Health Professionals Research Articles

4.Y.1. Climate trauma, public protest and the ethics of civil disobedience in our warming world

Abstract Eco-anxiety, defined as “a chronic fear of environmental dooms,” is related to both a direct experience of extreme weather events (e.g., floods, wildfires, hurricanes, droughts) as well as environmental changes. Although it is not yet being addressed as a proper disease, eco-anxiety is being related to symptoms such as obsessive thoughts about the climate and the total destruction of the planet, existential fear and feelings of guilt about one’s own carbon footprint, anger, frustration, depression, and anxiety, among others. Eco-anxiety is increasingly reported among children and young people (Hickman et al, Lancet Planetary Health, 2021). Less studied and understood is climate trauma at a societal level resulting from the ever-present, ever-growing threat of climate change.This session aims to facilitate a better understanding of the mechanisms that lead to this symptomatology as well as the reasons for our apparent collective paralysis as a society to act in accordance with the climate threats we face. This analysis will take into account aspects linked to cultural diversity and structural factors that can rationalise the inaction. Particularly following the COVID-19 pandemic, many states have introduced or strengthened laws restricting the right to protest, with implications for public protest about state inaction on climate change. The workshop also aims to address questions such as: Are public protest and civil disobedience rational responses to the climate crisis? Should health professionals protest publicly? How has eco-anxiety been used as a legal defence to criminal charges? How should professional accreditation bodies respond when a member is convicted in a climate protest? Is deregistration appropriate, or should we instead be hastening to revise professional codes of ethics and public health training curriculums to reflect ‘the single biggest threat facing humanity’? (WHO, 2021). In the United Kingdom, the UK Health Alliance on Climate Change has urged the General Medical Council ‘to be as lenient as the law allows’ with health professionals convicted of offences resulting from their protests against damage to nature, the climate, and health. Three expert panellists in mental health, law and ethics will present their perspectives in Pecha Kucha format. Key messages • Climate trauma at societal level may account for our collective paralysis in the face of climate change: yet political, structural and cultural factors must not be overlooked. • Ethical codes and training curriculums for public health professionals must be updated to reflect the evolving roles of PHP in response to climate change. Speakers/Panelists Jutta Lindert Hochschule Emden-Leer, Emden, Germany David Patterson University of Groningen, Groningen, Netherlands Farhang Tahzib Faculty of Public Health, Haywards Heath, UK

Determinants of Unmet Healthcare Needs During the Final Stage of the COVID-19 Pandemic: Insights From a 21-Country Online Survey

ObjectivesDuring the COVID-19 pandemic, essential health services experienced significant disruptions, impacting preventive and chronic care across the world.MethodsUtilizing the Pandemic Recovery Survey (PRS), conducted online with Facebook’s Active User Base across 21 countries between March and May 2023, this cross-sectional study identifies the magnitude of and key factors associated with unmet preventive and chronic care needs during the late stage of the COVID-19 pandemic.ResultsApproximately 28.2% of respondents reported unmet preventive care needs, and 42.1% experienced unmet chronic care needs, with key determinants including food insecurity (aOR 1.94, 95% CI 1.81–2.07 for preventive services; aOR 1.85, 95% CI 1.68–2.03 for existing conditions) and distrust in health professionals (aOR 1.09, 95% CI 1.03–1.15 for preventive services; aOR 1.53, 95% CI 1.41–1.66 for existing conditions).ConclusionThe findings underscore a widespread unmet need for health services, highlighting the impact of social determinants and trust in health professionals on service disruption. The results suggest that pandemic recovery efforts should focus on the most affected groups to bridge health disparities and ensure an equitable recovery.

Time taken for cardiology care and one-year results for primary care physicians' referrals for cardiology consultation in heart failure patients: clinical implications for heart failure management

Abstract Background and Purpose The clinical trajectory of patients with heart failure (HF) is characterised by frequent episodes of decompensation requiring urgent medical assistance, hospitalisations, and an increased risk of mortality. HF clinical guidelines recommend early visits by health professionals after hospital discharge, yet little evidence exists regarding the associations between delayed medical attention and outcomes in HF patients. To assess the clinical impact of the time taken to receive cardiology care for referrals from primary care physicians (PCPs) to a cardiology department in HF patients, we selected 6,859 HF patients who visited the cardiology service at least once between 2010 and 2021. Methods Using an interrupted time series regression model, we analysed the impact of integrating e-consultations into the healthcare model (implemented in 2013) and evaluated the time taken to receive cardiology care, as well as all-cause, cardiovascular (CV), and HF-related hospital admissions and mortality. The primary objective of this analysis was to examine the associations between delays in cardiology care following a PCP referral and 1-year outcomes (HF-related, cardiovascular, and total hospitalisations; and HF-related, cardiovascular, and total mortality). Results Almost 50% were women, and the mean age was 77.8 years. Arterial hypertension (79.6%), diabetes (34%), atrial fibrillation (51.4%), ischemic heart disease (20.4%), and cerebrovascular disease were the most prevalent comorbidities. The mean time from PCP referral to cardiology consultation in the overall population was 22.3 days: <8 days in 53.9%, 8-14 days in 17.1%, 15-30 days in 15.9%, and >30 days in 13.0% of patients, respectively. One year after cardiology consultation, 68.6% of patients required assistance in an Emergency Department; 22.5% were hospitalised for any cause, 14.9% for cardiovascular reasons, and 9.2% for HF-related issues. Moreover, total mortality at 1-year was 8.6%, comprising 4.3% cardiovascular mortality and 1.3% HF-related deaths. Multivariate analysis of the relationship between the time taken to receive cardiology care and 1-year outcomes revealed a significant increased risk associated with a longer delay in cardiology assistance, particularly evident in the subgroup of patients with previous hospital admissions due to worsening HF (see Table). Conclusions Throughout the follow-up period, a reduced time taken to receive care was independently associated with better 1-year outcomes. We believe that our experience can contribute to the development of a more efficient ambulatory care pathway for HF patients, especially those at high risk, such as those with a history of hospitalisation due to worsening events. Our findings further support the clinical guideline recommendation for early contact by health professionals following hospital discharge, extending it to include PCP referrals for cardiology consultations.

The effect of health literacy course on the level of health literacy in medical students

Abstract Health literacy (HL) concerns not only individuals but also health systems and health professionals. Most of the literature on HL has focused on patient factors, with little emphasis on the communication skills and practices of health professionals. Training is needed at all levels to understand the concept of HL and its impact on health inequalities. This study is an intervention study. Data were collected from 29 students taking the third year elective course at the Faculty of Medicine through an online survey. The survey consists of 40 questions aimed at assessing the demographic characteristics of the participants, the TSOY-32 Scale and some factors affecting HL. During the training period, role-play scenarios were played to teach the importance of HL, sample videos were watched to evaluate physician-patient communication, and case studies were conducted. The mean pre-test TSOY-32 scale score of the participants was 32.8±5.8. The mean post-test TSOY-32 scale score was 36.4±7.1. There was a significant difference between pretest and posttest groups in terms of TSOY-32 scale score (p = 0.033). Health professionals often overestimate patients’ HL levels and do not have sufficient competence to effectively manage limited HL. These gaps need to be addressed through the curricula of medical schools and specialties. Key messages • Training on health literacy improves medical students’ communication skills, bridging gaps in patient care. • Addressing health literacy in medical training enhances patient-doctor communication, vital for quality care.

Evaluating Accuracy of AI-Generated Travel Vaccine Recommendations: GPTs in Public Health

Abstract Introduction Artificial intelligence (AI), particularly generative pre-trained transformers (GPTs), holds promise for enhancing public health strategies like travel vaccine recommendations. This pilot study evaluated GPTs’ accuracy in delivering tailored vaccine advisories compared to standards set by public health professionals. Integrating AI’s data analysis capabilities into healthcare decision-making could improve recommendation precision and personalization. Methods This retrospective study analyzed GPT travel vaccine recommendation accuracy against a gold standard from health professionals for 90 travelers visiting various countries. Sociodemographic data and vaccine recommendation outcomes were examined. Accuracy assessments were stratified by age, sex, country of travel, duration of travel, type of travel, and specific vaccines. Results Preliminary results showed an 77.43% overall accuracy across all vaccine recommendations. Specific vaccine accuracies varied, with 97.78% alignment for hepatitis A, 93.51% for typhoid fever and 89.36% for rabies. However, lower accuracies were observed for cholera (33.33%) and encephalitis (56.25%). Moderate accuracies were noted for yellow fever (75%), 74.07% for malaria prophylaxis, diphtheria and tetanus (63.33%), and dengue (57.58%). Stratified analyses are expected to provide more realistic results and highlight discrepancies in certain groups. Conclusions This pilot demonstrates GPTs can be a valuable tool for supporting international vaccination professionals, but they are still not a substitute for these professionals, achieving 77.43% overall accuracy. Recommendations include: a) Educate health professionals in the use of GPTs, b) Developing guidelines for ethical and accurate AI use in public health, c) Using AI to strengthen surveillance and response systems. Combining AI with traditional strategies aims to optimize international traveler health outcomes. Key messages • Using artificial intelligence can optimize and facilitate the task of clinical consultancy in traveler’s advice. • It is necessary to establish guidelines for AI use to ensure ethical and accurate applications.

Project Health Resilience: a health literacy programme for 16–19-year-olds delivered by doctors

Abstract Background Project Health Resilience is an education-setting based health literacy pilot for Londoners aged 16-19. This is a transitional age when young people independently engage with health services. Greater health literacy levels improve use of preventive services, successful management of long-term health conditions and reduce emergency service use. Research during the COVID pandemic also demonstrated the importance of building trust with health professionals to reduce health inequalities. The impact of poor health literacy is observed universally. This intervention was developed to empower young people at a critical time. Methods 3 bespoke modules (healthcare access; medical emergencies; mental health resilience) were co-produced with young people and delivered by doctors. During 2023, 46 sessions were carried out with 712 attendances across 8 London settings. A mixed-methods approach, including questionnaires and interviews, was used for the evaluation. The study explored whether taking part resulted in increased awareness of services, knowledge, confidence and trust in health professionals. Results Participants reported that topics filled a crucial gap in their learning. Awareness and confidence increased for: awareness of different health services (increase of 18%) and mental health services (38%), confidence calling emergency services (13%), confidence dealing with medical (34%) or mental health emergencies (40%). Knowledge questions answered correctly increased across the 3 modules (46% pre vs 60% post). Trust levels increased and findings suggest that doctors delivering sessions was a key component. Conclusions Findings add to the evidence base around education-setting based health interventions improving health literacy. Providing a unique opportunity for adolescents to engage with health professionals can increase trust levels. Doctors delivering health education at this critical age is a pioneering model which can be replicated in other settings. Key messages • Health literacy education is particularly impactful at this critical age of transition; this can contribute to reducing health inequities across the life course. • Trust, collaboration, and co-production were core principles upon which this pilot thrived. Without input from young people, it is difficult to design appropriate and impactful interventions.

Professional health literacy of health professions in Austria - results of the HLS-PROF-AT study

Abstract Background Health professions play a crucial role in strengthening the health literacy (HL) of the population - provided that they themselves have the necessary professional HL. This encompasses competencies related to information and knowledge management, conveying information and knowledge, patient involvement and shared decision-making, and professional digital HL. In 2022 and 2023, data on professional HL were collected in Austria. Methods Nearly 4,400 healthcare professionals (doctors, nurses, physiotherapists, pharmacists, midwives, dieticians) were asked about their challenges across the four domains of professional HL. A score was calculated for each domain, with five additional subscores for the domain conveying information and knowledge. The relationship between socio-demographic, job-related and organisational characteristics and professional HL were investigated using T-tests, variance analyses and multivariate regression models. Results The greatest challenge for all healthcare professions is supporting patients in dealing with digital information, followed by conveying information and knowledge. Apart from pharmacists, the least difficulties were found in the domain patient involvement and shared decision-making. Furthermore, the results demonstrate that a high level of professional HL is associated with more favourable organisational conditions for HL-promoting patient communication and (very) good preparation in training for the tasks of professional HL. There is no systematic correlation between professional HL and years of professional experience. Conclusions Overall, healthcare professionals rated their professional HL positively. However, the results also highlight areas for improvement. Alongside promoting professional HL in the context of (further) training, it is important to enhance organisational framework conditions for promoting patients’ HL - ideally supported by initiatives to promote the organisational HL in healthcare organisations. Key messages • The greatest challenge for the health professions surveyed is to support patients in dealing with digital information and to convey information and knowledge to their patients. • Good preparation in training for the tasks of professional HL and favourable organisational conditions for HL-promoting patient communication are associated with a higher professional HL.

Breastfeeding knowledge, attitudes and practices of HIV-positive women in Africa, a systematic review

Abstract Background Breastfeeding (BF) is essential to ensure the health and survival of children, especially in regions where diarrhoea, pneumonia and malnutrition are common causes of child mortality. The WHO currently recommends, along with antiretroviral treatment, exclusive BF (EBF) for the first six months and mixed BF for the next six months and extending it to 24 months. In sub-Saharan Africa, more than one million HIV-positive women face the challenge of infant feeding due to limited access to treatment and safe water. The aim of this study was to understand the knowledge, attitudes, and practices of HIV-positive mothers in Africa to provide evidence for public health strategies. Methods We conducted a systematic review of studies on Knowledge, Attitudes and Practices of BF among HIV-exposed children in African countries, following the principles of the PRISMA statement and identified by searching major databases of records published between 2013 and 2023. Results Of the 498 articles identified, 21 met the inclusion criteria. 70% of the studies were conducted in Ethiopia, South Africa, and Kenya. 95% of the studies were conducted in health care facilities. Mothers showed good knowledge, attitudes and practices regarding EBF of HIV-exposed children, but low knowledge and fear of continuing to practice BF later on. The HIV-positive mothers mentions a range of recommendations received from health workers, identified as their main source of information. Stigma against mothers who practice EBF was found. The primary reason for early cessation of BF was due to work. Conclusions Knowledge, attitudes, and practices of the infant feeding currently recommended by WHO for HIV-positive mothers was weak. There is little evidence of what happens in other African countries and in women with limited access to the health system. Public health policies need to be strengthened to ensure that health workers are trained in the current guidelines to improve HIV-positive women’s BF. Key messages • HIV-positive mothers are afraid to continue breastfeeding their babies after 6 months. • More studies about the breastfeeding practices of children of HIV-positive mothers with limited access to health services are needed.

Effectiveness Of Team-Based Training Programs In Hospitals

The Effectiveness of Team-Based Training Programs in Hospitals aims to evaluate the effectiveness of team-based training programs in developing the competencies of health workers in hospitals. The research is based on the importance of collaboration between health professions to improve quality of care, but is often hampered by communication and coordination gaps. The research methodology involved systematically evaluating the training program qualitatively, measuring changes in trainees' competencies, and exploring participants' perceptions and experiences. The main objectives of the study were to evaluate the effectiveness of the program in developing health worker competencies, measure changes in participant competencies, explore participant perceptions and experiences, and provide recommendations for future program improvements. It is expected to provide valuable insights into the effectiveness of team-based training programs and identify areas that require improvement. This will be used to improve future training programs, with the ultimate goal of improving health worker collaboration and the quality of health services for patients. The implications of this study include contributions to human resource development in healthcare and the promotion of a culture of collaboration between healthcare professionals. The research findings from the study on the Effectiveness of Team-Based Training Programs in Hospitals indicate several positive outcomes. First, participants reported improvements in communication, particularly in emergency situations, where teams responded more swiftly and effectively. The program also led to enhanced coordination between shifts, reducing errors in patient care and improving the overall quality of services provided

4.B. Round table: Closing the loop in the European Health Data Space: relation between primary and secondary data use

Abstract Currently, data collection processes in healthcare institutions across Europe remain exclusively geared towards the needs of primary use. Neither medical professionals’ clinical workflows, nor the data infrastructures and data management processes established within different organisations allow for the kind of highly standardised and structured data collection, processing and segregation from operational systems that secondary use requires. The development of a European Health Data Space offers large possibilities for research and innovation. High quality or primary data and secure pathways are required for the secondary use of data. Closing the loop and making relevant information from secondary use of data available to clinicians and health care professionals is a crucial step to build trust and enable a cultural shift that will enable health innovations and targeted treatments reach all those who could benefit from them without delay. Closing the loop between primary and secondary use of data will accelerate the shift from treatment of illness to prediction and prevention in the way healthcare is delivered - a shift that will need to be accompanied by an overhaul of European health systems’ current funding and reimbursement models. Establishing trustworthy sources of information and guidance for the use of novel health technologies, as well as involving patients and their caregivers early in the development of concrete applications, could help to foster better understanding and build trust in this area. To ensure acceptance, it will be particularly important for these developments to be driven by identified problems and defined needs in healthcare. Efforts should be made to address and include all parts of the population, not just the highly engaged and usually highly educated patients who typically participate in collaborative initiatives. The workshop will provide a holistic understanding of the interconnectedness between primary data and secondary use of health data. High quality of data and secure pathways are required for the secondary use of data. The workshop will explore paths for the evaluation of data-driven innovation and its introduction into clinical pathways that need to be further developed and standardised across the EU and the role that different actors in the health data system must play to meet the needs for secure and high-quality of data for research and policy development. The importance of actors like healthcare professionals, patients and citizens as well as the role of industry, public-private partnerships and relevance of health data innovative solutions will be addressed by each of the panellists and collaboration pathways for closing the loop will be further explored. The discussion will use and build on the findings and solutions identified in the EIT Health Think Tank report ‘Implementing the EHDS across Europe’. Key messages • In order to move to a data sharing environment, a cultural shift is needed to foster an environment of equality and openness to share data. • Healthcare professionals, patients and citizens are active participants and public-private partnerships could be instrumental to foster novel solutions and trust in this cultural transformation. Speakers/Panelists Nienke Schutte Sciensano, Brussels, Belgium Milana Trucl European Patient Forum, Etterbeek, Belgium Sinead O’Connor Trinity College Dublin, Dublin, Ireland Aneta Tyszkiewicz EFPIA, Brussels, Belgium Elina Drakvik Sitra, Helsinki, Finland

How social and commercial determinants influence exclusive breastfeeding in the Philippines

Abstract Background The World Health Organization recommends exclusive breastfeeding (EBF) for the first six months after delivery. However, the EBF rate in the Philippines is only 29%. Existing literature suggests that the influence of infant formula marketing (IFM), communication channels, and traditional health beliefs are possible contributors to low EBF rates, but rare studies have been conducted in low-resource settings. Methods: To bridge the gap, 15 barangays in Palawan were selected; 97 interviews were conducted with lactating mothers (LM), health workers (HW), traditional healers, infant formula sellers, and community leaders (CL) to represent different perspectives. The results were coded and analyzed inductively. Results LM received EBF information through multiple resources. Poverty, lacking breast milk (BM), EBF education, and health benefits (HB) to infants are top contributors to EBF while maternal employment and no BM are top barriers to EBF. Elders, traditional health beliefs (THB), and the influence of COVID-19 can influence EBF in both directions. LM emphasized more on poverty and elders to EBF while HW and CL emphasized the role of EBF education and HB. Urban LM tend to have more regular EBF education, use pumps when going out, and are more influenced by IFM. LM in remote areas tend to have more THB, have more BM substitutes, and share BM. Social classes, locations, Indigeneity, migration, and poverty are intersectioned to influence EBF. Conclusions Multiple social and commercial determinants influenced EBF. LM is facing more challenges to EBF under globalization and capitalism. Remote LM are less benefited from new technologies and policies to promote EBF. Different stakeholders have echo chambers to perceive the determinants of EBF. To improve health equity and EBF, the situations of marginalized people in remote areas should be more considered in policy making. Community building should also be considered differently to assist in EBF. Key messages • The project focuses on social and commercial determinants of exclusive breastfeeding with people in extreme poverty. • The project includes plenty of Indigenous breastfeeding behavior that are underreported.

COVID-19 impact on childhood vaccination attitudes in pregnant antenatal class attendants in Rome

Abstract Background The COVID-19 pandemic caused a decrease in vaccination rates, impacting vulnerable populations such as pregnant women (PW), who concern about future children’s immunisations. The aim of this study was to assess whether the pandemic led to changes in childhood vaccination attitudes among PW attending antenatal classes at the Fondazione Policlinico Universitario A. Gemelli in Rome. Specifically, it assessed the impact of the pandemic on the perceived usefulness of information sources, their trust in healthcare workers (HCWs) and the National Health Service (NHS), their perception of the risk of infection and severity of vaccine-preventable diseases (VPDs), and their vaccination intentions. Methods A repeated cross-sectional study was conducted across three flu seasons by administering an anonymous questionnaire: one before and two during the pandemic. Intention to vaccinate children was expressed as the percentage of PW who selected each vaccination from the questionnaire. Trust in HCWs and the NHS, and perception of the risk of infection and severity of VPDs were expressed as the percentage of PW who answered “quite” or “very”. For the usefulness of information sources, mean scores were calculated. To assess differences of the three periods a chi-square test was performed (p = 0.05). Results Course attendance surged from 105 to 340. Significant shifts in vaccination intentions were noted: 7.5% and 10% decreases for measles (p = 0.02) and pertussis (p = 0.004), respectively, from 2019-20 to 2020-21. Perceived contagion risk decreased, but perceived disease severity increased. A significant reduction in the proportion of PW suspecting economic interest behind NHS workers promoting vaccination, and an increase in the perceived usefulness of non-institutional websites and of the advice from non-NHS physicians were noted. Conclusions PW’s attitudes towards vaccinations might have been modified by COVID-19 pandemic, regarding risk perception and trust in NHS HCWs. Key messages • Our findings suggests that PW’s attitudes towards childhood vaccinations might be modified by the COVID-19 pandemic, in particular risk perception and trust in NHS healthcare workers. • These findings could help Public Health to develop evidence-based interventions and communication strategies, to maintain vaccine confidence and mitigate potential adverse effects.

Gender-specific impact of COVID-19 in the UAE: Analyzing gender disparities in health and well-being

Abstract Background Understanding gender disparities in health impacts during pandemics is crucial. While early observations of the COVID-19 pandemic suggested higher severity and mortality rates among males, subsequent studies hinted at a disproportionate impact on females’ health and well-being. This study aimed to explore gender-specific differences related to COVID-19 in the United Arab Emirates (UAE). Methods Data from four independent surveys were analyzed to assess gender differences in knowledge about available vaccines, vaccine hesitancy, COVID-19 severity, admission to the Intensive Care Unit (ICU), anxiety among healthcare workers (HCWs), and psychological health of healthcare workers and the general population. Gender gaps were calculated as the absolute difference between males and females. Chi-square tests and logistic regression were performed to test the association between gender, age, and selected outcome variables. Results Males had a significantly higher risk of moderate to severe COVID-19 symptoms (71%) compared to females (63%). The gender gap in symptom severity was smallest among those aged 55+ and highest among adults aged 35-54. Post-discharge, 22% more females reported multiple conditions than males. Among HCWs, females showed lower knowledge (19% gap) and higher vaccine hesitancy (20% gap), with larger gaps among older age groups. Females also experienced more anxiety and psychological stress, especially in the 35-54 age group. Logistic regression confirmed higher odds for females in reporting vaccine hesitancy, long COVID-19 symptoms, and anxiety, even after adjusting for demographic factors. Conclusions This study highlights unequal health outcomes and burdens experienced by women and men during the COVID-19 pandemic in the UAE. The distinct challenges faced by women, including higher mental health burdens and persistent post-recovery symptoms, suggest systemic gender disparities that require targeted attention in healthcare policies and practices. Key messages • Gender disparities in COVID-19 were evident in the UAE with males experiencing severe COVID-19 symptoms, while females experienced post-recovery symptons, vaccine hesitancy, and stress. • Urgent action is required to address gender disparities in COVID-19 impacts, emphasizing mental health support and post-recovery care in policy formulation.

10.F. Skills building seminar: How public health professionals can use the right to health to advance climate action and justice

Abstract The climate crisis is the single biggest threat to global health, peace and security, a crisis multiplier, and a significant driver of health inequalities. In many areas of public health policy, legal action and litigation have delivered significant and long-lasting impacts. In April 2024, the European Court of Human Rights concluded that Switzerland had violated the right to health of older women in Switzerland by failing to meet its past greenhouse gas (GHG) emissions reduction targets and set future GHG targets. State-of-the-art public health evidence provided by the Intergovernmental Panel on Climate Change and Lancet Countdown on Health and Climate Change were vital to the Court’s decision, which has implications for all Council of Europe member states, and globally. Rigorous scientific evidence of health harms, including but not limited to heat stress, can inform other climate litigation grounded in the right to health. Public health researchers and practitioners are essential to this litigation. In recognition of this emerging role, in November 2023 the Faculty of Public Health (UK) and the Aletta Jacobs School of Public Health launched ‘From analysis to action: climate change litigation. A guide for public health professionals’ at the 16th European Public Health Conference. The guide was also endorsed by ASPHER, ASPPH, EUPHA, Global Consortium on Climate and Health Education, Global Network for Academic Public Health, Lancet Countdown, Public Health Ethics and Law Global Network, and WFPHA. This workshop will familiarise participants with recent rights-based climate litigation and explore the role of public health professionals in identifying, collecting, storing, assessing and presenting this evidence in a form that is accessible to court officials without medical training. First, there will be short presentations on 1) the role of the law in climate action and the role of scientific evidence of health harms in human rights litigation, and 2) How to collect and use scientific evidence of health harms in climate litigation (15 minutes). Small group discussions will follow, addressing questions such as: The health harm of climate change-related heat stress was a major factor in the 2024 decision of the European Court of Human Rights in KlimaSeniorinnen v. Switzerland: What other health harms could support future cases? In what population groups? What opportunities do you see today for public health researchers and practitioners to compile such evidence to make the most compelling case? How can public health researchers and practitioners work more closely with legal experts and affected communities to bring this evidence to court? (20 minutes) The workshop will conclude with a plenary discussion of these questions and the small group responses. (25 minutes) As a result of the workshop, participants will be better prepared to identify opportunities to contribute compelling evidence of health harms in climate litigation. Key messages • Rigorous scientific evidence of climate change-related health harms is proving central to success in rights-based climate litigation. • Public health professionals have a key role in identifying and presenting compelling evidence of health harms in climate litigation. Speakers/Panelists David Patterson University of Groningen, Groningen, Netherlands Farhang Tahzib Faculty of Public Health, Haywards Heath, UK

Antimicrobial resistance and infection prevention in care for people with intellectual disabilities

Abstract Background Antimicrobial resistance (AMR) has become one of the major public health threats worldwide. However, little is known about antimicrobial resistance and infection prevention and control (IPC) in long-term care facilities for people with intellectual disabilities. This study aims to assess knowledge, attitudes and perceptions towards AMR and IPC among healthcare professionals working in long-term care facilities for people with intellectual disabilities (ID-LTCFs) in the Netherlands. Methods We conducted a web-based cross-sectional survey study among medical and nonmedical trained healthcare professionals working in ID-LTCFs in the Netherlands. The survey study was carried out between July and November 2023 and consisted of validated survey items expanded with expert opinion and setting-specific items. Results In total, 109 medical and nonmedical trained healthcare professionals working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. Overall, knowledge levels about AMR and IPC differed between medical and nonmedical trained healthcare professionals working in ID-LCTFs, with medically trained professionals having a significant overall higher score on both topics. Knowledge regarding the perceived protective value of glove use was found to be insufficient. Moreover, healthcare professionals expressed a need for easy-to-read resources and tailored setting-specific information on AMR and IPC targeting both healthcare professionals as well as people with disabilities. Conclusions There is room for improvement regarding setting-specific IPC and hygiene policies, such as appropriate glove use in ID-LTCFs. As nonmedically trained professionals comprise most of the workforce within this setting, it is important to further tailor follow-up studies to the underlying factors that influence knowledge, attitudes and perceptions of these specific professionals within ID-LTCFs. Key messages • Developing setting and context-specific policies for infection prevention and control is crucial, particularly in long-term care facilities for people with intellectual disabilities. • Inclusive policy-making is key to combating antimicrobial resistance, and improving infection prevention and control in long-term care facilities for people with intellectual disabilities.

Climate change and its health effects - an optional subject for medical students

Abstract The Standing Committee of European Doctors urged to include training on the impact of climate change on health for health professionals. Currently, in the curriculum of most medical schools, the health-related impacts of climate change represent a peripheral part. The teaching of health effects of climate change should be made part of the training of health professionals and should be introduced in the curriculum of medical schools. ClimateMed is an Erasmus project that improves the curriculum and expands knowledge about the health effects of climate change at medical universities. The World Café method, based on round table discussions, was applied to assess the needs, summarize the proposals, and develop the necessary strategy. At the same time, a questionnaire was applied to those medical students from UMFST Targu Mureș who chose this subject as an optional subject. Students related the importance of understanding the diseases caused directly or indirectly by climate change, and reported what kind of topics should be included in a new course, in which semester/module and in what format it would be appropriate to teach it. The most frequently reported topics were: excessive heat and heat-related illnesses, extreme weather, vector-borne diseases, food safety, air pollution, and mental health. According to the goals of the project and students’ opinions, since 2023 medical students can choose Climate Change and Health Effects as an elective course. Based on the demand for medical universities to include in their curriculum knowledge related to the health effects of climate change, ClimateMed project can facilitate this integration and can promote the increase of teacher motivation and the development of methodological guidelines for university teachers. The project contributes to the preparation of some educational materials and the introduction of an optional subject in the training curriculum of the students of the Faculty of Medicine, UMFST Targu Mureș. Key messages • There must be made efforts to include training on the impact of climate change on health for health professionals, to introduce this subject in the curriculum of medical schools. • ClimateMed project can facilitate the integration of knowledge about the health effects of climate change into curriculum and can promote the practical use.

Feasibility and end-user perceptions of a novel digital care assistant and support program for people after stroke or transient ischemic attack (CAPS)

Abstract Background The Care Assistant and support Program for people after Stroke (CAPS) or transient ischaemic attack (TIA) is a clinician-led program designed to improve the secondary prevention of stroke. The program combines person-centred goal setting and risk-factor monitoring through a web-based clinician portal, SMS goal-aligned messages, a mobile application (app), and a wearable device. We aimed to determine the feasibility of CAPS among people living with stroke or TIA, and clinicians who would deliver the program in future. Methods Open label single group pre-posttest mixed-methods evaluation of the 12-week program. Eligible lived-experience participants were recruited through the Australian Stroke Clinical Registry. Eligibility: diagnosis of stroke or TIA in preceding 6 months - 3 years, ≥18 years old, smartphone/tablet ownership, living in the community. Following surveys and interviews of lived-experience participants, ten clinicians experienced in stroke care were invited to participate in focus groups to discuss the program. We used descriptive statistics to evaluate feasibility outcomes, i.e. participant perceptions of usability, acceptability and satisfaction, and clinician perceptions on program design and delivery. Results From 600 invitations, 34 eligible participants commenced the program (27% female, 33% TIA, median 1.7 years from index event; one withdrew). Usability of the CAPS app was rated as ‘Good’ to ‘Excellent’ (System Usability Scale), with moderate sustained usage by study conclusion (>60%). Participants frequently reviewed their health data within the app (average twice a day/participant over 12 weeks), and entered their health measurements an average 73 times/participant. The majority (≥90%) of participants thought the program fitted well into their daily lives or helped engage them in self-monitoring, with 76% indicating they would use the program, if publicly available. Clinician participants included three nurses, three allied health professionals, two neurologists, a stroke consultant, and a general practitioner (GP) in focus groups. Overall, eight had positive perceptions of the CAPS program. Three clinicians indicated the measurements collected in the app captured "vital information", and five saw the value of CAPS to improve secondary prevention. Recommended modifications to the program included tracking atrial fibrillation and blood cholesterol. Seven believed participants would receive the most benefit from the program if delivered within three months post-discharge. Six indicated that GP-led multidisciplinary care was the best model to deliver CAPS. Conclusions The CAPS program was feasible to deliver and acceptable to people living with stroke or TIA. Clinicians saw the value of CAPS for secondary prevention, with feedback prompting further focus groups with GPs to develop the potential model of care. Findings have informed the design of a Phase II randomised feasibility trial.

I am frail and my robot is stuck on the corridor: cohabitation of people with frailty and robots

Abstract UK and European policies promote research and innovation for people living with frailty (PLWF), as realistic strategies for independent living. Yet homes are not designed for PLWF or robots, even though robots could support PLWF with activities, i.e., exercise and companionship. Adoption of robots in homes is limited to devices such as automated vacuum cleaners and voice assistants. Robotics aimed at assisting PLWF have been thus far been tested in laboratories and the study of real homes for the co-habitation of robots and older people is often neglected. We draw on expertise from human-robot interaction, built environment, public health and clinical practice to facilitate optimisation of human and robot cohabitation for PLWF. For this, we have reviewed different robots-for-frailty, in terms of, ability to fit and move within homes. We utilised a range of methods and sources of information including meetings with allied health professionals, visited the Robot House and explored the available robots from a fit for purpose perspective, audited five flats for PLWF in Gloucester, England in accordance with the needs of those with frailty, simulated robot’s function within the home environment, using persona’s for different use case scenarios, trial testing of selected robots in the home environment for comparison with simulation, using knowledge gained to extrapolate this data to estimate suitability for frail individuals in their homes. Most robots currently available would not adequately fit in an independent living accommodation or the smaller ones could be a tripping hazard. The communal areas of independent living would be more realistic for such human robot interactions, rather than the actual households. The research informs the process facilitating the adoption of robots to benefit PLWF both feasible and desired. The research produced a framework that can lead to future research exploring robot and PLWF co-habitation in real home settings. Key messages • The cohabitation of humans and robots currently faces barriers relevant to independent living built-environment spatial restrictions. • Technologies that support independent living and frailty must develop in spatially-unobtrusive ways.

Telemedicine through social media to enhance guideline-directed revascularization in STEMI: a five-year analysis in a developing nation

Abstract Background Timely reperfusion reduces mortality in ST segment Elevation Myocardial infarction (STEMI). Telemedicine and social media have been variably used to improve STEMI care in community settings. We established a new care system for STEMI in a public health setting serving a population of over 80 million, in a state with from a developing nation. Purpose To enhance guideline directed revascularisation (GDR) in STEMI by networking non-percutaneous coronary intervention (PCI) capable hospitals to PCI capable hospitals in a hub-and-spoke model and implementing telemedicine via social media platforms (Whatsapp) over five years(2019-2023). Methods Eighteen Government medical college hospitals were identified as hubs and were provided with cardiac catheterisation laboratories and empowered to provide either round the clock (Phase I hubs) or office hour primary PCI (Phase II hubs). They were linked to 188 Taluk or District-level, non-PCI capable Government hospitals identified as spokes to form 18 STEMI clusters. Separate social media groups on WhatsApp were created for each of the clusters, facilitating the sharing of de-identified ECGs and clinical data from spokes for guidance on diagnosis and management by hub hospital cardiologists. Transfer to hub hospitals for catheter based therapies were coordinated through prior intimation in the cluster WhatsApp group to ensure timely arrival and treatment. A customised uniform protocol for STEMI management was developed and health care personnel were trained accordingly. Human resource support was provided to collect and submit cumulative daily data on the number of STEMIs, the revascularisation provided and mortality through online free web forms. Annual cumulative data on STEMI volumes and GDR were analysed. Results 71,907 STEMI patients were treated from 2019 to 2023. We observed a 67% increase in STEMIs treated per year from over five years (11,363 in 2019 to 18565 in 2023). Use of pharmaco-invasive therapy increased from 7.9% to 31.7% (Figure-1). There was a marginal increase in use of primary PCI. The count of patients without GDR decreased by 20%. There was a 6.7 fold (672 in 2019 to 4,535 in 2023) rise in patients referred from spoke to hub hospitals for catheter-based revascularization. Over five years, there was an increase in the proportion of patients receiving GDR. This increase was more evident in Phase II hubs (52% in 2019 to 87.1% in 2023). Commensurate with the increase in GDR, phase II hubs demonstrated a tangible decrease in mortality (Figure-2). Conclusion We have shown that networking of non-PCI-capable hospitals with PCI-capable hospitals in a hub and spoke model using social media groups, facilitates telemedicine, leading to improved GDR in STEMI. This innovative approach not only enhances connectivity but also contributes to more efficient and timely cardiac care in resource-constrained settings.Figure 1. Revascularisation in STEMIFigure 2.Mortality Trends in STEMI (hubs)

Telemonitoring activities of daily living in home healthcare services to support aging in place

Abstract Context Assessing older adults’ abilities to carry out their activities of daily living (ADLs) is a key determinant in the provision of homecare services for aging in place. Amidst a growing aging population and lack of human resources, continuous remote monitoring technology appears promising to support health and social care professionals (HSCPs) in identifying service needs. However, implementation studies conducted in real-life settings are lacking. This study is part of an on-going action design research project aimed at developing an ambient telemonitoring system monitoring ADLs to support clinical decision making. It focused on the initial step of implementation and aimed to understand 1) which HSCPs would want to use the system, 2) for which care recipient they requested it, and 3) for which reasons. Methods A multiple embedded case study utilizing mixed methods was conducted across 3 healthcare establishments in Quebec, Canada. Descriptive statistics from surveys and medical records was conducted to describe the profile of HSCPs and their care recipients. An inductive qualitative analysis was carried out through interviews with 23 HSCPs, in charge of 31 care recipients, to deepen our understanding of the reasons why they requested the system. Results HSCPs were primarily women (89%) occupational therapists (43%). Home care recipients were also primarily women (74%), with documented refusal of homecare services (65%), diagnosed with cognitive decline (94%), and living in a single-family home or apartment (68%). Overall, interviews revealed HSCPs challenges in getting the necessary information to assess their care recipients needs, despite the presence of in-home services and other strategies in place (e.g. informal carer support). Moreover, the telemonitoring system was perceived as promising for risk management. Conclusions There is an interest for the use of ADL telemonitoring technology in the delivery of home healthcare services for aging in place. Key messages • To facilitate its integration in practice, we explored the need for, and value of, ADLs telemonitoring technology by health and social care professionals (HSCPs) in real-life contexts. • By studying the integration of innovative technologies in home healthcare practices, such as ADLs telemonitoring, we aim to support HSCPs practice in fulfilling older adults desire to age in place.