Health Status Research Articles

Recent Advances in Amperometric Biosensors for Medical Applications: A Mini-Review.

Amperometric biosensors have emerged as a cutting-edge technology in clinical diagnostics, thanks to their high level of sensitivity, rapid analytical results, compact size, and ability to monitor health parameters non-invasively and continuously using flexible and wearable sensors. This review explores the latest developments in the field of amperometric biosensing for medical applications. It discusses the materials used to construct these sensors and pays particular attention to biosensors designed to measure glucose, lactate, cholesterol, urea, and uric acid levels. The review also addresses the technological limitations and drawbacks of these devices. Furthermore, it presents the current status and identifies future trends in the development of flexible, wearable biosensors capable of providing continuous monitoring of a patient's health status.

The health of older caregivers in Spain: a matter of age or a matter of care?

Abstract Introduction Informal care is crucial in Spain’s care system, with a rising number of caregivers aged 75 or older, yet studies on its health effects are lacking. This study aims to determine the differential impact of age and care-related variables on the health of older caregivers. Materials and methods This is a cross-sectional, national study with a sample of 3,870 informal caregivers from the Spanish 2020 Disability, Personal Autonomy and Dependency Survey. We performed a logistic regression where self-reported deterioration in caregiver health due to caregiving was the dependent variable and age (<75 vs. ≥ 75) was the independent variable. Caregivers’ sex, educational level (primary and lower or secondary and higher), income (<1,150 euros per month vs. ≥ 1,150), severe functional limitation of caregivers and care-receptors (yes or no), duration of care (< 8 years vs. ≥ 8 years), and daily hours of care were used as covariates. Results One in 6 caregivers was 75 or older (16,1%). Caregivers’ mean age was 58.4, and care-receptors’ 66.6 years. Women represented 63.0% of caregivers, and 42.8% of care-receptors. Up to 4.6% of caregivers had a severe limitation, and 43.7% of caregivers reported deterioration of their health due to caregiving. A greater perception of deterioration in caregiver health due to caregiving was associated with being 75 years or older (β = 0.34, p = 0.009). Covariates associated with caregivers’ health deterioration were being a woman (β = 0.77, p < 0.001), presence of severe limitation of care receptors (β = 0.58, p < 0.001), and increased daily hours of care (β = 0.01, p = 0.013). Caregivers’ severe limitation, level of education, income and years of care did not show a significant association with perception of health deterioration. Discussion Caregivers older than 75 years in Spain experience a key deterioration in their health associated with caregiving. This vulnerable population must be prioritized in health and social policies. Key messages • One out of 6 caregivers in Spain is aged 75 years or older. Caregiving impacts greatly in their health status. • Older caregivers is a vulnerable population that must be a priority for health and social services.

Measurability of overall health in patients with chronic gastrointestinal disorders

Abstract Background Chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) patients experience problems in all life areas. The Positive health (PH) concept, based on six different dimensions of health, may hold the answers for a broader understanding of the patients’ well-being. Aim To measure the overall health status of GI-HPB patients, according to the PH concept. Methods In 2019-2021, patients with GI-HPB attending the outpatient clinic of the Maastricht University Medical Center filled in questionnaires before consultation. The six dimensions of PH (bodily functions, mental well-being, meaningfulness, quality of life, participation, daily functioning) were measured by validated questionnaires (Gastrointestinal Symptom Rating Scale, Short Nutritional Assessment Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Short Form-36, Disease Experience Questionnaire, EuroQol-5D-5L). Results were compared to control groups and assessed with McDonald’s Omega, Zero-order Pearson correlations, and t-tests. Results The 235 participating patients scored lower on quality of life, participation, and daily functioning than healthy controls (p ≤ 0.001) but similar to those with other chronic conditions. Malnutrition (moderate-severe 45.6%) and depressive/anxious symptoms (35%/21.6%) were higher in the GI-HPB group compared to those with other chronic conditions. Conclusions Validated questionnaires addressing the six dimensions of PH showed a significant worse health status compared to controls, and malnutrition and depressive symptoms were higher compared to other patient groups. Key messages • GI-HPB patients have a lower quality of life, participate less, and have less daily functioning than healthy controls and higher malnutrition and depression than those with other chronic diseases. • By using validated questionnaires, an impression of the overall health status of patients can be obtained through the concept of Positive Health.

Workplace health promotion in the German Federal Armed Forces-Economic analysis and health benefits

Abstract Background In the German Federal Armed Forces (GFAF) workplace health promotion measures (WHPM) are implemented since 2015 to promote the health of military and civilian employees and thus improve the ability to defend state interests. Here the aim is to evaluate the social and health benefits associated with WHPM in relation to expenditures for WHPM. Methods Calculations are based on data from departmental reporting (full survey) on WHPM, the number of participants and days of incapacity for work (DIW). Mean indirect costs for the WHPM participation and DIW were calculated as 249.33 Euro per DIW. To assess the costs for the use of health care services and social and health benefits a longitudinal observational study (T0: 06-09/2022; T1: 06-09/2023) was conducted online and paper based. The survey invitation was addressed to 223.967 employees of the GFAF. Statistical analyses were performed using R software. Results In departments offering WHPM the chance of DIW is lower (-19%) compared to departments without WHPM offers and in case of DIW, the duration is shorter (-10%). In T0 23.568 (10.5%) and in T1 14.059 (6%) employees participated. 63.9% (T1: 3.070/4.805) reported positive effects of WHPM on their working ability and general health status (T1: 63.0% (3.013/4.782)). Of those participating in WHPM 81% (T0: 5.442/6.716) would recommend the GFAF as an employer. A number of 4.540 employees participated in both surveys, of which 2.249 participated in WHPM. The average costs per employee participating in WHPM compared to employees not participating are 0,4% higher (T0; T1: 3,5%) and thus almost equal. Conclusions Although WHPM need expenditures, the total costs per employee participating and not participating in WHPM are comparable. WHPM participants report better self-rated health status, higher working ability and commitment to the employer than non-participants. The chance of DIW is reduced in departments offering WHPM to its employees. *shared authorship Key messages • Although WHPM need expenditures, the total costs per employee participating and not participating in WHPM are comparable. • Employees participating in workplace health promotion measures report higher working ability and commitment to the employer.

Impact of the transition to retirement on alcohol consumption: a longitudinal analysis within SHARE

Abstract In an ageing society, the impact of retirement on behavioural risk factors and health status needs to be carefully assessed. Evidence on the short-term and long-term effects of retirement on alcohol consumption are contrasting and inconsistent. A longitudinal study was conducted based on data from the Survey on Health, Ageing and Retirement (SHARE) collected between 2004 and 2020 in 27 European countries and Israel. A repeated measure generalised estimating equation (GEE) model was fitted to estimate the relative risks (RR) and corresponding 95% confidence intervals (CI) of alcohol consumption (frequency, quantity, and binge drinking) at different time periods before and after retirement. We selected a cohort of 8,998 individuals who were employed at baseline and retired during follow-up (median follow-up: 9 years; maximum: 16 years). Compared to the year of retirement, the RR for habitual daily or near-daily drinking was 0.88 (95%CI 0.76-1.02) 10 years before retirement and 0.92 (95%CI 0.83-1.02). This pattern reversed post-retirement with a RR of 1.12 (95%CI 1.01-1.23) 3-4 years after retirement and 1.28 (95%CI 1.11-1.48) 10 years or more after retirement. No significant changes in the consumption of high volumes (more than 8 units of alcohol) were observed: while the frequency of regular drinking might increase post-retirement, the instances of heavy episodic drinking do not necessarily rise. Additionally, a reduction in occasional heavy drinking episodes was noted both before (RR 0.86; 95%CI 0.77-0.95, 5-9 years prior) and after retirement (RR 0.78; 95%CI 0.66-0.93, more than 10 years after). These findings underscore the complexity of alcohol use behaviours in the context of retirement. The increase in regular drinking post-retirement might be attributed to changes in daily structure, social interactions, or coping mechanisms for life transitions. The decline in binge drinking suggests a shift towards more moderated consumption patterns as individuals age. Speakers/Panelists Licia Iacoviello University of Insubria, Varese, Italy João Vasco Santos University of Porto, CINTESIS, ARS Norte, Porto, Portugal

Assessing Health Gains: A Cost-Utility Analysis

Abstract Background With the increase in life expectancy and the consequent shift in the epidemiology of chronic diseases, the need to enhance and measure the population’s health status is even more imperative. The aim of this study is to assess health gains and their associated costs provided by an Italian clinic. Methods A retrospective study was conducted on 129 patients admitted for short-term planned hospitalization from June 2020 to August 2023. At both admission and discharge, these patients completed the EQ-5D-5L questionnaire. Quality-Adjusted Life Years (QALYs) were calculated from the difference in EQ-5D-5L scores between discharge and admission, assuming that health gains (discounted at a rate of 3.5%) accumulate up to two years after discharge. Cost-utility analysis was performed using QALYs and invoices issued by the clinic (cost of hospital stay: 250 Euro/day). Patients were stratified by gender, age (geriatric and non-geriatric), and length of stay (LoS). Descriptive statistics (median and interquartile range) and statistical analysis (Mann-Whitney test) were conducted using STATA software. Results The sample comprised 129 patients (55% female) with a median age of 81 [11] years and a median LoS of 16 [16] days. The median QALY gained was 0.33 [0.38], higher for males (0.35 [0.34]) than females (0.29 [0.45]). Patients younger than 65 years old experienced a greater gain in QALY (0.41 [0.42]) than geriatric patients (0.32 [0.38]) (p > 0.05). Patients with a longer LoS had a greater gain in QALY (0.35 [0.42]) than those with a shorter LoS (0.23 [0.29]) (p < 0.05). The median cost per QALY gained was 14,337 Euro, lower for males (13,803 Euro), non-geriatric patients (13,743 Euro), and those with a shorter LoS (10,670 Euro) (p > 0.05). Conclusions Despite disparities in QALY gains between groups, the median cost per QALY gained remained relatively constant. These findings underscore the importance of tailored interventions for effective resource allocation. Key messages • Differences in QALYs indicate the need for personalized healthcare strategies to optimize patient outcomes. • The constant cost per QALY underlines the importance of effective and efficient allocation of resources.

The M-POHL Health Literacy Population Survey 2024-2026 (HLS24)

Abstract Background Inspired by the first European Health Literacy Survey (HLS-EU) and its policy impact, the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) was established in 2018 under the auspices of WHO Europe to monitor and strengthen health literacy (HL) in Europe. The Health Literacy Survey 2019-2021 (HLS19) was the first project of M-POHL, focusing on both general and specific aspects of HL. The follow-up survey (HLS24) builds on this work and will provide even more comprehensive data on HL by including more countries and new aspects of HL. By also focusing on NCDs and prevention, HLS24 is a key partner in the European Joint Action PreventNCD. Methods The HLS24 is a cross-sectional study based on nationally representative samples of the adult population (18+) in more than 20 participating countries. The HLS24 core questionnaire includes items on general HL, sociodemographics, health behavior, health status, and health care utilization. Some countries also include questions on prevention and early detection of chronic diseases and health problems. Five optional packages (OPs) enable countries to focus on specific aspects of HL, namely digital, communicative, navigational, vaccination and mental HL. Results HLS24 uses a harmonized set of HL instruments that provide a solid database for health policy decisions to strengthen HL and health equity in Europe. In addition to the three OPs on digital, communicative and navigational HL discussed in the following presentations, an 11-item set on vaccination literacy and a 21-item set on mental HL are provided. Conclusions Covering NCDs, prevention, digital health, immunization, and mental health, the HLS24 provides important data on current health challenges and highlights the needs of the European population regarding health information and services upon which policy and action interventions can be based.

Association of Life's Essential 8 metrics with mortality outcomes in US cancer survivors

Abstract Aims The increased in global cancer survivors and treatment complications has created an unmet need for effective long-term health strategies. This study aimed to evaluate the relationship between LE8 and all-cause, cancer-specific, and non-cancer mortality in cancer survivors in the US. Methods A prospective cohort study was conducted using a nationally representative sample of cancer survivors, age 40 years or older (n = 2205), derived from the US. Cancer diagnoses were determined through face-to-face interviews, while health status was gauged using the LE8 score on a scale of 0-100. Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations of overall and individual component of LE8 with overall, cancer-specific, and noncancer mortality, respectively. Result Among the 2205 participants (mean [SE] age, 66.4 [0.4] years; 54.1% females; 87.4% non-Hispanic White ethnicity), the average LE8 score was 65.5 ± 0.4, with diet having the lowest (45.5 ± 1.0) and the highest scores attributed to sleep (85.1 ± 0.7). During the up to 5.7 years follow-up period, 526 deaths were documented, comprising 174 cancer-related, 123 cardiovascular disease-related, and 229 from other causes. A high LE8 score was linked to a 71% reduction in all-cause mortality risk (HR: 0.29, 95% CI: 0.16-0.54) as well as significant reduction in the risk of cancer deaths (HR: 0.34, 95% CI: 0.13-0.88) and non-cancer deaths (HR: 0.26, 95% CI: 0.13-0.52). Higher LE8 scores were still correlated with reduced mortality in cancer survivors without cardiovascular conditions, while adherence to certain health behaviors was tied to a lower death risk. Conclusions In this study, high LE8 scores, especially the health behaviors component, were strongly associated with extended life expectancy and lower mortality rates.

Health status by time of arrival among Ukrainian refugees in Norway

Abstract Background Over 75000 refugees from Ukraine have come to Norway since February 2022. Previous studies show that the refugees have poor health for several domains, and reports suggest that those fleeing Ukraine at later stages have even poorer health. However, more systematic knowledge is lacking. This study aimed to measure self-reported health in a sample of adult refugees from Ukraine according to month of arrival to Norway in 2022. Methods Data were collected via an online, digital questionnaire, in a cross-sectional study design between 28.10.22 - 31.01.23. Recruitment was via multiple potential physical and social media contact points, including asylum reception centres, municipalities, non-profit organisations, and Facebook groups for refugees in Norway. The survey included self-reported health outcomes: overall health, oral health, presence of long-term illnesses or disabilities, and a short version of Hopkins Symptom Checklist (HSCL-5). Results Among 727 respondents, 82% were female, 65% aged 30-49 years, 69% had higher education and 53% responsibility for children in Norway. 383 arrived February-April (T1), 200 May-August (T2) and 144 September-December (T3). Compared to T1, later periods had higher proportions of males, a younger age distribution and lower proportions with higher education. Proportions reporting poor/very poor overall health, presence of long-term illness, and long-term disability were highest in T3. Oral health and HSCL-5 showed an opposite trend, with lower proportions reporting poorer health in both later periods. Respondents in T3 were still more likely to report poor health and long-term illnesses after adjusting for sex, age and education. Conclusions Respondents arriving later in 2022 generally reported poorer long-term health, but less psychological distress than those arriving earlier. These findings may help to inform planning of health services to refugees from Ukraine, especially in areas receiving large numbers of refugees. Key messages • Refugees from Ukraine arriving earlier to host countries appear to have generally better health compared to those arriving later. • Refugee health services should plan and scale accordingly when large numbers of refugees are expected as a result of international crises.

Correlates of food insecurity among university students in a low socioeconomic area

Abstract Background The prevalence of food insecurity (FI) is high and suggested to be growing among university students, with potential detrimental effects on their health status and academic performances. This cross-sectional study aims to identify the socioeconomic, demographic and lifestyle factors associated with FI among university students in a disadvantaged area. Methods An anonymous online survey was conducted from Nov 2022 to Jan 2023 among students enrolled at University Sorbonne Paris Nord, located in a low socioeconomic area in France. FI was assessed with one question distinguishing 2 levels of FI: quantitative (i.e. not having enough to eat) and qualitative (i.e. not having the desired food). This abstract focused on quantitative FI. To improve the representativeness of the sample compared to the total student population of the university, sample weights were used according to gender, study level and speciality, whether they were undergoing initial training or not, or obtained their baccalaureate abroad or not. Multivariable multinomial logistic regression models were used to identify factors associated with FI. Results A total of 5068 students provided valid answers (20% of the target population), 66% of whom were women, and 12% and 36% reported quantitative and qualitative FI, respectively. Being a man, an undergraduate, having obtained a baccalaureate abroad, not living in the family home, not receiving food from family, having no household food-heating facilities, reporting financial difficulties, relying on food charity and eating alone on a regular basis were positively associated with quantitative FI (P < 0.0001). Those reporting quantitative FI were more likely to report academic difficulties. Conclusions This study shows a high prevalence of FI in this student population and identifies several associated factors. Identifying students at greater risk of FI is an important first step to design and evaluate public health interventions. Key messages • The different socio-economic backgrounds of university students imply important food insecurity disparities among them. • University students present several factors associated with food insecurity, which should be considered when addressing food insecurity in this population.

Factors Influencing Quality of Life in the Disabled: Focus on Household Members Mental Health

Abstract Background Household members of the disabled experience various difficulties such as social isolation and the burden of caregiving. These difficulties can lead to mental health problems, which in turn affect the quality of life(QoL) of the disabled. Research on the QoL of the disabled is ongoing, but there are few studies addressing the mental health of household members. We aimed to investigate the impact of household members’ mental health on the QoL of the disabled. Methods We used data from the 2021 Disability and Life Dynamics Panel(nationwide survey). On the base of Patrick’s model of disability health promotion, we analyzed the impact of household members’ mental health on the QoL of the disabled by using correlation analysis and multiple regression analysis adjusted for gender, age, income level, employment status, education level, activities of daily living, participation in social activities, type and severity of disability, presence of multiple disabilities, and health status. Results The level of depression(r=-.316, p<.0001) and self-esteem(r=.248, p<.0001) of household members were found to be significantly correlated with the QoL of the disabled. The level of depression of household members had a significant negative impact on the QoL of the disabled(β=-.153, p<.0001), while self-esteem had a significant positive impact(β=.144, p<.0001). It was found that the level of depression had a greater impact on QoL than self-esteem. Conclusions Lower levels of depression and higher levels of self-esteem of household members are associated with higher QoL for the disabled. Improving the mental health of household members is crucial in improving the QoL of the disabled, enabling them to interact more positively with society. Additionally, as 27% of household members experience depressive issues, enhancing their mental health positively impacts on the overall well-being of families with disabilities. Efforts to enhance household members’ mental health are crucial. Key messages • Household members’ mental health significantly influences the quality of life of the disabled. • To improve the quality of life of the disabled, strengthening programs for promoting the mental health of household members and policy improvements are necessary.

Estimating risk using the novel Particulate Matters years index (ePM-years index). A report from the nationwide EP-PARTICLES study

Abstract Background Air pollution is the largest environmental risk factor, especially for cardiovascular disease (CVD). In this study, we present an original concept of estimating the risk associated with exposure to air pollution: the Particulate Matters years index (ePM-years index). Objective To assess the predictive performance of the ePM-years index. Methods The ePM-years index is an indicator of hypothetical exposure to air pollution. It is estimated by multiplying the number of years spent in a given environment by the difference between the average annual PM2.5 concentration and the allowed level of pollution given by World Health Organization (WHO) guidelines (Figure 1). We collected data from 2011 to 2020 on mortality and hospitalizations from National Health Fund and the Central Statistical Office in Poland, respectively. For further analysis, we used an age-standardized rate (SR), established on the European Standard Population structure. The source of air pollution data was GEM-AQ air quality modeling system. All data were connected with TERYT codes, all analyses were conducted at the county level (LAU-1) and then aggregated to the voivodeship level (NUTS-2). Poisson regression models were used to estimate associations between CVD mortality, ePM-years, and population level social and health status. We also estimated the attributable fraction of CVD mortality due to air pollution using AirQ+ methodology from the WHO. Results We recorded 4,010,531 deaths including 1,669,464 (41.6%) deaths due to CVD with a median age of 78.16 (SD=12.54), and 53.4% of females (N=914,932). Current smokers amounted to 29.9% (23.4%-33.2%). The main causes of death were coronary artery disease [405,268 (24.3%)] and heart failure [376,592 (22.6%)]. The mean Gross Domestic Product (GDP) per capita was 9644 EUR (7517-12,048), and the mean yearly PM2.5 concentration was 23.3 (SD=6.3) μg/m3, corresponding with the mean ePM-index 35.8 (21.5-66.6) in analysed time. The SR for CVD mortality was 500.3 (min. 461.9 – max. 604.5), the SR hospitalization rates were as follows: hypertension 312 (299-342), diabetes 90 (78.9-95.9), and HF 557.9 (310-728.4). There was an association of the ePM-years index with CVD mortality (shown as increase per 10 ePM-years): In Model 1 adjusted for GDP, risk ratio (RR) 1.023 (95% confidence interval (CI): 1.002-1.044); in Model 2 adjusted for comorbidities, RR=1.025 (95%CI: 1.004-1.046); in Model 3 adjusted for GDP, comorbidities and weather conditions RR=1.027 (95%CI: 1.005-1.049). We estimated that 16.2% (N=324,460) [95%CI: 12.54% -17.9%] of CVD deaths were attributable to PM2.5 exposure, using the WHO's air quality guideline as the reference. Conclusions The ePM-years index may be used as a tool for risk stratification for patients and incorporated into CVD outcomes prediction models. The index can help with planning of appropriate primary and secondary prevention schemes related to long-term pollution exposure.

5.D. Scientific session: Climate Change and Inequalities: Addressing Intersections and Impacts

Abstract Climate change poses one of the greatest challenges of our time, with far-reaching implications for environmental sustainability, social equity, and economic development. In recent years, growing attention has been paid to the intersecting dynamics between climate change and inequalities, recognizing that vulnerable populations are disproportionately affected by climate-related risks and impacts. This workshop aims to explore the multifaceted relationship between climate change and inequalities and examine the root causes of disparities. In this workshop we will explore intersectionality by examining how climate change intersects with various forms of inequality, including socio-economic and health status, gender, age, indigenous status, and geography, shaping differential vulnerabilities and experiences of climate impacts. This workshop aims to facilitate dialogue, knowledge exchange, and collaboration among public health researchers and professionals. We offer a unique opportunity to deepen our understanding of the complex interplay between climate change and inequalities, shedding light on overlooked aspects [?]. By bringing together diverse perspectives and expertise, the workshop aims to generate actionable insights and solutions that promote social justice, sustainability, and human rights in the face of climate change. The presentations in this workshop are thematically interconnected, addressing key aspects of climate change and inequalities from multiple angles. Topics include: Gender and climate justice, Climate change adaptation equity, Legal perspectives on climate change and inequalities and Climate Change Impacts on Respiratory Health. In conclusion, this workshop serves as a critical platform for advancing understanding, dialogue, and action on the intersection of climate change and inequalities. Key messages • Climate change interacts with socio-economic, health, gender, age, indigenous status, and geography, influencing vulnerabilities and impacts. • Vulnerable populations bear a disproportionate burden of climate change effects, including individuals with pre-existing lung conditions and children.

The wisdom layer: how to support evidence-informed policymaking

Abstract One of the returning challenges faced by public health scientists is bridging the ‘evidence-policy gap’-the disparity between identifying public health issues and implementing policies to address them. Despite the extensive literature documenting the challenges of promoting evidence-informed policymaking, opportunities for researchers to exchange experiences and learn from each other’s failures are limited. This presentation seeks to: (a) analyze key concepts in evidence-informed policymaking, based on the health information pyramid; (b) identify obstacles and facilitators in the translation of knowledge into actionable policy; and (c) present both successful and unsuccessful examples from our initiatives to influence health policy in Belgium. Specifically, we will discuss the concrete impact of the Belgian Health Status Report and the role this report plays in the development of actionable health objectives for Belgium. We will also cover the role of healthybelgium.be in governing and monitoring the health status of the Belgian population by discussing why this website has been recognized by WHO Europe as a model of good practice in evidence-informed policymaking.

Limited critical and communicative health literacy is related to poorer health among older adults

Abstract Background Health literacy-related challenges are expected to increase with age due to a discrepancy between individual capacity and health care demands. Knowledge about associations between health literacy and age-related health outcomes among older adults is scarce. This is important to address and promote optimal health in older adults. The study aims to investigate the association between health literacy and health status among older adults and explore differences between the younger old and the oldest old adults. Methods Cross-sectional study using SWEOLD population-based data from 2022, a national representative sample of people 77+ years in Sweden. Univariate and multivariate logistic regression analysis assessed associations between communicative- and critical health literacy and health outcomes. Models were adjusted for age, sex, and socioeconomic status, and stratified by age. Results Significant adjusted associations were found between inadequate and problematic health literacy and less than good self-rated health (OR 2.64, 95%CI: 1.61-4.33; 2.11, 95%CI: 1.40.3.17), and requiring assistance with medicine management (OR 5.26, 95%CI: 2.67-10.38, 2.14, 95%CI 1.08-4.22). Among the younger old (77-84 years) inadequate and problematic HL was associated with having lifestyle-related conditions (OR 1.77, 95%CI: 1.07-2.93, 2.75, 95%CI: 1.33-2.71). Among the oldest old (85+), inadequate health literacy was associated with higher likelihood of poor activities of daily living (ADL) (OR 4.48, 95%CI: 1.99-10.07) and frailty (OR 3.51, 95%CI: 1.43-8.47). Level of frailty increases earlier in age for individuals with limited HL than among those with sufficient HL. Conclusions Limited health literacy is a prevalent issue in the older population and is associated with negative health-related outcomes. To mitigate development of poor health and frailty and to promote healthy ageing, care organisations need to meet the needs of this population in a health literacy friendly way. Key messages • Limited health literacy among the older population is associated with several negative health-related outcomes. • Care organisations need to work actively to mitigate the development of poor health while promoting healthy aging among the older population in a health literacy-friendly and age sensitive manner.

Exploring health-related quality of life in Portuguese Informal Caregivers

Abstract Background Caregiving can be associated with several adverse health impacts, such as in terms of mental health, health services use, or health-related quality of life (HRQoL). This study assessed HRQoL levels in Portuguese Informal Caregivers, and their relationship with caregiver psychosocial characteristics (e.g., perceived general and mental health; perceived level of support) and caregiving circumstances (e.g., caregiving duration, caregiving hours). Methods A cross-sectional study was conducted through an online survey directed to informal caregivers. HRQoL was measured using the Portuguese translation of the EQ-5D-5L. This instrument yields two values for HRQoL: a health profile (EQvalue) covering five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and a visual analogue scale (EQvas). Bivariate analyses were performed and results with p-values below 0.05 were considered statistically significant. Results A total of 760 informal caregivers were surveyed (mean age 57 years (±9.9), 92.5% female, 41.5% at least university level, 44.4% works full or part-time). The mean total score for EQvalue (n = 733) was 0.8 (SD = 0.2). The mean total score for EQvas (n = 760) was 63.1 (SD = 21.5). The perceived general (p < 0.001) and mental (p < 0.001) health status, and the perceived access to healthcare (p < 0.001) were associated with EQvalue score. Also, EQvalue score was found to be directly correlated with the perceived level of support (r = 0.142; p < 0.001) and competence (r = 0,237; p < 0.001), and inversely correlated with the number of caregiving hours per day (r= -0,150; p = < 0,001) and the caregiving duration (r= -0,109; p = 0.008). Conclusions A significant relationship between caregiver HRQoL and several caregiver psychosocial variables was identified. Investing in and promoting the use of respite care services, as well as ensuring better access to healthcare for caregivers, appears important for improving caregivers’ HRQoL. Key messages • Improving caregivers’ access to healthcare and education or training programs (promoting a greater sense of competence) can be important in helping them maintain their quality of life. • Increasing the availability and promoting the use of respite care services by caregivers can be important in helping them maintain their quality of life.

Impact of digital health literacy on public health: an umbrella review

Abstract Background Digital health literacy (DHL) is increasingly important for public health initiatives in the digital era. However, its impact on public health outcomes remains unclear. This umbrella review synthesizes evidence on relationships between DHL and public health. Methods Electronic databases were searched from 2010 to January 2024 for reviews evaluating associations between DHL and public health outcomes. Two independent reviewers screened records and extracted data. Results were narratively synthesized and screened respect quality using Amstrar 2 check list. Results 12 reviews met the inclusion criteria. Higher population DHL was consistently linked to positive health behaviors like preventive screening uptake, medical adherence, chronic disease management, and vaccination. However, lower DHL correlated with health disparities and exacerbated risk of mis/disinformation. DHL interventions improved eHealth skills and health status. Conclusions Digital Health Ltieracy shapes engagement with digital public health tools and programs. Integrating DHL assessments into planning can help identify at-risk groups and optimize interventions. Developing population DHL through education represents an avenue to advance health equity and resilience against digital health threats. However, more evidence and more digital maturity of tools appear to be necessary. Key messages • Digital Health Literacy as milestone of next health generation. • Health outcomes are clearly linked to digital and digital health literacy.

The indirect costs of motherhood and fatherhood: impacts on income, working hours, and perceived health across 32 European countries

Abstract Background Parenthood may affect men’s and women’s personal lives, professional careers, and well-being differently. In the last decades, structural modifications in gender norms, the labor market, and family-supporting policies have occurred, but with cross-country variations, even within European borders. This study aimed to update the estimates on the impact of parenthood on men’s and women’s income, working hours, and perceived health status, and better comprehend their variation across 32 European countries, using a longitudinal approach. Methods Data from the European Survey on Income and Living Conditions (2004-2020) were used to estimate the income variation and the likelihood of transitioning into a non-income status, less than 40 weekly hours, and less than very good health status, from one year before to one year after parenthood. Estimates were done by sex and country. Pooled effects were estimated using random effects meta-analysis. Results We found a short-term 29% income penalty for women and a 12% income premium for men after parenthood. Seventy percent of women who transitioned their status after motherhood shifted to work less than 40 hours per week while no effect was found for men. Regarding perceived health, no shifts were overall observed. A large cross-country heterogeneity was found. Conclusions Motherhood-related income penalties concurred with losses of employment and reductions of weekly working hours, while among men the income premiums were not necessarily coupled with transitions to employed status or 40 weekly working hours. The cross-country heterogeneity is, probably, multifactorial, depending on countries’ policies, norms, labor market, and social structure.

Cardiogenic shock is more prevalent in racialised and newcomer populations and associated with higher mortality

Abstract Background The World Health Organization (WHO) has recognised social determinants of health (SDH) as non-medical factors that affect health outcomes. These SDH have a significant effect on health inequities, whereby more marginalised populations often have worse outcomes due to unfair and avoidable differences in health status. The Ontario Marginalization index (ON-Marg) is an area-level index derived from 42 census variables identifying differences in marginalisation, allowing identification of inequities between population groups and geographical areas. The ‘racialised and newcomer populations’ dimension of the ON-Marg characterises the proportions of recent immigrants and/or people belonging to ‘visible minority’ groups in geographical locales. These data can be used as a surrogate for individual patient data to investigate health outcomes related to this dimension. This study investigated the prevalence and mortality associated with racial marginalisation in patients admitted with cardiogenic shock at a quaternary cardiac referral centre. Methods A single-centre registry of CS admissions from 2014-2023 at a quaternary referral centre cardiac intensive care unit (CICU) in Ontario, Canada was studied. Patient postal codes were identified and mapped to ON-Marg ‘racialised and newcomer populations’ data using the Postal Code Conversion File. The ON-Marg data are categorised into equal quintiles, which was used to determine differences in distribution of CS cases and inpatient survival using the Chi-squared test and Kaplan-Meier methods. Only the index CS hospitalisation was included in the analysis. Results We identified 1513 patients, including 456 (30.1%) females, aged 60.2±16.1 years, with 333 (24.8%) due to acute myocardial infarction CS. The majority of patients were SCAI stage D (69.2%) with 488 (32.3%) dying and 186 (12.3%) receiving a heart transplant or durable ventricular assist device (VAD) before discharge. CS patients were more likely to be in the higher quintiles for marginalisation racialised and newcomer populations and these individuals had higher mortality (p=0.005, figure 1). In a survival analysis, with right-censoring for transplant or VAD, there were significant differences between marginalisation quintiles (figure 2). Conclusions Patients admitted with CS to a large cardiac centre were more likely to be from populations with higher levels of racialised and newcomer individuals. Increasing marginalisation was associated with higher mortality. This identifies a need for delineating whether these differences are aetiological or whether there are barriers in accessing high-quality care in a timely fashion. This could allow an improvement in outcomes for these patient groups. While census-based area-level marginalisation indices can be helpful for identifying possible barriers to equitable care, individualised patient-level data are needed to confirm these findings.

Cultural filters in processing information on COVID vaccines among minoritized groups in London, UK

Abstract Introduction Vaccination coverage among minoritized groups, including migrants, is low in the United Kingdom. Cultural factors are often cited as barriers, yet the broader impact of minoritization on vaccine acceptance remains understudied. We explored the intersection of culture with individual, familial, and systemic factors in shaping trust and perceptions of COVID-19 vaccines in East London, UK. Methods We conducted focus group discussions (n = 6) and interviews (n = 19) with individuals from minoritized backgrounds in East London to elicit their perceptions and experiences of COVID-19 and the vaccination programme. Thematic analysis was used to identify individual, social, and systemic factors influencing the processing of perceived value of information on COVID vaccines. Findings Culture was rarely cited as an explicit barrier to vaccine uptake. Instead, participants’ linked their perceived vulnerability and immunity to COVID-19 with age, sex and health status. Information about COVID vaccines was processed and acted upon in the context of gendered family dynamics and support. Community identity, gatekeepers and social networks further influenced the perceived legitimacy of information received. Some participants voiced how their minoritized status shaped trust/mistrust in the national health system’s and government’s delivery of the COVID-19 information and vaccination campaigns Conclusions Unpacking cultural filters is crucial for addressing vaccine-related information barriers in minoritized groups. Going beyond mere language translation, tailored communication materials should address social enablers and systemic barriers. Further, closer collaboration between community gatekeepers and healthcare professionals to facilitate optimal use of these materials is needed to improve vaccine uptake. Key messages • Culture should not be assumed to be the main factor contributing to non-adherence and non-uptake of public health vaccine. • Vaccine uptake can be improved by healthcare workers and key community gate-keepers working collaboratively with minoritized groups.