Preventive Care Research Articles

Future proof competencies for nurses working in primary care; a mixed methods study

Abstract Background Healthcare services, also those provided by nurses, are challenged by the increasing care demands of an ageing population and people with chronic conditions. To improve care efficiency and quality, now and in the future, nurses must have competencies regarding self-management support of patients, electronic communication, preventive care, and engaging relatives in care. This study aimed to assess primary care registered nurses’ (RNs) time allocation to these competencies and their perceived needs for further development of these competencies. Methods A mixed methods design was used, involving a nationwide survey (n = 303) and focus groups (12 participants), both with RNs working in community care services or general practitioners (GPs) practices. Survey data were analysed descriptively, and focus group transcripts underwent qualitative thematic analysis. Results The majority of RNs invest significant time in client self-management support (90%), preventive care (82%), and involving relatives in care (74%). RNs also recognized an increasing demand for these competencies in the future and the need to motivate patients and relatives to self-manage their health. Furthermore, RNs reported that competencies regarding electronic communication skills will become extra important in the future, yet currently only 37% dedicate substantial time to this. RNs face challenges in effectively utilizing electronic communication with patients and thus need opportunities to improve digital skills. Additionally, RNs desire enhanced collaboration with other healthcare professionals, such as GPs and medical specialists. Conclusions RNs’ limited time allocation and perceived inadequacy in electronic patient communication, underscore the importance of targeted training in this area, and prioritizing this by healthcare organizations. In addition, fostering collaboration between nursing staff and other healthcare professionals could support future proof nursing in primary care. Key messages • Nurses demonstrate resilience in addressing healthcare challenges, emphasizing client care, prevention and family engagement. • Training nurses in competencies for electronic communication with patients is essential to meet the anticipated increase in demand for this aspect in their practice.

Factors Associated with Dental Care Utilization for Oral Disease Prevention Among Adolescents in Multicultural Families in Republic of Korea

Objectives: This study utilized data from the 2022 Korea Youth Risk Behavior Survey to examine the utilization of preventive dental care among adolescents from multicultural families and analyze the associated factors. Methods: The number of adolescents from multicultural families, based on parental nationality, was 1361. The dependent variables were asymptomatic dental visits, sealant experience, and scaling experience. The independent variables included health perception factors (subjective health status, subjective oral health status), health behaviors (fruit consumption frequency, vegetable consumption frequency, sugary drink consumption frequency, drinking experience, smoking experience), and oral health behaviors (daily tooth-brushing frequency, tooth brushing after lunch, use of oral care products, oral symptom experience). Confounding variables included demographic variables (age, grade) and socioeconomic variables (academic performance, economic level, parental education level, mother’s nationality). Statistical analyses were conducted using a complex samples cross-tabulation and complex samples logistic regression. Results: Asymptomatic dental visits were significantly associated with subjective oral health status and sugary drink consumption. Those who perceived their oral health as “Healthy” had an odds ratio (OR) of 3.34 (CI = 1.76–6.32; p < 0.001), and those who perceived themselves “Normal” had an OR of 2.03 (CI = 1.08–3.82; p = 0.029). A sugary drink consumption of less than three times per week was linked with an OR of 1.68 (CI = 1.05–2.70; p = 0.031). Sealant experience was associated with brushing before bedtime (OR = 2.27, CI = 1.18–4.35; p = 0.014) and using more than one oral care product (OR = 1.97, CI = 1.27–3.07; p = 0.003). Scaling experience associated with oral symptoms (OR = 1.94, CI = 1.21–3.11; p = 0.006). Conclusions: To enhance access to preventive dental care utilization for adolescents from multicultural families, efforts are needed to raise subjective oral health awareness, improve oral health behaviors, and develop strategies that ensure timely preventive dental care.

Comparison of hospital treatments of the Roma settlements’ inhabitants in Slovenia

Abstract Background Roma ethnic minority in Slovenia was recognized as a vulnerable group with worse health indicators and significantly shorter life expectancy. The vast majority of Roma population in Slovenia have health insurance. We were investigating the use of hospital services in Roma population according to their age and comparing it with the rest of the population. Methods We determined the inhabitants of Roma settlements from the Slovenian register on residents. The data on hospital treatments used were from Slovenian national register on hospital treatments for the period 2018 to 2022. We compared different ratios according to certain hospital treatments within age categories of patients and co-pared those two groups. The frequency statistics, ANOVA and comparison of column proportion tests were used (p-value<0.005, 95% CI). Results Inhabitants of Roma settlements were more often treating in hospitals that rest of population. If comparing the frequency of hospital treatments between age groups only in Roma population, the percentage of hospital treatments steeply declines with age as well as the number of persons in age groups. The highest percentages and numbers of services are in the youngest age group of 0-15 years, and the lowest in the oldest group (75+). Therefore, significantly higher ratios of hospital treatments were detected in younger then in older age groups. Conclusions Roma children and youngsters (0-15 years old) had the highest rate of hospital treatments and it declined with the age. It was consistent with age pyramid of Roma as young population as well as emphasized care for children in culture. The steady decline rate of hospital treatments with age could be explain with delayed seeking of health care services in adult age and higher premature mortality that leads to smaller adult population. Additional and in-depth research is necessary to explain the root causes of higher premature mortality and use of primary and preventive health services. Key messages • Higher use of hospital treatments was caused by higher morbidity. It is necessary to explore the leading causes of hospital treatments and premature mortality. • It is necessary to explore the use of primary health care service, preventive service and level of health literacy of inhabitants of Roma settlements.

Consumer Preferences for Health Services Offered by Health Insurance Companies in Germany

Abstract German health insurance companies increasingly strive to position themselves as health partners to their customers to improve customers’ health and contain costs. However, there is uncertainty about customers’ preferences for health services offered by health insurance companies. Therefore, this paper studies consumer preferences for health services that are or could be provided by health insurance companies in Germany. An online survey was conducted using two stated preference techniques to collect and analyze the data (namely, rating and ranking of health services considered by insurance companies). A sample of 880 German health insurance customers between 18 and 65 years old filled out the online questionnaire, of which 860 submitted complete responses. Ordinal logistic regression analysis was used for the rating and ranking. Preliminary examinations, care management, and health programs were the three health services most important to the respondents. The results suggest that people want their health insurance to support them with preventive health services that offer direct therapeutic value and not just informational, economic, access-related, or convenience-related benefits. These preferences for health services are homogeneous for most subgroups of the population, implying that health insurance companies could consider an overall strategy to address these preferences for all clients by focusing on the important health services. Key messages • People value health services provided by health insurers that offer direct therapeutic value over those that offer only informational, economic, access or convenience benefits. • As preferences are homogeneous across the population, insurers could consider an overall strategy by focusing on the important health services.

Fall risk factors and prevention among older adults in primary care in Belgium, 2019-2021

Abstract Background Falls are a major public health problem and ageing populations further increase the burden of fall-induced injuries. Falling among older persons is a multifactorial health condition needing multifactorial care. General practitioners (GPs) are well placed to implement a multifactorial management. A surveillance study of accidental falls studied characteristics of falls, risk groups and fall risk factors as well as fall prevention by GPs. Methods A 3-year retrospective population-based study by the Belgian network of Sentinel General Practitioners (SGP) on all patients aged ≥ 65 years consulting their GP for new fall-related injuries. Descriptive statistics were used to characterize falls, fallers, fall risks and preventive measures. Logistic regression analyses were performed to identify factors associated with a multifactorial fall risk profile. Results During 2019-21, 1138 accidental falls were registered. Medical and/or nursing intervention was required for 24% and 22% had a severe injury. During consult, 30% was referred to hospital. 61% of patients showed at least one of the four most prevalent fall risks, i.e. deficits of mobility or balance, polypharmacy, cognitive impairment or psychotropic medication. A multifactorial fall risk profile was observed in 45% of fallers and was associated with recurrent falling (p < 0.001), fall location (p < 0.05), activity when falling (p < 0.01) and pandemic year 2020 (p < 0.05). Addressing surrounding and walking problems were the most frequently delivered preventive measures. For 28% of patients, other primary care providers (mainly nurse and physiotherapist) were involved in preventive care. Conclusions This study highlights the importance of identifying fall risk factors among fallers in primary care. Preventive fall measures, taken in about one in four general practice patients in collaboration with other healthcare providers, are crucial for preventing accidental falls in older persons in Belgium. Key messages • A multifactorial management of fall risk factors by GPs is crucial for preventing accidental falls in older primary care patients. • Strengthening collaboration between primary healthcare professionals is needed for improving fall prevention in Belgium.

Semmelweis University’s innovative Center of Preventive Services in support of healthy ageing

Abstract Issue/problem Europe’s aging population presents substantial hurdles for healthcare sustainability. To alleviate the social and economic impacts of age-related diseases, promoting healthy aging is imperative. However, motivating individuals to adopt a healthier lifestyle proves challenging. Description of the problem Semmelweis University, a leading institution in medicine, health sciences, and health care in Hungary and Central Eastern Europe, has addressed this challenge by establishing the Center of Preventive Services (CPS), serving 12,500 Semmelweis University employees. The CPS conducts comprehensive health risk assessments and offers consultations with specialists in preventive medicine, public health, dietetics, physiotherapy, and health psychology. Motivational interviewing is used to enhance patient engagement and commitment to healthy lifestyle changes. Results The CPS has effectively integrated preventive services into the university’s healthcare system, reaching a significant number of employees. Early results show improvements in participants’ lifestyle and health behaviors due to the effective use of motivational interviewing. According to the first preliminary result, a study on step count conducted within the CPS found that those taking part in motivational interviewing session were able to increase their average daily step count by 1074 (95% Confidence Interval: 116-2033) steps more than controls. Lessons The Semmelweis University’s CPS provides valuable lessons for integrating healthy aging-focused preventive care into healthcare systems: 1. Effective preventive care requires targeted interventions based on detailed risk assessment and motivational interviewing; 2. Embedding preventive services within existing health infrastructure improves accessibility and utilization; 3. Collaborative and multidisciplinary approaches are essential to comprehensively address the needs of ageing populations. Key messages • Motivational interviewing boosts the effectiveness and engagement of preventive health services, which is essential to meet the challenges of ageing populations. • The Semmelweis University’s model program shows that embedding preventive services into the infrastructure of existing institutions like universities is scalable for better public health.

Factors influencing an advanced nursing practice service for people with intellectual disabilities

Abstract Background People with intellectual disabilities (PWID) have less access to preventive healthcare services and are therefore more likely to suffer from certain chronic diseases. Advanced Practice Nursing (APN) can be a suitable approach for this group. However, APN is not yet widespread in all European countries. This intervention focuses on PWID in Hamburg, Germany, who receive case management and prevention focusing on stress, nutrition, mobility and addiction through community-based APN to improve their health status. We aimed to explore the facilitators, barriers and experiences of stakeholders in the context of the APN intervention. Methods We conducted 90 semi-structured problem-centered interviews with PWID, family members, professional caregivers and prevention service providers in 2023 and 2024. We employed convenience sampling. Data were analyzed by qualitative content analysis with mixed inductive-deductive coding using MAXQDA. Results Overall interviewees were satisfied with the intervention. It was reported that the clients exercised more, ate healthier, learned techniques to reduce stress and coped better with addiction. In addition, barriers to preventive services were reduced. We identified factors that positively influenced the success of the intervention: good interprofessional collaboration, successful relationship building with clients, concise goal setting and target group-specific work materials. Barriers were: neglect of the professional care network, difussion of agreements, lack of available prevention services, and communication problems. The results are preliminary. Conclusions This is one of the first evaluation studies of an APN intervention for PWID in Germany. The results show that this new form of care can be implemented if the relevant stakeholders work together and good relationships with the clients are established. Specific goals should be defined and the professional carergivers should develop a community network. Key messages • APN is a suitable approach for disease prevention and health promotion for people with intellectual disabilities, given interprofessional collaboration and a well-established relationship with clients. • Preventive healthcare for the target group is difficult to implement if the stakeholders do not work together and if there are insufficient suitable preventive services available in the community.

Healthcare accessibility of individuals at increased risk of STIs: a cross-sectional survey in Italy

Abstract Access to STI prevention and sexual health services in Italy, especially among vulnerable and marginalized groups, is inadequately documented. With the support of community organizations, a cross-sectional survey was conducted between September 2023 and March 2024 to assess health services accessibility among individuals at increased risk of STIs. A total of 1456 responses were analyzed. The respondents comprised 1327 (91.14%) cisgender men, 58 (3.98%) cisgender women, 11 (0.76%) transgender men, 10 (0.69%) transgender women, and 47 (3.23%) non-binary individuals. Overall, 93.8% were men who have sex with men, and 2.8% were women who have sex with women. Mean age was 38 (SD 12). Among respondents, 1284 (88.2%) had undergone HIV testing at least once [102 (7%) living with HIV; 45.1% diagnosed during prior year]. Overall, 563 (38.7%) had been diagnosed with at least one STI in the prior year. Chemsex was reported by 106 (7.3%), with 4.7%, 75.5%, and 35.5% using injective, inhaled or oral substances. Despite a high risk for STIs, 728 (50%) and 410 (28.2%) individuals, respectively, did not visit a specialist in infectious diseases or their primary care provider in the prior year. PrEP awareness was high: 1286 (88.2%) respondents were knowledgeable about it, but only 342 (23.5%) attended PrEP centers and 297 (20.4%) used it. Among PrEP users, 27 (7.9%) encountered difficulties obtaining the drug and 174 (50.9%) considered the cost prohibitive (before it became free). Additionally, 27 (7.9%) of those attending PrEP centers felt judged or disrespected. Overall, 1179 (80.9%) had heard of Mpox, and 1012 (69.5%) were aware of the vaccine, with 301 (20.6%) being vaccinated. Among those vaccinated, 18 (5.2%) felt judged or disrespected. Out of 55 (3.8%) individuals tested for Mpox, 13 (23.6%) tested positive, among which one reported feeling disrespected. The survey highlights critical gaps in healthcare access and awareness among individuals at increased risk of STIs in Italy. Key messages • In a final open-ended question, responders commented on various issues including high costs of services, insufficient provider training and the necessity for improved inclusion of LGBTQ+ individuals. • The robust response from typically hard-to-reach groups underscores the pivotal role of community involvement in enhancing awareness and accessibility of sexual health services, fostering inclusivity.

Semaglutide for the secondary prevention of cardiovascular disease in people with overweight or obesity, but without diabetes: a cost-effectiveness analysis

Abstract Background The recently published trial, SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) [1], was the first study to demonstrate that the glucagon-like peptide 1 receptor agonist, semaglutide, was superior to placebo in reducing the risk of major cardiovascular events in people with existing cardiovascular disease (CVD) and a body mass index of ≥27kg/m² but without diabetes. Despite the promising clinical benefits, the high cost of the medication has raised concerns about its financial viability and accessibility within healthcare systems. Purpose To explore whether use of semaglutide in addition to standard care (background use of lipid lowering, anti-hypertensive and/or anti-platelet therapies) for the secondary prevention of CVD in people with overweight or obesity is cost effective from the Australian healthcare perspective. Methods A Markov model was developed based on the SELECT trial, to evaluate the clinical outcomes and costs of a hypothetical population treated with semaglutide versus placebo over 20 years. With each annual cycle, subjects were at risk of having non-fatal CVD events (MI or stroke) or dying. Treatment efficacy, transition probabilities, and utilities were derived from the SELECT trial and published literature. Costs were obtained from Australian sources. The cost of semaglutide at a dosage of 2.4 mg/week (in line with SELECT) was estimated to be ~A$80 per week or A$4175 per year. The main outcome of interest was the incremental cost-effectiveness ratio (ICER) in terms of cost per year of life saved (YoLS) and cost per quality-adjusted life year (QALY) gained. All outcomes and costs were discounted by 5% per year. Costs are reported in 2023 Australian dollars (A$). Results Over a 20 year time horizon, treatment of 1000 hypothetical subjects with overweight or obesity and existing CVD with semaglutide compared to placebo prevented 126 non-fatal CVD events and 81 deaths, and yielded an additional 0.46 discounted life years and 0.48 discounted QALYs per person. The difference in total discounted costs was A$43,955 per person. This equated to ICERs of A$99,853 per YoLS and A$96,055 per QALY gained. Conclusions Assuming a willingness-to-pay-threshold of A$50,000 per QALY gained, semaglutide would not be considered cost-effective for the secondary prevention of CVD in people with overweight or obesity in Australia at current prices. A price reduction of 52% to less than A$2000 per year would be required for it to be considered a cost-effective treatment strategy in this setting. Given the modest event rates reported in SELECT, cost-effectiveness is likely to improve if use of semaglutide is targeted to higher risk groups. Moreover, SELECT primarily focused on cardiovascular benefits, however data supporting the impact of semaglutide on a number of other weight-related complications are anticipated and will inform a more holistic understanding of its cost effectiveness.

Barriers and facilitators to healthcare services of people with mental ill-health in Europe

Abstract Background People with mental ill-health (PMIH) have higher cancer mortality rates than the general population. Barriers to healthcare service access may be a contributing factor. The EU-funded CO-CAPTAIN project aims to reduce health inequalities by improving overall health and reducing cancer burden by adapting and implementing the Patient Navigation (PN) Model targeted at PMIH. This qualitative study explored healthcare system experiences of PMIH in Austria, Greece, Poland, and Spain. Methods Eighty-one participants (22-76 years old), including 34 PMIH, 10 caregivers, 14 care team members, 12 mental health organization representatives, and 11 service manager representatives, were recruited. Semi-structured interviews focused on awareness of cancer risk factors, healthcare system experiences, and perspectives on PN as an intervention. Interviews were transcribed verbatim and analyzed using thematic analysis. Results Three major themes emerged: (1) somatic health relevance and preventive services utilization and (2) barriers / (3) facilitators to preventive services access. Knowledge of cancer prevention services varied greatly. Participants were aware of associations between risky health behaviors and health. Burden of mental health problems and discrimination, insufficient access to information, and lack of service flexibility were noted as barriers. Considerations of individual circumstances, social support, and empowerment were named as facilitators. Conclusions Tailored interventions involving healthcare professionals and PMIH in development of supportive environments and health literacy have the potential of overcoming identified barriers to the use of healthcare services. Key messages • People experiencing mental ill-health are faced with significant structural barriers when accessing somatic health services. • Understanding people’s needs in terms of access and utilization of health care allows us to define guidelines for future personalized healthcare solutions.

Burden of disease and socioeconomic deprivation in Germany – regional patterns and variations

Abstract Within the scope of the BURDEN 2020 project (Burden of disease in Germany at the National and Regional Level) carried out by Robert Koch Institute (RKI) in collaboration with the German Environmental Agency and AOK Scientific Institute, burden of disease estimates for Germany and its regions become available for the first time. The national estimates of YLL, YLD and DALY are provided not only stratified by age and sex, but also by detailed regional level (96 spatial planning regions). The regional estimates provide valuable information and support the evidence-based decisions in health policies aiming at reducing the burden of disease in the country. To facilitate further the interpretation and usability of these estimates, the provided indicators were linked to the regional information on deprivation. For this purpose, the German index of socioeconomic deprivation (GISD) was used. The index was developed at the RKI and the last revised version was published in 2022. It is based on nine indicators which reflect the three subdimensions of deprivation: education, employment, and income. That is why GISD is a very suitable index for evaluating regional health disparities. Connecting both informations on BoD and deprivation, gives deeper insides in the regional differences within the country. Some diseases exhibit east/west differences, while others show north/south patterns or rural/urban distinctions. These differences reflect the variation in the prevention and health care needs for the different diseases in Germany. The results underline the necessity to study the regional inequalities separately for each disease. Different health conditions are connected to variations in settings and outline different needs in intervention programs and allocation of means.

Life course prevention - challenges for public health lying ahead

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

Using the innovative tool to prepare a quality national cancer control programme

Abstract Issue National cancer control programmes (NCCPs) are key documents in European Member States (MSs) used for the management of cancer policy. While some countries still have not prepared their NCCPs, there are several others, whose NCCP is not of high quality or not implemented. Description of the problem There is frequently a lack of knowledge in countries on how to prepare a quality NCCP or how to improve the existing one. Our objectives were: 1. To provide help in the preparation of an NCCPs and in cancer control to EU MSs 2. To enhance the availability of all the documents needed and provide best practices from other MSs. The development of an innovative tool was therefore the main objective of iPAAC Joint Action (JA). Streamlining of all NCCP-related documents prepared by the three JAs in cancer policy (EPAAC, CanCon, iPAAC) was central to the deliverables. Results The solution lied in the preparation of the interactive innovative tool called Roadmap on the Implementation and Sustainability of Cancer Control Actions (Roadmap). It was developed in a joint effort and collaboration between EU MSs and the European Commission. It is available online and can be used by all countries, including countries that are not part of EU, and who aim at preparing a high quality NCCP. The extensive content of the tool covers primary prevention, health promotion, screening, diagnosis, treatment, and health care, as well as a number of sub-areas with important contents, and over a hundred one-pagers, which include national and regional experiences. Among the latter, the European Guide for Quality NCCPs with instructions how to prepare a quality NCCP is presented as one pager. Lessons As the result of over 10 years of joint work in cancer control at EU level MSs have now both, the opportunity to learn from each other and the opportunity to access all key information they need for controlling cancer, including the instructions on the preparation of the key document, their NCCP. Key messages • Using the Roadmap countries have access to instructions and guidance for the preparation of a quality NCCP. • The Roadmap enables the access to all key documents for the management of cancer control in one place to all countries.

The Effect of Parents Health Literacy Level on Attitudes Towards Childhood Vaccinations

Abstract While the importance of vaccination services increases day by day, WHO declared vaccine hesitancy as one of the 10 threats to global health in 2019 due to the decrease in vaccination numbers in recent years. Raising parents awareness about childhood vaccines with adequate and accurate information is likely to positively affect vaccination decisions.Although the level of knowledge on this subject depends on parents being able to obtain information using the right sources, this situation can also be associated with a sufficient level of health literacy.This study aimed to evaluate how parents health literacy level affects their attitudes towards vaccines. This cross-sectional study was conducted through a facetoface survey with 400 parents of children under the age of 18 who applied to the Istanbul Faculty of Medicine, ChildHealthDiseasesPolyclinic. Asdata collection tools, a survey form including general approaches to preventive health services and knowledge level about vaccines, as well as the TSOY-32 and PACV were used. As a result of our study, the average of the correct answers given by the participants to the questions regarding their vaccination knowledge levels was determined as 12.1±4.3. The average health literacy general index score was found to be 33.6±4.5. It was determined that 2.5% of the parents had insufficient health literacy levels, and 67.8% had problematic or limited health literacy levels. Parents received a total score of 30.2±23.7 (13 (1-83)) from the PACV scale. It was determined that 13.5% of parents were hesitant about childhood vaccines. It was determined that individuals with vaccine hesitancy had lower general health literacy and vaccine knowledge levels, and they used the media and neighbors as sources of information at a higher rate. Additionally, it was determined that low level of knowledge about the vaccine(OR 1.4 95%CI 1.3-1.6). and using the media(OR 2.3 95%CI 1.0- 4.9) as a source of information poses a risk for vaccine hesitancy. Key messages • Providing community-based training to increase the health literacy level of parents will also create positive changes in vaccine hesitancy. • Community-based studies should be carried out regarding misconceptions about vaccines, especially those acquired from the media, and individuals should be made aware.

Health literacy in the evolving era of personalised medicine and digital health

Abstract Health literacy is pivotal for advancing public health, empowering individuals to grasp health information and make informed decisions. However, health literacy levels are often influenced by social and economic factors, with lower levels correlating with reduced disease-specific knowledge and underutilization of preventive health services. As healthcare technology rapidly evolves, particularly with the advent of personalised medicine (PM) and novel genetic testing methods, there’s an increasing demand for heightened health literacy to effectively navigate these transformative innovations and optimize health outcomes. The European ExACT project aims to assess the understanding of PM and related technologies across the EU. In this context, through a survey conducted in several European countries, including Italy, France, Spain, Poland, the Netherlands, Romania, Hungary, and Germany, demographic data and attitudes towards PM, genetic testing, health portals, and big data were gathered. Logistic regression analysis identified factors influencing knowledge and attitudes. Among 6581 respondents, the results highlight a broad awareness of genetic testing (81%) and health portals (54%) yet a lesser familiarity with PM (48%) and big data (37%). Education level, age, and gender influenced awareness, with Hungary showing significant awareness across all topics (OR 2.09 95%CI 1.46-2.98), Spain excelling in big data (OR 1.88 95%CI 1.55-2.27), and Poland leading in genetic testing knowledge (OR 2.68 95%CI 1.82-3.96). Differences between countries may indicate successful policies and factors that can be replicated. Overall, the study emphasizes the importance of enhancing health literacy and sheds light on the predicting role of sociodemographic factors. It underscores the significance of bolstering health literacy to effectively navigate the advancements in PM and digital health, improving health outcomes in light of these evolving healthcare landscapes. Key messages • In Europe, awareness of personalised medicine, health portals and big data is lacking. Educational initiatives are crucial for effective navigation of innovations, considering regional differences. • Social and economic factors affect health literacy levels, impacting disease-specific knowledge and healthcare utilization.

Advanced nursing practise as a preventive approach for adults with intellectual disabilities

Abstract Background Various barriers impede access to preventive health services for people with intellectual disabilities in Germany. As a result, they are more likely to suffer from certain chronic diseases. Internationally, Advanced Nursing Practice (ANP) has proven to be a suitable approach to care for this group. In Germany, ANP is not yet widespread. The aim of this study is to improve healthcare for people with intellectual disabilities through ANP-led case management. Methods A randomized controlled trial was conducted in an urban community setting. Inclusion criteria were: ICD-10 diagnosis F70-F79, age ≥18 and care level ≤3. The intervention group (IG) received four outreach home visits focused on prevention and health promotion. The control group (CG) received usual care. Allocation was done using computer-assisted, permuted block randomization. Researchers were blinded during data collection and analysis. The primary outcome was health status after 12 months (t2) (WHODAS). Secondary outcomes were health status after 6 months (t1), health-related quality of life (HQOL) after 6 and 12 months (EQ5D-VAS), and resilience after 6 and 12 months (RS-11). Analysis was performed via ANCOVA with Bonferroni correction at a significance level of 0.025. Results 214 participants were randomized. At t2, 176 participants remained (IG: n = 85, CG: n = 91). Health status at t2 showed a mean difference (MD) of -4.58 points in favor of the IG (p = 0.01). For resilience, a MD of + 1.95 (t2) points in favor of the IG was obtained (p = 0.05). We measured a MD for HQOL of -1.19 (p = 0.72) in favor of the CG. Conclusions A clinically relevant effect of ANP-led case management was achieved on the health status, but not on resilience and HQOL. ANP for people with intellectual disabilities can contribute to health promotion and thereby improve the community health. Therefore, ANP can be used as an innovative approach in the course of reorganization of healthcare for vulnerable populations in Germany. Key messages • ANP-led case management can have a clinically relevant effect on the heal status of people with intellectual disabilities over the course of one year. • ANP-led case management can be seen as a new approach to health promotion and disease prevention in Germany.

NCD prevention and control in Kenya: feasibility study of health kiosks in markets “HEKIMA Study”

Abstract Introduction Non-communicable diseases (NCDs) account for 50% of hospital admissions and 55% of hospital mortality in Kenya. Cardiovascular diseases (CVDs) lead NCD mortality at 14% due to high prevalence of multiple risk factors. Community markets are social institutions with untapped potential for public health. HEKIMA is a multi-phased theoretically driven intervention exploring whether health kiosks in community markets, manned by community health workers (CHWs) and supervised by health centre (HC) nurses, can improve the reach of preventive care to vulnerable communities. Methods A mixed methods study in Vihiga County targeting 320 participants aged 15 years and above. Nurses and CHWs were trained to deliver evidence-based CVD health promotion, risk screening, and early intervention. Multi-sector stakeholder consultations, readiness assessments of markets and HCs, and semi-structured interviews informed intervention development. Evaluation use the Re-AIM framework. Results At 6 months of intervention there 2224 kiosk users which exceeded target of 300; 61% primary school education; 77% females; median age - males 48y, females 52y. Proportion with high blood pressure, overweight, obesity, and diabetes 48%, 32%, 25% and 12% respectively. 30% were referred to HC, and 34% followed up at least once at the kiosk. High acceptability of HEKIMA among CHWs, nurses and market users led to HEKIMA kiosks being integrated in the primary healthcare pathway. Key enablers were multi-sectoral alliance of government, civic organisations, community market champions, local businesses and health sector; culture centred coproduction and capacity building Challenges included understaffing, commodity supplies and seasonality. Conclusions HEKIMA successfully promoted NCD prevention and control, particularly among vulnerable populations. Scaling up across Kenya is planned to explore translational impacts in different contexts. Key messages • Multisectoral alliance critical for prevention of NCDs. • Theoretically underpinned complex systems interventions addresse inequities.

Detection of ATTR cardiac amyloidosis using a novel artificial intelligence algorithm for wearable-adapted noisy single-lead electrocardiograms

Abstract Background Amyloid cardiomyopathy (ATTR-CM) is often underdiagnosed, with very few diagnosed before the onset of symptoms, leading to delayed use of disease-modifying therapies that could have substantial prognostic implications early in the disease course. In the US, the disease has a substantially higher prevalence among Black adults, who are further challenged by lower access to healthcare services and lower preventative care, further reducing the ability for clinician-led diagnosis. We sought to develop an approach for identifying ATTR-CM on noisy single-lead ECGs obtainable on portable and wearable ECG devices, allowing broad use in community screening. Purpose To develop a portable/wearable device-adapted AI-ECG algorithm capable of detecting ATTR-CM on noisy single-lead ECGs. Methods We identified patients with ATTR-CM from 2015 through June 2023 across 5 hospitals of a large U.S.-based hospital system using positive bone scintigraphy scans or pharmacotherapy with an approved transthyretin stabilizer. In the development cohort, we used lead I of 12 lead ECGs, commonly captured by portable and wearable ECG devices, to train a novel noise-adapted model explicitly designed to infer information against simulated real-world noises. For this, ECG signals were augmented using random Gaussian real-world noise within four frequency ranges at multiple signal-to-noise ratios. We tested the model in an independent set of cases and matched controls drawn from July through December 2023. Results The development cohort consisted of 1,011 ECGs from 234 patients (median age 79 years [IQR:70-85], 17% women), with 10:1 age- and sex-matched 10,110 controls with 10,110 ECGs (age 79 [IQR:70-85] years 17.7% female). In the independent test set of 139 ECGs from 47 patients (age 80 [75-86] years, 32% women) and matched controls (1390 ECGs and patients) from July through December 2023, the AUROC (area under the receiver operating characteristic curve) of the AI-ECG model for ATTR-CM was 0.90 [95%CI: 0.88-0.92] (A). The AUPRC was 0.44 [0.36-0.53]. The sensitivity and specificity of the model were 0.85 and 0.80. The positive predictive value ranged from 0.12 at a 3% prevalence level to 0.59 at a 25% prevalence (B). Conclusions A novel portable and wearable-devices adapted model demonstrates promising performance for detecting ATTR-CM on single-lead ECGs, representing a more accessible method for screening in community-dwelling adults.

Preliminary findings of the TB-HEART Study: prevalence of cardiac pathology among newly diagnosed patients with tuberculosis with and without HIV in Zambia

Abstract Background Cardiovascular diseases (CVD) burden is rapidly increasing in sub-Saharan Africa (SSA) where tuberculosis and HIV prevalence remain high.(1-3) Recent data suggest pulmonary tuberculosis (PTB) is associated with increased CVD morbidity.(4) However, the mechanisms of cardiac injury remain poorly understood. Purpose The TB-HEART study is a cross-sectional and natural history study consecutively recruiting participants with newly-diagnosed PTB, living with and without HIV in Zambia. The primary outcome is the burden of cardiac pathology in PTB patients with and without HIV. Methods Participants with bacteriologically-proven PTB, consecutively recruited from an outpatient settings in Zambia, undergo detailed clinical and functional assessments including point-of-care and standard two-dimensional (2D) echocardiography. Participants are reviewed at completion of TB treatment when all assessments are repeated. The target sample size is 250 participants with PTB, with and without HIV, matched 2: 1 to participants without PTB, stratified by HIV. Results Since 1 November 2023, we have recruited 73 participants with a mean age of 35.3±10.9 years of whom 51/73 (69.9%) are male and 19/73 (23.5%) are living with HIV. Baseline characteristics including cardiovascular risk factors, TB symptoms, anthropometry and clinical and functional observations at presentation, stratified by HIV status, are summarised in Table 1. We detected significant cardiac pathology (defined as left ventricular ejection fraction (LVEF) <51% and/or pericardial effusion >2cm in depth) in 8/65 (12.3%) participants for whom 2D-echocardiography had been completed. Median LVEF was 61.2% (IQR 57.7-67.8). LVEF was normal in 59/65 (91%); mildly abnormal in 5/65 (7.7%); and moderately abnormal in 1/65 (1.5%) participants, respectively. Pericardial effusion >0.5cm was detected in 16/65 (24.6% ) participants and maximum effusion depth was >2cm in 2/16 (3.1%), 1-2cm in 12/16 (75%) and <1cm in 2/16 (12.5%). 2D-echocardiography findings, stratified by HIV-status, are described in Table 2 alongside two echocardiography stills of typical pericardial effusion findings in one participant. Conclusions Our preliminary results demonstrate a higher than expected prevalence of cardiac pathology among participants with PTB with and without HIV, which ranges from 1-7% in autopsy studies and case series.(5-7) The most common cardiac pathology was pericardial effusion. Further analyses will include cardiac biomarkers; repeat clinical and echocardiographic assessments at TB treatment completion; and comparator data, to determine associations between prevalent cardiac pathology and PTB controlling for HIV and TB status, respectively. This may have important implications for clinical practice to prevent complications such as constrictive pericarditis; and policy design to better integrate TB and HIV patient services with preventative care to reduce future CVD risk.Table 1 - Baseline characteristicsFigure 1 and Table 2

Cancer prevention in people experiencing homelessness: feasibility of the Health Navigator Model

Abstract Background The Health Navigator Model (HNM) is a newly developed skill-mixed model that may improve access to cancer prevention services for over 895,000 People who are currently Experiencing Homelessness (PEH) in Europe. The aim of this study was to assess the feasibility and implementation of the model in European settings. Methods A co-designed pilot implementation study was undertaken in Austria, Spain, Greece and the United Kingdom. A total of 20 trained health navigators were appointed at support centres for PEH and facilitated PEH’s access to cancer prevention activities based on a comprehensive and tailored needs assessment. The study duration was 19 months, with two follow-ups. Feasibility data (recruitment/retention/participation rates, barriers, facilitators) were monitored throughout the study. Results More than 1,981 PEH were informed about the study and 652 of them participated. Most participants were male (64%), with low or no income (42%) and had previously experienced homelessness (51.7%). The mean age of participants was 47.4 years old. Overall, 69% of participants completed the first, and 42.5% completed the second follow-up. Main dropout reasons were loss of contact, loss of interest or having other priorities. Participants undertook a range of cancer prevention activities, including education (n = 494), workshops (n = 280), health consultations (n = 251), referrals for specialist care (n = 212) and cancer screening tests (n = 169). Difficulties in accessing the healthcare system, de-prioritising cancer and PEH’s complex needs were identified as the main barriers. Building trusting relationships with PEH, increasing cancer awareness and coordinating social and health services were identified as the main facilitators. Conclusions Implementing the Health Navigator Model was a feasible and dynamic process leading to improved equity and inclusion of people experiencing homelessness in cancer preventive services. Key messages • The Health Navigator Model is a feasible model to enhance cancer prevention among people experiencing homelessness following a person-centred, destigmatising approach. • Effective liaison between health and social services under the Health Navigator Model plays a critical role in facilitating access to cancer preventive care among people experiencing homelessness.