Prevention Policies Research Articles

Classrooms or Crackdowns? How Violence Affects Security Policy Preferences in Mexico

AbstractPenal policies have been the primary strategy of Latin American governments to combat crime, but preventative social policies such as youth education programmes may be more effective solutions. Penal and social policies are often treated as a trade-off by governments, who expect citizens—especially victims of violence—to be more supportive of punitive solutions. Using an original online survey experiment conducted in 2021 in Mexico, we challenge the idea of a trade-off between penal and social policies by studying how different policy solutions along the penal-welfare policy continuum affect victims’ support for increased state security presence. We unpack differences between victims of criminal perpetrators and state violence and those who are fearful of crime. Our vignette experiment reveals—in contrast to previous results—that crime victims are more supportive of state security presence when coupled with pre-emptive measures. Surprisingly, the same holds for victims of state violence and for those fearful of crime, including those residing in neighbourhoods with watch groups. Victimisation, by either crime or the state, raises demand for policies to increase employment and improve education.

ATUAÇÃO DO ENFERMEIRO NA ASSISTÊNCIA AO PRÉ-NATAL DE ALTO RISCO NAS UNIDADES DE SAÚDE

The assistance provided by nurses to pregnant women, especially those at high risk, is crucial to guarantee maternal health and good fetal development. Prenatal care is an essential tool in the identification, treatment and control of possible pathologies during pregnancy and postpartum, aiming to reduce morbidity and mortality rates. Recent studies show that, in 2020, approximately 60% of pregnancy-related deaths could have been avoided with adequate prenatal care, especially in high-risk pregnancies. In the state of Acre, between 2016 and 2021, 89 deaths related to pregnancy, childbirth and the postpartum period were recorded, reinforcing the need for prevention policies and specialized care. This study focuses on the role of nurses in basic health units, addressing the complexities of monitoring high-risk pregnancies and presenting the role of this professional in interpreting events and managing frailties. The method applied was a literature review, based on articles and journals from databases such as Scielo, Google Scholar and LILACS. The results demonstrated the importance of prenatal care in UBS and highlighted the protocols followed by nurses to humanize care and improve the quality of care. It is concluded that the continuous training of nurses is vital to guarantee satisfactory results in prenatal care, promoting and preventing complications in the mother-baby binomial.

Effect of Local Fire Risks and Preventive Measures on the Installation of Residential Firefighting Systems in Detached House

This study analyzes the major factors affecting the installation of residential firefighting systems in detached houses. In particular, it investigates the dependence of local fire risk and local government prevention efforts, along with housing and household characteristics, on the type of installation. This study used data from the 2020 Population and Housing Census, the first nationwide survey on residential firefighter system installation, and employed multinomial logistic regression analysis. The analysis results revealed that less than half of households had installed all firefighting systems, where the installation rate differed significantly by region. Housing and household characteristics also influenced the installation type. Local fire risk as well as the local government’s fire prevention policies positively affect the installation of residential firefighting systems.

Correlation analysis between urban environment features and crime occurrence based on explainable artificial intelligence techniques

ABSTRACT Crime and urban environments are considered to be closely related. However, there exists no clear understanding of this phenomenon. Therefore, this study analyzes the relationship between various urban environmental variables and crime occurrences and provides insights into the optimal placement of crime prevention facilities by developing a crime prediction map based on a paradigm of the Daegu city. To achieve this, we used 373,387 crime reports from Daegu as dependent variables and 370,000 random points. Independent variables included information such as the point of interest, land use, land cover, floating population, and card sales. The developed crime prediction map created using the model was used to evaluate the adequacy of CCTV installation locations and identify areas requiring new CCTV installations. The performances of various machine-learning models were compared and the XGBoost model (accuracy of 89.7 % and precision of 89.8 %) was selected. Key variables influencing crime report data were identified using the SHAP(SHapley Additive explanation) method. To analyze the spatial explanatory power of the relationship between crime and urban environmental variables, various buffer distances were tested, and a 20 m buffer distance was derived. The results of this study are expected to provide valuable data for crime prevention policies.

A comparative analysis of national dementia plans: preventive strategies in five European countries

Abstract Background About 8.5% of people aged +65 live with dementia in Europe. Preventive measures can avert up to 40% of cases. The aim of the study is to analyse National Dementia Plans (NDP) in Europe, to elicit how much dementia prevention is considered a priority and whether policies are evidence-based. Methods A qualitative comparative analysis was performed between NDPs of countries with the best healthy life expectancy in the elderly in Europe. The NDPs of France, Ireland, Italy, Spain, and Sweden were included. The consensus on actions and elements of prevention policies was evaluated, according to the WHO recommendations and to Cheung’s framework designed for evaluating chronic diseases policies. Results All the NDPs prioritised early diagnosis, public awareness, and community engagement for dementia risk reduction. They fostered the development of information system for data collection and established committees for progress monitoring. However, not all NDPs defined timelines for policy implementation and most of them expired years ago. NDPs included prevention research agenda, but their preventive actions did not address alcohol consumption, traumatic brain injury, and air pollution, representing 3 well-known risk factors attributable for the 15% of preventable cases. Neither integration of dementia with other chronic disease preventive strategies was present and a clear allocation of funds for NDPs always missed. Conclusions NDPs partially address risk factors of preventable cases. All countries need to update their NDPs, integrating new scientific evidence and allocating clear financial funds. This can potentially prevent millions of new cases, decreasing the burden of disease and improving the sustainability of health systems. Key messages • NDPs do not target adequately dementia in Europe. • New evidence-based preventive policies, including most recent identified risk factors, would have a clear impact on burden of disease and health systems’ sustainability.

Cardio Policy Optimiser: an integrated public health approach to enhancing cardiovascular health

Abstract Background Cardiovascular diseases (CVDs) remain a leading cause of mortality in Europe, with atherosclerotic-related conditions accounting for 80% of CVD deaths - a third of them premature. Despite extensive efforts over the past five decades, the decline in these deaths over the last 20-25 years has plateaued, highlighting the need for innovative approaches. Additionally, the co-occurrence of CVDs with other chronic conditions such as diabetes, hypertension, and renal and hepatic diseases, adds complexity to their management and prevention. Methods In Portugal, the pilot phase implemented a novel integrated approach combining a Bayesian epidemiological model - which incorporates genetic, sociodemographic, comorbidity, and lifestyle data - with an adaptive conjoint analysis model focusing on atherosclerosis policy intervention. These models are part of a comprehensive response framework that incorporates health outcomes and associated costs resulting from better prevention and diagnosis. Results Currently in the development and calibration stage, the model is expected to yield initial results by early September. Conclusions This modeling approach offers new opportunities for public health to intervene at early stages in the natural history of CVDs. It emphasizes enhancing prevention and early diagnosis to potentially reduce the incidence of acute episodes and associated mortalities. Moreover, the model facilitates rapid evaluation of the economic benefits derived from preventive policies, thereby supporting more informed public health decision-making. Key messages • The CPO model combines epidemiological and policy models to address cardiovascular morbidity and mortality. • It boosts early diagnosis and prevention, and assesses economic benefits from policies.

Antimicrobial resistance and infection prevention in care for people with intellectual disabilities

Abstract Background Antimicrobial resistance (AMR) has become one of the major public health threats worldwide. However, little is known about antimicrobial resistance and infection prevention and control (IPC) in long-term care facilities for people with intellectual disabilities. This study aims to assess knowledge, attitudes and perceptions towards AMR and IPC among healthcare professionals working in long-term care facilities for people with intellectual disabilities (ID-LTCFs) in the Netherlands. Methods We conducted a web-based cross-sectional survey study among medical and nonmedical trained healthcare professionals working in ID-LTCFs in the Netherlands. The survey study was carried out between July and November 2023 and consisted of validated survey items expanded with expert opinion and setting-specific items. Results In total, 109 medical and nonmedical trained healthcare professionals working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. Overall, knowledge levels about AMR and IPC differed between medical and nonmedical trained healthcare professionals working in ID-LCTFs, with medically trained professionals having a significant overall higher score on both topics. Knowledge regarding the perceived protective value of glove use was found to be insufficient. Moreover, healthcare professionals expressed a need for easy-to-read resources and tailored setting-specific information on AMR and IPC targeting both healthcare professionals as well as people with disabilities. Conclusions There is room for improvement regarding setting-specific IPC and hygiene policies, such as appropriate glove use in ID-LTCFs. As nonmedically trained professionals comprise most of the workforce within this setting, it is important to further tailor follow-up studies to the underlying factors that influence knowledge, attitudes and perceptions of these specific professionals within ID-LTCFs. Key messages • Developing setting and context-specific policies for infection prevention and control is crucial, particularly in long-term care facilities for people with intellectual disabilities. • Inclusive policy-making is key to combating antimicrobial resistance, and improving infection prevention and control in long-term care facilities for people with intellectual disabilities.

The updated nutrient profile underlying the Nutri-Score label and adult weight gain: A cohort study

Abstract Introduction Nutrient profiling systems are key tools in the development of nutrition-related policies. Their prospective associations with health outcomes are a crucial step in assessing their validity as public health measures. In 2023, the nutrient profiling system underlying the Nutri-Score -a nutrition front-of-pack label used in the European Union- was updated. The present study aims to investigate the updated nutrient profile’s association with weight gain, overweight and obesity. Methods The dietary and anthropometric data of 75,775 participants of the Nutrinet-Santé cohort study was retrieved for this study. Standardized dietary indices derived from both nutrient profiling systems (the 2015 NS-NPM DI (initial profile) and 2023 NS-NPM DI (updated profile)) were computed based on at least 3 24-hour dietary records upon the first two years of inclusion in the cohort. The associations between these indices and the risk of developing overweight and obesity were assessed using Cox proportional hazard models and weight gain using mixed models. Results Participants with a higher 2023 NS-NPM DI (i.e. a poorer nutritional quality of diet) were more likely to gain BMI over time (T3 vs. T1: +0.23% points of BMI/year, p < 0.0001), had a higher risk of developing overweight (HR T3 vs. T1: 1.33 [95% CI: 1.24-1.43]) and obesity (HR T3 vs. T1: 1.29 [95% CI: 1.14-1.45]). Overall, the 2015 NS-NPM DI displayed similar associations and effect sizes with the outcomes and the predictive ability of the two indices on overweight and obesity risk was not significantly different (p = 0.32 for overweight risk, p = 0.09 for obesity risk). Conclusions These results constitute a step in the validation of the recently updated nutrient profiling system and help support its use in public policies for non-communicable diseases prevention. Key messages • The 2023 updated nutrient profiling system underlying the Nutri-Score was associated with weight gain and obesity, two important risk factors in the development of non-communicable diseases. • The 2015 and 2023 NS-NPM DI showed similar prospective associations with overweight and obesity risk.

Factors associated with drowning in Portugal, 2019-2023

Abstract Worldwide, mortality from drowning amounted to 236.000 individuals in 2019, corresponding to 8% of the total global mortality, making drowning the third leading cause of death from unintentional injuries and a universal public health problem. Portugal has a coastal zone of 950 km long, with 658 bathing waters and, in 2023, 157 people died due to drowning. This work aims to determine the factors associated with drownings that occurred in Portugal, between 2019 and 2023. This epidemiological descriptive-analytical study used the National Maritime Authority database, regarding the users of the portuguese coastal zone who suffered maritime incidents between 2019 and 2023. SPSS was used for statistical analysis and the results of the Poisson regression models are presented as adjusted prevalence ratios (APR) with 95% confidence intervals, according to individual (sex, age group and nationality), temporal (period of the week and day) and environmental (maritime department and beach surveillance status) variables. The total sample was 406 drownings and 15 860 other maritime incidents. Overall, the frequency of drownings in Portugal was higher in men (APR=1.393, 95%CI=1.130-1.717, p=.002), in the >55y age group (APR=1.780, 95%CI=1.005-3.152, p=.048), in foreigners (APR= 1.293, 95%CI=1.037-1.612, p=.022), on weekends (APR=1.299, 95%CI=1.063-1.586, p=.010), in the afternoon (APR=1.584, 95%CI=1.127-2.226, p=.008) and on unsupervised beaches (APR=2.436, 95%CI=1.958-3.029, p<.001) in comparison with users who suffered other maritime incidents. Individual, temporal and environmental factors are associated with a higher frequency of drownings in Portugal. Despite the limitation of the study that only includes users suffering maritime incidents and not all users of the portuguese coastal zone, our results allow a preliminary characterization of the drowning profile in Portugal and can contribute to the design of preventive strategies and policies to address this public health problem. Key messages • This study shows that there are individual, temporal and environmental factors strongly associated with a higher frequency of drownings in Portugal. • Portugal has a large coastal zone and the characterization of a drowning profile is the first step for the development of prevention strategies in order to oppose drowning morbidity and mortality.

Joining forces to accelerate cancer and NCD prevention in Europe

Abstract JA PreventNCD, a Joint Action to prevent cancer and other non-communicable diseases (NCDs) aims to assist authorities in prioritizing the most effective prevention strategies and policies to reduce the burden of cancer and NCDs, focusing on both personal and societal risk factors. A key objective is to tackle social inequalities by addressing the root causes of NCD risk factors and adopting a life-course approach. Recognizing that health is created by policies in several sectors is key when addressing health determinants, including social and commercial determinants of health. Consolidated efforts across countries will be required to tackle some of these determinants. To achieve the project’s objectives, the JA PreventNCD will build a comprehensive European infrastructure for monitoring risk factors, disease burden, and the impact of policies and interventions. Rigorous evaluation will ensure that the project’s deliverables will have an impact at local, national and EU levels. Three technical work packages address common risk factors for NCDs through actions ranging from policies and structural measures at societal level to interventions targeting individuals. Another set of cross-cutting work packages address monitoring, social inequalities, and health in all policies. More than 100 partners across 25 countries are involved, with almost 100 pilots to be conducted over the course of the project’s four years. One way of ensuring sustainability of the project’s outcomes is the building of a sustainable governance structure through the establishment of an EU Consortium on Cancer Prevention. Furthermore, as a mechanism to ensure high policy relevance of this JA, a Policy Decision Maker’s Forum will be established to engage policymakers and ensure feasibility of the project’s recommended actions. Speakers/Panelists Claudia Habl Austrian National Public Health Institute, Vienna, Austria Ane Fullaondo Biosistemak, Bilbao, Spain Arnfinn Helleve Norwegian Institute of Public Health, Oslo, Norway

Factors associated with mosquito-borne disease protective behaviour in metropolitan France

Abstract Background Mosquito-borne diseases (MBD) are increasing and expanding their range throughout metropolitan France. Promoting individual protective behaviour is imperative, but research on its determinants is limited to southern regions. This study examines factors influencing MBD protective behaviour in the metropolitan French population. Methods 2,087 subjects responded to a self-administered online questionnaire in November 2023. The analysis plan was pre-registered. We fitted two mixed effects models to estimate the frequency and count of protective behaviours across sociodemographic groups and to identify which factors predict protective behaviour. Results Frequency of protective behaviour is significantly positively associated with getting bitten by mosquitoes often (β = 3.39; 95% CI: 3.10, 3.69) and sometimes (β = 1.54; 95% CI: 1.31, 1.76) compared to almost never, perceived MBD threat (β = 0.11; 95% CI: 0.06, 0.15), and having financial difficulties (β = 0.23; 95% CI: 0.02, 0.43). Count of protective behaviours is associated with getting bitten by mosquitoes often (β = 0.39; 95% CI: 0.30, 0.49) and sometimes (β = 0.14; 95% CI: 0.05, 0.23), perceived MBD threat (β = 0.02; 95% CI: 0.00, 0.03), MBD knowledge (β = 0.06; 95% CI: 0.04, 0.08), and having a chronic disease (β = 0.08; 95% CI: 0.02, 0.14). Models were adjusted for place of residence, education, and age. No associations were found between sex, having experienced an MBD, or confidence in public authorities to manage health crises. Conclusions This study provides the first insights into MBD protective behaviour and its associated factors considering all metropolitan French regions. Our results highlight several factors which may inform MBD prevention communication and policies focused on increasing individual protective behaviour. Key messages • People often bitten by mosquitoes are more likely to engage in more frequent and a higher number of mosquito-borne disease protective behaviour than people almost never bitten by mosquitoes. • Higher perceived mosquito-borne diseases threat is associated with more frequent and a higher number of mosquito-borne disease protective behaviour.

Characteristics of adolescents with acute alcohol intoxication in Belgium

Abstract Background Binge drinking and acute alcohol intoxication (AAI) are common in Belgian adolescents, posing a risk of serious health consequences. To develop cost-effective preventive measures for problematic alcohol use in adolescents in Belgium, more insight into the background of this group is necessary. Methods To gain more insight into the prevalence, medical characteristics and context of AAI, a retrospective multicentre hospital chart study was performed on adolescents aged 10 to 18 years with AAI in Antwerp, Belgium from 2015-2021. Furthermore, a prospective intervention study for adolescents with AAI in Antwerp was set up in 2023, of which the first results were not yet known at the time of submission. However, these results will be presented at the conference, if available. Results Over the study period, a total of 1032 admissions related to alcohol intoxication occurred in 1016 patients, with a median age of 16.6 years old and a median blood alcohol intoxication (BAC) of 1.95 g/L. There was combined drug use in 10% of the cases. Only 17% of the patients received additional care after admission. These findings did not significantly change over the study period. Multiple linear regression analyses indicated that after correcting for covariates, higher age, no combined drug use and decreased consciousness at admission were associated with more severe AAI cases (higher BAC). Conclusions AAI is prevalent among Belgian adolescents. Therefore, better-targeted preventive measures and policies are needed. Our findings could be taken into account when developing preventive measures. However, data addressing the demographics and context of AAI were mostly missing. Therefore, a prospective follow-up study was set up in Antwerp, which started in 2023 and is still ongoing. Furthermore, this study will investigate the feasibility and effectiveness of a follow-up intervention for this group of patients.

Collaborative efforts of the Joint Action PreventNCD and the WHO Europe to protect children from harmful marketing

Abstract Control and counter the effects of advertisements and online marketing is one of the policy actions that will be explored within the JA Prevent NCD that has the overall aim to “reduce the burden of cancer and other NCDs and common risk factors, both at a personal and societal level, and support member states by taking a holistic approach for the prevention of cancer and other NCDs, through coordinated action”. The work that will be building on the JA Best-ReMaP sustainability framework recommendations to improve the effective implementation of policies to reduce harmful marketing of unhealthy food, would at the same time comprehensively address also tobacco and alcohol maketing. Thirteen different countries are involved in the work package on regulation and taxation that has the overall objective to “improve compliance, coherence, wider implementation and enforcement of fiscal and regulative measures targeting major NCD-risks factors.” This includes a broad range of tasks from mapping existing policies and frameworks, accumulating knowledge on health taxes and fiscal policies, promoting the use of joint nutrient profile models, assessing the impact of labelling on products to create healthier behaviors, supporting the implementation of policies to reduce the impact of harmful marketing, strengthening regulations towards hazardous substances and developing monitoring indicators for policies for prevention of NCD. An overview of the concrete collaborative actions to support the implementation of the marketing regulation will be given: (1) on JA work with the MSs and especially presidency countries, to allow for the discussions on the development of the EU regulation for reduction of the harmful marketing; (2) on the EU stakeholders positions regarding marketing regulation; (3) on the collaborative actions in scaling up the KidAd app. (5) the development of an algorithm to detect alcohol, tobacco and nicotine-containing products will be jointly developed and piloted.

The very long-term risk of stroke after acute coronary syndrome and geographic differences. The ABC-10* study on heart disease

Abstract Background Little is known about the very long-term risk of stroke among acute coronary syndrome (ACS) survivors. Methods In this prospective study, we enrolled 535 ACS patients admitted to hospitals in three Italian provinces, discharged alive and followed for 24 years or death. The patient's residency was classified into three urban and three nearby rural areas. Results All patients completed the follow-up (6142 Perso-years). 85 (16%) patients suffered an acute stroke. Patients median age was 67 years, 70% were male, and 318 patients were residing in rural areas. Patients who had a stroke and those who had not shared most of the demographic and clinical characteristics. The incidence rate of overall stroke was 14/1000 person-year. Cox analyses showed older age (HR 3.13;95%CI 2.31-4.26), male gender (HR 1.88;95%CI 1.20-2.95), baseline diabetes (HR 2.25 95%CI 1.37-3.69), heart failure (HR 2.69;95%CI 1.71-4.24), and higher albumin/creatinine ratio (HR 1.75;95%CI 1.33-2.30) were all associated with an increased risk of stroke. while higher baseline eGFR, reperfusion, statin and beta-blockers treatment during follow-up were associated with a decreased risk; HR (0.55 (95%CI 0.42-0.72), 0.45(95%CI 0.29-0.71), 0.21(95%CI 0.13-0.34), and 0.37(95%CI 0.23-0.57), respectively). In the multivariate analysis, only older age (HR1.55;95%CI 1.08-2.21; p=0.02) was an independent predictor of stroke while statin treatment was independently associated with a lower risk (HR 0.35;95% CI 0.21-0.58; p<0.0001). However, all these variables did not predict the risk of stroke in competing risk regression analysis where death was treated as the competing event. A sub-analysis of the 43 patients who had a fatal stroke (FS) revealed 7/1000 person-year FS IR. The Cox regression and competing risk analyses of predictors of FS showed similar results. Interestingly, we observed an association between geographic areas of residence and the long-term FS risk as the risk increased going from rural to urban (HR 2.08;95%CI 1.14-3.80; p=0.02) areas and from north to middle and south provinces (HR 1.47;95%CI 1.00-2.15; p=0.04) in the univariate Cox regression analysis. Results kept true using multivariate Cox and Competing risk regression models. Conclusion This analysis reveals the significant urban-rural difference in the very long–term risk of fatal stroke among unselected ACS patients which highlights the importance of implementing a preventive policy based on area-specific knowledge.

Exploring UK adult and policy stakeholder perspectives on obesity prevention policy and inequalities

Abstract In England, 14 obesity strategies have been published, including 689 proposed policies, while rates of obesity persist, and inequalities worsen. This study explores adults’ attitudes in relation to food-related obesity policy and how socioeconomic inequalities in obesity are considered throughout the policy process through the perspective of policy stakeholders (PSH). 31 semi-structured interviews with UK-based adults (GPP) (18+) and 14 interviews with PSH categorised as government officials, academics, and advocacy group representatives were conducted and analysed using Braun and Clarke’s thematic analysis. Both PSH and GPP attributed obesity causation primarily to the food environment rather than to individual behaviour. The PSH identified the food industry’s role in shaping the environment. Level of deprivation was believed to exacerbate the barriers to healthy weight in both samples. All participants agreed that, in the UK, there was an unequal opportunity to attain a healthy diet. A disconnect was found between the GPP perspectives towards the barriers to healthy weight and their attitudes towards policy action. The GPP described mistrust in the government’s motives and willingness, fuelling the perspective that policy lacked impact and was disconnected from their lived experiences, particularly among participants of lower socioeconomic status and higher weight classifications. The PSH raised concerns regarding barriers to policy implementation, including inconsistent government commitment, competing priorities, and resistance to state intervention. PSH suggested that it was unfeasible to prioritise inequalities while population rates remain high, and the failure of implement proposed policies continue. This study shows the necessity of incorporating a health equity lens, breaking down policy silos, and amplifying community voices in the policy process to challenge assumptions regarding lived experiences and ensure healthier equitable policy outcomes. Key messages • The study shows the importance of integrating a health equity lens, breaking policy silos, and amplifying community voices to challenge assumptions and achieve more equitable policy outcomes. • Obesity policy requires greater consideration to inequalities to strengthen policy impact as demonstrated by all participants recalling the unequal opportunity to sustain a healthy weight in the UK.

Health Impact Assessment in Personalized Prevention: three applications on pharmacogenomic testing

Abstract Background In recent years, literature on the efficacy of genetic and genomic tests has expanded, yet the impact of personalized prevention programs that include such tests remains understudied. Our study aims to test the use of the Health Impact Assessment (HIA) framework, traditionally applied in non-health policy evaluation, to assess the impacts of personalized prevention policies. Methods We selected a policy mandating dihydropyrimidine dehydrogenase (DPYD) genetic test use before prescribing fluoropyrimidine for colorectal cancer (CRC) patients. Three HIAs are being conducted in Italy, Portugal, and Finland to assess the applicability across different contexts. The assessment involves literature review, comparative risk modeling, and stakeholder interviews. Three national steering committees, comprising representatives from key interest groups and experts, will evaluate evidence to gauge policy impacts and offer recommendations. Results The potential impacts identified include CRC patients’ outcomes, economic, organizational, patient experience, clinician workload, and equity. Preliminary results show a consensus in literature and national guidelines on the ability of the DPYD test to reduce adverse events and enhance the quality of life of CRC patients. However, the assessment reveals context-specific effects regarding equity, influenced by the prevalence of ethnic groups and variations in access to health services across regions. Differences also emerged on organizational aspects like the availability of resources such as laboratories and personnel. A lack of literature was observed on patient acceptability and clinician attitudes towards the test. Conclusions The use of HIA in personalized prevention might assist in identifying policy impacts often overlooked through the involvement of key interest groups in the assessment process. Such effort can further emphasize the significance of evaluating these programs while considering the geographical context. Key messages • Our study innovatively applies the Health Impact Assessment framework to evaluate personalized prevention programs in pharmacogenomic, addressing a critical research gap. • Preliminary findings underscore the importance of considering geographical factors in public health policy evaluation, highlighting nuanced context-specific effects.

A novel developed DGS can be used to identify gene loci that may be associated with osteoporosis

Abstract Purpose Previous meta-analyses only examined the association between single gene polymorphisms and osteoporosis; there is no compilation of all gene loci that correlate with osteoporosis in the literature. In this study, we develop a new literature-based approach, a decisive gene strategy (DGS), to examine the sufficiency of the cumulative sample size for each gene locus and to assess whether a definite conclusion of the association between the gene locus and osteoporosis can be drawn. Methods The DGS was used to search PubMed, Embase, and Cochrane databases for all meta-analyses that correlated gene polymorphisms with osteoporosis. Trial sequential analysis was employed to examine the sufficiency of the cumulative sample size. Finally, we assessed the importance of gene loci in osteoporosis based on whether there were enough sample sizes and the heterogeneity of the literature with the I2 value. Results After excluding 169 irrelevant publications, 39 meta-analysis papers were obtained. Among Caucasians, in 17 gene loci, there were eight gene loci (e.g., vitamin D Receptor ApaI rs7975232) with sufficient cumulative sample size to confirm that they were unrelated to the disease. Among Asians, in 15 gene loci, four gene loci that had sufficient sample sizes were risk factors: VDR FokI rs2228570 (odds ratio (OR) = 1.44, 95% confidence interval (CI) = 1.22-1.70), TGF β1 rs1800470 (OR = 1.35, 95% CI = 1.10-1.65), IGF1 rs2288377 (OR = 1.44, 95% CI = 1.28-1.62), and IGF1 rs35767 (OR = 1.20, 95% CI = 1.06-1.36), respectively, whereas one gene locus, ESR2 RsaI rs1256049 (OR = 0.69, 95% CI = 0.59-0.81), was a protective factor. Conclusions The DGS successfully identified five gene loci in osteoporosis that will apply to other diseases to find causal genes, which may apply disease-related genes in clinical practice, and to provide appropriate disease prevention policies. Key messages • The DGS that will apply to other diseases to find causal genes. • The DGS, which may apply disease-related genes in clinical practice, and to provide appropriate disease prevention policies.

Temporal trends, regional and socio-economic disparities of colorectal cancer burden in Cyprus

Abstract Background Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide and it is the third most common cancer in Cyprus. Previous studies have documented variations in CRC burden over time, across regions and area-based socio-economic deprivation. The aim of this study was to analyse the burden of CRC over time, across regions and area-based socio-economic deprivation in Cyprus for the time period 2000 to 2015. Methods A small area ecological study was performed, with census tracts as units of spatial analysis. The incidence and death date, sex and age of CRC were obtained from the population-based cancer registry of Cyprus. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed estimates of SIRs and SMRs were derived from the Spatiotemporal Bayesian Poisson log-linear model. To investigate temporal trends in the association between area-based socioeconomic deprivation and CRC burden, we have used the national socio-economic index. Results The burden of CRC was rising over time. The CRC cumulative incidence increase from 243.7 in the time period 2000-2007 to 347.3 per 100,000 persons in the time period 2008-2015.There was also a more pronounced geographical variation in SIR and SMR in the time period 2008-2015. Four areas out of 369 had smoothed SIR>1.15 while twenty-six areas had smoothed SMR>1.15, with most of those areas located at the east coast of the island and around the capital city. There was a temporal trend in the socio-economic inequalities of CRC burden. The areas in the third and fourth quartile of the socio-economic index had 23% and 45% lower rates of CRC incidence, and 33% and 47% lower rates of CRC mortality in the period 2008-2015. Conclusions These findings could shape national prevention policies, such as the national screening program of CRC starting in 2025 and protection strategies for CRC mortality. Key messages • Colorectal cancer screening should be geographically targeted for efficient resource allocation. • Public health interventions to improve colorectal-specific mortality risk should be geographically targeted.

Home and leisure accidents among children and young people up to 19 years old as an event observed in the EU-IDB surveillance system: 2012-2021 data

Abstract Paediatric injuries are widely acknowledged as a major public health issue among different medical disciplines. In the context of injuries and accidents, the surrounding environment of children and young people remains a major health concern. The present study was developed to extend current knowledge on the characteristics and magnitude of home and leisure accidents in this population. A descriptive, observational, cross-sectional study was developed under the EU-IDB (European Injury Database) collaborative network comprising up to 25 European countries and ten years of data collection (2012 to 2021). The methodology of the EU-IDB is a well consolidated standard for collecting injury data in Emergency departments, in compliance with the Eurostat methodological requirements for European health statistics. During the ten years of data collection in emergency departments, through EU-IDB surveillance 3 603 975 episodes of home and leisure accidents (HLA) were recorded at European level, involving people aged 0-19 years, constituting 34.5 % of hospital ED attendances due to HLA. Children and young people between 10 and 14 years old represented the major age group proportion of HLA(33.0%), the proportion of HLA increased across age groups until fourteen years old, being these differences statistically significant(p < 0,001). Falls were the most common cause of injuries among all age-groups, in the youngest group up to 4-years(54.4%), the 5-9years old (52.2%), the 10-14years old (46.1%) and in the oldest group between 15-19 years(37.5%), representing 47.2% of the total HLA mechanism. As regards to the treatment/follow-up, the vast majority of the HLA episodes were not admitted to hospital (92.9%). Hospital ED Injury data represent very useful information on the health burden of non-fatal injuries in this population of interest. These data could be used for the design of injury prevention policies and regulations for accidents that occur at home, school and outdoor spaces.

A Conceptual Model for Health Impact Assessment of Personalized Prevention Policies

Abstract Background Personalized prevention and pharmacogenomics are emerging fields in global health, promoting tailored approaches to disease prevention and individualized drug therapy, based on the individuals’ genetic profile. However, adoption of these technologies in public health is challenged by the possibility of health disparities. Health Impact Assessment (HIA) is a useful tool to address this issue, by examining how policies differentially impact population groups, guiding stakeholders to more equitable and inclusive outcomes. Solid frameworks for assessing health impacts are needed to avoid heterogeneity when accounting for equity outcomes in HIA. This study tested a conceptual model for HIA in personalized medicine, using a case study in pharmacogenetics to map potential impacts and outcomes, with a focus on health equity. Methods A conceptual model for a HIA was developed to map expected impacts and outcomes of a health policy, aimed at enforcing DPYD genotype-guided dosing to prevent fluoropyrimidine toxicity in colorectal cancer patients. The conceptual model was developed based on literature reviews and consultation with stakeholders. Identification of relevant impacts guided selection of indicators and quantitative impact assessment using a Markov chain model. Results Impact pathways were identified using a three-tiered reference framework encompassing individual and population perspectives, organizational factors, and overarching health system considerations. The final diagram outlined key outcomes in four categories: health, organizational, economic and equity. HIA projections using this model were obtained for the DPYD testing policy. Conclusions In the rise of personalized medicine and pharmacogenomics, health inequalities challenges need to be addressed before implementation in healthcare. This study provided a novel HIA conceptual model for personalized prevention policies based on genomic information, with an emphasis on equity. Key messages • HIA is an adequate tool to evaluate potential health inequalities resulting from personalized medicine policies in healthcare. • This study provides a validated framework for HIA of personalized prevention policies grounded in genomic data.