Public Health Challenge Research Articles

Predicting Obesity via Deep Learning: The Role of Chrononutrition

Abstract Background Obesity is a significant public health challenge, prompting the need for assessing effective tools for its monitoring and prevention. Chrononutrition investigates the role of timing, regularity and frequency of food intake on body metabolism and health. Here we aim to check if data on the distribution of calorie intake in the day may improve BMI prediction as compared to using only data on total day intake. Methods We apply deep learning on chrononutritional data on calorie intake over 6 daily timeslots from a nationally representative cross-sectional survey sample of the Italian population (INRAN-SCAI 2005/2006) comprising 2313 Italian adults 18-64 ys old with 3 day diet diaries. In particular, we implemented three deep neural network models, varying network configurations and feature selection. The 1st includes 18 (6 for each day diary) chrononutritional variables and the 3 day total intakes, beside age and sex; the 2nd includes age, sex and the 18 chrononutritional variables only; the 3rd uses age, sex and the 3 day totals only. We applied Early Stopping to limit overfitting. Optimization was conducted using the Adam algorithm, minimizing the mean squared error (RMSE), while mean absolute error (MAE) was the primary performance indicator. Results The results highlight that Model 3 outperformed the other models with MAE=2.514 and RMSE=3.476, indicating that for the purpose of predicting obesity, information on the time-of-day distribution of calorie intake is not increasing predictive ability of BMI on top of age, sex and total calorie intake in the day. Conclusions Additional use of day-time intake information worsened prediction of BMI via deep learning using this cross sectional Italian survey. However the error made is still sizeable and warrants the inclusion of other variables; our results don’t rule out the role of chrononutrition on metabolic health which may act through other biological mechanisms related to specific nutrients. Key messages • Chrononutrition data don’t improve BMI prediction over total calorie intake data in a cross-setional representative sample of the Italian population. • Deep learning approach to BMI prediction shows the importance of targeted selection of features in public health nutrition.

9.X.2. Activating the ASPHER-WHO Public Health Core Curriculum: Interprofessional Skills

Abstract The updated ASPHER-WHO Public Health Core Curriculum builds on ASPHER’s previous work on Competencies for Public Health Professionals (2006-2020), reflects the changing needs of our population and planet and public health professionals. The key objectives of this workshop are to: - Share the updated ASPHER core curriculum for public health; - Illustrate examples of public health challenges that young professionals have championed for inclusion; - Share the Faculty of Public Health (UK)’s work on Fair training as a case study on operationalising public health leadership on equality, diversity and inclusion and demonstrating the core competencies in action. A curricular content survey of member schools and programmes yielded responses from 60 schools, with > 500 submissions of detailed. subject curricula. These have been compiled into 36 Subject Areas in four Domains, namely: (1) Core Subject Areas in Public Health: (2) Subject-specific Areas in Public Health;(3) Core Cross-curricular Subject Areas; and (4) Core Interdisciplinary Professional Skills in PH. The development process was guided and grounded by the expertise and passion of young public health professionals. They are helping us make the core curriculum fit for purpose for the near future and provide them with the skills required to be a competent member of a supportive public health team in an ever changing world. This Workshop will profile selected Subject Areas from each Domain using real life challenges facing WHO European Region to show how the core curriculum integrates research, theory and practice to help build those essential interdisciplinary skills. The examples will focus on Economics in Public Health (Domain 1); Public Health and Criminal Justice; (Domain 2); Health Literacy and Infodemiology, Mental Health and Wellbeing (Domain 3); and Integrative Learning in Action; Communication Skills; Advocacy, Negotiation; Collaborations and Partnerships; and Leadership, Management and Implementation Science (Domain 4). Discussions for each of the Subject Areas will be led by an expert in the area. We will also illustrate an example of these competencies in action, how they are helping shine a light on the challenges we face in creating that supportive team and environment and how the potential for collaboration helps us to capitalise on the expertise available in some schools and programmes for the benefit of all. Key messages • Learning interdisciplinary skills are essential for effective public health analysis, advocacy and action. • Collaboration across countries, schools, professions and generations can create transformational change. Speakers/Panelists Mary Codd University College Dublin, Dublin, Ireland Karl F Conyard University College Dublin, Dublin, Ireland Jenny Houston University of Edinburgh, Edinburgh, UK Samia Latif Faculty of Public Health, London, UK Olalekan Popoola ASPHER, UCD, Dublin, Ireland

One Health Perspectives on Food System Transformation: Insights from the InsectERA Agenda

Abstract Background One Health framework recognises the interconnectedness of human, animal, plant and environmental health. With this understanding, it becomes imperative to address challenges such as those posed by food systems through a One Health lens. Food systems pose significant public health challenges, particularly in terms of food safety and security. Pressures from factors such as population growth, changing consumption patterns and intensified production systems, particularly animal-based protein production, contribute to environmental pressures. In addition, environmental changes, including climate change, further threaten food safety and access to healthy food. Methods Through the InsectERA agenda, funded as part of the Recovery and Resilience Plan, stakeholders collaborated across sectors to explore the potential of insects as bioindustrial tools to address food system challenges. A structured, integrated approach combining health and sustainability considerations was matured and applied to pilot food products developed through this initiative. Recognising the potential health and sustainability impacts of these products, a comprehensive assessment was carried out. Results This study defined a structured, integrated approach to assessing the health and sustainability impacts of foods developed under the InsectERA agenda. Key steps included i) identifying critical issues and questions, ii) prioritising considerations, iii) defining methodologies, iv) collecting and analysing data, and v) integrating results for communication. Conclusions The study highlights the importance of integrated approaches in addressing food system transitions. Integrated approaches, guided by the One Health framework, play a critical role in informing policy decisions by providing policy makers with robust evidence. There is an urgent need for food system transformation based on decisions that holistically consider health and sustainability impacts, to ensure the protection of Public Health. Key messages • Integrating health and sustainability into the transition of food systems, within the One Health framework, is crucial for identifying options that safeguard Public Health. • A structured, integrated approach within a multi-stakeholder environment offers robust insights for policy decisions, advancing sustainable food systems.

Policies and programs on children’s health promotion in the EU in the context of the JA Health4EUKids

Abstract Background Overweight and obesity prevalence are a global public health challenge. The prevalence is rapidly increasing, with significant health risks such as cardiovascular disease, type 2 diabetes, and cancer. Objectives To describe the state of the art of policies and programs (PPs) on children’s health promotion and responsive parenthood (children 0-12 years) in the EU, and to identify their gaps. Methods A cross-sectional study was carried out through an online survey, as part of the Health4EUKids Joint Action (JA) (HADEA n.101082462), between October and December 2023, targeting all EU member states (MSs) involved. Results The survey collected information about 74 PPs from 11 EU MSs of the JA. The PPs are primarily focused on healthcare (62.1%), education (24.1%), and social sectors (10.3%), with a focus on children aged 6-11 years. The settings for PPs include primary schools, communities, secondary schools, and healthcare services. The PPs are characterized by different degrees of innovation, controversy, equity, transferability, and sustainability, although the structural or systemic impact and public visibility appear to be lower among other characteristics. The formulation and design of PPs include problem analysis (73%), based on national or local data and on stakeholder consultation. As for implementation, most PPs are implemented upon release, but recommended action and allocated human resources are not fully adequate. Regular monitoring and evaluation (47.3%) are based on defined outcomes, standards, and indicators (63.5%). The results are disseminated to decision-makers and stakeholders (37.8%), through media, and to the general population (32.4%). Conclusions Most PPs are variable and context-dependent. It is necessary to align the policies with the implementation, in all its aspects, and to strengthen monitoring, evaluation, and communication with the relevant stakeholders, which currently appear to be the most lacking aspects. Key messages • Most European policies and programs are context-dependent, mainly in healthcare. Yet, a cross-sectoral trend involving health, education, and social sectors emerges. • The study stresses the need for better alignment between policy formulation and implementation to enhance the effectiveness of EU children’s health programs.

Introducing innovative policy instrument to reduce antibiotics use. Relevant evidence from Bulgaria

Abstract Background of the public health challenge Excessive individual consumption of antibiotics (ABs) increases global antimicrobial resistance (AMR). Therefore, shaping consumers’ behaviors towards responsible ABs use is an essential strategy in the battle with the silent pandemic of AMR. The EU One Health (OH) Action Plan against AMR targets making Europe a best-practice region. Overall consumption of ABs in the EU decreased significantly, especially during the COVID-19 pandemic. Bulgaria is the only EU country that has reported an annual increase in ABs use during this period (ECDC data). A growing part of Bulgarians, believe that ‘ABs kill viruses’ and is unaware that ‘unnecessary use of ABs makes them ineffective’ (Eurobarometer 2022). This limited understanding of adequate ABs use resulted in counterproductive behaviors that demand change. Introducing innovative policy instrument as a tool for behavioral change: Undeniably, drug prescription monitoring has the potential to change consumers’ behaviors. In October 2023 mandatory electronic prescribing (e-Rx) for ABs was introduced in Bulgaria at a primary healthcare level. Consequently, there was an observed decline exceeding 30% in ABs sales (IQVIA Bulgaria data), evidencing a reduction in ABs consumption. However, there were negative reactions by the stakeholders, due to time-consuming procedures, nonoptimal IT infrastructure, etc., and that led to e-Rx-moratorium. Finally, in April 2024, the e-Rx is sustainably introduced. Conclusions Legislative measures, like e-Rx, can hinder the chaotic use of ABs. Moreover, Bulgarians need to reflect on their behaviors and values of solidarity which OH offers. Herewith, a multidisciplinary team of academic educators unite their OH efforts in raising awareness related to AMR and the rational use of ABs. Years of national endeavors toward healthcare digitalisation led to the introduction of e-Rx for ABs in Bulgaria. Research will prove its relevance for the rest of Europe. Key messages • To the European community: The introduction of the innovative policy tool (e-Rx for antibiotics) in Bulgaria is a significant national effort in making Europe a best-practice region regarding AMR. • To the Bulgarian society: Antibiotics are not bonbons! Responsible ABs use of every one of us can contribute to the EU efforts to manage AMR. In the context of AMR, every person is a stakeholder.

“The Church of Fail”: Learning from Our Mistakes in Co-Creation (part II)

Abstract For the second activity, participants will be invited to break into smaller facilitated groups for a ‘peer-to-peer’ session where they will share further and discuss lessons learned and how they would do things differently going forward. They will do this by either working with one of their own failure stories/cases, or a predetermined case around critical aspects of co-creation, such as power imbalance or recruitment strategies. The groups will work with a facilitator and a template to discuss some key aspects of learning, such as what do you perceive as the failure, how could you address this, and the changes they could be made moving forward. The second session closes with each group nominating a presenter to share their reflections on the proposed solutions in plenary. The facilitator will close the workshop by inviting participants to sign up to join a collaborative effort to publish examples of failures and lessons learned when addressing complex public health challenges. This has the potential to increase awareness about the importance of embracing the power of failure, and break down the stigma that comes with admitting to your mistakes. Speakers/Panelists Sebastien Chastin Glasgow Caledonian University, Glasgow, UK

8.D. Scientific session: Equitable Immunization: Leveraging Prisons for Vaccination Equity in Europe

Abstract Addressing low vaccine coverage is a pressing public health concern in Europe, where pockets of unvaccinated individuals persist despite ongoing efforts. The European region sees an estimated 1.4 million individuals detained on any given day, with a significantly higher number passing through prisons annually due to high turnover rates. Those experiencing incarceration often come from socially marginalized and disadvantaged groups, facing a multitude of health challenges including non-communicable diseases, infectious diseases, mental illness, cognitive disabilities, and substance dependence. Despite their elevated health needs, individuals in prison frequently encounter barriers to accessing healthcare services, including preventive measures such as vaccination. Available but limited data suggest that individuals entering the prison system are often under-immunized, particularly against Hepatitis B Virus (HBV), influenza, measles, mumps, rubella (MMR), and pneumococci. Unfortunately, vaccination services within prisons are often insufficient, typically being provided according to national schedules or in response to outbreaks of vaccine-preventable diseases (VPDs). It’s crucial to distinguish between the availability of vaccination services and actual coverage, as the modalities of vaccination offerings vary across the region. While individuals in prison are recognized as a target group for HBV vaccination, the methods of offering vaccines may differ based on factors such as age or risk group. Nevertheless, systematic implementation of HBV vaccination in prisons has shown clear benefits for both incarcerated individuals and the wider community. Given the significance of vaccinations in preventing diseases like HBV and human papillomavirus (HPV), which are linked to cancer, initiatives like the Europe Beating Cancer Plan and the European Council Recommendation on vaccine-preventable cancer emphasize their importance. Prisons can serve as a strategic point for delivering comprehensive healthcare and vaccination services to incarcerated individuals, yet routine data on vaccination coverage at entry and uptake during incarceration are often lacking, hindering effective health planning. To address this public health challenge, the ‘Reaching the hard-to-reach: Increasing access and vaccine uptake among prison population in Europe’ (RISE-Vac) project consortium has been formed. This collaborative effort brings together diverse expertise and established networks in the field of prison health, reflecting the varied epidemiological and structural landscapes across Europe. The objective of this workshop is to showcase recent research findings, evidence-based practices, and policy recommendations aimed at enhancing vaccination equity in the European region. By sharing insights and best practices, we aim to bolster efforts to improve vaccine access and uptake among incarcerated populations, ultimately contributing to broader public health goals. Key messages • Prison health is public health: vaccination services in prison are essential to achieve immunization targets in Europe. • Maximizing inter-sectoral collaboration is crucial for bridging the gap in vaccination access and uptake among people living in prison in Europe.

Epidemiology of hepatitis C from 2015 to 2022 in a central Italian region: the OPT-HepaC project

Abstract Background Chronic hepatitis C virus (HCV) infection is a major global public health problem. This study investigated the evolving landscape of HCV in Tuscany (Italy) from 2015 to 2022, considering demographic shifts, clinical profiles, treatment regimens, and outcomes. Methods The study was conducted in order to characterize HCV-positive patients who started treatment between 2015 and 2022 in Tuscan prescribing centers. The study was part of OPT-HepaC, a project funded by Regional Health Service. Data on demographics, clinical history and outcomes were collected. Three different temporal eras were analysed: the period before andfter the universal availability of direct-acting antivirals (DAA) and the COVID-19 era. Treatment’s effectiveness was evaluated by the Sustained Virological Response (SVR12), assessed 12 weeks after the end of treatment. Outcomes included SVR12, non-SVR12 and lost to follow-up (LTFU). ANOVA, Kruskal-Wallis test and multinomial logistic regression were used for statistical analysis. Results 6882 HCV patients (age: 58.88±14.21) were treated by the centres participating at the study. Males (56.4%) and Italian (91.8%) were predominant. Sociodemographic and variable characteristics vary across the time. While the overall SVR12 remained stable over time (χ2(2)=0.357, p = 0.837), the LTFU rate significantly increased during the COVID-19 era. Facilitating factors for the non-SVR12 and LTFU outcomes were male gender (Odds Ratio (OR)=2.134, p = 0.006)/cirrhosis (OR = 1.713, p = 0.040)/HIV co-infection (OR = 3.251, p = 0.005) and DAA treatment of third generation (OR = 4.187, p = 0.006), respectively. Conclusions The study provides a comprehensive view of the HCV landscape, highlighting demographic changes, treatment regimens and outcomes. The COVID-19 pandemic affected service delivery, delaying HCV diagnosis/treatment and influencing the LTFU rate. Despite challenges, the region maintained high SVR12 rates, emphasizing the importance of sustained efforts in HCV care. Key messages • The study highlights the dynamic nature of HCV management in Tuscany. • The study emphasises the need for continuous adaptation to public health challenges, providing insights for future public health strategies.

Association between frailty and fear of falling among the elderly in Latvia

Abstract Background Frailty and fear of falling in the ageing population represent notable public health challenges. Fear of falling among the elderly population is a significant concern, as it can lead to decreased mobility, loss of independence, and increased risk of injury. Frailty intensifies this fear, as frail individuals often have reduced strength, balance, and coordination, making them more susceptible to falls. Methods Data from the population-based survey SHARE with respondents aged 50+ in Latvia of Wave 9 (collected 2022) was analysed. Frailty was assessed using the SHARE-Frailty Instrument. Fatigue, appetite, walking difficulties, and physical activity were self-reported and grip strength was measured using a hand grip dynamometer. Fear of falling was evaluated using visual material. Financed by the project RSU internal and RSU with LSPA external consolidation No.5.2.1.1.i.0/2/24/I/CFLA/005, Postdoctoral Grant Associated factors of frailty and fall-related mortality in the older population in Latvia No.RSU-PG-2024/1-0005. Results The sample comprised 1439 older adults from Latvia (60.4 % female) with a mean age of 67.9 (95% CI 67.5 - 68.4). Based on SHARE-FI, frailty and pre-frailty prevalence were 7.2% and 44.5% respectively. In the study, 11.3% of females and 6.5% of males interviewed reported experiencing fear of falling. Frailty was correlated with fear of falling in 43.7% of frail individuals and 11.5% of pre-frail individuals. After adjusting for age and gender, those with pre-frailty and frailty had greater odds of fear of falling. Conclusions Understanding the interaction between the fear of falling and frailty in older adults can guide the development of public health policies and initiatives that aim to mitigate the fear of falling and, consequently, reduce the prevalence of frailty. Promoting healthy ageing behaviours, such as regular exercise, balanced nutrition, and social engagement, can help prevent frailty and its associated risks. Key messages • Fear of falling results in limitation of activities, intensification of physical decline, and increased susceptibility to frailty. • Encouraging healthy ageing underscores the significance of early recognition of frailty symptoms and accessing suitable support.

Preventing type 2 diabetes in Portugal: a novel person-centered digital intervention

Abstract Introduction Diabetes, particularly type 2 diabetes (T2D), stands as one of the leading noncommunicable diseases worldwide. In Portugal, the prevalence of diabetes has surged, with T2D affecting 14% of adults in 2021. Its repercussions extend beyond individual health, deeply impacting familial, social, and community dynamics, presenting a significant public health challenge globally. Objectives The VA|PREVENTION project (https://doi.org/10.54499/2022.02969.PTDC) aims to assess the (cost-) effectiveness and implementation of an innovative person-centered digital intervention to prevent T2D among high-risk adults. Methodology A comprehensive approach encompasses the Behavior Change Wheel for intervention design, scalability principles, the WHO guidelines for digital health interventions, co-design, and the ISO framework for usability assessment. Evaluation will be pursued through a type 1 hybrid effectiveness-implementation study (randomized controlled trial), supplemented by qualitative and economic studies. Results The web application prototype features Ema, an automated virtual human coach (VHC), educational menus and a dashboard (version 1.0). Co-design included 2 workshops with 11 representatives of end-users and health professionals. Ema uses standardized techniques from an ontology to support behavior change, based on an initial assessment of low-level target behaviors (e.g. walking, fruit consumption, and reducing red meat intake), and barriers to performing these behaviors. Ema communicates in a helpful-cooperative style using a synthetic voice in European Portuguese, with its speech also appearing as subtitles on the interface. Users interact with Ema by pressing buttons or entering data, such as the daily number of steps. Ethics approval was granted for usability assessment with end-users. Conclusions The project is expected to yield health, scientific, technological, and policy impacts, powered by an exploitation and sustainability roadmap. Key messages • Innovative type 2 diabetes prevention through a scalable web app with a virtual human coach. • Comprehensive and robust approach for developing and evaluating the digital behavior change intervention.

Institutional Discrimination in Health Security Policies against Immigrants in South Korea

Abstract Background South Korea is poised to become Asia’s first mult-iethnic society with over 5% of its population, totaling more than 2.5 million, being immigrants. This demographic shift presents significant public health challenges linked to widespread, and even intensifying, institutional discrimination in healthcare services. Methods This study reviews discriminatory practices across ten essential health security programs, including National Health Insurance (NHI) system, disability assistance, occupational health services, maternal and child care services, national immunization program, health screening program, and assistance for catastrophic medical expenses. Government data and personal narratives were also reviewed to identify the discriminatory elements that can have significant consequences, including increased disease prevalence, higher incidence of occupational injuries, and broader socio-economic instability among migrants. Results Discriminatory elements were found in most programs, with the exception of emergency medical services. These programs commonly provide fewer benefits or impose stricter eligibility criteria for migrants compared to nationals. In particular, the Korean NHI system demands migrants to pay higher premiums and more rigorous maintenance requirements. Conclusions The findings emphasize the need for urgent reforms to equalize health insurance costs, simplify eligibility criteria for migrants, and broaden the scope of benefits to encompass all residency statuses. Implementing these changes will enhance public health infrastructure, improve occupational safety, and foster better integration of the diverse population, ultimately promoting social cohesion and a fairer health system for all. Key messages • A number of discriminatory elements against migrants have been identified in South Korea’s social security policies that can exacerbate health disparities. • Reforms are needed to expand benefits and relax eligibility criteria for migrants in key healthcare policies, including the National Health Insurance system.

Content validation of a test battery for assessing sleep quality in adolescents in Slovenia

Abstract Background Sleep constitutes a fundamental biological necessity, occupying approximately one-third of our lifespan. Consequently, the field of sleep research has experienced an increase in interest, prompted by the recognition of insufficient sleep as a significant public health challenge. As the majority of existing questionnaires in Slovenia have yet to undergo official translation and validation processes, the aim of our study was to conduct content validation of a questionnaire designed to assess the sleep quality among adolescents. Methods We developed a test battery for assessing the sleep quality of adolescents by combining a diverse array of questionnaires. We employed the Adolescent Sleep-Wake Scale, Pediatric Daytime Sleepiness Scale, Epworth Sleepiness Scale for Children and Adolescents, and Children’s Morningness-Eveningness Scale. Following the development of the entire test battery, a process of back-translation from English to Slovene occurred, followed by cultural adaptation. Results The designed questionnaire underwent content validation by a panel of 10 experts drawn from diverse disciplines. Evaluation of questionnaire items followed a planned methodology tailored for the content validation of measurement instruments, focusing on content relevance, clarity, and classification into subscales or factors. Our analysis revealed that the individual questionnaires demonstrate content validity, supported by notably high indices of content validity. Conclusions Translated questionnaires demonstrate decent content validity, thus rendering them valid clinical and research tools for assessing sleep quality in adolescents in Slovenia. Key messages • Our research indicates the availability of content-valid tools for sleep research. • Further investigation is needed to determine the reliability, specificity, sensitivity, and appropriateness of the factorial structure of measures for the quality of sleep.

11.A. Scientific session: Overcoming Real-World Challenges in Setting up Health Data Linkages for Public Health Policy

Abstract Background Linking available administrative data has gained momentum in the last years to enhance public health research and public health formulation. Linkage of diverse data sources can be leveraged to understand social-determinants of health, the cost-effectiveness of an intervention, and to evaluate impact of policies. For instance, data linkage has been proven to be a powerful approach to periodically analyze real-world progress of the COVID-19 pandemic. Today, we are witnessing an unparalleled increase in electronic health data stemming from citizens who interact with services such as healthcare providers, employers, sick funds, and other governmental structures. This enormous amount of data opens many innovative possibilities in epidemiological research. The main advantages of the secondary use of data are the following: 1) it is enriching for new collected data (e.g. survey study), 2) it provides comprehensive information of the target population, and 3) it is cheaper than new data collection. Data linkage between data sources is, however, often a herculean task, and it comes with considerable challenges such as: 1) juridical complexity related to intra-national and cross-border data governance procedures, 2) fragmented data integration, 3) data delivery delays. Addressing these challenges is essential to unlocking the true potential of data linkages for timely responses to emerging public health questions, thereby contributing to evidence-based policy and care and transforming our health research into a One Health approach. Objectives The workshop’s main aim is to present the researcher’s lessons-learned and approaches in applying data linkage from an European, and a country-level perspective through case-studies while creating a space for the public to share their own view. In this workshop we aim to 1) provide a helicopter overview of current data linkages approaches in Europe, 2) illustrate this with case studies from an international, and a country-level perspective, and 3) emphasize the challenges and disadvantages of those data linkages, while sharing potential solutions. Workshop outline The workshop is divided into a knowledge translation, and an interactive part. In the first part of the workshop, three speakers will give a presentation of each 10 minutes with a Q&A of 5 minutes between each presentation where data linkage will be introduced, and three case studies on how data linkage can be used will be presented. The first presentation will introduce approaches to data linkages in Europe, and will delve into how AI can be used during routine data linkage. The second presentation will show a case-study on how an international data linkages can be done in an European federated manner. The third presentation will further illustrate how nationally data can be linked to investigate health inequalities. In the second part of the workshop, the audience will be invited to interact with the speakers and share their experiences. Key messages • A comprehensive overview of different current data linkages approaches are provided, setting the stage for discussions on methods and best practices. • Administrative data linkages are a powerful tool to answer important public health challenges, but important challenges related to data governance need to be addressed to realize the full potential.

Mortality rate of percutaneous coronary interventions in st-segment elevation myocardial infarction patients under the public health insurance schemes of thailand

Abstract Background ST-elevation myocardial infarction (STEMI) presents a critical public health challenge internationally, including in Thailand. Currently, standard therapeutic interventions, particularly primary percutaneous coronary interventions (pPCI), are administered to Thai citizens. However, selected healthcare systems restrict access to specific pharmaceuticals and medical devices, causing inequalities in the quality of medical care amongst different healthcare systems. Such inequalities have the potential to significantly impact the quality of life of patients, particularly in the long term. Purpose The primary objective is to compare mortality rates within one year of STEMI patients after treatment with pPCI among the public health insurance schemes of Thailand. The secondary objective is to study prognostic determinants for one-year mortality rates among patients diagnosed with STEMI who have undergone pPCI. Methodology This study is a single-centre retrospective analysis of patients with STEMI treated with pPCI. It involves patients utilising various state health insurance schemes in Thailand from 1 January 2010 to 31 December 2020. Data collection occurred through the hospital's computerised management system and the registration administration office of the Department of Provincial Administration. The data analysis employed the Kaplan-Meier survival analysis, log-rank test, and Cox proportional hazards regression modelling method. Results The study involved 1,077 patients, categorised into three groups based on their state health insurance: Universal Health Coverage (UC) (546 patients, 50.7%), Social Security System (SS) (199 patients, 18.5%), and Civil Service Reimbursement (CS) (332 patients, 62.6%). The one-year mortality rates in these groups were 10.57%, 4.21%, and 6.47%, respectively (p=0.010). In the unadjusted model, the SS group showed a lower risk of one-year mortality rate (HR 0.38, 95% CI 0.18-0.80, p=0.011), and the CS group also demonstrated a lower risk (HR 0.59, 95% CI 0.35-0.99, p=0.047) compared to the UC group. In the adjusted model, only the CS group significantly reduced the risk of one-year mortality. Other factors that affected one-year mortality were age ≥65 years, a Killip score of 3-4, pre-discharge prescription of angiotensin-converting enzyme inhibitors, occlusion in the left anterior descending artery, and pericardial effusion. Conclusion Healthcare schemes play a significant role in influencing one-year mortality rates among STEMI patients treated with pPCI. The use of civil service reimbursement is a protective factor for the one-year mortality rate in STEMI patients. This information would be crucial for developing strategies and programs to aid healthcare policymakers at both regional and international levels in reducing morbidity and mortality.

Co-creation in public health: innovations and considerations

Abstract Danielle will delve into the essence of co-creation and its application in navigating the complexities of public health challenges. Delegates will gain insights into how co-creation fosters innovative solutions and discover key considerations essential when designing co-creation projects. Join us to explore the transformative potential of co-creation in addressing the pressing issues of public health.

The underestimated risk of prediabetes on cardiovascular outcomes in heart failure with reduced left ventricular function

Abstract Background The global prevalence of prediabetes and diabetes is increasing, highlighting an urgent public health challenge. While the cardiovascular (CV) risk of diabetes is well studied, profound data on the CV risk of prediabetes in patients with heart failure (HF) remain scarce in current literature. Therefore, we aimed to investigate the relationship of prediabetes and diabetes with common HF associated events such as all-cause, CV death and hospitalization for HF (HHF) in patients with HF with reduced ejection fraction (HFrEF). Methods Patients with HFrEF who were admitted to a tertiary academic center between 01/2005 and 07/2019 were included in the present analysis and then stratified according to their glycemic state. Prediabetes was defined as an HbA1c value between 5.7% and 6.4% and the absence of diabetes mellitus. The primary outcome was a composite of CV death and HHF. Secondary outcomes were the individual components of the primary outcome and all-cause death. We used cox regression models adjusted for age, sex, chronic kidney disease, body mass index, prior myocardial infarction, hypertension, CRP, and LDL-C. Results In total, 1,777 patients (median age 69 years, 24.3% female) were included in the present analysis and followed over a median of 4 years. Among them, 35.2% were diabetic, 18.7% prediabetic, and 46.1% showed non-impaired glucose metabolism. NT-proBNP levels were comparable between all glycemic groups. Both prediabetes and diabetes were found to significantly increase the risk of CV-death or HHF compared to those with normal glucose metabolism, with adjusted hazard ratios (HR) of 1.41 (95% Confidence Interval [CI]: 1.05-1.89) and 1.52 (95% CI: 1.17-1.97), respectively. This elevated risk applied to both components of the primary outcome, as illustrated in Figure 1. Notably, the increased risk of all-cause mortality was statistically significant only among diabetic patients (adj. HR 1.75; 95%CI: 1.30-2.36), with prediabetic patients showing a trend towards increased risk but not reaching statistical significance (adj. HR 1.40; 95%CI: 0.99-1.97). Conclusion The findings of this study underscores the independent associations between both prediabetes and diabetes with increased risks of cv-death and HHF in patients diagnosed with HFrEF. This emphasizes the critical role of glycemic status in the prognostication and management of HFrEF. The associations suggest that prediabetes is not merely a transient or benign state but has significant implications for cardiovascular health, particularly in the context of HF. In light of these findings, screening of prediabetes in patients with HFrEF might help to identify patients at risk who are susceptible for the development of HF related adverse events.Forest plot for all study endpointsKaplan-Meier curves for CV-death/HHF

Climate change and emerging infections: Risks, adaptation and response

Abstract Background Weather and changing climate are key drivers of the emergence, re-emergence and spread of infectious diseases globally. However, approaches to emerging infections and climate strategies are still largely being developed separately missing the opportunities for integrated climate adaptation actions to address infectious diseases. Description To inform the development of the UK national emerging infectious diseases plan, a literature review of the current and projected risks from extreme weather events and climate change on emerging infections in the UK is currently underway. This will support further work examining and co-designing adaptation options in the context of preparedness and response to emerging infections. Results Key preliminary findings from the literature review have indicated risks predominantly from evolving patterns of vector borne diseases as climatic conditions and habitat suitability of pathogens change. Changing temperatures and hotter summer temperatures have been associated with changing food-borne infection patterns. Further risks driven by extreme weather, including flooding and droughts, could perpetuate changes in water-borne infection patterns. Adaptation actions focussed on these infectious disease groups are currently under review and will cover risk assessment, data and surveillance, preparedness and response. Lessons This work integrates climate action with action on emerging infectious diseases. By examining the evidence on climate sensitive infections and co-designing solutions across teams, awareness is being raised and relationships and infrastructures built to better prepare and respond to both fundamental global public health challenges.

CULTURAL adaptation and validation of the Indonesian version of the Roland-Morris disability questionnaire: A psychometric analysis

BACKGROUND: Epidemiological evidence underscores low back pain (LBP) as a prevalent and consequential musculoskeletal disorder, posing a significant public health challenge. Patient-reported outcome measures (PROMs) play a crucial role in the diagnostic process for LBP, with the Roland-Morris Disability Questionnaire (RMDQ) being a commonly utilized tool in evaluating LBP. OBJECTIVE: This cross-sectional study aimed to cross-culturally adapt and validate the Indonesian version of the 24-item-RMDQ among nonspecific LBP (NSLBP) patients. METHODS: The RMDQ scales underwent forward-backwards translation, readability, and content validity assessments with NSLBP patients (n = 137), with a mean age of 38.6±11.8 years (59% female). Psychometric testing included assessments of internal consistency and 1-week test-retest reliability, convergent validity with pain numeric rating scale (PNRS), and the Physical Component Summary (PCS) and Mental Component Summary (MCS) of quality of life (Short Form 12). The construct validity using confirmatory factor analyses (CFA). RESULTS: The findings of this study indicated a good internal consistency (Cronbach α= 0.80) of the translated instrument. Moderate to good repeatability estimates of all RMDQ items were demonstrated with the total ICC of the total RMDQ score of 0.90 [95%CI (0.85–0.94)]. The instrument correlations with PNRS, PCS, and MCS were 0.54, 0.60, and 0.23, respectively. The goodness-of-fit test further affirmed an acceptable fit of the data, although low factor loadings were found in several RMDQ items. CONCLUSION: Although the factor structure of the RMDQ scale warrants further investigation, the overall findings support its suitability for clinical application in Indonesian NSLBP patients.

Digital Health in Croatia: Key stakeholders’ perspective of societal and institutional readiness

Abstract Background According to the literature, digital health brings an innovative approach to healthcare and an inevitable transformation and disruption. The potential of digital technologies is far-reaching, from preventive medicine to addressing public health challenges. However, the implementation also significantly depends on the social & cultural context. Methods To research Croatia’s expectations, challenges, and readiness for implementing digital health, interviews were conducted with physicians, patients, hospital managers, policymakers, jurists, and engineers (n = 75). Following identifying key themes, a survey was conducted among Croatian medical students (n = 775) at the end of 2022. Results Key stakeholders believe implementation preparedness is demonstrated through institutional and societal readiness. Prominent characteristics of societal readiness include appropriate infrastructure and legal and financial frameworks. Societal readiness is assessed through digital and health literacy and existing social practices within Croatian society. Only 4.6% of medical students believe Croatia’s healthcare system is ready to implement digital technologies. They perceive the highest readiness regarding digital education (63.7%) and the digital literacy of physicians (60.9%) while negatively evaluating healthcare infrastructure, financial resources, and patient literacy. The results highlight numerous aspects that must be addressed for successful implementation, many of which have been neglected in previous periods. Conclusions The research identifies critical aspects of the social context and presents valuable implications for the digital health transformation. Key stakeholders assess that institutional and societal readiness is not at the level required for the sustainable implementation of digital health, thus necessitating specific actions, ranging from governmental bodies and international organisations to the health system, education system, and media. Key messages • It’s crucial to align digital health implementation with the social & cultural context and capabilities. • The prerequisites for successful implementation necessitate engagement across various societal domains beyond the healthcare system.

6.Q. Round table: Artificial Intelligence in healthcare: navigating ethically with equity and workforce empowerment

Abstract Background Artificial Intelligence (AI) is emerging as a pivotal technology with vast promises for healthcare. However, integrating AI into clinical and public health settings must be cautiously approached to ensure that it does not inadvertently exacerbate existing health system problems. The healthcare workers, already under severe stress, could view AI as a threat to job security rather than as a support mechanism. Moreover, past experiences with digital transformations, such as Electronic Health Records, have shown that technological integration can sometimes increase rather than decrease the burden on healthcare workers, leading to burnout and dissatisfaction, and thus worsening the healthcare workforce crisis. Furthermore, equity and ethical considerations are paramount in the deployment of AI in healthcare. Data privacy, patient consent, and algorithmic bias must be addressed to ensure that AI applications are designed to support and enhance human decision-making that is sensitive to the social determinants of health and accountable to equity and social inclusion, to the needs and rights of the healthcare workforce, and the dignity of the patients and populations. While AI presents significant opportunities for health systems and healthcare workers, there is a lack of knowledge, evidence-based policies, and ethical frameworks that support equitable and human-centred approaches to AI implementation. Objectives This round table workshop aligns three major public health challenges: the integration of AI in health systems, the global healthcare workforce crisis, and the improvement of equity and equality. It critically explores capacity building for AI, equity in AI implementation, and regulatory measures for ethical and responsible AI deployment, addressing the following major questions: What are the critical impacts of AI on the healthcare workforce? How can the healthcare workforce be effectively upskilled and supported to adapt to the changes brought by AI technologies? What regulatory frameworks and governance models are necessary to ensure AI’s safe and ethical implementation in healthcare, that is also sensitive to equity, gender equality and the needs of minority groups? Finally, what actionable steps and leadership can public health take to implement AI technologies while addressing the healthcare workforce needs, equity issues, and ethical guidelines? The panellists will illuminate these questions from different disciplinary approaches, helping us to disentangle complexity and to build capacity for evidence-based and socially inclusive AI policies. The workshop contributes to better understand the risks and benefits of AI. It seeks to advance knowledge exchange of good practice experiences and effective implementation. Key messages • The effects of AI on the healthcare workforce must be monitored and strategies adapted to mitigate the healthcare workforce crisis and to upskill and empower healthcare workers. • There is a need for human-centred and ethically responsive AI implementation and governance measures that support equity, gender equality, and diversity in healthcare settings. Speakers/Panelists Abi Sriharan Schulich School of Business York University, York, Canada Kasia Czabanowska Maastricht University, Maastricht, Netherlands Bernadette Kumar Migration Health Unit, Norwegian Institute of Public Health, Oslo, Norway Marius-Ionuț Ungureanu Babeș-Bolyai University, Cluj-Napoca, Romania Farhang Tahzib Faculty of Public Health, Haywards heath, UK