bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health examination surveys for policy formulation
Authors: Rakovac I , Galea G , Fedkina N 
Published: October 2023

Abstract
Health examination surveys (HES) are one of the key data sources for health policy formulation and evaluation as well as monitoring of several health related Sustainable Development Goals (SDG) and other internationally agreed indicators for NCDs. The presentation will 1) highlight importance of health examination surveys in reporting accurately SDG and other internationally agreed NCD indicators; 2) Identify internationally agreed NCD indicators for which HES is used as data source; 3) give an overview of current levels of implementation of HES in the WHO European Region; and 4) Briefly describe available WHO tools related to HES.
Adaptation of the Digital Health Literacy Instrument and testing with German school-aged children
Authors: Rangnow P , Fischer L , Hartmann A , Renninger D , Stauch L , Dadaczynski K , Okan O 
Published: October 2023

Abstract

Background
Children and adolescents in particular navigate in the digital space intensively and use the Internet, social media, and apps to seek health related information. From a public health perspective, the increasing amount of online-based information requires them to possess the abilities to find, understand, evaluate, and apply health information, making digital health literacy more and more important. The Digital Health Literacy Instruments (DHLI) is a psychometrically tested instrument for assessing digital health literacy in adults, which has been adapted for children and adolescents in the United States, using cognitive interviews. However, this version has not yet been adapted for Germany. Hence, the aim of this study is to adapt and test a German version of DHLI for secondary schoolchildren.

Methods
The pretest tool was translated into German by three native speakers. To test the translated version of the DHLI adapted for secondary schoolchildren, cognitive pretests were conducted with N = 12 children and adolescents aged 10-17 years. The thinking aloud method and probing questions were used during the pretests. The aim of the evaluation was to maximize usability and comprehensibility of the adapted version for schoolchildren in Germany.

Results
In order to adapt the instrument for a German target group, preferred synonyms were identified during the pretests, as well as a preferred word collocation for health information, namely ‘information about health,’ which was used consistently for all items. Furthermore, two explanations were added in one instruction and one item.

Conclusions
Based on the results of the pretest analysis, a German version of the DHLI for children and adolescents is now available. Psychometric properties and the methodological quality of the schoolchildren's version of the DHLI have been analyzed in a representative quantitative study, shown in the subsequent presentation.
Sociodemographic differences in digital health literacy of schoolchildren: a representative study
Authors: Stauch L , Renninger D , Fischer L , Hartmann A , Rangnow P , Dadaczynski K , Okan O 
Published: October 2023

Abstract

Background
The increasing amount, availability, and use of digital health information through the Internet, social media, and apps highlights the relevance of digital health literacy in schoolchildren. Children and youth need digital health literacy in order to find, understand, and appraise health information and to make health decisions in everyday live. However, there is only limited to none evidence available on child and youth digital health literacy. This study aims at investigating digital health literacy of schoolchildren in Germany and explore associations with sociodemographic differences.

Methods
Data were collected from a representative sample of N = 1,448 secondary schoolchildren employing a face-to-face survey (CAPI) (Oct-Nov 2022). In addition to sociodemographic information (age, gender, migration, family affluence, education level), digital health literacy was measured using an adapted and translated self-report tool for secondary schoolchildren in Germany. Descriptive statistics, chi-square tests, and internal consistency were calculated using SPSS.

Results
Cronbach's alpha indicated a good internal consistency (α=.82) for the overall scale and an acceptable-to-good reliability for the subscales (α=.735-.866). Digital health literacy was low in more than half of the participants (52.9%). While no differences were found for gender (X2 (1)=0.25, p=.618) and migration background (X2 (2)=2.34, p=.31), lower digital health literacy was more frequent among younger children aged 9-11 years (X2 (2)=34.69, p = &lt;.001), children with low family affluence (X2 (4)=24.16, p = &lt;.001), and lower parental education (X2 (2)=8.26, p=.016).

Conclusions
The results of the first study of its kind in Europe suggests an elevated need to promote digital health literacy in schoolchildren. Public health and education policies and interventions are needed that pay attention particularly to younger children's needs, to those from lower family affluence, and lower parental education.
Teaching digital health literacy skills in schools: A quantitative study among teachers
Authors: Rangnow P , Fischer L , Hartmann A , Renninger D , Stauch L , Dadaczynski K , Okan O 
Published: October 2023

Abstract

Background
In societies increasingly characterized by media and information diversity, digital health literacy (DHL) is an essential key competence for public health. Due to their educational mandate, schools are an important setting for the promotion of DHL, with teachers playing an important facilitating role. While there are findings available on generic health literacy of teachers, evidence is lacking regarding their DHL and the level of teaching DHL in schools.

Methods
An online survey using a non-probability sample of school teachers in Germany was carried out (N = 1,600). DHL was measured using a translated version of the adult Digital Health Literacy Instrument (DHLI) tool. The level of teaching DHL was assessed using self-developed items based on the seven DHLI dimensions. Descriptive analyses and chi-square tests were conducted in SPSS.

Results
A large number of teachers reported the level of teaching DHL to be problematic (45,5%) or even inadequate (22,2%). While operational skills, e.g., using a keyboard, are the most likely to be taught in the context of seeking health information, 31% of teachers reported that these skills were not or hardly addressed at their school. Adding self-generated health content, e.g., how to create health-related messages on social media, is the least taught skill, 81% reported that this is taught hardly or not at all. The degree to which DHL is taught is associated with their age (p &lt; .048), school position (p &lt; .001), and own DHL (p &lt; .001), which was found to be low for 44% of teachers.

Conclusions
The results show that hardly any DHL content is taught in German schools. However, as teaching of DHL in school plays a significant role in student DHL, it should be integrated more often into teaching and learning situations. The links between teacher DHL and the degree to which DHL is taught suggest that teachers’ DHL should be systematically promoted. Education policies in Germany should support incorporating DHL into the curriculum.
Costs and control strategies of healthcare-associated infections in an Italian university hospital
Authors: Mosconi C , De Santo C , Ciccacci F , Carestia M , Guarente L , Di Giovanni D , Morlino G , Moramarco S , Cicala M , Orlando S 
Published: October 2023

Abstract

Backgrounds
Healthcare-associated infections (HAIs) increase morbidity, mortality, and costs, necessitating effective prevention strategies. This study estimates the additional costs of HAIs in a university hospital in Rome, Italy Policlinico Tor Vergata (PTV), to inform policymakers, healthcare professionals, and researchers.

Methods
We conducted a retrospective cohort study, including all patients admitted or discharged in 2018. We applied propensity score matching (PSM) to balance study groups and then we analysed cost differences using the average treatment effect on the treated (ATT) approach. Costs were calculated using the Diagnosis Related Groups (DRGs) system. Outcome measures included the real reimbursement cost in euros and the relative cost increment using adjusted logarithmic transformation.

Results
12,033 patients were included: 6,653(55%) female, 5,380 (45%) male, with a median age of 67. In total, 1,212 (10.1%) infected patients were compared to 10,821 (89.9%) non-infected patients. Predominant infections were urinary tract infections (UTI) (48.8%) and blood stream infections (BSI) (34.4%), while Staphylococcus spp. (37.5%) and Enterococcus spp. (36.4%) were the most common pathogens. The propensity score analysis showed a 59.7% (95% CI: 48.8% to 71.3%) cost increase for infected patients. They incurred an additional €4,988 (95% CI: €4,173 to €5,804) in costs. Subgroup analyses revealed cost variations across infection sites and pathogens, with Klebsiella P. having the greatest economic impact at €7,586 (95% CI: €5,301 to €9,871) and BSI also at €9,719 (95% CI: €8,137 to €11,307).

Conclusions
This study highlights the significant additional cost burden of HAIs in the PTV. Interventions with an equal or lower cost per HAI averted can be considered cost-effective. Public health actions, including enhancing infection prevention, developing or revising policies, and strengthening surveillance systems, should be prioritised to address ongoing HAI challenges.

Key messages
• Our study reveals a significant 59.7% cost increase (€4,988in our hospital) for HAI patients, highlighting the need for cost-effective prevention strategies in healthcare settings.
• Findings emphasise the importance of enhancing infection prevention measures, policy development, and strengthening surveillance systems to reduce HAI-associated costs.
Suicide attempts among Swedish healthcare workers – a population-based cohort study
Authors: Nevriana A , Brulin E , Almroth M , Pan K-Y , Bodin T , Kjellberg K , Hemmingsson T , Falkstedt D 
Published: October 2023

Abstract

Background
While there are abundant studies on healthcare workers’ (HCWs’) suicide risk, studies on HCWs’ suicide attempts are rarer. Most previous studies on HCWs’ suicide attempts were based on cross-sectional self-reported information among selected occupations, i.e., physicians, and did not consider potential multiple attempts. This study aimed to determine the risk of suicide attempts among a wide range of healthcare professions using information from Swedish nationwide population registers.

Methods
This population-based cohort study included 4.9 million Swedish workers aged 20 years and above residing in Sweden in 2005 who were followed until their death, emigration, age 65, or 31 December 2020. The suicide attempts rates (number of secondary care visits with ICD-10 codes X60-84 and Y10-34 during follow-up) among HCWs were identified and compared with the general working population. The following occupations were included: physicians, nurses, dentists and dental hygienists, psychologists, psychotherapists, counsellors, pharmacists and prescriptionists, therapists and other allied health professionals, assistant nurses, and healthcare administrators. Adjusted rate ratios (aRRs) were estimated using Poisson regression controlling for demographics, socioeconomic, and health status.

Results
Most HCWs have an increased risk of suicide attempts compared to other workers. The highest risk was observed among nurses (aRR 1.48, 95% CI 1.42-1.56) and assistant nurses (aRR 1.33, 95% CI 1.30-1.35). The association was stronger in males (aRR nurses 1.56, 95% CI 1.35-1.81) than in females (aRR nurses 1.41, 95% CI 1.34-1.48). The risks were similar over the age at follow-up and calendar year.

Conclusions
Many HCWs were at increased risk of suicide attempts. Unlike patterns observed in the general population, male HCWs might have a higher increase in suicide attempt risk. Preventive efforts for suicide attempts within the healthcare system might need to be improved.

Key messages
• Healthcare workers were at increased risk for suicide attempts, and the risk might be stronger in male than female HCWs.
• The risk for suicide attempts among healthcare workers was similar throughout age and calendar year.
Sibling complexity and psychiatric disorders in late adolescence among the Finnish 2000 birth cohort
Authors: Junna L , Remes H , Martikainen P 
Published: October 2023

Abstract

Background
Due to the increasing family instability and multipartner fertility in Western countries, more children have half- and stepsiblings. While numerous studies link family instability and complexity with mental health problems, the focus has typically been on the parents while a small but growing literature suggest that sibling constellations with half- and stepsiblings may also be important for adolescent mental health.

Methods
This study is based on administrative register data of all children born in Finland in 2000 and residing there at ages 0 − 15 (n = 56,372). We identified the biological parents, their cohabiting partners, and any full, half and step siblings that the index child has from birth to age 15. We used Cox proportional-hazards models to compare differences in psychiatric disorders from age 16 to 19 for boys and girls by different sibling constellations. Psychiatric disorders were identified as any disorders treated in specialized outpatient or hospital care (n = 7,999).

Results
Almost one in five children in the birth cohort had a cohabiting half sibling and almost 4% had a step sibling. Psychiatric disorders in late adolescence were more prevalent among children in different sibling compositions with half or step siblings. For example, the preliminary results show that adjusting for confounders such as socioeconomic status and living with both biological parents or not, boys and girls with an older half sibling had a 44% (95% confidence interval 34-55) higher risk of psychiatric disorders when compared to children with biological siblings only. The corresponding difference in risk for those with younger half siblings was 24% (11-55).

Conclusions
Psychiatric disorders were more prevalent in late adolescence among children with half and/or step siblings. Future studies on family complexity are likely to benefit from including information on sibling characteristics in addition to those of the parents.

Key messages
• Adolescents growing up with half or stepsiblings had a higher prevalence of psychiatric disorders in late adolescence.
• More studies on sibling composition and adolescent psychiatric disorders are needed to inform the type of supportive measures that may benefit children living with half and stepsiblings.
Evaluation of a school health promotion program using the holistic WHO approach
Authors: Kien C , Klingenstein P , Pell A , Griebler U 
Published: October 2023

Abstract

Background
A school health promotion program guided by the WHO approach is implemented in approximately 40% of public secondary schools in Lower Austria. Program advisors support participating schools in developing a systematic plan for the promotion of health and wellbeing of all students and teachers. This study aimed to evaluate the effectiveness of the program and identify potential areas for program optimization.

Methods
We applied a non-randomized controlled cluster trial with pre- and post-measurements (T0: October 2021 and T1: June 2022). We invited students, teachers and school principals of 30 program schools (PS) and 29 non-program schools (NPS) to fill in an online-questionnaire. We analyzed data of 2706 students, 451 teachers and 47 principals.

Results
The study showed that PS had established more favorable structures for school health promotion (HP) than NPS (e.g., established HP-team, financial resources setting objectives). Although PS implemented more HP activities than NPS (8.5 versus 6.3 activities), they merely took place as one-time events. At student level, an advantage for the PS over time was shown with respect to two out of 19 endpoints (subjective health status [b = 0.19, p &lt; 0.001] and uptake of additionally offered physical activity lessons [b = 0.09; p = 0.04]). In two out of 19 endpoints, an advantage was also shown for the NPS (opportunities for physical activity during lessons and breaks [b = 0.06; p = 0.001], opportunities for participation [b = 0.20; p = 0.001]). At teacher level, in five out of 25 endpoints, the teachers of PS reported more favorable results than NPS’ teachers.

Conclusions
A supportive structure for school health promotion may be helpful for implementing more health promoting activities in schools. However, these activities do not seem to be profound enough to have an impact on the students. Teachers would need more support in implementing HP activities.

Key messages
• Structures for implementing health promoting activities are in place.
• However, the implemented activities did only show limited effect on students.
11.P. Workshop: Inequities in physical and mental health, and health care utilization for LGBTQ groups across Europe
Authors:   Organised by: EUPHA-SGMH,   Chair persons: Corina Lelutiu-Weinberger (USA), Arjan van der Star (EUPHA-SGMH)
Published: October 2023

Abstract

Compared to heterosexual cisgender-identified individuals, lesbian, gay, bisexual, and transgender and queer (LGBTQ) individuals evidence pronounced poor mental and physical health outcomes, as well as sub-optimal healthcare access and utilization. Yet, most of the evidence documenting these disparities comes from a small group of Western countries. This limited knowledge across health conditions and geographical regions leaves multiple important questions unanswered. In particular, it remains unknown to what degree these disparities may be generalizable to contexts that have not yet been studied. This workshop includes novel reports on disparities in health, wellbeing, and healthcare access between LGBTQ groups and their heterosexual cisgender counterparts across several European countries where such data were not previously available. Through these four presentations, we explore health inequalities across Europe in physical and mental health, as well as healthcare utilization. Findings emphasize a continued need for attention to systems that can be modified (e.g., trainings of healthcare cadre, resource allocation) to reduce health disparities that uniquely burden LGBTQ groups. Andreas Pfister (Zurich University of Applied Sciences, Switzerland) will present the first national systematically documented psychosocial burden and healthcare access disparities for LGBTQ individuals compared to their heterosexual cisgender counterparts in Switzerland. Sladjana Baros (Centre for Disease Prevention and Control, Department for HIV, Hepatitis, Sexually Transmitted Infections and Tuberculosis, Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut’, Republic of Serbia) will present findings from the HIV testing cascade among men who have sex with men at high risk for HIV. Michal Pitonak (Center for Epidemiological and Clinical Research of Drug Abuse and Dependence, National Institute of Mental Health, Klecany, Czech Republic) will present data on disproportionate rates of psychological distress reported by lesbian, gay and bisexual individuals compared to heterosexual individuals in the Czech Republic. Lastly, Luis Roxo (Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden) will present population-based data on differences in mental health services and unmet mental health needs based on sexual orientation among Swedish young adults.

Key messages
• Despite being the first of such evidence, findings from these four European countries are consistent with reports from other global regions, signalling that these disparities are universal.
• A clear need emerges for structural changes to increase access to and expertise in affirmative LGBTQ healthcare to reduce disproportionate morbidity rates for LGBTQ people in Europe.
Health inequalities of LGBT persons in Switzerland – Results from the first national LGBT health study
Authors: Pfister A , Krüger P , Eder M 
Published: October 2023

Abstract

Background
Internationally, there is evidence that lesbian, gay, bisexual and transgender persons (LGBT persons) have poorer health outcomes than the heterosexual or cisgender population. In addition, LGBT populations face more frequent and unique healthcare access barriers. Barriers to healthcare among LGBT persons in Switzerland remained undocumented until recently, when the Swiss Federal Council mandated a report describing the health and healthcare access of LGBT persons, and related health inequalities.

Methods
Two data sets were included in analyses: (1) two waves of the representative Swiss Health Survey (SHS 2012, 2017) n = 29,793, ages 16 to 74, including 858 LGB persons, and (2) data from a non-representative national online survey (May to July 2021), including 1,542 LGB cisgender and 522 transgender persons, ages 15 to 81. Data were analyzed using descriptive and inferential statistics (e.g. binary logistic regression), controlling for potential confounding factors (e.g. year of study, age), using the Health Equity Promotion Model as a conceptual framework.

Results
The most significant areas of health inequalities across the groups of interest were mental health, experienced discrimination and violence, healthcare access barriers, substance use, and sexual health. For example, LGB persons experienced significantly higher rates of depression (16.0% vs. 7.4%; p&lt;.001) and suicide attempts (11.0% vs. 3.3%; p&lt;.001) compared to the heterosexual population. Additionally, LGB persons abstained from seeking medical care significantly more often than heterosexual persons (16.2% vs. 6.9%, respectively) due to a lack of trust in the healthcare system.

Conclusions
Besides targeted action in the identified (health) areas, a Health in All Policies Approach is needed to improve the lives and health of LGBT people in Switzerland by diminishing stigmatization and discrimination, and by implementing LGBT inclusive and specific protocols in healthcare and other settings.