bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of public health services in implementing heat health action plans in Germany
Authors: Geffert K , Rehfuess E , Rechel B 
Published: October 2022

Abstract

Background
The rise in extreme heat periods is a major public health challenge of climate change and the World Health Organization therefore recommends the implementation of heat health action plans (HHAPs). In Germany, HHAPs are not implemented in a comprehensive manner nor nationwide. Public health authorities have been identified as key actors with regards to heat and health. This study aims at assessing the role of public health services in the implementation of HHAPs in Germany.

Methods
First, a review of the scientific and grey literature on the role of public health services in heat adaptation in Europe was conducted. Second, a policy document analysis of the legislation of Germany's federal states for public health services and their potential role in the implementation of HHAPs was carried out. Finally, semi-structured interviews with selected experts from multiple sectors at the local, federal and national level on their perception of the role of public health services in the implementation of HHAPs in Germany were undertaken.

Results
Preliminary findings show that the legal framework for public health services in the different federal states addresses environmental health and civil protection to varying extents, but that climate change-specific health risks are barely mentioned. The expert interviews revealed perceived barriers for the public health services to implement HHAPs, notably with regards to personnel (e.g. competencies, time), organizational structures (e.g. financial resources, administrative structures, legal mandates) and competing other tasks (e.g. COVID-19 response). Facilitators included motivated individuals, funding opportunities for cross-sectoral collaboration and political support.

Conclusions
The role of public health services in HHAP implementation in Germany varies widely between the different geographic settings and is influenced by several factors at the individual, organizational and political level.

Key messages
Mediation of behavioural and socioeconomic risk factors associated with malaria in children in Ghana
Authors: Habermann T , Lorenz E , Puradiredja DI 
Published: October 2022

Abstract

Background and objectives
Malaria remains a major global public health concern and a leading cause of morbidity and mortality especially among children &lt;5 years in Ghana. While an association between poverty and malaria has long been recognised, evidence on the causal pathways between socioeconomic position (SEP) and malaria is scarce. Our study contributes to addressing this gap by investigating the association whilst taking mediation through potential behavioural and socioeconomic factors into account. This can help to identify more specific targets for interventions on a structural level.

Methods
Using data of 3,004 children from the Malaria Indicator Survey of the Demographic and Health Surveys Program conducted in Ghana in 2019, a household wealth index (quintiles) was derived using principal component analysis based on household assets. Causal multiple mediation analyses investigated mediating effects of treatment-seeking, bed net (LLIN) use, educational attainment, and housing conditions on the association between socioeconomic position and children's malaria fever events.

Results
Higher maternal educational attainment and housing conditions jointly mediate 18% of the association between socioeconomic position and malaria fever events (OR = 0.98; 95%CI = 0.96-0.99). Maternal educational attainment and seeking formal prenatal health care jointly mediate 20% of the total effect (OR = 0.98; 95%CI = 0.95-1.00), in presence of a lower socioeconomic position. No strong mediation was found for educational attainment jointly with the use of LLINs between malaria and socioeconomic position in this study (OR = 0.99; 95%CI = 0.97-1.01).

Conclusions
As shown by the proportions mediated between malaria and socioeconomic position, findings suggest that current malaria control efforts could be strengthened by investments at the structural levels, such as increased (female) education, targeted improvements in housing, and stronger integration of informal health care.

Key messages
Protection against invasive meningococcal disease and vaccination policy in the Netherlands
Authors: Ohm M , Knol M , Sanders E , Berbers G 
Published: October 2022

Abstract

Background
A rise in serogroup C invasive meningococcal disease (IMD-C) led to introduction of MenC vaccination in 2002 in the Netherlands at 14 months of age, accompanied by a mass-campaign for all children between 1 and 18 years (coverage 94%). Due to an IMD-W outbreak in 2016-17, the MenC vaccine was replaced by a MenACWY vaccine and an adolescent booster at 14 years was introduced next to a mass campaign for 14-18 year-olds in 2018.

Aim/methods
We explored meningococcal antibody status in the Netherlands across the population in 2006-07, 2016-17 and 2020 in consecutive cross-sectional serosurveillance studies. Furthermore, we assessed the vaccine impact and effectiveness of the recent MenACWY vaccination campaign. We determined long-term protection in both adolescents and adults after a MenACWY vaccination and investigated sex-related differences in the vaccine response in adolescents.

Results
MenC antibody levels were low in 2016-17, except in recently vaccinated toddlers and individuals who were vaccinated as teenagers in 2002. We demonstrated waning of MenC immunity 15 years after the mass campaign and highlighted the lack of meningococcal AWY immunity across the population, which underlined the importance of the recently introduced MenACWY (booster) vaccination. The MenACWY vaccination program was effective in preventing IMD-W in the target population. Long-term protection was achieved for MenC, MenW, and MenY in 94-96% of adolescents five years postvaccination, but in adults only in 32%, 65% and 71% for MenC, W and Y. Adolescent antibody responses were higher in girls than in boys for all serogroups at most timepoints after MenACWY vaccination. The differences in average titers were however small and the percentage of participants with protective titers was very high for both sexes.

Conclusions
The current meningococcal vaccination policy in the Netherlands provides protection across the population against IMD-ACWY and seems sufficient on the long-term.

Key messages
Analysing hospital travel times in central Athens using Google Maps services
Authors: Xifaras NC , Roubou E , Altsitzioglou P 
Published: October 2022

Abstract

Introduction
The importance of timely care is well documented for numerous emergency conditions, including STEMI and ischemic stroke, where low symptom-to-balloon/symptom-to-needle times are crucial for mortality and disability. The study of all potential delays helps us understand the constraints we have to work under. Here, we use Google Maps services to map the travel times from central Athens areas to on-duty hospitals

Methods
We built our code in the Python programming language, using the Google Maps Distance Matrix API to perform real-time trip duration calculations based on real-life data. As reference points, we used a set of Athens neighbourhoods provided by the Municipality as open data; we considered only public secondary and tertiary health facilities as valid destinations, and based our calculations based on the available daily duty schedules.

Results
Our algorithm collected 43,200 data points in total over two weeks, using 144 starting points. The average trip durations to reach an on-duty department formed a right-skewed distribution (-0.424), with a mean of 19.55 minutes and a median of 19.95 minutes. The maximum average time was 26.78 minutes, and the overall maximum was 44 minutes. Average travel times to cardiology, general surgery, neurology and internal medicine ERs, which experience a heavy patient load, were higher than the total mean (20.60/22.06/21.31/20.51 mins respectively). We found no correlation between the average travel time and average distance from a hospital or the geographical location, but we were able to create a map with hotspots of high/low travel times.

Conclusions
Our approach to collecting accurate trip data has shown the impact of time-of-day and location on trips to hospitals, even for patients within the same larger area. As acute care can be time-sensitive, similar wide-scale modelling could be used to create systemic solutions, e.g. data-guided spatial distribution of facilities or transportation.

Key messages
Fostering mental health and chronic diseases self-management among professional truck drivers
Authors: Desrosier D , Carrière ME , Chartrand S , Gaudet MV , Jbilou J 
Published: October 2022

Abstract

Most passengers and goods in Canada travel by road. The trucking industry is the backbone of the tangible goods economy. However, the health and well-being of this aging workforce is in jeopardy. Recent data reveals that 86% of the truckers’ community are 50 years old and over, 4% are female and 5% are immigrants. Moreover, 75% of the male truckers self-reported one or more health condition (54% obesity, 19% hyperlipidemia, 18 % high blood pressure, 11 % type II diabetes). Despite, the high prevalence of risk factors (e.g. stress, depression/anxiety, lower level of education, social isolation and financial challenges) and preventable chronic diseases among truckers, in New Brunswick and elsewhere in Canada, there is a lack of on-the-road accessible lifestyle change programs. Therefore, tailored interventions are needed to appropriately support them adopt healthy behaviors. Using the Re-AIM Framework, we carried out 23 semi-structured interviews to inform the development of tailored educational material. The aims were: to describe the needs and challenges and to design a truckers-sensitive educational intervention. The theoretical foundation of this qualitative study is articulated around concepts extracted from cognitive and behavioural theories (transtheoretical model of behaviour change). Qualitative analysis of verbatims identified four major themes: Lifestyle challenges, Social and individual representation of healthy behaviors, Health education strategies and communication and Motivational and engagement strategies. Drawing upon these findings we developed tailored educational material and pre-validated them with a small group of professional truck drivers. Our findings informed the development of an educational intervention to support truckers manage and improve their mental health and self-management of chronic diseases. The next step is to implement a randomized clinical trial to test and assess acceptability, feasibility, and effectiveness of our intervention.

Key messages
Participation in prevention measures during the corona pandemic in Germany in 2020/21
Authors: Jordan S , Kuhnert R , Schmid-Küpke N , Starker A 
Published: October 2022

Abstract

Background
The availability and use of preventive measures such as diet courses, sports groups, and counselling services were hindered by containment measures set by the German government and local authorities to reduce the spread of the COVID-19 pandemic. Regulations on contact restriction, closure of sport and leisure facilities made it difficult to use prevention programs in 2020 and 2021. So far, no information is available to what extent the participation of the population in prevention programs has changed as a result of the pandemic and whether there are group differences regarding socio-demographic characteristics.

Methods
We used standardized telephone interviews of the adult German-speaking population to ask for changes in the participation in prevention measures in the last 12 months as a result of the corona pandemic. The data were collected between 17.3.2021 and 18.08.2021 in four cross-sectional surveys and is representative of the population aged 18 years and older in Germany. Analyses of the weighted and pooled data were conducted for n = 3,998 individuals by gender, age and education.

Results
Almost one third of the respondents reported a lower use of programs (28.3%). An unchanged use of the programs was stated by 6.5%, a higher use by 2.1%. 63.2% said they did not use such programs. More women (33.6%) than men (22.7%) reported reduced pandemic-related use (p &lt; 0.0001). For women, we observed a difference between age and education groups, but not for men: Lower participation was reported by a higher proportion of older than younger women (p &lt; 0.0001). More women with high education reported an increased use than ones with low education (p = 0.003) (preliminary results).

Conclusions
The observed differences indicate to different barriers to use prevention measures during the pandemic, especially for women. To promote equal opportunities, resilient structures of prevention and health promotion should be built for future crises in advance.

Key messages
Physical activity change across retirement by device measured work-related and commuting activity
Authors: Pasanen S , Halonen JI , Suorsa K , Leskinen T , Kestens Y , Thierry B , Pentti J , Vahtera J , Stenholm S 
Published: October 2022

Abstract

Background
Work-related and commuting physical activity before retirement may contribute to changes in physical activity and sedentary time after retirement, and the aim of this study was to examine these associations.

Methods
Study population consisted of participants of the Finnish Retirement and Aging study (n = 119). Activity behaviour was measured with GPS and accelerometer devices. The participants provided 637 measurement days before and 557 days after retirement. Work-related physical activity was defined as physical activity accumulated at workplace. Commuting activity was dichotomised based on the speed of trips between home and workplace to active (&lt;20 km/h) and passive (≥20 km/h) commute. Participants were divided into four groups: non-active workers and commuters, non-active workers but active commuters, active workers but non-active commuters, and active workers and commuters. Linear regression analysis with generalized estimating equations were used for statistical analysis.

Results
The change in physical activity during retirement transition markedly varied by the activity group. Lower work-related activity was associated with an increase in light physical activity and a decrease in sedentary time. Conversely, higher work-related activity was associated with a decrease in light physical activity and an increase in sedentary time, except among those active workers who were active commuters. Particularly the active workers but non-active commuters increased their sedentary time (48 min, 95% Cl 20 to 76) and decreased their light physical activity (54 min, 95% Cl -80 to -29). No statistically significant changes in moderate-to-vigorous physical activity were observed.

Conclusions
Our results suggest that work-related physical activity is associated with changes in physical activity behavior when retiring. Special attention should be targeted to active workers who are non-active commuters to maintain physical activity and decrease sedentary time after retirement.

Key messages
Development and early results of a comprehensive sexuality education experience in Italian schools
Authors: Chinelli A , Torri E , Martinelli D , Farinella M , Rancilio L , Galipò R , Meli P , Ubbiali M , Suligoi B , Tavoschi L 
Published: October 2022

Abstract

Background
Comprehensive sexuality education (CSE) is an integrated approach to sexual health and wellbeing promotion, especially effective when performed in school settings, but it is not included in Italian school curricula. This study describes the creation and early results of a pilot experience targeting students attending 20 lower secondary schools (LSS) in 4 Italian regions within EduForIST project, funded by the Ministry of Health.

Methods
A literature review and a national survey were used to collect guidelines and best practices in the field of sexuality education (SE), along with focus groups and multisectorial expert consultations. The results informed the development of 4 modules of 2 hours each, addressing: changes in adolescence; emotions and relationships; sexual identities and diversity; sexual consent, pregnancy and sexually transmitted infection (STI) prevention, sexual health services. A final session was dedicated to evaluation.

Results
The pre-test results referred to 14 classrooms of 5 schools within 2 Regions, for a total of 266 students. A high level of uncertainty was reported, regarding the topics of personal identity development (37,4%), experiencing intense emotions during adolescence (18,1%), the definitions of gender identity, sexual orientation and stereotype (42,1%), STI symptoms (58,7%) and prevention (43,4%). The post-test results were available for 153 students. Pre/post analysis showed an increase of correct answers (p&lt;.05) for 12/15 items investigated. A total of 102 students responded to the satisfaction questionnaire, with positive results.

Conclusions
Preliminary results revealed knowledge gaps and high levels of uncertainty among LSS students. Early pre/post evaluation suggested that the pilot activity was effective in enhancing knowledge and decreasing uncertainty in all domains. Evidence collected through this study will foster awareness among policy makers on the value and urgency of introducing CSE in Italian school curricula.

Key messages
Implementation gaps of the Portuguese National Health Plan: a stakeholders’ perception analysis
Authors: Costa A , Rosa A , Costa L , Mexia R , Dias CM , de Almeida T Caldas 
Published: October 2022

Abstract

Background
The Portuguese National Health Plan (PNS) 2012-2016, extended to 2020, was the strategic health document shaping the direction of intervention within the Health System. The National Institute of Health Doutor Ricardo Jorge (INSA) is the institution responsible for carrying out its final evaluation. To underpin PNS final evaluation a multistep process was designed.

Methods
A mixed methods study using a convenience sample was implemented to assess stakeholders’ perception about five PNS dimensions: dissemination, communication, implementation, impact, and evaluation. For this purpose, two different tools were used. Semi-structured interviews with former health policy managers were conducted. In addition, an online survey was designed and widely distributed to additional stakeholders. From October 2019 to February 2020, data was collected using two separate instruments. Integral transcriptions of the interviews were made. Qualitative content analysis and quantitative descriptive analysis were used.

Results
A total of 12 interviews and 179 valid surveys were obtained. Regarding stakeholders’ perception about PNS implementation process, there was an overall positive recognition about the strategic and operational relevance of the PNS, as a common dialogue platform and a tool for health improvements both for health status and health system function in Portugal. Among pointed implementation barriers, management was mentioned as the major constraint, mainly due to shortage of human and financial resources to carry out the recommended interventions within the PNS timeline.

Conclusions
As part of the evaluation process the research team found relevant gain knowledge of the wider context in which PNS was developed and implemented, based on stakeholders’ perception. Their considerations are important not only to support the definition of the questions and criteria for PNS final evaluation, but also to highlight key issues for the future policy cycle.

Key messages
The Italian Roma, Sinti and Travellers Health Project for equity in access to care
Authors: Diodati A , Proietti MC , Eugeni E , del Gaudio R , Sisti LG , Curtale F 
Published: October 2022

Abstract

Issue
In 2015, Italy approved the National Action Plan for Health for and with Roma, Sinti and Travellers (RSC); however, it is still not fully applied at a local level. The INMP (funded by the National Operational Programme for Social Inclusion), implemented the “Health Project - Promotion of strategies and tools for equity in access to health care for RSC”, aimed to support the implementation of the Plan by Local Health Authorities (ASL).

Description
The project lasted from March 2019 to December 2021. INMP worked with 7 ASL to design interventions and develop tools to address RSC health needs. The SODA (Strategic Options Development and Analysis) method as a participatory process aimed at identifying strategies and models for the execution of the Plan among relevant stakeholders was used. Moreover, RSC communities’ engagement strategies and a community-based Proximity Public Health (PPS) approach were adopted in designing and developing health promotion interventions.

Results
INMP performed 38 interviews with ASL health operators highlighting barriers and strategies in the local implementation of the Plan. Tools orienting to social and health services and health education materials for hard-to-reach groups were produced. A training course for 14 RSC facilitators and 5 training courses attended by over 200 NHS operators have been organized. ASL were supported in developing health promotion initiatives, based on the engagement of both local RSC communities and third sector entities.

Lessons
The project has enabled the ASL to develop local protocols for the implementation of the Action Plan. In line with this capacity-building activity, the project trained both health operators and RSC facilitators fostering the dissemination of the PPS culture in designing and providing care for hard-to-reach groups. Given the positive results obtained, INMP is still collaborating with both ASL and the Third Sector on additional activities related to the Project in 2022.

Key messages
Social support and poverty alleviation among asylum-seekers and refugees in Wales
Authors: Wells M , Seage H 
Published: October 2022

Abstract

Background
Wales is working toward being a Nation of Sanctuary for asylum-seekers and refugees and has resettled between 6,000 and 10,000 refugees since 2001. Uprooted social support networks during the period of asylum-seeking process predispose this population to poverty. The aim of this research was to explore the role of social support among asylum-seekers and refugees in alleviating poverty and its adverse impact on their health and wellbeing. Understanding the importance of social support in promoting the health and wellbeing of asylum-seekers and refugees is a critical factor for informing public health interventions and policies to improve outcomes for tackling poverty among this population in Wales.

Methods
A qualitative research method, based on social support framework, was adopted. Semi-structured interviews were utilised to collect data from a purposive sample of 8 participants. All the participants were recruited through a refugee support organisation in Cardiff, Wales and were interviewed in the community hub of this organisation. The interviews were digitally recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA).

Results
Results show two formal (government, charities) and three informal (family, friends, and peers) sources of social support as the potential pathways that alleviate the impact of poverty on the health and wellbeing of asylum-seekers and refugees. These sources provide access to language courses, education, employment, housing, food, and sense of belonging in the new communities of resettlement.

Conclusions
Enhancing access to formal and informal sources of social support is of vital importance to tackling the pernicious impact of poverty on the health and wellbeing of asylum-seekers and refugees. Providing social support for this population should be given uttermost consideration for public health interventions and policy decisions in an effort to protect and promote their health and wellbeing.

Key messages