bluuebunny/crossref_metadata_2025_split huggingface dataset:
9.N. Workshop: How to solve shortages and uneven distribution of health workers in Europe?
Authors:   Organised by: Nivel (Nethrlands),   Chair persons: Ronald Batenburg (EUPHA-HWR)
Published: October 2023

Abstract

Background
Europe's health workforce is under extreme pressure. The increasing challenge of an uneven distribution of health workers within countries is amplified by a structural problem of shortages, inappropriate skill mix, inadequate working conditions and ageing of health workers. In this workshop the results from five research projects, ROUTE-HWF, OASES, AHEAD, TASHI and METEOR (joined in the EU Health Workforce project cluster) will be presented. The ROUTE-HWF, OASES and AHEAD projects focus on the uneven distribution of health workers resulting in ‘medical deserts’, while the TASHI project focusses on task shifting and METEOR on the retention of health workers. In this workshop it will become clear which lessons can be learned from the five projects and how they complement each other. How should retention and task shifting policies be implemented locally, and can they mitigate the uneven distributions of health workers? And vice versa, how should retention and task shifting policies by customized in different types of medical deserts? By combining the five projects into one workshop their links and added values will be made clear. While all projects are based on cross-national comparisons and aim to improve health workforce policy by in-depth research, they also differ and complement approaches to overcome the pressing struggles of the current health workforce.

Aims and Objectives
The aim of this workshop is to present the key findings of the different projects, focusing on the need for different solutions for countries to mitigate structural problems of health workers.

Workshop format
This will be a regular workshop. During the workshop, all five projects will shortly present their key results and after each there will be room for discussion. At the end of the workshop there will be room to discuss the complementarity of the five projects, and how they jointly provide an overview of policy options to mitigate structural problems related to medical deserts, task shifting and retention of health workers.

Key messages
• The workshop will give insight into the specific problems of medical deserts and the possible approaches with regard to retention and task shifting policies.
• The workshop will give insight into the need for customizing policy solutions to attach the complex problem of health care worker shortages and regional disparities.
Exploring subjective risk-benefit perception as an integral component in risk communication
Authors: Lohmann M 
Published: October 2023

Abstract
Consumer health protection involves assessing and communicating risks. One-way risk communication may cover information on food safety regulations, food handling practices, and contaminants in food, as well as concerns related to food recalls, outbreaks, or other safety issues. This approach is legitimate if the aim is simply to share information. However, adequate risk communication needs to reach people with the information they need, in a form they can use, and overcome discrepancies between scientific risk assessment and risk perception of laypersons. Often risks that are low from a scientific point of view are overestimated by the public (e.g., pesticide residues, genetically modified food), or the opposite (e.g., foodborne pathogens). Furthermore, foods also have health benefits, and the balance between adverse and beneficial effects is difficult to perceive. Communication related to food should consider all aspects of food choices, including health beliefs, cultural practices, and personal preferences that influence choices and perception of risk and benefits. In this presentation, we will explain how an institute for risk assessment with a mandate for risk communication can apply quantitative and qualitative methods to identify patterns of perception and behaviour. Quantitative methods are used to measure risk perception and communication, qualitative methods to investigate psychological aspects and motivations, and media analyses to reveal topics that are prioritized in the media, which can influence risk perception. We will show how social science methods can be used to understand how consumers respond to risk-benefit information and discuss how common metrics for assessing both risks and benefits are expected to facilitate communication of results of RBA. The challenges that these metrics pose for risk-benefit communication and whether it is to be expected that consumers will be able to accurately weigh between risks and benefits will also be discussed.
COMMA: A microsimulation model investigating the impact of COVID-19 lockdowns on depression
Authors: Thompson K , Qi J , Pham A , Viviani E 
Published: October 2023

Abstract

Background
The COVID-19 pandemic has highlighted the importance of tailored preparedness plans to cope with potential disease outbreaks. During the pandemic, a major challenge for policymakers was finding the balance between containing the disease and supporting mental health and well-being. Although COVID-19 lockdowns and accompanying restrictions mitigated the spread of the virus, many countries witnessed significant increasing rate of depression during these periods. It is not clear the extent to which different lockdown scenarios impacted depression rates, and whether these effects might be felt in the future.

Methods
In this study, a microsimulation model, COMMA (COvid Mental-health Model with Agents), was developed to simulate behaviors of individuals under different lockdown scenarios, both actual and hypothetical, and of varying duration, sequence and severity. COMMA helps to understand how the prevalence of depression changed in each scenario. The characteristics of simulated population were synthesized based on health cohort data from Lifelines. The data included participants living in the Dutch city of Groningen during the pandemic.

Results
Preliminary results show that hard lockdowns resulted in increased rates of depression. Light lockdowns had smaller effects on depression rates. In all simulations with lockdowns, depression rates had almost rebounded to pre-COVID levels, although they remained slightly higher than in simulations with no lockdowns at all.

Conclusions
COMMA is the first microsimulation model to examine COVID-19 lockdowns’ impact on mental health, and offers important insights into the actual, hypothetical and potential effects of lockdowns on mental health.

Key messages
• Simulations showed that lockdown severity mattered, with hard lockdowns resulting in elevated rates of depression.
• This study highlights that lockdowns are not without secondary health consequences, which may be important for policymakers to consider during future pandemics.
Healthy Finland survey as the latest uptake for 50 years of population health monitoring in Finland
Authors: Lundqvist A , Tolonen H 
Published: October 2023

Abstract
In Finland, population-based health examination surveys (HESs) have been conducted in regularly since early 1960's to obtain information on population health and health determinants. These surveys have covered adult population living in the mainland Finland. Surveys have always been conducted by specially trained personnel using international standardized protocols such as WHO MONICA protocol or EHES protocol. The latest HES, Healthy Finland, is ongoing and will run until June 2023. The Finnish Institute for Health and Welfare (THL) had the responsibility of the coordination of the preparation phase as well as conducting the survey. Survey planning was started already in early 2021 with a multidisciplinary group including representatives from different stakeholders. Survey sample includes 66.000 randomly selected adults aged 18+ years living in Finland. In the 1st phase, they receive a questionnaire to be filled in. Questionnaire covers topics such as quality of life, health, use of health care services, lifestyles, background information, work ability and functional capacity, wellbeing, accidents, and sexual and reproductive health. In the 2nd phase, 10.000 of those selected to the survey were invited to health examination including for example anthropometric measurements, blood pressure, spirometry test, collection of biological samples and sub-studies. This from these national HESs has been widely used for policy making, planning and evaluation of the prevention programmes, as epidemiological background for clinical treatment guidelines of several diseases, and for research. Information obtained from the Healthy Finland survey will be used for the evaluation of wellbeing service counties which are responsible for the organization of social and health care services in Finland. Survey will generate new information about health inequalities by providing information not only by age and sex but also by education and other socio-economic indicators.
A hidden epidemic during COVID-19: Sleep disturbance and alcohol use among healthcare workers
Authors: Lee B , Ling M , Boyd L , Sheen J 
Published: October 2023

Abstract

Background
The COVID-19 pandemic has led to significant mental health issues among healthcare workers (HCW), including depression, anxiety, and post traumatic stress disorder. Emerging studies are now showing that HCWs are facing additional mental health challenges such as insomnia and alcohol use disorder that also require urgent attention. The current study thus aimed to evaluate the prevalence and factors related to sleep disturbance and alcohol use in Australian HCWs.

Methods
In January 2023, 211 Australian hospital HCWs completed an online cross-sectional survey that included a modified version of the Coronavirus Health and Impact Survey, a single item measure of sleep disturbance, a single item measure of alcohol use, and a demographic measure. Missing data were imputed and analysed using adjusted multivariate regressions and relative weight analysis to determine key predictors of outcomes.

Results
Results show that 172 (81.5%) participants experienced sleep disturbance affecting their personal or occupational life, with 49 (23.2%) at very or extremely high levels. With alcohol use, 73 (34.6%) reported monthly intake, 58 (27.5%) reported weekly intake and 8 (3.8%) reported daily intake. Sleep disturbance was significantly associated with poor pre-covid mental health (p &lt; 0.001, R2=17.66%), time spent outdoors (p &lt; 0.01, R2=4.2%), poor physical health (p &lt; 0.05, R2=4.9%), COVID infection worries (p &lt; 0.05, R2=3.9%), and providing direct care to COVID patients (p &lt; 0.05, R2=3.1%). Alcohol use was higher in physicians compared to nurses (p &lt; 0.01, R2=3.1%) and associated with direct care of COVID patients (p &lt; 0.05, R2=2.4%) and relationship stress (p &lt; 0.05, R2=1.9%).

Conclusions
These findings are the first to investigate sleep disturbance and alcohol use in Australian HCWs and shows that these challenges pose a significant risk for this cohort. Findings highlight at risk groups and potential treatment targets to address these outcomes.

Key messages
• Sleep disturbance and alcohol use are increasingly becoming a growing concern for HCWs, indicating an urgent need for interventions and supports to prevent long term consequences.
• Findings highlight 4 risk and 1 protective factor for sleep disturbance and 3 risk factors for alcohol use that can be targeted in interventions and supports for HCWs.
Patients’ factors of choice in dental care and impact of the Covid-19 pandemic – a systematic review
Authors: Felgner S , Handrock J F , Schroll C C , Schütte F , Henschke C 
Published: October 2023

Abstract

Background
Patients often face individual challenges at their dentist, e.g., high co-payments. Why patients decide for or against dental treatment can be determined by many factors: own financial resources, preferences, and external circumstances. The study's aim is to identify these factors with an international perspective.

Methods
We systematically searched for literature in three biomedical databases. Factors of choice etc. were extracted from relevant publications. We used a qualitative approach for analysis, and the MMAT (Mixed Methods Appraisal Tool) for quality assessment.

Results
After multistage screening of n = 4,226 publications by two reviewers, n = 233 relevant articles of different study types [qualitative (n = 42), quantitative (n = 177), and mixed-methods (n = 14)] were included in the analysis. Data collection was realized across different settings [e.g., practice (n = 18)] and approaches (e.g., interviews) in n = 49 countries. Included studies focused on specific treatments (e.g., caries treatment) or treatments in general (e.g., dental tourism). Across countries, various factors of choice (n = 101) were identified, divided into three categories: (I) ‘dentist & dental institution’ (e.g., communication), (II) ‘patient’ (e.g., fear), and (III) ‘treatment’ (e.g., durability). Cost and dental fear were mentioned most frequently (n = 148, n = 73). In countries with most articles [UK (n = 28), Saudi Arabia (n = 23), USA (n = 22), India (n = 19), and Brazil (n = 14)], the cost factor was identified most often [e.g., USA (n = 16, 73%)]. One publication addressed the Covid-19 pandemic reporting that treatment appointments were cancelled by patients due to their fear of infection with SARS-CoV2. Study quality is highly variable.

Conclusions
A variety of factors influence patients’ choice regarding dental treatment. There is little research on impact of the Covid-19 pandemic. Regulatory measures and information efforts should be adapted to reduce patients’ access barriers to dental care.

Key messages
• A variety of factors influence patients’ choice regarding dental treatment.
• Fear of SARS-CoV2 infection is a new factor of choice in dental care from patients’ perspective.
Cancer risk behavior and healthcare utilization among people experiencing homelessness in Europe
Authors: Grabovac I , Doñate-Martínez A , Alhambra-Borras T , Blanes V , Gomez Trenado R , Barrio Cortes J , Gawronska J , Belogianni K , Tabaki I , Jeleff M 
Published: October 2023

Abstract

Background
People experiencing homelessness (PEH) are a vulnerable population, having higher cancer morbidity and mortality compared to the housed population. Reasons for this may be due to higher prevalence of risky health behaviors but also owning to barrier to access and utilize healthcare services. This study aimed to show the prevalence of risky health behavior and utilization of healthcare services in PEH in Austria, Greece, Spain and the UK.

Methods
Data from 262 PEH participating in an ongoing longitudinal study on cancer prevention and early detection were included in a preliminary analysis (03/2023). Participants were adults, with no history of cancer recruited during their visits to social and healthcare services. Demographic data, high-risk health behaviors and visits to healthcare services were collected via questionnaires.

Results
Mean age of participants was 47.6 years (SD = 12.9) with 56.2% identifying themselves as male. The majority (50.4%) were homeless for up to 3 years and 61.6% had no history of homelessness. On average, 13.6 (SD = 10.2) cigarettes per day were reported by 62% of active smokers, 51% reported regular alcohol intake and 20.6% reported use of illicit drugs. Multimorbidity (co-occurrence of two or more chronic illnesses) was prevalent in 20.2% of participants. Half of participants reported having health insurance and 55% reported utilizing health care services in the past 12 months. The average number of visits to general practitioners and medical specialists was 3.9 (SD = 5.5) and 2.1 (SD = 5.1), respectively with an average of 2.2 (SD = 7.3) nights spent in hospital.

Conclusions
The proportion of PHE engaging in high-risk health behaviors is higher and utilization of health services is lower compared to the housed population. PEH may benefit from improved access to preventive and community health services, which is currently assessed by implementing the Health Navigator Model as part of the Horizon 2020 CANCERLESS project (GA965351).

Key messages
• High prevalence of risky health behaviors and multimorbidity in PEH was observed.
• The reported low health care utilization among PEH may be due to structural barriers.
Smoking status of medical students and changes during the COVID-19 pandemic
Authors: Babjakova J , Wimmerova S , Argalasova L 
Published: October 2023

Abstract

Background
Smoking is a major public health threat that contributes to many diseases and deaths. This study aimed to investigate cigarette and alternative tobacco products (ATP) use and knowledge among students. Additionally, changes in smoking prevalence and contributing factors during the COVID-19 pandemic were examined.

Methods
The cross-sectional, anonymous online survey was conducted among students from the Faculty of Medicine, Comenius University in Bratislava, by sending e-mails with links, during November-December 2022. Our study population consisted of 783 students with a mean age of 22.7±2.7 years; 68.1 % of students studied in Slovak; 67.0 % of respondents were female; 21.8% did not have COVID-19, and 6.6% were not vaccinated. The data were analyzed by SPSS 25.

Results
Out of these, 89 were current smokers (11.4%), 216 ex-smokers (27.6%), and 478 non-smokers (61.0%) in the study sample, significantly higher number of smokers were men (16.2% vs 9.1%; p = 0.004), more foreigners (9.4% vs 15.6%; p = 0.021). A total of 170 medical students (21.8%) reported using any kind of alternative tobacco product, with a significant intersexual difference (27.4% males vs. 18.9% females; p &lt; 0.001), more Slovaks (22.9% vs. 19.4%; p = 0.503). The pandemic did not affect a significant change in classic nicotine product intake for 11.4%; 11.8% of students decrease intake; while 8.0% increased their intake. 17.5% of users of ATP did not change their habits during the pandemic; 7.0% of students decrease intake; 12.6% increased. Respondents who were smokers and ex-smokers reported an increase in alcohol consumption during the pandemic more frequently than non-smokers (23.6% and 21.5% vs. 10.7%, respectively).

Conclusions
The results show the high consumption of different tobacco products, and the lack of knowledge and awareness among medical students, future healthcare providers, who should serve as a model for their patients and the public. Supported by KEGA 015UK-4/2022

Key messages
• As future healthcare providers, medical students will play key role in health promotion and disease prevention, and they should serve as a model for their patients and the general public as well.
• Our study emphasizes increasing awareness and education regarding tobacco use and the need for intervention in the field of disease prevention at medical faculties.
Mediterranean diet in five Mediterranean countries: the DELICIOUS project
Authors: Godos J , Laudani S , Guerrera I , Mata A , Pardo M A , Busó P , Grosso G 
Published: October 2023

Abstract

An abandonment of traditional dietary patterns is growingly observed in Mediterranean countries, especially among younger generations. This study aimed to explore determinants of Mediterranean diet (MD) adherence in 5 Mediterranean countries (Italy, Spain, Portugal, Egypt, and Lebanon) within the context of the EU funded project DELICIOUS (UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and LIfestyle in Children and adolescents through behavIOUral change actionS). The sample consisted of 2011 parents of children and adolescents aged 6-17 years old. The main background characteristics, including age, sex, education, family situation, weight status, physical activity levels, sleep and screen time duration, were collected. The level of adherence to the MD was assessed using the KIDMED index. Eating habits (i.e., breakfast, place of eating, etc.) were also investigated. Logistic regression analyses were performed to test for likelihood of higher adherence to the MD. The mean KIDMED score in the study sample was 6.1 [standard deviation (SD) 2.0] with significant differences across countries [Lebanon 5.7 (SD 2.0), Italy 5.8 (SD 2.1), Spain 6.3 (SD 2.1), Egypt 6.5 (SD 1.9), and Portugal 6.5 (SD 2.0)]. A total of 865 participants were deemed as highly adherent to the MD [highest tertile, mean KIDMED score = 8.0 (SD 0.9)]. Major determinants of higher adherence to the MD were the following: among background characteristics, younger age group, higher physical activity level and adequate sleep duration; regarding dietary habits, having breakfast, out-of-home eating, eating with family members and at school, and home-cooked meals were associated with higher MD adherence. Parents’ younger age and higher education were also determinants of higher adherence. In conclusion, a cluster of healthy lifestyle behaviors can be observed among Mediterranean children and adolescents as determinant of higher adherence to the MD.

Key messages
• Lifestyle habits tend to cluster into healthy behaviors.
• Differences in Mediterranean diet adherence may occur across countries.
The link between smart device use and ADHD—how can reading and physical activity make a difference?
Authors: Chen C C , Lin W Y , Zou M L , Hsu H W , Lin W C , Chen Y H 
Published: October 2023

Abstract

Background
Attention deficit and hyperkinetic disorders (ADHD) lead to poor academic performance and relationship problems in schoolchildren. While improper use of smart devices was found to have a negative impact on children's attention and behavior, few studies used a computerized self-administered scale for children to assess suspected ADHD more accurately. Therefore, this study aimed to investigate impact of weekend smart device usage on ADHD and child behavior, as well as the moderating effect of children's reading habits and activity levels.

Methods
A total of 137 students aged 6-8 in Taiwan participated in this study between Dec 2022 and Mar 2023. Data was collected through the self-reported instruments of Child Behavior Checklist for Ages 6-18 to assess behavior and an online questionnaire to gauge smart device usage by parents. The Computerized Attention Diagnostic Assessment (CADA) was conducted by children to evaluate their attention performance. Multiple linear regression was used for analysis.

Results
After adjusting for potential confounders in a stratified analysis, we found that among children with less physical activities, higher smart device usage was associated with more anxious/depressed (β = 8.40, p &lt; 0.01), social problems (β = 6.48, p = 0.01), and thought problems (β = 6.43, p = 0.02), while among those with higher activities, higher device usage was associated with better picture attention scores (β = 5.67, p = 0.0237). Meanwhile, children who don't read habitually, higher smart device usage was associated with more somatic complaints (β = 3.31, p = 0.0235).

Conclusions
We highlighted the modifying effects of reading and physical activities on the link between smart device usage and attention and behavioral problems. In this digital age, it is imperative to provide parents with guidance on how to encourage reading and physical activities to help children mitigate the negative impact of smart device usage, including attention deficit and emotional problems.

Key messages
• High device usage in inactive or non-reading children is linked to behavioral problems like anxiety, social issues, and somatic complaints.
• Promoting physical activities and reading can mitigate negative effects of device usage, highlighting the need for parental guidance in the digital age.