Health Professionals Research Articles

Communication of EU agricultural antibiotic use policies to farmers & implications for public health

Abstract Background It is estimated that by 2050, ten million people will die each year from antimicrobial resistant infections. AMR is driven by the improper use of antimicrobials, particularly in agriculture. 73% of the antimicrobials sold globally are used in food-producing animals. Problem EU regulations 2019/6 and 2019/4 on veterinary medications and medicated feed require behavior change by farmers to reduce their antimicrobial use. While this is welcomed by public health professionals, the response of the farming community is more complicated, as these regulations exist within the complex context of the global food system and current political unrest between farmers and the EU. Given the influential role of agricultural media for farmers’ decision making, it is critical to understand how AMR and associated public health and EU policies are being communicated to farmers and how the views of specific stakeholders including farmer representative organizations, veterinary bodies and government regulators are being represented. To examine this problem, a case study content analysis of three major agricultural newspapers in Ireland is undertaken. Results Preliminary results suggest that AMR and AMU have been covered in the agricultural media with specific coverage on these EU policies. This includes negative coverage, with key terms such as “threatens”, “risk”, or “warns”, as well as potentially positive views (e.g. “hope”). Preliminary results also suggest that the agricultural media might be a useful source to identify the farming community’s concerns and reactions to EU policy, for example calls by farmer representative bodies for the national government to intervene. Lessons Public health professionals must recognize the important role of farmers in addressing AMR. Evaluating how EU policies on AMR are represented in the agricultural media can help to better understand how this public health issue and its solutions are being communicated to these important stakeholders. Key messages • Public health professionals must recognize the importance of animal health and the role of farmers in addressing the AMR problem. • It is critical to evaluate how EU policies on AMR and associated One Health issues are communicated to non-public health professionals.

Monthly Tracking of Infant Mortality in Portugal: Post-COVID Trends

Abstract Background The Infant Mortality Rate (IMR) is a fundamental health indicator that reflects the overall well-being of populations. Recognizing the need for more timely data to inform public health strategies, the authors have presented a novel method for monitoring IMR monthly instead of traditional annual reporting. Our work aims to increase further the robustness of a novel method for monitoring IMR monthly. Methods This new approach leverages the Portuguese E-Death Certification System (SICO) and Statistics Portugal (2016-2024) data. It provides the most recent insights into IMR trends in Portugal, highlighting the post-pandemic period. This method allows for the analysis of cumulative deaths under one year of age against live births over the previous 12 months, offering a more responsive metric to guide interventions. Results The updated analysis reveals a continued pattern influenced by the dynamic public health landscape of the COVID-19 pandemic, including the phasing out of restrictions and the end of mandatory mask usage. The pandemic has significantly impacted IMR trends, with Portugal experiencing a decline in IMR during the stringent phases, reaching historically low levels. This trend slightly reversed following the lifting of restrictions, underscoring the urgent need for understanding the complex interplay between public health policies and infant mortality. In the post-pandemic period, the IMR increased until October 2023, showing a later (up to February 2024) global decreasing trend within the range of 2.5 and 2.9 deaths per 1000 live births. Conclusions Recent updates confirm the effectiveness of real-time IMR monitoring as a vital tool for policymakers and health professionals. Portugal’s experience underscores the importance of real-time health indicators in managing public health crises. It stresses the need for further research to understand factors affecting IMR and to continue reducing infant mortality. Key messages • COVID-19 restrictions correlated with a historical low in Portugal’s IMR, showcasing the impact of stringent public health measures. • Post-lockdown, the rise in IMR after the phasing out COVID-19 restrictions and later stabilization underscores the challenges and the necessity for dynamic health policies.

Why greenhouse agricultural workers do not use pesticide protection methods? A case study

Abstract Background Exposure to pesticides in individuals working in greenhouse agriculture is an important public health problem that threatens their health more than individuals working in other agricultural jobs for the same period of time, causing an increase in mortality and morbidity rates. Applying protection methods plays an important role in reducing/preventing exposure-related health risks. It is aimed to explore the reasons why greenhouse agricultural workers do not use pesticide protection methods. Methods This case study was adopted the descriptive qualitative approach between February-March 2024. Individual in-depth face-to-face interviews were conducted with semi-structured interviews, resulting in 20 participants. The inclusion criteria for participants include being a greenhouse agricultural worker (at least 1 year), being 18 years of age or older, using pesticides, not using any personal protective equipment, and not engaging in protective behavior. Braun and Clark’s (2021) reflexive thematic analysis methodology was used to analyze the data. Results In this study generated three main themes and fourteen subthemes. The main themes identified were a) personal attitudes/ characteristics b) negative features of the physical environment, c) negative features of personal protective equipment. Conclusions The reasons why greenhouse agricultural workers do not use pesticide protection methods are individual attitudes/characteristics such as laziness and not to care about, negative characteristics of the environment such as temperature, humidity and wetness, and negative characteristics of personal protective equipment such as being heavy and inflexibility. Health institutions and health professionals serving in regions where agricultural workers should develop interventional studies, intervention programs and strategies to protect and improve the health of these individuals. Key messages • Greenhouse agriculture workers do not use any of the pesticide protection methods due to individual attitudes/characteristics, negative characteristics of environment and personal protective equipment. • Health professionals can ensure that greenhouse agricultural workers use pesticide protection methods by increasing their awareness of health risks and planning interventional studies.

Culinary medicine in type 2 diabetes management: co-designing the Cook2DIAbeat training program

Abstract Background Type 2 diabetes (hereinafter diabetes) stands among the top ten drivers of disease burden. Globally, more than 59 million adults are living with diabetes with a projection of 15% increase by 2045. The Cook2DIAbeat project aims to develop a tailor-made nutrition training program based on culinary medicine, for patients with diabetes to achieve lifelong dietary changes. The aim of the present work was to reveal potential drivers and barriers related to lifelong dietary modifications. Methods The study was implemented in February-July 2023 in Spain, Belgium, Greece, and Cyprus. A mixed-method co-design methodology was conducted: co-creation sessions with individuals with diabetes, family members, and healthcare professionals, and an online survey with patients with diabetes. Results In total, 23 health professionals and 25 patients and family members participated in the co-creation sessions, and 212 patients in the online survey. Patients and health professionals recognized the added value of the culinary approach for diabetes management. The main perceived barriers for changing dietary habits included difficulties accessing reliable and non-conflicting information, lack of time, emotional and psychological issues, and limited social support. Individuals at an advanced age and of low socioeconomic status seem to demand specific educational approaches addressing the actual challenges of their daily life. Conclusions The study indicated that training should provide reliable information and address psychosocial aspects. The translation of the dietary guidelines through the culinary medicine approach seems to be well-received by the target group. Last, the content needs to be tailored to suit the specific age group and socioeconomic background of the patients. Key messages • Reliability, practicability are three key characteristics of a nutrition training program in diabetes management. • Cultural and socioeconomic barriers needs to be taken into consideration.

3.X.1. Health literacy in Europe: Building a comparative database for shaping public health policy

Abstract Health literacy (HL) is a key determinant of health and a lever for health equity. It refers to the extent to which individuals are able to deal with health-related information, communicate with health professionals, and navigate the health care system to restore, maintain, protect, and improve their health and well-being. It is the result of an interplay between personal motivation, individual competencies and the health information and service environment. HL is strongly related to health behaviors and issues such as obesity, the social determinants of health, and the use of health systems, which have been under pressure since COVID-19. The development and implementation of targeted public health interventions to promote HL in the European Region require reliable and comparable data on population HL to identify the main HL challenges and the most affected population groups. The WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) has started monitoring population HL and conducted the first M-POHL Health Literacy Survey (HLS19) in 17 countries in the WHO European Region between 2019 and 2021. In preparation for the 2nd M-POHL Health Literacy Survey (2024-2026; HLS24), the HLS19 instruments were further improved and supplemented by a new measure on mental HL. These instruments are also of interest to the European Joint Action PreventNCD with its specific task on HL and non-communicable diseases (7.4). The workshop will provide insights into the M-POHL HLS24, the largest HL survey in Europe, and the HL instruments used. It consists of four presentations, one describing the M-POHL HLS24 project and three on specific HL instruments used to assess different aspects of HL in the European general population: HLS24-DIGI for digital HL; HLS24-COM-P for communicative HL; HLS24-NAV for navigational HL. Each presentation will describe the revised item set and results from pretests. We invite the audience to ask questions and to engage in a (cross-cutting) discussion with the presenters. Expected impact: The presentations will provide a comprehensive overview of the advanced family of instruments used in the HLS24 study, their quality, and the expected HL data for Europe. They will provide a deeper understanding of how HL will be measured in the M-POHL HLS24 project. Key messages • The advanced family of HL instruments used in the M-POHL HLS24 project enables comprehensive HL monitoring in Europe. • The data collected in HLS24 will provide a solid database for shaping public health policy to strengthen population HL and promote health equity in Europe.

Health literacy from the perspectives of children and adolescents - a meta-ethnography

Abstract Background The current literature on health literacy rarely considers the views of children and adolescents. The aim of our qualitative evidence synthesis was therefore to develop a child- and adolescent-centered conceptualization of health literacy. Methods We conducted a meta-ethnography of qualitative studies. Our iterative literature search considered the literature up to November 2023. We dually screened 1596 abstracts and 97 full texts, assessed the methodological limitations of the 32 included studies, and considered 21 data-rich studies in the analysis. We extracted first- and second-order constructs, translated the studies into each other, and developed a coherent argumentation. We dually assessed the trustworthiness of the evidence. Results The resulting model comprises micro-, meso-, macro- and chronosystems. It highlights the influence of demographic, cognitive and psychological factors on the development of health literacy in children and adolescents at the micro level, the social environment, including family, friends, peers, teachers, and health professionals at the meso level, and the media and internet, the health and education system, the living environment, and the social narrative about health at the macro level. The chronosystem shows the impact of upbringing, development, and experience. Children absorb health information actively and passively, employing various strategies to evaluate its trustworthiness. They seek advice from their social environment, which acts as a source of information and influencing factor. Different types of information are weighed up and ranked before action is not taken. Conclusions Existing models of health literacy are too one-dimensional to be applied to children and adolescents and do not consider their social and living environment. The proposed model offers a comprehensive understanding of health literacy in children and adolescents. It can be used as a basis for future interventions to improve health literacy. Key messages • Health literacy of children and adolescents is significantly influenced by a combination of internal and external factors. • By incorporating the perspectives of children and adolescents, we have developed a more inclusive and nuanced understanding of health literacy.

Harnessing social marketing for interdisciplinary health management: enhancing public health outcomes

Abstract Social marketing in health leverages the principles of traditional marketing to influence behaviours that benefit individuals and communities. It involves using marketing techniques to promote public health initiatives, aiming to change attitudes and behaviours towards healthier choices. By strategically framing health messages, social marketing can effectively reach diverse populations, encouraging them to adopt practices that enhance their wellbeing. This approach not only increases awareness about health issues but also empowers people to take proactive steps in managing their health, ultimately leading to improved public health outcomes. Showcasing a forward-thinking approach to public health management, this plenary session seeks to shed light on the transformative role of interdisciplinary collaboration in enhancing health outcomes. Recognising that health and wellbeing are influenced by a myriad of actors beyond the healthcare sector, there is a growing imperative to empower professionals from diverse disciplines with health management principles. By effectively ‘social marketing’ health management to those outside the traditional health sector, such as in architecture, urban planning, construction, education, transportation, and manufacturing, health-oriented decision-making can be seamlessly integrated across these fields. The session will highlight innovative approaches for engaging non-health stakeholders in decision-making processes, leveraging the expertise of health management and public health professionals. By facilitating a dialogue between health professionals and experts from other sectors, the session will explore the potential and challenges of intersectoral partnerships, and challenge policymakers, health managers, and stakeholders in the health sector to actively engage non-health professionals in their pursuit of improved health outcomes for European citizens. Case studies from across Europe where interdisciplinary collaborations have led to social programming and infrastructure developments that enhance health and wellbeing will be presented. The case study ‘Compassionate leadership’ will delve into how organisation leaders can harness their health management capacity to foster a supportive environment that prioritises wellbeing. ‘Health-centric design in public spaces’ will demonstrate the impact of designing public areas with a focus on health, showcasing how thoughtful urban planning can significantly enhance community health. The third case study, ‘Architecture for better health and healing’ will highlight the role of architectural design in promoting health and recovery, emphasising the importance of creating spaces that support healing. Finally, ‘Educating to health’ will underline the significance of educating young people to healthy habits, sustainability, and physical and mental wellbeing, illustrating how this can lead to healthier communities. By fostering broader interdisciplinary collaboration, it is possible to unlock innovative solutions to health challenges and ultimately create healthier, more resilient communities across Europe. Moderator Tiago Correia Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Portugal, and Board Member of the EHMA Speakers/Panellists Marina Macchiaiolo Rare Diseases and Medical Genetics Unit, Bambino Gesù Children’s Hospital, Italy, and President of the Italian Committee for the United World Colleges Stefano Capolongo Department of Architecture, Construction Engineering and Built Environment (ABC), Politecnico di Milano, Italy

Life course prevention - challenges for public health lying ahead

Abstract Issue/problem Demographic and epidemiological transitions have now shifted the focus from vulnerable population groups onto the active population, in particular young adults. At the same time lessons from the covid-19 pandemic taught us about missing actions on the elderly. While the latter have shown compliance and have followed most preventative activities, we observe scepticism and reluctance in the young adults. Description of the problem The covid-19 pandemic showed that young to middle-aged adults were the most reluctant group to adhere to preventative measures but in complying to the recommendations concerning vaccination. Since European activities are now focusing on addressing determinants of NCDs and are hoping to mobilise all population strata, including young and middle-aged adults, it would be important to explore how this mindset might affect the overall attitude to prevention. Results Health policy should explore specifically the needs of young to middle-aged adults (e.g. ages 30 to 44) to list their specific needs, expectations from preventative activities. On the other hand, it would be necessary to find out about the concerns, reluctance, and objections. The interplay of these will play a significant role in acceptance of present and future preventative activities. Exploration on these topics presents the following challenges: 1. Multiple sources of information on given health problems; 2. Lack of structured accessible and well-understandable explanations of advantages and benefits; 3. Inappropriate communication by health professionals or agencies on their behalf; 4. Complexity of the problem, which is then translated into complex and not easily understood messages. Lessons Learning about the specific needs of young adults, their expectations from the health systems in terms of prevention and health care as these will shape their overall attitude to prevention and have an impact on their families, particularly children. Key messages • Knowledge about expectations, needs, concerns, and reserves with respect to prevention is essential for the future activities on prevention. • Involving young and middle-aged adults in the preparation of the future preventative activities for their population groups is essential.

Atrial fibrillation, prevention and rehabilitation in a primary healthcare setting. A feasibility study

Abstract Background Atrial fibrillation (AF) often influences daily life with symptoms like palpitations, dyspnoea, fatigue, fear and anxiety. Research show that patients with AF benefit from prevention and rehabilitation interventions. However, evidence is scarce and mainly hospital-based, and it is unknown whether the transition to the primary healthcare sector gives the same positive results. In 2019, a Danish primary care Health Center and the cardiology department at the local hospital completed a multidimensional prevention and rehabilitation intervention for patients with AF. Purpose To investigate the feasibility of delivering a multidimensional prevention and rehabilitation intervention for patients with AF in a primary care Health Center. Methods This study was a mixed-methods, non-randomized, intervention, feasibility study. A convergent mixed-methods design was used, and results were illustrated in side-by-side joint displays. Patients were included at a Hospital AF clinic referring to the Health Center. The prevention and rehabilitation intervention consisted of risk factor management, patient education, physical activity and yoga. Two patient-reported outcomes measures (PROMs) were used, the HeartQoL measuring health-related quality of life (HRQoL) and the Hospital Anxiety and Depression Scale (HADS) measuring symptoms of anxiety and depression. Data were collected at baseline (T0), at end of intervention (T1), and at two-months follow-up (T2) and analysed descriptively. Focus group interviews were analysed thematically and covered experiences of participating, needs and preferences, outcomes and feasibility of collecting PROMs. The reporting was guided by the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. Results 43 patients (53% women; median age 66 (range 52-81) years) completed the intervention. Table 1 shows that HRQoL increased, and symptoms of anxiety and depression decreased. These results maintained at follow-up. Figure 1 shows the qualitative themes. Patients experienced being understood and supported by health professionals and peers. They thought it difficult to know what their needs were. However, some patients had specific preferences for interventions. For changes in outcomes, the patients identified that gaining tools and knowledge about the disease from the interventions helped. It was feasible to collect PROMs during the intervention and finally, the patients had an attention to what comes next, when finishing the intervention in the primary care setting. Conclusion It was feasible to deliver a multidimensional prevention and rehabilitation intervention for patients with AF at a primary care Health Center. HRQoL increased and symptoms of anxiety and depression decreased. The patients experienced being supported and gaining tools and knowledge to handle AF. Future large randomized controlled trials must confirm these results.

Participation rate and yield of indirect cascade genetic screening for familial hypercholesterolemia using a web-based communication platform (CATCH): a randomized multicenter implementation trial

Abstract Introduction Cascade genetic screening for familial hypercholesterolemia (FH) is poorly performed when direct contact with relatives by health professionals is not allowed. We aimed to compare the effectiveness of implementing a web-based communication platform in a large-scale cascade genetic screening program for FH, while maintaining the confidentiality of indirect family contacts. Methods The CATCH study is a prospective randomized open-label multicenter implementation trial that promotes family cascade genetic screening in Swiss adults older than 16 years with a newly diagnosed pathogenic variant for FH. Each family was randomly assigned to a multigenerational indirect cascade genetic screening (1:1) either via the possibility to use of a web-based platform designed to send pre-prepared text messages or emails, and allowing to connect to a specialized clinical center, or a cascade genetic screening via the local recommended procedure. The primary outcome was the 6-month participation rate of relatives, defined as the number of genetic tests performed within 6 months after referral, over the number of eligible relatives for screening, i.e. living first-degree relatives aged 5 years or older. The secondary outcome was the 6-month yield of positive genetic tests, defined as the number of positive tests over the number of eligible relatives. Both outcome estimates were obtained after accounting for family clusters. Results Between 11/20 and 12/23, we enrolled 221 adults with a phenotype of FH for genetic testing, with 87 of them having confirmed genetic FH, corresponding to a total of 401 eligible relatives for cascade screening, with 102 relatives eventually undergoing genetic testing. Among the 87 index cases with genetic FH, 44 were randomly assigned to the web-based platform screening, and 43 were assigned to the local procedure screening. The 6-month participation rate of relatives was 71 of the 218 eligible relatives (29% [95% CI 21–38]) for the web-based platform screening, and 31 of the 183 eligible relatives (14% [95% CI 8–23]) for the local procedure screening (odds ratio (OR) 2.46 [95% CI 1.22–4.98]), p=0.012) (Figure). Similarly, the yield of detection of positive relatives was higher for the web-based platform screening, (16% [95% CI 11–23]) compared to the local procedure screening (7% [95% CI 4–13]), with OR of 2.43 [95% CI 1.11–5.30], p=0.026. Among the 55 positive relatives identified with genetic FH within 6-months, 13.0% were younger than 18 years, 25.5% were current smokers, and 56.0% were not using any lipid-lowering drugs. Conclusions The effectiveness of cascade genetic screening for FH was approximately doubled by integrating a web-based platform that facilitates family communication and access to specialized clinical centers. Modern communication technology is well suited to be integrated in large-scale indirect genetic screening programs to increase the early identification of patients at high cardiovascular risk.

Integrating SDGs, One Health and transdisciplinarity into AMR Education Strategies

Abstract Introduction The increasing prevalence of Antimicrobial Resistance (AMR) threatens modern medicine, undermines food security, and impedes environmental sustainability. The complexity of AMR requires various stakeholders to contribute to mitigate this challenge. We discuss the critical need for integrating the One Health framework, transdisciplinarity, and Sustainable Development Goals (SDGs) within AMR education; and demonstrate how these integrations enhance the effectiveness of educational strategies against AMR. Methods Through a review of existing literature and analysis of multiple interventions, we synthesize findings from instances where One Health strategies have been applied. We assess their effectiveness in fostering cross-sector collaboration and enhancing health outcomes, thereby providing a grounded framework for developing integrated educational strategies. Results Our analysis reveals that AMR education programs incorporating the SDGs and One Health principles are more likely to foster interprofessional collaboration and a deeper understanding of AMR. Case studies demonstrate that such educational approaches significantly improve the preparedness of health professionals in managing AMR through innovative and cooperative approaches. Despite the significant potential of One Health education in impacting global health positively, current interventions lack specific SDG indicators directly related to AMR, suggesting a gap in policy and global health prioritization. Conclusions By aligning AMR education with SDGs and One Health, there is an opportunity to enhance global health security. We call for a paradigm shift in educational strategies to effectively combat AMR, advocating for policy reforms and curriculum adjustments to incorporate these integrated approaches. The findings are crucial for educators, policymakers, and healthcare professionals aiming to redesign AMR education to be more comprehensive and globally oriented. Key messages • AMR education integrated with SDGs and One Health enhances interprofessional collaboration and understanding, improving health professionals’ preparedness to manage AMR effectively. • Current AMR educational strategies lack specific SDG indicators; aligning education with SDGs and One Health can significantly boost global health security.

Same term, but unequal understanding: differences in digital public health intervention features

Abstract Digital technologies have transformed healthcare delivery and public health, with many countries integrating interventions such as online consultations, electronic health records, and telemedicine to improve population health and healthcare accessibility. Multinational assessments for benchmarking system maturity ask for the degree of implementation of such tools. However, are these interventions as comparable as they claim to be? This talk presents a qualitative analysis of 179 digital public health (DiPH) interventions described in scientific articles. We categorized interventions based on their implementation stages, public health functions, and reported and non-technical features. Telemedicine, health apps, and electronic health record interventions dominated the diverse landscape. While these technology groups already differed greatly in their functions, we identified equally significant differences in the reported intervention characteristics within the groups. For example, telemedicine was not only used in healthcare settings for patients and health professionals but also in primary prevention and research for researchers, policymakers, and healthy individuals. Different interventions reported varying functions, such as remote monitoring, self-monitoring, alarm systems, patient motivation, and user empowerment modules. So, is there one common telemedical intervention? No. Instead, all individual technologies differed to varying degrees. The analysis underscored the diversity of DiPH interventions among and within intervention groups and highlighted the importance of precise terminology for effective planning and evaluation. Instead of using broad classifications like ‘telemedicine,’ interventions should be defined and communicated based on specific technological functions, non-technical characteristics, use cases, and user groups. This approach will promote cross-disciplinary collaboration and foster international comparability across DiPH systems.

Building bridges: mobile mental health care units in four European countries

Abstract Background Individuals living in rural and remote areas may have limited access to mental healthcare due to lack of facilities, socioeconomic reasons, stigma and lack of mental health literacy. To meet the needs and provide needs-based care care mobile mental health care clinics were established in some countries in Europe, including in Belgium, Germany, Greece and in Moldowa. A mobile clinic is a customized motor vehicle that travels to communities to provide mental health care. The mobile clinics are an integral part of the health care system and help ensure access to mental care. Aims To describe mobile care clinics in two countries in Europe using a case study design. Results Mobile clinics deliver a wide variety of mental health services, are heterogeneous and consist of multidisciplinary teams, including physicians, social workers, and other health professionals. The organization and financing of the Mobile mental health clinics is different in the four countries (e.g. part of the mental health care system in Belgium, and Moldova, part of initiatives in Germany and Greece). Due to data protection no detailed data on patients can be provided at the moment. The structures on mental health care mobile clinics in the four countries will be described in detail in the talk. Discussion Mobile clinics often serve as a bridge between communities and the mental health care system. Another important issue in rural areas is the ongoing aging of the population. The number of Elderly patients is expected to rise in the future. The care of those patients is challenging for the mental health and the primary care system. There is a necessity for establishing bridges between mobile clinics and hospital care.

Driving innovation in primary healthcare though co-creation with stakeholders in Switzerland

Abstract Issue/problem Primary healthcare systems worldwide face challenges such as socio-demographic shifts, increasing chronic diseases, rising costs, and workforce shortages, demanding innovative solutions for the future of primary care. Description of the problem Addressing the complex challenges of creating a resilient primary healthcare model involves considering interdependent factors such as health policies, funding, workforce training, technology, and evolving diseases, alongside diverse stakeholder interests. To tackle this, the ‘Health2040: Co-creation of a Future Outpatient Primary Healthcare Model in Switzerland’ project was launched in 2023 to develop a forward-looking model by integrating insights from various stakeholders. Results The project involved 40 stakeholders, including patients, researchers, healthcare professionals, policy-makers, and insurers, in two full-day workshops aimed at co-creating a vision and actionable framework for Switzerland’s future primary care. The first workshop focused on developing and visualizing potential models, while the second targeted the transition to these new models and the creation of an implementation plan. These sessions were underpinned by a comprehensive literature review on emerging primary care models, providing a scientific foundation for the discussions. Lessons Successful co-creation requires significant preparatory efforts and innovative creativity techniques, such as Future Newspapers, brainstorming, games, and user personas. Engaging stakeholders throughout various stages of the project helped to enhance relevance. Feedback from a steering group on the workshop’s concept, methodologies, and evidence synthesis was instrumental. Healthcare practitioners also contributed their insights on patient personas, ensuring the models developed were pertinent to actual healthcare practices. Stakeholder engagement process was essential for fostering innovative ideas and ensuring stakeholder buy-in for the developed solutions. Key messages • Co-creation with stakeholders is a promising way to develop innovative solutions for health systems. • Integrating stakeholder input is crucial at all the project stages, from preparation to evaluation.

A healthcare workforce assessment model using reimbursement data in Luxembourg

Abstract Background The assessment of the healthcare professional (HCP) headcount and level of activity is a real challenge for policy makers. In Luxembourg, there is no uniform definition of practicing HCP. This work focused on identifying a method to assess HCP headcount and their level of activity in Luxembourg, while finding national consensus. Methods A thorough literature review was conducted to find methods that assess practicing HCP and identify their level of activity. Eligible were scientific papers or national reports discussing methods on employed and self-employed HCP. National reimbursement data were used for preliminary data explorations conducted alongside the ‘General Inspectorate of Social Security’ in Luxembourg and discussed with the ‘Institut national d’assurance maladie-invalidité (INAMI)’ in Belgium. Two working groups were planned with national stakeholders to discuss HCP assessment methodologies. Both the collaborations and the working groups led to a preliminary validated HCP assessment method. To reach national consensus, a Delphi study is planned in June 2024, using the eDelphi.org platform. Invited panelists include researchers, professionals, healthcare practitioners, decision makers and policy makers, patient representatives, and insurers. Results The literature review found 16 eligible papers on HCP headcount and HCP’ level of activity. Finally, the Belgian method, developed by experts from INAMI, using reimbursement data and establishing a median reimbursement for each medical specialty was retained for Luxembourg. The results of the Delphi study will inform on the level of agreement on relevance, clarity and completeness of the proposed methodology for Luxembourg. Discussion Finding national consensus represents a strong foundation for efforts to advance the use of the proposed methodology in healthcare workforce assessment and planning. Key messages • Counting something as simple as healthcare professionals requires a strong methodology that held the buy-in of all major stakeholder. • As working behavior of HCP evolves over time, it is crucial to not only count professionals but also full-time equivalents for policy makers to plan ahead in an accurate manner.

Knowledge and attitudes of the Italian population on sharing health data: a cross-sectional study

Abstract Background Healthcare digitization enhances data accessibility but faces data management and privacy challenges. The study sought to explore the Italian public’s understanding and views on storing and sharing health data for treatment and research purposes, as well as factors influencing their attitudes toward health data management and sharing. Methods A cross-sectional questionnaire assessed socio-demographic information, knowledge about health data sharing, and attitudes toward sharing data for treatment and scientific purposes. Descriptive analyses and multivariable logistic regressions were performed to examine the associations between sociodemographic factors and knowledge/attitudes about data storage and sharing. Results A total of 1,389 citizens participated. Most respondents (65.4%) thought that healthcare providers could access personal health data nationwide, while 94% expressed willingness to share personal health data nationwide. A high percentage of respondents (73%) fully agreed that storing and sharing personal health-related data could improve research and quality of care. Males and younger individuals (<41 years) were likelier to have higher data-sharing knowledge (adjusted Odds Ratio [adjOR] 1.50, 95% Confidence Interval (CI) 1.03 - 2.18, and adjOR 1.99, 95% CI 1.29 - 3.08 respectively). Lower educational-level respondents exhibited lower positive attitudes towards sharing health data for treatment and research purposes (adjOR 0.18, 95% CI 0.05-0.58 for high school, and adjOR 0.11, 95% CI 0.03-0.41 for middle school or lower, compared to those with a university degree). Conclusions The findings offer valuable perspectives for European policymakers, healthcare practitioners, and researchers who aim to enhance data handling, foster cooperation, and maximize the benefits of health data for tailored care and scientific progress. Key messages • Italian citizens show strong willingness to share health data nationwide for treatment and research, suggesting a favorable environment for collaborative healthcare initiatives. • Sociodemographic factors such as age and education level influence attitudes towards health data sharing, stressing interventions to ensure equitable access and participation in data-driven healthcare.

Co-creating stigma-prevention strategies for mental health interventions with migrant populations

Abstract Background The ADVANCE project aims to address mental health disparities among people in a situation of vulnerability in Europe. Through a co-creation approach, workshops were conducted to devise stigma prevention strategies during the implementation of mental health promotion interventions for migrant populations in Italy and Denmark. Methods The methodology involved two rounds of scenario-based workshops, a participatory method that elicit expert opinions to solve local problems and anticipate future ones. Round 1 included two separate workshops with (1) end-users and umbrella organizations, and (2) healthcare practitioners and decision-makers, to ensure diverse perspectives and minimize the impact of power imbalances. Participants brainstormed strategies to minimize stigma and optimize the intervention scenario. In Round 2, a mixed-group workshop was held to refine the strategies. Workshops occurred in Copenhagen and Verona in March 2024. Content analysis of the data was carried out. Results In Denmark, discussions emphasized tailored presentation of the intervention promoting shared experiences and normalizing mental health challenges, language sensitivity, participation through self-identification, and attention to relational aspects in intervention delivery to combat stigma effectively and enhance acceptability and engagement with the intervention. In Italy, proposed strategies included group exercises to raise awareness and promote open dialogue about cultural differences, language barriers, and discrimination. Discussions also considered the intersectionality of stigma, including factors like gender, socioeconomic status, and sexual orientation. Common themes included language sensitivity, facilitator training, and inclusive and safe spaces. Conclusions Scenario-based workshops can be a valuable tool to facilitate the co-creation of stigma-prevention strategies while involving all stakeholders in promoting effective mental health interventions. Key messages • Co-creation approach fostered stakeholder collaboration, yielding tailored strategies that promote inclusivity, acceptability and engagement with mental health interventions for migrant populations. • Context-specific approaches that emphasize trust, confidentiality and cultural sensitivity were prioritised to tackle stigma when implementing interventions and promoting mental health equity.

Including highly educated migrants in academia to improve their health—protocol for a pilot intervention

IntroductionNorway’s healthcare system needs a diversified work force to meet societal demands for improved cultural competence. However, many migrants in Norway who were educated as health professions in their home countries are not practicing these professions. This may negatively affect their physical and mental health and hinder their personal social integration. Though good health is often seen as a precondition for work, relevant working activities can also improve health. However, including health professionals with foreign education in academic institutions prior to receiving necessary accreditation is a complex task. This study will pilot an intervention aiming to improve health through meaningful integration of these professionals in academic environments.Materials and methodsThis paper is a protocol for a non-randomized pilot intervention study targeting migrants who are waiting for their health education accreditation in Norway. To test the benefits of meaningful activity on health and explore possibilities for implementing such activity, we have designed a six-month long intervention consisting of including nurses, doctors, and other highly educated migrants with healthcare backgrounds between 20 and 67 years of age, into health-related working tasks, at two higher education institutions in Bergen, Norway. The intervention will be tailored according to the participant’s expertise. This hybrid type 2 pilot protocol paper will present how feasibility, fidelity, dose received (satisfaction), and dose of exposure (participation), will be assessed and whether the intervention is experienced as beneficial for the participants’ health as primary outcome utilizing both quantitative and qualitative methods.ConclusionWe present a complex, personalized intervention that has the potential for large scale implementation in the future. By thoroughly presenting our designed intervention and assessment methods, this protocol will add to the study’s transparency and facilitate replicability and comparison with future studies. This study will be of benefit to the migrants themselves, policy makers, government agencies and academia at large as it can point to a unique and sustainable way of speeding up the integration of highly educated migrants in their respective fields in a new host country.

Pengaruh Pemberian Omlet Daun Katuk Terhadap Kejadian Kurang Energi Kronis (KEK) pada Ibu Hamil di Puskesmas Bukit Kemuning

Chronic Energy Deficiency (CED) is a nutritional problem in pregnant women which is currently a nutritional problem in the world. The World Health Organization (WHO) explains that the prevalence of Chronic Energy Deficiency (KEK) in general in pregnancy is 35% to 75% (Abadi Putri, 2020). Lampung Province, KEK pregnant women is 13.62%, while in North Lampung Regency it is 9.92% (Riskesdas, 2018). The aim of this research is to find out whether there is an effect of giving katuk leaf omlet on the incidence of chronic energy deficiency (CED) in pregnant women at the Bukit Kemuning Community Health Center. This type of research uses a quasi-experimental method (quassy experiment) with a one group pretest-posttest design. The population of this study was all pregnant women with Chronic Energy Deficiency (CED), namely 16 pregnant women. The sampling technique uses the total sampling method. Data were collected using observation sheets and body weight measurements using digital scales and LILA measurements using LILA tape. The statistical tests used were the paired test to the T-Test and the Wilcoxcon Test. The results of the study. Giving katuk leaf omlet affected the weight of KEK pregnant women at the Bukit Kemuning Community Health Center (p-value = 0.000) and giving katuk leaf omelette had an effect on the LILA of KEK pregnant women in Bukit Kemuning Community Health Center (p-value = 0.027). Giving katuk leaf omelette for 30 days had an effect on the incidence of KEK at the Bukit Kemuning Community Health Center. In this research, it is hoped that health workers can provide mothers with the ability to consume nutritious food, and can introduce other local PMT which are consumed by pregnant women. Pregnant women with CED must consume food according to their needs to meet their nutritional intake.

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.