bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adherence to the Mediterranean Diet and Urinary Sodium Excretion in people at high risk of dementia
Authors: Rodrigues J , Barbosa M , Sousa D , Costa A R , Lunet N , Tedim Cruz V , Padrão P 
Published: October 2023

Abstract

Background
Both adequate sodium intake and adherence to the Mediterranean Diet (MedDiet) are largely described as important factors for the prevention and control of hypertension and cerebrovascular diseases. However, data regarding sodium intake in the MedDiet is scarce. This study aims to quantify the association between the MedDiet adherence and sodium excretion.

Methods
This cross-sectional analysis was carried out under the MIND-Matosinhos randomized controlled trial, a community-based program for Portuguese adults at high risk of dementia. The adherence to the MedDiet was assessed through the Portuguese version of the Mediterranean Diet Adherence Screener questionnaire, and a score ≥10 indicated a high adherence. A 24h urine collection was used to evaluate creatinine and sodium excretion. Excessive sodium excretion was defined as ≥ 2000 mg/day. Sociodemographic, lifestyle and health-related data were obtained through structured questionnaires. The association between the adherence to the MedDiet and urinary sodium excretion (recoded into two categories by the median) was quantified by calculating Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) using a binary logistic regression.

Results
A total of 126 individuals (24 to 83 years old; median age of 70.0) was included in this study (58.7% female). High adherence to the MedDiet was observed among 15.9% of the sample whereas excessive sodium excretion was reported by 84.1%. After adjusting for confounders, participants with high adherence to the MedDiet showed a higher sodium excretion (OR = 4.05; 95% CI: 1.33-12.37).

Conclusions
A high adherence to the MedDiet was associated with a higher sodium excretion. Thus, an increased adherence to this dietary pattern seems to have limited effects on the adequacy of sodium intake. This highlights the importance of public health measures to reduce sodium intake when following a MedDiet namely by improving consumer empowerment.

Key messages
• Despite the well-known protective effect of the Mediterranean Diet on hypertension and cerebrovascular diseases, the role of sodium intake within this dietary pattern is still understudied.
• The Mediterranean Diet can be an important source of hidden sodium, which enhances the need to invest in public health measures to reduce sodium intake, namely through culinary medicine education.
Monitoring drugs and prison in Europe: key issues and challenges in collecting information and evidence on drug related problems and interventions in prison
Authors: Montanari L 
Published: October 2023

Abstract
The EMCDDA published a methodological framework to monitor drugs and prison in Europe, with the objective to set up methods and tools for collecting and analysing harmonised data across Europe on the issue of drugs and prison. Two data collection tools are available: a “European Questionnaire on Drug use among people in Prison (EQDP)” aimed at collecting epidemiological data on drug use and drug related problems on people incarcerated during a given time period and; a “European Facility Survey Questionnaire in Prison (EFSQ-P)” aimed at collecting data on availability, coverage and provision of drug related interventions inside prison. The two monitoring tools include a short and long version and are accompanied by methodological guidelines. The toolkit should be used across countries to improve international comparisons and European harmonisation as well as to provide data to national governments or international organisations (e.g. EMCDDA, WHO, UN and others). Based on challenges identified among responding countries a check list of key issues in collecting data on drugs and health information in prison settings was drafted. This check list aims to provide a practical guide for those who want to start gathering data on drugs and health in prison; it has been drafted and agreed by a group of European experts who have implemented drugs monitoring in prison using the EMCDDA tools. The check list aims to discuss possible options and present best practices in drugs monitoring in prison in the different phases of research/data collection. The check list includes examples and recommendation on how to address the following issues: accessing prison, planning data collection, sampling procedures according to type of data to be collected, mode of administration/data gathering, data analysis and dissemination; ethical issues, involvement of people living in prison and staff in all phases of data gathering.
Cancer prevention for people experiencing homelessness: Co-designing the Health Navigator Model
Authors: Schiffler T , Gil-Salmerón A , Doñate-Martínez A , Rico Varadé M , Barrio Cortes J , Kouvari M , Karnaki P , Moudatsou M , Tabaki I , Grabovac I 
Published: October 2023

Abstract

Introduction
Cancer is the second leading cause of death for people experiencing homelessness (PEH) due to limited access to cancer prevention services. This study aimed to co-adapt the Health Navigator Model (HNM), integrating end-users’ and organizations’ voices in the design of a care delivery model combining Patient Navigation and Patient Empowerment - models that have been shown to benefit different health outcomes by reducing health inequalities and improving access to cancer prevention services.

Methods
Participatory qualitative research was conducted through focus groups between December 2021 and January 2022 across four European countries (Austria, Greece, Spain, and United Kingdom). Seven focus groups with an overall sample size of 56 participants were conducted, including 41 professional stakeholders and 15 PEH. Focus groups were audio-recorded, transcribed verbatim, and thematically analyzed.

Results
Analysis identified four key features of the HNM, including (1) assessment of needs and barriers to access health care (e.g., seeking solutions regarding barriers to care); (2) promoting cancer awareness and self-management (e.g., encouraging user involvement in health-related decisions); (3) facilitating access to preventive services (e.g., coordinating and supporting attendance of clinical appointments); (4) providing practical assistance (e.g., assisting with paperwork). Regarding the profile of health navigators, a health or social care professional background accompanied by active engagement with relevant/local stakeholders to improve intervention delivery is enhanced.

Conclusions
The HNM is a person-centered intervention to improve self-care and build relationships with PEH. Health Navigators should provide practical assistance, coordinate access to cancer prevention care and promote cancer awareness and self-management. The HNM is currently piloted and evaluated across four European countries as part of the Horizon 2020 CANCERLESS project (GA 965351).

Key messages
• The Health Navigator Model is a person-centered intervention responsive to the needs of people experiencing homelessness, building trusting relationships, and improving levels of self-care.
• Health Navigators should provide people experiencing homelessness with practical assistance and coordinated access to cancer prevention care while promoting cancer awareness and self-management.
Lessons from the health system resilience testing pilot in Finland
Authors: Tynkkynen L , Karreinen S , Keskimäki I , Satokangas M , Viita-aho M 
Published: October 2023

Abstract
Finland is a Nordic welfare state with universal access to health care. The health system has recently undergone a major reform and health care and social and rescue services are organized by 21 well-being service counties, the city of Helsinki and Helsinki-Uusimaa Hospital district which all get funding from the state. Publicly funded health services are mainly provided by public health centers and hospitals. The resilience testing tool developed by the European Observatory on Health Systems and Policies and the OECD was piloted in Finland in the early April 2023. The participants (n = 17) represented e.g. the key ministries, the Prime Minister's Office, Ombudsman for children, well-being service counties, municipalities, and the university hospitals. The tool was piloted by using a pandemic scenario in which those most seriously affected are small children with substantially increased hospitalizations and mortality. The adults are mainly asymptomatic. At population level the spreading of the disease is rapid and overwhelms the service system in waves. The scenario was chosen because it is difficult to predict the onset and cause of the next pandemic, or its effects on the health system. The Covid-19 pandemic placed health systems around the world to a test, but it is important that preparedness to the next pandemic is not developed solely based on the experiences from Covid-19. In this presentation we describe the main lessons learned from the Finnish resilience testing pilot. These include both lessons related to the tool itself and its further development as well as lessons from the discussions based on the pandemic scenario. The discussions by the multi-stakeholder group reflected well the health system subfunctions presented in the resilience testing tool framework. However, the discussions also captured themes that are not currently visible in the framework such as ethical considerations, values, and political determinants of health system response.
Conditions for implementation of whole school health promotion in the Netherlands
Authors: Vennegoor G , Van Assema P , Molleman GRM , Van Empelen P , Dieleman J , Jansen MWJ 
Published: October 2023

Abstract

Background
Around 35 years ago, the Health Promoting School (HPS) framework was introduced to promote student health behaviors. It is an integrated approach, including education, school health policy, health services, and a stimulating social and physical environment. Implementation of such whole school HPS programs often remains challenging due to the dynamic school system. In order to strengthen implementation and reduce heterogeneity in effects, the present study aimed to understand what works, for which schools and under which conditions.

Methods
In 2020, 535 schools filled out the HPS Implementation Questionnaire to determine the degree of HPS implementation, showing considerable variety. Based on their implementation scores, 21 ‘lower HPS’ and 22 ‘higher HPS’ schools (16 primary; 15 secondary; 12 secondary vocational) were recruited by Public Health Services for a visit in 2022 to examine differences. Data on implementation and 35 contextual factors (related to individuals, the school organization, HPS framework, and socio-political environment) were collected by observations, a semi-structured group interview, a questionnaire, document analysis, and field notes. Data were analyzed thematically in Nvivo, and will be followed up by Qualitative Comparative Analysis in R.

Preliminary results
Most evident conditions for degree of implementation were: 1) capacity (time), 2) employee attitude (mainly at primary schools), 3) program champion (mainly at secondary schools), 4) professional implementation support, 5) turbulence (e.g. merger), and 6) management support (mainly at secondary schools). Activity budgets and social support among employees were key factors as well, but did not explain differences in implementation.

Conclusions
In order to strengthen implementation of HPS programs, more efforts are needed to: 1) intensify support for schools in terms of time and professional advice, and 2) achieve a positive school climate among employees and management.

Key messages
• Implementation of HPS programs is challenging due to the dynamic nature of schools.
• Offering support and achieving a positive school climate are crucial to strengthen HPS implementation in schools.
Conditions for professional support of school health promotion implementation in the Netherlands
Authors: Vennegoor G , Van Assema P , Molleman GRM , Dieleman J , Jansen MWJ 
Published: October 2023

Abstract

Background
The Dutch Healthy School Program (‘Programma Gezonde School’; HSP) is a whole school approach including education, stimulating physical and social environment, health services, and school health policies. Implementation support is offered by Healthy School Advisers employed at 25 regional Public Health Services (PHSs). To strengthen this professional support, this study aimed to map conditions for the degree of support offered by PHSs and received by schools.

Methods
The data collection plan was developed together with a Community of Practice. In 2021 and 2022, two rounds of semi-structured group interviews were conducted in 8 PHSs (N = 1-4 employees and ±3.5 hours in total per PHS). Interviews focused on the degree of support (intensity, quality, context-focus, position in PHS and region) and 24 contextual factors regarding: 1) Healthy School Advisers, 2) PHS organization, 3) collaboration with partners, and 4) broader context. Additional data were collected from public websites, year reports, and the Dutch registry of implementing HSP. Data were analyzed thematically in Nvivo.

Preliminary results
There is large variation in all aspects of support between PHSs. Main conditions for this variation are related to the PHS organization: its policy, internal support, capacity, and (long-term) allocated budget. Other key conditions are related to collaboration with partners: coordination, division of responsibilities, and communication structure. Prerequisites for all PHSs were cohesive adviser teams, the HSP, and national school health promotion focus.

Conclusions
In order to strengthen professional support for whole school health promotion implementation, it is essential to: 1) establish strong positioning and (long-term) resources in the organization, 2) establish clear coordination between Healthy School Advisers and partners supporting schools, 3) maintain cohesion among adviser teams, and 4) maintain and intensify national (school) health promotion policy.

Key messages
• Degree of professional support for whole school health promotion varies substantially.
• Positioning in the organization and clear coordination among professionals are key in strengthening support.
Work ability trends 2000-2020 and projections until 2040 in Finland
Authors: Lahti J , Reinikainen J , Kontto J , Zhi Z , Koskinen S , Laaksonen M , Partonen T , Elonheimo H , Lundqvist A , Tolonen H 
Published: October 2023

Abstract

Background
Population in Europe and throughout the world is ageing rapidly. Projections of the work ability of the working-age population are of importance for policy makers to prepare for future challenges. The aim of this study is to examine age-group and birth-cohort trends in perceived work ability in Finland in 2000-2020 and make projections of work ability up to 2040 based on the observed birth-cohort development.

Methods
We used a series of population representative cross-sectional surveys conducted in Finland 2000-2020, i.e. the Health 2000 Survey, the Regional Health and Wellbeing Study 2010, 2012, 2013, 2014, 2015, 2017, FinHealth 2017 and FinSote 2018 and 2020. Self-reported estimates of current work ability in relation to the person's lifetime best on a scale from zero to ten were used, scores 8-10 indicating good work ability. For projecting work ability multiple imputation was used (R package mice).

Results
Trends (2000-2020) by 5-year birth-cohorts born between 1961 and 1995 showed that work ability has declined over time among older birth-cohorts while in the two younger cohorts a stable development before 2017 and a steep decline between 2017 and 2020 was observed. Trends by 5-year age-groups showed a declining trend of good work ability among 20-44-year-olds, a stable trend among 45-54-year-olds and an improving trend among over 55-year-olds. Among the under 55-year-olds the prevalence of good work ability ended up around 75% and at 68% among the 55-59-year-olds, 58% among the 60-69-year-olds and 49% among the 70-74-year-olds in 2020. Birth-cohort projections suggest a declining work ability among 30-74-year-olds in the future. By 2040, the prevalence of good work ability is projected to decline 10-15%−points among 45-74-year-olds.

Conclusions
The decreasing work ability seen in younger age groups and the declining projections until 2040 are highly concerning. Efforts to counteract the projected decline in work ability are needed.

Key messages
• The observed decline in perceived work ability in younger age groups and the projected decline in the prevalence of good work ability among the middle aged and older are concerning.
• Efforts to counteract the projected decline in work ability are urgently needed.
6.O. Workshop: Overview of Comprehensive Sexuality Education Status in Moldova, Georgia, Tajikistan and Kyrgyzstan
Authors:   Organised by: BzgA - Federal Centre for Health Education (Germany),   Chair persons: Johanna Marquardt (Germany)
Published: October 2023

Abstract

Sexual and reproductive health (SRH) is a key dimension of overall health and wellbeing of individuals. Comprehensive Sexuality Education (CSE) is one of the most important means of promoting and supporting youth is their sexual and overall development, and a key component of HIV and sexually transmitted infections (STIs) prevention. It is widely recognised that school plays a central role in learning about health and health promotion skills, including sexuality and sexual health. Nevertheless, there is often a lack of evaluation of CSE implementation in school curriculums. This is why UNFPA (United Nations Population Fund) and BZgA (Bundeszentrale für gesundheitliche Aufklärung), in cooperation with UNESCO((United Nations Educational, Scientific and Cultural Organization), WHO (World Health Organization) and IPPF EN (International Planned Parenthood Federation), conducted a study in Moldova, Georgia, Tajikistan and Kyrgyzstan to assess the status of CSE. In this workshop, we will describe the study process, reflect on the main findings in four countries and discuss two case studies of Moldova and Georgia. The speakers will also share their experiences of translating these findings into advocacy measures and achievements since the study conducted in 2022. The data was collected using the standardized Sexuality Education Review and Assessment Tool (SERAT) via desk reviews of relevant policies, curricula and national data, questionnaires, stakeholder interviews (e.g., with teachers, representatives of technical working groups and ministries of education, young people) and discussions to validate the findings. Overall, we have seen that all four countries teach sexuality education, which is supported by adequate legal and policy frameworks, and integrate it into their school curricula. The comprehensiveness of the curriculum, teacher training and learning methods differ across the four countries. In Georgia, the biggest CSE-related challenge is that there is a stigma in society around sexuality-related issues and there is a need to support an open dialog with key stakeholders. In Moldova, this was the second SERAT assessment within 5 years, which demonstrated a significant progress in the development of sexuality education program since 2017, achieving a much higher score of compliance with the international standards for CSE.

Key messages
• This study shows that the four countries assessed are on a positive track in implementing and expanding their sexuality education programmes, which are supported by a legal and policy environment.
• Gaps still remain in teacher training, monitoring and evaluation, and the comprehensiveness of the delivered content.
Social exclusion of the SGM community in Rwanda: public perceptions and lived experiences of SGM
Authors: Stojanovski K , Igonya E , Otukpa E , Twahirwa L , Rukundo A , Ushie B 
Published: October 2023

Abstract

Background
Sexual and gender minorities (SGM) are “othered” from society. This study quantifies and explores the process of “othering” of SGM Rwandans through the lens of those who “other” and those who experience “othering.”

Methods
We conducted a mixed methods study surveying 499 & conducting focus groups with 59 SGM. We surveyed 1,254 & conducted 16 interviews with non-SGM. Among non-SGM, the outcome was a continuous variable measuring attitudes toward SGM. Among SGM, the continuous dependent variable was from 13 questions measuring discrimination across life contexts (e.g., work, health). We conducted adjusted linear regressions to explore predictors of “othering” among non-SGM and associations between discrimination and SGM identity among SGM. We report beta coefficients and 95% confidence intervals. We used thematic analysis to analyze the qualitative data to examine the context and nuance of “othering” and its impacts on SGM.

Results
The average score for SGM support among the public was 12 (SD = 4.7) (20 is more discrimination). As compared to those who knew zero SGM, persons who knew 5+ had scores that were 1.3 points lower (95% CI -2.2, -0.5), while the score was lower for those that knew 1-5 (-0.2), it was not significant (95% CI -0.8, 0.5). Among SGM, 67% experienced discrimination. In adjusted models, we found that transgender & non-straight participants experienced more discrimination. The qualitative findings found that “othering” occurs in many contexts, such as housing, employment, healthcare, and virtually, but trans persons are most impacted. One participant shared, “A transgender [person] may face more discrimination than a gay based on their physical appearance.”

Conclusions
SGM Rwandans are widely “othered” with negative implications for their ability to live authentically and participate in everyday experiences. However, results indicated that if non-SGM persons were acquainted with LGBTQ+ community members, discrimination is lessened.
Transgender people in different European and Latin American countries: A cross cultural comparison in some relevant measures
Authors: Giami A , Barrientos J , Scandurra C , Valerio P 
Published: October 2023

Abstract

Background
Prejudice against transgender & gender-diverse people persists & is associated with physical & mental health harm. This study describes & characterizes comparative data between countries on gender self-definition/expression & its relationship to gender incongruence diagnosis.

Methods
We used snowball sampling for a face-to-face survey in France (N = 379; 2010), Italy (N = 167; 2015-2016), Brazil (N = 391; 2016), & Chile (N = 377, 2018). Participants were 18+ years & identified as transgender. An open-ended item was used to capture the self-designation of gender: “How would you describe your gender identity in your own words?” We conducted chi-square bivariate analyses and multivariate regression models to examine variation in gender self-definition across countries & its relationship to obtain a change of legal sex/gender markers between countries & incongruence diagnoses.

Results
The preliminary results indicate that self-definitions vary across countries. In France, categories were man, trans man, woman, trans woman, & trans. In Brazil & Chile, a traditional cultural category not in European countries was expressed: travesti. Results showed that a “non-binary” had to be included too. Results showed that lower percentages of trans persons in Chile (22% of trans men & 15% of trans women, Brazil (25% & 12%, respectively) & Italy (10% and 21%, respectively) changed their legal gender markers, as compared to France (34% and 35%, respectively) (p &lt; 0.000). The results showed differences between countries considering the self-definition made by each participant regarding obtaining gender incongruence diagnosis with higher rates of diagnosis in Italy and France (p &lt; 0.001).

Conclusions
These findings show that transgender identity varies between countries & over time. The results indicate the importance of self-identification in trans-health studies, which have implications for global policy and research on the health of trans-identifying persons.