Health Officials Research Articles

ANALYSIS OF QUALITY OF LIFE AND COMPLIANCE LEVEL OF PULMONARY TB PATIENTS AND BODY MASS INDEX IN POST-TRANSFERENCE TREATMENT ANTI TUBERCULOSIS IN HOSPITAL dr. M HAULUSSY AMBON

Tuberculosis is the most common multi-systemic infection, with various types of manifestation and clinical description, lung is the most common location for developing tuberculosis disease (WHO, 2018). As many as 58% of cases of pulmonary TB occur in 3 (three) countries such as Southeast Asia. Based on profile Service Health Maluku Province, in 2021 number of invention Pulmonary TB cases Service Health (Health Office) of Maluku Province to end in 2019 it reached 6,379 people or by 0.35 percent of total population in the province the largest as 1.8 million people.This research uses a quantitative observational design with a cross sectional approach. With sample use systematic type Purposive sampling of 83 respondents. Data analysis using linear regression. Results test statistics show the most influential variable to level pulmonary tuberculosis treatment is a level indicator compliance with level significance sig 0.000. Based on the results of the Multiple Linear Regression analysis, it shows that with a p-value of 0.00 0 < 0.05, H 1 is accepted, so it is concluded that there is a simultaneous influence quality of life as well as the level of compliance of TB lung sufferers And body mass index on post treatment tb lung at DR M Haulussy Ambon Regional Hospital.

The effects of ventilation layout on cough droplet dynamics relating to seasonal influenza

The primary aim of this paper is to investigate airborne virus transmission in a typical meeting room relating to the heating, ventilation, and air conditioning (A.C.) systems. While the installation of 4-way cassette A.C. systems in offices and meeting rooms has become increasingly common, their efficiency in mitigating short-range airborne virus spread remains poorly understood. Addressing this gap is critical in the post-pandemic era, where understanding the limitations of various ventilation systems is paramount for public health. We systematically compare the performance of the 4-way cassette A.C., various configurations of mixing and displacement ventilation systems, and natural ventilation in controlling the spread of respiratory viruses. Our research uniquely integrates evaporation models to accurately simulate cough clouds' multiphase behavior under both quiescent and thermally influenced conditions. The study benchmarks these systems against two widely recognized ventilation standards (i.e., 5 air changes per hour and 10 l/s per person), offering evidence-based insights applicable across diverse indoor settings. Our findings reveal significant thermal effects in the quiescent case, resulting in 32.3%, 54.3%, and 8.0% changes in the axial, vertical, and lateral spread of the virus-laden droplets, respectively. Notably, the 0.5 m/s 4-way cassette A.C. system demonstrated superior performance, reducing the axial spread by 29.6% compared to other mechanical ventilation configurations. Furthermore, the role of exhaust outlets or doors was found to be critical in shaping the spread pattern in natural ventilation scenarios. This work can offer practical guidance to office workers, engineers, and public health officials on enhancing indoor airborne infection control.

Survey of state animal health officials reveals lack of personnel and resources to manage equine infectious disease outbreaks.

The purpose of the study was to assess the challenges faced by state animal health officials (SAHOs) when managing equine disease outbreaks. A survey was conducted to assess SAHOs' collaboration with horse owners and practicing veterinarians to provide biosecurity and infection disease control. It was sent to 180 email addresses listed in the Equine Disease Communication Center website database. The responses in each category for each question were tabulated and reported as a percentage. There were 72 survey responses from 45 states. The number of states responding suggested that the results represent SAHOs' current opinions. Fifty percent of responders identified the lack of resources and training for equine health management and equine reportable disease prevention and control. There is a lack of owner compliance in managing disease outbreaks, and boarding stables, horse shows, and racing facilities require the most resources for outbreak management. The survey indicated on-site communication as the most effective for managing an outbreak, and the Equine Disease Communication Center is to be a valued resource for alerts and disease information. At the state level, there is a lack of needed personnel and resources to effectively manage an equine infectious disease outbreak. Furthermore, failure of veterinary and owner compliance in reporting and managing equine infectious diseases allows disease spread. Lack of sufficient resources for management of reportable diseases will potentially result in disease spread with a negative impact on horse health and the equine industry.

Medicaid expansion and medications to treat opioid use disorder in outpatient specialty care from 2010 to 2020

IntroductionMedications for opioid use disorder (MOUD) are considered the first line treatment for opioid use disorder. As states expanded Medicaid beginning in 2014 under the Affordable Care Act, policymakers and public health officials were interested in the potential for expansion to increase access to MOUD. This study examined whether there were changes in MOUD use within outpatient admissions to specialty treatment facilities in Medicaid expansion states beyond the initial expansion period. MethodsAnalyses were conducted using 2010–2020 data from the Treatment Episode Data Set – Admissions. For states that expanded Medicaid prior to 2015, a difference-in-differences analysis was conducted to evaluate whether expansion was associated with an increased proportion of MOUD treatment comparing the initial 2014–2017 period and the 2018–2020 period to 2010–2013. We then conducted a difference-in-differences analysis to examine the overall effect of Medicaid expansion on outpatient MOUD using all states that passed expansion at any point during the study period. ResultsAmong outpatient treatment episodes for OUD in states that expanded Medicaid in 2014, there was a 9.5 percentage point (95 % CI: 0.7–18.2) increase in the probability of receiving MOUD during the initial expansion period from 2014 to 2017 compared to 2010–2013 period, and a 7.5 percentage point (95 % CI: −8.1 –23.1) increase in 2018–2020 (compared to the 2010–2013 period) after adjusting for individual-level covariates. After incorporating states that expanded Medicaid between 2015 and 2020, there was a 6.4 percentage point (95 % CI: −0.01–13.0) increase in the probability of receiving MOUD among individuals receiving care after expansion (compared to the pre-expansion period). During the study period, there was variability among states in the change in probability of receiving MOUD from prior to after Medicaid expansion from an almost 30 percentage point increase in New York to an almost 20 percentage point decrease in Washington, DC. ConclusionsMedicaid expansion increased the probability of receiving MOUD in outpatient settings across states from initial expansion through 2020. However, these results were not statistically significant. Additionally, significant variability between states warrants further study and suggests that improving access to MOUD will require additional state and local strategies.

Examining select sociodemographic characteristics of sub-county geographies for public health surveillance

BackgroundMapping health outcomes related to environmental health hazards at the county level can lead to a simplification of risks experienced by populations in that county. The Centers for Disease Control and Prevention’s National Environmental Public Health Tracking Program has developed sub-county geographies that aggregate census tracts to allow for stable, minimally suppressed data to be displayed. This helps to highlight more local variation in environmental health outcomes and risk data. However, we wanted to understand whether the aggregation method used was aggregating sociodemographically similar or dissimilar areas with one another. This analysis attempts to explore whether the distributions of select people who may be at increased risk for exposure to environmental health hazards as identified by the Tracking Program are preserved in these sub-county geographies with the census tracts used as the foundation to create them.MethodsMean values of three sociodemographic characteristics (persons aged 65 years and older, people from racial and ethnic minority groups, and population below the poverty level) for each sub-county geography in five states were calculated and placed into five break groups. Differences in break groups were determined and compared for each sub-county geography and census tract.ResultsThe sociodemographic characteristics among the census tracts and two aggregated sub-county geographies were similar. In some instances, census tracts with a low population or a highly skewed population (e.g., very high percentage of population aged 65 years and older) were aggregated with dissimilar census tracts out of necessity to meet the requirements set by the Tracking Program’s aggregation methodology. This pattern was detected in 2.41-6.59% of census tracts within the study area, depending on the sociodemographic variable and aggregation level.ConclusionsThe Tracking Program’s sub-county aggregation methodology aggregates census tracts with similar characteristics. The two new sub-county geographies can serve as a potential option for health officials and policymakers to develop targeted interventions using finer resolution health outcome and environmental hazard data compared to coarser resolution county-level data.

Maternal Self-Health on Toddler Diarrhea associated with Environmental Sanitation in Deli Tua Health Center Area

Morbidity surveys conducted by the Sub-directorate of Disease Control Prevention and Environmental Health (P2PL) of the Health Office from 2000 to 2010, there was an increase in the incidence of diarrhea. Many factors contribute to the increasing incidence of diarrhea, especially among children under five years of age, including maternal personal hygiene and environmental sanitation. In 2014 there were six diarrhea outbreaks that were widely spread in five provinces and six districts or cities, the number of patients increased to 2,549 people with twenty-nine deaths (CFR 1.14%) and North Sumatra was one of the five provinces with the most cases. This study was conducted in Deli Tua Subdistrict, Deli Serdang Regency, North Sumatra, for approximately 8 months from April to December 2016 is an observational analytic study with a cross sectional approach. The sample of this study were 50 mothers who brought their toddlers to the Deli Tua Health Center. The statistical analysis used was chi square test. The results showed there was a relationship between the mother's hand washing behavior (p = 0.05), the use of water sources (p = 0.04) and the age of toddlers (p = 0.00) with the incidence of diarrhea in toddlers in the Deli Tua Health Center working area.

Local Supports to Break the Cycle: A Description of Intersectional Interventions to Address Adverse Childhood Experiences and Drug Overdose.

Adverse childhood experiences (ACEs), substance use disorders (SUDs), and overdose are interconnected issues impacting individuals and communities at multiple levels of the social ecology and across generations. Few studies describe approaches that intentionally and simultaneously address these issues. This paper examines activities of 15 sites across the country that were designed to simultaneously prevent ACEs, SUD, and overdose. This paper describes the work at the intersection as well as gaps and opportunities. Describing ways to implement intersectional programming may assist other organizations in taking similar steps in their communities. From December 2020 through July 15, 2023, funded sites received technical assistance from the National Association of County and City Health Officials and the Centers for Disease Control and Prevention for 18months to support the implementation, adaptation, and/or expansion of evidence-based programs to address ACEs, SUD, and overdose. Activities were coded to identify intersectional interventions that addressed ACEs, SUD, and overdose. Most of the ACEs prevention strategies and overdose prevention priority areas/guiding principles from which communities could choose were represented. Most activities were implemented with caregivers and families and addressed ACEs through interventions to lessen harm or to promote social norms. Primary prevention and coordination of resources were the most used overdose prevention priority area/guiding principle. It is possible to address the intersection of ACEs, SUD, and overdose on a local level. Opportunities to further address the intersection include incorporating more secondary and tertiary prevention strategies, expanding economic supports, and increasing the work focused on equity.

Detection of Hepatovirus A (HAV) in wastewater indicates widespread national distribution and association with socioeconomic indicators of vulnerability.

Wastewater-based epidemiology, which seeks to assess disease occurrence in communities through measurements of infectious disease biomarkers in wastewater, may represent a valuable tool for understanding the occurrence of hepatitis A infections in communities. In this study, we measured concentrations of Hepatovirus A (HAV) RNA, in samples from 191 wastewater treatment plants spanning 40 US states and the District of Columbia from September 2023 to June 2024 and compared the measurements with traditional measures of disease occurrence. Nationally, 13.76% of the 21,079 wastewater samples were positive for HAV RNA, and both concentrations and positivity rates were associated with NNDSS hepatitis A case data nationally (Kendall rank correlation coefficient = 0.20, concentrations; and 0.33, positivity rate; both P < 0.05). We further demonstrated that higher rates of wastewater HAV detection were positively associated with socioeconomic indicators of vulnerability including homelessness and drug overdose deaths (both P < 0.0001). Areas with above average levels of homelessness were 48% more likely to have HAV wastewater detections, while areas with above average levels of drug overdose deaths were 14% more likely to have HAV wastewater detections. Using more granular case data, we present a case study in the state of Maine that reinforces these results and suggests a potential lead time for wastewater over clinical case detection and exposure events. The ability to detect HAV RNA in wastewater before clinical cases emerge could allow public health officials to implement targeted interventions like vaccination campaigns.IMPORTANCEDespite the existence of a highly effective vaccine for hepatitis A, outbreaks in vulnerable populations remain common. The disease can be asymptomatic or subclinical, and disproportionately impacts populations with inadequate access to healthcare, leading to a severe underestimation of the occurrence of this viral infection. This study investigates the potential for wastewater measurements of biomarkers of the causative agent of hepatitis A (HAV RNA) to provide insights into disease occurrence. Results highlight the potential for wastewater-based epidemiology to be a complementary tool to traditional surveillance for monitoring and controlling HAV transmission.

Legal Protection For Consumers Related To The Circulation Of Hard Drugs By Unlicensed Drug Stores In Indonesia

One of the aspects of welfare that must be achieved in line with the national aspirations of Indonesia is public health, which is acknowledged as a fundamental right governed by the 1945 Constitution. However, there is a growing risk of hard drug misuse due to people's inclination to self-medicate without a prescription. Government Regulation Number 51 of 2009 and Law Number 17 of 2023 stipulate that only pharmacists with a prescription from a doctor are authorized to administer hard substances. Nonetheless, it is still common for illicit drug outlets to offer strong pharmaceuticals to customers without a prescription, which puts their health at risk. This study employs a normative juridical methodology that combines a case-based and statutory approach. Despite the legal protections for consumers regulated in Law Number 8 of 1999 (UUPK), many consumers do not understand their rights and obligations, so they are vulnerable to fraud and health risks. The findings of this research indicate the need for increased public awareness and stricter law enforcement to protect consumers from the misuse of hard drugs. As well as supervision by BPOM and the Public Health Office as an effort to control the circulation of hard drugs without a doctor's prescription, which are sold in drug stores that do not have a business license.

Financing immunisation in Kenya: examining bottlenecks in health sector planning and budgeting at the decentralised level

BackgroundDecentralisation has increasingly been adopted by countries as an important health sector reform aimed at increasing community participation in decision making while enhancing swift response at decentralised levels, to accelerate the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level.MethodsData were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software.FindingsThe study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Limited budget allocations and delayed and untimely disbursement of funds were reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation due to their perceived intangibility influenced resource allocation to the programs.ConclusionThe findings highlight the need for effective strategies to align planning and budgeting processes, increased technical support to counties to enhance the requisite capacity, and efforts to improve budget execution to improve budget credibility. Counties should plan to increase their funding commitment toward immunisation to ensure sustainability of the program as Kenya transitions from GAVI support.

Context dependent preferences in prestige bias learning about vaccination in rural Namibian pastoralists

Extensive work in the social sciences suggests that vaccination decisions are subject to incentives, biases, and social learning processes, including prestige bias transmission. High status figures, like doctors and public health officials, can be effective messengers for vaccination information and uptake under certain conditions. In communities where there is significant medical mistrust and less interaction with markets and formal medical systems, prestige bias social learning may operate through different channels. Here, we examine the role of prestige bias on vaccine decisions in two ethnic groups (Himba and Herero) with varying levels of market integration and experiences with formal healthcare systems. Participants completed a ranking task, comparing the influence of four prestigious individuals on vaccine decisions and a survey on medical mistrust. Using Plackett-Luce models, we compare the influence of location, ethnic affiliation, and other covariates on rankings. A multi-level model compared the influence of those within and outside one's ethnic group, as well as specialist (doctor/healer) and generalist (chief/governor) prestige figures. Results indicate changes in the rank of prestigious individuals across the rural-urban gradient. Our results demonstrate significant variability in prestige-biased social learning about vaccine decision making. Medical mistrust did not impact rankings. Contrary to previous work, we find that whether a prestigious individual is locally prominent is more important than their expertise in the relevant domain (health and healing). These findings emphasize the need for more context-specific studies of prestige bias, which can improve our understanding of healthcare decision-making and guide public health messaging across diverse contexts.

The Effect of a Tailored Educational Flyer on Colorectal Cancer Screening Among Rural Residents: Lessons Learned from a Pilot Randomized Trial.

Background/Objectives: Stool-based tests, such as the fecal immunochemical test (FIT), have been widely used for increasing colorectal cancer (CRC) screening. Small media, such as printed materials or flyers, are known to be an effective intervention to increase CRC screening by fecal tests. However, more evidence is needed to determine whether such small media are effective in improving screening uptake of a mailed FIT intervention targeted at rural populations in the USA. Methods: In this randomized study, 1230 FIT kits were mailed from July to December 2022 to rural Nebraskans aged 45-74 who were not up to date on CRC screening. Half of the participants (n = 608) also received a tailored, one-page, gender-specific educational flyer created based on focus groups with rural residents. Logistic regression was used to determine predictors of returning the FIT. Results: Study participants were predominantly female (76%), non-Hispanic White (83%), and within the age group of 55-64 (43%). Overall, 192 (15.6%) kits were returned (16.1% from the flyer group; 15.1% from the no-flyer group). However, we found no significant differences between the flyer and no-flyer groups (Adjusted Odds Ratio [AOR]: 1.21; 95% CI: 0.88-1.66). Females (AOR: 1.78; 95% CI: 1.19-6.14) and the oldest (65-74) age group (AOR: 5.03; 95% CI: 2.78-8.47) were more likely to return FIT kits than males and the youngest (45-54) age group. Conclusions: A tailored educational flyer was not effective in improving the CRC-screening-rate-by-mailed-FIT approach for rural populations. Future research should explore the content, timing, and mode of delivery of educational interventions as well as other multi-component strategies to improve screening rates. Public health officials might also consider developing strategies targeted at males and younger (45-54) age groups.

Sanitation Control of Ferry Ports in Tanjung Harapan Harbor

Environmental sanitation is an activity to create healthy environmental conditions in the port area. Good sanitation conditions can prevent disease transmission. Sanitary conditions in the Port of Tanjung Harapan Selat Panjang are not good enough, characterized by rat catching which increases every year, poor drainage conditions, and inadequate sanitation facilities. The purpose of this study is to evaluate the management of sanitation at Tanjung Harapan Harbor in Selat Panjang to become input material to make it better in the future. This research uses a qualitative method with a system approach based on input, process and output where the data collected comes from interviews, observation and documentation and is analyzed using triangulation. Sanitary management of the Port of Tanjung Harapan Selat Panjang is managed by port management and supervised by the Port Health Office. Sanitary management at the Port of Tanjung Harapan Selat Panjang is already running but not optimal, there are still obstacles from the aspects of human resources, large financing and inadequate infrastructure such as the unavailability of TPS and WWTP for waste management. Port sanitation management must be maintained to prevent the development of disease vectors and transmission of various types of diseases. The need for good cooperation between the manager and the Port Health Office to create a healthy port.

Exploring demographic, healthcare, and socio-economic factors as predictors of COVID-19 incidence rate: A spatial regression analysis.

This study investigated the relationship between demographic, healthcare, and socio-economic factors, and COVID-19 incidence rate per 100,000 population in Thailand at the province level between January 2020 and March 2022, using a five-phase approach by spatial analysis. OLS models were initially used with significant variables: household, hospital, and industry density, nighttime light index (NTLI). Spatial dependency led to spatial error (SEM) and spatial lag models (SLM), performing better with similar significant variables being applied. SEM explains 58, 65 and, 70 percent in Wave 1, 4 and 5 of COVID-19 variation. SLM explains 25 and 76 percent in Wave 2 and 3 of incidence rate. Positive associations were found between incidence and household density, hospital/medical establishments with beds, Nighttime Light Index (NTLI), and negative with population, hospital, and industry density. Wave 5 showed significant changes with negative for household, hospital, and industry density, urban population; positive for hospital/medical establishments with beds, internet access, NTLI. The study showed that significant predictors of COVID-19 incidence rate vary across waves. Population, household and hospital density, urbanization, access to medical facilities, industrialization, internet access, and NTLI all play a role. The study suggests SEM and SLM models are more appropriate, providing useful information for policymakers and health officials in managing pandemic in Thailand.

The Effectiveness of CATIN Class on Pregnancy Readiness of Prospective Brides in The Working Area of Citangkil 2 Health Center, Cilegon City

Prospective brides and grooms are a strategic target group in efforts to improve their health before pregnancy. Before the wedding, many prospective brides and grooms do not have enough knowledge and information about reproductive health in a family, so that after marriage pregnancies are often not planned well and are not supported by optimal health status. The number of marriages in Indonesia in 2023 will reach 1.58 million and 68,185 will come from Banten Province. Maternal mortality still reaches 127 cases of maternal death per 100,000 births and the incidence of anemia in pregnant women is 9.2% in 2023. The aim of this research is to determine the effectiveness of prospective brides and grooms or CATIN (Calon Pengantin) classes on the pregnancy readiness of prospective brides in the Industrial Area of ​​the Citangkil 2 Community Health Center, Cilegon City. Research methods is qualitative research. Population in this study were prospective brides and grooms who registered at KUA in July 2024 in the Citangkil 2 Health Center Working Area, Cilegon City, totaling 12 informants, consisting of 10 Catins and 2 expert informants from KUA and Health officers. There is an influence of information sources related to the socialization of the catin class program from KUA officers and Community Health Center Health Workers on the pregnancy readiness of the prospective bride and groom and knowing the attitude of the prospective bride and groom, the attitude of the KUA officers and the attitudes of health workers who take part in the catin class. There is a change in attitude after participating in the catin class service.

Best Management Practices to Mitigate Contamination of Karstic Aquifers from Emergency Fire-Control Runoff

We propose best management practices to increase karstic aquifer drinking water supplies’ resilience to potential hazardous material impacts where first responders and public safety officials suspect emergency firefighting runoff has entered the subsurface in the aquifer recharge zone. Karstic aquifers are unique because of their direct openings to the land’s surface, which allows contaminants in runoff or other surface waters to rapidly enter the subsurface and impact aquifer water quality. In the United States, 20% of the land surface is karst, and about a third of the groundwater used for drinking comes from karstic aquifers. Proposed best management practices emphasize on-site, real-time evaluation of the transport and fate of HAZMAT that may enter the subsurface and focus on water quality sampling, runoff and groundwater flow modeling, nontoxic dye tracing, and related studies for use in planning before and during an event and after emergency response has ended. We recommend best management practices for evidence-based screening of high-risk sites to facilitate placement of hazardous material sampling devices and emergency responder deployment. The best management practices, tools, curricula, and training described combine with earlier work by the authors to provide a comprehensive menu of actions to (1) help first responders prevent or limit flushing of hazardous material into a karstic aquifer; (2) help emergency management officials understand the consequences of contamination and issue data-driven geographically focused health and safety risk communications; and (3) help provide health and safety officials with relevant science- and data-based information that can help mitigate human and environmental health risks.

Sleep difficulties as a universal risk factor for injury among adolescents in 46 countries

Abstract Background Poor sleep is common among adolescents and associated with unintentional injuries. The current evidence base is limited by differences in measures of sleep and injury implemented across studies. We examined the potential universality of the relationship between poor sleep and injury cross-nationally using self-reports from 229,589 adolescents in 46 countries that were collected using common procedures and measures. Methods A cross-sectional study was conducted using records from the 2017/18 Health Behaviour in School-aged Children (HBSC): World Health Organization cross-national study. The prevalence of sleep indicators (difficulties in falling asleep, insufficient sleep, social jet lag) and medically treated injuries (overall, multiple) were described across countries and by gender. Multivariable modified Poisson regression analyses were conducted within and across countries to test the consistency of the association between poor adolescent sleep and injuries. Results Overall, indicators of poor sleep were reported by nearly half of adolescents, and varied by gender and across countries. Country-level analyses found consistently positive associations between indicators of poor sleep and injuries. Pooled (multi-country) analyses further demonstrated a universality of these relationships across sleep indicators and injury outcomes. The strength of relationships varied by gender, with more robust associations detected among girls compared to boys. Conclusions Poor sleep is a robust and mainly consistent risk factor for injury among adolescents across countries and regions. Public health officials and policymakers should therefore recognize adolescent sleep as a health priority. The promotion of sleep hygiene may represent a novel target for injury prevention at regional and national levels. Key messages • Poor sleep, in the form of sleep difficulties, insufficient sleep, and social jet lag, were robust and mainly consistent injury risk factors among adolescents across 46 countries. • Public health officials should recognize sleep hygiene as a novel focus for adolescent injury prevention.

Reflective model assessment of adherence to COVID-19 non-pharmaceutical interventions

Abstract Background Non-pharmaceutical interventions (NPIs) decrease COVID-19 transmission. We identified behavioral factors that affected NPI adherence according to Normalization Process Theory (NPT) in medical students, travel seekers, and people with substance use disorder using reflective model measurement, which previously had not been conducted. Public health officials should consider factors that influence adherence to create preventive strategies for COVID-19. Methods In a cross-sectional design, medical students and people with substance use disorders in treatment comprised a probabilistic sample, and travelers and COVID-19 suspected persons comprised a convenience sample. Participants were from Split-Dalmatia County (n = 656) in the Mediterranean and consented to self-administered surveys in 02/2021. Sociodemographic data, locus of control (LoC), and moral behavior were collected. Partial least squares structural equation modeling (PLS-SEM) was used to measure reflective assessment of NPI adherence according to NPT. Results PLS-SEM reflective model assessment provided two-group specific factors in inverse relationships which determined NPI adherence with excellent goodness of fit (χ2=1.292, df = 1; p = 0.297). Significant negative factors covariance estimate (-0.716) revealed an increase in adherence to the first factor, NPIs and internal LoC [0.640], as the second factor, age (≤25) and highest education level (1.362), decreased. LoC was the mechanism by which sex (MLsex=-0.017, SE = 0.007, p &amp;lt; 0.016) and being a student or person with substance use disorder (MLgroup=-0.008, SE = 0.003, p = 0.015) showed indirect effect on NPI adherence. Conclusions Students and people with substance use disorders more adhered to NPIs. Higher-educated younger adults with a tendency toward external LoC facilitated the normalization. Public health interventions could encourage these subgroups to act as promoters to increase NPI adherence in similar settings. Key messages • COVID-19 non-pharmaceutical interventions and psychological factors of students and people with substance abuse disorder influenced adherence. Targeted interventions could promote adherence. • Public health officials should consider that preventive strategies may be more effective in highly educated adults younger than 25 years of age.

General Practitioner Availability and Accessibility in Serbia Before and During the Pandemic

Abstract Background During the COVID-19 pandemic in Serbia, state-owned primary health centres’ general practitioners (GPs) served as the first point of care for adults (the population aged 19 years and older) and gatekeepers of the health system. The study highlights changes in the overall availability, accessibility, and workload of GPs during the pandemic. Methods We used routine health facility data at the national level to describe the changes in GPs over the past three years, before the pandemic (2017-2019) and during the pandemic (2020-2022). Specifically, we looked at the total number of GPs, the percentage of specialists, the average number of citizens per GP, the services used per capita, the average number of visits per GP, and the leading causes of morbidity. Results The study found a decrease in the total number of GPs in both periods (before: -10%, during: -9%) and in the number of specialists (before: -2%, during: -3%). During the pandemic, the average number of citizens per GP varied. In 2022, the average number of visits per GP decreased noticeably to 3557 GPs, of which 37% were specialists. In the same year, each GP received 6661 annual visits and served 1509 citizens on average. However, these figures exhibit considerable regional and geographical differences. Circulatory and respiratory diseases were the most common reasons for visiting a GP (about 14% and 13% of all visits, respectively). Up to 10% of all visits resulted in either a diagnosis of external factors that influence health status or in ill-defined symptoms, clinical and laboratory findings. Conclusions This study’s findings underscore the critical reductions in availability, accessibility, and workload of general practitioners in the Serbian public sector and emphasize the importance of strengthening the primary healthcare system to better respond to future challenges. Key messages • Public health officials should prioritize the development of effective strategies and policies that focus on improving the quality and accessibility of primary health care services in Serbia. • A greater investment in general practice is necessary to ensure it can effectively meet the population’s needs during health emergencies.

7.X.1. Providing BoD estimates on a regional level – necessity in assessing health inequalities

Abstract Burden of disease indicators, such as Disability-adjusted life years (DALY), Years lost due to disability (YLD) and Years lost due to death (YLL) have become standard indicators in public health reporting systems. Due to the combination of morbidity and mortality, the DALY provides valuable information on the burden due to specific diseases. These tools are employed by policymakers to devise intervention programs with the objective of enhancing the collective health of the population. Studies at the subnational level offer a greater added value to the public health information systems. Identifying variations in health outcomes and disease burden across different regions is a key factor when introducing targeted interventions and allocating resources. Health inequalities persist also in countries with good health systems and well-developed welfare state. There are notable contrasts in the political, economic and social environments across Europe. Moreover, the European countries are at different stages of the epidemiological transition, which encompasses a range of factors influencing health and modifiable risk behaviours. These differences are determined by socioeconomic inequalities at national and sub-national level, such as municipalities, counties and others. It is therefore imperative to provide BoD indicators at the most possible detailed regional-level and to link this information with further indicators such as deprivation indexes or Gini coefficients. Obtaining regional-level data for BoD analysis and health inequalities is not straightforward and can pose many challenges. Data availability is usually scarce and may involve significant resources in collecting it. Data quality and data completeness can also pose challenges in the reporting systems, which can result in under-reporting of certain diseases and overlooking health problems in the population. Also, countries with smaller populations are confronted with the challenge of a limited number of cases, which poses difficulties in obtaining regional estimates. The following workshop presents examples from European BoD studies, that have analysed health inequalities at regional level. The first presentation shows a country comparison study of the overall YLL and their association with socioeconomic and geographical inequalities. The second is from an Estonian study, representing a country with a small population that has developed its own methodology for assessing regional health issues. The third presentation from the German BoD study presents results on 96 spatial planning regions, which have been combined with the German index of socioeconomic deprivation. The final presentation brings example from Norway, where the association between YLL and education and income is examined at municipality level. Key messages • By comparing BoD estimates at the regional level, policymakers and public health officials can identify areas with higher disease burdens, indicating potential health inequalities. • Linking information on BoD indicators with data on regional and socioeconomic inequalities is essential when monitoring developments and tailoring strategies in public health outcomes.