Ministry Of Health Research Articles

Sexual health education in Italian schools: preliminary results of EduForIST3 national project

Abstract Background School-based comprehensive sexuality education (CSE) is the best approach to disseminate scientific evidence and promote healthier sexual behaviours among young people. However, in Italy, CSE is not included in schools curricula. This study, funded by the Ministry of Health, seeks to investigate information uptake and attitudes towards sexuality among adolescents included in a pilot CSE intervention in 6 Italian regions, from December 2023 to June 2024. Methods A 10-hours education intervention was implemented in a convenient sample of 26 upper and lower secondary schools (U/LSS), covering topics such as changes in adolescence, relationships and consent, sexual identity, sexually transmitted infections (STIs), contraception and sexual health services. Students’ evaluation comprised pre/post tests assessing knowledge, attitudes towards sexuality and satisfaction. A Solomon 4-group design study was used to compare intervention and control classes. A follow-up test will be conducted 4-6 months post-intervention. Results Preliminary analysis of available data as of 30 April, 510 pre-tests and 266 post-tests, showed incremented correct answers in all items. A significant increase (p<.05) was found in 12/21 items for USS and in 9/19 items for LSS, especially in the domain STIs symptoms and prevention, among those mostly appreciated. Over 90% of students considered schools as suitable setting to receive CSE, preferably by external experts. Ongoing qualitative and long-term analysis will provide further insights of the overall impact of the activity. Conclusions The pilot CSE intervention increased the knowledge and attitudes of the students involved. Additional insights will be available after study completion. Findings from this study will contribute to evaluate the effects of CSE initiatives on sexual health knowledge and attitudes among Italian secondary schools students, as well as the effectiveness of such programs in fostering healthier behaviours. Key messages • Providing evidence-based, relevant information and education on sexual health to young people in secondary schools increases their knowledge and improves attitudes towards sexuality. • CSE should be included in Italian school curricula in order to promote an incremental uptake of information and to improve young people’s sexual health.

Public Health Challenges for 2050 in the Netherlands

Abstract Every 4 years, the National Institute for Public Health and the Environment (RIVM) carries out the Dutch Public Health Foresight Study, commissioned by the Ministry of Health. The ninth edition (PHFS-2024) compiles an outlook on future public health and the health care system in the Netherlands. It combines a business-as-usual Trend Scenario with literature study and a range of qualitative and mixed-methods approaches. The Trend Scenario comprises projections up to 2050 for a broad range of epidemiological indicators. Such as (healthy) life expectancy, disease burden, life style factors. The qualitative and mixed methods approaches supported an incremental intersubjective process. Methods were a focus groups study, stakeholder sessions and workshops. An important innovation in this study was the Citizen Council and Panel. The outcomes show that demographic development, in particular growth of the group people at high age with multimorbidity, will lead to high pressure on the formal and informal health care system but also on e.g. mental health. A life course approach applied shows that decreasing mental health of youth will have long term consequences. Also, overweight will deeply impact older people’s health in the future. Lastly, climate change in combination with e.g. energy transition will deeply affect our society and living environment. Next to these challenges, there will also be opportunities to improve health. Building a climate-proof living environment that also stimulates healthy life styles and social interaction is one of them. However, improving health has linkages with policy areas outside the traditional public health domain as well and requires, firstly, a Health in/for All Policies approach. Secondly a whole-of-society approach in which companies and civil organizations take action is needed. All these efforts can only be effective if people and communities are put at the core of all health policies.

Monitoring the digital healthcare transition in Italy: Initiatives, metrics and feedback from Primary Care Physicians

Abstract Italy’s healthcare sector has undergone significant digital transformation since 2008, driven by national strategies and reforms overseen by the Ministry of Health, the Ministry of Economy and Finance, and the Agency for Digital Italy. Key initiatives include the establishment of centralized booking systems, electronic health records (EHR), ePrescription, dematerialization of medical reports and disease certificates, patient summary, and telemedicine services. Despite regional variations, progress in the EHR adoption has been notable. Ongoing investments under the 2021 National Recovery Plan aim to further enhance digital healthcare infrastructure by 2025 through the involvement of the Italian National Agency for Regional Healthcare Services (AGENAS). Currently, Italy monitors progress through comprehensive measurement frameworks tracking digital health initiatives’ implementation and impact. These encompass indicators reported quarterly by public healthcare facilities regarding the implementation of patient portals, regional registries, network infrastructure, regional EHR systems (i.e., n° of users), and digital laboratory reports. In parallel, we conducted a cross-sectional survey assessing knowledge, opinions and concerns among primary care physicians (PCPs) following the 2022 reform, which introduced Community Hospitals, Community Houses, and telemedicine in primary care. The survey highlighted mixed opinions and insufficient knowledge among PCPs regarding the novelties. Clearer communication and coordination with territorial services appears necessary. Many GPs are engaging in telemedicine, but digital literacy gaps remain, as only 35.7% believed they had necessary digital literacy. This is an insight into Italy’s digital health roadmap, mainly involving primary care and focusing on achievements, challenges, and future prospects in utilizing digital solutions across healthcare settings.

Envisioning telemedicine in the EU health systems: Insights from policy experts and cancer patients

Abstract Background Conducted as part of WP4 (Sustainability) of the eCAN Joint Action, the aim of this foresight exercise was to understand how telemedicine services in EU-Member States (MS) could be implemented in a patient-centric way to tackle cancer. Methods Based on a literature review, we identified factors that impact on the implementation of telemedicine in EU MS; these were integrated to an online survey. Health policy experts were invited to rank 34 factors using a 7-point Likert scale to better understand the barriers and facilitators of telemedicine services at the health system level, whilst patient associations ranked 28 other factors to capture end-users’ view. Next, survey respondents were invited to a foresight workshop to collect qualitative data and gain a forward-looking perspective. Results 20 health policy experts working in digital health across 14 EU MS, predominantly from Ministries of Health, and 8 cancer patient associations from 5 EU MS responded to the surveys. For a sustainable integration of telemedicine services in the EU, policy experts recommend developing a clear legal framework, embracing a hybrid healthcare model, and enhancing digital literacy. They stress the importance of telemedicine as a complementary tool, advocating for solid IT infrastructure, privacy safeguards, and the integration of health equity. Similarly, cancer patients emphasise the importance of being able to choose between telemedicine and in-person visits, focusing on personal interaction. They advocate for the involvement of patients in the design and testing of telemedicine services, ensuring solutions meet their preferences. Conclusions Policy experts and patients are in favour of hybrid models for cancer care. Recommended public health actions include: i) develop legal frameworks to complement in-person care with telemedicine; ii) boost digital literacy and IT infrastructure, ensuring privacy and health equity; and iii) involve patients in design for tailored services. Key messages • Both the EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person healthcare services. • Both the EU Member States and cancer patients champion telemedicine with a focus on equity, privacy, digital literacy and a hybrid model of care that respects patient preferences for cancer treatment.

Performance and trend of core measures among oral cancer patients: A population-based cohort study

Abstract Objectives This study explores the performance and trend of core measures, which were established as evidence-based indicators to assess and improve the quality of care for oral cancer patients. Methods This retrospective cohort study uses the National Health Insurance Research Database (NHIRD), Taiwan Cancer Registry, and Cause of Death Statistics, provided by the Health and Welfare Data Science Center (HWDC), Ministry of Health and Welfare (MOHW). The study population was adult patients hospitalized for oral cancer surgery with stage I-IV between 2014 and 2021. The trend tests and the generalized linear mixed model (GLMM) were applied. Results A total of 23392 oral cancer patients were enrolled. The core measure set used in this study included five indicators (two process-related and three outcome-related indicators). Process indicators’ mean achievement rates significantly increased from 82.6% to 85.7% (p = 0.018, trend test). On the other hand, most patients demonstrated good achievement rates to the outcome indicators (98.9% to 99.3%) (p = 0.218, trend test). Overall indicators’ 100% achievement rate increased over time from 62.9% in 2014 to 66.2% in 2021 (p < 0.001, trend test). Subgroup analyses were performed by age, stage, and comorbidity score. The analysis of the GLMM revealed that the 100% achievement to overall indicators was positively associated with age<45, not-low socioeconomic status, body mass index ≥ 24, squamous cell carcinoma, recent treatment year, treated with surgery only, negative surgical margins, and receiving care in a high-volume hospital (all p < 0.01). Conclusions The results highlight a significant measurable improvement in the quality of oral cancer care. However, there is still room for enhancement in process indicator performance. Key messages • The results highlight a significant measurable improvement in the quality of oral cancer care. • There is still room for enhancement in process indicator performance.

Factor Influencing Unmet Healthcare Needs among the disabled

Abstract Background The unmet Healthcare needs (UHNs) of the disabled are not only detrimental to their quality of life but also can lead to serious health outcome including death. A variety of factors including socioeconomic, personal, environmental factors affect UHNs for the disabled. Methods We analyzed the UHNs status and influencing factors among 4,326 adult the disabled using Korea disability Life Data. Chi-square analysis was conducted to identify differences in UHNs according to characteristics of general, disability, environmental of the disabled. Logistic regression analysis was conducted to determine factors affecting UHNs. Results Those with low educational level (aOR=1.23, 95% CI = 1.02-1.48), those enrolled in private insurance (aOR=1.23, 95% CI = 1.02-1.50), those need help with daily living (aOR=1.30, 95% CI = 1.06-1.59), those who rarely go out (aOR=1.57, 95% CI = 1.27-1.92), those who use taxis (aOR=1.41, 95% CI = 1.05-1.89) or call taxi for the disabled when going to the hospital (aOR=1.37, 95% CI = 1.01-1.88), the communication disabled (aOR=1.30, 95% CI = 1.03-1.65), those with poor subjective health status (aOR=1.25, 95% CI = 1.04-1.49), those felt the explanation of treatment results was insufficient (aOR=4.04, 95% CI = 1.37-11.93), and those dissatisfied with healthcare services (aOR=3.52, 95% CI = 2.74-4.51) were more likely to experience UHNs. Conclusions Effective healthcare service provision for the disabled requires not only financial assistance but also social support, along with education for healthcare staff, policies with the characteristics of disabilities. Funding: This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165) and by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2024-00394642) Key messages • The disabled need not only financial support when using healthcare services, but also support from society, such as accompanying them to the hospital and providing transportation. • Education for healthcare staff who communicate with the disabled and provision policy to provide appropriate healthcare services according to the characteristics of disabilities are needed.

Cardiovascular diseases risk assessment: the Italian Health Examination Survey 2023 - CUORE Project

Abstract Background The reduction of NCDs premature mortality is pursued by the WHO; risk conditions targets are recommended as well as population-level monitoring of cardiovascular disease (CVD) risk. The Italian Ministry of Health (MoH) has strengthened prevention/health promotion and supported periodic CVD risk assessment through national health examination surveys (HESs), funded by the MoH-CCM and conducted within the CUORE Project. Methods In 2023 a new HES started including the 10-year fatal and non-fatal CVD risk assessment based on knowledge of sex, age, smoking habit, measured systolic blood pressure and fasting total and HDL serum cholesterol, and presence of diabetes (on measured fasting serum glycemia and/or treatment) and anti-hypertensive therapy. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy, aged 35-69 years, without previous CVD, are available (585 men, 617 women). Determinations were assayed by a central lab. CUORE Project functions developed on and for the Italian adults were used. Results Mean values of the CVD risk assessment resulted 6.9% (95% CI: 6.3-7.4) in men and 2.3% (2.1-2.5) in women. For men aged 35-44 years risk was 1.6% (1.5-1.8), for 45-54 years 3.8% (3.5-4.2), for 55-64 years 10.0% (9.0-10.9), for 65-69 years 17.6% (16.4-18.9); for women was 0.5% (0.4-0.6), 1.0% (0.9-1.1), 3.3% (2.9-3.7) and 6.0% (5.5-6.6) respectively. Prevalence of CVD risk less than 5% was 57% (49-64) in men and 88% (84-93) in women, of 10-15% risk were 22% (15-28) of men and 9% (5-14) of women, of 15-20% risk were 5% (1.6-8.0) of men and 0% of women, of over 20% risk were 2% (0-3.6) of men and 0% of women. Conclusions Compared to 2008, these data showed stable mean levels of CVD risk both in men and women at any age-classes and stable prevalence of CVD risk classes. CVD risk perception represents a challenge in primary prevention especially for young age groups and women. Key messages • In the Italian general population, CVD risk assessment remained stable compared to 15 years ago. • CVD risk perception represents a challenge in primary prevention.

Development of rapid methods to monitor nutritional standards in sustainable healthy public catering

Abstract Background The WHO and FAO in the Second International Conference on Nutrition stress the role of nutrition standards for public facilities catering services (CS) and in the Sustainable Healthy Diet guiding principles (SHD) underline synergies among foods, nutrients present in dietary patterns and their bioavailability, degree of food processing, and subsequent health impact. In Italy almost one in 10 people eat a meal in CS every day. In accordance with SHD, the Italian Ministry of Health (MH) in the national guidelines for CS indicate activating procedures for the conservation of nutritional qualities (NQ) of micronutrients and bioactive substances. The central purchasing body of the Region of Friuli Venezia Giulia have applied these criteria, introducing the process of critical control points of nutrient analysis (NACCP) in the Public Procurement for the school catering of 69 municipalities and for all 18 regional hospital with more than 3 million meals per year served. The aim of the project was to develop rapid and cheap methods for monitoring the NQ of meals by applying the NACCP process. Methods 150 samples of pasta, milk and also vegetables, meat, fish with different degrees of processing, were taken from the CS and analysed both with chemical techniques and with optical rapid techniques (1300 analyses). Results The samples were subjected to conventional analyses to determine the oxidation state and the content of characterizing molecules such as polyphenols, histamine, and total compounds of Maillard. The same samples were then analyzed by color measurements. The results showed a good correlation between the two analytical systems, in particular the color measurements and the Maillard compounds and the color measurements and the oxidation state. Conclusions Project findings can be applied in the NACCP process to rapidly cost-effectively monitor the nutritional quality of CS meals, and adhere to WHO and FAO the SHD guiding principles and MH guidelines for CS. Key messages • The development of rapid methods of monitoring the nutritional standards of public catering can implement sustainable food systems thereby promoting the healthy diets recommended by the FAO and WHO. • Rapid methods of monitoring nutritional standards represent an innovative component in improving the culture of food and nutritional security in public catering.

Introduction of wastewater surveillance of SARS-CoV-2 in Ukraine

Abstract Since the Russian invasion, Ukraine has faced humanitarian crises and challenges in diseases surveillance. The primary healthcare (PHC) system struggled with growing numbers of internally displaced and wounded people. In October 2022, the PATH-led, USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project, supported implementation of wastewater surveillance (WWS) for SARS-CoV-2 in four oblasts on request of the Ministry of Health (MoH), expanding to 18 oblasts by October 2023. Samples were collected from 64 sites twice per week and tested for SARS-CoV-2 and influenza A/B using BioExtract® Premium Mag test kits in regional laboratories. From October 2022 to April 2024, 4,784 samples were collected at municipal aqueducts, with SARS-CoV-2 delta and omicron variants detected across all regions. WWS sample results were compared with routine surveillance to assess trends in concentrations and reported cases among population. Gradual decrease in SARS-CoV-2 concentration to zero by May 29, 2023, coincided with a decrease in morbidity. In the last week of August 2023, the concentration of the SARS-CoV-2 in wastewater began its gradual increase with the beginning of new cases registration among the population within 2 weeks, by mid-September. From October 2023, SARS-CoV-2 dominated in 96.6% of positive WWS testing results; in other specimens, influenza and respiratory viruses have been identified. The implementation of WWS in Ukraine highlighted its effectiveness as a public health tool in settings where traditional surveillance methods are disrupted, providing timely data on the viral pathogens for outbreaks prediction and responses, underscoring its role in preventive health measures. The MOH of Ukraine recommended extending the method nationwide for routine surveillance of SARS-CoV-2 and other pathogens, enhancing Ukraine’s capacity to manage public health threats and strengthen the resilience of its health system against future crises. Key messages • WWS in Ukraine underscores its effectiveness as a public health tool, providing timely data on viral pathogens for outbreak prediction and response in disrupted settings. • Notable decline in SARS-CoV-2 concentration in wastewater correlates with reduced morbidity, highlighting WWS’s predictive value.

Sodium and potassium intake in adults: the Italian Health Examination Survey 2023 – CUORE Project

Abstract Background The WHO recommends a 30% relative reduction in mean population intake of salt/sodium within 2025 (baseline 2010) and an adequate potassium intake. To these ends, the Italian Ministry of Health (MoH) has strengthened prevention/health promotion. To update the assessment of the habitual salt and potassium intake in the Italian general adult population, national health examination surveys (HESs), funded by the MoH-CCM, are conducted within the CUORE Project. Methods In 2023 a new HES started including salt and potassium intake assessment by the use of 24h urine collection. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy and aged 35-74 years are available (686 men, 702 women). Urinary excretion is assayed by a central lab. Persons with urinary volume < 500 ml and/or a urinary creatinine content referred to body weight outside the range of population mean ± 2 standard deviations are excluded. Results Out of 657 men and 671 women, mean level of salt per day was 9,2 g (95% CI: 9,0-9.5 g) and 7,1 g (6,9-7,3 g) respectively, and mean level of potassium per day was 2,9 g (2,8-3,0 g) and 2,4 g (2,3-2,5 g) respectively. A salt intake level lower than the WHO recommended target of 5g/day was detected in 9,5 % (5,2 -13,9 %) of men and 23,7 % (17,5 -29,9 %) of women and a potassium intake level higher than the WHO recommended target of 3510 mg/day was detected in 22,4 % (16,3 -28,6 %) of men and 9,7 % (5,4 -14,0 %) of women. Conclusions These preliminary data showed that in Italian adults the average salt intake is still higher and the average potassium intake is still lower than recommended. Compared to 2008, the habitual salt intake decreased of about 12% in 2018 and remained stable in 2023; the habitual potassium intake remained stable in 2008, 2018 and 2023.These results justify and encourage the ongoing preventive initiatives of MoH, facilitating the meeting of WHO targets. Key messages • In Italian adults the average salt intake is still higher than recommended and the habitual salt intake decreased compared to 15 years ago. • In Italian adults the average potassium intake is still lower than recommended and remained stable compared to 15 years ago.

Lipids and glycemia profiles in adults: the Italian Health Examination Survey 2023 - CUORE Project

Abstract Background WHO recommends monitoring glycemic and lipid profiles in the population to control and prevent NCDs. The target for glycemic/diabetes is to halt the rise within 2025 (2010 as baseline). The Italian Ministry of Health (MoH) has strengthened prevention/health promotion and supported their periodic assessment through national health examination surveys (HESs), financed by MoH-CCM and conducted within the CUORE Project. Methods In 2023 a new HES started including the assessment of fasting serum glycemia, total and HDL cholesterolemia and triglyceridemia. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy and aged 35-74 years are available (687 men, 704 women). Glycemia and lipids profiles were assayed by a central lab. Elevated glycemia/diabetes (DM): glycemia ≥ 126 mg/dl and/or on medication. Elevated total cholesterol/hypercholesterolemia (HChol): total cholesterol ≥ 240 mg/dl and/or on medication. Results Glycemia mean level was 97 mg/dl (95%CI: 95-99) in men and 90 mg/dl (89-91) in women; DM resulted 10% (5-14) and 8% (4-12) respectively. Among those with DM, about 2 in 10 men and 1 in 10 women were unaware; about 2 and 3 of 10 were aware but not on medication, respectively. Total cholesterol mean level was 192 mg/dl (189-195) in men and 200 (197-202) in women; HChol resulted 24% (18-31) and 29% (22-36) respectively. Mean level of HDL cholesterol was 48 mg/dl (48-49) in men and 59 mg/dl (58-60) in women; mean level of triglycerides was 121 mg/dl (115-126) and 95 mg/dl (92-98) respectively. Among those with HChol, about 1 in 10 men and 2 in 10 women were unaware; about 2 of 10 were aware but not on medication. Conclusions Compared to 2008, these preliminary data showed a significant decrease of glycemia, total cholesterol and triglycerides means values both in men and women, as well as of DM and HChol prevalence, but improvements on their awareness and control are still necessary. Key messages • In the Italian adult general population significant improvements in lipids and glycemia profiles occurred compared to 15 years ago. • The implementation of periodic health examination surveys is important for estimating indicators based on objective measurements and for estimating awareness and control of risk conditions.

Postgraduate medical education in Public Health: the Italian scenario and a call to action

Abstract Introduction Public health training in Italy takes place within postgraduate medical training in Hygiene and Preventive Medicine. With 39 university schools of public health, spread across 17 of Italy’s 20 regions, the landscape is diverse. The government determines the number of available contracts annually. This study aims to provide an up-to-date analysis of the saturation of places in Public Health programmes, as well as an assessment of mobility trends between northern and southern Italy from 2017 to 2023. Methods Data on admissions, withdrawals and resignations were obtained from the Ministries of Universities and Health and from the archives of the ‘Associazione Liberi Specializzandi’ (ALS). Mobility was assessed as moving from the central-northern regions to the southern-islands of Italy, and vice versa, between registration with the Medical Council and specialisation programme enrollment. Results Between 2017 and 2023, a total of 2301 residents enrolled across Italy, out of 2953 available positions nationwide. During this period the number of available national places, increased from 180 to 576, impacting overall seat saturation. In 2017, 98.3% of positions were covered, compared to only 46.5% in 2023. Regarding the mobility trend, southern students attending northern schools increased from 8.3% in 2017 to 22.4% in 2023, while northern students attending southern schools decreased from 17.9% to 1%. However, the number of dropouts and withdrawals was higher in the North. Mobility students scored lower than non-mobility students nationally. Key messages • From 2017 to 2023, the number of residents enrolled increased, while the allocation rate decreased. There was a shift in mobility patterns, with more southern students moving north. • Addressing the identified inequalities and understanding the underlying factors driving mobility patterns is crucial for effective planning and allocation of resources.

3.O. Scientific session: Migrant labour exploitation and health: How can research foster protection of migrant workers?

Abstract Migrant workers sustain essential industries such as the food supply chain, construction, and domestic and care work. They tend to perform onerous and risk-laden tasks at low pay without employment or health protections, and often under exploitative terms (e.g., debt bonding, piecework). Current evidence on associations between migration, employment terms and conditions, and health indicates profound inequities in work-related health outcomes for migrant workers. Although the COVID-19 pandemic highlighted these disparities and their potential social and public health implications, migrant workers continue to be overlooked by public health scholars and policymakers. Supranational regulations (such as EU directives) and national policies rarely consider migrants in their role as workers, and little research is dedicated to questions at the intersection of migration, employment, and health. The invisibility of migrant workers is also a matter of disciplinary and sectoral silos, with different aspects of migrant labour regulated separately by Ministries of Immigration, Labour, Agriculture, Health, and others. These silos create incompatible, context-contingent definitions, terminologies, and administrative categorizations, leading to inconsistent data collection and data gaps which, in turn, translate into policy blind spots. Data that are comparable across contexts and that refer to migration, employment/work and health are generally scarce. For some sectors and contexts, virtually no data exist; e.g., for migrant workers in agriculture, construction, and domestic work, and for migrant workers in low- and middle-income countries. There is barely any evidence about interventions to improve the structures that dictate migrant workers’ employment conditions or obligations of employers. Given the limited participatory research with migrant workers, we have a very poor understanding of their views and viable intervention options, and migrant workers’ voices thus also remain absent from policymaking. This workshop aims to contribute to greater visibility of - and ultimately action on - migrant labour exploitation in research and policy. To this end, it will map current challenges and shortcomings in generating evidence on the links between migration, work/employment, and health; and it will suggest ways to improve research and interventions to address migrant workers’ health, based on the speakers’ experience in developing intervention-focused evidence in different contexts. The workshop will conclude with an open discussion to identify further relevant questions and elaborate steps towards better research and greater protections for mobile worker populations. Key messages • Harm from exploitative working conditions among migrant workers is substantial, yet data collection methods and intervention designs are limited. • For public health research to effectively help protect the health and rights of migrant workers, it is essential to share methods and insights across disciplines to drive research for action.

Public and professional attitudes to the digitisation of health and social care in Ireland

Abstract Background The European Commission has set targets for all EU citizens to have access to electronic medical records by 2030. In Ireland the Sláintecare health reform programme has set goals around the use of digital technologies in health and social care. The Health Information and Quality Authority (an independent authority established to drive high-quality and safe care for people using health and social care services in Ireland) in partnership with the Health Service Executive (public healthcare provider) and the Department of Health (Ministry) conducted a National Engagement on Digital Health and Social Care. The aim of this engagement was to understand the opinion, attitudes and comfort levels of the public and professionals working in health and social care around digitisation of health and social care. Methods The National Engagement on Digital Health and Social Care used a mixed-method approach to data collection. There were two surveys, a national telephone survey with a representative sample of the public (n = 2009) and an online survey with professionals working in health and social care (n = 1020). There were separate focus groups with professionals and with the public, including representatives of minority groups. Results Preliminary results indicate that the public and professionals have positive attitudes to digital health and social care. Of the public surveyed 73% said that they are likely to access their online health record. Professionals feel that when the public have access to information via an online health record they will be better informed about their health (88%). Both the professionals and public feel that it is important to ensure patient choice around the format and delivery of care. Conclusions The research provides valuable insights and gives the public and professionals a platform to voice their opinions and have a meaningful impact on how digital health and social care is developed and implemented in Ireland. Key messages • This research provides unique insights and a deeper understanding into the attitudes of Irish public and professionals working in health and social care towards digital health. • Research findings will inform national policy, legislation and recommendations on the use of digital health tools in Ireland.

A Multidisciplinary One Health Approach to Addressing Unsanitary Conditions: The Case of Cascais

Abstract Unsanitary conditions in domiciles often stem from complex social and health-related issues, involving the elderly and/or individuals with mental health problems. These situations typically lead to a decreased quality of life for those involved, directly and indirectly, and may pose a risk to public health depending on their magnitude. In Cascais municipality, identified cases of unsanitary conditions undergo a multidisciplinary analysis. It has been established a Local Technical Group for Domiciliary Unsanitary Situations, comprising various institutions such as local authorities, law enforcement agencies, civil protection, health and social security ministries, and the animal rescue center. This group operates under a One Health approach, encompassing human health, environmental health, and animal health. Interventions are determined by the working group, with the aim of promoting health and enhancing citizens’ quality of life. Cases of unsanitary conditions reported are subsequently discussed within the technical group, which has regular meetings, and may organize joint assessment visits and appropriate actions. This social and environmental initiative responds to the growing need to address unsanitary and cluttered living conditions, which significantly impact individuals’ physical, emotional, and social well-being. The objective is to restore housing conditions in homes by removing waste and unnecessary items, contributing to general individual well-being. While international studies suggest a correlation between unsanitary conditions and hoarding disorder, it’s crucial to differentiate between distinct and independent situations caused by various physical, psychological, and cognitive processes. The establishment of a Local Technical Group for Domiciliary Unsanitary Situations exemplifies a proactive approach to addressing complex health and social challenges, emphasizing collaboration, and holistic intervention strategies, always with a One Health approach. Key messages • Addressing unsanitary conditions is crucial for safeguarding public health, impacting physical, emotional, and social well-being. • The establishment of a Local Technical Group for Domiciliary Unsanitary Situations, under a One Health framework, reflects a collaborative approach to addressing complex health and social challenges.

Implementing a pilot primary care program: Armenia’s steps toward universal health coverage

Abstract Problem Armenia has struggled to transform its ineffective primary healthcare (PHC) system into one that can address the non-communicable disease burden, which causes 93% of mortality. To address this issue, Armenia aims to establish universal health coverage and invest in high-quality primary care. Description In 2023, the Armenian Ministry of Health signed a multisectoral policy to implement a pilot primary care program to trial a multitude of reforms related to diabetes (DM) and hypertension (HTN). Pilot interventions include pathways for screening/diagnosis, provider training, free medications and diagnostics, and new provider financial incentives. The key question to be answered is if these pilot interventions cause DM and HTN health outcomes to improve. Beginning in 2024, the program is being piloted in a primary care clinic in Dsegh. Results As a result of the 2023 Ministerial policy, multisectoral stakeholders designed and implemented this pilot program. Baseline focus groups found that the pilot addresses the financial barriers that community members noted lead to delays in seeking care and that providers perceive the pilot to be beneficial to their patients. Although final results are not yet available, the pilot has already positively changed features in the national EMR and brought together stakeholders in a way never done before. Lessons The pilot’s innovation comes from it being the first time that hypertension and cholesterol medications are provided by the government for free, provider bonuses are based on outcome indicators, indicator targets are set this high, a point-of-care A1c machine is utilized, and a robust monitoring and evaluation (M&E) plan is implemented, all of which are currently shaping discussions on national policy. For countries similarly working on strengthening primary care, it is recommended to pilot specific reforms and establish mechanisms through M&E systems that allow pilots to inform evidence-based decision making. Key messages • To move towards universal health coverage, pilot programs designed with multi-sectoral stakeholders are needed to trial suggested healthcare reforms. • It is essential to invest in monitoring and evaluations systems to generate the data necessary to develop evidence-based policies.

Factors influencing abortion care-seeking outside of formal healthcare settings: lived experiences from Rwandan young women

BackgroundInformal abortions, commonly known as unsafe abortions, refer to all induced abortions that occur outside of formal healthcare settings conducted without the assistance of a licensed, trained healthcare provider. Despite the legalization of safe induced abortion care services, informal abortions continue to be among the major causes of maternal mortality and morbidity among young women in Rwanda living in rural areas with limited or no access to safe abortion care services. The purpose of this qualitative study was to gain an in-depth understanding of the lived experience of seeking informal abortions from the perspective of young women in rural Rwanda and to identify the underlying factors for these women seeking abortion care services outside of the formal healthcare setting.MethodsThis qualitative study was guided by a descriptive phenomenology in rural Rwanda, specifically in a selected district located in the Northern Province of Rwanda. Ten young women between 18 and 24 years of age, who had the experience of seeking informal abortion services from informal providers within the last eight years participated in audio-recorded, in-depth, face-to-face interviews. Collected data were analyzed using Colaizzi’s (1978) seven steps of the phenomenological method.ResultsThe study found that young Rwandan women still seek unregulated abortions to end their unintended pregnancies due to limited access to or utilization of sexual reproductive health and rights services. Among the reasons for seeking abortion care services outside of the formal healthcare setting in Rwanda were sociocultural and economic factors and the stigma associated with terminating unintended pregnancies before marriage.ConclusionIn light of the findings of this study, the authors recommend the Ministry of Health and its stakeholders to expand access to comprehensive adolescent and youth-friendly reproductive health and reproductive rights while addressing the sociocultural stigma through public awareness and economic factors that play a big role in unregulated abortions rather than safe abortion care services.

Distinguishing factors in regional variations of TAVI in Japan: the unique role of administrative facility standards compared to other procedures in a high-cost medical care subsidy system

Abstract Background Transcatheter aortic valve implantation (TAVI) is less invasive than surgical aortic valve replacement and is becoming increasingly popular worldwide, particularly among patients with aortic valve stenosis (AS) due to aging. However, regional differences are expected to exist not only between countries but also within a single country. Reports from Western countries indicate the presence of regional differences in TAVI and the reasons for these differences, which include differences in medical infrastructure, economic resources, health insurance systems and policies, geographic factors, and availability of specialized medical personnel. TAVI is expensive, but in Japan, the economic aspect is relatively unimportant due to the high-cost medical assistance system. Furthermore, there is little socioeconomic disparity between regions. In such a society, we have reported that the number of specialists and resources for PCI can explain regional differences in ablation and endovascular treatment (EVT). However, unlike those other cardiovascular procedures, there are specific requirements for facilities to perform TAVI, such as the number of transesophageal echocardiographies, as well as cardiologists and cardiovascular surgeons, and the equipment itself, such as hybrid operating rooms. We examined how these facility requirements, which are thought to be controlled by the government, are related to regional differences in TAVI implementation. Methods and Results We used the Japanese Ministry of Health, Labour and Welfare national database to determine the rate of TAVI for patients with AS performed per 100,000 population aged ≥40 years in all 47 prefectures in 2022. A linear regression model was developed to assess factors contributing to the regional medical supply, including the rates of PCI per 100,000 population aged ≥40 years and the numbers of cardiologists, cardiovascular surgeons, cardiovascular intervention and therapy training facilities, cardiovascular surgery base facilities, and TAVI facilities. The numbers in the highest and lowest regions were 26.6 and 3.9 (a 6.8-fold difference) for TAVI number. The number of TAVI facilities contributed most significantly to the TAVI volumes (P = 0.0105), while the rates of PCI and other factors did not contribute significantly. The number of TAVI facilities was positively correlated with the number of transesophageal echocardiographies the most (r = 0.353). Conclusion This study revealed large regional variations in TAVI volumes in Japan, of which administrative facility standards were a major determinant.

2.L. Round table: Monitoring health reforms to inform policy innovation: the Health Systems and Policies Monitor

Abstract Background The European Observatory on Health Systems and Policies’ (Observatory) Health Systems and Policy Monitor (HSPM) network convenes an international group of around 50 national health systems researchers from over 40 institutions across 31 high-income countries, including all EU countries, Canada, Israel, the UK and the US. In advance of the HSPM annual meeting, experts share the current year’s “top-three” health reforms in their countries via a standardized survey, soliciting details on content and general implementation processes. Reforms are iteratively organized into to 2 of 11 clusters, derived from the WHO health system building blocks. Experts then discuss background, status and content of national reforms in the year’s main clusters and initiate cross-country collaborations. A repository of over 650 reforms since 2018 has been created and is available online, showcasing reform patterns in HSPM countries. The collected data have informed studies on reform trends in HSPM countries from 2018-2019 and between 2020-2022, with work ongoing. Data are also consulted by researchers and policymakers wishing to learn about and from reforms in other countries. This workshop specifically aims to: • Inform participants about the methodologies used by the HSPM network to track reforms • Highlight common trends in major health reforms across countries since 2018 • Discuss national health reforms and the value of understanding and tracking these across countries • Identify research gaps in reform monitoring relevant to policy makers • Discuss how the health system research community can generate more relevant and actionable evidence Added-value The comparative analysis of reform trends provides insights into how systems operate and the types of reforms more likely to be implemented. The sharing of these insights also serves as a source of inspiration, allowing countries to learn from each other’s successes and failures and adopt proven best practices. This is relevant for policymakers and researchers striving to support health systems strengthening. Therefore, the workshop will support knowledge exchange between researchers and policymakers by (1) informing researchers and policymakers about similar ongoing reforms in other countries and (2) identifying areas where researchers can contribute to country reform agendas, and (3) stimulating interest in cross-country collaborative research on similar and topical reforms in different countries. Format This is a roundtable workshop chaired and moderated by the Observatory. An overview of reform trends and patterns since 2018 will set the scene, followed by an interactive discussion with policymakers and HSPM network members to (1) delve into trend dynamics and implications for health policy and research and (2) identify major (missing) research areas relevant to policymakers. In addition, we will leverage the geographic scope and expertise of the audience to reflect on the value of monitoring reforms. Key messages • Cross-country exchange of information on reform trends and implementation patterns can inspire future reforms and help policymakers identify promising policy approaches abroad. • Knowledge exchange between researchers and policymakers helps to determine evidence gaps and to generate relevant and actionable evidence that can drive policy innovation. Speakers/Panelists Reinhard Busse Berlin University of Technology, Berlin, Germany Ines Fronteira National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal Iwona Kowalska-Bobko Jagiellonian University Medical College, Institute of Public Health, Cracow, Poland Isabel de La Mata DG SANTE, European Commission, Luxembourg, Luxembourg Vesna-Kestrin Petric Ministry of Health, Ljubljana, Slovenia

Evaluation of the Beneficial Parenting Partnership Model Assimilation in Parent-Infant Centers

Abstract Background The Beneficial Parenting Partnership (BPP) model is being implemented in Parent-Infant Centers (PIC) across Israel to improve the partnership skills of PIC nurses when working with parents, promote child development, and enhance parental well-being. This initiative is being led by the Israeli Ministry of Health, Goshen NGO, and Lotem company and is supported by the Yad Hanadiv and Bernard van Lear foundations. Methods The first data collection (T1) was held from December 2022 to January 2023 among 706 parents of children aged two weeks to 36 months (M = 8.17 months, SD = 7.48) who visited one of 18 PICs. Research assistants approached the parents and asked for their agreement to fill in the study questionnaire. Of these, 328 parents agreed to participate in the follow-up study (T2) held in January-February 2024 using a telephone survey. Differences in the parent’s satisfaction, visit experience, and parental well-being were assessed using parried sample T-tests. A linear regression model was calculated to assess the factors predicting the increase in the parent’s visit satisfaction. Results Significant differences were measured between T1 and T2 in parental satisfaction (M = 4.51 and 4.71 retrospectively, P < 0.001), parental positive visit experience (M = 4.58 and 4.68 retrospectively, P = 0.019), and parental well-being (M = 3.81 and 3.97 retrospectively, P < 0.001). Findings suggest a marked improvement in satisfaction, visit experience, and reported well-being after a year of BPP model assimilation among PIC nurses. The regression model, explaining 42% of the variance in increased parental satisfaction, indicated that a higher increase could be predicted by a higher increase in positive visit experience and a higher trust level in the PIC nurse at T1. Conclusions The BPP model’s assimilation among Israeli PIC nurses was successful, resulting in improved parent experience, satisfaction, and well-being. Key messages • The Beneficial Parenting Partnership model is well-suited for implementation among nurses working with parents of babies and toddlers to promote collaborative nurse-parent communication. • During routine meetings at Parent-Infant Centers, nurses can act as a catalyst for promoting parental well-being.