Health Status Of Population Research Articles

Symptoms of acute stress, anxiety, and depression following Türkiye-Syria earthquake among Syrian population: national survey during the acute phase

ABSTRACT Background: On 6 February 2023, an earthquake with a 7.8 magnitude wreaked destruction in northern Syria to add a new emergency status in the country. This study aims to evaluate the mental health status of the Syrian population in the immediate phase of the earthquake. Methods: This nationwide cross-sectional study was conducted in Syria from 17 February to 6 April. Data were collected on socio-demographics, trauma exposure characteristics, and levels of acute stress, depression, and anxiety. The NSESSS Checklist for the APA was used to assess ASD symptoms, PHQ-9 for depression, and GAD-7 for anxiety. Linear mixed-effects models were employed to identify predictive factors while accounting for governorate as a random effect and time elapsed as a fixed factor. Results: The rate of probable ASD symptoms was significant, with 55.3% of participants exhibiting these symptoms, including 10.3% reporting severe-to-extreme levels of severity. Similarly, 71.6% of participants exhibited symptoms of depression and 59.1% showed symptoms of anxiety. Furthermore, 40.4% of participants displayed a co-occurrence of ASD along with anxiety and depression. Linear mixed effects models indicated that symptoms were predicted by female sex, displacement, poor economic status, and a positive mental health history time elapsed, physical trauma, belief in the ongoing risk of earthquakes, feelings of dizziness, recurrent night-time fear arousal, and a continued sensation of seismic activity. Conclusion: This study demonstrated the high rates of symptoms of ASD, anxiety, and depression across the Syrian population during the immediate aftermath of the earthquake. High portions of people may acquire co-occurring symptoms represented by different mental health problems. These findings highlight the need for immediate actions to enhance mental health support in Syria.

Association between World Trade Center disaster exposures and body mass index in community members enrolled at World Trade Center Environmental Health Center

Studies suggest that environmental disasters have a big impact on population health conditions including metabolic risk factors, such as obesity and hypertension. The World Trade Center (WTC) destruction from the 9/11 terrorist attack resulted in environmental exposures to community members (Survivors) with potential for metabolic effects. We now examine the impact of WTC exposure on Body Mass Index (BMI) using the data from 7136 adult participants enrolled in the WTC Environmental Health Center (EHC) from August 1, 2005, to December 31, 2022. We characterized WTC-related exposures by multiple approaches including acute dust-cloud exposure, occupational or residential exposures, and latent exposure patterns identified by synthesizing multiplex exposure questions using latent class analysis. Employing multivariable linear and quantile regressions for continuous BMI and ordered logistic regression for BMI categories, we found significant associations of BMI with WTC exposure categories or latent exposure patterns. For example, using exposure categories, compared to the group of local residents, local workers exhibited an average BMI increase of 1.71 kg/m2 with 95% confidence intervals (CI) of (1.33, 2.09), the rescue/recovery group had an increase of 3.13 kg/m2 (95% CI: 2.18, 4.08), the clean-up worker group had an increase of 0.75 kg/m2 (95% CI: 0.09, 1.40), and the other mixer group had an increase of 1.01 kg/m2 (95% CI: 0.43, 1.58). Furthermore, quantile regression analysis demonstrated that WTC exposures adversely affected the entire distribution of BMI in the WTC EHC Survivors, not merely the average. Our analysis also extended to blood pressure and hypertension, demonstrating statistically significant associations with WTC exposures. These outcomes highlight the intricate connection between WTC exposures and metabolic risk factors including BMI and blood pressure in the WTC Survivor population.

Men’s Health in Disasters: A Systematic Scoping Review

Background: Disasters affect men and women unequally. While both male and female populations have their own needs, capacities and vulnerabilities, little is known about the men’s health status in disasters. Thus, the present review is aimed to identify and explain the impacts of disasters on men’s health status in the world. Methods: The current scoping review was conducted using PRISMA protocol 2020. Web of Sciences, PubMed, Scopus databases were searched using related keywords. Inclusion and exclusion criteria were used to select the relevant references. EndNote software, version 17, was applied to manage the citations. The data were analyzed using thematic analysis. Results: A number of 13 references was selected for final analysis after screening process. Physical and sexual health were the most frequent aspects of men’s health which was studied by the gender and disaster researchers (23.1%). Men’s health aspects in disasters were categorized as physical health, mental health, social health and sexual health. Conclusion: Men are visible as the capable group in disasters and their health needs (physical, mental, social, sexual and spiritual health) may likely not be considered post-disasters. Developing gender analysis tools for assessing the vulnerabilities, needs and health status of male population in disasters as well as establishing a sex-disaggregated database for effective decision-making regarding men’s health during disasters are highly suggested.

Impacts of economic sanctions on population health and health system: a study at national and sub-national levels from 2000 to 2020 in Iran

BackgroundFormal evidence regarding the effects of sanctions on population health status and the health system is scarse in Iran. Given the intricate and multifaceted nature of sanctions, a nuanced understanding of their impact is imperative. We aimed to investigate the magnitude and effects of sanctions on population health and healthcare system during the last two decades in Iran.DesignThis is a mixed-methods research. We quantified the impact of sanctions using 28 indicators, i.e. macroeconomic, healthcare resources and health outcomes indicators from 2000 to 2020. The concurrent qualitative study aimed to explore the pathway of the effect by considering perceptions of both patients and health policy makers towards sanctions; Interview data was analyzed using content analysis.SettingThis study was conducted in Iran at both national and sub-national levels.ResultsOur findings revealed that the trend of 11 indicators (39.2%) had changed after the change point in 2009; four indicators (14.2%) significantly deteriorated after the change point. Further, five indicators revealed significant increases during the sanctions period: Out-of-Pocket payment (OOP), household expenditure on food and mortality rates due to Chronic Obstructive Pulmonary Disease (COPD), thalassemia and hypertension. Our qualitative analysis revealed that patients identified availability, cost and quality of medicines and healthcare services as the most significant challenges that compromised population’s health. From the policy makers’ perspective, the effect of sanctions on health system functions and infrastructures, i.e. economic, political, social, educational and research had significant repercussions on population health.ConclusionWe could not find compelling evidence to establish significant associations between the imposition of sanctions and the trend of population health. Nevertheless, our qualitative study revealed people’s deteriorating life experiences, e.g. increasing catastrophic health expenditure, limited access to necessary medicine, medical equipment, procedures and interventions, imposed by sanctions, with ultimate reducing impact on the overall quality of life. It seems that sanctions have negatively affected financial and physical access to medication and healthcare services. Nonetheless, Iran has demonstrated remarkable resilience against their highly detrimental effects, maybe due to its established economic infrastructure and healthcare system.

Hematological parameters of the European hake (Merluccius merluccius) in Toroneos Gulf, northern Greece: A case study

Background: The European hake (Merluccius merluccius) is a commercially valuable demersal species widely distributed in the Mediterranean Sea. Assessing the condition of fish populations in their natural habitats is challenging due to the lack of reliable reference points. Objective: This study aimed to utilize hematological analysis as an economical method to evaluate the physiological and health status of European hake, addressing the gap in hematological data for this species. Methods: Blood samples were collected from the caudal vein of 40 adult European hakes caught from the Toroneos Gulf (northern Greece) using a commercial bottom otter trawl. An automated hematological analyzer was used to assess hematological parameters alongside biometric and biological indices. Results: Female hakes showed significantly higher white blood cell (WBC) counts, thrombocyte (TC) counts, and red cell distribution width (RDW) than their male counterparts. Strong correlations were observed among various hematological parameters, notably between WBC and red blood cells (RBCs), hematocrit (Ht), and hemoglobin (Hb); between RBC and both Ht and Hb; between TC and both mean platelet volume and platelet distribution width (PDW); and between mean corpuscular Hb concentration and RDW. Significant differences were noted in RBCs, Hb, and Ht compared to data from wild-caught European hake populations in Argentina and Denmark. Both trawling depth and duration were found to significantly affect RBC, WBC, Hb, and Ht values, while having no notable impact on TC. Fish captured at an average depth of 80 m and with a trawling duration of 30 min exhibited significantly elevated hematological indices. Conclusion: This study demonstrates that hematological analysis is a valuable, cost-effective tool for assessing the physiological and health status of European hake populations in the Mediterranean. Notable differences in hematological parameters based on sex, as well as significant correlations among key blood metrics, underscore the importance of understanding species-specific hematological profiles. The influence of trawling depth and duration on certain blood parameters highlights the need for standardized sampling protocols in population health assessments. These findings contribute essential baseline hematological data for European hake, facilitating more informed fisheries management and conservation strategies.

Assessment of Maternal and Infant Health Status in Durham Region

I completed my practicum as a Student Epidemiologist at the Durham Region Health Department with the Health Analytics and Research Team (HART). HART is tasked with conducting population health assessments in the Durham Region. As a member of HART, I played a critical role in assessing the maternal and infant health status of the local population using data from the Better Outcome Registry and Network (BORN) information system (BIS), a database that contains critical reproductive and child health data in Ontario. Specifically, my primary responsibilities included data extraction and data coding, which encompassed a series of tasks, spanning from data cleaning to data analysis in STATA. By analyzing BORN data, I was able to refine my statistical and programming skills. Moreover, I collaborated with public health program staff to develop infographics that disseminated critical maternal and infant health information to various communities. The infographics I assisted with covered a wide range of maternal and infant health topics, including issues such as gestational diabetes and maternal mental health concerns. From here, I was able to effectively communicate health information in a concise and understandable manner. In addition, I had the opportunity to attend various public health workshops and group meetings during my practicum. These experiences not only expanded my knowledge of diverse public health topics but also afforded me greater familiarity with public health practice. In summary, my time at the Durham Region provided me with an exceptional opportunity to apply the knowledge I gained in school to real-world practice. It was a valuable and enriching experience that significantly contributed to my professional development in the field of public health.

Can China's national comprehensive medical reform increase medical resources and reduce healthcare burden: evidence from Chinese provinces.

China's national comprehensive medical reform (NCMR) is an important attempt in the reform of healthcare system, and quantitative evaluation of its effect is of great significance for continuously deepening medical reform, grasping the reform direction, and building a healthy China. Therefore, focusing on medical resources and medical burden, this study aims to systematically explore the policy effectiveness and the provincial heterogeneity of NCMR, as well as the potential influencing factors. Utilizing the collected multi-period panel data of 31 provinces in mainland China in 2006-2021, we regarded the release of the two batches of pilot provinces in NCMR as a quasi-natural experiment and comprehensively adopted a Staggered difference-in-differences (DID) model and Synthetic Control Method (SCM), combined with word frequency statistics and grouping regression analysis. NCMR can effectively increase the number of licensed physicians by 12.6% and reduce the per capita medical expense for in-patients by 7.2% in the pilot provinces. Furthermore, the NCMR policy effect in different pilot provinces shows various characteristics, and only Jiangsu, Zhejiang, and Chongqing achieve both the growth of medical resources and the reduction of medical expenditure. Meanwhile, word frequency statistics are conducted based on related policy descriptions and news reports on the official websites, so as to summarize the specific policy means in the three provinces, and provide a reference for other provinces to practice the healthcare reforms. Besides, extensibility analysis shows that the effect of NCMR is affected by the population aging and health status. Groups with low degree of population aging (low-AG)/high population health status (high-HE) performed a more obvious reform effect. This study provides beneficial policy implications for increasing medical resources, reducing medical burden, and promoting medical reform process.

Global trends in importance of 24-hour movement behaviors to pediatric health: Implications for South Korea.

Cultivating a 24-hour movement behavioral profile conducive to health and well-being, marked by adequate levels of physical activity, limited screen time, and sufficient sleep, has emerged as an important avenue for promoting pediatric health. We aimed to provide evidence of this potential, this multiphase, multimethod, and integrative review comprehensively investigated the global trends in health promotion initiatives and status of the Korean pediatric population. This integrative review comprised three phases employing various review methods: an environmental scan of existing guidelines for 24-hour movement behaviors worldwide, a rapid review of physical activity-related indicators from Global Matrix data, and a systematic review of 24-hour movement behaviors among children and adolescents in South Korea. The growing recognition of a holistic approach to the 24-hour movement behavior paradigm in pediatric health promotion has led to the establishment and adoption of 24-hour movement guidelines in different countries and by the World Health Organization (WHO). Korean health authorities have also responded to this need by releasing a translated report of the WHO guidelines for physical activity and sedentary behavior as well as the 2024 update of the Physical Activity Guidelines for Koreans. Accordingly, actions must be followed in policy, research, and practice. This is critical considering that Korean children and adolescents exhibit an unfavorable profile of 24-hour movement behaviors compared to the global average. Among those aged 0-6 years, the weighted averages for guideline adherence were 18.2% for physical activity, 38.1% for sedentary behavior, and 76.2% for sleep. For those aged 12-18 years, the weighted averages for guideline adherence were 20.4% for physical activity, 55.9% for sedentary behavior, and 26.2% for sleep. Building on these current findings, this integrative review provides three priorities for pediatric health promotion policy and practice and three recommendations for future research.

The Adolescent Mental Health Consequences of Social Media Usage

This paper looks into the impact of social media on an individual’s mental health status in the adolescent population. The scope of the study includes both addiction and recovery, addressing risks such as anxiety, depression, and distorted self-perception associated with the continuous use of social platforms like Instagram, TikTok, Facebook, etc. Besides recognizing the detrimental impacts of bullying, body image comparison, and excessive use of screens, the paper also underlines some advantages of social media, such as connecting people and access to assistance. In the present research, numerical indicators and empirical observations are used, i.e. the nvestigation is conducted on the basis of the mixed research method. It reveals variations in social media effects amongst adolescents based on the moderating variables of individual characteristics and situational context. The paper ends with solutions to alleviate the negative effects, such as digital literacy education, parental guidance, and mental health strategies while fostering the healthy usage of social media regarding mental health. These findings suggest the need for a longitudinal study in order to assess the changes over time in this somewhat new aspect.

Physical performance in the health environment: an undervalued practical and inexpensive tool.

In this article, Festa et al. highlight that the assessment of physical performance is not currently valued as a simple and practical tool for estimating health status in the general population. Consequently, the purpose of this opinion article is to highlight the importance of testing and classifying physical performance as an indicator of overall health, encouraging health professionals to consider them as an accessible and inexpensive tool for the public health context, in contrast to laboratory assessments.

ASARA-A technology-driven maternal and child healthcare model of Araku

Tribal populations form 8.6% of total India’s population. The health indicators of tribal populations lag behind their non-tribal counterparts. Limited access to healthcare services, poor transportation facilities, increased out-of-pocket expenditures for health, distinct cultural practices and remote settlement among many others contribute to the poor health status of the tribal populations. However, to achieve sustainable development goals by 2030, it is extremely important to address the healthcare needs of the tribal population. The current paper is the first part of the model of care working paper series that discusses the components of the ASARA project to highlight the impacts of the decade long efforts towards improving maternal and child care in the region.

Inferring diagnoses from prescription data: a machine-learning approach

Abstract Estimating disease prevalence is a fundamental while challenging public-health goal: in the absence of solid diagnostic data, it typically requires expensive and time intensive studies. Analyzing existing medical records is an alternative, complementary approach. In particular, prescription records offer a glimpse into the health status of populations, prescribing patterns, and operational dynamics. We asked whether these could be used to infer diagnostics and, therefore, estimate disease prevalence. We used the Portuguese electronic medical prescriptions dataset (ADD NUMBERS) and trained a machine learning model that captures the probability that specific drugs are prescribed for the same or related medical conditions. We 1) constructed a manually-curated dataset of diseases and associated medications; 2) used this dataset to train embeddings models; 3) tested these models against human-classified data; 4) used the trained/tested model to uncover comorbidities associated with a) antibiotic prescription (to validate the model), and b) the impact of COVID-19 in prescription patterns of chronic-diseases. The model was able to accurately identify drugs used for targeting ten specific diseases, with few false positives and false negatives. Our analysis showed that the COVID-19 pandemic had almost no effect on the number of prescriptions for some chronic diseases (such as diabetes and depression), but, importantly, had a strong impact on the number of new diagnoses, with new users of diabetes medication in 2019 dropping by more than 16.8% in 2020. Medical prescriptions offer a promising tool to quickly assess disease prevalence, underdiagnosis, and allow a broad overview of the medical status of the population, especially in the face of health emergencies that strongly pressure the medical system. Key messages • We propose a new approach to infer diagnostics from prescription data with several promising applications. • We propose a new approach to infer diagnostics from prescription data with several promising applications.

Population health status and green urban areas: impact on health outcomes in two Italian regions

Abstract Background Living in urban areas has been linked to a rise in noncommunicable diseases. Nevertheless, there is scarcity of evidence emphasizing the combined impacts of certain urban attributes (e.g. pollution, excessive soil sealing, urban temperatures) and the existence of green spaces on health outcomes. Further studies are imperative to evaluate the association between chronic illnesses such as dementia and ischemic heart disease, and the presence of urban green areas. Methods We conducted an ecological study in two Italian regions. Prevalence of chronic diseases in Tuscany and Latium were obtained at the municipality level from public health databases available online and Normalized Difference Vegetation Index (NDVI) was calculated for 2023. Descriptive analyses and Poisson regression models were run to assess the association between green space and chronic diseases prevalence, adjusting for age, sex, education, employment, foreign residents, income, urbanicity and spatial correlation. Results Preliminary analyses were conducted on 273 municipalities in Tuscany. Mean prevalence per 1000 inhabitants of dementia and ischemic heart disease were 15.75 (SD = 5.3) and 48.25 (SD = 11.06), respectively. Mean NDVI across municipalities was 0.37 (SD = 0.04). Higher green exposure is associated with lower prevalence of ischemic heart disease (β= -0.21; p < 0.05) and dementia (β=-0.3, p < 0.05). Analyses will be executed for the Latium region and complete results will be available by mid-June. Conclusions The presence of urban greenery appears to be associated with a reduction in chronic illnesses. While further studies are warranted, it is crucial to adopt urban policies focused on green spaces and citizens’ health outcomes. Generating evidence for decision-makers is essential for shaping urban environments in ways that promote both health and overall human wellbeing. Key messages • Living in green urban areas appears to positively impact human health, reducing chronic disease prevalence. • Greenery serve as a tool for mitigating and adapting to the climate crisis, promoting health.

The wisdom layer: how to support evidence-informed policymaking

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

Health status, healthcare use and prevention in Travellers in Nouvelle Aquitaine, France, 2019-2022

Abstract Background The poor health status of underserved populations is compounded by low vaccination uptake, leading to a greater risk of epidemics. On October 2017, a measles outbreak started in the southwest of France among under-vaccinated social groups, including Travellers. We aimed to describe the health status, healthcare use and child measles-mumps-rubella (MMR) vaccination coverage in Travellers according to their environmental and living conditions. Methods A cross-sectional study with a three-stage random sample design was conducted between October 2019 and March 2022 in the Nouvelle-Aquitaine region in France. Trained social workers administered face-to-face questionnaires to collect data on adults and children. Anthropometric measurements, vaccination records, and data using an environmental exposure questionnaire were also collected. Results The participation rate was high (73.6%), with 1030 adults and 337 children included. Concerning the adults, 36.6% had obesity, 14.4% reported diabetes, 24.7% hypertension, and 14.4% major depression. The prevalence of major depression was significantly higher in adults living in precarious and unauthorized housing than in those with adequate housing (19.8 vs. 14.7%, p = 0.03). The unmet health care needs in the last 12 months was 48.4%. With regard to children, 45.3% had full (i.e., 2-dose) MMR vaccination coverage at 24 months and 17.9% had obesity. Finally, 74.5% of the households experienced housing insecurity, and 22.2% did not have a supply of drinking water. Conclusions Traveller children and adults faced deleterious environmental and living conditions potentially affecting their health, healthcare use, and vaccination coverage. These results demonstrate the need for urgent interventions for underserved populations which take into account their difficult living conditions. Key messages • Travellers have a greater burden of chronic diseases than the general French population and measles-mumps-rubella vaccination coverage among Traveller children is lower than in the general population. • The more precarious the housing, the more likely Travellers are to report having a chronic disease (social exclusion gradient).

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

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

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.

Cross-sectional study for profiling health status, health-related demographics, and health-seeking behaviour of the Scheduled Caste Population in selected areas of Chennai and Chengalpet Districts of Tamil Nadu

Background: Scheduled Caste (SC) population forms a large section of the Indian population who are often marginalised and deprived of social, economic and health benefits due to ignorance and socio-cultural milieu. Though various studies have been conducted on the socio-economic and political conditions of the SC population in Tamil Nadu, limited data is available on the status and determinants of their health. Objectives: The study's objectives were to estimate the health status of the SC population, health-related socio-demographic conditions and the population's health-seeking behaviour. Method: The observational, cross-sectional study was conducted in five SC-predominant areas of Chennai and Chengalpet districts of Tamil Nadu. Their health status, socio- demographic conditions, including household conditions, and health-seeking behaviour were estimated. Result: A total of 1452 households and 6072 participants of the SC community were studied, mostly belonging to the Adidravida community. Most households were of Upper-lower socioeconomic class with basic household amenities. A total of 11.54% of the adult population had a history of diagnosed chronic illnesses. Nearly one-fifth of reproductive-age women had menstrual irregularities. Non-communicable and infectious diseases were the most frequent reason for health care centre visits. Conclusion: Extensive and continuous screening of health status and chronic diseases is essential for early diagnosis and intervention. Focused interventions on improving socio- demographic status can further strengthen the health condition of the SC community. Integrating all systems of medicine in public health can help cater to the health requirements of all sections of the community. Concerted efforts can cut down the burden of chronic diseases.

Lessons for Strengthening a Resilient Health System from the View of Health Facilities During the COVID-19 Pandemic: A Qualitative Study.

Coronavirus disease 2019 caused significant negative damage to the health status of populations and health systems globally. In Uganda, our previous study revealed that the strict Public Health and Social measures (PHSMs) and the closure of Entebbe Regional Referral Hospital (ERRH) led to missed healthcare access among the citizens in the Entebbe municipality. Limited studies, however, exist on the impact of the response measures on the local health systems. This study aims to explore the impacts of these measures on the local health service provision from the views of health facilities in Entebbe. We used a thematic framework method, grounded by the health systems resilience framework consisting of five components: (1) health service delivery; (2) medical products and technology; (3) health workforce; (4) public health functions; and (5) governance and financing. Key informant interviews with eight representatives from four private hospitals and four health centers were conducted from September to October 2022. Fifteen themes and 25 subthemes were identified. With the closure of the ERRH and the strict PHSMs, the citizens faced various difficulties in accessing the needed health services. The facilities received an overwhelming number of patients and faced various challenges, such as a lack of medicine, healthcare workers, facility capacity, and no means to transfer patients. Nevertheless, the facilities made efforts to maintain the required services. Moreover, mobilizing vertical and horizontal actors through a flexible network, from the district health office to community health volunteers, helped to coordinate the medicines, transportation for both patients and healthcare workers, conduct patient tracking, etc. Our study suggested the importance of an integrated system of public health and health service delivery systems, the formalization of a vertical cooperative mechanism, and the introduction of public health insurance for strengthening resilient health systems. These insights may benefit other sub-Saharan cities.

Health Promoting Behaviors among Reproductive Age Women in Serbia: The Results from a National Health Survey.

Certain lifestyle characteristics, such as dietary patterns, physical activity, and maintenance of recommended body weight, low-risk alcohol consumption and non-smoking are associated with the lower likelihood for the development of chronic-non communicable disease in the general population. These lifestyles are called health promoting behaviors (HPBs). We aimed to examine the prevalence of the HPBs among the women of reproductive age in Serbia and the factors associated with the compliance with four or more of these behaviors. The study was the secondary analysis of the data from the National Health survey in Serbia from 2019 that examined social, health status, mental health (using PHQ-8) and lifestyle characteristics of the general population in Serbia. The prevalence of compliance with four or more HPBs was 22%. Among the HPBs the most frequent was a non-risky alcohol consumption reported by 2585 participants (99.2%), followed by normal weight (2018-69.2%) and non-smoking (1469-69%), daily fruit and vegetables intake (969-33.2%) and sufficient aerobic PA (216-7.9%). Multivariate logistic regression analysis with four or more HPBs as an outcome variable showed that the association of compliance with four or more HPBs with tertiary education (OR 1.91, 95% CI: 1.32-2.76) use of prescription medications (OR: 0.62, 95% CI: 0.44-0.87) and score on PHQ-8 (OR: 0.88, 95% CI: 0.79-0.98). There is a need for deeper promotion of health-related behaviors among all educational and vocational groups, including health promotion activities at the primary health care level, which is available to the entire population.