Non-communicable Diseases Research Articles

Diabetes mellitus EU comorbidity index: using data from EHIS 2019 and GBD disability weights

Abstract Background Individuals with diabetes mellitus (DM) exhibit several of comorbidity burdens, with lower perceived quality of life also being a factor. Literature on the impact of DM is available, including studies on the index devised by (A. Andreella et al., 2023) for the assessment of comorbidities of health conditions. This study aims to adapt and validate this index for use as a standardized DM comorbidity index within the EU. Methods A cross-sectional study was carried out using microdata from the European Health Interview Survey (EHIS) 2019. The study included adults aged 25 years or older who reported having DM (n = 20,042) from 27 EU member states. Comorbidity index was calculated to assess the comorbidity of having 9 non-communicable diseases using disability weights obtained from the Global Burden of Disease 2019 and self-perceived general health using multiplicative approach. Beta regression analysis was used to evaluate the association between comorbidity index and several demographic, socioeconomic and lifestyle variables. Comorbidity index was calculated for each nomenclature of territorial units for statistics (NUTS 2). Results The comorbidity index ranged from 0.049 to 0.993. The results indicated that having a higher education and residing in urban areas were less likely to have a high comorbidity index. Being unemployed or in other employment statuses demonstrated a significant, positive association with the index. Income exhibited a gradual, positive association with each quintile, while consuming fruits and vegetables less than once a week was found to be associated with an increased index. The highest comorbidity index was observed in Calabria (Italy), followed by Lubuskie (Poland), and the lowest was observed in Antwerp (Belgium), followed by Övre Norrland (Sweden). Conclusions By identifying comorbidity burden, targeted interventions and regional-specific strategies can be implemented to improve the quality of life for individuals with DM. Key messages • Quantifying the burden of comorbidities allows understanding of health status of DM patients. • Comorbidity index shows geographic variation in the EU which contributes to tailored policy interventions.

3.X.1. Health literacy in Europe: Building a comparative database for shaping public health policy

Abstract Health literacy (HL) is a key determinant of health and a lever for health equity. It refers to the extent to which individuals are able to deal with health-related information, communicate with health professionals, and navigate the health care system to restore, maintain, protect, and improve their health and well-being. It is the result of an interplay between personal motivation, individual competencies and the health information and service environment. HL is strongly related to health behaviors and issues such as obesity, the social determinants of health, and the use of health systems, which have been under pressure since COVID-19. The development and implementation of targeted public health interventions to promote HL in the European Region require reliable and comparable data on population HL to identify the main HL challenges and the most affected population groups. The WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) has started monitoring population HL and conducted the first M-POHL Health Literacy Survey (HLS19) in 17 countries in the WHO European Region between 2019 and 2021. In preparation for the 2nd M-POHL Health Literacy Survey (2024-2026; HLS24), the HLS19 instruments were further improved and supplemented by a new measure on mental HL. These instruments are also of interest to the European Joint Action PreventNCD with its specific task on HL and non-communicable diseases (7.4). The workshop will provide insights into the M-POHL HLS24, the largest HL survey in Europe, and the HL instruments used. It consists of four presentations, one describing the M-POHL HLS24 project and three on specific HL instruments used to assess different aspects of HL in the European general population: HLS24-DIGI for digital HL; HLS24-COM-P for communicative HL; HLS24-NAV for navigational HL. Each presentation will describe the revised item set and results from pretests. We invite the audience to ask questions and to engage in a (cross-cutting) discussion with the presenters. Expected impact: The presentations will provide a comprehensive overview of the advanced family of instruments used in the HLS24 study, their quality, and the expected HL data for Europe. They will provide a deeper understanding of how HL will be measured in the M-POHL HLS24 project. Key messages • The advanced family of HL instruments used in the M-POHL HLS24 project enables comprehensive HL monitoring in Europe. • The data collected in HLS24 will provide a solid database for shaping public health policy to strengthen population HL and promote health equity in Europe.

Barriers to Personalised Prevention: Perspectives from a Multi-Stakeholder Consultation

Abstract Background The high and increasing burden of Non-Communicable Diseases (NCDs) demands a healthcare shift towards prevention. Personalised preventive interventions (PPIs) that consider biological, sociocultural, environmental, and behavioural characteristics of individuals, are not as widely adopted as other personalised medicine approaches. To identify the main barriers and gaps that are hindering the adoption of PPIs in healthcare systems, we consulted a wide range of European stakeholders, including health professionals, policy makers, citizens and patients, and researchers. Methods The consultation process included experts’ interviews and an online survey, taking place over 10 months in 2023/2024. Interviews were analysed using qualitative Thematic Analysis. The online survey development was based on the barriers identified by the interviewed experts, complemented with findings from the literature. Respondents scored their level of agreement/disagreement using a 6-point Likert scale. Descriptive statistical analysis was performed. Results A total of 26 semi-structured interviews and 270 complete surveys were obtained. Overall, the main barriers highlighted were: 1) Health systems strategies are geared towards curative care and not prevention. 2) Awareness and understanding of the concept of PPIs is low. 3) There is a lack of basic and life-long training for health professionals on PPIs; 4) There is insufficient evidence for PPIs to raise the necessary policymakers’ interest. 5) Health literacy of citizens and patients is low. 6) There is insufficient prevention research, evidence of cost-efficiency and regulation procedures for translation into health practice. Conclusions Identified barriers are interconnected and the challenges extend beyond prevention to personalized medicine interventions. Collaborative efforts are needed to elevate visibility and engage stakeholders, facilitating integration of PPIs into healthcare systems for widespread adoption. Key messages • This consultation offers valuable insights on challenges that need to be addressed to enable the integration of PPIs into healthcare and reduce the burden of NCDs. • Investments in disease prevention and PPIs should stand as a global key priority.

Physical activity and sedentarism among non-binary gender identified university students

Abstract Background Physical inactivity (PA) and sedentary behavior (SB) are modifiable risk factors for non-communicable diseases (NCDs). Data indicates that non-binary gender identified people find it difficult to perform PA, this is a disadvantage for them to reach their full health potential. Methods Students were selected by convenience sampling to complete a survey between October-November 2023. A validated PA questionnaire was included. PA and SB were classified into 4 levels: Active but sedentary, extremely sedentary, physically active and discreetly active. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results Out of 32 students did not identified themselves as binary gender. In our sample, 28,1% (vs 12.9% binary students) don’t do PA. Of those doing PA, 52,2% don’t meet World Health Organization recommendations. Among those who perform PA, there no difference in the amount of minutes/week of moderate or intense physical activity performed. Regarding SB, 93,8% spend >6 hours/day in SB (vs 84.7% binary students, mean 7,82 vs 8,75, Sg. 0,032). When grouped into PA/SB categories 65,6% (vs 40,5%) were extremely sedentary in contrast to 1,4% physically active (vs 8.8%). Conclusions In Spain, 1 in 4 young people does not identify with the male/female categories. In our sample, physical inactivity and sedentarism are higher among those who do not identify as male/female. Once they commit to physical activity, there is no difference in the time spent between those who meet the WHO recommendations. More research is needed to understand the reasons for these differences and ensure barrier-free access to healthy lifestyle habits on campus. Key messages • Non-binary gender identified students are less physically active and more sedentary than their peers. • Once they commit to physical activity recommendations, there are no differences among their performance.

Metabolic syndrome prevalence has increased in Finland from 2000 to 2023

Abstract Obesity presents a metabolic burden that leads to increased non-communicable disease (NCD) morbidity with metabolic syndrome (MS) as a pathway. The aim was to examine the trends in the obesity and MS prevalences. The study included health examination survey data collected in 2000 and 2023 (n = 7 258, 20-64 years). Examination measurements, blood samples, questionnaires, and register data were collected. MS criteria (ATPIII/AHA) included at least 3 of the following: increased waist circumference, elevated fasting glucose or medication, elevated triglyceride or medication, elevated blood pressure (BP) or medication, and decreased HDL-cholesterol or medication. Participants were divided according to BMI (normal weight 18.5-24.9 kg/m2, overweight 25.0-29.9 kg/m2, obesity 30.0-34.9 kg/m2, severe obesity = >35.0 kg/m2). Weighted prevalence and 95% confidence intervals (CIs) of MS and obesity were calculated considering sampling design and non-response. Prevalences of normal weight decreased from 2000 (men 32%, 95% CI 30-35; women 45%, 95% CI 43-47) to 2023 (men 26%, 95% CI 23-28; women 34%, 95% CI 32-37) and obesity increased from 2020 (men 17%, 95% CI 15-18; women 15%, 95% CI 14-17) to 2023 (men 20%, 95% CI 18-22; women 18%, 95% CI 16-20) as did severe obesity (in 2000: men 4%, 95% CI 3-5; 6%, 95% CI 5-7 - in 2023 men10%, 95% CI 8-12; women 13%; 95% CI 11-14). The prevalence of MS increased from 37% (95% CI 34-39) to 45% (95% CI 43-48) in men and 30% (95% CI 28-32) to 37% (95% CI 34-39) in women. The prevalence of MS with obesity varied from 2000 to 2023 from 73-77% in men and 69-61% in women and with severe obesity from 88-91% in men and 79-76% in women. From 2000 to 2023, no MS components remained stable with normal weight (men 29-25%, women 44%) and obesity (both sexes <1%). The prevalence of MS has increased in the last 20 years. Obesity is a major risk factor for MS that increases the future burden MS and, consequently, of NCD on societies. Key messages • Metabolic syndrome has increased in Finland from 2000 to 2023. At the same time, the prevalence of those with normal weight has decreased and severe obesity increased. • The global obesity pandemic will further increase the burden of NCD’s in the future. This is already visible with increasing metabolic syndrome prevalence.

7.I. Skills building seminar: Beyond the jargon: an interactive workshop for effective risk communication

Abstract Risk communication plays a central role in epidemiology to provide information for disease surveillance and outbreak control. It is one of the of the eight core functions that WHO Member States must comply with as part of the International Health Regulations (2005) ensuring national and global preparedness for health threats. It refers to the timely and accurate exchange of information between public health experts or authorities and individuals who are confronted with a threat to their survival, health, economic or social well-being. At its core, risk communication is about empowering people exposed to a risk to make well-informed decisions in order to mitigate potential risks and adopt preventive actions and measures. Risk communication considers political, social, and economic factors; it analyses risk and risk perception; and it places a great emphasis on dialogue with impacted and targeted populations to help them make the best decisions they can. Therefore, it requires an understanding of stakeholders’ perceptions, concerns, and beliefs, as well as their knowledge and practices. In the context of the COVID-19 pandemic, the need for effective and efficient risk communication has become even more evident than before. Risk communication should be able to recognise and deal with rumours and disinformation, and reach the most vulnerable groups, who have a higher risk of contracting the virus and suffering from COVID-related consequences. Lately, increasing attention has been given to this topic. The WHO set-up, in April 2023, a technical Advisory Group for Risk Communication, Community Engagement and Infodemic management (TAG-RCCE-IM) to provide independent review and technical advice in the context of emergency preparedness and response in Europe. The Joint Action PreventNCD aims to also build a framework for country-specific communication strategies for non-communicable diseases (NCD) patients in health crises in one of the Work Packages, by collecting and analysing health communication strategies in different European countries targeting NCDs. In this interactive skills-building seminar, we will share with the participants the knowledge, skills, and process of effective risk communication by using case studies from experts in the field. The session will start with a presentation on the core elements of risk communication followed by examples from the field. This workshop will foster an inclusive interactive environment where participants will hear from panellists sharing their experiences from different settings such as international organisations and national public health institutes. Participants will be split into groups and will be provided with a piece of scientific output, such as a research study or epidemiological report and encouraged to translate this technical message into a clear, concise message that can effectively communicate the key points to the general public. Key messages • Risk communication is essential to fight disinformation while empowering the public to make informed decisions related to their health and well-being. • Epidemiologists and researchers should be encouraged to employ efficient and targeted communication strategies when disseminating their findings. Speakers/Panelists Stefan Schaub Bundeszentrale für gesundheitliche Aufklärung (BZgA, Cologne, Germany Federica Rossetti Sciensano, Brussels, Belgium Stefan Adrian Voinea WHO/Europe, Copenhagen, Denmark

Climate Change Impacts on Respiratory Health: Bridging Inequalities in Children and Adults

Abstract Respiratory diseases rank as the third leading global cause of mortality, with climate change exacerbating their prevalence and severity. Wild fires, floods, extreme heat events, infectious diseases, urban air pollution and aeroallergen exposure contribute to respiratory health deterioration. Vulnerable populations, including individuals with pre-existing lung conditions and children, bear a disproportionate burden of these effects. We centrepiece the connection of climate change to respiratory health inequalities, while bridging the evidence gap regarding increasing extreme heat and cold events, ambient and indoor air pollution exposure with significant ramifications on respiratory health. Specifically, we will showcase research on the tailored, multidisciplinary NCD prevention package named FRESHAIR4Life, targeting air pollution exposure in mid- to late adolescents from disadvantaged populations. Given the high burden of non-communicable diseases (NCDs) and air pollution exposure as major contributors, urgent preventive interventions are required, particularly in disadvantaged populations. Initiating preventive interventions during adolescence is considered an optimal window of opportunity for long-term health benefits. Furthermore, we will present a robust evidence base delineating climate change’s impact on lung health among vulnerable European populations. We will discuss how narratives on climate-induced lung health issues are co-created with affected communities and stakeholders to facilitate policy translation. The aim of these presentations is to break silos among health professionals, fostering collaboration from the respiratory community to the public health community. Through lung health collaborations we seek to deepen understanding and catalyze action to address the intersection of climate change, respiratory health, and inequalities, ultimately working towards a healthier and more equitable health for all.

COMPLICAÇÕES CRÔNICAS DO DIABETES MELLITUS TIPO 2

Diabetes mellitus is defined as a chronic non-communicable disease (NCD), being a syndrome characterized by persistent hyperglycemia, resulting from metabolic disorders, which may occur due to the destruction of insulin-producing beta cells or resistance to insulin action. The increase in plasma glucose occurs due to defects in the secretion and/or action of insulin produced by the pancreas, and can be subdivided into three main types: Type 1 Diabetes mellitus (autoimmune), Type 2 Diabetes mellitus (insulin resistant) and Diabetes gestational mellitus. Diabetes is characterized by multiple complications, acute and chronic (divided into microvascular and macrovascular), which constitute an important cause of early mortality. Chronic microvascular complications are associated with specific injuries caused by difficulty in passing blood to the endothelium. This obstruction occurs due to chronic hyperglycemia that triggers endothelial inflammation, resulting in the production of advanced glycolysis products, leading to oxidative stress, inflammation and the appearance of microthrombi, making this passage difficult. Macrovascular complications, in addition to hyperglycemia, are also related to problems such as dyslipidemia, systemic arterial hypertension and smoking. Such factors can lead to stroke, acute myocardial infarction and peripheral arterial obstructive disease. This work proposes a critical review of the existing literature on the chronic complications of Type 2 Diabetes mellitus, highlighting screening, prevention and treatment measures. It is concluded that technical and clinical knowledge about the pathophysiology and alternative interventions is essential for the immediate and comprehensive care of patients with Type 2 Diabetes mellitus, as well as the prevention of its chronic complications.

Mothers to Babies & Art of Creation: Canadian stakeholder engagement during intervention development

Abstract Background The 2021 British Medical Research Council framework, outline that effective development of interventions requires engagement of diverse stakeholders. In practice, however, engaging stakeholders in health intervention development often receives insufficient investment. The Mothers to Babies (M2B) Study and its linked Art of Creation (AoC) Intervention Project comprise a joint case study in prioritizing stakeholder engagement. Methods From 2016 to 2019, our M2B team dedicated its financial and personnel resources to assessing community health priorities for preventing non-communicable diseases (NCDs) in Hamilton, Canada. Motivated by a “first 1000 days” approach (i.e. health environments through pregnancy and infancy have outsized impacts on NCD risks across a child’s life), we worked with stakeholders to identify acceptable, feasible complex intervention strategies supportive of health behaviours among pregnant Hamiltonians. To this end, we surveyed 434 pregnant people of diverse backgrounds and ran focus groups, interviews, and meetings with 69 stakeholders with diverse orientations to pregnancy and family health provision. Results M2B’s work indicated two areas actionable through a complex, behavioural intervention: 1) lack of knowledge about the first 1000 days, and 2) need for platforms for peer support and empowerment. These themes were centred in the development and the stakeholder-engaged implementation/evaluation of the ongoing AoC intervention study. AoC uses outreach through local cultural institutions and arts-based workshops to facilitate understanding of the first 1000 days. AoC increases participants’ knowledge of the first 1000 days, supports social relationships among participants and is enjoyable and empowering. Conclusions Investing three years and dedicated personnel to stakeholder engagement by M2B yielded the development of AoC, a complex health promotion intervention that fits the diverse priorities of Hamilton communities.

Physical activity promotion as intersectoral planning in Milan Health Protection Agency

Abstract Issue/problem Physical activity is a protective factor for preventing Noncommunicable diseases (NCDs) and, for this reason, it plays an important role in all the different guidelines for prevention and health promotion. The Italian Regional Prevention Plans and in particular the Lombardy one promote physical activity with a systemic approach, through both upstream and downstream actions to encourage the role of communities. Description of the problem Based on the regional plan, the Health Protection Agency (HPA) of the Metropolitan City of Milan developed locally validated actions and best practices for the promotion of physical activity, through the cross-sectoral involvement of different stakeholders (health system, companies, universities, local authorities, sports associations, etc.). Results Physical activity is embedded in all lines of health promotion activities in local planning documents. Sustainable and active mobility activities have been implemented in companies and schools with a comprehensive approach. Validated regional programs (Pedibus, Walking Groups, ecc.) have been implemented in the local community, along with the construction of permanent local laboratories for physical activity, structured through the development of specific territorial networks and providing for integration with the socio-sanitary setting. Lessons Promoting physical activity becomes an opportunity to both consolidate territorial networks and to develop evidence-based health promotion actions able to meet the different health needs of the population and to produce a structural change in living contexts. Key messages • Physical activity is both a protective factor for health promotion and a tool for implementing intersectoral and equity-oriented system actions from a life-course perspective. • Promoting physical activity becomes an opportunity to consolidate territorial networks.

Healthy design strategies to promote Urban Public Mental Health, according to the contemporary cities’ climate resilience and the SDGs’ challenges

Abstract According to the “Urban Health Rome Declaration” at European meeting “G7 Health” that defines the strategic aspects and actions to improve Public Health into the cities, and referring to the Agenda 2030 in which the 11th SDG argue about “Sustainable Cities and Communities. Make cities and human settlements inclusive, safe, resilient and sustainable”, one of the most expressive syntheses of the challenging relationship between urban planning and Public Health is stated by WHO (2016): “Health is the precondition of urban sustainable development and the first priority for urban planners”. Referring to the Healthy Cities & Urban Health definitions, we can consider Public Health not merely an aspect of health protection and promotion, but an individual and collective condition, strongly influenced by the environmental context and by the strategies implemented by local Governments. The “Health in All Policies” strategy, clearly underlines how health doesn’t depend only on the supply of healthcare services, but also, on the quality of outdoor and indoor living environments. Aim of the Presentation 3 is the share the findings of a literature review about the link between the urban contexts’ morphological and functional features; the results are divided into: 14 Health Outcomes, representing the main Non-Communicable Diseases (NCDs) whose come from the urban environment’s quality and by the adoption of healthy lifestyles; 8 types of Environmental Risk Factors (Urban Heat Island Effect; soil/air/acoustic/light pollution; vehicular traffic; Safety & Security; weak attractiveness of places); and 14 Healthy Urban Planning Strategies (green/blue/grey infrastructures; biodiversity protection; adverse meteoric events management; public transport systems; vehicular traffic reduction; pedestrian and cycling paths; social and functional mix; urban solid waste’s management; renewable energy and efficiency; outdoor spaces lighting; Design for All).

Regional variation in incidence and mortality due to hypertension in Sao Tome and Principe

Abstract Background The analysis of incidence and mortality due to hypertension (HT) provides statistical data for addressing public health programs, particularly in low-income countries where poor health systems impose constraints to address non-communicable diseases (NCDs). This study aims to assess the geographic pattern of incidence and mortality due to HT in Sao Tome and Principe (STP). Methods This is a descriptive ecological study. Aggregated data on new cases of and deaths due to HT by gender, age-group and district (2022-2023) were extracted from the Health National Database (STP Ministry of Health). Age-standardized incidence and mortality rates (ASIR and ASMR) and respective 95% confidence interval (95%CI) were obtained. Mortality-to-incidence ratio (MIR) was computed by district (lower values indicate better quality of care). Comparison between districts was done through standardized incidence ratios (SIR) and respective p-value. Analyses were stratified by gender. Results ASIR and ASMR per 100,000 were, respectively, 1168.9 (95%CI:1103.3-1237.6) and 76.8 (95%CI:62.0-96.2) among men and 2460.6 (95%CI:2365.0-2559.0) and 99.7 (95%CI:81.4-121.6) among women. Incidence of HT was significantly higher than expected (p < 0.001) in Agua Grande, Caue and Lemba with SIR varying from 122.8% (Agua Grande) to 201.1% (Caue) in men and from 125.1% (Lemba) to 224.1% (Caue) in women. Instead, Mé-Zochi presented much lower incidence than expected for both, men (SIR=43.1%;p<0.001) and women (SIR=38.4%;p<0.001). Large differences between districts were observed in MIR, varying from 0% (Caue and Lobata) to 84% (Mé-Zochi) in men and from 0% (Lobata) to 57% (Mé-Zochi) in women. Conclusions According to our findings there is, not only, a high incidence rate of HT, but also regional variation in this rate, deserving particular attention from policy-makers. Regional variation in hypertension incidence could be partially explained by differences in the quality of healthcare services. Key messages • Awareness should be given to the high incidence of hypertension demanding preventive strategies in the field of public health. • Public health strategies should address the quality of care in regards to the prevention, diagnosis and monitoring of hypertension.

Wine Phenolic Compounds: Chemistry, Functionality and Health Benefits

Wine phenolic compounds, often known as polyphenols, are a diverse group of secondary bioactive compounds derived from grapes. They play a crucial role in defining the sensory characteristics, functionality, and health benefits of wine. This review explores the complex chemistry of these compounds, focusing on key classes such as flavonoids, which include flavanones, flavonols, anthocyanins, and flavan-3-ols, and non-flavonoids, such as hydroxycinnamic acids, hydroxybenzoic acids, and stilbenes. The health benefits of wine phenolics, particularly their antioxidant and anti-inflammatory properties, are also discussed in relation to preventing and reducing the risk of non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, and neurodegenerative conditions. Furthermore, this review summarized the most current data from human population-based research that investigated the bioactivity of these red wine phytochemicals with relevant health benefits for NCDs. Finally, this review proposes some perspectives for future research to better understand the bioavailability, metabolism, and long-term health effects of these compounds.

8.H. Scientific session: Coordinated actions to improve our response to Long COVID at EU and national levels

Abstract The COVID-19 pandemic still has very real and far-reaching consequences for European citizens, healthcare systems and economies. It has been estimated that approximately 10%-20% of people that were infected by SARS-CoV-2, develop Long COVID. Countries within the European Union and elsewhere have been responding to Long COVID in various ways. Some countries initiated a more extensive response to Long COVID, including the creation of multidisciplinary Long COVID clinics. In other counties, Long COVID should be addressed within existing infrastructures within the health care system, which can be hampered by the siloed approach of how services for people with chronic conditions is organised. Moreover, a coordinated and uniform response to Long COVID is complicated by the fact that there is a large variety of terms and definitions of Long COVID and the fact that long COVID symptom are often similar to symptoms of other diseases, thus hampering specific characterisation of patients. While substantial progress has been made in understanding Long COVID we still need more answers about its causes and the most effective treatments. It is also important to understand the impact that Long COVID has on individual lives of those who are being affected - and their families - as well as on societies as a whole. The session aims to take stock of a number of recent insights relating to Long COVID, also with the purpose to identify opportunities for a more coordinated and harmonized approach towards Long COVID at national and international levels. The session will provide room for discussions and engagement with the audience, allowing to help inform future policy agendas. As such, better ways to understand and address Long COVID can also be beneficial for health systems as a whole, given the parallels with how services are provided and policies are set up to address other chronic (non-communicable) diseases. Key messages • Long COVID is still poorly understood, in part relating to the complexity of the condition, also having considerable impacts on individuals and societies. • A more harmonised response can help improve the manners to address it, this to support those still suffering from this long term impact of the COVID-19 pandemic.

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.

An update on the concept and importance of health literacy in young people

Abstract The burden of non-communicable diseases is a growing public health crisis that requires immediate action. As health literacy (HL) has been strongly linked with health behaviours and health outcomes, it has many potential implications for health care and health education. Although recent research has emphasised the importance of developing HL early in life, much of the research has focused on understanding and improving HL in adult populations. As young people socialise in different contexts and are exposed to different health-related situations, they require different HL competencies. As part of a wider project, this study aims to gather the perceptions of international academics and community-based practitioners on the concept and importance of HL in and for young people. Specifically, the study aims to (i) explore current understandings of the concept of HL in young people; (ii) examine the importance of HL for young people; (iii) identify those at risk of having low levels of HL; and (iv) determine the specific health behaviours that young people are currently struggling with. A stakeholder mapping exercise was used to recruit academic and community-based practitioners to take part in a one-to-one interview (n = 29). Reflexive thematic analysis was used to analyse the data. The preliminary findings suggest that HL is a very broad yet individualised concept that is critical to develop at an early age given the difficulty young people face in adopting healthy behaviours in their social and physical environment. Furthermore, the participants highlighted that minority groups, such as members of the travelling community and refugees, and those from low socioeconomic populations, are at greatest risk of low HL. Finally, the health issues that appeared to be of most concern in young people were vaping, social media use and poor mental health. These findings can be used to inform appropriate interventions and policies to target the HL of young people. Key messages • Health literacy is a very, yet individualised, concept that is critical to develop given the difficulty young people face in adopting healthy behaviours in their social and physical environment. • Minority groups, such as members of the travelling community, refugees, and those from low socioeconomic populations are at greatest risk of low levels of health literacy.

Reducing obesity and overweight: Subregional Policy Dialogues in the WHO European Region

Abstract In the WHO European Region, obesity and overweight stand as leading causes of disability and premature mortality. They contribute significantly to the burden of noncommunicable diseases, hindering efforts to achieve sustainable development goals related to health, including SDG goal 3.4, aiming to reduce premature mortality from NCDs by one-third by 2030. Despite some policy successes such as sugary drinks taxes, restrictions on marketing unhealthy products to children, and physical activity promotion campaigns, no country has managed to halt the rising levels of obesity. Addressing obesity requires a comprehensive approach, and WHO endeavors to support countries in implementing a wide range of policy actions across various settings. The WHO Special Initiative for NCDs and Innovation has recently adopted a subregional approach to promote evidence-based, data-informed policy action. In June 2022, it organized a series of obesity dialogues, including sessions for the Western Balkans. This session will outline the methods and outcomes of these dialogues, including stakeholder engagement, presentation of the latest obesity data, evidence-based policy recommendations, and the process of prioritizing policy options with decision-makers. It will consider the lessons learned from this process, offering insights not only for the health agenda but also for addressing other complex public health, environmental, or social challenges, which require multisectoral collaboration and comprehensive, policy actions on many levels.

The Workplace Health Promotion project in an Italian manufacturing

Abstract Introduction The Workplace Health Promotion (WHP) program aims to improve employee’s health and well-being in the workplace by intervening in lifestyles. The objective of our study was to assess the impact of the WHP promoted by the Local Health Authority Tuscany South-East at a manufacturing. Methods The program was set at the STOSA Company in Radicofani (Siena, Italy) between 31 May 2017 to 31 December 2021, with a one-year interruption due to the COVID-19 pandemic. Based on an assessment of the workers’ health status, we identified nutrition and fighting smoking as areas of intervention. The WHP project was integrated into the company policy and targeted all staff. Evaluation of interventions was conducted using an anonymous paper questionnaire (Regional Decree no. 1565, Annex 3) administered in three moments: at the beginning of the project (T0), one year later (T1), and at the end (T2). We conducted a descriptive and inferential analysis (chi-square test) with R. Results We collected 131 (T0), 136 (T1), and 123 (T2) responses. The cohort is composed entirely of males (T0 M:F 122:8, T1 130:6, T2 109:14). The median age is 40 years (SD 8.24 (T2)). There is a statistically significant difference in the perception of health status by education (p<.001), type of work (p<.001), smoking habit (p<.001), and the change in smoking habit (p<.001). The whole sample positively evaluated the interventions on nutrition and fighting to smoke. Moreover, the entire sample reported improvements in their diet since the beginning of the project. Conclusions The COVID-19 pandemic caused difficulties in carrying out the project and possible changes in workers’ lifestyles. However, positive outcomes were observed in the targeted areas. The company has evaluated positively the WHP’s project and decided to maintain the good practices acquired. Key messages • The workplace represents a privileged setting to promote healthy lifestyles and prevent non-communicable diseases. • Collaborations between health authorities and other sectors are strategic to reach the general population.

Exploring vocal biomarkers as non-invasive fine-tuning assays of cardiovascular health: heart failure model

Abstract Background Mobile health (mHealth) technologies offer a promising avenue for non-invasive heart failure monitoring through vocal biomarkers. The relationship between feature changes in anonymous and standardized voice recordings of heart failure patients and the NYHA scores of the same patients is assessed, aiming to identify vocal biomarkers as delicate indicators of chronic noncommunicable disease progression and/ or fluctuation. Methods In a cardiology outpatient setting, 55 chronic heart failure patients provided voice recordings via a mobile app, performing specific vocal tasks prospectively. We analyzed waveforms visually via Mel spectrograms and extracting features by audio processing, focusing on chroma centroids and tonnetz measurements across 147 clinical and laboratory parameters (Mean NYHA: 2.62, SD: 0.56). Applying Ordinary Least Squares (OLS) test, we assessed the relevance of spectral bandwidth mean (0.04), spectral bandwidth std (0.00), spectral roll-off std (0.011) between NYHA scores, given each p-score < 0.05. Results 147 voice recordings taken from 55 patients were analyzed to examine whether there were any correlations between changes in the voice recordings and NYHA scores. OLS test underscored the significance of spectral bandwidth mean (0.04), spectral bandwidth std (0.00), spectral roll-off std (0.011) between NYHA scores with p-value < 0.05. These findings show the potential role of multiple vocal features in reflecting heart failure progression and/or fluctuation. Analysis based on the clinical status progression from NYHA 2 to NYHA 3 over time showed notable changes in chroma centroids (mean = 0.006, std = 0.174, skew = 0.179, kurtosis = 0.205) and tonnetz (mean = 0.023, std = 0.131, skew = 0.023, kurtosis = 4.247). Conclusion This investigation highlights vocal biomarkers' potential in heart failure management, offering insights into non-invasive monitoring techniques and shows the importance of standardised recording procedures and patient engagement for data integrity. Future directions include quantifying vocal changes' correlation with clinical status and integrating additional parameters (e.g., edema, weight) to enhance predictive models for personalised care.Vocal features according to NYHA scores

Rehabilitation delivery models to foster healthy ageing - a scoping review

Abstract Background Rehabilitation is crucial for healthy ageing among older adults, who face heightened risks of non-communicable diseases, infections, injuries, and mental health issues. Yet, understanding tailored rehabilitation for this demographic remains limited. To fill this gap, we conducted a scoping review to identify rehabilitation delivery models targeting older adults’ functioning and healthy ageing. Methods We systematically searched Medline and Embase (January 2015 to May 2022) for English-language studies on rehabilitation approaches for older adults. Three authors independently screened records for eligibility and synthesized findings through quantitative and qualitative analysis. Results Among 6,933 records, we assessed 585 articles, identifying 283 studies with 69,257 participants. Six main rehabilitation delivery models emerged, with outpatient (24%) and telerehabilitation (22%) being predominant. Multidisciplinary teams (31.5%) often followed integrated care principles (30.4%). However, most studies adopted a disease-centric approach (59.0%), neglecting prevalent issues like pain, sensory impairments, incontinence, and sexual dysfunctions. Therapeutic exercises (54.1%) and self-management education (40.1%) were common interventions. Conclusions Our scoping review outlines diverse rehabilitation delivery models for older adults, highlighting gaps in addressing prevalent issues and emphasizing evidence-based strategies to promote healthy ageing. It underscores the need for systematic functional assessment and expansion of rehabilitation programs to cover prevalent health concerns. While limitations include reliance on published research and not assessing model effectiveness, this review lays groundwork for future research and innovation in rehabilitation and healthy ageing. Key messages • The scoping review identifies six rehabilitation delivery models for older adults. • The scoping review advocates for evidence-based strategies for enhancing healthy ageing through rehabilitation.