Public Health Issue Research Articles

Prevalence of carbapenem-resistant Enterobacterales (CRE) in Saudi Arabia: A systematic review and meta-analysis

Antimicrobial resistance is a significant public health issue. In addressing the threat of multidrug resistant bacterial infections, carbapenems have been used. The carbapenem-resistant Enterobacterales (CRE) are, however, rapidly expanding worldwide. Since the issue of CRE is also a problem in Saudi Arabia, the current meta-analysis was performed to comprehensively evaluate the resistance rates to the main carbapenem antibiotics and determine the actual prevalence of CRE in the country. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed. Different web databases including PubMed, Scopus, Web of Science, and ScienceDirect were searched for relevant records. Data were extracted, and summary estimates for resistance to carbapenems were calculated using DerSimonian-Laird method of meta-analysis and the random-effects model. From a total of 787 retrieved records, 69 studies were found fully eligible and were included in the final analyses. More than 50 % of all the studies were conducted after 2010, and the most frequently examined members of the Enterobacterales were Escherichia coli and Klebsiella pneumoniae. The pooled prevalence estimate for imipenem resistance was 6.6 % (95 % CI: 4.7–9.2), 9.1 % (95 % CI: 6.7–12.3) for meropenem, and 18.6 % (95 % CI: 11.9–27.9) for ertapenem. High heterogeneity (I2 > 97 %, p < 0.001) was observed for all the estimates. Compared to other regions of the country, there was higher resistance rates in the Al-Qassim and Al-Jouf provinces. Additionally, resistance to ertapenem was as high as 34.2 % in the most recent study period (2021–2024). Proteus spp was the most prevalent CRE (26.2 %). This review highlights an increasing rate of carbapenem resistance among Enterobacterales, emphasizing the need for collaborative efforts to implement strict infection control and prevention measures. Consistent surveillance is indispensable for safeguarding public health, guiding clinical decisions, and strengthening efforts to tackle the challenges of antibiotic resistance.

Advanced Therapeutic Medicinal Products in Bone and Cartilage Defects.

The number of patients with functional loss of bone and cartilage tissue has shown an increasing trend. Insufficient or inappropriate conventional treatments applied for trauma, orthopedic diseases, or other bone and cartilage-related disorders can lead to bone and cartilage damage. This represents a worldwide public health issue and a significant economic burden. Advanced therapeutic medicinal products (ATMPs) proposed promising alternative therapeutic modalities by application of cell-based and tissue engineering approaches. Recently, several ATMPs have been developed to promote bone and cartilage tissue regeneration. Fifteen ATMPs, two related to bone and 13 related to cartilage, have received regulatory approval and marketing authorization. However, four ATMPs were withdrawn from the market for various reasons. However, ATMPs that are still on the market have demonstrated positive results, their broad application faced limitations. The development and standardization of methodologies will be a major challenge in the coming decades. Currently, the number of ATMPs in clinical trials using mesenchymal stromal cells or chondrocytes indicates a growing recognition that current ATMPs can be improved. Research on bone and cartilage tissue regeneration continues to expand. Cell-based therapies are likely to be clinically supported by the new ATMPs, innovative fabrication processes, and enhanced surgical approaches. In this study, we highlighted the available ATMPs that have been used in bone and cartilage defects and discussed their advantages and disadvantages in clinical applications.

CASE REPORT: GIANT HYDATID CYST OF THE LIVER IN A YOUNG PATIENT: SURGICAL MANAGEMENT AND LONG-TERM FOLLOW-UP

Hydatid disease, caused by the parasite Echinococcus granulosus, remains a significant public health issue in endemic areas, especially in rural settings. This report presents the case of an 18-year-old female patient residing in a rural area, with no significant medical history, who developed a symptomatic hepatic hydatid cyst. The patient was treated surgically without preoperative antiparasitic therapy and was placed on postoperative albendazole. The case highlights the importance of timely surgical intervention and long-term follow-up to prevent recurrence.

Rural-urban differentials in undernutrition among women in India: Evidence from a decomposition approach.

Background: Global healthcare and nutrition policies have not eliminated the pressing public health issue of undernutrition, which remains a paramount public health concern in countries like India, coinciding with overweight and obesity, in the form of dual burden of malnutrition. Aim: This study delves into the rural-urban differential in undernutrition among reproductive-aged women in India for targeted policy interventions and to achieve universal health coverage. Methods: Data from the recent iteration of the National Family Health Survey (NFHS-5; 2019-21) were utilized to examine the factors influencing rural-urban differentials in women's undernutrition. A set of logistic regression and Fairlie's decomposition analysis are employed to identify the associated covariates and understand the factors driving these differentials. Results: The analysis reveals that rural women are significantly more vulnerable to undernutrition compared to urban counterparts, with factors such as education, wealth status, age, and dietary diversity playing key roles. The decomposition analysis of the rural-urban gap revealed that the variables considered in the study accounted for approximately 75% of the disparity. The difference in household wealth between rural and urban areas contributed about 63% of the explained gap, followed by educational status (16%), age group (11%), dietary diversity (8%), religion (5%), and media exposure (4%). Conclusion: The findings underscore the importance of targeted interventions addressing socio-economic inequalities to mitigate undernutrition among women in India. Enhancing access to education, improving economic opportunities, promoting dietary diversity, and challenging cultural norms are crucial steps towards achieving equitable nutritional outcomes and reducing the existing rural-urban disparity.

How can we support the development of health literacy in young people?

Abstract Over the past two decades, there has been an increased interest in Health literacy (HL) to improve health behaviours and health outcomes. Due to its potential impact, HL is considered one of the major issues in public health and is increasingly being recognised in recent policies and initiatives. Although, the research justifying the importance of HL continues to grow, there is a lack of research focusing on strategies to improve HL and challenges that are faced when supporting HL, particularly in young people. Thus, this study aimed to explore, from the point of view of international academics and community-based practitioners, (i) key considerations when supporting young people’s HL; (ii) major challenges to supporting young people’s HL; and (iii) possible solutions to overcome such challenges. A stakeholder mapping exercise was used to recruit academic and community-based practitioners to take part of in a one-to-one interview (n = 29). Reflexive thematic analysis was used to analyse the data. The preliminary findings suggest that: the participants feel the use of participatory approaches is essential when designing a HL-focused program; the importance of embedding HL education and awareness into schools; the value in using interactive style learning; and the importance of targeting those ‘hardly reached’ populations. The participants highlighted that accessibility to schools; difficulty in engaging young people; and ensuring programs are sustainable as major challenges. Solutions to overcome which challenges were posited, including professional development for teachers; the development of engaging and context specific programs that target the young person’s physical and social environment; and importance of influencing national policies to value HL. These findings can be used to inform interventions and policies to target the HL of young people. Key messages • The importance of adopting participatory approaches when developing health literacy interventions. • The importance of developing feasible, context specific and engaging health literacy curricula within schools.

Cross-cultural adaptation and validation of the Chinese version of the Trauma Resiliency Scale (tRS-18)

BackgroundTrauma is a prevalent issue in public health, where individuals who experience physical injuries are also at risk of compromised mental health. Psychological resilience is considered a positive indicator that can predict the prognosis of trauma patients throughout their traumatic experiences. Currently, there is a lack of tools in China for measuring the psychological resilience of trauma patients. The aim of this study was to translate and cross-culturally adapt the Trauma Resiliency Scale (tRS-18) into Chinese and to test its reliability and validity in China.MethodsThe Trauma Resiliency Scale (tRS-18) was translated into a Chinese version suitable for the Chinese language environment using the Brislin translation model. A convenience sampling method was used to select 588 trauma patients as study subjects. Reliability was assessed using Cronbach’s alpha coefficient, 14-day test-retest reliability, and split-half reliability. Validity was examined through the content validity index, structural validity, and convergent validity. Structural validity was specifically evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).ResultsThe total variance explained by the single-factor model in the exploratory factor analysis (EFA) of the Chinese version of the tRS-18 was 62.048%, and the factor loading of each item exceeded 0.4. The results of the CFA indicated that the model demonstrated a favorable fit index (X2/df = 1.620; RMSEA = 0.046; SRMR = 0.026; NFI = 0.945; CFI = 0.978; GFI = 0.927; TLI = 0.975; IFI = 0.978). The Cronbach’s alpha coefficient of the reliability index was 0.963, the test-retest reliability was 0.970, and the split-half reliability was 0.964, which were all within the reference value range.ConclusionThe Chinese version of the tRS-18 has good validity and reliability and can be used as an assessment tool for trauma resilience in trauma patients.

6.F. Scientific session: Understanding the impact of climate change on health: the latest reports from EEA and NPHIs

Abstract Climate change poses a significant threat to human life and wellbeing worldwide. Extreme weather events like heatwaves, storms or floods can have adverse impacts on health, as can many other factors influenced by climate change, such as allergens, UV radiation and vector-borne diseases. In order to support the action needed to protect and promote health and wellbeing, many National Public Health Institutes (NPHIs) aim to keep relevant stakeholders informed on the scientific evidence of the impacts of climate change on health. Reports that synthesise the evidence can help in the development of suitable and health-relevant climate change adaptation and mitigation measures. In this workshop, European Environment Agency assessments on climate and health are presented, including the European Climate Risk Assessment Report and recent outputs of the European Climate and Health Observatory. Next, three NPHIs introduce their recent national reports on the impact of climate change on health, sharing lessons learned and valuable insights into their content, process and reception, highlighting similarities and differences. The workshop will feature presentations by NPHIs from the United Kingdom (UK Health Security Agency), Germany (Robert Koch Institute), and the Netherlands (National Institute for Public Health and the Environment) as well as the European Climate and Health Observatory. The perspective of the European Climate and Health Observatory offers Europe-wide insights as a provider of tools and knowledge that support actions from NPHIs and other health actors. Our aim is to highlight the value of such reports, and inform and inspire NPHIs and other stakeholders that may be considering the publication of similar reports. The format of the workshop will be informative and interactive, with opportunity for Q&amp;A, discussion, and engagement with the audience. By showcasing the recent reports, the workshop aims to increase awareness of climate change as a public health issue and establish NPHIs as key climate actors. Furthermore, it aims to highlight the importance of having a national, up-to-date evidence base to drive climate measures and enhance resilience. Key messages • National evidence-based reports on climate change and health are a useful tool for informing health-relevant climate change adaptation and mitigation measures. • Through the public health functions of surveillance, monitoring, responding and evaluating, NPHIs play a crucial role in collating and assessing the evidence on the health effects of climate change.

Implications of Big Data Analytics, AI, Machine Learning, and Deep Learning in the Health Care System of Bangladesh: Scoping Review.

The rapid advancement of digital technologies, particularly in big data analytics (BDA), artificial intelligence (AI), machine learning (ML), and deep learning (DL), is reshaping the global health care system, including in Bangladesh. The increased adoption of these technologies in health care delivery within Bangladesh has sparked their integration into health care and public health research, resulting in a noticeable surge in related studies. However, a critical gap exists, as there is a lack of comprehensive evidence regarding the research landscape; regulatory challenges; use cases; and the application and adoption of BDA, AI, ML, and DL in the health care system of Bangladesh. This gap impedes the attainment of optimal results. As Bangladesh is a leading implementer of digital technologies, bridging this gap is urgent for the effective use of these advancing technologies. This scoping review aims to collate (1) the existing research in Bangladesh's health care system, using the aforementioned technologies and synthesizing their findings, and (2) the limitations faced by researchers in integrating the aforementioned technologies into health care research. MEDLINE (via PubMed), IEEE Xplore, Scopus, and Embase databases were searched to identify published research articles between January 1, 2000, and September 10, 2023, meeting the following inclusion criteria: (1) any study using any of the BDA, AI, ML, and DL technologies and health care and public health datasets for predicting health issues and forecasting any kind of outbreak; (2) studies primarily focusing on health care and public health issues in Bangladesh; and (3) original research articles published in peer-reviewed journals and conference proceedings written in English. With the initial search, we identified 1653 studies. Following the inclusion and exclusion criteria and full-text review, 4.66% (77/1653) of the articles were finally included in this review. There was a substantial increase in studies over the last 5 years (2017-2023). Among the 77 studies, the majority (n=65, 84%) used ML models. A smaller proportion of studies incorporated AI (4/77, 5%), DL (7/77, 9%), and BDA (1/77, 1%) technologies. Among the reviewed articles, 52% (40/77) relied on primary data, while the remaining 48% (37/77) used secondary data. The primary research areas of focus were infectious diseases (15/77, 19%), noncommunicable diseases (23/77, 30%), child health (11/77, 14%), and mental health (9/77, 12%). This scoping review highlights remarkable progress in leveraging BDA, AI, ML, and DL within Bangladesh's health care system. The observed surge in studies over the last 5 years underscores the increasing significance of AI and related technologies in health care research. Notably, most (65/77, 84%) studies focused on ML models, unveiling opportunities for advancements in predictive modeling. This review encapsulates the current state of technological integration and propels us into a promising era for the future of digital Bangladesh.

Contributing to healthier populations by reducing energy poverty via innovative financial models

Abstract Issue/problem Energy poverty is a major challenge affecting 9.3% of the EU population (EUROSTAT 2022). Health problems attributable to energy poverty include respiratory diseases, heart attacks, stroke, and mental disorders. Governments must act quickly and intervene with policies and programmes that reduce energy poverty and promote citizens' health and well-being. Description of the problem We propose Social Impact Bonds (SIBs), a new family of instruments that address serious social challenges, to finance interventions targeting energy poverty,improving the health and well-being of households in a context of limited public resources. For this purpose, data from interventions to increase energy efficiency and combat energy poverty implemented during one year in 6 pilot sites in the framework of the EU project WELLBASED are used. First, a compliance check will be carried out, followed by an estimation of the costs, savings, and benefits of the application of SIBs to finance energy poverty reduction interventions with an impact on health. Results The results of the analysis will show whether the intervention to reduce energy poverty meets the necessary characteristics for a SIB to be implemented. In addition, the possible key actors that could lead its implementation are identified. Lessons If the interventions for the reduction of energy poverty carried out under the WELLBASED project are successful, SIBs could be considered as a valuable alternative to finance interventions that combat energy poverty and increase the well-being of citizens. Key knowledge on how to apply SIBs makers to tackle a serious social issue with important consequences on health will be at disposal of (EU and worldwide) local authorities and policy. Key messages • Energy poverty is a public health issue, requiring urgent support measures. • SIBs fund interventions via public-private collaboration to fight energy poverty and boost citizen wellbeing.

Consumption and expenditure of antidepressants and anxiolitycs in 14 European countries

Abstract Background Since the burden of depressive and anxiety disorders, assessing the use and spending of drugs commonly prescribed for treating such conditions is a valuable barometer of mental health assistance and healthcare services. The current research aims to evaluate the consumption of antidepressants and anxiolytics and the relative expenditure among 14 European countries (Austria, Czech Republic, Finland, Germany, Hungary, Italy, Latvia, Luxembourg, Norway, Portugal, Slovak Republic, Slovenia, Spain and Sweden). Methods A retrospective longitudinal study was assessed based on pooled time series analysis of secondary data over ten years (2012-2021). Defined Daily Doses (DDD) per 1,000 inhabitants and health expenditure per capita (current US$, computed on purchasing power parity) were considered. Linear and quadratic trends were calculated for defining relationships between the variables of interest. Results Prevailing patterns of consumption and spending show an increase in antidepressants and a decrease in anxiolytics. Noteworthy is the growth slope of antidepressant consumption in three selected countries, Portugal, Spain, and Sweden, by over two and a half times from 2012 to 2021. In addition, for a few countries, there is a pattern contrary to most countries for anxiolytics (Latvia, Spain) and discordant between consumption and expenditure for antidepressants (Austria, Hungary). Conclusions The widespread growth of antidepressant use deserves attention. As a public health issue, the prescription and use of antidepressants should be addressed by targeted policies for integrating multifaceted strategies. Key messages • Monitoring consumption and expenditure of antidepressant and anxiolytic drugs represents a valid tool for assessing the efficacy and availability of mental healthcare services among the population. • The growth in the consumption of antidepressants represents a relevant public health issue and deserves attention for the evaluation of an integrated approach of assistance.

4.K. Scientific session: The realm of the information ecosystem and its public health impact

Abstract Workshop background As a field of science, study, practice, and policy, infodemic management has emerged during the Covid-19 pandemic but has since been emancipated and can be translated to any topic where information ecosystems play a vital role. In particular relevant to public health, infodemic managers have grown in the ranks of institutes of public health, academic institutions, UN agencies and civil society organizations, tackling outbreaks and public health issues as wide as mpox, Marburg, teen mental health, chronic diseases, seasonal influenza, Ebola and routine immunization. Aiming at improving public health strategies, they are responsible for exploring and investigating personal and organizational (health) information ecosystem, generating evidence, identifying patterns of communication and information flow, tackling the onset and distribution of circulating mis- and disinformation, better understanding information voids, and respond to citizen needs concerning information demands around emergencies. In this workshop, we will focus on several common challenges associated with implementing whole-of-society interventions and strategies for resilience to health misinformation. Solving these challenges, which often are too big just for the health system to solve, will sometimes require creativity, out-of-the-box thinking as well as cross-disciplinary perspectives and new partnerships. Infodemics are also a global challenge that can easily cross borders, which is why country-to-country discussions of experiences by participants is encouraged-while no previous infodemic management experience is required. Workshop objectives The workshop will be organized as a research symposium with five speakers from infodemic management, health information, and health literacy. They will provide a solid introduction to infodemic management from different perspectives and angles. (i) The first presentation will introduce a study on health information seeking and health literacy in midwife-led care and the modern information environment. (ii) The second presentation will discuss how fact-checking organizations can partner within public health for a healthier internet. (iii) The third presentation will focus on unravelling misinformation by investigating the associations between health literacy and resilience. (iv) The fourth presentation will present a novel web-platform for credible health information and tackling misinformation. (v) The fifth presentation focuses on the impact of misinformation on social media in the context of natural disasters. The format of this workshop will be 5x8-minute presentations, including Q&amp;A with the audiences, followed by a 20-minute panel discussion, reflecting the relevance of the results to public health research, practice and policy. Key messages • Infodemic management seeks to quickly understand the public’s information and health needs improve future public health responses, especially during emergencies. • Whole-of-society approaches are needed to address and mitigate harms caused by infodemics by developing closer partnerships and understanding between health systems and the public.

Communication of EU agricultural antibiotic use policies to farmers &amp; implications for public health

Abstract Background It is estimated that by 2050, ten million people will die each year from antimicrobial resistant infections. AMR is driven by the improper use of antimicrobials, particularly in agriculture. 73% of the antimicrobials sold globally are used in food-producing animals. Problem EU regulations 2019/6 and 2019/4 on veterinary medications and medicated feed require behavior change by farmers to reduce their antimicrobial use. While this is welcomed by public health professionals, the response of the farming community is more complicated, as these regulations exist within the complex context of the global food system and current political unrest between farmers and the EU. Given the influential role of agricultural media for farmers’ decision making, it is critical to understand how AMR and associated public health and EU policies are being communicated to farmers and how the views of specific stakeholders including farmer representative organizations, veterinary bodies and government regulators are being represented. To examine this problem, a case study content analysis of three major agricultural newspapers in Ireland is undertaken. Results Preliminary results suggest that AMR and AMU have been covered in the agricultural media with specific coverage on these EU policies. This includes negative coverage, with key terms such as “threatens”, “risk”, or “warns”, as well as potentially positive views (e.g. “hope”). Preliminary results also suggest that the agricultural media might be a useful source to identify the farming community’s concerns and reactions to EU policy, for example calls by farmer representative bodies for the national government to intervene. Lessons Public health professionals must recognize the important role of farmers in addressing AMR. Evaluating how EU policies on AMR are represented in the agricultural media can help to better understand how this public health issue and its solutions are being communicated to these important stakeholders. Key messages • Public health professionals must recognize the importance of animal health and the role of farmers in addressing the AMR problem. • It is critical to evaluate how EU policies on AMR and associated One Health issues are communicated to non-public health professionals.

What do we know about femicide in Italy? Data and insights from a repeated cross-sectional study

Abstract Background Gender-based violence represents a huge public health issue, affecting mental, physical health and productivity. It is a significant obstacle to achieving gender equality and the empowerment of all women. While the overall homicide rate is decreasing in Italy, femicide, the intentional killing of women due to gender-related motivations, remains stable over time. This is the first study in Italy to evaluate potential risk factors of femicide, exploring the sociodemographic characteristics of victims and perpetrators of femicides, as well as the geographic distribution across Italy, with insights into differences between the size of municipalities and between geographic areas. Methods A repeated cross-sectional study was conducted to investigate femicides in Italy from 2020 to 2023 using data sources from Non Una Di Meno, an Italian NGO, and the Italian National Institute of Statistics. Results Our preliminary findings show that the majority (83%) of homicides of women were femicides. On a final sample of 403 femicides, in most cases (94,3%) the victims were more likely to be hit by their current or former partner or by a family member. In 97% of cases perpetrator was a man. In more than 50% of cases, both the victims and the perpetrators were under 55 years old (respectively, 51,8% and 57,9%). Femicide rates was 0.33 per 100,000 women. There appear to be no significant differences between the rates of femicide as the size of the municipality and the geographic macro-area vary, highlighting the extensive spread of the phenomenon throughout the territory. Conclusions Our findings show that femicide is a systematic and widespread phenomenon that occurs mostly within the home and needs interventions at the European level to prevent systemic violence against women. Moreover, this study provides methodological considerations to define femicide, suggests improvements to data collection methods and offer insights for future research in this field. Key messages • It is important to gather robust data on gender-based homicide, as it represents a public health issue. • Femicide is a pervasive and systematic phenomenon that predominantly occurs within the home and requires intervention at the European level.

Developing new methods for patient care pathway assessment for breast cancer patients in Hungary

Abstract Issue The idea of progressive healthcare models is to treat patients preferably in one location as close to their homes as possible. This contradicts the demands of efficiency: to centralise the availability of expensive procedures and highly specialised staff. Healthcare systems need to navigate between these challenges, especially in public health issues such as cancer care. Description of the problem Achieving the best possible health outcomes requires evidence-based policies that find balance between the demands of accessibility and efficiency. Therefore, we aimed to set up a methodology to review the healthcare model and assess patient movements across the system. We analysed the roaming paths of breast cancer patients diagnosed in Hungary in 2017. Inter-hospital roaming was represented as a graph: hospitals were the nodes, patient movements from one hospital to another were directed edges. This allowed us to apply network analysis: modularisation, weighted degrees calculation, etc. We then introduced the measure of terminality. A hospital is terminal in a given pathway if it is the last new one, i.e. all hospitals visited later had already been visited before. Terminality is defined as the proportion of terminal events among all pathways that cross a given hospital. The rationale of this is that the last hospital in cancer pathways is usually not the highest level one: after advanced treatments, patients are often referred back to local hospitals. Results Testing the method on Hungarian breast cancer patients we observed that results fit our prior expectations. The official ranking of hospitals on the progressivity scale (reflecting the availability of advanced treatments) shows sufficient agreement with terminality. Minor differences may point to situations where the healthcare system does not work fully according to regulations. Lessons Our methodology is recommended for system level patient pathway analysis in order to develop evidence-based healthcare policies. Key messages • Graph representation of inter-hospital patient roaming supports evidence-based policy developments for more efficient patient pathways in cancer care, regardless of the healthcare system design. • The applied new network analysis methodology can help assessing the real life processes of cancer care in a healthcare system through identifying the specifics of inter-hospital patient movements.

Intention to use HIV pre-exposure prophylaxis (PrEP) in health sciences students

Abstract Introduction HIV is a public health issue, and as such, there are currently programs for the use of pre-exposure prophylaxis for HIV (PrEP) in various public institutions, with family physicians being one of the pillars to provide information and raise awareness among individuals at risk for HIV who wish to use these strategies. Objectives To determine the factors associated with the intention to use PrEP among university students in the healthcare field in the Veracruz-Boca del Río region. Methods A cross-sectional, prospective, and analytical study was conducted from August 2023 to March 2024, including students from healthcare-related majors at universities in the Veracruz region. An instrument was used to assess the level of knowledge about PrEP (Cronbach’s alpha of 0.8), with scores ranging from 0 to 10. Students were invited to participate in this research at different faculties of health sciences. Results 508 subjects participated, with 299 (58.9%) females and 386 (76.0%) heterosexual; 65.9% had never heard the term ‘PrEP,’ and 12% learned it from social media. The intention to use PrEP was positive in 81.5% of subjects in case of becoming a high-risk person for acquiring HIV. The level of knowledge about PrEP showed a score of 2.2 (SD ± 2.6), with 3.7% having high knowledge, 10.2% having a passing grade, and 55.9% scoring above the median (1.4) of the group’s scores. No association was identified between gender identity, sexual orientation, academic characteristics, and sources of information with the intention to use PrEP (p &amp;gt; 0.05). Knowledge level above the median of 6 points showed an odds ratio of 2.95 (95% CI 1.03-8.3) for the intention to use PrEP (p &amp;lt; 0.05). Conclusions The level of knowledge increases the probability of the intention to use PrEP in young people, making it essential for the primary care physician to carry out this training and awareness activity within their daily interactions with young patients. Key messages • It is essential to generate education programs on Prep for the population, as this will favor informed decision making on the use of these medicines in case they are required. • It is necessary to provide people with general information about Prep, since despite the existence of active programs for its distribution, most people have never heard anything about this drug scheme.

A Good Practice for Learning with Public Health Professionals Globally: Humphrey Fellowship Program

Abstract Background International collaborations are valuable yet often undervalued assets that enhance the quality of public health education and bolster the development of the public health workforce. Objectives The Humphrey Fellowship Program, part of the Fulbright Exchange Program, facilitates mid-career professionals’ visits to US-based host universities for an academic year. Fellows engage in a semi-structured fellowship period to achieve self-defined goals, emphasizing professional development, expanded experience, and intercultural exchange. This study advocates for the program’s contribution to enhancing public health education. Results Currently, two universities host fellows in public health. Over decades, fellows have engaged with faculty and professionals, participated in classes and meetings, visited institutions for development purposes, and completed US-based affiliations, contributing significantly to their own and the public health workforce’s advancement. This interaction-based learning approach aids in navigating social and ethical challenges by fostering a deeper understanding of public and global health issues across countries. Conclusions The Humphrey Fellowship Program in public health stands as a commendable model. Similar initiatives could be beneficially replicated in the European region, leveraging local and global successes to strengthen ties with public health education institutions, student communities, and beyond. Key messages • Programs that facilitate international interactions can enhance public health professionals’ understanding of global perspectives. • The Humphrey Fellowship Program in the US stands as a commendable practice for mid-career public health professionals, contributing significant value to the education at host universities.

Public Health In Conflict And War: A Response To An Ever Evolving Landscape

Abstract Background The bases for this proposal are the current and ongoing conflict and war situations around the world, causing turmoil for nations and hardship and public health crises for people. We can no longer ignore the critical and time-sensitive need to address issues of Public Health (PH) in conflict and war in our education and training programmes. Objectives To consider appropriate themes and topics in Conflict and War that should be included in PH education and training programmes; and to consider how and where they are best represented. Member schools of the Association of Schools of PH in the European Region (ASPHER) were asked to provide details of their curricula relating PH in Conflict and War. Submissions on this topic were received from over 10 schools. Information was collated into logical themes, to which elements of the curriculum were mapped. In a modified Delphi process, respondents were asked for their level of agreement for inclusion in a curriculum and at what level content should be delivered. Results Findings from the survey allowed identification of seven main themes from topics provided: Contextual Factors; Preventive Strategies; Emergency Preparedness; Impact and Response; Conflict Resolution and Solidarity, Rehabilitation and Recovery. Respondents had high levels of agreement that content should be included in curricula and be delivered at every level in PH education and training. Conclusions PH education and training have been deficient in not including PH in Conflict and War as a subject area in programmes. The knowledge and expertise developed of necessity in some places can be shared across the ASPHER network and beyond to increase awareness of the PH considerations of conflict and war. Key messages • Public health in war and conflict zones is critical due to unique challenges and urgent needs of affected populations. • An Integrated curriculum is vital for addressing conflict’s long-term health impact and preparing skilled workforce for health, resilience, action and laying the path to peace.

Co-creation in public health: innovations and considerations

Abstract Danielle will delve into the essence of co-creation and its application in navigating the complexities of public health challenges. Delegates will gain insights into how co-creation fosters innovative solutions and discover key considerations essential when designing co-creation projects. Join us to explore the transformative potential of co-creation in addressing the pressing issues of public health.

Connecting Past to Present: Does Historical Redlining Affect Current Life Expectancy?

Previous research has documented a strong relationship between currently living in the redlined zones of the 1930s and suffering from a higher prevalence of disease. However, little is known about the relationship between historical redlining, modern-day redlining, and current resident health outcomes. This paper aimed to simultaneously model the associations between both historical redlining and modern-day redlining on current health outcomes. In this paper, we used structural equation modeling to uncover relationships between current and historical redlining practices and modern-day life expectancy, exploring two levels of potential mediating factors: (1) racial segregation and structural racism; and (2) mediating health outcomes. We analyzed data from 11,661 census tracts throughout the United States using historical redlining data from 1940, modern redlining data from 2010 to 2017, racial segregation and structural racism indices from 2010 to 2019, health outcome data from 2021 to 2022, and life expectancy data from 2010 to 2015. Historical redlining was measured using Home Owners' Loan Corporation (HOLC) ratings, which ranged from 1.0 for favorable neighborhoods ("greenlined") to 4.0 for unfavorable ("redlined") neighborhoods. Modern-day redlining was measured using Home Mortgage Disclosure Act (HMDA) data, which were transformed into four quartiles, ranging from level 1 (low mortgage rejection rates) to level 4 (high mortgage rejection rates). We found a significant relationship between historic redlining and current life expectancy, with average life expectancy decreasing steadily from 80.7 years in HOLC 1 tracts to 75.7 years in HOLC 4 tracts, a differential of 5.0 years between the greenlined and redlined tracts. We also found a significant relationship between modern-day redlining and current life expectancy, with average life expectancy decreasing steadily from 79.9 years in HMDA 1 tracts to 73.5 years in HMDA 4 tracts, a differential of 6.4 years. In the structural equation model, historical redlining had a total effect of decreasing life expectancy by 1.18 years for each increase of one in the HOLC rating. Modern-day redlining had a total effect of decreasing life expectancy by 1.89 years for each increase of one in the HMDA quartile. This paper provides new evidence that the legacy of redlining is not relegated to the history books but rather is a present and pressing public health issue today.

Effects of aerobic exercise on executive function among overweight and obese children: a systematic review and meta-analysis

ObjectiveOverweight and obesity are serious public health issues worldwide and significantly impair children’s executive function (EF). However, there is no consensus regarding the benefits of aerobic exercise, on the EF of overweight and obese children. This study systematically evaluated the intervention effects of aerobic exercise on EF and its subcomponents (inhibitory control, working memory, and cognitive flexibility) in overweight and obese children.MethodsWe searched six databases—PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, and China National Knowledge Infrastructure—until March 17, 2024 for randomized controlled trials examining the effects of aerobic exercise on the EF of overweight and obese children the Cochrane Risk of Bias Assessment Tool. Following heterogeneity testing, RevMan 5.4 and Stata 17.0 were used for meta-analysis and subgroup analysis of the three indicators. The standardized mean difference (SMD) and 95% confidence intervals (CI) were used as statistical measures for effect analysis with the SMD value as the effect size and a p-value of ≤0.05 indicating statistical significance.ResultsEighteen studies involving 1,260 participants were included. Aerobic exercise significantly improved overall EF (SMD = −0.50, 95% CI [−0.68, −0.32], p &amp;lt; 0.01) with a moderate to high positive effect on inhibitory control (SMD = −0.52, 95% CI [−0.72, −0.31], p &amp;lt; 0.01) and working memory (SMD = −0.63, 95% CI [−1.06, −0.20], p &amp;lt; 0.01) but not on cognitive flexibility (SMD = −0.32, 95% CI [−0.71, 0.07], p = 0.11). These results suggest that EF in overweight and obese children is influenced by factors such as exercise characteristics and body mass index (BMI). Subgroup analysis revealed a significant moderating effect of exercise type, exercise intensity, session time, and individual BMI on EF.ConclusionAerobic exercise selectively improved EF in overweight and obese children. Subgroup analysis indicated that cognitive engagement in ball game interventions of at least moderate intensity and a single session of 25–40 min are more beneficial for improving EF in overweight and obese children. Extremely obese children (BMI &amp;gt; 25 kg/m2) do not benefit from the intervention, highlighting the need for a specific focus on intervention outcomes in future studies.