Health Care Approach Research Articles

Unmet Needs of Children and Young Adults With ADHD: Insights From Key Stakeholders on Priorities for Stigma Reduction.

Individuals with ADHD continue to face stigma, which can negatively impact their access to, adherence to, and quality of mental health services, as well as their overall wellbeing. Perspectives of various stakeholders regarding priorities for stigma reduction remain underexplored. This study explores young adult, parent, teacher, and mental health care professional perspectives on unmet needs of children and young adults with ADHD in the Netherlands, in the context of stigma reduction. A total of 24 respondents participated in seven small focus group discussions (FGDs). The FGDs facilitated in-depth discussions exploring stakeholder group perspectives on unmet needs of children and young adults with ADHD in educational, professional, and social settings. Data was analyzed using thematic content analysis. Three thematic categories of unmet needs were identified: (1) a lack of awareness, knowledge, and understanding of ADHD; (2) insufficient personalized approaches in education and health care; and (3) limited accessibility of information and support services. Within theme 1, respondents primarily highlighted the importance of improving education for primary school teachers and mental health care professionals. Theme 2 underscored the need for increased capacity for personalization and attention to the sociopsychological factors of ADHD, alongside recognizing strengths. Theme 3 emphasized the need for easy access to reliable information and mental health care, including peer networks, as well as proper follow-up and continuity of care. Findings highlight the need for improving our understanding of ADHD as a complex biopsychosocial condition, which requires specific adjustments in education and mental health care. Interventions to improve support and disrupt stigmatization should meet diverse needs, incorporate multi-level strategies, and involve key stakeholders.

How patient-reported outcomes and experience measures (PROMs and PREMs) are implemented in healthcare professional and patient organizations? An environmental scan.

Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are becoming essential parts of a learning health system, and using these measures is a promising approach for value-based healthcare. However, evidence regarding healthcare professional and patient organizations' knowledge, use and perception of PROMs and PREMs is lacking. The objectives of the study were to: 1- Describe the current knowledge and use of PROMs and PREMs by healthcare professional and patient organizations, 2- Describe the determinants of PROMs and PREMs implementation according to healthcare professional and patient organizations. We conducted an environmental scan using semi-structured interviews with representatives from healthcare professional and patient organizations. Interviews were recorded and live coded based on the Franklin framework. We used inductive and deductive thematic analysis to extract information about the main themes addressed during the interview (awareness of PROMs and PREMs, examples of implementation and use of PROMs and PREMs, tools used, vision for future implementation, barriers and facilitators to implementation and the best way to collect PROMs and PREMs data). 63% of healthcare professional organizations (n = 19) and 41% of patient organizations (n = 9) that were contacted agreed to have a representative interviewed. The representatives from both the healthcare professional and patient organizations acknowledged the importance of assessing patients' experience and outcomes. However, they considered the implementation of PROMs and PREMs tools to be scarce within their organizations, in clinical practice and in the education system. Patient organizations were worried that overuse of PROMs and PREMs could lead to depersonalization of practice. Barriers to implementing PROMs and PREMs included lack of awareness of tools, resistance to change and lack of motivation to complete or explain the questionnaire. Barriers also included factors such as lack of financial, technological and human resources and issues with integration of data and inconsistency of digital platforms. This environmental scan revealed a lack of awareness of tools by healthcare professional and patient organizations' representatives and limited implementation. Adequate training, technological integration, and demonstration of PROMs and PREMs benefits to foster broader adoption in clinical and organizational settings is dearly needed. Addressing these challenges is essential for enhancing value-based care.

From Silos to Synergy: A Scoping Review of Team Approaches to Outpatient Eating Disorder Treatment.

This scoping review synthesizes the available evidence on team outpatient eating disorder treatment, focusing on team composition, reported health and service outcomes, and reported principles of Interprofessional Collaborative Practice (IPCP), a synergistic healthcare approach characterized by shared values and ethics, clear roles, communication, and teamwork. A comprehensive search was conducted across five databases, targeting studies published between January 2004 and August 2024 that discussed team-based outpatient eating disorder treatment. Peer-reviewed and gray literature were included if they detailed team composition, characteristics, dynamics, experiences, processes, or outcomes. Forty-five studies met the inclusion criteria; nearly half were case reports or lacked primary data. Treatment teams commonly comprised mental health professionals, dietitians, and medical practitioners. Clinical outcomes, such as body mass index and psychopathology, were the most frequently reported, while satisfaction and organizational outcomes were underrepresented. IPCP principles were inconsistently reported, with "Roles/Responsibilities" and "Communication" most frequently mentioned but often superficially addressed. The evidence base for team outpatient eating disorder treatment lacks rigor and depth. Future research should focus on refining the integration of roles across disciplines, developing comprehensive outcome measures for benchmarking, and applying IPCP principles more systematically.

Burden of Non-Communicable Disease and It’s Association with Weight Status: A Cross-Sectional Study in a Rural Community of Bangladesh

Background: Non-Communicable Diseases (NCDs) are now the leading causes of morbidity and mortality worldwide. Bangladesh has also experienced a rapid epidemiological shift from communicable diseases to non-communicable diseases due to growing urbanization and lifestyle alteration over the last few decades and this transition is also prominent in rural community of the country. Among all modifiable factors, overweight or obesity is the key risk factor for NCDs. This study aimed to determine the burden of NCD and its link to the body weight status of the rural population of Bangladesh. Materials and methods: This cross-sectional study was conducted in a village of Gomostapur Upazila under Chapainawabganj district from February to April 2024 among 135 people. The data were collected with face-to-face interview and Body Mass Index was measured. The data were compiled and tabulated according to key variables and analyzed with IBM SPSS 29.0.2. Results: Majority 44.5% of the study people belonged to age group 21-40 years. Among them 47.4% were male and 52.6% were female. Maximum respondents were of low-middle socioeconomic condition. Among them around 3/4th of the population was suffering from NCDs. Most of the respondents 24.4% had bone and joint pain followed by Hypertension, Asthma, COPD, Diabetes and Heart Disease at 20.7%, 17.0%, 14.1% and 10.4% respectively. Hypertension, Diabetes, Cardiovascular Disease, Stroke and Cancers were more prevalent in the older age group. Hypertension, Diabetes, Stroke and Bone-Joint Pain were seen more in female participants whereas male respondents had more prevalence of Asthma, COPD. Most of the study population had BMI above 25 kg/m2 and the study showed maximum NCDs were prevalent considerably in overweight and obese groups. Conclusion: The study revealed that, NCDs are highly prevalent among obese older rural population of Bangladesh while management, prevention, awareness and research are low. The integrated programs must be designed and implemented through a primary health care approach and high risk-group targeted interventions should be procurable to combat the rising burden of NCDs. IAHS Medical Journal Vol 7(1), June 2024; 74-79

Abstract 4136013: Pre-operative Frailty Status and Short-term Complications Among Adults Undergoing Transcatheter Aortic Valve Replacement

Introduction: The use of Transcatheter Aortic Valve Replacement(TAVR) has provided a safer alternative to open surgical approaches. The introduction of frailty scoring systems has proven effective in improving healthcare approaches and outcomes in various aspects of medicine. As there is a paucity of data on the impact of frailty among TAVR patients, we aim to conduct a retrospective study to investigate further. Methods: Our study analyzed adult cases with a primary procedural code for TAVR among hospitalizations between 2016 and 2021 through the National Inpatient Sample(NIS). Frailty status was explored through the criteria of Gilbert’s frailty index. Multivariable regression models helped evaluate differences in short-term outcomes and complications between them. Results: Our study involved 374200 cases of TAVR that were divided into LFR(285425 cases, 76.3%), IFR(86005 cases, 23.0%), and HFR(2770 cases, 0.7%). Compared to patients with LFR, patients with MFR and HFR showed higher odds of several complications, including cardiogenic shock(MFR: aOR 6.933, p<0.001, HFR: aOR 13.303, p<0.001), acute kidney injury(MFR: aOR 9.737, p<0.001, HFR: aOR 26.685, p<0.001 ), use of invasive mechanical ventilation(MFR: aOR 10.763, p<0.001,HFR: aOR 39.432, p<0.001), events of acute myocardial infarction(MFR: aOR 3.32, p<0.001, HFR: aOR 6.021, p<0.001), need for transfusion of blood products(MFR: aOR 3.027, p< 0.001, HFR: aOR 5.938,p<0.001), post-procedural bleeding(MFR: aOR 2.475, p<0.001, HFR: aOR 3.277, p<0.001), IABP use(MFR: aOR 4.942, p<0.001, HFR: aOR 9.703, p<0.001), and need for pericardiocentesis(MFR: aOR 3.804, p<0.001, HFR: aOR 4.217, p<0.001). Moreover, patients with MFR and HFR reported higher mortality risks than those with LFR(MFR: aOR 6.375, p<0.001, HFR: aOR 16.035, p<0.001 )(Table 1). Conclusion: Our study confirms the higher odds of various complications with increasing frailty status, including all-cause in-hospital death. A careful assessment of pre-operative frailty status along with close monitoring of pre-, peri-, and post-operative status will help improve the outcomes and provide care in a timely fashion.

Patient-Centered Care Models in Primary Healthcare: A Systematic Review of Implementation and Outcomes

This systematic review evaluates the implementation and outcomes of patient-centered care (PCC) models in primary healthcare settings. Patient-centered care is a foundational approach in primary healthcare, emphasizing patient preferences, needs, and values to improve the quality of care and health outcomes. A comprehensive literature search was conducted across PubMed, Cochrane, and MEDLINE databases, focusing on studies that assessed the impact of PCC models such as the Patient-Centered Medical Home (PCMH) and shared decision-making. Forty studies met the inclusion criteria, covering a range of patient populations and healthcare settings. Findings indicate that PCC models enhance patient satisfaction, improve health outcomes, and increase patient engagement in care. Additionally, these models positively impact provider satisfaction and may reduce healthcare costs by lowering emergency visits and hospitalizations. However, challenges in implementation, including provider workload and resource needs, were commonly reported. This review underscores the effectiveness of PCC models in primary care and highlights the need for structured, resource-supported implementation strategies. Further research is recommended to optimize PCC approaches across diverse populations and healthcare systems.

Depressive symptoms and determinants among people who inject drugs in Kaduna State, Nigeria

Background: People who inject drugs (PWID) are known to have higher rates of mental health disorders, particularly depression. Despite this, there is a lack of research on the prevalence of depression among PWID in Nigeria.Aim: This study aimed to determine the prevalence of depressive symptoms and their determinants among PWID.Setting: The study was conducted in Kaduna State, Northwest Nigeria where a needle and syringe programme (NSP) for PWID was recently initiated.Methods: A cross-sectional survey was conducted among PWID using a multi-stage sampling technique. Data were collected using structured interviews and digitalised questionnaires covering socio-demographics, depression symptoms (PHQ-9) and perceived social support (MSPSS).Results: A total of 525 participants were included in the study, with the majority being males (73.3%) aged 24–35 years (54.5%). The study revealed a high prevalence of depressive symptoms among PWID, with 47.4% reporting major symptoms. Predictors of depression identified among PWID included older age, female gender, divorce, unemployment, having primary education and moderate social support.Conclusion: The study underscored a concerning prevalence of depressive symptoms among PWID, notably linked to diverse sociodemographic factors, emphasising the need for holistic, context-specific mental healthcare approaches for this population.Contribution: This study contributes to the limited research on the mental health of PWID in Nigeria. It highlights the need for targeted mental health interventions that consider the unique sociodemographic characteristics of this population.

Dual Gold Nanostructures-Based Stretchable Electrochemiluminescence Sensors for Hydrogen Peroxide Monitoring in Endothelial Mechanotransduction.

Hydrogen peroxide (H2O2) release during blood flow is commonly provoked by the cyclic stretch and dynamic shear stress of endothelial cells and is of vital significance for maintaining vascular function. Flexible and stretchable electrochemical sensors show great capability in retrieving mechanical stimulation-induced H2O2 variation; however, cell secretions, especially electroactive constituents' interferences, remain a big concern for sensing accuracy. Herein, we developed a stretchable electrochemiluminescence (ECL) sensor by synthesizing L012-reduced gold nanospheres and decorating them onto a polydimethylsiloxane film-supported gold nanotubes substrate (Au NTs/PDMS) to form dual gold nanostructure-modified meshwork interface. Given the specific reaction between L012 and H2O2, the as-prepared Au-L012/Au NTs/PDMS exhibited outstanding selectivity toward H2O2 quantification. Through culturing human umbilical vein endothelial cells (HUVECs), real-time monitoring of transient H2O2 release from mechanically sensitive HUVECs in stretching states was realized. This work successfully incorporated the ECL sensing model into in situ cellular sensing, therefore expanding the application mode of the ECL approach for health care and biomedical investigation.

Examining functional sexual and reproductive health and right-based friendly services: perspectives from exit adolescents, caregivers, and health workers at health services delivery points in Tanzania

BackgroundThe lack of adequate access to and use of sexual and reproductive health care by youth and adolescent, n low- and middle-income countries persists despite international accords on their rights, which exposes them to violence against children; early and unintended pregnancies; and sexually transmitted infections. This study examined functional sexual and reproductive health and right-based friendly services as perceived by exit male and female adolescents, caregivers, and health workers at the Tanzanian health services delivery points as they were the ones who would share their opinions to establish a diversified and representative reality about the matter based on sex.MethodsThis was a multicentric study among 205 randomly selected participants in eleven selected health facilities within the three regions of Tanzania including Dar es Salaam, Dodoma, and Kigoma regions using a one-time descriptive cross-sectional design with a quantitative research approach from 01 to 30 November 2022. Triangulation technique of data collection activities using structured questionnaires and observation checklist adopted from the Tanzanian Ministry of Health was used to collect data. IBM Statistical Package for Social Sciences version 26 data entry templates (Sa PSS – 26) were used to analyze data descriptively to establish frequencies and percentages.ResultsResults indicated that 205 participants were assessed in this study with a response rate of 100%. Exit adolescents (46%); health workers in dispensaries (60%), and community members (42%) were more likely to confirm the availability of functional SRH right-based adolescent and youth-friendly services at the health services delivery points. The SRH displays (50%); adolescent rights (6%) and confidentiality (5%) were the least reported functional SRH aspects by the study participants. It was noted that the 11 health services delivery points in their totality did not fully implement the National standards in providing the services to adolescents and youth of which standards III (54.0%) and VIII (46.1%) scored the lowest.ConclusionThe results of this study have uncovered that there is disperities in the availability and accessibility of functional SRH right-based adolescent and youth-friendly services across the levels of health facilities; among adolescents and community members. Hospitals were more likely to confirm the availability of Functional Right Based Youth Friendly Services than at health centers and dispensaries with female adolescents, youth, and community members being disadvantaged. There is a need to address issues of differentials in equity to the accessibility of services among adolescents, youth, and community members by improving functional sexual and reproductive health and right-based friendly services provision infrastructures, health care workers capacity building, and mechanisms or approaches to increase adolescents’ access and uptake to SRHR services.

Unraveling the Gut Microbiota: Implications for Precision Nutrition and Personalized Medicine

Recent studies have shown a growing interest in the complex relationship between the human gut microbiota, metabolism, and overall health. This review aims to explore the gut microbiota–host association, focusing on its implications for precision nutrition and personalized medicine. The objective is to highlight how gut microbiota modulate metabolic and immune functions, contributing to disease susceptibility and wellbeing. The review synthesizes recent research findings, analyzing key studies on the influence of gut microbiota on lipid and carbohydrate metabolism, intestinal health, neurobehavioral regulation, and endocrine signaling. Data were drawn from both experimental and clinical trials examining microbiota–host interactions relevant to precision nutrition. Our findings highlight the essential role of gut microbiota-derived metabolites in regulating host metabolism, including lipid and glucose pathways. These metabolites have been found to influence immune responses and gut barrier integrity. Additionally, the microbiota impacts broader physiological processes, including neuroendocrine regulation, which could be crucial for dietary interventions. Therefore, understanding the molecular mechanisms of dietary–microbiota–host interactions is pivotal for advancing personalized nutrition strategies. Tailored dietary recommendations based on individual gut microbiota compositions hold promise for improving health outcomes, potentially revolutionizing future healthcare approaches across diverse populations.

The critical intersection of mental health and oral health in severe mental disorders.

To highlight the critical need for integrated healthcare approaches for individuals with severe mental disorders and poor oral health. Review and discussion of factors contributing to elevated DMFT (decayed, missing, and filled primary teeth) indices in individuals with severe mental disorders. Higher DMFT indices are reported in individuals with schizophrenia and bipolar disorder due to medication side effects, cognitive impairments, and socio-economic challenges. Emphasis on the necessity of combining mental and dental health services through regular dental check-ups, specialized education programs, and professional collaboration. Integrated healthcare strategies are essential to improve overall patient care and well-being for those with severe mental disorders.

A life course perspective on mental disorders and psychopharmacologic drug use among persons living with cerebral palsy

In this study, we investigated the prevalence of mental disorders and the use of psychopharmacologic drugs among individuals with cerebral palsy (CP). We studied how the association between CP and mental illness develops over the life course (between ages 5 and 65 years), and how it varies across disability specific factors (intellectual disability, gross motor function and communicative ability). We used logistic regression models on a longitudinal matched case-control data material on all persons with CP in Sweden linked to several administrative registers including, the national patient registers and the pharmaceutical registers.Our results showed that the probability of being diagnosed with mental disorders and being dispensed psychopharmacologic drug was significantly higher among persons with CP compared to persons without CP across the different outcomes [OR=1.52–4.7]. For some mental and neurodevelopmental disorders including sleep disorders, autism, and ADHD, and for the use of anxiolytics and sedatives, there was a sizeable gap already in childhood. However, the excess burden of mental illness appeared to grow over the life course, indicating that adults with CP may be a particularly disadvantaged group. Diagnosis for mental disorders and dispensation for psychopharmacologic drugs were not consistent with respect to disability specific factors, especially communicative and intellectual function, which indicates the need for systematic approaches in the mental health care of individuals with CP.

Prediabetes and cardiovascular risk factors: the effectiveness of a guided self-determination counselling approach in primary health care, a randomized controlled trial

BackgroundIdentify individuals who are at risk of Type 2 diabetes, who also are at a greater risk of developing cardiovascular disease is important. The rapid worldwide increase in diabetes prevalence call for Primary Health Care to find feasible prevention strategies, to reduce patient risk factors and promote lifestyle changes. Aim of this randomized controlled trial was to investigate how a nurse-lead Guided Self-Determination counselling approach can assist people at risk of type 2 diabetes to lower their coronary heart disease risk.MethodsIn this randomized controlled study, 81 people at risk of developing type 2 diabetes were assigned into an intervention group (n = 39) receiving Guided Self-Determination counselling from Primary Health Care nurses over three months and a control group (n = 42) that received a diet leaflet only. Measurements included the Finnish Diabetes Risk Score questionnaire and biological measurements of Hemoglobin A1c protein, Body Mass Index, fasting blood glucose, Blood pressure, Cholesterol, High-density lipoprotein, and triglycerides, at baseline (time1), 6 (time2) and 9 months (time 3).ResultsA total of 56 participants, equal number in intervention and control groups, completed all measurements. A significant difference between the intervention and control groups, in coronary heart disease risk was not found at 6 nor 9-months. However, within-group data demonstrated that 55.4% of the participants had lower coronary heart disease risk in the next ten years at the 9-month measurement. Indicating an overall 18% relative risk reduction of coronary heart disease risk by participating in the trial, with the number needed to treat for one to lower their risk to be nine. Within the intervention group a significant difference was found between time 1 and 3 in lower body mass index (p = 0.046), hemoglobin A1c level (p = 0.018) and diastolic blood pressure (p = 0.03).ConclusionsAlthough unable to show significant group differences in change of coronary heart disease risk by this 12-weeks intervention, the process of regular measurements and the guided self-determination counselling seem to be beneficial for within-group measures and the overall reduction of coronary heart disease risk factors.Trial registrationThis study is a part of the registered study ‘Effectiveness of Nurse-coordinated Follow-Up Programme in Primary Care for People at Risk of T2DM’ at www.ClinicalTrials.gov (NCT04688359) (accessed on 30 December 2020).

Humanising and optimising HIV health care for refugees and asylum seekers.

Displaced populations living with HIV, including refugees and asylum seekers, face substantial challenges across various regions globally. The intersection of forced migration and HIV presents both shared challenges and region-specific differences. Key issues include little access to health care, pervasive stigma, discrimination, and disruptions in the continuity of HIV care. Refugees often encounter barriers such as legal, cultural, and economic disparities that impact their overall health outcomes. Although HIV prevalence differs across regions, displaced populations consistently face disproportionate challenges including high-risk environments and little health-care access. Addressing these challenges requires a focus on equitable health-care access, with both actionable local interventions and broader global policy changes and an emphasis on long-term sustainability. Reliable and continuous drug supplies, interagency collaboration, and holistic health-care approaches are essential. International collaboration, robust evidence generation, and comprehensive responses are urgently needed to address the complex interplay between forced migration and HIV among vulnerable populations.

From Data Integration to Precision Medicine: A Value-Based Healthcare Approach for Sarcoma Care.

The transformation of healthcare from a fee-for-service model to value-based care is particularly crucial in managing complex and rare diseases like sarcoma, where data fragmentation and variability present significant challenges. This manuscript reviews strategies for structured and harmonized data integration-a critical precursor to precision medicine in sarcoma care. We demonstrate how standardizing data formats, ontologies, and coding systems enable seamless integration of clinical, economic, and patient-reported outcomes across institutions, paving the way for comprehensive predictive analytics. By establishing robust value-based healthcare (VBHC) frameworks through digital transformation and predictive models, including digital twins, we create the foundation for personalized sarcoma treatment and real-world-time clinical decision-making. The manuscript also addresses practical challenges, including the need for system standardization, overcoming regulatory and privacy concerns, and managing high costs. We propose actionable strategies to overcome these barriers and discuss the role of advanced analytics and future research directions that further enhance VBHC and precision medicine. This work outlines the necessary steps to build a cohesive, data-driven approach that supports the transition to precision medicine, fundamentally improving outcomes for sarcoma patients.

Management of severe traumatic brain injury in pediatric patients: an evidence-based approach.

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. The decision-making process in the management of severe TBI must be based on the best available evidence to minimize the occurrence of secondary brain injuries. However, healthcare approaches to managing TBI patients exhibit considerable variation. Over an 18-month period, a multidisciplinary panel consisting of medical doctors, physiotherapists, nutritional therapists, and nurses performed a comprehensive review on various subtopics concerning TBI. The panel identified primary questions to be addressed using the Population, Intervention, Control, and Outcome (PICO) format and applied the Evidence to Decision (EtD) framework criteria for evaluating interventions. Subsequently, the panel formulated recommendations for the management of severe TBI in children. Fourteen evidence-based recommendations have been devised for the management of severe TBI in children, covering nine topics, including imaging studies, neuromonitoring, prophylactic anticonvulsant use, hyperosmolar therapy, sedation and analgesia, mechanical ventilation strategies, nutritional therapy, blood transfusion, and decompressive craniectomy. For each topic, the panel provided clinical recommendations and identified research priorities. This review offers evidence-based strategies aimed to guide practitioners in the care of children who suffer from severe TBI.

1.O. Scientific session: Trans & Gender-Diverse Individuals’ Mental & Behavioral Health Risks & Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

6.Y.2. AI and health care: what are the capabilities and limitations?

Abstract With the rapid advancement of artificial intelligence (AI) technologies and their implementation in health care, there is a critical need to explore the different applications and implications of AI. This workshop seeks to look at different aspects of AI, both potential applications for AI technology in health, public opinions of use of AI in health care, and the reality of implementing AI in different contexts. Understanding health care approaches to AI from different countries is a unique opportunity for shared learning of innovations across various sectors of health care and patient engagement in order to most effectively engage this emerging field. AI, in whichever form it may be incorporated into health care, has the opportunity to impart meaningful, innovative change, but understanding this new technology comes with important questions. This session will dive into research on AI in various areas of health care by 1) looking at different ways AI is being harnessed in health care; 2) discussing lessons which can be learned and adapted from other countries; 3) discussing promising solutions and approaches to implementing AI in health care; 4) discussing the limitations or concerns of integrating AI in health care. The panel will be composed of 1 moderator and 2 panelists. Panelists are experts in their fields, established researchers and practitioners, and alumni of the Harkness Fellowship from Germany and the United Kingdom. A moderator will briefly frame the discussion for the audience and introduce the speakers and their presentations before leading an interactive, engaging question and answer portion. The coherence of this panel lays in its theme of leveraging AI to enhance healthcare delivery and understanding ways we can work across countries to foster ethical, equitable AI technologies that revolutionize healthcare practices with the ultimate goal of improving patient outcomes and health system efficiencies. Dr. Saira Ghafur from the U.K. will begin by presenting her research on evidence-based reasons for implementing AI in health care and Dr. Benedikt Simon from Germany will close out by discussing his work in AI in Germany and the challenges that have prevented robust integration. Each panelist will speak for roughly 8-10 minutes, with about 5 minutes reserved for moderator and audience questions. Key messages • Sharing cross-country experiences and research enables us to better understand how AI can impact health care. • In weighing both the benefits and challenges or limitations of implementing AI, we can best understand effective approaches to utilizing AI in health care.

Dispensing of antibiotics in community pharmacies before, during, and after the COVID-19 pandemic

Abstract Background Antibiotic resistance threatens our capability to successfully treat bacteriological infections, becoming a major threat to public health. Therefore, measures must be taken to minimize de incidence of multi-drug resistant bacterial infections. Antimicrobial Stewardship is a systemic healthcare approach devised to foster, enhance, oversee, and assess the judicious application of antimicrobials, aiming to safeguard their efficacy in the future, whilst advocating and safeguarding public health. In the initial phase, a correct diagnosis of antimicrobial utilization is pivotal for the proper implementation of an Antimicrobial Stewardship Program. Methods A cross-sectional study encompassing the Alentejo region, Portugal, with a specific focus on central Alentejo, was conducted to analyze the dispensing of antimicrobials in community pharmacies, alongside the examination of the prescribing locations, before, during, and after the COVID-19 pandemic, from 2019 to 2023. Results The number of antibiotic packages dispensed decreased, as expected, during the COVID-19 pandemic, but returned to pre-pandemic levels after its conclusion. In several prescribing locations, the proportion of cephalosporins and quinolones exceeded the maximum expected value. Conclusions The implementation of an appropriate Antimicrobial Stewardship Program in this region is necessary to ensure the correct prescription of antimicrobials, decreasing the risk that antibiotic resistance pose to public health. Emphasis on the application of the Clinical Practice Guidelines issued by the Portuguese Directorate-General of Health regarding the proper approach to bacterial infections should be intensified so that all prescribing locations exhibit proportions of cephalosporins and quinolones below the maximum expected value. Key messages • Antimicrobial resistance poses a threat to public health. • Stewardship is crucial for appropriately safeguarding public health by reducing antimicrobial resistance emergence.

Bridging gaps: A closer look at the health of sexual and gender minorities in Austria

Abstract Austria has long lacked comprehensive data on the health and well-being of sexual and gender minorities (SGMs). The 2022 LGBTIQ+ Health Report addresses this gap by presenting a comprehensive overview of the health status of SGMs in Austria. To contextualize SGM health issues, a review of the literature, health surveys, and action plans across Europe was conducted in the initial project phase. Then a questionnaire was developed in collaboration with an expert group for quantitative data collection. A total of 1,047 individuals participated in the survey; analyses of the quantitative data were enriched by insights from ten qualitative interviews. Detailed findings cover SGMs’ health status and experiences of discrimination as well as access to healthcare and health-promoting factors. Participants rated their health status lower than the average in Austria. A high number reported encountering discrimination in healthcare, especially among intersex and trans participants. While approximately half of the respondents were satisfied with healthcare provision, around 16% expressed dissatisfaction. Finally, a significant proportion of participants reported having foregone healthcare services at least once despite having health issues. Our work underscores the importance of recognizing the diverse needs of distinct groups within the SGM spectrum. It is crucial to avoid oversimplification by grouping them into a single SGM category as this obscures the unique challenges and inequalities faced by each subgroup. The rapid evolution of terms adds complexity to this work. Moreover, attention should be directed towards intersectionality within these groups as some are hard to reach with an online survey. Navigating the seas of public health innovation, our exploration of SGM health in Austria reveals not only the challenges but also the imperative for inclusive and tailored healthcare strategies. Key messages • The 2022 LGBTIQ+ Health Report Austria reveils SGM health realities: lower health status, discrimination, and unmet healthcare needs, urging targeted interventions. • Acknowledging diverse SGM groups and evolving terminologies, our study underscores the need for nuanced, intersectional healthcare approaches.