Health Authorities Research Articles

Critical Evaluation of Neglected Consensus Risk Factors Causing the Recurrent Upsurge of Cholera Outbreaks in Some Regions in Cameroon: A Systematic Review

Background: Cameroon is a developing nation and has been enlisted amongst the several countries in sub-Sahara Africa situated in West and Central Africa to be experiencing the recurrent cholera outbreaks. The World Health Organization (WHO), Cameroon health authorities and others researchers have considered a few risk factors that are believed to be contributing to the current and on-going cholera outbreaks in Cameroon. These risk factors include the wide circulation of Vibrio cholerae in the country, limited access to safe-drinking water in some areas, a seasonal pattern of cholera re-occurrence and inadequate water, sanitation and hygienic (WASH) conditions, unstable political atmosphere that have resulted to internally displayed persons, very poor and vulnerable persons, refugees and humanitarian crises and continued unnecessary imposed lock-downs and road-blocks. However, despite these enormous efforts made by Cameroon health authorities so far and its partners over the past decades in responding and tackling all these risk factors, the recurrent outbreak of cholera in Cameroon still remained a great challenge and potential humanitarian crisis, an unendingly reality with bewilderment amid uncertainty, threatening and vulnerability to many affected regions. Aim: This systematic review seeks to critically evaluate, identify and classify some previously overlooked consensus risk factors driving cholera endemicity, pandemicity or epidemicity in Cameroon. By highlighting these neglected factors, this review hopes to inform evidenced -based intervention to finally combat the persistence recurrent upsurge and burden of future outbreaks of cholera in Cameroon. Methodology: The current Systematic reviews gathered information from various sources using different search engines provide a comprehensive overview of existing research. These include Academic Search Engines, Specialized Search Engines, Grey Literature, Primary Sources, Secondary Sources, Registers and Repositories, Open Access Sources, Hand Searching and Other Sources. Results: The current systematic review gathered information from diverse sources and identified and classified six groups of neglected consensus risk factors, along with their associated variables, contributing to cholera outbreaks in Cameroon. Additionally, the review assessed the level of intervention and preventive measures offered by the Cameroon health authorities and other stakeholders, categorizing them as either low or high, for both documented and undocumented strategies. All data sources were thoroughly referenced accordingly ensuring transparency and accountability. Conclusion: In spite of extensive research by the World Health Organization and Cameroonian health authorities identifying and documenting numerous risk factors contributing to Cameroon's ongoing cholera outbreaks, these efforts have not prevented or eradicated recurring episodes. Decades of enormous work and efforts by Cameroonian health authorities have been incapable to eradicate cholera. This systematic review unequivocally shows that without addressing the neglected consensus risk factors and variables, Cameroon could face a high likelihood of continued cholera outbreaks. Therefore, this review underscores the urgent need for Cameroon health authorities to adopt a multifaceted approach, addressing the identified neglected consensus risk factors and variables. Implementation of targeted interventions, strengthened health infrastructure, and community engagement are crucial to prevent future cholera outbreaks. Future research should focus on developing context-specific solutions, enhancing existing strategies, and evaluating the effectiveness of interventions.

Compliance with WHO Standards in Monitoring and Evaluating the COVID- 19 Pandemic in the Philippines and Vietnam

This research is concerned with the compliance of the Philippines and Vietnam with World Health Organization (WHO) standards in the monitoring and evaluation (M&E) of COVID-19 policies. Document analysis helps to explore the M&E plan for implementing the set of standards from WHO for COVID-19 prevention in the Philippines and Vietnam while surveys define the perception of the local health authorities on the compliance of the Philippines and Vietnam authorities with the WHO standards. Comparing the situation report shared with WHO by those countries would clarify the valuable information. As a result, compliance levels in the Philippines are perceived to be moderately high to high. Respondents in Vietnam rated compliance at a very high level. However, the two countries still have gaps in their COVID-19 M&E systems. Therefore, recommendations are then proposed for the enhancement of the M&E of COVID-19 policies and compliance with WHO.

Securing commitment and control for the supply of plasma derivatives for public health systems. II: A survey of national pathways.

Pressures on the supply of plasma-derived medicinal products (PDMPs) have led to the efforts to increase the level of plasma collected by public health authorities. Public blood collectors were assessed regarding their routes towards domestically sourced plasma and PDMPs. The collectors' operations were specified and analysed. Models were classified according to the type of plasma collection system and contract fractionation arrangements. Commitment and control to a public plasma collection system are the key features that need to underpin plasma collection.

Future health technology trends, policy, and governance perspective: the Turkish case

BackgroundAdvanced health technologies that emerge with the development of technology have an impact on health systems. This study aimed to determine the effects of these technologies on Türkiye’s health system and present policy recommendations to reshape Türkiye’s health system and policies accordingly.MethodsInterviews were conducted with senior managers, bureaucrats, policy-makers and decision-makers from seven different institutions on the subject. Content analysis was performed on the data obtained and evaluative categories were established.ResultsIt was concluded that these technologies would not have a positive impact on two identified themes, a negative impact on seven themes and a predominant impact on five themes in Türkiye.ConclusionsTo adapt to the new health ecosystem in Türkiye, it is recommended to increase digital literacy, conduct economic evaluations of technologies, promote domestic production, ensure up-to-date follow-up, collaborate with the engineering field, enhance health technology evaluation practices, improve access to technologies and ensure that the infrastructures of health institutions are compatible with technologies. Various policy suggestions have been presented for the development of Türkiye’s health system.

Contact Tracing Different Age Groups During the COVID-19 Pandemic: Retrospective Study From South-West Germany.

Contact tracing was implemented in many countries during the COVID-19 pandemic to prevent disease spread, reduce mortality, and avoid overburdening health care systems. In several countries, including Germany, new systems were needed to trace potentially infected individuals. Using data collected in the Rhine-Neckar and Heidelberg (RNK/HD) districts in southwest Germany (population: 706,974), this study examines the overall effectiveness and efficiency of contact tracing in different age groups and stages of the pandemic. From January 27, 2020, to April 30, 2022, the RNK/HD Health Authority collected data on COVID-19 infections, quarantines, and deaths. Data on infection, quarantine, and death was grouped by age (young: 0-19 years; adult: 20-65 years; and senior citizens: >65 years) and pandemic phase (infectious wave plus subsequent lull periods) and analyzed for proportion, risk, and relative risk (RR). The overall effectiveness and efficiency of contact tracing were determined by calculating quarantine sensitivity (proportion of the infected population captured in quarantine), positive predictive value (PPV; proportion of the quarantined population that was infected), and the weighted Fβ-score (combined predictive performance). Of 706,974 persons living in RNK/HD during the study period, 192,175 (27.2%) tested positive for SARS-CoV-2, 74,810 (10.4%) were quarantined, and 932 (0.132%) died following infection. Compared with adults, the RR of infection was lower among senior citizens (0.401, 95% CI 0.395-0.407) and while initially lower for young people, was ultimately higher for young people across all 5 phases (first-phase RR 0.502, 95% CI 0.438-0.575; all phases RR 1.35, 95% CI 1.34-1.36). Of 932 COVID-19-associated deaths during the study period, 852 were senior citizens (91.4%), with no deaths reported among young people. Relative to adults, senior citizens had the lowest risk of quarantine (RR 0.436, 95% CI 0.424-0.448), while young people had the highest RR (2.94, 95% CI 2.90-2.98). The predictive performance of contact tracing was highest during the second and third phases of the pandemic (Fβ-score=0.272 and 0.338, respectively). In the second phase of the pandemic, 5810 of 16,814 COVID-19 infections were captured within a total quarantine population of 39,687 (sensitivity 34.6%; PPV 14.6%). In the third phase of the pandemic, 3492 of 8803 infections were captured within a total quarantine population of 16,462 (sensitivity 39.7%; PPV 21.2%). The use of quarantine aligned with increasing risks of COVID-19 infection and death. High levels of quarantine sensitivity before the introduction of the vaccine show how contact tracing systems became increasingly effective at capturing and quarantining the infected population. High levels of PPV and Fβ-scores indicate, moreover, that contact tracing became more efficient at identifying infected individuals. Additional analysis of transmission pathways is needed to evaluate the application of quarantine in relation to infection and death risks within specific age groups.

India’s Vaccine Diplomacy and Global Health Governance: A Soft Power Approach in the Context of Public Policy and Religious Values

Research Problem: India's vaccine diplomacy during the Covid-19 pandemic has not only emerged as a significant tool of soft power but also involves moral and ethical dimensions closely tied to religious values and public policy. In the midst of a global crisis, the interaction between India’s vaccine diplomacy and the religious and public policy frameworks of recipient nations requires deeper exploration. Research purposes: This article aims to analyze the role of India’s vaccine diplomacy in relation to public policy and religious values in recipient countries, examining how India’s global health initiatives influence moral and ethical perceptions of vaccine distribution, fairness, and international solidarity. Research methods: The study employs policy analysis through a comprehensive literature review, focusing on the relationship between vaccine diplomacy, public policy, and responses from religious communities in the recipient countries. It also explores the ethical and spiritual dimensions of India’s health diplomacy approach and its impact on public health policies. Results and Discussion: The findings reveal that India’s vaccine diplomacy, through initiatives like "Vaccine Maitri," not only strengthens political ties with neighboring and global countries but also interacts with religious value systems, influencing public acceptance of vaccines. Moral values such as solidarity and justice, integral to many religious traditions, reinforce positive responses to the vaccine initiatives. Additionally, in some nations, religious communities have played a significant role in promoting vaccine acceptance by framing the health response in moral terms. Research Implications and Contributions: This research highlights the importance of integrating religious values into public health policy, particularly in global health contexts. Vaccine diplomacy rooted in moral solidarity and universal ethical principles, aligned with religious values, has the potential to enhance international cooperation and reduce vaccine hesitancy. Thus, this study contributes to understanding how religion and public policy can collaborate effectively in addressing global health challenges.

One Health literacy and governance of health leaders across three countries following the pandemic

Abstract Background To address health threats and promoting health of all, One Health is an important approach. To foster the implementation of One Health, a framework proposed by Blankart et al. (2024) postulates a reinforcing relationship between One Health literacy and governance after being triggered by an external event. We build on this model and aim to explore how the postulated mechanism differs among health policy and practice leaders across the UK, Germany, and Switzerland after the external triggering event of the COVID-19 pandemic. Methods We developed an online survey instrument for each of the 5 elements of the framework and conducted it in April 2024. We targeted mid- and end-career leaders and senior experts from the Sciana network that reported about their personal experiences and perceived changes (scale from -5 to + 5). We performed descriptive and inferential statistics to analyse the data. The survey was complemented by structured interviews to gather contextual information. Results Leaders and experts (N = 30, response rate: 30%) increased their One Health literacy (mean: 2.2), increasingly engaged with One Health principles (mean: 1.0), which resulted in more calls for optimized One Health governance (mean: 2.4). The interviewees reported that they adopted and implemented a more consistent One Health governance (mean: 2.6), which led to more familiarity with One Health principles (mean: 2.3). According to the results, the average effect on One Health literacy and Governance was stronger in Germany, followed by Switzerland and the UK. Conclusions We have demonstrated that triggering events such as the COVID-19 pandemic have led to improvements in One Health literacy and subsequently One Health governance. We therefore suggest that the postulated framework holds in practice and have showed that there are important differences in uptake between leaders in the three countries. Further research may build on these findings and develop more effective health policy. Key messages • We have contributed to the understanding of how pandemics improve One Health literacy and subsequent One Health governance using the example through a survey of leaders in health policy and practice. • Based on the understanding of triggering events’ effect on One Health literacy and governance specific recommendations for the implementation of One Health in public health can be developed.

Institutional distrust and levels of functional impairment related to indoor air-associated symptoms: A Finnish population-based study

IntroductionWhile distrust in social institutions has been linked with poor health outcomes, this association has not been examined in relation to indoor air (IA). We investigated the relationship between functional impairment due to IA-associated symptoms and distrust in social institutions, both in general and distrust particularly in IA-related questions. MethodsThe Finnish population-based Indoor Air and Health survey (n=1750) was utilized to assess any IA-associated symptoms and functional impairment due to these symptoms within the past 12 months. The associations between levels of functional impairment and distrust in social institutions (health care, juridical system, government officials, construction business, media, and social media) were analyzed using multinomial logistic regression adjusted for gender, age, and education. ResultsOf the respondents with symptoms (23.1 %), the level of functional impairment varied from severe (1.8 %) to no impairment (4.9 %). Distrust in social institutions was more common in IA-related questions than in general. Higher levels of functional impairment were associated with increased distrust particularized in IA-related questions in other institutions except for media and social media: higher levels of functional impairment were associated with increased trust in these institutions. The strongest associations were observed with distrust in health care and government officials (aOR 4.10, 95 %CI 1.97–8.53, and aOR 3.35, 95 %CI 1.62–6.94, for those with severe impairment compared to those with no IA-associated symptoms). ConclusionsHigher levels of self-reported functional impairment due to IA-associated symptoms were associated with decreased trust in most social institutions, but with increased trust in media and social media. These findings should be considered in communication on and prevention of IA-associated health issues.

TB Care in Ukraine: Understanding Access Barriers at the Primary Healthcare Level

Abstract Background In the WHO European Region, Ukraine is a high-priority country for TB control, being one of nine globally with high rates of multidrug-resistant TB. The WHO emphasizes patient-centered TB care, prioritizing patients as key figures in the care continuum. Thus, our aim was to explore barriers impacting the accessibility of TB services for patients at the primary healthcare level (PHC) in Ukraine. Methods During December 2022-June 2023, a qualitative study was conducted across eight PHC facilities in the Kyiv, Odesa, Mykolayiv, and Volyn regions. The study comprised: 4 focus groups involving 27 family doctors, 16 in-depth interviews with managers and health authorities from regional and national levels, as well as 25 interviews with TB patients. All data was transcribed, manually coded and deductively analyzed. Results All participants highlighted the benefits for patients of providing TB care continuum at the PHC level, yet the program lacks clear requirements for training of family doctors and nurses. Overall family doctors perceived positively various TB training they received; but despite this, they expressed doubts and reported a lack of practical skills, affecting the quality of care provided. Patients highlighted several barriers in interacting with healthcare providers, including stigma and cases of dismissive behavior of healthcare workers, communication challenges, and breaches of patientś data confidentiality. Patients also mentioned self-stigma, and perceptions of family doctors as poorly trained in TB. Still, patients who received healthcare services from the same family doctor “during long time” positively described their experience with TB services too. Conclusions Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine. To achieve this, a comprehensive TB training program tailored for PHC family doctors and nurses should be developed and implemented. Key messages • Expanding TB healthcare services to primary healthcare levels in Ukraine can be beneficial for patients. Training primary healthcare staff can enhance TB care quality. • Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine.

Mapping the Policy Alternatives for Rare Cancer

Abstract Issue This policy research addresses the issue of rare cancers in the European Union (EU). Rare cancers have an annual incidence rate of less than 6/100 000 and face challenges in diagnosis, clinical care, and research investment. Survival rates for rare cancers are lower compared to common cancer types, with significant variations among EU Member States. Description of the problem Policy frameworks for rare cancers are often fragmented and greatly vary across the EU. This study aims to develop a tool for assessing policy alternatives by reviewing existing national rare cancer policies, conducting interviews with experts, and analysing core stakeholders at the EU level. Results The main policy alternatives covered five domains: definition, registration, organisation of care, access to innovative therapies, and funding. Interviews revealed four policy options for each domain. Six core stakeholders were determined: patient organisations, healthcare professionals, researchers, industry, health legislators, and health authorities. A pilot policy assessment tool was developed on this basis. Lessons The pilot study coherently explored policy alternatives for rare cancers in the EU. Using these findings, policymakers and researchers can assess the impact of different policy options at a national level and contribute to the development of a unified EU policy framework for rare cancers. The pilot survey was also useful to collect input from the core stakeholders. Key messages • This study identifies key policy domains and feasible alternatives. A pilot preference assessment study based on these options can aid in EU policy development. • Navigating rare cancer policy complexities demands collaboration and innovation. Engaging stakeholders and exploring alternatives can forge a more effective EU framework for addressing rare cancers.

The Workplace Health Promotion project in an Italian manufacturing

Abstract Introduction The Workplace Health Promotion (WHP) program aims to improve employee’s health and well-being in the workplace by intervening in lifestyles. The objective of our study was to assess the impact of the WHP promoted by the Local Health Authority Tuscany South-East at a manufacturing. Methods The program was set at the STOSA Company in Radicofani (Siena, Italy) between 31 May 2017 to 31 December 2021, with a one-year interruption due to the COVID-19 pandemic. Based on an assessment of the workers’ health status, we identified nutrition and fighting smoking as areas of intervention. The WHP project was integrated into the company policy and targeted all staff. Evaluation of interventions was conducted using an anonymous paper questionnaire (Regional Decree no. 1565, Annex 3) administered in three moments: at the beginning of the project (T0), one year later (T1), and at the end (T2). We conducted a descriptive and inferential analysis (chi-square test) with R. Results We collected 131 (T0), 136 (T1), and 123 (T2) responses. The cohort is composed entirely of males (T0 M:F 122:8, T1 130:6, T2 109:14). The median age is 40 years (SD 8.24 (T2)). There is a statistically significant difference in the perception of health status by education (p<.001), type of work (p<.001), smoking habit (p<.001), and the change in smoking habit (p<.001). The whole sample positively evaluated the interventions on nutrition and fighting to smoke. Moreover, the entire sample reported improvements in their diet since the beginning of the project. Conclusions The COVID-19 pandemic caused difficulties in carrying out the project and possible changes in workers’ lifestyles. However, positive outcomes were observed in the targeted areas. The company has evaluated positively the WHP’s project and decided to maintain the good practices acquired. Key messages • The workplace represents a privileged setting to promote healthy lifestyles and prevent non-communicable diseases. • Collaborations between health authorities and other sectors are strategic to reach the general population.

The effect of 2 years COVID-19 pandemic on myocardial infarction and stroke admissions: nationwide registry study, sex differences and mortality

Abstract Background Throughout the COVID-19 pandemic many countries reported a decline in myocardial infarction (MI) and stroke admissions. Factors leading to the decline remain uncertain. Purpose In this nationwide study spanning the first two years of the COVID-19 pandemic we evaluated the changes in MI and stroke admissions as the effect of pandemic intensity and nationwide lockdown. We also investigated sex and age differences. We benefited from the fact that the Czech Republic had both, the lowest and one of the highest COVID-19 incidence. Methods We compared the first (March 1, 2020, to February 28, 2021) and the second (March 1, 2021, to February 28, 2022) pandemic years overall and during the COVID-19 waves with the preceding year (March 1, 2019, to February 28, 2020). The occurrence of MI and stroke, patient characteristics, and mortality data were obtained from two nationwide registers covering every hospitalization and every death in the Czech Republic. Results During the first and second pandemic year as compared to the preceding year there were 13,856 and 14,123 vs 15,499 MI admissions, representing a -10,6% (p<0.001) and -8,9% (p<0.001) decline; and 23,194 and 23,231 vs 25,046 stroke admissions, representing a -7.4% (p<0.001) and -7.2% (p<0.001) decline respectively. The significant decline appeared in both MI and stroke in all COVID-19 waves (spring 2020, spring 2021, autumn 2020/winter 2021, -autumn 2021/winter 2022). The greatest MI hospitalization decline (-16%) occurred during the first strict national lock down, during the first COVID-19 wave (spring 2020), the pandemic wave with the lowest COVID-19 incidence. Both, MI and stroke admissions reversed to pre-pandemic numbers during the summer (2020, 2021) when most lockdown restrictions were lifted. The decline in MI was greater in women than in men during both the first (-11.8%, -10%; p<0.001) and second (-10.8%, -7.9%; p<0.001) pandemic years, also for stroke in women greater than in men during the first (-9%, -5.9%; p<0.001) and second (-9.7%, -4.8%; p<0.001) pandemic years. The 30-day all-cause mortality in patients with MI was higher during the first (10.6%; p<0.001) but not the second (9.6%; p=0.34) pandemic year as compared to the preceding year (9.3%), whereas the 30-day mortality in patients with stroke remained unchanged. Conclusions There was a decline in both MI and stroke admissions during the first two years of the pandemic, but such decline was not related to COVID-19 incidence. The greatest reduction in both, MI and stroke admissions, appeared during the first lockdown in the first COVID-19 wave (spring 2020), the period of the lowest COVID-19 incidence. Moreover, the decline in MI and stroke admissions was greater in women. This highlights potential sex differences in health effect. Health authorities should be aware of these findings, in order to adapt their message and restriction measures in case of future major epidemics.Myocardial infarction casesStroke cases

Radiation exposure of patients undergoing multiple-slice CT scans in Romania

Abstract Ionizing radiation is largely used in medicine due to its role in the diagnosis and treatment of patients. In the past 50 years computed tomography (CT) has become indispensable for medical practice because it offers sub-millimeter cross-sectional imaging of any region of the body. New CT scanners use thinner slices, providing more accurate results, but also an increased radiation exposure with possible long-term harmful effects for the patients. The parameter used as an indicator of radiation dose in CT is the dose-length product (DLP). The study included 4507 patients who were CT scanned using a 16, 32, 64 or 128-slice CT machine. DLP was measured for head, sinuses, thorax, abdomen, pelvis, abdomen+pelvis, and trunk scans - regions for which the health authorities have established national diagnostic reference levels (DRL - the expected radiation dose received by a patient in CT). One-way ANOVA was used to analyse data considering the use of contrast agents, the gender, age, and weight of patients. Average DLP values were higher (up to 80%) than national DRL for all regions in 64 and 128-slice scans. The highest DLP values were registered in contrast CT for all scanners (p < 0.01); the maximum average (a threefold increase compared to DRL) was measured in the 32-slice sinuses contrast CT. Average DLP correlated with patients’ gender and weight (p < 0.01), but the influence was lower compared to the use of contrast agents. In conclusion, CT scans acquired using thinner slices lead to more accurate results and high-quality images, but the study suggests an increased radiation exposure. CT has an uncontestable contribution to a precise and rapid diagnosis, but more attention must be given to the stochastic effects risks associated with the radiation dose received during a CT scan. Are all scans necessary? Do all patients really need to receive high doses? The role of the practitioner is decisive, and the justifiable process is “a must” in all radiodiagnosis practices. Key messages • CT doses must be kept “as low as reasonably achievable” while maintaining diagnostic image quality. • Justification, dose limitation, and optimisation are fundamental principles of radioprotection.

Lesson learned from a co-designed vaccination initiative with undocumented people in the Netherlands

Abstract Issue/ problem ‘The coronavirus does not take document status into account’. The COVID-19 pandemic highlighted the importance of equal healthcare access for all. Yet, undocumented people face numerous personal and practical barriers in accessing health. Ensuring the protection of the most vulnerable is a global concern. Description of the problem In 2021, a regional initiative aimed to remove barriers and create a trusted environment for undocumented people to receive vaccinations. This collaborative effort included public health departments, NGO’s, community groups, (self) organized migrant organizations, GP’s and embassies. Regular meetings identified the population’s needs. A medical doctor was made available 24/7 to address questions and concerns. Actions were undertaken to build trust, foster collaborations between health authorities and communities and to improve vaccine service access and design. Results Working in partnership fostered trusted, multi-sectorial relationships, resulting in a vaccination initiative that met the diverse needs of the undocumented people. Widespread community-driven outreach through flyers and social media reached those who normally are not reached. Supported by over 40 volunteers, three vaccination events were organized in which 693 doses were administered. All parties made their contribution, e.g. with different migrant communities providing hot meals. The initiative began at the grassroots level in the communities and was then executed in partnership with the involved parties, making it highly successful. Lessons Inclusive engagement, addressing concerns and sharing clear information not only supports trusted relationships but also strengthens social cohesion. Collaborating directly with the communities ensured the initiative was tailored to their needs, thereby lowering the barriers for accessing healthcare. Achieving this success required a foundation of trust, mutual respect and a collective commitment from all involved. Key messages • Codesigning vaccination initiatives with the communities is essential for success. • Trusted partnerships, community involvement and mutual commitment were key elements for lowering barriers to accessing health.

Developing regional Diabetes Registries in Italy: pilot projects implementation within JACARDI

Abstract Issue/Problem In Italy a National Diabetes registry is planned but not yet set up at the Ministry; JACARDI is contributing to speed up the process so that critical gaps in health data availability can be filled. While some regional registries exist, the lack of cohesion and standardization hinders the tracking of prevalence, incidence, and sequelae, crucial for evidence-based policymaking amidst rising diabetes rates. Description of the Problem The JACARDI project, supported by EU funding and running for four years, engages 76 partners from 21 countries and includes 142 national-level projects. Among its focus areas is enhancing data availability, aiming to establish harmonized regional Diabetes registries in Italy to tackle this issue. These efforts aim to create a scalable model enabling data linkage, diabetes type differentiation, and socio-demographic integration. Collaboration with health authorities and societies, drawing insights from existing registries, informs the development process. Results A total of 11 regional Diabetes registries are currently in the design phase of implementation. They adhere to a clearly defined methodology, with established essential parameters and data linkage. Consensus on these parameters and linkage was reached through stakeholder discussions, drawing on past registry experiences. The primary goal of the registries is to monitor diabetes prevalence, stratify incidence by demographics, and track sequelae to inform targeted interventions and resource allocation. While scalability beyond Italy may encounter administrative challenges, standardized protocols facilitate transferability. Data Protection stands out as a significant implementation obstacle. Lessons Standardized data collection, stakeholder collaboration, and sustainability are vital in registry development. Leveraging data availability for surveillance demonstrates adaptability and scalability, offering valuable insights for enhancing diabetes management. Key messages • Standardized data collection and stakeholder collaboration are pivotal in establishing effective diabetes registries, fostering equity and improving health outcomes. • Leveraging data availability for surveillance offers a scalable and sustainable approach to diabetes management, facilitating informed policymaking and interventions.

Working conditions in OOH-PC centres in Romania: an interview study with healthcare professionals

Abstract Considering the amplifying primary care workforce shortage, the existing knowledge gaps in out-of-hours primary care delivery (OOH-PC) in Romania, as well as the extreme county-to-county variation in the number of functioning OOH-PC centers across the country, from 0 to 32, we set out to document health workers’ perspectives on existing challenges in after hours primary care. Using a qualitative study design, we conducted semi-structured interviews with a purposive sample of 20 healthcare professionals (HCPs): family doctors and nurses providing clinical services in urban and rural OOH-PC centres, family doctors with coordinating and administrative roles, representatives of professional associations and health authorities, as well as emergency doctors and paediatricians. We examined interview transcripts employing thematic analysis. The data collected and analysed revealed several challenges in the provision of care, including physician shortages, increasing workload, low payments, and an organisational model that lacks coordination with other levels of care and services. The analysis of the interview data identified five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH centre premises (rest space, security), and insufficient financial compensation for after-hours health service provision. Working conditions in OOH-PC centers in Romania constitute a drawback to after hours primary care service provision. Health workers shortage and extreme variation in the number of functioning centres across the country suggest inconsistencies in the governance of OOH-PC. Improving working conditions to recruit and retain health professionals in OOH-PC, combined with targeted policies to optimise organisation and coordination of OOH-PC with other levels of care are as timely as ever to ensure equitable services to the population. Key messages • Current working conditions in OOH-PC Romania impact negatively the health workforce and lead to uneven access for the population. • Improvements in working conditions, service integration, and organisation model are timely for the alleviation of OOH-PC provision.

Whooping cough – a recurrent epidemic

Abstract Background Whooping cough (WC), or Pertussis, is a vaccine-preventable and highly contagious infectious disease. Although it has a relatively low fatality rate, approximately 13% of reported cases develop secondary bacterial pneumonia. This was because of several recurrent epidemics across Europe in the last decades, with the latest beginning in mid-2023 and still ongoing. The Central Region of Portugal is currently being affected, and this study aims to describe the current epidemic at the regional level. Methods Data from epidemiological inquiries of confirmed and probable cases of WC pertaining to the Central Region of Portugal from January 2020 till April 2024 was gathered from the mandatory report national epidemiological surveillance system (SINAVE). Both a temporal comparison of number of cases and a statistical space-time scan with permutation were conducted (software SaTScan v10.) Results A comparison by month of reported cases shows an increase in cases from September 2023 until December 2023 followed by an exponential increase from January 2024 until April 2024 denoting an ongoing epidemic. In the statistical space-time analysis of 107 reported cases between September 2023 and April 2024, 8 nonsignificant clusters were identified with different locations involved in non-overlapping periods. Conclusions The finding of several unrelated clusters, even though nonsignificant, during a short time period indicates that Pertussis transmission is ongoing at the local level probably through asymptomatic or barely symptomatic cases that act as reservoirs. Clinicians must hold a high clinical suspicion for a timely diagnosis, treatment and report and health authorities must reinforce control measures to limit the spread of this disease. Key messages • Pertussis remains a disease of significant concern recurrent outbreaks across Europe show that public health local authorities have an important role in timely management of cases and outbreaks. • Local level transmission and intervention may play a pivotal role in the epidemiologic dynamic of Pertussis.

Time-dependent networks for the treatment of acute coronary syndrome in South East Tuscany

Abstract Introduction The importance of timely reperfusion therapy in Cardiovascular diseases is crucial, leading to the creation of time-dependent networks for Acute Coronary Syndrome treatment. The ACS-STEMI treatment network in Tuscany operates across three health authorities (LHAs),including South-East Tuscany. The network ensures ACS-STEMI treatment in 12 hospitals integrating new territories such as Piombino and Elba into the network. Aim of the study is to assess the impact of an analytical monitoring system of the times to reperfusion treatment and the actions to improve the performance of the network. Methods In this retrospective study an analytical evaluation of the network’s performance was conducted. We utilized data on patient transport, symptom onset to medical contact times, and outcomes from the National Outcomes Program (PNE).Analytical evaluations in 2021 measured the network’s performance, identifying main delay causes. The treatment process is divided into periods from symptom onset to coronary reperfusion, and interventions like public campaigns, ECG transmission and fast-track transfers have been implemented. Results South East Tuscany LHU had the lowest 30-day mortality rate for ACS patients in Italian hospitals with 300 cases annually in 2020 and 2021.Improvements continued into 2022 and 2023, further reducing mortality rates in patients initially admitted to SPOKE hospitals. For Piombino and Island of Elba residents,30-day mortality decreased from 8.8% (2017-2020) to 5.7% in 2022. The Grosseto hub treated 80% of STEMI patients within 90 minutes in 2022. Conclusions The establishment of a well-organized time-dependent network for ACS-STEMI treatment in Tuscany has significantly improved patient outcomes, demonstrating the critical role of timely and efficient care pathways. The network’s success is attributed to several factors, including improved accessibility, enhanced coordination among healthcare facilities, and effective use of technology and resources. Key messages • Treatment networks for ACS/STEMI can improve health outcomes in peripheral areas. • Structured clinical-care pathways in delivering high-quality care for ACS patients reduces ACS mortality.

Assessing contextual factors influencing scale-up: a interactive approach involving stakeholders

Abstract Issue Pilot interventions are not always put into practice at scale. When they are, effectiveness is often highly reduced in the field due to contextual factors. To effectively implement a scale-up, stakeholders’ involvement is crucial. Curema is an international research evaluating an intervention aiming to reduce malaria transmission by distributing RDTs and treatments in mobile hard-to-reach populations. This intervention might be scaled-up in Brazil, Suriname, and French Guiana as a tool of national malaria programs for specific areas and populations. Description of the problem An interactive pre-planning assessment was conducted involving key stakeholders -implementers, decision-makers, and researchers - in working sessions, semi-structured interviews, and formal meetings. Mendelow’s Power/Interest Matrix was used to map stakeholders and a SWOT analysis was conducted using ExpandNet/WHO Framework to evaluate contextual factors and identify levers and obstacles influencing the scale-up. Results A total of 23 participants were involved. Health authorities had high power and generally high interest, while implementers and recipients had lower power and different interest levels. National engagement for WHO E2025 or E2030 enhanced scalability and represented a main opportunity in the three countries. Nevertheless, several regulatory and administrative aspects were identified as potential obstacles to be addressed to make scale-up realistic. Funding was also a major concern for sustainability. The need for regional cooperation was emphasized to achieve malaria elimination. Lessons Despite financial and regulatory challenges, a window of opportunity is open to scale-up Curema. Identifying and involving stakeholders in a pre-planning assessment and advocating for foster regional cooperation are crucial steps to support the scale-up. Stakeholder analysis should be refined during the scaling-up to capture further changes in factors that might influence the process. Key messages • Engagements with WHO represent windows of opportunity to enhance Curema scale-up. • Stakeholder involvement and regional cooperation are crucial for scaling up Curema in Brazil, French Guiana and Suriname.

Assessment of heavy metal contamination in groundwater of rural areas of Kurdistan Province Iran: A comprehensive study

This study focuses on the contamination of groundwater by heavy metals (HMs) in the Kurdistan Province of Iran, an area heavily reliant on these water resources, especially in rural regions. This research aimed to quantify the concentrations of 20 HMs in groundwater sources and assess the associated health risks, including both carcinogenic and non-carcinogenic effects, for different age groups. The study was conducted in 2024. We collected 155 groundwater samples from water resources of the villages in Kurdistan Province, west of Iran. The study encompassed comprehensive sampling of groundwater from various wells and springs throughout the province, which was subsequently subjected to thorough laboratory analysis utilizing Inductively Coupled Plasma Mass Spectroscopy (ICP-MS) for the quantification of heavy metal (HM) concentrations. The highest concentrations of As, Co, Cu, and Mo were 7.90, 0.22, 2.48, and 1.68 μg/l, respectively. It was related to the cities of Qorveh, Sanandaj, Baneh, and Qorveh respectively. A Health Risk Assessment (HRA) was performed, indicating that, while the concentrations of most HMs were within the thresholds established by national and international standards, certain metals, such as arsenic and lithium, presented notable non-carcinogenic risks, especially to children. These metals were responsible for over 48 % of the cumulative hazard index (HI) across all ten cities evaluated. Furthermore, the HI for the adult demographic exceeded 1.0 (specifically 1.23) exclusively in Qorwe city. The study also identified a high carcinogenic risk associated with lead across the province, which has a carcinogenic risk of 7.3 × 10−03 in 10 studied cities, which is more than the guideline value of 10−04. The findings underscore the urgent need for continuous monitoring and the implementation of preventive measures to safeguard public health. The results provide crucial insights for policymakers and health authorities, facilitating informed decisions to mitigate the health risks posed by HM contamination in the region's groundwater.