Health Network Research Articles

Enhancing SARS-CoV-2 Lineage Surveillance through the Integration of a Simple and Direct qPCR-Based Protocol Adaptation with Established Machine Learning Algorithms.

Emerging and evolving Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) lineages, adapted to changing epidemiological conditions, present unprecedented challenges to global public health systems. Here, we introduce an adapted analytical approach that complements genomic sequencing, applying a cost-effective quantitative polymerase chain reaction (qPCR)-based assay. Viral RNA samples from SARS-CoV-2 positive cases detected by diagnostic laboratories or public health network units in Ceará, Brazil, were tracked for genomic surveillance and analyzed by using paired-end sequencing combined with integrative genomic analysis. Validation of a key structural variation was conducted with gel electrophoresis for the presence of a specific open reading frame 7a(ORF7a) gene deletion within the "BE.9" lineages tracked. The analytical innovation of our method is the optimization of a simple intercalating dye-based qPCR assay through repositioning primers from the ARTIC v4.1 amplicon panel to detect large molecular patterns. This assay distinguishes between "BE.9" and "non-BE.9" lineages, particularly BQ.1, without the need for expensive probes or sequencing. The protocol was validated against lineage predictions from next-generation sequencing (NGS) using 525 paired samples, achieving 93.3% sensitivity, 95.1% specificity, and 92.4% agreement, as measured by Cohen's Kappa coefficient. Machine learning (ML) models were trained using the melting curves from intercalating dye-based qPCR of 1724 samples, enabling highly accurate lineage assignment. Among them, the support vector machine (SVM) model had the best performance and after fine-tuning showed ∼96.52% (333/345) accuracy in comparison to the test data set. Our integrated approach provides an adapted analytical method that is both cost-effective and scalable, suitable for rapid assessment of emerging variants, especially in resource-limited settings. In this work, the protocol is applied to improve the monitoring of SARS-CoV-2 sublineages but can be extended to track any key molecular signature, including large insertions and deletions (indels) commonly observed in pathogenic agent subtypes. By offering a complement to traditional sequencing methods and utilizing easily trainable machine learning algorithms, our methodology contributes to enhanced molecular surveillance strategies and supports global efforts in pandemic control.

Factors associated with general practitioner-led diagnosis of long COVID: an observational study using electronic general practice data from Victoria and New South Wales, Australia.

To investigate associations between sociodemographic factors, pre-existing chronic comorbidities, and general practitioner-led diagnosis of long COVID. We conducted a retrospective observational case-control study using de-identified electronic general practice data, recorded between January 2020 and March 2023, from 869 general practice clinics across four primary health networks in Victoria and New South Wales. Sociodemographic factors and pre-existing chronic comorbidities associated with general practitioner-led diagnosis of long COVID. A total of 1588 patients had a recorded general practitioner-led long COVID diagnosis. Females exhibited a higher likelihood of general practitioner-led long COVID diagnosis (adjusted odds ratio [aOR], 1.58; adjusted confidence interval [aCI], 1.35-1.85) compared with males. Patients aged 40-59 years had a higher likelihood of general practitioner-led long COVID diagnosis (aOR, 1.68; aCI, 1.40-2.03) compared with patients aged 20-39 years. The diagnosis was more likely in patients of high socio-economic status (aOR, 1.37; aCI, 1.05-1.79) compared with those of mid socio-economic status. Mental health conditions (aOR, 2.69; aCI, 2.25-3.21), respiratory conditions (aOR, 2.25; aCI, 1.85-2.75), cancer (aOR, 1.64; aCI, 1.15-2.33) and musculoskeletal conditions (aOR, 1.50; aCI, 1.20-1.88) were all significantly associated with general practitioner-led long COVID diagnosis. Female sex, middle age, high socio-economic status and pre-existing comorbidities, including mental health conditions, respiratory conditions, cancer and musculoskeletal conditions, were associated with general practitioner-led long COVID diagnosis among general practice patients. These factors largely parallel the emerging international evidence on long COVID and highlight the patient characteristics that practitioners should be cognisant of when patients present with symptoms of long COVID.

Perspectives and insights of critical care clinicians, patients and families from culturally and linguistically diverse backgrounds around end-of-life care in an ICU: a scoping review protocol.

Protocol to explore what is known about communication between critical care providers and patients and families from culturally and linguistically diverse backgrounds (defined as people who are either from minority ethnic groups, non-English-speaking backgrounds who may have diverse cultural, linguistic, spiritual and religious affiliations and opinions) about death, dying, end-of-life care and organ donation in the intensive care unit (ICU). Patients from culturally and linguistically diverse backgrounds experience barriers to optimised care when admitted to the ICU. These barriers appear to derive from differences in language, cultural, societal and ethical expectations between patients, their families and healthcare professionals. These barriers may significantly impact the delivery of end-of-life care to patients from culturally and linguistically diverse backgrounds. Therefore, this has the potential for inadequate management of medical, psychological and existential distress. Studies of all designs reporting for adult (age ≥18 years) patients and family members from culturally and linguistically diverse backgrounds at end-of-life in the ICU setting will be included. Studies that report results for patients aged <18 years or that are based outside the ICU will be excluded. Relevant sources will be retrieved, and their citation details will be imported into the Joanna Briggs Institute (JBI) System for the Unified Management, Assessment and Review of Information. This scoping review was guided by the JBI methodology for scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A systematic search was conducted in EBSCOhost, Web of Science, PubMed Central and SciELO, OVID Medline, CINAHL, and Scopus, limited to English-language publications, without date limitation. Key study characteristics and findings will be extracted using a data extraction tool developed by the reviewers. Anticipating heterogeneous study designs, findings will be presented as a thematic synthesis. This is a protocol for a scoping review, formal ethics approval from the Human Research Ethics Committee (HREC) of the Local Health Network will be obtained for research projects that could potentially stem from this review and will then be subsequently disseminated through proper channels.

Initiatives to improve lung and sleep health in children: Delphi consensus from the pediatrics, pulmonary, and sleep conference.

The lung and sleep health of adults is heavily influenced by early factors, both genetic and environmental; therefore, optimizing respiratory health begins in childhood. Multiple barriers impede improvements in lung and sleep health for children. First, the traditional siloing between general pediatric care in the community, pediatric pulmonary and sleep subspecialty care, and the research community limits the translation of knowledge into practice. Additionally, identifying and addressing health disparities remains a challenge. The 2021 NHLBI-sponsored workshop "Defining and Promoting Pediatric Pulmonary Health (DAP3H)" was a first step in defining critical gaps in our current healthcare system in identifying and optimizing lung and sleep health in children. The workshop identified key opportunities including measuring pulmonary function in young children, sleep-focused outcomes, developing biomarkers, and longitudinal research cohorts. To expand on the work of DAP3H and continue initiatives to improve childhood lung and sleep health, the Pediatrics & Pulmonary Network: Improving Health Together conference was held in 2023. A modified Delphi process was applied to form consensus surrounding gaps, barriers, and action items, with the goal of identifying the most urgent opportnities for improving childhood lung and sleep health. Cross-cutting foundational principles were identified as: (1) Authentic Stakeholder Collaboration & Engagement, (2) Reach & Implementation in Real World Settings, (3) Understanding Current Landscape & Resources and (4) Purposeful Diversity, Equity, & Inclusion Initiatives. To improve lung and sleep health in children, these principles should be the foundation for research design, development, and implementation.

Pediatric Learning Health Networks in Solid Organ Transplantation-Engaging all Stakeholders to Achieve Health for Children Who Require Transplantation.

Learning Health Networks (LHN) have evolved within medicine over the past two decades, but their integration into transplantation has been more recent. In this paper, we describe three LHNs in end-stage organ disease/transplantation, their common and unique features, and how their "actor-oriented" architecture allowed for rapid adaptation to meet the needs of their patients and practitioners during the recent COVID-19 pandemic. The structure and focus of the Improving Renal Outcomes Collaborative (IROC), Starzl Network for Excellence in Pediatric Transplantation (SNEPT), and the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) are reviewed. We discuss the critical role of patient and family engagement, focusing on collaboration with Transplant Families. Finally, we review challenges common to the LHN concept and potential common areas of alignment to achieve the goal of more rapid and sustained progress to improve health in pediatric transplantation. LHN in transplantation are essential to accelerate knowledge dissemination and improve outcomes.

Roles of Quiet in Health Care Organizations.

This anecdote of one regional academic health network's reputational demise suggests what might be learned about tendencies of undervaluing chaplaincy expertise, peace, and quiet in the everyday operations of professional caregiving.

The Lehigh Valley Health Network narcolepsy cohort: clinical and polysomnographic analysis of 304 cases.

We aimed to characterize clinical features, comorbidities and polysomnographic characteristics of a large cohort of patients with narcolepsy. We undertook a retrospective chart and polysomnographic review of all patients with a diagnosis of narcolepsy type 1 (NT1) or narcolepsy type 2 (NT2) seen within the Lehigh Valley Health Network between 2000 and 2022. We found 304 cases with a diagnosis of narcolepsy (52 NT1, 252 NT2), based on International Classification of Sleep Disorders, third edition criteria. Compared to NT2, patients with NT1 had younger diagnosis age (24.5 versus 27.4 years, p=0.03), shorter diagnostic gap (3.0 versus 4.6 years, p=0.002), more frequent sleep paralysis (55.8% versus 19.4%, p<0.0001) and hypnagogic hallucinations (46.2% versus 25.4%, p=0.003), and higher Epworth Sleepiness Scale (ESS) scores (17.8 versus 16.7, p=0.02). The most common comorbid sleep disorders were breathing disorders (17.4%) and insomnia (15.5%). Migraine was the most common neurological disorder. Depression was more common in NT2 than NT1 [12 (23.1%) versus 94 (37.3%), p=0.05]. On the Multiple Sleep Latency Test, patients with NT1 had more sleep onset REM periods (SOREMPs) than patients with NT2 (≥3 SOREMPs in 59.2% versus 26.9%, p<0.0001). Only in NT2, hypnagogic hallucinations and higher ESS scores were associated with higher numbers of SOREMPs (p=0.0277 and p=0.0179 respectively). This is one of the largest monocentric studies to date of patients with narcolepsy and confirms the frequent comorbidities of narcolepsy. Specific clinical characteristics and comorbidities may help differentiate NT1 from NT2.

Using Social Network Analysis to Identify Influential Community Organizations

BackgroundWe used a social network approach to identify influential community organizations within integrated public health networks in three regions in Texas, US: Houston/Harris County, Cameron County, and Northeast Texas. The study aimed to understand how network structures influence organizational performance in COVID-19 response. MethodsIn collaboration with community partners in each region, we administered a snowball sampling network data collection. Initial seed sets for the regions of 23, 25, and 55 organizations identified other organizations that then responded to the survey, which expanded the sets to 268, 145, and 138, respectively. Principal component analysis (PCA) identified key network structures—centrality and brokerage—and we introduced two network-based performance measures: Fulfillment Rate (FR), which measures securing needed resources, and Provision Rate (PR), which measures providing resources to others. We tested hypotheses to examine the associations between these network structures and organizational performance. FindingsCentrality consistently emerged as a predictor of organizational performance across all three regions. Community organizations that are more centrally positioned, rather than broker organizations, play a critical role in meeting resource needs and providing services to other organizations. Centrally positioned organizations conducted more COVID-19 tests, whereas brokers administered fewer vaccines. InterpretationsThis study suggests that public health interventions should prioritize central organizations for resource allocation and distribution. Our network-based performance metrics offer new avenues for evaluating organizational effectiveness in networked public health systems, with broader applicability to future crises and public health planning.

Trauma Program Value Assessment at an Academic Health Network System Over 12 Years.

Trauma is a leading cause of global death, with 200000 deaths and over 3 million non-fatal injuries/year in the United States. We aim to assess trauma care value for patients who underwent urgent laparotomies (LAP) and thoracotomies (THO) in our Health Network System. Clinical variables (v = 84) from trauma patients (>18 yo) were retrieved retrospectively (Jan-2010 to July-2016) and prospectively (Aug-2016 to Sept-2021) from a Health System warehouse under IRB-approved protocols. Patients were divided according to their Injury Severity Score (ISS) into mild/moderate cases (ISS <15) and severe cases (ISS >15). Value was assessed using quality and cost domains. Quality surrogates included graded postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), patient satisfaction (PS), and textbook (TB) cases. Total charges (TCs) and reimbursement index (RI) were included as surrogates for cost. Value domains were displayed in scorecards comparing Observed (O) with Expected (E) (using the ACS risk calculator) outcomes. Uni-/multivariate analyses were performed using SPSS. 41,927 trauma evaluations were performed, leading to 16044 admissions, with 528 (3.2%) patients requiring urgent surgical procedures (LAP = 413 and THO = 115). Although the M:F ratio (7:3) was similar in LAP vs THO groups, age and BMI were significantly different (41.8 ± 19.1 vs 51.8 ± 19.9 years, 28.6 ± 9.9 vs 27.4 ± 7Kg/m2, respectively, P < .05). Blunt trauma was involved in 68.8/77.3% of the LAP/THO procedures, respectively (P < .05). Multivariate analyses showed ISS, age, ASA class, and medical center as factors significantly predicting PC (P < .05). Postoperative complication grades from the LAP/THO groups showed above-average outcomes; nonetheless, LOS was higher than the national averages. The Trauma Program holds high value in our Health Network System. Protocols for decreasing LOS are being implemented.

Nursing Home Staff with Children: Unique Needs Among Single and Partnered Parents.

Nursing home (NH) staff job dissatisfaction and turnover are associated with lower care quality. However, little is known about the impact of being single on workplace experiences. Guided by the Job Demands-Control-Support Model, we compared job satisfaction, turnover intention, and psychological distress for single and partnered parents working in NHs. Employee and manager data from the 2011-12 wave of the Work Family Health Network study were combined (N=1,144) to define parents with complete data (N=586). Bivariate tests and multivariate regressions clustering observations within NHs were used. Most single parents (n=190, 32%) were nursing assistants (NAs) (n=142, 74.74%) or licensed practical nurses (LPNs) (n=29, 15.26%). Compared to partnered parents, single parents were similar on turnover intention and job satisfaction, but they were more likely to report distress (OR=1.79, 95% CI 1.09, 2.94) observed only among NAs (OR=2.08, 95% CI 1.12, 3.85). Psychological distress was associated with greater turnover intent (β =0.02, p<.05) among NAs and LPNs, yet only among single parents (β =0.04, p<.01). Distress was more likely with higher family-to-work conflict (OR= 1.67, 95% CI 1.18, 2.36) and work-to-family conflict (OR=1.60, 95% CI 1.20, 2.14) among licensed nurses, yet the distress-work-family conflict associations were only significant for partnered parent nurses. Supporting NH staff depends upon knowing their parental, relationship, and occupational status. Additional research is needed to understand and develop strategies to mitigate psychological distress and increase resources particularly among NA single parents employed in NHs.

Implementation of organizational health literacy depending on school characteristics in Germany

Abstract Background Children and adolescents are important target groups for health promotion measures to sustain a healthy upbringing. Organizational health literacy in schools is a promising environmental intervention to strengthen health literacy in school children. This study examines the relationship between school characteristics and the implementation of organizational health literacy. Methods School principals in Germany were invited to complete a 20-minute online survey between November 2022 and July 2023. An 8-item self-report tool was used to measure organizational health literacy in schools (OHLS-Q-SF) that comprehends eight different areas within schools to become health literate. A hierarchical cluster analysis was carried out to identify groups according to the composition of the socioeconomic status of the student body. Descriptive statistics, Mann-Whitney-U tests, and Kruskal-Wallis tests were performed. Results 598 school principals (73.6% female, Ø 52.3 years old) who worked at primary schools (49.1%), secondary schools (37%), and special education schools (13.9%) completed the survey. Cluster analysis revealed two groups. The first one (36.8%) contains schools with mainly students with lower socioeconomic status, and the second group (63.2%) contains schools with more students from middle or higher socioeconomic status. The socioeconomic status of students within the schools showed no significant results for any area of organizational health literacy, whereas all eight areas are more likely implemented if the schools already participate in a school health promotion program or network (p &amp;lt; 0.001). Conclusions Participating in a school health promotion program was associated with higher levels of implementation in all areas of organizational health literacy in schools. This finding highlights the importance of those programs. Integrating organizational health literacy into those interventions can be a beneficial approach to sustaining health literate schools. Key messages • Participating in a school health promotion program or network might facilitate schools to become health literate organizations. • In Germany, the socioeconomic status of the students within the schools is not associated with the implementation of organizational health literacy.

Prevecardio: a single-visit population screening model for detection and prevention of 10-year cardiovascular risk

Abstract Introduction Cardiovascular diseases (CVDs) are a major contributor to global mortality. The early detection of cardiovascular risk factors, coupled with timely intervention strategies, is essential for CVD prevention. PreveCardio was developed as an innovative, single-visit population screening model designed to facilitate the early identification and management of cardiovascular risk factors within a population of 1 million in a European capital city region totaling 6 million inhabitants. Purpose This study aimed to ascertain the prevalence of cardiovascular risk factors within the general population and to evaluate the effectiveness of the PreveCardio model in estimating 10-year cardiovascular risks and promoting preventive interventions. Methods In this cross-sectional prevalence study, individuals aged 50 to 75 from a health network were randomly selected and invited to participate in a comprehensive health check. The 30-minute screening consisted of lifestyle evaluations, anthropometric measurements, and blood tests for lipid profiles and glycated haemoglobin. The methodology was designed to provide participants with immediate feedback on their results, cardiovascular health and practical guidance for risk management. Results From the 8,492 individuals solicited, 3,546 took part in the screening: 56,83% were female, mean age 61,17 ± 7,33 y.o. Picture 1 shows the population's percentages with various modifiable cardiovascular risk factors, including 20% with active smoking, 30% with sedentarism, 16% with risky alcohol consumption, 49% with non-adherence to the Mediterranean diet, 40% with overweight, and 30% with obesity. The screening revealed new diagnoses of LDL-hypercholesterolemia in 47% participants, high levels of blood pressure in hypertension range in 49%, prediabetes in 30% and diabetes in 2% (Picture 2). After use SCORE2 and SCORE-OP risk prediction algorithms, PreveCardio is estimated to potentially prevent between 39 to 202 fatal and non-fatal cardiovascular events over 10 years. Predictive modelling based on PreveCardio data projected that expanding the screening across the capital region could prevent at least 26,260 cardiovascular events over 10 years. Conclusion(s) PreveCardio has established itself as a viable and effective model for the early detection of cardiovascular risk factors in a general population. It holds significant promise for public health impact by potentially reducing the incidence of CVD through comprehensive screening and proactive intervention.

The process of developing a framework for code of ethics

Abstract Issue/Problem The World Health Organisation (WHO) and Association of Schools of Public Health in the European Region (ASPHER) roadmap for the professionalisation of the public health workforce has noted ethics as a pillar for professionalisation. It also highlights the need for code of ethics and professional conduct for all public health professionals and institutions. The Global Network for Academic Public Health (GNAPH), in collaboration with EUPHA, ASPHER, and the UK Faculty of Public Health has been working together for a code of ethics. Description of the problem The WHO/ASPHER group asked for a framework to be developed by the expert group as part of the rollout of the professionalisation agenda. The objective of this work was to develop a guide that is applicable to different countries within Europe to develop their own of code of ethics and conduct. A modified Delphi approach to building consensus amongst professionals in ethics included law, academia, and public health professionals. The questions sought to be answered were what and how to develop a framework and what should be included in the guide for creating a public health code of ethics. Results Throughout this method we developed five values, and twelve principles that are essential for the development of a code of ethics through a consensus building exercise. This framework was the first of its kind as part of the professionalisation agenda for different regions. There will be ongoing work piloting this framework in practice with various professional groups and institutions. Lessons Throughout this process, the need and demand across the public health community for ethical education and development of code of ethics was made evident. Collaboration between academics, ethicist, lawyers, and public health professionals and policy makers were key in developing a public health code of ethics. Identifying the challenges with monitoring and evaluating of its implementation a public health code of ethics. Key messages • Ethics, and a code of ethics are an essential component of the professionalisation agenda of the public health workforce. • There is need for continued collaboration and partnership with public health professionals and institutions in enacting its implementation and evaluation.

11.Q. Round table: A Guide for creating a code of ethics for public health professionals and institutions

Abstract The professional discipline of public health is driven by its values. Public health professionals face decisions that have far-reaching ethical implications. Our norms, values, beliefs and the way we see the world, as individuals, communities and institutions which serve us, do matter and fundamentally affect our decisions, behaviours, policies, and practice. The ability to be aware and reflect on norms and values when taking decisions, is a decisive professional virtue in public health practice. The World Health Organisation (WHO) and Association of Schools of Public Health in the European Region (ASPHER) Roadmap for the professionalisation of the public health workforce, has highlighted ethics as an essential pillar for professionalisation, a core competency, and the need for a Code of Ethics and Professional Conduct for good public health practice. In order to further advance the issue the Global Network for Academic Public Health (GNAPH), ASPHER, the European Public Health Association (EUPHA), the UK Faculty of Public Health and other partners set up an expert international joint working group on public health ethics and law (PHELWG). The PHEL expert working group - which includes senior public health professionals, ethicists, lawyers and academics - has been working to carry out research and develop a guide for creating a Code of Ethics and Professional Conduct for public health professionals and institutions. This has included consideration of the competencies, principles and values for good public health practice. The project has involved literature review, research and the wide professional experience of the international group of experts who have been working on the issue.The development of a guide for creating a code of ethics for public health professionals and institutions is part of the overall objective of the PHELWG to build a ethico-legal competency, capacity and resilience of public health workforce. The proposed Guide and related resources will be a timely resource, practical tool and support for public health professionals, organisations, or regulatory bodies to develop their own local country code of ethics and build further ethico-legal capacity of their public health professional workforce and institutions. Purpose of the roundtable workshop will be to: - present the guide on creating a code of ethics for public health public health professionals and institutions, which will be launched at that time - Share the proposed ethical competencies/skills, principles and values for good public health practice, with particular consideration of Indigenous knowledge and world views - reflect and consult with the workshop participants around the guide and the proposed pilot sites for implementing the Codes in various centres. Key messages • Development of Code of ethics and professional conduct is a key requirement for public health professionalization. • The Guide for creating code of ethics by international expert group provides significant resource for development of codes locally. Speakers/Panelists Kasia Czabanowska Maastricht University, Maastricht, Netherlands Farhang Tahzib Faculty of Public Health, Haywards heath, UK Paul Athanasopoulos Public Health Department, Stirling, UK

The effect of Covid deaths on premature mortality trends in Northern Dimension partnership countries

Abstract Background Potential Years Life Lost (PYLL) is an established method to measure, follow trends and compare disease burden within and between countries. Northern Dimension Partnership in Health and Social wellbeing (NDPHS) network was established in 2003 and includes the following countries: Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Poland, Russia, and Sweden. Due to the Russian invasion to Ukraine, Russia is now excluded from the collaboration. Methods Premature mortality is defined as a death before the age of 70 years. PYLL-rates per 100,000 population are presented in six cause of deaths categories: total mortality, external causes, vascular diseases, cancers, alcohol-related deaths and suicides. Furthermore, 2021 data included deaths due to the Covid infection. Data were obtained from Eurostat and analyses are standardized to EU standard population. Results PYLL-rates declined from 2003 to 2017 in all countries and in most causes of death sub-groups. The total (all causes, all countries) PYLL-rate declined between 2003 and 2017 from 7072 to 5154 in men and from 3263 to 2532 in women. However, from 2017 to 2021 the total PYLL-rate increased to 5469 in men and 2623 in women. The increase was explained by Covid mortality. When Covid deaths were excluded, a minor decrease was observed also between 2017 and 2021. In 2021, total PYLL-rates vary largely between countries: from 2804 to 12,393 in men and from 1781 to 4460 in women. Differences between countries in Covid-related and other cause-specific PYLL-rates were also large. In all countries and causes of death sub-groups PYLL-rates were markedly higher in men compared to women. Conclusions The number of years lost due to premature preventable mortality have declined markedly in all NDPHS countries in the last two decades. Between 2017 and 2021, some increase was observed due to the Covid-related deaths. Differences between countries in premature mortality are still large. Key messages • The number of years lost due to premature preventable mortality have declined markedly in all NDPHS countries since 2003 but still, in 2021, differences between countries were large. • Covid-related deaths caused an increase in premature mortality between 2017 and 2021.

Community gardening: metaphorical reconstruction of transformative health governance

Abstract Transdisciplinary working has been defined by the inclusion of non-academic stakeholders in the process of knowledge production. While theoretical, phenomenological and experimental dimensions have been described in the literature, Rigolot proposes transdisciplinarity as a ‘way of being’ that stretches beyond professional life. The promise of transdisciplinarity however does not always meet the expectations in practice. How to get started, maintain and overcome barriers requires guidance. In an action-oriented evaluation research study we explored this dimension in the Dutch All about Health collaborative platform, which since 2014 facilitates a continuous development of bottom up health initiatives, networks, alliances and other forms of collaboration and learning. From our case studies we developed the Transformative Health Governance model. The model shows the ongoing and reciprocal connections between the actions, the context and intermediate results that were verified in a survey among 103 platform participants. Five types of returns are also building blocks that increase the chance of real (yet hardly measurable) increasing health benefits. They reinforce each other in a continuous process of ideation, integrative approach, innovation, implementation, and impact. The context provides for acceleration or deceleration of that process. With the help of a cartoonist we translated our model into an ongoing cycle of community gardening and maintenance. This metaphor makes the intangible of underlying social processes more tangible, providing a bit more grip on the building blocks, timing and time aspects, as well as deeper understanding the role and necessity of conflict and explicit conflict engagement rather than management. Moreover the cartoon elicits recognition, acknowledgement and spirit to continue their rowing against the systems-invoked tide for better health. It serves as a concrete aid to transdisciplinary working towards planetary health.

Alcohol-related premature mortality in Northern Dimension partnership countries 2003-2021

Abstract Background Potential Years Life Lost (PYLL) is an established method to measure, follow trends and compare disease burden within and between countries. Northern Dimension Partnership in Health and Social wellbeing (NDPHS) network was established in 2003 and includes the following countries: Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Poland, Russia, and Sweden. Due to the Russian invasion to Ukraine, Russia is now excluded from the collaboration. Iceland is not included in the analyses due to too small number of events. Methods Premature mortality was defined as a death before the age of 70 years. Alcohol-related deaths included the following ICD-codes: E24.4, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, Q86.0, R78.0, X45, X65, Y15, K73, K74.0-K74.2, K74.6, O354, P043 and G4051. PYLL-rates per 100,000 population are presented separately for men and women in four time points: 2003, 2013, 2017 and 2021. Data were obtained from Eurostat and analyses are standardized to EU standard population. Results In the whole NDPHS area, alcohol related PYLL-rates declined between 2003 and 2017: from 527 to 458 in men, and from 159 to 134 in women. However, between 2017 and 2021 the rates increased: to 509 in men and to 154 in women. In 2021, the highest alcohol-related PYLL-rates were in Latvia (1696 in men and 530 in women) and the lowest in Norway (94 in men and 43 in women). Thus, the differences between countries in alcohol-related PYLL-rates were 20-fold in meles and 10-fold in females. In all countries the rates were 2-3 times higher in men compared to women. Conclusions Alcohol use is an important cause of premature mortality and disease burden in NDPHS area. There are marked differences in alcohol-related PYLL-rates between sexes and countries. The increase in alcohol-related PYLL-rates between 2017 and 2021 may be related to the Covid-pandemic. Key messages • Alcohol use is an important cause of premature mortality and disease burden in NDPHS countries, and there are marked differences in alcohol-related mortality between sexes and countries. • Reduction of total alcohol consumption is an evidence-based most effective public health measure to reduce alcohol-related health harms.

5.E. Round table: Crafting Policies for Health Promotion: evidence from local settings

Abstract As communities vary in their needs, challenges, and resources, tailoring health promotion policies to specific contexts becomes imperative for effectiveness. Drawing upon the expertise of seasoned practitioners, policymakers, and researchers, this workshop offers a multifaceted perspective on navigating the complexities inherent in designing, implementing, and evaluating locally tailored health promotion policies, with a specific focus on environmental and social factors. The workshop will make it possible to compare different experiences from various European countries, with high-level speakers who have different backgrounds and roles in their countries and regions, thus providing an interesting and interactive way of comparing and examining real-world examples and best practices. The examples provided delve into: participatory techniques to design healthier environments, to identifying, collecting and elaborating evidence upon which to build policies and actions that are effective in addressing specific health challenges. Through the examples presented, we will seek to make the case for multi-actor and multisectoral collaboration. In addition, we will try to understand How do subnational authorities and partners identify priorities for action. A common question asked to the speakers will therefore: how can a variety of actors (local and regional authorities, university and research centres...) come together to support cross-sectoral action? How can policymakers be supported towards creating environments that prioritize the well-being of all, ensuring a healthier and more prosperous future for everyone? The end goal will be to enable attendees to be equipped with actionable strategies and tools to foster meaningful change within their own communities, by understanding the intricate interplay between community dynamics, stakeholder engagement, evidence-based practices, and policy implementation strategies. The workshop is being organized by the WHO Regions for Health Network (RHN). Key messages • Tailoring health promotion policies to specific contexts is imperative for effectiveness, considering the diverse needs, challenges, and resources of different communities. • Subnational authorities and partners must identify priorities for action and collaborate across sectors to address specific health challenges effectively. Speakers/Panelists Klara Dokova Medical University of Varna, Varna, Bulgaria Camilla Ihlebaek Norwegian University of Life Sciences, Aas, Norway Jo Peden Public Health Wales, Cardiff, UK Odile Mekel NRW Centre for Health, Bochum, Germany Liesbeth van Holten Province of Utrecht, Utrecht, Netherlands

One-year risk of all-cause death and major cardiovascular events in patients presenting with hypertensive crisis. A report from a global federated research health network

Abstract Background Few data are available about the clinical course of patients presenting with hypertensive crisis who are discharged alive from hospital. Purpose To assess the long-term risk of adverse events in patients with hypertensive crises. Methods Retrospective study utilizing a research health network. Based on the ICD-10-CM codes recorded between 2000 and 2022, from 85 health care associations mainly located in the United States, patients with hypertensive crisis were subdivided into hypertensive urgencies (I16.0) and hypertensive emergencies (I16.1). In those with hypertensive emergencies, the type of target organ damage was reported, ie. central nervous system (ischemic stroke, hypertensive encephalopathy, intracerebral hemorrhages), cardiovascular (CVS: myocardial infarction (MI), heart failure (HF), aorta dissection (AD)), or renal (acute kidney failure). Primary outcomes were the one-year risks of all-cause death, and major cardiovascular events (MACE: MI, stroke, cardiac arrest, AD, and HF). Secondary outcomes were the risks for each type of MACE. Cox regression analysis after propensity score matching (PSM) 1:1 was used to produce hazard ratios (HRs) and 95% Confidence Intervals (95%CIs). Results Overall, we identified 25 294 patients with hypertensive emergency (age 62.4±15.7, 46.1% females) and 21,737 patients with hypertensive urgency (age 63.5±17.2, 55.5% females). Patients with hypertensive emergency were more likely males, Black or African American origin and showed a higher prevalence of chronic hypertensive-related complications, vs. those with hypertensive urgency. After PSM, patients with hypertensive emergency showed a higher risk of all-cause death (HR, 1.34, 95%CI 1.25-1.44) and MACE (HR 4.09, 95%CI 3.87-4.33), vs. those with hypertensive urgency. Of the secondary outcomes, patients with hypertensive emergency had increased risks of MI (HR 3.33, 95%CI 3.03-3.67), stroke (HR 4.73, 95%CI 4.33-5.17), cardiac arrest (HR 1.30, 95%CI 1.07-1.58), AD (HR 5.49, 95%CI 3.90-7.73), and HF (HR 3.01, 95%CI 2.74-3.14). All the different types of organ involvement during the hypertensive emergency were each associated with similar long-term risks of adverse events (Figure 1). Conclusion Patients with hypertensive emergency have a high long-term risk of MACE and all-cause death. Preventing the onset of target organ damage in patients with hypertensive crisis is crucial to mitigate their long-term risk of adverse events.

ANÁLISE ACERCA DO CONHECIMENTO DE GESTANTES E PUÉRPERAS SOBRE A IMPORTÂNCIA DA TRIAGEM NEONATAL EM UMA UNIDADE DE SAÚDE E SEUS IMPACTOS QUANDO NEGLIGENCIADA

Neonatal screening based on the “heel prick test” biological matrix is a fundamental test performed in newborns for the screening of genetic, metabolic, and infectious diseases that can lead to health problems or irreversible deficiencies if neglected. The heel prick test is a public health policy adopted in many countries, including Brazil, and is widely recognized as one of the most important procedures in preventive medicine, in order to guarantee comprehensive care and universal access. Thus, the National Neonatal Screening Program (PNTN) was created in 2001, to promote and implement screening actions with a special focus on prevention, early intervention, and monitoring of children whose disease is included in the program's criteria. It is necessary that the health team guide the pregnant woman during the prenatal period, and the puerperal women, as well as their respective companions, on how and where to perform the “heel prick test”, highlighting its purpose to ensure effective awareness. Therefore, the present study aims to analyze the level of knowledge about neonatal screening in pregnant and postpartum women in the public health network. As well as introduce them to the importance of tracking in a timely manner to manage positive cases through monitoring and follow-up during treatment.