations relying heavily on sponsorship deals, some stated they would refuse gambling sponsorship for ethical reasons but recognised that sporting clubs in poorer financial positions may be more vulnerable to taking up gambling sponsorship.

Conclusions
As elite sporting organisations begin to move away from gambling sponsorship, gambling companies may target community sport. The authors consider practical strategies to protect communities from sponsorship from harmful industries.

Key messages
• Sporting organisations navigate ethical dilemmas when considering gambling sponsorships, weighing values, reputation, and financial viability. Policy action is needed to protect local communities.
• Community sporting organisations face increased risk of gambling sponsorship as elite sporting clubs move away, prompting the need for protective strategies.
Determinants of health prevention behaviors in Portugal
Authors: Novais A , Barros P P 
Published: October 2024

Abstract

Background
One of the main causes of death in developed societies are chronic non-communicable diseases, often originated by risky behaviors as tobacco consumption, poor diet, excessive alcohol consumption and lack of physical activity. Changing lifestyles can thus lead to a reduction in chronic diseases and in their economic costs. The objective of this study is to understand what the main factors associated with health behaviors are.

Methods
We used the data collected through the Portuguese National Health Surveys from 2014 and 2019. The sample analyzed was composed of individuals aged 15 or more years old living in the national territory at the time the surveys were conducted. Data on demographics, socio-economic variables and health related variables was used. A maximum likelihood estimation was performed using a multivariate probit model, by using health behaviors (weekly exercise, healthy diet, non-smoking, and prudent alcohol consumption) as the outcomes of the analysis.

Results
The results point to a strong association between social class and health behaviors, particularly between higher income and healthy diet. It is important to highlight that having an appointment with a General Practitioner is positively associated with all healthy behaviors. For all behaviors but healthy diet, the coefficients are statistically significant at a 5% significance level and non-smoking displays the highest one (0.135).

Conclusions
This study presents the first step to understand the determinants of health prevention behaviors, which is important to design policies targeting lifestyles. One of its main conclusions indicates that social class (income and education) and GP appointments are associated with health behaviors. Further research would be needed to study the underlying mechanisms through which some of these factors impact behaviors. This presentation was supported by National Funds through FCT, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020).

Key messages
• This study is an important step in the formulation of policies targeting lifestyles since it allows us to understand which factors are associated with health behaviors.
• From this study one can conclude that social class characteristics, particularly income, and access to GP appointments are associated positively with health behaviors.
Navigating Burnout: Exploring Pharmacists’ Attitudes toward Patient Care
Authors: Jocić D , Krajnović D 
Published: October 2024

Abstract

Background
The study aimed to investigate the link between pharmacists’ burnout levels and their attitudes toward patient care, crucial for addressing burnout’s impact on service quality and fostering positive patient interactions.

Methods
The study utilized the Shirom-Melamed Burnout Questionnaire (SMBQ) to assess burnout levels among 442 community pharmacists. Additionally, the five-point Likert Scale of General Attitudes and Beliefs of Pharmacists about their Work with Patients (SOSUF), developed by the authors, was employed to measure pharmacists’ cognitive, affective, and behavioral attitudes toward patient care. Statistical analyses involved correlation and regression procedures.

Results
Moderate burnout levels among pharmacists observed (mean SMBQ score: 4.18 ± 0.96, range: 1.45 to 6.55), alongside generally positive attitudes toward patient care (mean SOSUF score: 3.44 ± 0.37). Regression analysis revealed a moderate positive correlation between burnout and attitudes toward patient care (R = 0.336, R Square = 0.113, Adjusted R Square = 0.111, p &lt; .001). Burnout impacted pharmacists’ attitudes, notably in perceptions of patients not appreciating their efforts (r = -0.317, p &lt; 0.001), finding patient interactions challenging (r = -0.409, p &lt; 0.001), and disregarding their advice (r = -0.333, p &lt; 0.001).

Conclusions
Despite generally positive attitudes toward patient care, burnout moderately correlates with negativity, notably impacting perceptions of patient appreciation, interaction challenges, and adherence to advice. Addressing burnout is crucial for maintaining positive patient care attitudes and ensuring quality service delivery.

Key messages
• Burnout impacts pharmacists’ patient care attitudes, emphasizing the need for intervention to enhance healthcare delivery.
• Implementing strategies to reduce burnout among pharmacists can improve patient care outcomes.
A Training-of-Trainers program for health facilitators fighting malaria in a vulnerable community
Authors: Carboni C , Jimeno Maroto I , Galindo M , Plessis L , Lambert Y , Vreden S , Suarez-Mutis M , Miller Bordalo J , Douine M , Sanna A 
Published: October 2024

Abstract

Background
When Public Health is challenged by issues related to migrant and vulnerable populations, health facilitators’ profiles are crucial to accessing communities and increasing intervention effectiveness and acceptability. The French overseas region, French Guiana, is concerned with a migrant population living in vulnerable conditions far from healthcare and being a major reservoir of malaria. Curema is an intervention implemented to fight malaria in this population by distributing RDTs, and treatments after an appropriate training of participants. Facilitators from the community are employed to provide health education and enroll participants.

Objectives
An intensive theoretical-practical training program was realized to enable facilitators to master procedures related to the intervention. The training was designed using the CDC Training-of-Trainers (ToT) framework and adult learning principles. It was composed of initial and on-the-field training, both based on bidirectional, participative, and dynamic working spaces. A mixed-method evaluation was carried out to assess training effectiveness and quality.

Results
Group dynamics and adaptations driven by facilitators’ needs were key elements of a high-quality training program. Satisfaction was elevated for training format and learning results. Statistically significant improvements in knowledge level demonstrated good effectiveness. During the initial training, difficulties persisted regarding some tasks to be performed during the intervention: further on-the-job training addressed them, improving facilitators’ practices in the field.

Conclusions
High-quality, effective, and appropriate training programs are required for intervention involving facilitators’ profiles. Training design is crucial to achieve it. ToT model has been shown to allow high satisfaction, learning results, and good implementation in the field. Initial and on-the-job training are an indispensable continuum to sustain good practices and motivation.

Key messages
• If health facilitators from the community are actors in public health interventions, appropriate training is necessary to ensure good implementation.
• ToT seems an optimal model for training health facilitators.
Consumption and expenditure of antidepressants and anxiolitycs in 14 European countries
Authors: Martella M , Minutiello E , Gianino M M 
Published: October 2024

Abstract

Background
Since the burden of depressive and anxiety disorders, assessing the use and spending of drugs commonly prescribed for treating such conditions is a valuable barometer of mental health assistance and healthcare services. The current research aims to evaluate the consumption of antidepressants and anxiolytics and the relative expenditure among 14 European countries (Austria, Czech Republic, Finland, Germany, Hungary, Italy, Latvia, Luxembourg, Norway, Portugal, Slovak Republic, Slovenia, Spain and Sweden).

Methods
A retrospective longitudinal study was assessed based on pooled time series analysis of secondary data over ten years (2012-2021). Defined Daily Doses (DDD) per 1,000 inhabitants and health expenditure per capita (current US$, computed on purchasing power parity) were considered. Linear and quadratic trends were calculated for defining relationships between the variables of interest.

Results
Prevailing patterns of consumption and spending show an increase in antidepressants and a decrease in anxiolytics. Noteworthy is the growth slope of antidepressant consumption in three selected countries, Portugal, Spain, and Sweden, by over two and a half times from 2012 to 2021. In addition, for a few countries, there is a pattern contrary to most countries for anxiolytics (Latvia, Spain) and discordant between consumption and expenditure for antidepressants (Austria, Hungary).

Conclusions
The widespread growth of antidepressant use deserves attention. As a public health issue, the prescription and use of antidepressants should be addressed by targeted policies for integrating multifaceted strategies.

Key messages
• Monitoring consumption and expenditure of antidepressant and anxiolytic drugs represents a valid tool for assessing the efficacy and availability of mental healthcare services among the population.
• The growth in the consumption of antidepressants represents a relevant public health issue and deserves attention for the evaluation of an integrated approach of assistance.
A healthcare workforce assessment model using reimbursement data in Luxembourg
Authors: Leite S , Goetzinger C , Urbain M , Berthet F , Shinn C 
Published: October 2024

Abstract

Background
The assessment of the healthcare professional (HCP) headcount and level of activity is a real challenge for policy makers. In Luxembourg, there is no uniform definition of practicing HCP. This work focused on identifying a method to assess HCP headcount and their level of activity in Luxembourg, while finding national consensus.

Methods
A thorough literature review was conducted to find methods that assess practicing HCP and identify their level of activity. Eligible were scientific papers or national reports discussing methods on employed and self-employed HCP. National reimbursement data were used for preliminary data explorations conducted alongside the ‘General Inspectorate of Social Security’ in Luxembourg and discussed with the ‘Institut national d’assurance maladie-invalidité (INAMI)’ in Belgium. Two working groups were planned with national stakeholders to discuss HCP assessment methodologies. Both the collaborations and the working groups led to a preliminary validated HCP assessment method. To reach national consensus, a Delphi study is planned in June 2024, using the eDelphi.org platform. Invited panelists include researchers, professionals, healthcare practitioners, decision makers and policy makers, patient representatives, and insurers.

Results
The literature review found 16 eligible papers on HCP headcount and HCP’ level of activity. Finally, the Belgian method, developed by experts from INAMI, using reimbursement data and establishing a median reimbursement for each medical specialty was retained for Luxembourg. The results of the Delphi study will inform on the level of agreement on relevance, clarity and completeness of the proposed methodology for Luxembourg.

Discussion
Finding national consensus represents a strong foundation for efforts to advance the use of the proposed methodology in healthcare workforce assessment and planning.

Key messages
• Counting something as simple as healthcare professionals requires a strong methodology that held the buy-in of all major stakeholder.
• As working behavior of HCP evolves over time, it is crucial to not only count professionals but also full-time equivalents for policy makers to plan ahead in an accurate manner.
Reflective model assessment of adherence to COVID-19 non-pharmaceutical interventions
Authors: Pavić M P , Pranić S M , Matelić T , Kljucević Z , Gotovac M , Jurčev Savicević A , Kozina T , Kozina S 
Published: October 2024

Abstract

Background
Non-pharmaceutical interventions (NPIs) decrease COVID-19 transmission. We identified behavioral factors that affected NPI adherence according to Normalization Process Theory (NPT) in medical students, travel seekers, and people with substance use disorder using reflective model measurement, which previously had not been conducted. Public health officials should consider factors that influence adherence to create preventive strategies for COVID-19.

Methods
In a cross-sectional design, medical students and people with substance use disorders in treatment comprised a probabilistic sample, and travelers and COVID-19 suspected persons comprised a convenience sample. Participants were from Split-Dalmatia County (n = 656) in the Mediterranean and consented to self-administered surveys in 02/2021. Sociodemographic data, locus of control (LoC), and moral behavior were collected. Partial least squares structural equation modeling (PLS-SEM) was used to measure reflective assessment of NPI adherence according to NPT.

Results
PLS-SEM reflective model assessment provided two-group specific factors in inverse relationships which determined NPI adherence with excellent goodness of fit (χ2=1.292, df = 1; p = 0.297). Significant negative factors covariance estimate (-0.716) revealed an increase in adherence to the first factor, NPIs and internal LoC [0.640], as the second factor, age (≤25) and highest education level (1.362), decreased. LoC was the mechanism by which sex (MLsex=-0.017, SE = 0.007, p &lt; 0.016) and being a student or person with substance use disorder (MLgroup=-0.008, SE = 0.003, p = 0.015) showed indirect effect on NPI adherence.

Conclusions
Students and people with substance use disorders more adhered to NPIs. Higher-educated younger adults with a tendency toward external LoC facilitated the normalization. Public health interventions could encourage these subgroups to act as promoters to increase NPI adherence in similar settings.

Key messages
• COVID-19 non-pharmaceutical interventions and psychological factors of students and people with substance abuse disorder influenced adherence. Targeted interventions could promote adherence.
• Public health officials should consider that preventive strategies may be more effective in highly educated adults younger than 25 years of age.