Public Health Perspective Research Articles

A chance for countries to support Ireland's world‐leading cancer warning labels for alcohol containers

AbstractIreland has regulated for all packaged alcohol products to include a health warning that states that ‘there is a link between alcohol and fatal cancers’. This warning is being opposed in the World Trade Organization by 12 member states who are raising that the warning is an unnecessary barrier to trade. The World Health Organization is supporting Ireland. Countries should not oppose Ireland's warning which is defensible from legal and public health perspectives.

Rethinking Tourism Post-COVID: A Public Health Perspective

This paper examines the evolving relationship between tourism and public health in the context of the COVID-19 pandemic. It explores how tourism contributed to the spread of the virus and the subsequent impact on public health systems. The pandemic has reshaped the tourism industry, emphasizing the need for public health measures to be integrated into tourism planning and recovery efforts. This study highlights the economic implications of COVID-19 on tourism, public health adaptations, and the future of sustainable and resilient tourism practices. By rethinking tourism from a public health perspective, the paper provides insights into creating a more resilient industry post-pandemic.

How Built Environment Characteristics Influence Social Interactions During Neighbourhood Walks Among Urban Inhabitants

As an accessible and low-risk mode of transportation and recreational activity, walking both produces and is produced by socio-spatial urban features. The health benefits of walking transcend physical fitness, remaining integral to mental health and to fostering social connectedness in urban communities. Understanding what drives walking behaviour, therefore, warrants attention from a public health perspective. This qualitative case study focuses on the social interactions of inhabitants during neighbourhood walks and how built environment features influence walking patterns and experience. Using diaries, maps, and semi-structured interviews with 45 inhabitants of a mid-sized Canadian city, this research investigates the influence of permanent and temporary physical features on the perceived quality of inhabitants’ walks. The findings show the public visibility of urban modifications influences walking behaviour and improves social interactions, leading to a heightened sense of belonging and community. Inhabitant-led modifications in the urban space were mostly neighbourhood-bound and voyeuristic, whereas administrative interventions were more successful for collectivization. Both types of interventions are argued to foster social connectedness through different mechanisms, with positive impacts on inhabitants’ health and wellbeing. The findings underscore the relevance of community-led and administratively planned interventions in built environments in positioning public health policies associated with social cohesion and connectedness.

Physical Fitness and Self-Perception in Adolescents: A Public Health Perspective

Adolescence is a critical period for physical and psychological development. The relationship between physical fitness and self-perception, particularly in the context of adolescents, has garnered significant attention due to its implications for long-term health outcomes. This article explores the intersection of physical fitness and self-perception in adolescents, emphasizing the role of physical activity in shaping self- esteem, body image, and mental health. From a public health perspective, promoting physical fitness in this age group can contribute not only to improved physical health but also to better psychological well-being. The article discusses interventions, policy initiatives, and practical recommendations to support adolescents in developing positive physical fitness habits and fostering healthy self-perception.

Suboptimal health among Chinese middle school students may be associated with psychological symptoms and sleep duration: a cross-sectional survey in China.

Suboptimal health status (SHS) is an intermediate status between ideal heath and illness, it is characterized by the perception of health complaints, general weakness, decreased immunity and low energy. An increasing number of Chinese middle school students are suffering from psychological symptoms (PS), particularly anxiety and depression. The relationship between SHS and PS is unclear in adolescents. This study aimed to investigate the prevalence of SHS and the correlation between SHS and PS among Chinese middle school students and to identify the SHS-related risk factors from the perspective of public health. A cross-sectional study was conducted with the cluster sampling method among 1955 middle school students in Shantou, China. SHS was assessed by Suboptimal Health Status Questionnaire-25 (SHSQ-25). And the PS of anxiety and depression were assessed with Generalized Anxiety Disorder Scale (GAD-7) and Beck Depression Inventory-II Scale (BDI-II) self-assessment questionnaires. Variate logistic analysis was applied to explore risk factors of SHS. The relationship between SHS and PS among Chinese middle school students was subsequently analyzed. Among the 1955 participants, 1904 middle school students were finally included in the analysis, the effective response rate was 97.39%. The prevalence of SHS was 10.3% (197/1904) while the prevalence of anxiety and depression was 30.7% (585/1904) and 34.1% (649/1904), respectively. A strong correlation was identified between SHS and PS among middle school students. With the aggravation of anxiety and depression, the probability of suffering from SHS increased (both P<0.01). The scores for various dimensions of SHS among the depression and anxiety groups were higher compared to those of the non-depression and non-anxiety groups (all P<0.01 ). Multivariate regression showed that compared with sleeping less than six hours, 6-8h is a protective factor for SHS (OR = 0.486, 95%CI = 0.278-0.851). Attention should be given to SHS and PS in Chinese middle school students, as they are strongly associated. Lack of sleep is a risk factor for SHS, so sufficient sleep should be recommended to prevent it. Identifying additional risk factors and promoting adequate sleep will improve adolescent health.

Relationship between maltreatment and mental health in adolescents: A school-based study in Indonesia.

Maltreatment affects emotional development in adolescents and inhibits social adjustment. This study aimed to analyze the relationship between maltreatment and mental health among adolescents. A cross-sectional study was conducted on adolescents in the first and second grades of middle school (12-14 years old) and high school (15-17 years old) in eight cities and municipalities in the province, selected through several stages of simple random sampling (N = 1837). The International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool for Children (ICAST-C) questionnaire for detecting maltreatment was translated, simplified, and validated by an expert based on a theoretical framework that involved pediatricians, public health, and medicolegal perspectives. The Strengths and Difficulties Questionnaire (SDQ) was used to assess emotional states. ICAST-C and SDQ scores were transformed to logit values using Rasch model analysis. Distribution frequency and linear regression were used for data analysis. The results indicated that 85.6% of adolescents aged 12-14 and 83% of those aged 15-17 experienced physical maltreatment, while 89.4% of the 12-14 age group and 82.9% of the 15-17 age group experienced psychological maltreatment. The emotional states of the two groups were 52.8% and 59.2%, respectively. There was a significant correlation between the experience of physical maltreatment and emotions among 12-14 (r1 = 0.148 (0.190-0.257)) and 15-17 years old (r1 = 0.047 (0.084-0.156)). There was a significant correlation between the experience of psychological maltreatment and emotions among 12-14 years old '(r2 = 0.191 (0.270-0.350)) and 15 to 17 years old (r2 = 0.097 (0.167-0.252)). In conclusion, physical and psychological maltreatment were correlated with mental health states among adolescent students in West Java, Indonesia.

Long-term characterization of behavior phenotypes in children with seizures: Analytic approach matters.

Behavioral problems in children with new onset epilepsies have been well established in the literature. More recently, the literature indicates the presence of unique behavioral patterns or phenotypes in youth with epilepsy that vary significantly in vulnerability and resilience to behavioral problems. This study contrasts the interpretation of behavioral risk as inferred from cross-sectional versus latent group analytic perspectives, as well as the presence, consistency, stability, and progression of behavioral phenotypes in youth with new onset epilepsy and sibling controls over 3 years. Three hundred twelve participants (6-16 years old) were recruited within 6 weeks of their first recognized seizure along with 223 unaffected siblings. Each child's behavior was recorded by parents and teachers frequently over 36 months using the Child Behavior Checklist (CBCL), and each child completed self-report measures of depression symptoms over 36 months. Measures were evaluated cross-sectionally and longitudinally to identify clusters with prototypical behavioral trajectories. Cross-sectional analyses exhibited a pattern of generalized and undifferentiated behavioral problems compared to sibling controls at baseline and prospectively. In contrast, latent trajectory modeling identified three distinct behavior phenotype clusters across all raters (parents, teachers, and youth) over baseline and longitudinal assessments. CBCL Cluster 1 (~30% of youth with epilepsy) exhibited behavior similar to/better than controls, Cluster 2 (~50%) exhibited moderate behavior issues, and Cluster 3 (~20%) exhibited the most pronounced/problematic behavior, falling into Achenbach's clinically relevant behavior range. Behavior within clusters remained stable and consistent. Teachers' and children's behavior assessments corresponded to these cluster groupings consistently over 36 months. Predictors of cluster membership include seizure syndrome type and social determinants of health. This study demonstrates the varying public health perspectives of behavioral risk in youth with epilepsy that result as a function of analytic approach as well as the presence of distinct latent behavioral trajectory phenotypes over time in youth with new onset epilepsy.

Retraction: Evaluation of sleep quality and duration using wearable sensors in shift laborers of construction industry: a public health perspective

Retraction: Evaluation of sleep quality and duration using wearable sensors in shift laborers of construction industry: a public health perspective

Heat and the city: Thermal control, governance and health in urban Asia

This special issue focuses on the under-studied but increasingly pressing issue of urban heat. Cities are getting hotter, both due to the global crisis of climate change, and the related phenomena of Urban Heat Islands, which locally amplify increased global temperatures and exposure to solar radiation. We know a great deal about how heat is affecting cities from a scientific and public health perspective. Urban studies scholarship, however, has been slower to foreground heat as a social, spatial, and political category of analysis, at least in comparison to discussions of carbon emissions and their control, energy and infrastructure, rising sea levels or flooding, and activism towards sustainability. While many of these themes also figure in this collection, our focus is on the varied phenomena of urban dwellers feeling, avoiding, suffering under, mitigating, culturally interpreting and attempting to anticipate and plan for, the reality of elevated air temperatures and solar radiation. What we call thermal control, governance, and health is the multi-level and multivalent social and material response to uncomfortable and potentially injurious temperatures, an elusive topic this special issue makes visible and constitutes what we hope will be an ongoing urban research agenda.

Integrated fuzzy decision-making methodology with intuitionistic fuzzy numbers: An application for disaster preparedness in clinical laboratories

Society is on constant alert due to the increasing frequency and severity of Seasonal Respiratory Diseases (SRDs), posing significant challenges from both a humanitarian and public health perspective. The recent COVID-19 pandemic has tested the capacity of clinical laboratories to address seasonal infections, epidemic outbreaks, and critical emergencies. This scenario has led to operational burdens, primarily from resource limitations, a lack of proactive planning, and the low adaptation to unforeseen circumstances. Coupling different data-driven approaches considering multi-criteria weighting, interdependence assessment, and outranking are critical for devising effective interventions upgrading the operability of clinical labs during SRDs. Nonetheless, a deep literature review revealed there are no studies using these hybridized approaches when addressing this problem. Consequently, this article proposes the application of an innovative hybrid Multicriteria Decision-Making (MCDM) methodology that integrates the Intuitionistic Fuzzy Analytic Hierarchy Process (IF-AHP), Intuitionistic Fuzzy Decision Making Trial and Evaluation Laboratory (IF-DEMATEL), and Combined Compromise Solution (CoCoSo) to assess the disaster preparedness of clinical laboratories during SRDs. Initially, we applied IF-AHP to assign the relative weights to criteria and sub-criteria, considering the inherent hesitation and uncertainty in decision-making. Subsequently, IF-DEMATEL was utilized to analyze the interrelationships between criteria, providing insights into the interrelations among clinical lab disaster management drivers. Finally, the CoCoSo method was applied to estimate each lab’s Preparedness Index (PI) and detect response gaps when coping with SRDs. The suggested methodology was validated across nine clinical laboratories in Colombia during the most recent respiratory pandemic. This study contributes to the healthcare sector authorities by identifying key criteria and sub-criteria affecting the response of clinical labs, the elicitation of main response drivers in clinical labs when facing SRDs, and the calculation of a multidimensional indicator representing the preparedness of the labs. This work also enriches the literature by applying the IF-AHP, IF-DEMATEL, and CoCoSo approach to a challenging case study requiring a multi-method data-driven application. Furthermore, it suggests future directions to improve the proposed framework in other related contexts.

Predictors for psychosocial consequences of screening for liver diseases in Germany: a LASSO approach

Abstract Background Medical screening is extensively used across various disciplines for early disease detection and prevention of severe progression aiming to reduce disease-specific burden, improve quality of life and promote health. However, screening is debated due to unclear evidence of its overall benefits from a public health perspective. Screening is associated with improved health behavior and cost-effectiveness. However, studies identified adverse effects of screening like psychosocial burden. Most results originate from cancer screening and it is unclear whether they are transferable to other contexts. Within a research program, a systematic screening procedure to detect patients with liver cirrhosis at early stage in an asymptomatic general population was evaluated. In this study, we aimed to identify patient characteristics that predict and explain variance in psychosocial outcomes of screened patients. Methods This study analyzed data from 523 participants who underwent a systematic liver disease screening in Germany from Jan 2018 to Feb 2021. We used bootstrapped LASSO regression with 10-fold validation to evaluate the influence of various predictors on the outcomes measured by the Psychological Consequences of Screening Questionnaire (PCQ). The constructs measured by the PCQ are social, physical and emotional dysfunction associated with screening. Results We identified lower severity of comorbidities, higher subjective social status, stronger social support, older age, better critical health communication skills and higher health literacy as relevant predictors of lower psychosocial dysfunction, indicating their protective role in preventing psychosocial burden of screening. Conclusions From a public health perspective, medical screening offers should take into account patients’ individual context regarding their subjective social status, health impairments, personal social networks and health literacy skills to reduce post-screening psychosocial burden. Key messages • Social support, age, health literacy and higher subjective social status were positively associated with lower psychosocial consequences of liver screening. • The findings indicate that liver screening should be carried out, taking into account the individual’s situation and resources available.

Equity and diversity maturity matrix for structured diversity inclusion in the EU JACARDI project

Abstract Issue There is increasing awareness on the importance of integration of cultural and ethnic diversity perspectives to reduce prevailing health inequities effectively and sustainably. There is, however, limited experience and practical tools for systematic integration of these perspectives in public health. Description of the problem The EU Joint Action for Cardiovascular Diseases and Diabetes (JACARDI) project, conducted 11/2023-10/2027 has developed a structured and systematic approach for integrating equity and diversity perspectives in all its 142 pilots across 21 European countries. Results Equity and diversity perspectives are embedded in the harmonized stepwise methodology for pilots, supported with a practical Equity and diversity maturity matrix. The maturity matrix is based on the JACARDI 4Cs Equity and diversity explanatory framework (Critical reflection; Context and data; Co-design; inclusive and accessible Communications). The content of the matrix is divided into concrete steps related to pilot’s planning and implementation, each with three levels of maturity that aim at gauging how equity and diversity perspectives are applied in practice: Approaching, Meeting, Exceeding. Pilots are encouraged to strive for any of these three levels, considering their available resources and previous experiences in diversity inclusion. Lessons Effective and sustainable change toward more equitable and diversity inclusive practice requires seamless integration of these perspectives in other routine activities. Training and continued practical and motivational support are key for adherence to novel approaches. In addition to being a practical tool, the Equity and diversity matrix acts as a structured self-evaluation tool to monitor how equity and diversity principles are translated into practice.

Climate change perception and mental health: the public health perspective

Abstract Climate change is increasingly recognized as a critical environmental stressor with significant psychological impacts. Despite consolidated evidence describing the impact of various aspects of climate change on numerous physical and mental health outcomes, a novel and burgeoning area of research is now assessing the association between climate change perception/awareness and health. In fact, the increasing awareness of climate change and its impacts on natural and human systems is not only a matter of environmental concern but also of significant psychological importance. Awareness of climate change involves understanding its causes, foreseeing its long-term global and local impacts, and recognizing the limited window available for effective mitigation and adaptation. This level of awareness, while necessary for proactive behavior, has been linked to various psychological responses, including chronic stress, anxiety, and feelings of helplessness and despair, collectively referred to as ‘eco-anxiety.’ The association between climate change awareness and mental health is complex and mediated by various individual and social factors. As the reality of climate change becomes more integrated into the public consciousness, it is imperative to address the accompanying psychological impacts. In this presentation, the main issues related to climate change perception/awareness and mental health will be discussed through the lens of public health.

Planetary Health: a public health answer to climate change and other Anthropocene challenges

Abstract Although in the last century, humanity achieved extraordinary outcomes in terms of health, social and economic improvements, the Earth ecosystems around us suffer of high levels of degradation. This issue poses our recent public health and development gains at risk. The Anthropocene, a new geological era we are living in since mid 20th century, is indeed characterized by humanity’s dramatic impact on Earth’s biophysical conditions. Planetary Health is a relatively new field, oriented to solutions, based on transdisciplinarity and social movement, focused on analyzing and addressing the impacts of human disruptions to Earth’s natural systems on human health and all life on Earth. In this presentation, a brief overview of the main issues related to the Anthropocene in the public health perspective will be provided and new tools for the analysis of planetary health challenges will be proposed, citing relevant case studies for discussion.

Cadmium exposure and hypertension: a systematic review and a dose-response meta-analysis

Abstract Background Since the shape of the relation between Cd exposure and risk of HTN has not been previously investigated, we aimed to perform a systematic review with dose-response meta-analysis in epidemiological studies. Methods After registration of the review in PROSPERO database (ID: CRD42022382030), we searched for eligible articles in online databases using Mesh-terms/keywords related to Cd, HTN, and BP. Eligible criteria were: adult population, assessment of exposure through Cd concentrations in blood or urine, risk estimates for HTN, observational design. Whenever possible, we computed summary odds ratio (OR) with 95% confidence interval (CI) and performed a dose-response meta-analysis on overall studies and subgroups. Results We eventually included 8 articles for both the qualitative and quantitative analysis published between 2006-2023 almost of cross-sectional design, 7 and 4 assessing blood and urine Cd concentrations, respectively. Comparing the highest versus lowest exposure, we found increased risk of HTN for both blood (OR = 1.12, 95% CI 0.92-1.36) and urine assessment (OR = 1.09, 95% CI 0.94-1.28). Dose-response meta-analysis showed an almost linear increased risk for blood Cd concentrations until 1.5 µg/L above with it plateaued. In contrast when using urine concentrations for exposure assessment, risk started to increase above 0.5 µg/g creatinine. Conclusions Our results confirm the recent findings of non-linear relation between Cd exposure and risk of both CVD and diabetes and the subsequent need to lower Cd exposure on a public health perspective. Key messages • Cadmium exposure showed positive association with risk of hypertension. • Public health efforts should be implemented to lowed cadmium exposure to decrease CVD risk.

Educational achievement and health during adolescence in second generation immigrants in Sweden

Abstract Background Over the last decades, immigration have increased markedly in Sweden. Educational achievement is essential for successful integration; however, second generation immigrants have been shown to lag behind. There is a complex intertwinement between educational attainment and health outcomes. Thus, schooling is crucial in terms of integration but also from a public health perspective. We aim to compare school performance and health in children of immigrant parents and children of parents born in Sweden. Methods In this population-based cohort study, 1723 children were followed from birth to age 20. Of these 246 (14.3%) had at least one parent born abroad. Logistic regression was performed controlling for gender, language spoken at home and sociodemographic data obtained at 3 months, 3-, 12- and 20 years. Outcome measures were school performance at age 12 (n = 984), grades from compulsory and upper secondary school (n = 1668) and register data on psychiatric diagnoses (n = 737). Self-response questionnaires on general health, long term health problems and psychiatric conditions were administered at age 20 (n = 731). Results There were no differences in reading (p = 0.676) or mathematics (p = 0.324) at age 12, eligibility to upper secondary school (p = 0.298) or university (p = 0.232) between second generation immigrants and children of native-born parents. No differences in frequency of psychiatric diagnoses (p = 0.112), presence of long-term health problems (p = 0.267) or self-reported health (p = 0.595) were shown. Conclusions The results indicate that young adults born in Sweden in the middle of the 1990’s with immigrant parents perform similarly in school compared to children of parents born in Sweden. They are not at increased risk for mental illness, long-term health conditions and report their general health equivalently to children of native-born. The comprehensive school system and child health programs used in Sweden are likely important factors to promote education and health. Key messages • In a birth-cohort of children followed into early adulthood, no difference in educational achievement or health was shown between second generation immigrants and children of parents born in Sweden. • International comparative studies are needed to highlight the importance of underlying structural and socio-cultural factors.

The association between periodontal disease and coronary artery disease: insights from imaging, observational and genome-wide data

Abstract Background Periodontal disease is the sixth most common disease worldwide. It has been suggested that it may be a contributory risk factor for coronary artery disease (CAD). From a public health perspective, prevention of periodontal disease is relatively straightforward and cost-effective: daily brushing, flossing and, where applicable, smoking cessation. Purpose This study utilises imaging, longitudinal and genomic data to characterise the association between periodontal disease and CAD. Methods 481,915 individuals from the UK Biobank were included in this study, 18.9% (n = 91,022) of whom had self-reported periodontal disease. For the imaging analysis, a maximum of 59,019 had paired cardiovascular magnetic resonance (CMR) data. Multivariable linear regression models were constructed to examine the association of periodontal disease on CMR outcomes with LV end-diastolic volume, LV mass, LV mass:volume ratio (MVR), LV ejection fraction, LV global longitudinal strain and native T1 values considered as prognostically important phenotypes. The relationship between periodontal disease and incident CAD was assessed using Cox proportional hazards regression models. To examine the relationship of genetically-determined periodontal disease on CAD, a de novo GWAS for periodontal disease was performed and a genome-wide polygenic risk score (PRS) was constructed. Results Periodontal disease was associated with a significantly higher LV MVR (effect size = 0.00233, 95% confidence interval [CI] = 0.0006, 0.004) and significantly lower LV native global T1 value (effect size = -0.86 ms, 95% CI = -1.63, -0.09). The presence of periodontal disease was independently associated with a significantly increased hazard of incident CAD (HR = 1.09, 95% CI = 1.07, 1.13) at a median follow-up time of 13.8 years (Figure 1). Each standard deviation increase in the periodontal disease PRS was associated with increased odds of CAD (OR = 1.03, 95% CI = 1.02, 1.05) (Figure 2). Conclusion Using an integrated approach across imaging, observational and genomic data, periodontal disease is independently associated with biomarkers of subclinical remodelling as well as incident CAD. These findings highlight the potential importance of periodontal disease in the broader context of cardiovascular disease prevention.

Living conditions in Italian administrative detention centres for migrants: a scoping review

Abstract Since 2011, Italy has experienced a growing flow of migrants, despite the implementation of restrictive and detention-oriented procedures. Detention facilities for migrants must provide health protection and general assistance to the person. Considering the critical state of the centres reported by various sources, this study gives an overview of the conditions in Italian detention facilities for migrants from a public health perspective. A scoping search of the peer-reviewed and grey literature was performed to investigate the public health standards currently in force in Italian detention facilities for migrants and refugees (Hotspot and CPR-Pre-removal Detention Centres). Articles published from 2009 to 2021 in English and Italian were included and qualitatively described in five categories: provision of healthcare, living conditions, protection of vulnerable detainees, access to legal advice, and the Covid-19 pandemic. 11 peer-reviewed studies and 24 grey documents were included. Guidelines on screening procedures for infectious diseases or vaccines appeared to be hastily followed; chronic and mental diseases were not appropriately addressed. The facilities were described as run-down, with scarce and poor-quality meals, and lacking of educational activities. A lack of protection for vulnerable categories was reported, including unaccompanied minors. The Covid-19 pandemic further exacerbated pre-existing issues, highlighting systemic weaknesses in preparedness and response. Life conditions within the centres for migrants in Italy fall significantly short of acceptable standards. The main problems are the unavailability of cultural mediation services and the insufficient protection of mental health. The overall conditions appeared to be not dignifying and violations of the law are, if not frequent, present and well recognised. Urgent reforms are warranted to address these shortcomings and ensure the humane treatment and protection of migrants within these facilities. Key messages • Italy is responding to the recent inflow of migrants with policies oriented to detention and repatriation. To this, it established de-facto detention centres for migrants, namely Hotspot and CPRs. • The public health standards of migrants’ repatriation centres are poorly followed and life inside the centres appears misereble.

A lifestyle program for socially vulnerable community-dwelling elderly

Abstract Problem Socially vulnerable older adults often face lower health literacy and limited access to health care. Description of the problem Current lifestyle programs are often insufficiently adapted to this socially vulnerable target group. As a result, these older adults are underrepresented in lifestyle programs. From a public health perspective, lifestyle programs that improve the poorer physical and mental health of these older adults, should be made more accessible by involving the expertise, participation and needs of this group. The aim of this study was to develop and implement a lifestyle program adapted to the expectations and needs of socially vulnerable older adults. Results Both the target group and the local community (health) centers were involved during the co-creative phase of development. A neighborhood analysis was used to identify and reach out to the target group. Motivators and barriers for a healthy lifestyle were identified through focus groups. The developed program consisted of 10 weekly group sessions. Various health aspects were integrated, including exercise, nutrition, stress, sleep, positive psychology, meaningful living, and motivation. Nine centers for community dwelling older adults in Flanders and Brussels were included. In total, 93 older adults were recruited out of which 76 completed the full program. In the final phase, the program was evaluated by means of objective and subjective measuring methods. Finally, the local community (health) centers are currently involved in the program’s sustainability through a trainers’ program. Lessons The belongingness, the catering, the empowering attitude of the trainer and the ‘fun’ factor turned out to be success factors for the adherence to the program. The participating centres experienced an increase in numbers of older adults that were attracted to their activities that are focused on healthy lifestyle behaviors. The continuity of the program is currently being examined. Key messages • A neighbourhood analysis in collaboration with local partners helped to reach the target group. • The program was made attractive by the involvement of the older adults, the fun-factor and the small groups.

Development of an assessment process for digital medical devices in Austria

Abstract Issue/problem Digital medical devices have experienced a rapid development in recent years and are playing an increasingly important role in healthcare. These devices offer numerous benefits and can improve patient care. However, despite their potential benefits, the use of digital medical devices also poses risks and regulation from governmental side is needed from a Public Health Perspective. This is why some countries already implemented assessment processes for Digital Medical Devices (e.g. Germany and France) leading to the question how such a process could be established in Austria too. Description of the problem While digital medical devices must fulfil requirements set by the medical device regulation to enter market, several other aspects are of interests when offering digital medical devices in routine care. These include e.g. medical effectiveness, data security and interoperability. The objective of the ongoing pilot project is to develop a process for the assessment of quality-assured digital medical devices in Austria in 2024. For this, a combination of literature research, interviews and workshops with relevant stakeholders is used in order to gain all necessary information. Process and assessment criteria will be tested and revised in a pilot phase with several digital medical devices. Results At the end of the project, an assessment framework as well as a potential evaluation process will be designed in accordance with relevant stakeholders. Moreover, legals aspects and the potential integration into the austrian health telematics infrastrucutur will be assessed. This will form a basis for implementing digital medical devices within the austrian healthcare system. Key messages • The result of this project aims to build the basis for implementing an evaluation process for digital medical devices in Austria. • The establishment of an evaluation process for digital medical devices supports the integration of quality assured digital medical devices in healthcare.