Global Public Health Research Articles

How characteristics of place affect multimorbidity: a systematic scoping review

Abstract Background Multimorbidity has become a global public health challenge. Increasing work has identified different individual- and household-level determinants of multimorbidity; however, our understanding of how characteristics of place affect multimorbidity remains limited. This scoping review aims to identify the place-based risk factors of multimorbidity and to synthesis evidence (longitudinal in particular) on how place-based risk factors affect multimorbidity. Methods Following PRISMA-ScR guidelines, a predefined search strategy (https://osf.io/bf84m) was run across 7 major databases in 2023, with a double screening and data extraction process. English-language peer-reviewed studies exploring the relationship between place-based characteristics (from neighbourhood to region) and multimorbidity among the general population aged over 18 years old were included from 2010 to 2023. Results Out of 7761 records, 129 underwent full-text review, resulting in 76 included studies (15 longitudinal). We identified 12 types of place-based risk factors of multimorbidity, with area-level deprivation/SES, pollution, and urban/rurality most frequently examined. Fairly consistent findings suggested that people in more deprived, polluted, or urbanised areas were more likely to be multimorbid, which may further vary by multimorbidity definitions/measurements. Other place-based risk factors, such as social cohesion and greenspace availability, were linked to different single health conditions, but their associations with multimorbidity were underexplored. Finally, we proposed a potential theoretical framework that links place and multimorbidity through multiple pathways based on the synthesised evidence. Conclusions There remains only a partial understanding of how ‘place’ affects multimorbidity. Future studies should employ more precise measures for both place-based risk factors and multimorbidity and use longitudinal designs and analytical approaches for more causal insights. Key messages • This is the first scoping review that proposed a theoretical framework that demonstrates the links between place and multimorbidity. • This study will greatly benefit local policymaking and public health intervention initiation.

Predictive machine learning algorithms for metabolic syndrome among Tunisian adults

Abstract Background Metabolic syndrome (MS), a cluster of interconnected risk factors for cardiovascular disease and type 2 diabetes, poses a significant health burden globally. In Tunisia, amidst an ongoing epidemiological transition, the prevalence of MS presents a growing concern. Our study aimed to identify the potential risk factors of MS and propose better machine learning (ML) based models for predicting MS among Tunisian adults. Methods Data was sourced from the Tunisian Health Examination Survey THES-2016, encompassing individuals aged 20 years and older. MS was defined based on the criteria set by the International Diabetes Federation. Logistic regression (LR) was employed to determine risk factors for MS. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. Five ML algorithms (Naïve Bayes, Support Vector Machine (SVM), Artificial Neural Network (ANN), AdaBoost, and Random Forest (RF)) were utilized to predict MS. Performance evaluation was conducted using accuracy, precision, recall, and area under the curve (AUC) metrics. Results Among the 8908 participants, the prevalence of MS was 32.8% (95% CI: 31.4% - 34.6%). LR identified age group 60-69 years (aOR: 18.5, 95% CI: 16.9-19.9, p < 0.001), female sex (aOR: 1.7, 95% CI: 1.2-1.9), sedentariness (aOR: 1.6, 95% CI: 1.5-1.8) and low education level (aOR: 1.2, 95% CI: 1.1-1.4) as significant factors associated with MS. Among ML models tested, AdaBoost had the highest accuracy (89.8%), followed by SVM (89.6%). Naïve Bayes had the highest Recall (98.1%) and the most performant AUC (91.4%), while RF had the highest Precision (70.8%). The ANN had an accuracy of 89%, a precision of 70.4%, a recall of 78.7% and an AUC of 85.1%. Conclusions Our study highlighted the effectiveness of ML algorithms like AdaBoost and SVM in predicting MS among Tunisian adults, offering potential as early detection tools. However, further validation with larger datasets is necessary to solidify their utility in healthcare settings. Key messages • Metabolic syndrome, a complex of cardiovascular risk factors, presents a substantial global public health challenge and is particularly pronounced in Tunisia. • Machine learning algorithms, notably AdaBoost and Support Vector Machine, demonstrate promise in forecasting and addressing metabolic syndrome.in Tunisian adults.

An Overview of Tobacco Control Policies in China

The tobacco epidemic is a global public health concern as the toxic substances in tobacco pose a severe threat to human health. In response to this issue, countries around the world have adopted various strategies to control tobacco use. The Chinese government began to pay attention to the health hazards of smoking in the 1970s and joined the international community in tobacco control endeavors by becoming a signatory of the World Health Organization Framework Convention on Tobacco Control in the early 21st century. It has further intensified its tobacco control measures in recent years with its “Healthy China” strategy. This article gives an overview of tobacco control policies released by the Chinese government over the years, with a separate analysis of the provisions on smoking control stipulated in the Health China Action Plan (2019-2030). Also discussed are the outcomes of those policies and the challenges China faces in tobacco control, as well as the lessons China can learn from international experiences in this regard.

Culturally-relevant physical activity for public health promotion: global evidence synthesis

Abstract Background The WHO has noted the importance of cultural insights for health. Culturally-relevant physical activity has a growing evidence base in many regions and specific populations, but the scope and scale for global health promotion is underexplored. Methods A multinational expert team used a critical literature review method to: (1) define culturally-relevant physical activity; (2) delineate relevant characteristics supporting inclusion in population-level health promotion and surveillance; and (3) provide agenda setting in research, policy, and practice from a global public health promotion perspective. The critical review method, which evaluates rather than summarizes literature, was chosen as the research evidence is complex, broad, and has not been synthesized previously from this perspective. Results Culturally-relevant physical activity was defined as practices that include physical activity based on a population’s cultural customs. These can be Indigenous (e.g., hula, an Indigenous dance of Native Hawaiians) or regional (e.g., Shota (Shotë), an Albanian folk dance). Practices have shared characteristics that support multi-dimensional value for health, engagement, and healing. These include a collectivist, intergenerational component, passed from elders and shared forward with children as part of a community. Many have foundations in nature, a strength for health and wellbeing in green and blue spaces. Many include traditional art, clothing, accessories, and music with deep significance, including care for the tools and location of practice (e.g, drums, boats, land). Many practices would not be captured in harmonized public health surveillance systems despite their value. From this synthesis, research hypotheses were created and next steps proposed. Conclusions This evidence synthesis supports engagement, planning, uptake, policy, surveillance, and study of culturally-relevant physical activity for public health promotion locally and globally. Key messages • An important strength of culturally-relevant physical activity is that it is context and population specific. However, this may hide the scope and scale of the existing evidence supporting this work. • This evidence synthesis confirms how culturally-relevant physical activity is valuable globally across shared assets in research and practice, supporting next steps for public health promotion.

Prediction of mental health risk in adolescents via a smartphone app: a feasibility pilot study

Abstract Background The prevalence of mental health problems in adolescents is a global public health concern. Machine learning (ML) can analyse multidimensional data collected by phone sensors (passive tracking) and symptom self-reporting (active tracking) to model and predict mental health states. However, research in adolescents is lacking. This study investigated the feasibility of using ML to predict mental health in a non-clinical population of adolescents from active and passive data collected through the Mindcraft mobile app. Methods We recruited 103 secondary students (aged 14-18) who first completed the Strengths and Difficulties Questionnaire (SDQ) and then used the Mindcraft app for two weeks. The app integrates sensor data (location, steps, noise, light, battery, app usage) and self-reports. We extracted 85 sensor-based features and 19 from questionnaires to develop a gradient-boosted ensemble ML model. This model identifies students with abnormal SDQ scores and was evaluated using leave-one-out cross-validation. Results All students completed the active questionnaires; 67 also provided passive sensor data. 31 had abnormal SDQ scores. Using passive data, the ML model reached a balanced accuracy of 0.64 and an AUC score of 0.57. Incorporating both data types improved accuracy to 0.67 and AUC to 0.70. Feature importance scores showed step count and questionnaire on racing thoughts and hopefulness as most significant. Conclusions Our findings affirm the potential of integrating passive and active data collection to monitor mental health in real-world settings. Our ML model demonstrated moderate accuracy in predicting adolescents’ mental health risk measured with a behavioural screening questionnaire. This study will guide the development of a ML-driven, personalised mobile intervention for early symptom detection and mental health self-management, which might constitute an innovative and scalable tool for mental health prevention and intervention in adolescents. Key messages • This study shows the feasibility of using active and passive data to predict mental health risk in adolescents. • This study informs the development of a personalised machine learning-driven mobile intervention.

The role of communication in the successful implementation of the Slovenian NCCP

Abstract Issue Cancer remains a significant global public health challenge, necessitating comprehensive strategies for effective control and management. Slovenian National Cancer Control Programme (NCCP) addresses this challenge by prioritizing proactive communication with various stakeholders engaged in cancer care planning, delivery and advocacy. The communication strategy within this programme plays a pivotal role in its successful implementation. Description of the problem Active engagement and collaboration among stakeholders is crucial for achieving the programme’s objectives. NCCP seeks to address this challenge through various communication activities by fostering dialogue, sharing best practices, and facilitating networking opportunities among oncology professionals throughout Slovenia. Additionally, it seeks to strengthen partnerships with sectors beyond health and prioritizes engagement with cancer patient advocacy groups. Results The programme has devised a long-term communication strategy, guiding annual communication plans to engage stakeholders and foster support for its objectives. Notable communication activities in the period 2022-2024 include: organizing annual meetings for different oncology stakeholders including cancer patient associations, hosting impactful professional events, conducting visits to regional cancer hospitals, distributing e-newsletters and managing a NCCP website. Initial outcomes indicate strengthened communication and collaboration among professionals and institutions in the field of oncology nationwide. Engagement with patient advocacy groups has facilitated discussions on topics important to patients. Lessons Effective communication with diverse stakeholders is crucial for comprehensive cancer control. Collaborating across sectors enhances the impact of cancer control initiatives. Enhanced networking fosters innovation and synergy among oncology professionals, positioning Slovenia for greater success in cancer control. Key messages • Slovenia’s NCCP prioritizes proactive communication, fostering collaboration among stakeholders. Annual events, newsletter, and partnerships strengthen awareness and drive comprehensive cancer control. • Long-term communication strategy of Slovenia’s NCCP drives stakeholder engagement, and supports strategic objectives. This proactive approach strengthens comprehensive cancer control efforts.

Next-generation public health surveillance: extreme heat event prediction and monitoring system

Abstract Background Extreme Heat Events (EHEs) are a growing threat to public health. The increase in the frequency of occurrence of once rarer EHEs and the rise in their average temperatures are dangerously drastic for public health outcomes. Despite this, existing public health surveillance (PHS) systems fail to leverage IoT and AI technologies to facilitate real-time, continuous monitoring of EHE indicators and its associated health risks. This study closes this gap by proposing a comprehensive PHS system that can, in real-time monitor and predict EHE indicators to provide timely alerts to public health authorities. Methods The EHE PHS system collects EHE detection metrics, including indoor temperature and humidity levels, from IoT sensors and thermostats to map them across Canada, primarily focusing on low-income communities. The system also integrates historical climate data (surface temperature, humidity, wind speed and direction, and air quality indicators) from Environment Canada. The system uses the data to train initial prediction models including CNN, LSTM and GNN. The validated model will be integrated into the system, enabling real-time EHE prediction. The output will be displayed in user-friendly visualizations on the EHE PHS system’s dashboard capabilities. Results The system allows for the analysis of real-time data through dashboards and provides alerts when certain indicators (e.g. excessive or prolonged heat) detrimental to public health outcomes are detected. The alerts enable valuable lead time for public health authorities to implement proactive measures, such as issuing heat advisories and deploying resources to vulnerable areas. Conclusions The EHE PHS system will serve as a blueprint for global public health researchers, utilizing IoT and AI technologies for proactive crisis prevention. This knowledge will inform the development of heat-resilient policies and set a precedent for global public health crisis prevention. Key messages • The proposed EHE PHS system uses AI and IoT technologies, to enhance EHE prediction, risk identification, and real-time monitoring for effective public health interventions. • By integrating advanced predictive models and environmental data, the system facilitates early detection of EHE risk, which can significantly mitigate the health impact on vulnerable populations.

Social norms and social opportunities: a qualitative study of influences on tobacco use among urban adolescent girls in Ghana

BackgroundTobacco use is a global public health threat and a leading preventable cause of death in the world. While cigarette use among youth has been decreasing in high-income countries, low- and middle-income countries have contrastingly high rates of adolescent smoking. In Ghana, smoking prevalence is lower than in other parts of the African continent and more common among men than women; however the gender gap in tobacco use among adolescents has narrowed, with shisha use among girls recently surpassing boys. These trends toward increased relative use among adolescent girls are a cause for concern and highlight the need for interventions to prevent and/or reduce tobacco use in this population.MethodsWe conducted in-depth interviews with girls aged 13–20 (n = 148) and their parents (n = 7) in Ghana’s largest two cities – Accra and Kumasi, to explore the physical, social, and psychological context underlying smoking perceptions and behavior.ResultsWe identified 11 key insights into influences on smoking behavior, organized into the broader themes of perceptions of smoking, environmental factors, and internal factors. Findings underscore that perceptions around smoking are very much driven by girls’ social world, which is generally small and parent-centric for non-smokers at younger ages but can start to expand as girls get farther along in school or leave school entirely. After what may have been a sheltered adolescence, many older girls in Ghana look for ways to express their independence in decision-making and a few may use their developing agency to rationalize limited or infrequent tobacco use if they perceive the benefits to them outweigh the potential consequences.ConclusionsOur findings highlight strong social influences on girls’ perceptions, exposure to opportunities, and decision-making in ways that can often be protective against smoking, particularly at younger ages, but may also leave girls unprepared to manage challenging situations later in life. Understanding this context in Ghana will be important for any future programming aiming to prevent smoking initiation among adolescents.

2.G. Practice session: Africa and Europe: peer-to-peer HIS assessments for NCD, mental health and injuries surveillance

Abstract Public health surveillance is the basis for evidence-informed decision-making and health (systems) research, globally. Without robust data, public health challenges cannot be tackled. NCDs, mental health conditions and injuries (NCDI/MH) are among the biggest global public health challenges. Their risk and protective factors, including social, political and commercial determinants of health, transcend borders and require multi-disciplinary, multi-stakeholder and long-term responses. Since 2006, comparable national data on NCDI/MH are being collected in Europe on the basis of European Core Health Indicators (ECHI) and the European Health Interview Survey (EHIS). Currently, EU and WHO EURO are working together to set up a new Health Information Network. At EU level, a sustainable health information infrastructure is still lacking, despite extensive preparations in EU-funded projects. Part of these project activities were health information system (HIS) assessments, applying the WHO EURO Support tool to strengthen health information systems for peer-to-peer assessments. In the African region, the Africa Centres for Disease Control and Prevention (Africa CDC), founded in 2017, made NCDI/MH prevention and control a strategic priority. In 2021, it launched its first continental NCDs, Injuries Prevention and Control and Mental Health Promotion Strategy (2022-26) under which the organization supports its Member States. At the 3rd International Conference on Public Health in Africa (Zambia, Nov. 2023), Africa CDC presented a continental Guidance to strengthen NCDI/MH surveillance. The Guidance was developed in collaboration with Robert Koch Institute (RKI) and is based on desk reviews, surveys and national HIS assessments. Both Europe and Africa performed HIS assessments to strengthen NCDI/MH surveillance; standardized tools from WHO EURO and from the International Association of National Public Health Institutes (IANPHI) were used and adapted to fit peer-to-peer approaches and regional contexts. This workshop will present and discuss methodological approaches, experiences and lessons learned, thereby initiating knowledge exchange across continents. The presentations will address the following points: - From top-down to peer-to-peer: methods & tools used in HIS assessments - From paper to practice: the importance of site visits in HIS assessments - From educated guesses to evidence: outcomes of HIS assessments at country level - From evidence to action: translation of HIS assessment outcomes into HIS improvements - From pilot to scale-up: challenges, lessons learned, sustainability of HIS developments To our knowledge, this workshop is the first one at the EPH to bring together practitioners in HIS strengthening for NCDI/MH from Africa and Europe. The workshop offers a unique opportunity to engage with the audience and to explore options for international collaboration. Key messages • Interregional collaboration helps reduce health information inequalities, facilitating better global management of high burden health challenges, such as NCDs, mental health conditions and injuries. • Peer-to-peer HIS assessments in Africa and Europe strengthen NCDI/MH surveillance. They build evidence for policy advice, research and health education and add the benefit of forging expert networks.

Role of nonpharmacological concussion management in children: systematic review of randomized controlled trials.

Concussion is a global public health problem that affects many children worldwide. Most patients present with postconcussion syndrome and normal brain imaging find- ings. Despite the high incidence of concussion in children, published research on nonpharmacological management is lacking and much more often concerns pharmacological interventions. This systematic review aimed to evaluate the role of nonpharmacological interventions in managing concussion based on randomized controlled trials. The PubMed, Scopus, Web of Science, and Cochrane data- bases were extensively searched for articles published between January 2013 and July 2023. A modified patient intervention, comparison, and outcome framework was used to construct the search strategy and eligibility criteria. Risk of bias was assessed using the Risk of Bias-2 tool. A total of 16 studies conducted between January 2013 and July 2023 were analyzed. Three studies were conducted in an acute care setting (<24-hour postinjury) involving rest, computer time, and doing nothing, while the other 13 studies were conducted in a chronic care setting (>24-hour postinjury) and included aerobic exercise, collaborative care intervention, cervical spine rehabilitation, education by physiotherapists, a hyperbaric oxygen therapy protocol, family intervention therapy, virtual reality, traditional occupational therapy, virtual rehabilitation, oculomotor control exercises, vestibular rehabilitation, coordination exercises, and balance exercises. This systematic review highlights the importance of nonpharmacological therapy in pediatric concussion cases. Active rehabilitation may yield promising outcomes. Another interesting approach may be useful in pediatric concussion management. How- ever, this systematic review shows a lack of high-quality literature supporting nonpharmacological pediatric con- cussion treatments.

Policies and programs on children’s health promotion in the EU in the context of the JA Health4EUKids

Abstract Background Overweight and obesity prevalence are a global public health challenge. The prevalence is rapidly increasing, with significant health risks such as cardiovascular disease, type 2 diabetes, and cancer. Objectives To describe the state of the art of policies and programs (PPs) on children’s health promotion and responsive parenthood (children 0-12 years) in the EU, and to identify their gaps. Methods A cross-sectional study was carried out through an online survey, as part of the Health4EUKids Joint Action (JA) (HADEA n.101082462), between October and December 2023, targeting all EU member states (MSs) involved. Results The survey collected information about 74 PPs from 11 EU MSs of the JA. The PPs are primarily focused on healthcare (62.1%), education (24.1%), and social sectors (10.3%), with a focus on children aged 6-11 years. The settings for PPs include primary schools, communities, secondary schools, and healthcare services. The PPs are characterized by different degrees of innovation, controversy, equity, transferability, and sustainability, although the structural or systemic impact and public visibility appear to be lower among other characteristics. The formulation and design of PPs include problem analysis (73%), based on national or local data and on stakeholder consultation. As for implementation, most PPs are implemented upon release, but recommended action and allocated human resources are not fully adequate. Regular monitoring and evaluation (47.3%) are based on defined outcomes, standards, and indicators (63.5%). The results are disseminated to decision-makers and stakeholders (37.8%), through media, and to the general population (32.4%). Conclusions Most PPs are variable and context-dependent. It is necessary to align the policies with the implementation, in all its aspects, and to strengthen monitoring, evaluation, and communication with the relevant stakeholders, which currently appear to be the most lacking aspects. Key messages • Most European policies and programs are context-dependent, mainly in healthcare. Yet, a cross-sectoral trend involving health, education, and social sectors emerges. • The study stresses the need for better alignment between policy formulation and implementation to enhance the effectiveness of EU children’s health programs.

Epidemiology of hepatitis C from 2015 to 2022 in a central Italian region: the OPT-HepaC project

Abstract Background Chronic hepatitis C virus (HCV) infection is a major global public health problem. This study investigated the evolving landscape of HCV in Tuscany (Italy) from 2015 to 2022, considering demographic shifts, clinical profiles, treatment regimens, and outcomes. Methods The study was conducted in order to characterize HCV-positive patients who started treatment between 2015 and 2022 in Tuscan prescribing centers. The study was part of OPT-HepaC, a project funded by Regional Health Service. Data on demographics, clinical history and outcomes were collected. Three different temporal eras were analysed: the period before andfter the universal availability of direct-acting antivirals (DAA) and the COVID-19 era. Treatment’s effectiveness was evaluated by the Sustained Virological Response (SVR12), assessed 12 weeks after the end of treatment. Outcomes included SVR12, non-SVR12 and lost to follow-up (LTFU). ANOVA, Kruskal-Wallis test and multinomial logistic regression were used for statistical analysis. Results 6882 HCV patients (age: 58.88±14.21) were treated by the centres participating at the study. Males (56.4%) and Italian (91.8%) were predominant. Sociodemographic and variable characteristics vary across the time. While the overall SVR12 remained stable over time (χ2(2)=0.357, p = 0.837), the LTFU rate significantly increased during the COVID-19 era. Facilitating factors for the non-SVR12 and LTFU outcomes were male gender (Odds Ratio (OR)=2.134, p = 0.006)/cirrhosis (OR = 1.713, p = 0.040)/HIV co-infection (OR = 3.251, p = 0.005) and DAA treatment of third generation (OR = 4.187, p = 0.006), respectively. Conclusions The study provides a comprehensive view of the HCV landscape, highlighting demographic changes, treatment regimens and outcomes. The COVID-19 pandemic affected service delivery, delaying HCV diagnosis/treatment and influencing the LTFU rate. Despite challenges, the region maintained high SVR12 rates, emphasizing the importance of sustained efforts in HCV care. Key messages • The study highlights the dynamic nature of HCV management in Tuscany. • The study emphasises the need for continuous adaptation to public health challenges, providing insights for future public health strategies.

Novel dual-pathogen multi-epitope mRNA vaccine development for Brucella melitensis and Mycobacterium tuberculosis in silico approach.

Brucellosis and Tuberculosis, both of which are contagious diseases, have presented significant challenges to global public health security in recent years. Delayed treatment can exacerbate the conditions, jeopardizing patient lives. Currently, no vaccine has been approved to prevent these two diseases simultaneously. In contrast to traditional vaccines, mRNA vaccines offer advantages such as high efficacy, rapid development, and low cost, and their applications are gradually expanding. This study aims to develop multi-epitope mRNA vaccines argeting Brucella melitensis and Mycobacterium tuberculosis H37Rv (L4 strain) utilizing immunoinformatics approaches. The proteins Omp25, Omp31, MPT70, and MPT83 from the specified bacteria were selected to identify the predominant T- and B-cell epitopes for immunological analysis. Following a comprehensive evaluation, a vaccine was developed using helper T lymphocyte epitopes, cytotoxic T lymphocyte epitopes, linear B-cell epitopes, and conformational B-cell epitopes. It has been demonstrated that multi-epitope mRNA vaccines exhibit increased antigenicity, non-allergenicity, solubility, and high stability. The findings from molecular docking and molecular dynamics simulation revealed a robust and enduring binding affinity between multi-epitope peptides mRNA vaccines and TLR4. Ultimately, Subsequently, following the optimization of the nucleotide sequence, the codon adaptation index was calculated to be 1.0, along with an average GC content of 54.01%. This indicates that the multi-epitope mRNA vaccines exhibit potential for efficient expression within the Escherichia coli(E. coli) host. Analysis through immune modeling indicates that following administration of the vaccine, there may be variation in immunecell populations associated with both innate and adaptive immune reactions. These types encompass helper T lymphocytes (HTL), cytotoxic T lymphocytes (CTL), regulatory T lymphocytes, natural killer cells, dendritic cells and various immune cell subsets. In summary, the results suggest that the newly created multi-epitope mRNA vaccine exhibits favorable attributes, offering novel insights and a conceptual foundation for potential progress in vaccine development.

Effect of unprocessed and minimally processed foods on blood pressure in children

Abstract Background The poor eating habits of children, including a decrease in the consumption of unprocessed foods and an increase in the consumption of processed foods, have been associated with excess body weight, which is a well-established risk factor for cardiovascular diseases (CVDs), especially high blood pressure (BP). We aimed to investigate whether the consumption of unprocessed and minimally processed foods is associated with high BP in children at nine years of age. Methods Cross-sectional study of 142 Brazilian children participating in a cohort study conducted at the participant’s home. The child’s food consumption markers were evaluated using the Brazilian Food and Nutrition Surveillance System (SISVAN) and were classified by NOVA. Using a standardized procedure for approaching the child, BP was measured by the auscultatory method. Biological, socioeconomical, demographic, and anthropometric data of the mother and child were also collected. Logistic regression analysis adjusting for important predictors was used to evaluate the association between food consumption and BP. Results The prevalence of high BP in children was 20.4%, and the mean systolic and diastolic BP were significantly (p &amp;lt; 0.05) higher in children classified as high BP (110.1 and 71.3 mmHg, respectively). An important proportion (44.8%) of children had excess body weight (&amp;gt;85th percentile) and high BP when compared to eutrophic children. Not consuming healthy foods was associated with high systolic BP, even after adjustment for other important covariates (OR = 3.97; p = 0.028). Conclusions Not consuming healthy foods was associated with increased odds of children having high BP at nine years of age. Interventions promoting a healthy diet and the consumption of fruits and vegetables in childhood may contribute to preventing diseases associated with CVD, a global public health problem. Key messages • Educating parents to avoid processed foods and monitoring children’s BP are essential actions to prevent associated chronic diseases throughout life. • Public policies aimed at educating parents to encourage the consumption of healthy foods may significantly contribute to reducing adverse cardiovascular outcomes.

Global health resource distribution during COVID-19 and in future pandemics: Here’s what people say

Abstract During the COVID-19 pandemic, countless individuals across the world needed novel and sophisticated health care resources simultaneously, leading to dramatic global shortages. How to distribute resources in such situations? This dilemma is neither new nor understudied: Its complexity is well known to medical ethicists, public health scientists and philosophers. Building on this knowledge, powerful global distribution frameworks were proposed already early into the pandemic. Despite this knowledge, no globally consensual regulations existed (and exist) on the political sphere. Worse still, numerous countries hoarded resources for themselves, increasing global inequalities and prolonging the pandemic for everyone. For future emergencies, it is thus necessary to develop immediately applicable strategies. Because public acceptance is key for such interventions, evidence on the public opinion towards allocation principles is strongly needed. In 2021, we asked representative samples of N = 2694 adults in England and Germany to rate seven COVID-19-specific global allocation principles. In line with literature on justice attitudes in general, extensions of bifactor(S-1) models showed that participants would have preferred a more equity- or equality-based global resource distribution during the pandemic, presenting themselves as more cosmopolitan than global leaders. Trying to understand these attitudes better, we tested preregistered hypotheses on relations with other constructs and found positive associations between equity- and equality-directed preferences and global human identification, among others. To ensure generalisability on future pandemics, we collected data from a second cohort in spring 2024. All results will be presented in detail. With their responses, European citizens call upon the development of fairer and more efficient global distribution mechanisms. This global public health perspective could inform preparations for future global emergencies. Key messages • European citizens would have preferred a more equity- or equality-based global distribution of scarce health care resources during the COVID-19 pandemic than global leaders organised. • Citizens’ global perspective on public health and their strong emphasis on global fairness should inform preparations for future pandemics and other global emergencies.

Narrowing socioeconomic inequalities in coronary heart disease: insight from Mendelian randomization

Abstract Background Socioeconomic inequalities in coronary heart disease (CHD) represent a pressing global public health concern. However, which dimensions of socioeconomic status (SES) affect CHD and the potential modifiable mediators remain elusive. Methods We performed two-sample Mendelian randomization (MR) analyses based on summary data from large-scale genome-wide association studies in populations of European ancestry. Specifically, by applying bidirectional univariable MR (UVMR) and multivariable MR (MVMR), we investigated the causal relationships of education, occupation, income, Townsend deprivation index (TDI) with CHD and the independent effects of these SES indicators. We further employed a two-step MR to comprehensively profile the mediating effects of 23 behavioral, 3 psychological and 5 biological factors in the relationships. Results An independent causal association was observed between genetically predicated education and CHD, with a 30% lower risk of CHD (OR: 0.70; 95% CI: 0.53-0.93) for each 4.2-year of schooling. Each one-s.d. higher household income was causally, but not independently, associated with a 39% lower risk of CHD (OR: 0.61; 95% CI: 0.49-0.77). No significant causal association was suggested for occupation and TDI with CHD, and no reverse causal effect was observed for CHD on the SES indicators. Of 31 candidate mediators, nine factors mediated the effect of education on CHD significantly, with an individual mediation proportion of 33.5% for smoking, 29.2% for sedentary behaviour, 14.4% for blood lipids, 13.4% for BMI, 11.7% for systolic blood pressure, 9.5% for diastolic blood pressure, 7.8% for well-being spectrum, 6.4% for depression and 2.8% for blood glucose. Conclusions This study highlights that education was the primary SES indicator affecting CHD with considerable mediation by a number of modifiable risk factors. These findings inform policies to mitigate disparities of CHD risk attributable to socioeconomic inequalities. Key messages • Education can be prioritized over other common SES indicators as an essential strategy to reduce the burden of CHD. • Interventions for narrowing socioeconomic inequalities in CHD could focus on more easily modifiable mediating factors.

6.X.2. Food Insecurity in Europe: Voices from across Europe

Abstract Food insecurity (FI), “lack of regular access to enough safe and nutritious food for normal growth and development and an active and healthy life”, is a global public health issue. The United Nations (UN) have identified achieving food security as a key Sustainable Development Goal (SDG), where all people should “have access to safe, nutritious, and sufficient food all year round.” However, disasters related to the consequences of changing climates, pandemics, wars, displacement of populations, high inflation rates, changes in social protection systems, and food system changes challenge the achievement of this SDG. FI persists even in high-income countries including Europe. This workshop session will foster a knowledge, research and experience exchange on the situation of individuals / different population groups in the context of FI in different European countries. Starting with a contribution from Austria, the term food poverty is introduced and considered from a food system perspective / from an equity perspective. The second contribution illuminates the relationships between FI, shopping behaviours and social support among food bank users in Germany during the COVID-19 pandemic. The final third contribution comes from the Netherlands and explores the needs and perceptions regarding healthy eating among people at risk of FI. In all three studies, standardized measurement tools were applied to measure FI but recruiting methods and data collection methods varied considerably between and within the studies. The session enhances the knowledge on FI in Europe from different perspectives. Key messages • Food insecurity does exist in Europe: there is a need for regular, consistent monitoring across European countries. • Food insecurity involves more than just access to food; it also considers nutritious and climate-friendly options, addressing the link between climate, health, and equity.

Climate change and emerging infections: Risks, adaptation and response

Abstract Background Weather and changing climate are key drivers of the emergence, re-emergence and spread of infectious diseases globally. However, approaches to emerging infections and climate strategies are still largely being developed separately missing the opportunities for integrated climate adaptation actions to address infectious diseases. Description To inform the development of the UK national emerging infectious diseases plan, a literature review of the current and projected risks from extreme weather events and climate change on emerging infections in the UK is currently underway. This will support further work examining and co-designing adaptation options in the context of preparedness and response to emerging infections. Results Key preliminary findings from the literature review have indicated risks predominantly from evolving patterns of vector borne diseases as climatic conditions and habitat suitability of pathogens change. Changing temperatures and hotter summer temperatures have been associated with changing food-borne infection patterns. Further risks driven by extreme weather, including flooding and droughts, could perpetuate changes in water-borne infection patterns. Adaptation actions focussed on these infectious disease groups are currently under review and will cover risk assessment, data and surveillance, preparedness and response. Lessons This work integrates climate action with action on emerging infectious diseases. By examining the evidence on climate sensitive infections and co-designing solutions across teams, awareness is being raised and relationships and infrastructures built to better prepare and respond to both fundamental global public health challenges.

4.C. Scientific session: Navigating through complex challenges of responding to outbreaks of multidrug-resistant organisms

Abstract Antimicrobial resistance is one of the top ten global public health threats according to the WHO, contributing to millions of deaths each year. While outbreaks of multidrug-resistant organisms (MDROs) are well studied in hospital and nursing home settings, knowledge gaps exist concerning the complex challenges of outbreaks of MDROs among vulnerable patient populations, such as patients with intellectual disabilities or elderly patients living longer at home with multiple comorbidities. The coordination of such outbreaks requires a multidisciplinary approach as these patients often receive care throughout different healthcare settings, including long-term care and home-based nursing care. We delve into the complexities of coordinating an MDRO outbreak response involving healthcare professionals from various healthcare settings. The challenges inherent to the coordination of multidisciplinary involvement and the use of innovative strategies for outbreak preparedness and surveillance, will be thoroughly examined based on scientific evidence and practice based experiences. Workshop objectives • To exchange experiences on managing cross-institutional outbreaks of MDROs • To foster deeper understanding of the complexities of multidisciplinary involvement during MDRO outbreaks among vulnerable patient populations The workshop structure: - A brief introduction will be provided on the generic challenges in providing long-term care to vulnerable patient populations carrying MDROs. We will subsequently illustrate potential challenges faced during a cross-institutional MDRO outbreak among these patients through a realistic scenario (5 min): A patient with severe intellectual and physical disabilities living in both a long-term care facility as well as with family at home, unexpectedly turns out to be carrying an MDRO after recent hospital admission. As the patient receives nursing care from both from family members and nursing staff in different healthcare settings, a cross-institutional MDRO outbreak has occurred requiring a coordinated response. - Hereafter, individual presenters will address evidence- and experience-based challenges faced in MDRO outbreak responses within the specific healthcare settings covered in the previously presented scenario. We will navigate through the scenario together with the participants, discussing practical and ethical dilemmas, and explore ways for containing the MDRO outbreak while maintaining effective and compassionate healthcare delivery. In addition, we will discuss the use of public health innovations, such as social network analysis as a basis for the development of a stress test exercise to improve preparedness for MDRO outbreaks, and the role of wastewater surveillance in MDRO outbreaks. Discussions will be facilitated by (online) voting tools to invite participants to exchange experiences (40 min). We conclude with an exciting quiz to summarize the key messages of this workshop (10 min). Key messages • Healthcare setting, knowledge, proportionality and well-being of vulnerable patients populations are important to acknowledge during cross-institutional MDRO outbreaks. • Novel stress test exercise and wastewater surveillance are potential methods to improve preparedness and surveillance, respectively, during cross-institutional MDRO outbreak responses.

Family function, psychological distress and burden in informal caregivers of people with dementia

Abstract Background Dementia presents a public health priority due to its high global prevalence, mortality, economic cost, and caregiver burden (CB). Dementia care can be stressful and may negatively influence the health of informal caregivers. This cross-sectional study aimed to identify psychological and social factors associated with subjective CB in informal home care providers of people with dementia (PwD), controlling for sociodemographic, clinical, and care-related variables. Methods We included 115 informal caregivers of PwD from community settings (mean age: 54.0±12.4 years; 81.7% women). Participants fulfilled the Zarit Burden Interview (ZBI-12), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), the Family APGAR, and the short IQCODE used to assess dementia severity. Multiple linear analyses were used to analyse the data. Results The mean caregiving duration was 4.8±4.8 years, and 55.7% of informal caregivers extend care for &amp;gt;40 hours/week. We found that a total of 52.5 % of informal caregivers experienced a high CB (ZBI-12 cut-off score: 17). Univariate analyses showed an association between depression (β = 0.36; p &amp;lt; 0.001), anxiety (β = 0.52; p &amp;lt; 0.001), family dysfunction (β = 0.36; p &amp;lt; 0.001), and CB. Regression analyses showed that CB was the most strongly associated with anxiety (β = 0.51; p &amp;lt; 0.001). This association weakened (0.47; p &amp;lt; 0.01) when family function was added to the final model (β=-0.22; p &amp;lt; 0.05). The final model explained 23.5% of the variance in CB. No associations between the caregiver's age, sex, caregiving duration, the extent of care per day, use of community care, dementia severity, and depression were identified. Conclusions Long-term care for people living with dementia can be very demanding. Thus, the implementation of tailored interventions to enhance family function and diminish psychological distress can mitigate level of caregiver burden. [Grant support: APVV-22-0587]. Key messages • Dementia caregiving is a global public health priority. • The caregiver’s burden and distress can be alleviated by the interventions focusing on family dysfunction.