Health Service Planning Research Articles

Measurement tools used to assess individual health assets among refugee populations: a scoping review.

Forced migration is increasing globally, which has detrimental effects on the physical and mental health of refugees, who may face significant challenges accessing healthcare services. However, refugees also possess considerable strengths or assets that can protect against various health challenges. Identifying and strengthening the individual health assets of refugees is critical to promoting their health and mitigating these health challenges. Yet, there is a paucity of data on refugees' individual health assets, including tools to measure them. Therefore, this scoping review aimed to identify and summarise the available measurement tools to assess the individual health assets of refugees. We conducted a comprehensive literature search using six electronic databases and a Google search without restrictions on publication dates. We used Arksey and O'Malley's methodological framework approach to streamline the review processes. Forty-one eligible studies were included, from which 28 individual health asset tools were identified. Of these, 11 tools were tested for validity in refugee populations. Among the validated tools, thereliability scores for the measures of individual health asset outcomes, including resilience (Child and Youth Resilience Measure, Wagnild and Young's Resilience Scale, and Psychological Resilience Scale), acculturation (Vancouver Index of Acculturation and Bicultural Involvement Questionnaire), self-esteem (Rosenberg Self-Esteem Scale), and self-efficacy (Generalized Self-Efficacy Scale), ranged from good to excellent. The findings provide guidance for health service planners, humanitarian organisations, and researchers regarding the appropriateness and quality of tools that can be applied to assess individual health assets, which are crucial for designing culturally sensitive asset-based health promotion interventions for refugees.

Unpacking the Mood States of Children and Youth in Saskatchewan, Canada, in the Context of the COVID-19 Pandemic: Insights from the “See Us, Hear Us 2.0” Study

Background/Objectives: The COVID-19 pandemic created a growing need for insights into the mental health of children and youth and their use of coping mechanisms during this period. We assessed mood symptoms and related factors among children and youth in Saskatchewan. We examined if coping abilities mediated the relationship between risk factors and mood states. Methods: “See Us, Hear Us 2.0”, a cross-sectional study of 563 child–parent dyads, provided the data. The dependent variable, current mood state, was measured by the CoRonavIruS health Impact Survey (CRISIS) scale. Independent variables included sociodemographics, behaviors, household conditions, and coping ability. Multiple linear regression and mediation analyses were conducted, ensuring sample representativeness with sampling weights and addressing missing data through multiple imputations. Results: The participants reported mood symptoms (“moderate” to “extreme”) ranging from 23% to 38% on the CRISIS scale. Factors such as older children, hybrid learning, disrupted activities, and increased screen time worsened moods. The ethnic minority groups (BIPOC) living in mid-sized cities/towns experienced more negative moods compared to Whites residing in cities. Coping ability mediated the relationship between extracurricular activities and mood states. Conclusions: Our results underscore the importance of tailored interventions, recognizing the diverse needs of specific age groups, gender identities, and ethnicities and addressing the adverse effects of the pandemic-related disruptions on the mental health and well-being of school children in Saskatchewan. Our study also suggests prioritizing the diverse needs of children and youth during the planning and implementation of mental health services in the province.

Determinants of healthcare utilization under the Indonesian national health insurance system – a cross-sectional study

BackgroundIndonesia has implemented a series of healthcare reforms including its national health insurance scheme (Jaminan Kesehatan Nasional, JKN) to achieve universal health coverage. However, there is evidence of inequitable healthcare utilization in Indonesia, raising concerns that the poor might not be benefiting fully from government subsidies. This study aims to identify factors affecting healthcare utilization in Indonesia.MethodsThis study analysed cross-sectional survey data collected by the “Equity and Health Care Financing in Indonesia” (ENHANCE) Study. Andersen’s behavioural model of health services use was adopted as a framework for understanding healthcare utilization in Indonesia. Sociodemographic variables were categorized into predisposing, enabling and need factors. Outcome measures included the utilization of primary and secondary health services. Multi-level logistic regression models were run to examine factors associated with each type of health service utilization.ResultsOf the 31,864 individuals included in the ENHANCE survey, around 14% had used outpatient services in the past month. Fewer than 5% of the study population had visited hospitals for inpatient care and about 23% used maternal and child health services in the past 12 months. Age, gender and self-rated health were key determinants of health services utilization. No significant differences in primary care utilization were found among people with different insurance status, but people who received subsidised premiums under the JKN were more likely to receive primary care from public health facilities and less likely from private health facilities. Compared to people who pay JKN insurance premiums themselves, the uninsured and those whose premiums were subsidised by the government were less likely to visit public and private hospitals when other factors were controlled.ConclusionThis study demonstrates that the distribution of healthcare utilization in Indonesia is largely equitable as predisposing factors (age and gender) and health need were found to greatly influence the utilization of different types of health services. However, enabling factors such as health insurance status were also found to be associated with inequity in utilization of hospital services. Further policy actions regarding resource allocation and health service planning are warranted to achieve a more equitable pattern of health service use in Indonesia.

Trends in the Clinical Characteristics and Outcome of Infective Endocarditis: ANationwide Study From 2016 to 2021.

Infective endocarditis (IE) is still a fatal disease, and given its rarity, ongoing updates to patient characteristics and outcomes of IE are essential for providing precision diagnoses and effective treatments. This study sought to examine temporal trends in the clinical characteristics and in-hospital occurrence of adverse outcomes of IE. Using the Japan nationwide administrative database, we identified patients with IE in Japan from 2016 to 2021. A total of 17 407 patients with IE (37.8% women; median age, 72 [interquartile range, 59-81] years) were identified. The incidence of IE increased from 2.02 per 100 000 population in 2016 to 2.59 per 100 000 population in 2021. The median age of the patients increased from 70 years in 2016 to 73 years in 2021, and patient backgrounds were becoming more complex. The in-hospital mortality rate was 14.5%, which significantly increased from 14.1% in 2016 to 15.4% in 2021. Higher age (odds ratio [OR], 1.34 [95% CI, 1.29-1.40]), heart failure (OR, 1.37 [95% CI, 1.18-1.59]), cerebrovascular complications (OR, 1.78 [95% CI, 1.59-1.99]), renal failure (OR, 2.36 [95% CI, 2.06-2.70]), and sepsis (OR, 2.79 [95% CI, 2.48-3.13]), were independently associated with an increased in-hospital mortality rate. In contrast, cardiac surgery (OR, 0.47 [95% CI, 0.41-0.55]), and a higher number of total cardiac surgeries (OR, 0.77 [95% CI, 0.65-0.92]) independently predicted a lower in-hospital mortality rate. The characterization and comprehensive analysis of IE in Japan provides valuable insights into the epidemiology, risk factors, and outcomes of IE, which may inform health service planning and treatment strategies.

The long-lasting impacts of the COVID-19 pandemic on population-based cancer survival: what are the implications for data analysis?

Monitoring trends of cancer incidence, mortality and survival is vital for the planning and delivery of health services, and the evaluation of diagnostics and treatment at the population level. Furthermore, comparisons are often made between population subgroups to explore inequalities in outcomes.During the COVID-19 pandemic routine delivery of health services were severely disrupted. Resources were redeployed to COVID-19 services and patient risk of COVID-19 infection required serious consideration. Cancer screening services were paused, the availability of healthcare providers was reduced and, in some cases, patients faced difficulty in accessing optimal treatment in a timely manner.Given these major disruptions, much care should be taken when interpreting changes in cancer survival estimates during this period. The impact on cancer incidence and mortality statistics that have already been reported in some jurisdictions should drive further thought on the corresponding impact on cancer survival, and whether any differences observed are real, artificial or a combination of the two.We discuss the likely impact on key cancer metrics, the likely implications for the analysis of cancer registration data impacted by the pandemic and the implications for comparative analyses between population groups and other risk factor groups when using data spanning the pandemic period.

Validation of the rates of adverse event incidence in administrative healthcare data through patient chart review: A scoping review protocol

Background Patient safety is a key issue for health systems and a growing global public health challenge. Administrative healthcare data provide a coded summary of a patient and their encounter with the healthcare system. These aggregated datasets are often used to inform research and decisions relating to health service planning and therefore it is vital that they are accurate and reliable. Given the reported inaccuracy of these datasets for detecting and recording adverse events, there have been calls for validation studies to explore their reliability and investigate further their potential to inform research and health policy. Researchers have since carried out validation studies on the rates of adverse events in administrative data through chart reviews therefore, it seems appropriate to identify and chart the evidence and results of these studies within a scoping review. Methods The scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. A search of databases such as PubMed, CINAHL, ScienceDirect and Scopus will be conducted in addition to a search of the reference lists of sourced publications and a search for grey literature. Following this, Covidence will be used to screen the sourced publications and subsequently extract data from the included sources. A numerical summary of the literature will be presented in addition to a charting based on the qualitative content analysis of the studies included. Conclusions This protocol provides the structure for the conduct of a review to identify and chart the evidence on validation studies on rates of adverse events in administrative healthcare data. This review will aim to identify research gaps, chart the evidence of and highlight any flaws within administrative datasets to improve extraction and coding practices and enable researchers and policy makers to use these data to their full potential.

New Ways of Working to Manage and Improve Quality in Integrated Care Systems in England

Background: Integrated Care Systems (ICSs) in England were formally established in July 2022 to coordinate the planning and delivery of health and care services. A key responsibility was to address the quality of these services. Our study aimed to examine how ICSs approach this responsibility and to identify opportunities and barriers experienced in their early establishment and development. Method: A sample of four ICSs were recruited to participate. Interviews and meeting observations were undertaken in two phases (before and after the inception of ICSs) around 12 months apart. A total of 112 interviews were carried out with senior figures in the four ICSs supplemented by observation of relevant meetings and analysis of relevant documents. Results: Regarding quality, ICSs demonstrated several new ways of working. They set-up new structures for quality governance and created whole-system strategies for quality centred on major responsibilities regarding population health and health inequalities. These strategies required new and relevant metrics to assess quality and outcomes and a greater focus upon co-production in the development of services. They aimed to strike a fine balance between long-standing requirements for quality assurance and new responsibilities for quality improvement. New approaches were underpinned by new collaborations between system partners extending beyond healthcare to include Local Authorities (responsible for social care and public health) and local communities. Conclusion: To address the many challenges of quality, ICSs have created new ways of working cultivating different kinds of collaborative relationships compared to established hierarchical, siloed and top-down ways of working prior to their formation. A focus on improving population health and reducing inequalities has required a shift from ‘here and now’ urgent problem-solving to working with longer timelines. Such changes require patience in the context of political pressure to devote efforts to more salient problems such as waiting lists.

The projected burden of arthritis among adults and children in Australia to the year 2040: a population-level forecasting study.

Understanding how many people could be living with arthritis in the future is essential for planning health service needs and national health workforce requirements, and for arthritis advocacy and policy development. This study aimed to forecast the size of different populations with arthritis in Australia and associated health system expenditure, up to the year 2040. In this population-level forecasting study for Australia, prevalence data for arthritis, osteoarthritis, and rheumatoid arthritis were obtained from the Australian Bureau of Statistics 2022 National Health Survey. Prevalence rates for juvenile idiopathic arthritis were sourced from 2021 Census data. Overall, age-specific and sex-specific prevalence data were applied to national population projections to forecast arthritis, osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis populations for 2025, 2030, 2035, and 2040. The base case analysis considered medium population growth; sensitivity analyses considered low and high growth scenarios. Health system expenditure data from the Australian Institute of Health and Welfare were extrapolated to base case projections for the years 2025, 2030, 2035, and 2040, and were then inflated to future dollars. To understand the broader context and implications of our projections through the lens of lived experience, an arthritis consumer researcher and members of the Arthritis Australia Consumer Advisory Panel reviewed the arthritis burden estimates. With population growth and ageing, 5·39 million (95% CI 5·19-5·58) people are projected to have arthritis in Australia in 2040, representing an increase of 31% from 4·11 million (3·95-4·27) in 2025. By 2040, 3·11 million (2·99-3·23) people are expected to have osteoarthritis, 749 000 (652 000-846 000) are expected to have rheumatoid arthritis, and about 8500 children and adolescents are expected to have juvenile idiopathic arthritis. The age-standardised rate of osteoarthritis is forecast to increase for males from 6·28% in 2025 to 7·03% in 2040, and for females from 10·82% to 12·18% over this period. The age-standardised rate of rheumatoid arthritis is forecast to increase for males from 1·56% in 2025 to 1·75% in 2040, and for females from 2·62% in 2025 to 2·94% in 2040. Little change is anticipated in the number of children and adolescents with juvenile idiopathic arthritis (estimated at 8500 individuals in 2040). Based on current spending levels of AU$2100 per person with osteoarthritis and $1918 per person with rheumatoid arthritis, annual health system expenditure for osteoarthritis and rheumatoid arthritis is conservatively forecast to exceed AU$11·92 billion by 2040. Using the latest national-level data, this study has generated contemporary projections of the substantial burden of arthritis (both population size and health-care costs) in Australia. These projections underscore the importance of well-resourced health services that can capably deliver timely, high-value care to a growing number of people with arthritis. Arthritis Australia and National Health and Medical Research Council.

Framework for collaborative local climate adaptation scenario development- nexus between climate resilience, public health service and spatial planning

Framework for collaborative local climate adaptation scenario development- nexus between climate resilience, public health service and spatial planning

Health Promotion and Health Literacy in the Legal Foundations of the Austrian Healthcare System

Health reform sees health promotion (HP) and health literacy (HL) as essential cornerstones for achieving health policy goals. This article examines the extent to which the legal foundation in the Austrian healthcare system provides a basis for orientation towards HP and HL. The focus of the analysis was set on medical professions, the health care and nursing professions, hospitals, and primary health care facilities. In a first step, legal and other relevant documents were reviewed. For this, a literature-based coding grid was created. In a second step, the legal bases were analyzed and interpreted using the coding grid. Recommendations were derived from the analysis of the legal basis and experts' assessments. Health promotion and health literacy are included in the general legal foundations. However, HP/HL is primarily conceived as a supplementary service with separate financing and is thus less understood as an integral part of any patient contact. The primary health care units and the nursing professions have a relatively clear mandate with regard to HP/HL compared to the hospitals and medical professions. Overall, it was recognized that terminology should be used more coherently and operationalized for the respective areas of cure and care. In particular, the legal bases relating to the medical professions do not build on one another in a coherent manner. Having adequate staff is the key to HP/HL. If these are in place, competencies in the field of HP/HL should be required, promoted, evaluated, and rewarded. HP/HL should be an integral part of any care setting. The concepts of health promotion and health literacy should be operationalized in the legal frameworks of health professions and organizations. This is especially true for the Physicians' Act and for hospitals. Furthermore, the role of patients should be strengthened and the involvement of users in the planning of health services should be further developed.

The Impact of COVID-19 on Fertility Rates in China: An Empirical Analysis Using ARIMA Modeling

Abstract: This paper conducts an in-depth empirical analysis of the impact of COVID-19 on fertility rates in China using ARIMA modeling and forecasting techniques. The study reveals a significant and fundamental decline in birth rates throughout the pandemic, indicating that the long-term downward trend is more pronounced than ever. This unprecedented drop underscores the severity and uniqueness of the COVID-19 crisis's influence on reproductive behavior. The findings align with prior research on the global economic and health challenges' effects, but the scale and speed of changes during the pandemic remain unparalleled. These dynamics highlight the necessity to reassess and strengthen population management strategies and healthcare systems, particularly in reproductive health and family planning services. Despite utilizing a comprehensive dataset, limitations regarding data scope and sample size persist. Future research should broaden data scope and sample size, analyze regional differences, undertake long-term longitudinal studies, and incorporate multivariable analysis to better understand the pandemic's impact on fertility decisions.

Trends in the health status of Ukrainian refugees in Norway according to month of arrival during 2022

BackgroundMore than 35 000 refugees from Ukraine applied for temporary collective protection in Norway during 2022. Previous studies have shown that the refugees have poor health in several domains, and crude reports have suggested that those fleeing Ukraine at later stages have even poorer health. However, more systematic knowledge is lacking. This study aimed to analyse trends in self-reported health in a sample of adult refugees from Ukraine, by month of arrival to Norway during 2022.MethodsData were collected via an online, digital questionnaire, in a cross-sectional study design between 28.10.22–31.01.23. Recruitment was via multiple physical and social media contact points, including asylum reception centres, municipalities, non-profit organisations, and Facebook groups for refugees in Norway. The survey included the following self-reported health outcomes: overall health, oral health, presence of long-term illnesses or disabilities, and a short version of the Hopkins Symptom Checklist (HSCL-5).ResultsAmong the 727 respondents, 82% were female, 65% were aged 30–49 years, 69% had higher education and 53% were responsible for children in Norway. There were 383 respondents who arrived between February-April (T1), 200 between May-August (T2) and 144 between September-December (T3). Compared to T1, respondents who arrived in the two later time periods were more often male, had younger age distributions, and were less likely to have completed higher education. The proportions of respondents reporting poor/very poor overall health, presence of long-term illnesses and long-term disabilities were highest in T3. Oral health and HSCL-5 showed the opposite trend, with lower proportions reporting poorer health among respondents in both later periods. Respondents in T3 were still more likely to report poor/very poor health and long-term illnesses after adjusting for sex, age group and education (adjusted odds ratio, aOR: 2.71 [95%CI 1.51–4.89]) and 1.74 [1.14–2.65], respectively).ConclusionsRespondents who arrived later in 2022 generally reported poorer long-term health, but less psychological distress than those who arrived earlier in the year. These findings may help inform the planning of health services for refugees from Ukraine, especially in areas receiving large numbers of refugees.

Abstract 4124769: Temporal Changes in Clinical Characteristics and Oucomes of Infective Endcarditis: A Report from JROAD-DPC Study

Background: Despite advances in medical science and patient care, infective endocarditis (IE) is still a serious and life-threatening disease. Considering the recent shifts in predisposing clinical backgrounds of cardiovascular disease, such as an aging population and increased usage of prosthetic valves and cardiovascular implantable electronic devices, ongoing updates to patient characteristics and outcomes of infective endocarditis (IE) are essential for providing precision diagnoses and effective treatments. Objective: To examine temporal trends in the clinical characteristics and in-hospital occurrence of adverse outcomes of IE. Methods: Observational study of using a nationwide Japanese administrative database (JROAD-DPC), that is operated by the Japanese Circulation Society. IE was identified based on the code of the International Classification of Diseases, Tenth Revision. The study outcomes were in-hospital mortality and IE-compatible complications (heart failure, cerebrovascular episodes, renal failure, and sepsis). Results: Between the years 2016 and 2021, a total of 17,407 IE patients (37.8% female; median age 72 (IQR, 59-81) years) were identified in JROAD-DPC database. The incidence of IE increased from 2.02 per 100,000 population (2,534 cases) in 2016 to 2.59 (3,183 cases) in 2021. The median age of the patients increased from 70 years in 2016 to 73 years in 2021, and patient backgrounds were becoming more complex. Notably, the proportion of patients older than 80 years rose from 25.4% to 30.8%. The in-hospital mortality rate was 14.5%, which significantly increased from 14.1% in 2016 to 15.4% in 2021. Higher age (OR, 1.34; 95% CI, 1.29 to 1.40; <.001), heart failure (OR, 1.37; 95% CI, 1.18 to 1.59; P<.001), cerebrovascular complications (OR, 1.78; 95% CI, 1.59 to 1.99; P<.001), renal failure (OR, 2.36; 95% CI, 2.06 to 2.70; P<.001), and sepsis (OR, 2.79; 95% CI, 2.48 to 3.13; P<.001), were independently associated with increased in-hospital mortality. In contrast, cardiac surgery (OR, 0.47; 95% CI, 0.41 to 0.55; P<.001), and a higher number of total cardiac surgeries (OR, 0.77; 95% CI, 0.65 to 0.92; P<.004) independently predicted a lower in-hospital mortality. Conclusions: The characterization and comprehensive analysis of IE in Japan provide valuable insights into the epidemiology, risk factors, and outcomes of IE, which may inform health service planning and treatment strategies.

Self-harm-related mental health presentations to emergency departments by children and young people from culturally and linguistically diverse groups in South Western Sydney.

Rates of self-harm among children and young people (CYP) have been on the rise, presenting major public health concerns in Australia and worldwide. However, there is a scarcity of evidence relating to self-harm among CYP from culturally and linguistically diverse (CALD) backgrounds. To analyse the relationship between self-harm-related mental health presentations of CYP to emergency departments and CALD status in South Western Sydney (SWS), Australia. We analysed electronic medical records of mental health-related emergency department presentations by CYP aged between 10 and up to 18 years in six public hospitals in the SWS region from January 2016 to March 2022. A multilevel logistic regression model was used on these data to assess the association between self-harm-related presentations and CALD status while adjusting for covariates and individual-level clustering. Self-harm accounted for 2457 (31.5%) of the 7789 mental health-related emergency department presentations by CYP; CYP from a CALD background accounted for only 8% (n = 198) of the self-harm-related presentations. CYP from the lowest two most socioeconomic disadvantaged areas made 63% (n = 1544) of the total self-harm-related presentations. Findings of the regression models showed that CYP from a CALD background (compared with those from non-CALD backgrounds) had 19% lower odds of self-harm (adjusted odds ratio 0.81, 95% CI 0.66-0.99). Findings of this study provide insights into the self-harm-related mental health presentations and other critical clinical features related to CYP from CALD backgrounds that could better inform health service planning and policy to manage self-harm presentations and mental health problems among CYP.

Analysis Of The Quality Of Family Planning (Kb) Health Services On Children's Nutritional Status At Sigambal Public Health Center, Rantau Selatan District, Labuhanbatu Regency

Background: Family planning services play an important role in supporting reproductive health and family well-being, especially in ensuring adequate nutrition for children. Objectives: to investigate the relationship between the quality of family planning (FP) health services and children's nutritional status at the Sigambal Health Center, Rantau Selatan District, Labuhanbatu Regency. Research method: structured interviews with mothers who participated in the family planning program and anthropometric measurements of their children.Results: there was a significant relationship between the quality of family planning services and children's nutritional status. High-quality family planning services have a positive impact on children's nutritional outcomes, as evidenced by improvements in weight and height indicators according to WHO standards. Factors determining service quality include the availability of contraception, the expertise of health workers, and community involvement in family planning initiatives.Conclusion: This study emphasizes the importance of improving family planning services by ensuring adequate resources, ongoing training for health personnel, and encouraging community participation. These efforts are critical to improving children's nutritional status in the region

Experiences of psychological, social and organisational work environments in occupational health service in Sweden: a cross-sectional survey

BackgroundThe aim of this study was to compare and describe different professionals’ experiences of workplace psychological and social factors in occupational health (OH) organizations in Sweden.MethodsThis cross-sectional study with a descriptive and comparative design included 472 respondents with common professions in the occupational health service (OHS) in Sweden. Data were collected with “The General Nordic Questionnaire for Psychological and Social Factors at Work” (QPSNordic). The professions have been compared pairwise using the Independent Samples Kruskal-Wallis test, adjusted by Bonferroni correction for multiple tests on subscales and single items and these are presented descriptively.ResultsThe experience of the psychological and social work environment on job task measurement level differed between the professionals. Experiences on social and organizational as well as on individual measurement levels are similar between the professionals who perceive them as satisfactory. Out of the 472 respondents, 7% reported that they had seen someone being subjected to harassment and bullying at the workplace during the last six months.ConclusionsThe experience among the professionals differs most in the Job task measurement level. The results indicate that although different OH professionals experience psychological and social factors at work in different ways, their experiences are generally satisfactory even though harassment and bullying do exist. The research about occupational health professionals and their work environment is sparse. Further applied research is needed for the planning and development of occupational health services in Sweden.

6.G. Scientific session: The importance of using country-specific severity distributions in burden of disease indicators

Abstract One of the most commonly used health gap summary measures in the field of public health is the Disability-adjusted life year (DALY). It has become the key metric for quantifying the burden of disease (BoD) and is used as an information source for setting priorities for health care and health service planning. The DALY metric quantifies gaps between a theoretical population in perfect health and the current health status related to both morbidity and mortality. It is the sum of the number of healthy life years lost due to disability (YLD) and death (YLL). The YLD summarises the loss of healthy life time using the frequency of diseases differentiated by severities or related health states (including sequelae). Depending on each health state, it converts the time spent with diseases into YLD by weighting each year with health limitation with so-called disability weights. This allows the two indicators YLL and YLD to be added to the DALY. Consequently, severity distributions are a means of describing the range of health loss along specific health states, which enables an accurate mapping with disability weights. For most of the diseases, these distributions are usually categorised as mild, moderate, severe, or no health loss (asymptomatic). Conditions with higher severity levels contribute more to the YLD and thus, to the overall disease specific BoD. The severity distributions are highly dependent on utilization at the individual level, but also on available health care services at the society level, which indicates that differences by settings are to be expected. Changes over time in the share of severe cases, for instance, may reflect the effectiveness of health interventions and policies. This underlines the importance of severity distributions, as they also reflect information about the quality of healthcare for those affected. The Global Burden of Disease (GBD) study applies for a significant proportion of their considered diseases uniform severity distributions across countries and broader regions. They acknowledge concerns over applying estimates of severity distributions based on limited data, noting that it is the only available information that they were able to use. As the YLD estimates are often utilized to develop and prioritize health policy interventions, there is a necessity for country-specific estimates that are evidence based and less susceptible to model assumptions. In most cases, the estimation of severity distributions involves complex methodology as data for such assessments are very limited or hardly reliable. In the following workshop, general concepts and country cases from Germany, Scotland, and Belgium will be presented covering a variety of diseases. The examples underline the importance of estimating national and even regional severity distributions when identifying the importance of diseases or comparing the health conditions of populations across time. Key messages • As the Burden of disease indicators are predominantly used to prioritize health interventions and allocate resources, it is crucial to use accurate information in the severity levels of disease. • Severity distributions reflect the health care services and vary across different settings. Utilising country-specific severity distributions when estimating Burden of Disease indicators is essential.

Towards more effective health monitoring: a comparison of different data sources

Abstract Background Monitoring the prevalences of chronic diseases and their risk factors at the population level is important to support effective prevention measures, health service planning and health policy-making. The utilization of register information is cost-effective in population health monitoring, but the validity of information is important to assess. The aim of this study was to compare the information on most common chronic diseases and risk factors collected from a population-based Healthy Finland survey and national health registers. Methods The study population comprised of 4785 individuals aged 20 years or over from the nationally representative Healthy Finland Health Examination Survey conducted in 2023. Information on the most common chronic diseases were derived from both survey data (including measured and self-reported data) and the national registers. The prevalence in survey data were compared with prevalence in register data for those individuals who participated in the survey. Register data was examined for the previous five years and was obtained from the Care Register for Health Care and medical registers, depending on availability of data. Weighted prevalences were calculated taking into account the sampling design and non-response. Results For all examined risk factors and diseases, the prevalence was higher in survey data than in register data. The difference was the greatest for elevated blood pressure: the prevalence in survey data was 48.6% (95% CI 46.5, 50.7) versus 17.3% (15.6, 19.0) in register data. The prevalence of diabetes was 11.5% (10.4, 12.5) in survey and 6.9% (5.9, 7.9) in register data. For sleep apnea, the prevalence in survey data was 8.4% (7.4, 9.3) and 4.4% (3.7, 5.1) in register data. Conclusions Register-based information provides more reliable prevalences on diseases needing urgent treatment. Survey data brings out also previously unidentified diseases cases that do not show in registers. Key messages • Register data is cost-effective in health monitoring, but surveys are needed for monitoring risk factors. • Utilizing diverse data sources enhances getting reliable information to support decision-making.

Digital health spaces in the city of Lisbon. The role of digitalization in linking boundaryless hospitals and smart health cities

Abstract Digital transformation is reshaping every aspect of society, including healthcare. The concepts of ‘Boundaryless Hospitals’ (BH) and ‘Smart Health Cities’ (SHC) represent a forward-thinking approach to healthcare that leverages digital technologies to enhance service delivery, operational efficiency and patient outcomes, including healthy mobility. This session delves into the complex role of digitalization in creating interconnected health and spatial environments where the flow of data and resources across physical and virtual barriers is optimized. BH embody a healthcare model where digital tools, health information systems and AI-powered diagnostics are integrated to provide care that transcends traditional hospital walls into the city. This approach not only facilitates greater accessibility and flexibility in patient care but also enhances the capacity for healthcare providers to offer personalized and timely interventions, embracing public health altogether. SHC integrates health technology into urban planning and public health services to create ecosystems that actively contribute to the health and wellbeing of their populations. Using big data analytics, IoT and other digital infrastructures, these cities support sustainable health practices, disease prevention, and efficient crisis response, promoting an overall healthier populace. This session will explore how digital health spaces can bridge the gap between these concepts. Discussions will focus on public health challenges and opportunities, examining the case of the city of Lisbon on how digital platforms can facilitate interactions between healthcare providers, patients, and urban environments. Best practices from pioneering projects around the globe will be highlighted. Participants will engage in comprehensive analyses of Lisbon case that demonstrate successful integration of digital health technologies in various contexts, contributing to the resilience and adaptability of healthcare infrastructures.

Health status by time of arrival among Ukrainian refugees in Norway

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