National Prevention Research Articles

Experiences and challenges of pre-exposure prophylaxis initiation and retention among high-risk populations: qualitative insights among service providers in Thailand.

Pre-exposure prophylaxis (PrEP) has been an essential element of the national combination prevention package and included in the Universal Health Coverage (UHC) of Thailand since 2019. As a part of the national monitoring and evaluation framework, this qualitative study aims to describe experiences and barriers concerning PrEP initiation and retention among service providers from both hospital and Key Population Led Health Service (KPLHS) settings under the country's UHC roll-out. Between September and October 2020, ten focus group discussions with PrEP service providers from both hospitals and KPLHS across Thailand were conducted of which there were six hospitals, one health service center, three KPLHS. All interviews were recorded and transcribed verbatim to identify providers' experiences, attitudes, and perceived barriers regarding PrEP service delivery in Thailand. Among the 35 PrEP service providers, most of them reported positive attitudes toward PrEP and believed that it is an effective tool for HIV prevention. Men who have sex with men were perceived to be the easiest group to reach while PrEP uptake remains a challenge in other key populations. Integration of a PrEP clinic with other HIV services at hospitals made most healthcare providers unable to adopt an active approach in recruiting new clients like at KPLHS settings. Challenges in delivering PrEP services included lack of public awareness, high workload, limited benefit package coverage, structural and human resources. Additional services to address different health needs should be considered to increase PrEP uptake among harder-to-reach populations. Novel approaches to PrEP service integration and close collaboration between hospitals and KPLHS would be essential in optimizing PrEP uptake and retention. Support regarding raising awareness, expanding service coverage and access, improving facilities and workforce, and providers' capacities are crucial for the success of the national PrEP programme.

Characteristics and outcomes of people in suicidal crisis at two emergency departments: a service evaluation.

Emergency departments (EDs) provide critical opportunities for nurses to support suicide prevention. This article details a service evaluation that was undertaken to explore the characteristics and outcomes of people in suicidal crisis at two EDs in the East of England during June 2023. Data routinely collected by the ED mental health liaison team were combined with a retrospective case note review of the local NHS mental health trust's electronic patient records. Attendees had a mean age of 35 years and seven months, and were often diagnosed with depression or emotionally unstable personality disorder. Most had a history of self-harm and were currently known to mental health services. Suicide-specific interventions were rarely recorded by nurses and relapse behaviours were prevalent after presentation. Local and national suicide prevention strategies should encourage nurses to address gaps in support, thereby improving patients' experiences in and beyond the ED.

Human cat borne rabies as the new epidemiology of the disease in the Andes mountains.

Rabies virus (RABV) is the etiologic agent of rabies, a fatal brain disease in mammals. Rabies circulation has historically involved the dog has the main source of human rabies worldwide. Nevertheless, in Colombia, cats (Felis catus) have become a relevant species in the epidemiology of rabies. To characterize rabies cases in humans in Colombia in the last three decades in the context of the epidemiology of the aggressor animal. We conducted a retrospective longitudinal epidemiological study of human rabies caused by cats' aggression, collecting primary and secondary information. Variables considered included the demography of the patient, symptoms, information about the aggressor animal as the source of infection and the viral variant identified. We found that the distribution of rabies incidence over the years has been constant in Colombia. Nevertheless, between 2003 and 2012 a peak of cases occurred in rural Colombia where cats were the most frequent aggressor animal reported. Most cats involved in aggression were unvaccinated against rabies. Cat's clinical signs at the time of the report of the human cases included hypersalivation and changes in behaviour. Human patients were mostly children and female and the exposure primarily corresponded to bite and puncture lacerations in hands. The RABV lineage detected in most cases corresponded to variant 3, linked to the common vampire bat (Desmodus rotundus). The geographical presentation of cat borne RABV in humans occurred along the Andes mountains, epidemiologically known as the rabies red Andean corridor. By finding cats as the primary source of rabies spillover transmission in Colombia, this report highlights the importance of revising national rabies control and prevention protocol in countries in the Andes region. Our results demonstrate that rabies vaccination for outdoor cats needs to prioritize to reduce the number of rabies-related human deaths.

Whole-genome sequencing, multilocus sequence typing, and resistance mechanism of the carbapenem-resistant Pseudomonas aeruginosa in China

Pseudomonas aeruginosa is a significant pathogen responsible for severe multisite infections with high morbidity and mortality rates. This study analyzed carbapenem-resistant Pseudomonas aeruginosa (CRPA) at a tertiary hospital in Shandong, China, using whole-genome sequencing (WGS). The objective was to explore the mechanisms and molecular characteristics of carbapenem resistance. A retrospective analysis of 91 isolates from January 2022 to March 2023 was performed, which included strain identification and antimicrobial susceptibility testing. WGS was utilized to determine the genome sequences of these CRPA strains, and the species were precisely identified using average nucleotide identification (ANI), with further analysis on multilocus sequence typing and strain relatedness. Some strains were found to carry the ampD and oprD genes, while only a few harbored carbapenemase genes or related genes. Notably, all strains possessed the mexA, mexE, and mexX genes. The major lineage identified was ST244, followed by ST235. The study revealed a diverse array of carbapenem resistance mechanisms among hospital isolates, differing from previous studies in mainland China. It highlighted that carbapenem resistance is not due to a single mechanism but rather a combination of enzyme-mediated resistance, AmpC overexpression, OprD dysfunction, and efflux pump overexpression. This research provides valuable insights into the evolutionary mechanisms and molecular features of CRPA resistance in this region, aiding in the national prevention and control of CRPA, and offering references for targeting and developing new drugs.

Cholera and diarrheal diseases in Cuamba District, Niassa Province, Mozambique: Systematic healthcare facility-based surveillance strengthening, characteristics of suspected cholera and diarrheal patients, and incidence of diarrheal diseases.

Mozambique is one of the countries in Africa that is continuously at risk of cholera outbreaks due to poor sanitation, hygiene, and limited access to potable water in some districts. The Mozambique Cholera Prevention and Surveillance (MOCA) project was implemented in Cuamba District, Niassa Province to prevent and control cholera outbreaks through a preemptive cholera vaccination, strengthened surveillance system for cholera and diarrheal diseases, and better understanding of cholera-related healthcare seeking behavior of local populations, which may further guide the national cholera control and prevention strategies. This article presents the surveillance component of the MOCA project. A prospective healthcare facility (HCF)-based surveillance of cholera and diarrheal disease was conducted in six HCFs in the District of Cuamba from March 2019 to December 2020. A systematic surveillance procedure has been put in place with capacity building in selected sentinel HCFs and a basic microbiology laboratory established on-site. Patients presenting with suspected cholera or other diarrheal symptoms were eligible for enrollment. Clinical data and rectal swab samples were collected for laboratory confirmation of Vibrio Cholerae and other pathogens. A total of 419 eligible patients from six HCFs were enrolled. The median age was 19.8 years with a similar age distribution between sentinel sites. The majority were patients who exhibited diarrhea symptoms not suspected of cholera (88.8%; n = 410). Among those, 59.2% (210/397) were female and 59.9% (235/392) were 15 years and above. There were 2 cholera cases, coming outside of the catchment area. The incidence of diarrheal diseases ranged from 40-103 per 100,000 population. No Vibrio cholerae was isolated among surveillance catchment population and Escherichia coli spp. (82/277; 29.6%) was the most common pathogen isolated. Efforts were made to strengthen the systematic surveillance of suspected cholera with standardised patient screening, enrolment, and diagnostics. The first basic microbiology laboratory in Niassa Province established in Cuamba District under the MOCA project needs to be integrated into the national network of laboratories for sustainability. No reports of laboratory confirmed cholera cases from the surveillance catchment area may be highly related to the pre-emptive oral cholera vaccine (OCV) mass vaccination campaign conducted in 2018 and the use of drugs by local populations prior to visiting the sentinel HCFs. Continued systematic cholera surveillance is needed to closely monitor the cholera endemicity and epidemics, and further evaluate the long-term impact of this vaccination. High incidence of diarrheal illnesses needs to be addressed with improved water, sanitation, and hygiene (WaSH) conditions in Cuamba District. Efforts integrated with the prioritization of prevention measures are fundamental for the control of cholera in the country.

Clinical, molecular, and drug resistance epidemiology of HIV in Jordan, 2019-2021: A national study

BackgroundLimited epidemiologic studies have been conducted in Jordan describing the HIV epidemic. This study aimed to address this gap to inform HIV prevention and control. MethodsA nationally-representative cross-sectional study was conducted among adults living with HIV in Jordan. Laboratory testing included HIV viral load and next-generation-sequencing-based clinical genotype. Log-binomial regression estimated risk ratios (RRs) and 95% confidence intervals (CIs). ResultsAmong 231 (70%) participants, most were male (184/80%), and from Jordan (217/94%). Among 188 treatment-experienced-participants (>6 months), 165 (88%) were virally suppressed. High-level resistance was most frequent against nucleoside reverse transcriptase inhibitor (13/81%), and integrase-strand transfer inhibitor (INSTI) (10/62%) drugs among viremic (≥1000 HIV copies/mL) treatment-experienced participants with drug-resistant mutations (DRMs, n = 16). Common HIV subtypes (n = 43) were B (6/14%), A1 (5/12%), and CRF01_AE (5/12%); additionally, novel recombinant forms were detected. In multivariate analysis, independently higher risk for late diagnosis (n = 49) was observed with diagnosis through blood donation (vs check-up: RR 2.20, 95%CI 1.16-4.17) and earlier time-period of diagnosis (1986-2014 vs 2015-2021: RR 2.87, 95%CI 1.46-5.62). ConclusionsLate diagnosis and INSTI resistance endanger national HIV prevention and treatment in Jordan—high-level resistance to INSTI suggests therapeutic drug monitoring is needed for treatment efficacy and conservation of treatment options.

Human Rights and Equality Institutions in Europe

National Human Rights Institutions (NHRIs) are state bodies mandated to protect and promote human rights. Their mission is to identify and tackle systemic problems while raising fundamental rights awareness in countries in which they have been established. Human rights institutions at the national level include Ombudsman (some specialising in particularly vulnerable groups), Equality Bodies, National Preventive Mechanisms, National Monitoring Mechanisms, Data Protection Agencies, and more. In this article, we analyse the strengths and weaknesses of both centralised and fragmented systems of human rights institutions. Using examples from several European countries, we particularly examine how the fragmentation of institutions affects their resilience to pressures which can adversely impact the promotion and protection of human rights and equality at the national level. We argue that opting for a certain NHRIs’ system might exert significant influence on the independence and effectiveness of individual institutions, as well as on the overall comprehensiveness of a nation’s human rights infrastructure.

Right to Privacy and Constitution: An In-Depth Analysis

This paper presents a detailed analysis of the relationship between the right to privacy and the Constitution, examining the theoretical foundations, contemporary challenges, and legal implications of this crucial union in the context of fundamental rights. Privacy, understood as the right to be left alone and to control personal information, has evolved as a cornerstone of democratic and progressive societies. We begin by exploring the roots of the right to privacy in legal and philosophical theories, highlighting how this concept has gained importance in safeguarding human dignity and individual freedom. It also discusses historical and social influences that have shaped the perception of privacy in the context of the formation of modern Constitutions. Subsequently, emerging challenges related to privacy in the digital age are examined. The increasing interconnectivity through information technologies and the proliferation of personal data have posed new challenges to privacy protection, necessitating a critical reevaluation of existing constitutional laws and guarantees. Tensions between the right to privacy and other societal needs, such as national security and crime prevention, are also explored in an attempt to identify a balance that can safeguard both interests. Furthermore, the paper addresses recent legislative and jurisprudential developments regarding the right to privacy, both at the national and international levels. The analysis focuses on crucial court decisions, privacy laws, and legislative debates that have shaped the current legal framework. Finally, potential future developments in the context of the right to privacy and the Constitution are explored, taking into account technological advances, ethical challenges, and emerging societal needs. The aim is to provide a comprehensive and in-depth understanding of how the right to privacy integrates and evolves within the constitutional framework, contributing to a critical understanding of an increasingly relevant topic in contemporary society. Received: 25 December 2023 / Accepted: 25 February 2024 / Published: 23 April 2024

Anti-Herpes Zoster Vaccination of Fragile Patients in Hospital Setting: A Nudge Intervention in Italy.

A nudge intervention against Herpes Zoster, created and implemented in Italy, is presented in order to administer the Shingrix vaccine on a sample of frail patients, as required by the National Prevention Plan. Individual and contextual factors associated with vaccine adherence were investigated. 300 frail adult subjects underwent a full vaccine cycle with recombinant-Shingrix vaccine (RZV vaccine). Hospital Presidia of the Salerno University Hospital Authority, a Hospital Presidium of the Salerno Local Health Authority, and the Public Health Laboratory of the University of Salerno (Campania) participated in the intervention. An ad hoc questionnaire was administered with the following scales: EQ-5D, PSS-10, MSPSS, and representations of HZ and its consequences. Some variables, such as peer support, doctor-patient relationship, level of education, and perception of health, are important in vaccine adherence and information processing. The following factors emerged from the factor analysis: Trust in collective knowledge and collective responsibility (F1); beliefs about virus risk and vaccine function (F2); information about virus and symptomatology (F3); and vaccine distrust (F4). Factor 4 correlates negatively with social support indices (R = -0.363; p < 0.001). There is a significant relationship between factor 3 and satisfaction with national information campaigns (F = 3.376; gdl = 5; p-value = 0.006). Future vaccination campaigns should be built with the aim of personalizing information and developing contextualized strategies, starting from understanding the stakeholders involved, cultural contexts, and organizational settings.

Prevalence of work-related musculoskeletal disorders and associated factors affecting emergency medical services professionals in Jordan: a cross-sectional study

ObjectivesEmergency medical services (EMSs) personnel are at high risk for developing work-related musculoskeletal disorders (WMSDs). However, no studies have yet investigated the prevalence and effect of these disorders on the...

Impact of climate change on dengue incidence in Singapore: time-series seasonal analysis

ABSTRACT This study aimed to identify the meteorological factors that contribute to dengue epidemics. The monthly incidence of dengue was used as the outcome variable, while maximum temperature, humidity, precipitation, and sunshine hours were used as independent variables. The results showed a consistent increase in monthly dengue cases from 2013 to 2021, with seasonal patterns observed in stationary time-series data. The ARIMA (2, 1, 3) × seasonal (0, 1, 2)12 model was used based on its lowest Akaike Information Criterion (AIC) values. The analysis revealed that a 1-unit increase in rainfall was positively correlated with a small 0.062-unit increase in dengue cases, whereas a 1-unit increase in humidity was negatively associated, leading to a substantial reduction of approximately 16.34 cases. This study highlights the importance of incorporating weather data into national dengue prevention programs to enhance public awareness and to promote recommended safety measures.

System-Wide Thromboprophylaxis Interventions for Hospitalized Patients at Risk of Venous Thromboembolism: Focus on Cross-Platform Clinical Decision Support.

Thromboprophylaxis of hospitalized patients at risk of venous thromboembolism (VTE) presents challenges owing to patient heterogeneity and lack of adoption of evidence-based methods. Intuitive practices for thromboprophylaxis have resulted in many patients being inappropriately prophylaxed. We conducted a narrative review summarizing system-wide thromboprophylaxis interventions in hospitalized patients. Multiple interventions for thromboprophylaxis have been tested, including multifaceted approaches such as national VTE prevention programs with audits, pre-printed order entry, passive alerts (either human or electronic), and more recently, the use of active clinical decision support (CDS) tools incorporated into electronic health records (EHRs). Multifaceted health-system and order entry interventions have shown mixed results in their ability to increase appropriate thromboprophylaxis and reduce VTE unless mandated through a national VTE prevention program, though the latter approach is potentially costly and effort- and time-dependent. Studies utilizing passive human or electronic alerts have also shown mixed results in increasing appropriate thromboprophylaxis and reducing VTE. Recently, a universal cloud-based and EHR-agnostic CDS VTE tool incorporating a validated VTE risk score revealed high adoption and effectiveness in increasing appropriate thromboprophylaxis and reducing major thromboembolism. Active CDS tools hold promise in improving appropriate thromboprophylaxis, especially with further refinement and widespread implementation within various EHRs and clinical workflows.

High-quality acceleration of the Chinese national schistosomiasis elimination programme to advance the building of Healthy China

The goal of achieving elimination of schistosomiasis across all endemic counties in China by 2030 was proposed in the Outline of the Healthy China 2030 Plan. On June 16, 2023, the Action Plan to Accelerate the Elimination of Schistosomiasis in China (2023-2030) was jointly issued by National Disease Control and Prevention Administration and other 10 ministries, which deployed the targets and key tasks of the national schistosomiasis elimination programme in China. This article describes the progress of the national schistosomiasis control programme, analyzes the opportunities to eliminate schistosomiasis, and proposes targeted recommendations to tackle the challenges of schistosomiasis elimination, so as to accelerate the process towards schistosomiasis elimination and facilitate the building of a healthy China.

Prevalence of cardiometabolic risk factors according to urbanization level, gender and age, in apparently healthy adults living in Gabon, Central Africa.

The prevalence of cardiometabolic risk factors (CMRFs) is increasing in sub-Saharan Africa and represents a serious public health issue. Accurate data are required to implement adapted prevention programs and healthcare strategies. Thus, the aim of this study was to estimate the prevalence rates of CMRFs according to the level of urbanization, age and gender in Gabon. A cross-sectional study was conducted in northern (Bitam), western coast (Libreville, Melen) and southeast (Koulamoutou) areas of Gabon using the World Health Organization's (WHO) stepwise approach for the surveillance of chronic disease risk factors. Participants over 18 years of age, without known underlying disease, living in rural and urban areas of Gabon were included. Sociodemographic, biological, and behavioral data were collected. Univariate and multivariate analysis were used to identify the CMRFs. Of the 978 participants, 499 lived in urban and 479 in rural areas. Their median age was 38[28-50] years. Tobacco (26.1% vs 6.2%; p < 0.01) and excessive alcohol consumption (19.4% vs 9.6%; p < 0.01) predominated in rural than in urban areas, respectively. Urban dwellers had more often insufficient physical activity than rural people (29.5% vs 16.3%; p < 0.01). In total, 79.9% of participants aged under 54 years had a high blood pressure;10.6% of the younger participants had pre-hypertension. Metabolic syndrome was more frequent in women (21.7%) than in men (10.0%) (p < 0.01); 6.4% of men and 2.5% of women had a high Framingham score (p = 0.03). Finally, 54.0% of the participants had three or four CMRFs. The multivariate analysis showed that men were more likely to be smokers and to be at risk of pre-hypertension or high blood pressure (p < 0.01). Women were more likely to be obese or to have a metabolic syndrome (p < 0.01). Living in urban areas was also a risk factor for hypertension, diabetes, metabolic syndrome and high LDL cholesterol level. The prevalence of CMRFs was high in the study population. Disparities were observed according to urban and rural areas, gender and age. National prevention and healthcare strategies for cardiometabolic diseases in Gabon should consider these observed differences.

An evaluation of the quality, suitability and impact on equity of clinical practice guidelines relevant to preterm birth for use in Aotearoa New Zealand

BackgroundPreterm birth is a leading cause of perinatal morbidity and mortality and a defining event for pregnant people, infants, and whānau (extended families). Recommendations have been made for a national preterm birth prevention initiative focusing on equity in Aotearoa New Zealand, including the development of a national best practice guide. An understanding of the number and quality of guidelines, and consideration of their suitability and impact on equity is required.MethodsGuidelines were identified through a systematic literature search, search of professional bodies websites, and invitation to regional health services in Aotearoa New Zealand. Obstetric and midwifery clinical directors were invited to report on guideline use. Identified guidelines were appraised by a 23-member trans-disciplinary Review Panel; quantitatively using the AGREE-II instrument and qualitatively using modified ADAPTE questions. The quality of guidelines available but not in use was compared against those in current use, and by health services by level of maternity and neonatal care. Major themes affecting implementation and impact on equity were identified using Braun and Clarke methodology.ResultsA total of 235 guidelines were included for appraisal. Guidelines available but not in use by regional health services scored higher in quality than guidelines in current use (median domain score Rigour and Development 47.5 versus 18.8, p < 0.001, median domain score Overall Assessment 62.5 versus 44.4, p < 0.001). Guidelines in use by regional health services with tertiary maternity and neonatal services had higher median AGREE II scores in several domains, than those with secondary level services (median domain score Overall Assessment 50.0 versus 37.5, p < 0.001). Groups identified by the Review Panel as experiencing the greatest constraints and limitations to guideline implementation were rural, provincial, low socioeconomic, Māori, and Pacific populations. Identified themes to improve equity included a targeted approach to groups experiencing the least advantage; a culturally considered approach; nationally consistent guidance; and improved funding to support implementation of guideline recommendations.ConclusionsWe have systematically identified and assessed guidelines on preterm birth. High-quality guidelines will inform a national best practice guide for use in Taonga Tuku Iho, a knowledge translation project for equity in preterm birth care and outcomes in Aotearoa.

Text4Hope: An e-Mental Health Tool for Mitigating Psychological Symptoms among Young Adults

IntroductionChronic stress, anxiety, and depression can interfere with young adults’ everyday function, academic achievement, and interpersonal relationships. Interventions aimed at preventing the deterioration or possibly onset of these mental disorders among young people are timely.ObjectivesTo assess the impact of a supportive text messaging program (Text4Hope) on the psychological well-being of young adults.MethodsThis study adopted both longitudinal and naturalistic controlled trial designs. Longitudinal study: compared baseline and 6th week outcomes in the same group of young adult subscribers. Naturalistic controlled study: compared clinical parameters in two groups of Text4Hope young adult subscribers: (i) intervention group (IG), subscribers who received once-daily supportive text messages for 6-weeks and completed 6th-week evaluation between 26 April and 12 July 2020, and (ii) control group (CG), subscribers who joined Text4Hope the same time frame, completed a baseline survey and were yet to receive text messages. The prevalence and severity of moderate-high stress, anxiety, and depression was measured using standardized scales. Inferential statistics, including the t-test, McNemar test, chi-square, and binary logistic regression analyses, were used to evaluate the differences in the prevalence and severity of the psychological symptoms.ResultsLongitudinal study: subscribers who completed both the baseline and 6th-week surveys, had significant reduction in the prevalence of moderate-high stress (8%) and likely GAD (20%) from baseline to six weeks. The largest reduction in mean scores was for the GAD-7 scale (18.4%). Naturalistic study: significantly lower prevalence for likely Moderate Depressive Disorder (25.2%) and suicidal thoughts/thoughts of self-harm (48.4%), with a small effect size in the IG compared to CG.Image:ConclusionsTheText4Hope program has been demonstrated as an effective e-mental health tool for mental health support for young adult subscribers. This is particularly encouraging, as young adults have already adapted to SMS text messaging and texting. Therefore, this mode of intervention can be used to supplement existing treatments for psychological problems impacting young adults. In addition, the cost effectiveness and easy scalability of supportive text message interventions mean that policymakers and governments can quickly implement similar programs as part of national youth suicide prevention strategies.Disclosure of InterestNone Declared

Mental health front-liners: Police officers’ knowledge and attitudes towards suicide in Malta

IntroductionPolice-officers are in a strategic position of providing the first immediate response to a crisis as mental health frontliners.ObjectivesIn this nation-wide cross-sectional study, we explored knowledge and attitudes towards suicide in the local police force, a crucial first step in the design and implementation of effective suicide prevention programmes.MethodsAn online, anonymous questionnaire was distributed to all local police-officers (n=2600). It contained questions about their demographics and their experience with suicide while on duty, along with 34 statements from the validated tool Attitudes Towards Suicide (ATTS) (Renberg &amp; Jacobsson. Suicide Life Threat Behav. 2003; 33 52-64), scored on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree).ResultsThe sub-scale “Suicide as a right” was positively correlated with “Tabooing” (r (201) = .25, p=&lt;.001), “Normal-common ” (r (201) = .29, p=&lt;.001), and “Resignation” (r (201) = .47, p=&lt;.001), but negatively correlated with “Incomprehensibility” (r (201) = -.26, p=&lt;.001), and “Preparedness to Prevent” (r (201) = -.19, p=&lt;.001), meaning such individuals had a more permissive attitude towards suicide. On the other hand, the subscale Preventability was found to be positively correlated with Incomprehensibility (r (201) = .21, p=&lt;.001) and Preparedness to Prevent (r (201) = .30, p=&lt;.001).Females scored higher in the sub-scale Non-communication (M=3.40, 95% CI [3.29, 3.51]) while males scored higher in Preventability (M=3.35, 95% CI [3.27, 3.44]). The higher the educational status of police-officers, the more they adopt a pro-prevention attitude to suicide (M=3.67, 95% CI [3.44, 3.89]) and the more likely they are to appreciate that suicidal thoughts and behaviour can be common (M=3.40, 95% CI [3.20, 3.60]). Participants with a mixed/different composition at home (M=4.05, 95% CI [3.86, 4.24]) and/or have experienced only between 0 to 2 situations related to suicide in the past one year alone (M=4.05, 95% CI [3.94, 4.16]), were the most likely to feel prepared to prevent suicide.Conclusions This study brings out different attitudes police-officers hold towards different aspects of suicide, influenced by their gender, educational background, personal life at home and total exposure to suicide during their career. Training programmes can help improve their knowledge and attitudes towards suicide, leading to a more positive behavioural response to individuals in crisis and create a safer environment. Malta, through an EU-funded programme, is currently investing its resources on drafting a national suicide prevention strategy, and such educational opportunities for our frontliners will ensure we have the right tools in screening, identifying, treating, and saving more lives.Abbreviations:M: Mean score; CI: Confidence IntervalDisclosure of InterestNone Declared

Statistical model of the dynamics of suicides in ukraine before a full-scale war

IntroductionThe problem of suicides is one of the most critical problems of the public health care system. In Ukraine, official data on the number of deaths and their causes were released by the State Statistics Service only in 2021, on the eve of a full-scale military invasion. This made it possible to conduct statistical analysis and build a mathematical model of the seasonal dynamics of suicidal activity in Ukraine.ObjectivesDevelop a statistical model of the dynamics of the number of completed suicides, considering regions of Ukraine and months. For this, a time series of the number of suicides from 2005 to 2021 was created, a mathematical and statistical analysis of the dynamic characteristics of the time series was carried out, and a forecast of the dynamics of the number of completed suicides was built.MethodsTime series analysis using autocorrelation analysis with the calculation of Leung-Box statistics and the method of seasonal exponential smoothing were applied.Results Autocorrelation of the absolute indicators of the number of completed suicides made it possible to construct correlograms for each separate region of Ukraine. In order to ensure the statistical reliability of the autocorrelation coefficients, the number of lags was equal to 50, based on the fact that k ≤ n/4, where k is the maximum number of lags, and n is the number of observations. The correlograms of the regions that characterized the built statistical model of the dynamics of changes in the number of completed suicides were clustered in the form of four groups. The calculation of the coefficient of determination indicated that a high proportion of the total variation for Ukraine as a whole (R2=0.656) and for its individual regions (R2=0.731±0.051) can be explained using the model we built, and the model itself should be evaluated as consistent. Based on the developed model, it was established that the period from March to May, July and, to a lesser extent, January is characterized by the highest number of suicides.ConclusionsThe constructed statistical model of the dynamics of suicides in Ukraine is coherent and statistically reliable. It can be used for forecasting, provided corrections are made, taking into account the social changes of wartime. The study of chronobiological aspects that drew attention during the analysis is promising for further targeted scientific research and may be of practical interest for the creation of national suicide prevention programs in Ukraine.Disclosure of InterestNone Declared

A study exploring regional level predictors of suicide rates across time in Sweden

AbstractIntroductionIn Sweden, four lives are lost to suicide each day. Hence, identifying relevant risk factors to inform effective prevention strategies is key. Such strategies can range from individual (‘micro’) -level prevention methods, to broader national suicide prevention policies.ObjectivesWhilst a range of studies have explored individual-level risk factors, highlighting municipal, regional, or national-level predictors can be valuable to identify broader social and contextual determinants. This study will therefore aim to go beyond proximal predictors of suicide by looking through a wider national- and regional-level lens in Sweden.MethodsThis project will be conducted utilizing routinely collected and publicly available data and applying longitudinal modelling to investigate potential predictors of changes in suicide rates across time in Sweden. More specifically, the study will explore whether regional data on economic (e.g. proportion of state benefit recipients), socio-demographic (e.g. educational level) and healthcare related variables (e.g. trust in the healthcare system) are associated with suicide rates over time.ResultsThis is an ongoing project and results will be available and presented at the time of the conference.Conclusions Utilizing publicly available data to explore potential predictors of suicide rates is not only cost-effective, but adding such findings to existing knowledge of individual-level risk factors can also be important when targeting wider policy and ensuring effective coordination and implementation of regional suicide prevention strategies.Disclosure of InterestNone Declared

State-Level Firearm Laws and Firearm Homicide in US Cities: Heterogenous Associations by City Characteristics.

Despite well-studied associations of state firearm laws with lower state- and county-level firearm homicide, there is a shortage of studies investigating differences in the effects of distinct state firearm law categories on various cities within the same state using identical methods. We examined associations of 5 categories of state firearm laws-pertaining to buyers, dealers, domestic violence, gun type/trafficking, and possession-with city-level firearm homicide, and then tested differential associations by city characteristics. City-level panel data on firearm homicide casesof 78 majorcities from 2010 to 2020 wasassessed from the Centers for Disease Control and Prevention's National Vital Statistics System. We modeled log-transformed firearm homicide rates as a function of firearm law scores, city, state, and year fixed effects, along with time-varying city-level confounders. We considered effect measure modification by poverty, unemployment, vacant housing, and income inequality. A one z-score increase in state gun type/trafficking, possession, and dealer law scores was associated with 25% (95% confidence interval [CI]:-0.37,-0.1), 19% (95% CI:-0.29,-0.07), and 17% (95% CI:-0.28, -0.4) lower firearm homicide rates, respectively. Protective associations were less pronounced in cities with high unemployment and high housing vacancy, but more pronounced in cities with high income inequality. In large US cities, state-level gun type/trafficking, possession, and dealer laws were associated with lower firearm homicide rates, but buyers and domestic violence laws were not. State firearm laws may have differential effects on firearm homicides based on city characteristics, and city-wide policies to enhance socioeconomic drivers may add benefits of firearm laws.