bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health literacy and unhealthy lifestyle behaviors in older adults: does social connectedness matter?
Authors: Wieczorek M , Meier C , Kliegel M , Maurer J 
Published: October 2023

Abstract

Background
Given the high prevalence of low health literacy (HL), the lifestyle-related morbidity, and the importance of the social environment in later life, we aimed to investigate the association between HL and unhealthy lifestyle behaviors and explore the moderating role of social connectedness in this relationship in a population-based sample of adults aged 58+.

Methods
We used data from 1,455 respondents to Wave 8 (2019/2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) in Switzerland. Current smoking, risky alcohol consumption, suboptimal daily consumption of fruits/vegetables, and lack of engagement in physical activity were considered to derive the number of unhealthy behaviors. Three HL categories were defined based on the HLS-EU-Q16 score: inadequate, problematic, and sufficient. Social connectedness was assessed using the Social Connectedness Scale. Associations were examined using Poisson regression models, controlling for sociodemographic and health characteristics and including an interaction term between HL and social connectedness to test the moderation hypothesis.

Results
Overall, 72.2% of respondents reported at least one unhealthy behavior, 6.6% had inadequate HL, and 19.8% were socially isolated. Respondents who had inadequate HL were more likely to have a higher number of unhealthy behaviors than those with sufficient HL (Average marginal effect (AME)=0.22, p &lt; 0.01). We found a significant interaction between HL and social connectedness (p = 0.04), with a stronger positive association between inadequate HL and the number of unhealthy behaviors in socially isolated individuals (AME=0.34, p &lt; 0.05).

Conclusions
Greater social connectedness seems to buffer the positive association of low HL with unhealthy lifestyle behaviors in older adults. Implementing tailored interventions aimed at improving HL may foster the adoption of healthy lifestyles, especially in socially isolated older individuals.

Key messages
• Social connectedness may mitigate the negative impact of low HL on the number of unhealthy behaviors, highlighting the importance of social reserve in making healthy lifestyle choices in later life.
• Implementing HL-tailored health-promoting lifestyle interventions, including family or community components, would help tackle the double burden of low HL and unhealthy behaviors in older adults.
Use of outpatient healthcare services before and after the onset of unemployment
Authors: Rinne H , Blomgren J 
Published: October 2023

Abstract

Background
The onset of unemployment may entail adverse health effects and, thus, increase the need for healthcare services. On the other hand, the onset of unemployment may weaken access to the healthcare services, which may as such decrease the overall use of healthcare services. The aim was to examine the use of outpatient healthcare services in different sectors of healthcare before and after the onset of unemployment and to study whether job loss affected the use of these services.

Methods
Longitudinal individual-level register-based data was utilized on all individuals living in the City of Oulu, Finland, who became unemployed in 2017 (N = 1,999), their propensity matched controls (N = 1,999), and unmatched controls (N = 58,459) in a quasi-experimental design. Use of outpatient healthcare services was examined in one-month periods from 12 months before to 12 months after the onset of unemployment. Several socio-demographic factors, along with sickness and employment histories, were used for propensity score matching. Difference-in-differences analysis was used to measure the differences in the use of outpatient healthcare services between the unemployed and their matched controls.

Results
The use of healthcare services decreased significantly after the onset of unemployment. This was due to a decrease in the use of occupational healthcare services. No change related to job loss was observed in the use of public or private healthcare services. The number of healthcare visits increased again after the unemployment ended. Difference-in-differences analyses showed that compared to propensity score matched controls, becoming unemployed reduced the use of healthcare services.

Conclusions
When access to occupational healthcare services ceases, other healthcare services do not appear to fill the gap among those who become unemployed. Adequate healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status.

Key messages
• The overall use of outpatient healthcare services decreases significantly after job loss in Finland because of a decrease in the use of occupational healthcare services.
• Adequate and easily accessible healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status or other socio-demographic factors.
Quality improvement in multi-professional primary health care units: Lessons learned from Austria
Authors: Radl-Karimi C , Petschk K , Siebenhofer A , Spary-Kainz U , Posch N , Paier-Abuzahra M 
Published: October 2023

Abstract

Issue/problem
In 2017, Austria started the establishment of multi-professional primary health care units (PCUs) to better meet patients’ and healthcare professionals’ needs including a focus on health promotion, health literacy and patients with chronic diseases. Currently, Austria has 40 operational PCUs. In the province of Styria, the quality of care in PCUs is monitored through quality indicators (QI) in annual surveys. The patient questionnaire includes items on patient satisfaction, shared decision-making, and self-management. The PCU team questionnaire covers organizational routines and working satisfaction.

Description of the problem
Only few improvement initiatives were launched in response to the QI surveys, especially for low-performing QI. In addition, the concept of quality indicators seemed difficult for the teams to understand. As a result, from 2021 on, the surveys are being conducted every other year. In the intervening years, PCU teams get the opportunity to discuss and reflect on the previous yeaŕs results in facilitated workshops.

Results
We held workshops in the ten PCUs in Styria from October 2022 to February 2023. In the workshops, the teams identified six strengths (e.g. providing a wide range of services) and six weaknesses (e.g. appointment coordination) of the PCUs with corresponding actions for improvement (e.g. managing the patient flow).

Lessons
Combining the QI surveys with workshops lead to practical actions for quality improvement as well as a better understanding of the relevance of quality indicators among PCU teams and funders. Workshops provided the teams with a dedicated space for reflecting on organizational processes, which they may not have the opportunity to do amidst their heavy workload and still adjusting to PCU structures.

Key messages
• Engaging the PCU teams in the quality improvement process ensures that the resulting actions are more relevant to their needs and priorities.
• Our quality indicators as well as the identified actions for quality improvement are highly transferable to other primary care settings and countries.
Nothing about us without us - community perspectives
Authors: Sarma N 
Published: October 2023

Abstract
The fourth workshop contribution will represent the important perspective of self-organisation and NGOs. A debate on discrimination-sensitive communication can only and exclusively take place if the people who are being talked about have a say - people with experiences of racism and other forms of discrimination. The focus herein should be on partnership and participation rather than paternalism. It is therefore important to talk about self-organisation, self-advocacy and empowerment - and how language, concepts and categories can be sensitively developed with the participation of all those concerned.
The City of Cork Food Policy Council – Inter-agency collaboration towards a fairer, healthier, more secure and sustainable local food system
Authors: Harrington J 
Published: October 2023

Abstract
Food has long played a significant part in Cork's identity and Cork regards itself as ‘the food capital of Ireland’. In contrast Cork city has areas of severe social disadvantage and, in line with other parts of the country, there are rising levels of diet-related ill-health and where up to one in eight households experiences food poverty (Kenny and Sage, 2019). To date, Cork City does not have an Urban Food Strategy. The Cork Food Policy Council is a partnership between representatives of the community, food retail, farming, fishing, restaurant/catering, education, environmental and health sectors and local authorities. It was established in 2012 to work towards the achievement of a fairer, healthier, more secure and sustainable food system within the City and throughout the region. As a multidisciplinary group that works closely with the Cork Healthy City initiative, it has pioneered innovative approaches to bring food systems thinking into the city, working at both local and policy levels. This recognises the position and value of food within the fabric of city life, and for its multifunctional benefits to health, community, infrastructure and spatial thinking. The presentation will focus on the interagency nature of this group and how a greater understanding and collaboration among local policy drivers has led to innovative actions in the city and the groundwork towards co-creating a food strategy for the City.
The role of the perceived food environment on the eating behavior of people with lower socioeconomic positions in municipal settings
Authors: Inac Y , D’Hooghe S , De Ridder K 
Published: October 2023

Abstract

Food environments are an important determinant of diet and play a crucial role in the development of obesity and overweight. People with lower socioeconomic position (LSEP) often have an unhealthier diet. Perceived characteristics of the food environment have a critical and distinct role in influencing diet, since they take people's experiences and reality into account. Therefore, the aim of this study was to explore the role of the perceived food environment on the eating behavior of people with LSEP in two municipalities in Belgium, and to identify potential actions which can be taken by these municipalities to promote a healthy diet. 23 people with LSEP were recruited through purposeful convenience sampling until data saturation was achieved. The photovoice and photo-elicitation method were used to capture respondents’ perception of their food environment and to identify potential actions, both individually (n = 16) and in group (n = 7), that play a role in a diet. All data was transcribed and analyzed thematically using NVIVO 20.0. Multiple local actions to improve a healthy diet were identified during the interviews and focus groups. Respondents identified affordable and accessible cooking classes, opening a social restaurant/store and including affordable healthy recipes in the municipal newspaper as potential actions. Actions such as making at-home delivery of healthy groceries financially accessible to everyone and to distribute vouchers instead of food parcels at food banks also came forward. Furthermore, respondents cited a lack of information about where healthy food was available as a barrier and identified a central overview of affordable and healthy food and communal field visits to local food producers such as farmers as potential actions. These results show that people with LSEP identified a wide variety of actions related to the food environment that local governments and related stakeholders can take to promote healthy eating.

Speakers/Panelists
Ingrid Stegeman
EuroHealthNet, Brussels, Belgium
Negative experiences on social media and mental health among adolescents. The “LifeOnSoMe”-Study
Authors: Skogen J C , Andersen AIO , Finserås T R , Ranganath P , Brunborg G S , Hjetland G J 
Published: October 2023

Abstract

Background
Cyberbullying has been widely studied and is associated with poor mental health outcomes in adolescents. However, adolescents frequently also experience a range of other negative experiences, such as name-calling, exclusion, and unwanted attention or contact from others. Few previous studies have investigated how adolescents’ mental health is affected by these more common and relatively less severe types of negative experiences on social media (SOME). The aim of the present study was to assess the associations between mental health outcomes and two aspects of negative experiences on SOME; unwanted attention and negative acts and exclusion.

Methods
This study is based on a survey conducted in 2020/21 consisting of 3,253 Norwegian adolescents (mean age 17 years; 56% female). Eight statements about negative experiences on SOME were asked and combined into two composite measures: “Unwanted attention from others” and “Negative acts and exclusion”. Dependent variables in regression models were symptoms of anxiety, symptoms of depression, and quality of life. Covariates included age, gender, subjective socioeconomic status, and amount of SOME-use.

Results
Both “negative acts and exclusion” and “unwanted attention from others” on SOME were consistently positively associated with self-reported symptoms of depression and anxiety, and negatively associated with mental well-being in both crude and adjusted analysis.

Conclusions
The results indicate a potential important relationship between experiencing negative events on SOME, even presumably less severe events, and worse mental health and well-being. Future research should investigate the potential causal relationship between negative experiences on SOME and mental health, as well as exploring potential precipitating and intermediating factors.

Key messages
• The findings from this study indicate that commonly reported negative experiences on social media is associated with poor mental health and well-being among adolescents.
• The present study highlight the need to also focus on less severe but commonly occuring negative experiences on social media.
Challenges and Benefits of Social Media Influencers for Adolescent Health – A Scoping Review
Authors: Gell S , Engel E , Heiss R , Karsay K 
Published: October 2023

Abstract

Background
Social media has become the primary source of entertainment, information, and news for adolescents. Influencers play a key role in this new information environment as content providers, with a large number of followers. While they can motivate and inform young people about health topics, they may also share questionable information driven by commercial interests. This scoping review aims to synthesize existing literature on the benefits and challenges influencers represent for adolescents’ health.

Methods
The review followed the PRISMA-ScR approach, with predetermined databases, inclusion and exclusion criteria, and a search string developed. The review produced 1699 items, and after duplicate removal, title, abstract, and full-text screening, 51 articles were included. Along the topic of adolescents’ health and social media influencers, prevalent benefits and challenges were synthesized from the 51 articles.

Results
Identified challenges (n = 41) revolved around regulating influencer marketing, adapting laws to social media environments, enforcing existing laws, and strengthening social media literacy among adolescents and professionals. Benefits (n = 21) included tailoring health campaigns to social media environments and target groups with influencers and using the authenticity and trustworthiness of influencers to increase range and engagement with health information.

Conclusions
Most challenges focus on regulation and policy efforts rather than harnessing the advantages of influencers for health campaigns on social media. Health professionals need to expand and adapt their skills and content to cater to these new information environments.

Key messages
• Introducing and enforcing policies to regulate influencers and to increase media literacy among adolescents and professionals pose major challenges.
• Influencers are capable of providing authentic and trustworthy channels, as well as expertise, for social media health campaigns.
A Smoking Prevention Intervention in an Online Community Game: Results from a Pilot Trial
Authors: Le Roux E , Martin P 
Published: October 2023

Abstract

Background
Innovative methods for smoking prevention interventions need to be investigated to increase attractiveness, access hard-to-reach populations, and increase effectiveness. We studied the feasibility and immediate effects of an intervention to reinforce norms and behaviors of young people related to antismoking, integrated into a popular online community game.

Methods
A pilot randomized controlled trial was conducted through the HABBO online community. The intervention group was exposed to repeated discussion sessions with small groups of peer players and two facilitators once a week for 1 month (four sessions), inside the game. The control group had access to antismoking information websites. Process indicators (attractiveness, participation) and immediate outcomes (norms and intentions with regard to smoking) were assessed by questionnaire.

Results
One hundred sixteen players were invited to participate in the intervention; 10 did not meet eligibility criteria, 30 were allocated to the intervention group, and 76 to the control group. Median age was 23. Twenty-four percent were not in education, employment, or training. A median of eight players attended each session and the median number of exchange chats by session was 399; 70% of chat time was occupied by the players. Twenty players attended all four sessions. Immediate norms, representations, and intentions were evaluated in 39 players and showed small differences between groups.

Conclusions
Delivering and evaluating a smoking prevention intervention in an online game is feasible. In the targeted online community game, the intervention was attractive and allowed the delivery of innovative interventions to audiences with diverse social profiles. Long-term effects, sustainability, and evaluation methodology are discussed.

Key messages
• Entertainment video games (which have no initial interest in health issues) can be used as a field of intervention in public health.
• Innovative contexts for delivering public health actions make it possible to reach audiences that more traditional interventions would not reach and open up prospects for reducing social inequalities.
The use of health care databases for surveillance of congenital anomalies: A EUROlinkCAT study
Authors: Loane M , Garne E , Morris J K , Bakker M K 
Published: October 2023

Abstract

Background
Although health care databases were not designed for research or surveillance, they are increasingly used by researchers to investigate the epidemiology of congenital anomalies (CAs). Identifying specific CAs that can be accurately identified in hospital databases and those that are poorly recorded will enable surveillance of CAs. We evaluated the accuracy and the quality of the coding of CAs in hospital databases compared to EUROCAT data.

Methods
The EUROlinkCAT project linked data from eleven EUROCAT registries I eight countries to electronic hospital databases. The coding of specific CAs in hospital databases was compared to the codes in the EUROCAT registries (gold standard). For birth years 2010-2014 all linked live birth CA cases and all children identified in the hospital databases with a CA code were analysed. Registries calculated sensitivity and Positive Predictive Value (PPV) for 17 selected CAs. Pooled estimates for sensitivity and PPV were then calculated for each anomaly using random effects meta-analyses.

Results
Most registries linked more than 85% of their cases to hospital data. Gastroschisis, cleft lip with or without cleft palate and Down syndrome were recorded in hospital databases with high accuracy (sensitivity and PPV &gt;85%). Hypoplastic left heart syndrome, spina bifida, Hirschsprung's disease, omphalocele and cleft palate showed high sensitivity (&gt;85%), but low or heterogeneous PPV, indicating that hospital data were complete but may contain false positives. The remaining anomaly subgroups showed low or heterogeneous sensitivity and PPV, indicating that the information in the hospital database was incomplete and of variable validity.

Conclusions
Electronic health care databases cannot replace CA registries, although they can be used as an additional ascertainment source for CA registries. CA registries are still the most appropriate data source to study the epidemiology of CAs.

Key messages
• European hospital databases can accurately record a limited number of anomalies that are visible at birth, diagnosed prenatally and/or require hospitalisation or surgery in the first year of life.
• Additional data sources are needed to capture all children with CAs as hospital databases have limited information or codes to identify pregnancies that result in termination for fetal anomaly.
Exploring the gender gap in end-of-life care: ethical considerations for dementia patients
Authors: Yakov G , Halevi Hochwald I 
Published: October 2023

Abstract

Background
Dementia is a common, terminal disease that significantly reduces the quality of life. Home hospice services face ethical challenges when caring for patients in the final stages of the disease. While gender differences are known to exist in various aspects of care, limited research has explored gender variation in end-of-life care perceptions. This study aims to explore how home hospice staff consider gender, particularly regarding ethical issues.

Methods
The study used a phenomenological qualitative approach, conducting semi-structured interviews with 30 multi-professional home hospice staff members caring for dementia patients.

Findings
Caregivers tend to ignore gender when caring for elderly patients at the end of their lives. This non-gender-related approach is evident in their attitudes towards ethical issues, such as respecting patients, considering their welfare and dealing with communication difficulties. However, disregarding gender when caring for dementia patients within the home hospice framework raises questions regarding the dying person's perception of human dignity, their wishes, and their overall welfare.

Conclusions
Given that gender is a crucial component of a person's identity, the staff's non-gender-related approach towards end-of-life care reflects the non-gender-related social construction of the elderly. This raises concerns about the quality of care provided to end-of-life patients. To ensure that patients’ dignity is preserved in the final stages of their lives, it is necessary to provide training for caregiving staff on the importance of considering gender in end-of-life palliative care.

Key messages
• Home hospice staff tend to ignore gender when caring for dementia patients. Neglecting gender raises ethical concerns and questions about patient dignity and welfare.
• Considering gender in end-of-life palliative care is crucial to ensure high-quality care for patients with dementia in the final stages of their lives.