Public Health Issue Research Articles

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.

Barriers and enablers towards integrated care for sexual violence victims in humanitarian settings

Abstract Background Sexual violence (SV) is a complex public health issue that necessitates a coordinated multisectoral response. Ideally, this response should be provided through an integrated care package to strengthen timely access and comprehensive care for victims. However, in humanitarian settings with high levels of SV, care is often offered through fragmented silos, exacerbating the burden on the health workforce and victims. Methods Using the Valentijn framework, a qualitative, real-time Delphi study was conducted with 17 SV care experts representing 7 geographical subregions to gain informed opinions on key contextual and health system barriers and enablers for integrated care for SV victims in humanitarian settings. Results Challenges and enablers reported across the diversity of the participants’ contexts showed consistency. Contextual challenges included volatile contexts, collapsed health systems, and poor infrastructure. Professional challenges included a lack of expertise among healthcare providers (HCPs), high staff attrition, and compassion fatigue among HCPs. Health systems challenges included poor referral and coordination mechanisms, insufficient resources, misaligned donor-programme priorities and low prioritisation of SV comprehensive care. Key enablers reported were effective networking, community engagement, capacity building, co-locating services, participatory management, promoting staff’s sense of ownership, digitalised information systems, and joint patient files. Conclusions The sustainability of integrated care for SV victims can be strengthened by ensuring HCPs access regular psychological support and training and are incentivised to provide quality care. Regular coordination among actors, including donors, can support integrating care that responds to patients’ holistic needs. Further research is needed to assess HCPs’ and SV victims’ experiences of current service delivery and how to optimise integrated care in humanitarian settings. Key messages • Addressing care providers challenges in humanitarian settings, such as high attrition, lack of training, psychosocial support, and burnout, can ensure proper integration of sexual violence care. • Integration of sexual violence care demands systemic changes, including aligning donor-programme goals, building accountability mechanisms and the buy-in of political and community leaders.

10.K. Skills building seminar: Practical and methodological guidance for conducting online qualitative surveys in public health

Abstract Online qualitative surveys are surveys which prioritise qualitative (open text) questions in data collection. Researchers have stated that these types surveys have rich potential for qualitative researchers. They are able to collect rapid insights into new or emerging areas of health, and are an effective way of reaching populations who may not otherwise engage in qualitative interview studies or focus groups. Although these types of surveys are increasingly used by public health and health promotion researchers, there is very limited discussion in the research literature to guide researchers about the practical and methodological aspects of such surveys. This creates some challenges for qualitative researchers - as well as funders, and peer reviewers - in assessing the rigour and robustness of these studies. Using data from a range of online qualitative surveys that we have conducted with youth and adults relating to gambling, alcohol, climate change, and the commercial determinants of health, we describe the processes associated with developing, implementing, interpreting, and writing up online qualitative survey data. In this practical and interactive multimedia workshop and developing on the work of Braun, Clarke and colleagues, with a focus on Big Q interpretivist qualitative approaches. We will provide: 1. Practical examples, and lessons learned from our own studies about survey design, question development, the importance of rigorous piloting strategies, the use of novel techniques to prompt detailed responses from participants, and the decisions that are made about data cleaning. 2. Examples of the types of responses that can be expected in different types of surveys, and how decisions are made about the quality of responses to questions. 3. Guidance about how to analyse the volume of qualitative data that is generated from such surveys, including developing robust mechanisms to ensure trustworthiness of decision making and data interpretation. 4. Tips based on our role as journal editors about how to present qualitative survey data, and how to respond to challenging reviewer comments. Participants will be provided with a booklet containing survey templates, question examples, tips and examples of how to respond to reviewer comments. Key messages • Online qualitative surveys have rich potential for collecting insights about emerging public health issues. • This workshop will provide practical and methodological guidance for researchers who are interested in using these surveys. Speakers/Panelists Hannah Pitt Deakin University, Burwood, Australia Simone McCarthy Deakin University, Armadale, Australia Samantha Thomas Deakin University, Geelong, Australia

Hybrid accountability in global health public-private partnerships: a literature and case study

Abstract Background Recent global health public-private partnerships (PPPs) offer novel approaches to public health issues, yet they lack clear public accountability. Hence, it remains unclear how accountability is organised and practiced. This research examines accountability in global health PPPs, how it is manifested, and derives lessons for developing an accountability framework. Methods The study utilized both a scoping literature review, examining the databases SCOPUS, Web of Science and MEDLINE, which yielded 35 eligible articles from 334 records, and an exploratory case study focused on an accountability event within the Global Stop Tuberculosis Partnership (STBP), incorporating a document analysis and an expert interview to enhance insights from the literature review. Results Authors studying PPPs often conceptualized accountability broadly and favoured a view tied to hierarchical state-led governance and democracy. However, at the global level, this political accountability is largely absent. In PPPs, it is replaced by a mix of bureaucratic, legal, social, audit, fiscal, and rather soft accountability mechanisms. Also, PPPs' accountability landscape is dynamic, shaped by different normative considerations and by the interdependence among partners. In 2020, the allegations for misconduct at the STBP exemplified public reputational accountability, followed by audit accountability leading to an enforced soft accountability to STBPs' mission & purpose. Conclusions This study highlights the necessity for rethinking accountability in global health PPPs due to the limitations of existing structuralist frameworks. A new hybrid accountability framework is proposed. It considers a strong accountability focus on PPPs' purpose, their processual dynamics, and normative aspects. Lastly, it is recommended to further investigate the trade-off between transparent accountability mechanisms and the practical necessity for confidential backstage processes in PPPs. Key messages • Exploring a hybrid accountability framework in global health PPPs beyond only static accountability snapshots, helps to understand PPPs’ true dynamic, purpose-driven and individualized accountability. • Without regulatory mechanisms and state governance, individual action and new collaboration become essential, requiring soft accountability mechanisms as increased trust and cooperation among partners.

Commuting violence: Social, mental and academic consequences. Is this concept necessary to adopt?

Abstract Introduction Violence has emerged as a pressing public health issue due to its global impact, prompting the need to coin the term ‘commuting violence’ (CV). This term refers to any form of aggression experienced by students traveling from the University to other locations such as their homes or vice versa, considering that this situation could have health and academic consequences for students. Objectives To determine the consequences associated with CV in university students. Methods A cross-sectional and prospective study was conducted, including students from a Medical School in Veracruz, Mexico, from August to December 2023. Invitations to participate were extended to students of medicine, chiropractic, and radiology technology. Results A total of 279 participants with a mean age of 20 (±3.0) years were included. 89.6% of students perceive insecurity on their journey to the university, primarily due to the presence of suspicious individuals (93.9%); 70.6% of participants reported knowing a peer who has experienced CV, leading them to avoid certain streets (92.5%) to avoid it. Insecurity felt on the journey home from school showed a significant association (OR/CI95%) for anxiety due to JV of (7.2/3.2-16), stress due to CV of (11.1/4.74-25.9), and paranoia due to CV of (4.48/2.02-9.92). A total of 140 (50.2%) students reported experiencing CV, with the most frequent manifestations being sexual harassment (79.3%) and verbal harassment (57.8%), as well as two (1.4%) attempted rapes. Experiencing CV was positively associated with students avoiding class schedules before 8:00 a.m. (3.6/1.69-7.63) and after 6:00 p.m. (4.6/1.7-11.94), as well as absenteeism (7.37/2.51-21.67) and thoughts of dropping out (12.9/2.75-60.36) (p < 0.05). Conclusions PV is a relevant situation that exists within the well-being of students, impacting them both in anticipation and when faced with it. The concept of CV should be considered for use in future research. Key messages • We propose the concept of Commuting violence as an element to be taken into account since it has been demonstrated that this situation interferes with the academic activity of the students. • Commuting violence occurs during academic activities, so universities should propose actions to make students feel safe on their daily journey to the university.

2.X.1. Sleep Health Disparities across the life-course: from research to public health policy

Abstract Poor sleep health is a recognized common problem across the life cycle, globally. Factors that contribute to this problem include the demands of a “Western” lifestyle (urgency, productivity), economic stressors, social and environmental determinants of health, and global crises including international conflicts, political tensions, and climate change. There is a growing consensus that optimizing sleep health should be a public health priority because poor sleep patterns are a modifiable risk factor for myriad health outcomes, such as cardiovascular disease, diabetes, cancer, cognitive decline, mental illness, and early mortality. In Canada, a nationwide sleep consortium funded by the Canadian Institutes of Health Research (CIHR) was recently formed with a mandate to generate new knowledge that will inform clinical practice and support public health initiatives to deliver resources where they are most needed. The proposed workshop organized by the Chronic Disease EPH section will start with a general overview of the impact of sleep health disparities across the life-course, from childhood to older age, as well as discuss evidence-based public health approaches to promote sleep hygiene and mitigate the risk of adverse health outcomes, including chronic disease (Saverio Stranges). It will be followed by three presentations to address the root causes of sleep health disparities and their impact on chronic disease (Dayna Johnson); participatory research with families and care providers on infant sleep intervention development (Elizabeth Keys), and strategies to address common sleep disorders among middle-aged and older adults (Tetyana Kendzerska). Key messages • Sleep health disparities are a neglected public health issue. • Optimizing sleep health is both a clinical and public health priority, as sleep patterns represent a modifiable risk factor for a range of adverse health outcomes.

Human-swine interface: is the hepatitis E virus a real risk for humans?

Abstract Background Hepatitis E virus (HEV) is the agent of hepatitis E, an emerging public-health infection with an increasing incidence in Europe. Due to the apparent lack of species barriers, HEV is considered a zoonotic agent, with swine as the main reservoir. This study investigated HEV prevalence in humans and domestic pigs in Northern Italy, a highly anthropic area with the highest pig farm density, to gain insights into the risk of HEV transmission from swine to humans. Methods A total of 508 blood samples were collected from blood donors (341 males and 167 females; from 18 to 66 years old) and from 1619 pigs in 40 different farms. Serological analyses were performed with ELISA to detect anti-HEV antibodies. In addition, 120 faecal pool samples collected from the pig farms with the highest seroprevalence and 69 salami produced in the same area were analysed to detect viral genome by Real-time PCR. Results In humans, HEV seroprevalence was 4.9% (CI95% 0.03-0.07); positive donors were mainly males, with seroprevalence increasing up to 12% (CI95% 0.09-0.15) in the 46-55 age group. Seroprevalence in swine was 53.00% (CI95% 0.50-0.55), with HEV detected in only 1% (CI95% 0.001-0.045) faeces. All food samples tested negative. Conclusions Even if the seroprevalence in pigs highlighted that HEV was actively circulating in the farms, the low seroprevalence in humans, the scarce HEV detection in swine faeces, and the absence in food products suggested that HEV transmission via faecal-oral or foodborne routes is unlikely, probably due to the implementation of severe biosecurity measures and high standards of hygiene in swine farms, and the continuous assessment of the critical points in the pig supply chain (from farm to fork). The serological surveillance of humans and the monitoring of farmed animals are needed to support the competent authorities in timely managing public health issues, improving human health and veterinary safety from a One Health perspective. Key messages • In the human-swine interface is important to monitor HEV presence. • The One Health approach is essential to control zoonotic diseases.

Needs assessment to design a multidisciplinary training programme within the EU-PROMENS project

Abstract Background Mental health as a public health issue warrants a comprehensive prevention-oriented approach whereby capacity building as well as a multisectoral and life-course approach are crucial. The ‘Capacity-building on mental health: multidisciplinary training programme and exchange programme for health professionals,’ project enhances and improves the capacity of professionals across Europe in the field of mental health. Various professionals are targeted 1) health professionals working in the mental health sector, 2) teachers and educators working in the educational setting, 3) social workers working in various community settings and 4) prison staff. Objectives To understand the needs, gaps, obstacles in capacities, competencies, and to build upon existing programmes a mixed methods study, adopting a convergent parallel design is conducted to design and develop the programme. First, a literature review is conducted complemented with interviews, focus group discussions and a survey among various stakeholders to enrich the data. The training will be piloted in The Netherlands, Spain, Czech Republic, Croatia, Finland and Austria. Thereafter it will be rolled out in the 21 remaining EU countries as well as in Norway, Iceland and Ukraine. Results Various gaps and competencies identified from different perspectives build a solid fundament for a comprehensive multidisciplinary training programme tailored to the needs of various professionals within the mental health arena. Preliminary results show that 98 multidisciplinary training programmes exist, with about half containing training materials and limited reports on evaluation. Conclusions The comprehensive needs assessment will assure a multidisciplinary training programme is suitable and relevant for various professionals to ensure a well-designed capacity-building programme. Key messages • Various gaps and needs among various professionals exist. • A comprehensive study strengthens alignment of training to needs and gaps among various professionals.

Fast lane for decision making: The PHIRI Rapid Exchange Forum

Abstract Issue & Problem The COVID-19 pandemic demanded swift, yet structured exchange of knowledge, data and good practices between experts and institutions supporting national governments in decision making for crisis response. Thus, in March 2020 population health experts from several European countries started to meet online, complementing the more formal EU Health Security Committee meetings. The European Commission understood the high need of Member States for evidence-based, and structured cross-country exchange and supported it as part of the Population Health Research Infrastructure (www.PHIRI.eu) project. Since then, the PHIRI Rapid Exchange Forum (REF) is a knowledge-sharing platform that brings together public health researchers, practitioners, policymakers, and other stakeholders to share information, experiences, and best practices in public health implementation research even if the EU co-funded PHIRI project has ended. The forum aims to promote collaboration and networking, facilitate the dissemination of research findings, and accelerate the translation of evidence into policy and practice. Lessons Through the PHIRI REF, participants can engage in interactive discussions, workshops, and presentations on various public health topics, including infectious diseases, digitalisation, health emergency simulations, health systems strengthening, and community health interventions. The platform is designed to be user-friendly and accessible to all, with a particular focus on European countries. By May 2024, the REF-Secretariat at the Austrian National Public Health Institute GÖG had organised 60 REF meetings, with in average 20 attendees from 12-15 countries. The monthly 1-hour online meetings cover in a moderated, structured format pre-agreed topics that are proposed by the participating countries. All findings and topics are documented and publicly available at the EU Health Information Portal (https://www.healthinformationportal.eu/rapid-exchange-forum). Key messages • The success of the Rapid Exchange Forum highlights the importance of collaboration and information exchange between population health experts in addressing global health challenges. • Having a pre-established information exchange network on urgent public health issues is of utmost importance as it enables rapid and trustworthy communication among relevant stakeholders.

Determinants of COVID-19 vaccination acceptance based on the novel Omale INDEPT FORCIS Framework and recommendations for subsequent pandemics: a qualitative study among community members in Ebonyi state, Nigeria

BackgroundThe unprecedented COVID-19 pandemic has become an endemic disease of global public health importance. Mass COVID-19 vaccination has been an essential global control strategy amidst challenges of limited acceptance. Because of globalization, COVID-19/similar diseases vaccination acceptance and the determinants in any particular setting are important global public health issues. Using a novel and pragmatic framework, this study explored determinants of COVID-19 vaccination acceptance among community members during the pandemic in Ebonyi state, Nigeria, and made policy-relevant recommendations on how to increase vaccination acceptance in subsequent outbreaks/pandemics.MethodsThis qualitative study was based on the novel and pragmatic Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four ‘Cis’) Determinants of Vaccination Acceptance Conceptual Framework – Omale INDEPT FORCIS Framework. On April 26 and 27, 2022, 20 semi-structured face-to-face focus group discussions were conducted in local language and pidgin English with 100 purposively selected consenting/assenting community members aged 15 years and above who had resided in the community for at least one year. Data was analysed using deductive (with some inductive) thematic analytic approach.ResultsThe many, diverse, and significant determinants of COVID-19 vaccination acceptance found were factors that were individual-related (individual experiences and perceptions and knowledge about COVID-19, COVID-19 vaccine/vaccination, and the vaccination process/system, sociodemographic, individual’s condition (e.g. pregnancy)); COVID-19-related (factuality, transmissibility, frequency, severity, fatality); COVID-19 vaccine/vaccination-related (safety/side-effects, effectiveness, speedy production); COVID-19 vaccination process/system-related (real availability/accessibility); family, group, and other individual-related (experiences and perceptions and actions); and broader local, national, international, and global (LONING) context-related (socio-political, economic, historic, health system factors). The broader LONING contextual factors included the unprecedented disinformation/conspiracy theories, non-sustained COVID-19 risk/behaviour change communication, enforcement and non-enforcement or termination of peculiar control policies/measures (lockdowns, social/physical distancing, use of face mask etc.), mandatory COVID-19 vaccination policies, provision of incentives, past experiences regarding the Ebola viral disease outbreak, (un)trustworthiness of the Nigerian health system and her international/global partners, and the (un)trustworthiness of the governments in Nigeria and bad/good governance, inclusive of the failure of the Ebonyi state government to distribute the COVID-19 palliatives to the people during the lockdowns.ConclusionThe evidence illuminates complex and interrelated, specific underlying, and peculiar policy-relevant LONING determinants of COVID-19 vaccination acceptance and emphasizes the need for concerted and comprehensive LONING strategies (involving all the relevant LONING stakeholders/policy makers) in addressing these determinants to increase vaccination acceptance among community members in subsequent outbreaks/pandemics in Ebonyi state/Nigeria and similar settings.

6.X.2. Food Insecurity in Europe: Voices from across Europe

Abstract Food insecurity (FI), “lack of regular access to enough safe and nutritious food for normal growth and development and an active and healthy life”, is a global public health issue. The United Nations (UN) have identified achieving food security as a key Sustainable Development Goal (SDG), where all people should “have access to safe, nutritious, and sufficient food all year round.” However, disasters related to the consequences of changing climates, pandemics, wars, displacement of populations, high inflation rates, changes in social protection systems, and food system changes challenge the achievement of this SDG. FI persists even in high-income countries including Europe. This workshop session will foster a knowledge, research and experience exchange on the situation of individuals / different population groups in the context of FI in different European countries. Starting with a contribution from Austria, the term food poverty is introduced and considered from a food system perspective / from an equity perspective. The second contribution illuminates the relationships between FI, shopping behaviours and social support among food bank users in Germany during the COVID-19 pandemic. The final third contribution comes from the Netherlands and explores the needs and perceptions regarding healthy eating among people at risk of FI. In all three studies, standardized measurement tools were applied to measure FI but recruiting methods and data collection methods varied considerably between and within the studies. The session enhances the knowledge on FI in Europe from different perspectives. Key messages • Food insecurity does exist in Europe: there is a need for regular, consistent monitoring across European countries. • Food insecurity involves more than just access to food; it also considers nutritious and climate-friendly options, addressing the link between climate, health, and equity.

Estimating the impact of the COVID-19 vaccination programme in Ireland: December 2021-March 2023

Abstract Background In Autumn 2023, COVID-19 booster vaccines were offered to all those aged ≥50 years in Ireland. There was concern that vaccine fatigue would impact uptake. We aimed to quantify the direct impact of the COVID-19 vaccination programme on averted outcomes in individuals aged ≥50 years, during a period of Omicron variant dominance, to inform vaccination strategy and public health communication. Methods We conducted a retrospective observational study from December 2021 to March 2023 in Ireland. We considered as averted outcomes symptomatic SARS-CoV-2 presentations to primary care, emergency department (ED) presentations, hospitalisations, intensive care unit (ICU) admissions and deaths due to COVID-19. We used an adapted formula from other vaccine impact published studies, including national data on notified outcomes, vaccine coverage data and vaccine effectiveness (VE) estimates, sourced from the WHO’s live systematic VE review, to estimate the count and prevented fraction of outcomes in ≥ 50-year-olds averted by the COVID-19 vaccination programme. The number of expected outcomes in the absence of vaccination was calculated by summing the counts of outcomes observed and outcomes averted. Results Between December 2021 and March 2023, the COVID-19 vaccination programme averted 48,551 symptomatic presentations to primary care (36% of expected), 9,517 ED presentations (53% of expected), 102,160 hospitalisations (81% of expected), 3,303 ICU admissions (89% of expected) and 15,985 deaths (87% of expected). Conclusions During Omicron dominance, the COVID-19 vaccination programme averted symptomatic and severe outcomes, including deaths due to COVID-19, underscoring the benefits of COVID-19 vaccination. In the context of vaccine fatigue emerging as an important public health issue in Ireland and internationally, these findings can inform future COVID-19 booster vaccination programmes and communication about the reason for and importance of COVID-19 vaccination. Key messages • The COVID-19 vaccination programme in Ireland prevented illness and death in people aged ≥50-years. Vaccination therefore protected population health and the healthcare system. • These findings can be used to inform future COVID-19 vaccination policies, planning for winter, pandemic preparedness and communisation about the importance of ongoing COVID-19 vaccination programmes.

Is the medical curriculum failing patients with obesity? - A public health concern

Abstract Introduction Despite the global surge in obesity, it often receives insufficient attention in medical curricula, potentially impacting its management. This study aims to assess the preparedness of medical students in managing obesity. Methods A cross-sectional survey was conducted by disseminating a mixed-methods anonymous questionnaire to medical students studying at the University in Malta. A sample size of 117 participants was determined a-priori. Descriptive statistics and chi square testing were conducted. and coupled with thematic two-stage coding analysis of qualitative data. Results 189 participants were recruited. The majority expressed dissatisfaction with the teaching of obesity and its management during the MD course (pre-clinical = 90%; clinical = 74.4%, p = 0.006). Clinical students expressed dissatisfaction regarding the adequacy of their pre-clinical education (82.65%) and clinical attachments (70.40%), in equipping them with the theoretical knowledge and foundational skills necessary for managing patients with obesity. No significant difference between clinical and pre-clinical students’ knowledge was noted except concerning diagnostic criteria (preclinical: 63.33% versus clinical: 89.90 %; p < 0.001). Thematic analysis highlighted the importance of curricular obesity teaching, need for a holistic approach towards obesity, and hesitancy in treating patients with obesity. Conclusions The gap between medical students’ perceived readiness and the growing obesity epidemic is a public health concern. Without proper training, future doctors may struggle to manage obesity, posing risks to health outcomes and healthcare systems. Urgent curricular reforms are necessary to prioritize obesity education and ensure physicians are equipped to address obesity, to meet national needs. This requires collaboration among stakeholders, especially post-COVID-19, to align medical education with public health needs while addressing the severity of the obesity epidemic in Europe. Key messages • A gap between students’ attitudes and their understanding of obesity education was identified in this study, indicating a need for curriculum reform. • This presents a critical public health issue, as it leaves the new generation of doctors ill-equipped to address the growing obesity epidemic across European countries.

Developing HPV Vaccination Communication Strategies: Assessing Knowledge, Attitudes, and Barriers Among Healthcare Professionals in Kazakhstan

Background: Cervical cancer, predominantly caused by human papillomavirus, remains a major public health issue globally and in Kazakhstan, where it ranks among the most common cancers in women. A pilot HPV vaccination programme in Kazakhstan was suspended in 2017 due to mass parental refusals, and it is planned to be restarted in the coming years. This study aims to assess the knowledge, attitudes, barriers, and sources of information about HPV and the HPV vaccine among healthcare professionals in Kazakhstan. Methods: A cross-sectional study (December 2022–May 2023) involving 1189 healthcare professionals in Kazakhstan used a self-administered questionnaire. Statistical analysis included descriptive statistics, mean knowledge score, between-group comparisons, and binary logistic regression to identify factors linked to higher knowledge and vaccine recommendation. Results: The study found that the average knowledge score for HPV and the HPV vaccine among participants was 11 out of a possible 18. Correct answers to the questionnaire were observed more frequently among physicians than among nurses (p < 0.001). In our study, 72.6% of healthcare professionals expressed a positive intention to recommend the HPV vaccine. The likelihood of recommending the HPV vaccine was significantly higher among those with higher knowledge of HPV and its vaccine (OR 1.8; 95% CI 1.3–2.5; p < 0.001), those familiar with cervical cancer patients (OR 2.0; 95% CI 1.5–2.8; p < 0.001), and those with positive attitudes towards the COVID-19 vaccine and childhood vaccination (OR 2.3 and 1.5, respectively). Healthcare professionals identified key barriers to HPV vaccination, including public mistrust (49.4%), fear of side effects (45.9%), and insufficient knowledge among healthcare professionals themselves (30.3%). Information from the internet, including articles and journals, was the most commonly used source of information, followed by social media and colleagues. Conclusions: The disparities identified call for a tailored, multifaceted communication strategy that addresses the diverse needs of health professionals to address the differences in awareness between different groups, in order to ensure successful implementation and coverage of HPV vaccination across Kazakhstan.

Unplanned emergency department attendances due to home and leisure accidents in the elderly Portugal

Abstract Home and Leisure Accidents (HLA) have been identified as a relevant public health issue with individual, societal and economic consequences. So, common cause of injury-related morbidity and mortality, especially among older people. Evidence shows that most of HLA among the older ones are associated with identifiable and modifiable risk factors. However, more detailed information about the context and characteristics of such events is needed. This study aimed to characterize the occurrence of HLA in victims aged 65 and over related to hospital Emergency Department (ED) of the National Health Service in Portugal based on hospital records, through EVITA system. A descriptive analysis of the data was performed. Bivariate comparisons were performed using Pearson’s chi-square test with a significance level of 5%. In this analysis, the statistical program SPSS V.27 was used. During the 2022 year the older people aged 65 and over represented 25% of the total of attendances in the emergency department. In the 2022 year there were 70 452 HLA in people victims aged 65+, constituting 32% of hospital ED attendances by HLA (preliminary data). The results show that 65,9% of the attendances were amongst the age group of 75 years and beyond. More frequently reported in females (64,3%) than in males (35,6%), being these differences statistically significant (p < 0,01). The summer season for both age groups had higher proportion of HLA. In both age groups 65-74 years and 75 years and over most of HLA occurred at home (65,2%; 68,8%), followed by outdoor spaces (12,2%; 6,7%), public area (3,4%; 13,6%) and transport area (9,2%; 5,5%), these differences were statistically significant (p < 0,01). Regarding to the products/agents most involved in the HLA the “floor” was the leading category in age group 65-74 years (27,1%) and in the oldest 75 years and over (43,0%). Considering that globally HLA can be prevented, this information reinforces the importance of this problem and its magnitude. Key messages • The older people represented 25% of the total of attendances in the emergency department in the year in analysis. 13% of ED attendances occurred due to HLA. • The National Injury Surveillance System provides information that allows to know the characteristics and circumstances of HLA that occur in older people.

Co-planning as a public health tool: the Milan Health Protection Agencies’s Local Gambling Plan

Abstract Issue/problem Gambling represents a public health, social, and economic problem. Lombardy Region, according with national and regional law, has approved the Regional Plan for the prevention and contrast of Pathological Gambling. The Health Protection Agencies (HPA) of the Metropolitan City of Milan, as the other HPAs, implemented the Local Gambling Plan, based on a context analysis and in synergy with all the actors involved. Description of the problem Since 2019, the Milan HPA’s Local Gambling Plan has been implemented through collaboration with non-profit entities (TSEs), which are involved via public tendering. The implementation of the new Italian ‘Code of the Third Sector’ changed the TSEs engagement modalities. For this reason, a complex co-planning process has been initiated in order to increase the level of active citizenship and to enhance public health, in line with horizontal subsidiarity principle. Results The Co-planning procedure promoted the integration among local health services, non-profit entities and municipalities with the aim of gambling prevention and contrast, ensuring the continuity of prevention programs and the involvement of local stakeholders in addressing a public health issue. During the co-planning, 9 working groups were established to define objectives, project actions, monitoring and evaluation methods, ensuring the common interest of all actors involved. Lessons For the health and social system, the co-planning procedure becomes an opportunity to translate what is foreseen by the regulations into local actions. It allow the active participation of local stakeholders involved into the co-construction and achievement of public health objectives and the promotion of communities’ empowerment. Key messages • Co-planning is both a process and a tool for local welfare. • Co-planning involved multiple actors, among which the public institution that ensures satisfaction of health needs through governance actions.

Relationship Between Gross Motor Function and Nutritional Status of Children with Cerebral Palsy-A cross-sectional study in a Tertiary Care Hospital of Bangladesh

Background: Cerebral Palsy (CP) is one of the most common causes of chronic disability in children. Childhood malnutrition is a major public health issue in low- and middle-income countries. The gross motor function of children with CP can easily be assessed by the tool Gross Motor Function Classification System- Expanded &Revised (GMFCS-E&R). This study aimed to determine the relationship between GMFCS and nutritional status in children with cerebral palsy. Method: This cross-sectional observational study was conducted in the Department of Pediatric Neurology, IPNA, BSMMU from October 2019 to August 2020. All the patients aged 2-12 years were diagnosed as CP by clinical criteria and classified by GMFCS. Nutritional status (weight for age, height for age, weight for height, BMI) is assessed and classified according to the World Health Organization growth charts. Then linear and multinomial logistic regression methods to determine the associations between GMFCS and nutritional status. The correlation between motor function and nutritional status was assessed. Results: Among the 50 children 68% were male and 32% were female. The mean age of the CP children was 4.90±3.05 years. Most patients (66.0%) came from poor families followed by 24% from the middle class. Functionally majority of patients were in GMFCS level IV (28.0% ) and level V (20.0%). Maximum patients in spastic quadriplegia 42%, spastic hemiplegia 16%. The level of GMFCS was associated with nutritional status, as determined by anthropometry. Moderate and severe underweight significantly related with GMFC level IV and V. Moderate and severe stunted was significantly related with IV and V GMFC level. Moderate wasted was significantly related to GMFC levels III and IV. Mild malnutrition was significantly with GMFC level II and III. Severe malnutrition is significantly related to GMFC level IV and V. Conclusion: This study showed majority of cerebral palsy cases had severe functional gross motor disability and also severe grade of malnutrition. A significant association between severe grade of malnutrition and severe grade of motor disability was found. J Bangladesh Coll Phys Surg 2024; 42: 342-349

Assaults against pandemic heroes: an observational study in the Metropolitan City of Genoa in Italy

Abstract Background Escalating violence against healthcare workers is a significant public health issue that undermines care quality and workers’ health. This descriptive study aims to examine trends in aggression across different pandemic phases. Methods The study analysed reported violence among healthcare workers from 2018 to 2023 within a Local Health Authority in Genoa, Italy. Variables of interest included the severity of aggression, the professionals affected, and the locations of incidents. Data was analysed using appropriate statistical methods, including multinomial logistic regression, to assess relationships across pandemic phases. Results Reported aggressions rose from 48 incidents in 2018 to 103 in 2023, totaling 463. Pre-pandemic physical violence was at 39%, dropping to 27% during and after the pandemic (χ²=7.4, df = 2, p < 0.025). Nurses experienced the highest violence rates, with an average of 72% pre-pandemic and 74% post-pandemic, reducing to 51% during the pandemic if compared with doctors (Coef -0.80; 95%CI -1.45|-0.15). Over half of incidents occurred in Emergency and Psychiatric Services, from 77% before to 51% after pandemic. Conversely, violence in Local Services rose from 7% before to 24% during and 28% after pandemic (χ²=56.9, df = 6, p < 0.000). If compared to Hospitals, violence in Local Services increased during (Coef 1.44; 95%CI 0.40|2.48) and post-pandemic (Coef 1.001; 95%CI 0.13|1.87), and in Psychiatric Services decreased post-pandemic (Coef -0.98; 95%CI -1.67|-0.29). Conclusions Violence against healthcare workers shifted during and post-pandemic, mirroring the decentralisation of healthcare due to pandemic. The urgent development and implementation of effective violence prevention strategies are imperative. These should include training, psychological support, security enhancements, and a strong organisational culture that prioritises safety and respect. Protecting healthcare workers is crucial for their well-being and to ensure high healthcare quality. Key messages • Escalating violence undermines care quality and healthcare worker well-being. Effective prevention strategies are essential, including training, support, and an organisation that prioritises safety. • Nurses are the main victims of violence. Violence is higher in Emergency Departments, but incidents are increasing in Local Health Services, due to organisational changes during and post-pandemic.

Patterns of alcohol use in Belgium, 2013-2020

Abstract Despite numerous efforts worldwide to reduce the harmful effects of alcohol, its impact on health remains significant, contributing significantly to the loss of healthy life years. In Belgium, alcohol use is still a major public health concern, ranking among the highest in alcohol consumption across Europe. This study aims to use available nationally representative data to estimate and evaluate the time trends of alcohol use patterns in Belgium from 2013 to 2018. We used repeated cross-sectional survey data from the Belgian Health Interview Survey (BHIS), which includes self-reported alcohol use and sociodemographic data, to create a time series of annual consumption from 2013 to 2018. This included current and former drinkers, and lifetime abstainers by year, sex, region, and age groups. We applied a Bayesian hierarchical model, using the Integrated Nested Laplace Approximation to create the time series and forecast trends for 2020. In Belgium, the prevalence of current drinking remained at a similar level of 80% from 2013 to 2020, with similar rates observed in the Flemish (FL) and Walloon (WA) regions. However, the Brussels-Capital region (BR) had a slightly lower prevalence of 70%. Trends remained relatively stable across all regions during this period. The national level of former drinkers increased from 5% in 2013 to 8% in 2020, with BR and FL showing similar increases, while WA experienced a decline. Abstainer rates rose from 15% in 2013 to 19% in 2020 nationally, with varying increases in each region. Specifically, abstainer rates in FL increased from 13% to 17% and in WA from 14% to 20%, while BR saw an increase from 19% to 22%. Overall, declining trends were evident, with men exhibiting higher prevalence rates across all categories. Time trends from the BHIS reveal consistent and high use of alcohol in Belgium over 7 years, emphasizing the ongoing public health challenge. Urgent policy interventions are needed to reduce the impact of alcohol on health Key messages • Alcohol use in Belgium is still a pressing public health issue, with high prevalence rates of current drinking in the population. Different patterns of alcohol use can be seen between regions. • Understanding the role of alcohol on population health as an attributable burden can improve health monitoring.

Latent tubercolosis infection in the migrant population: an Italian surveillance experience

Abstract Background The Special Reception Center (“Centro Accoglienza Straordinario” or CAS in Italian) concept was born in Italy in 2014 to receive the large number of migrants arriving in Italy. There are around 3100 centres are in Italy, of which 200+ in Tuscany. Each Center’s objective is to support migrants’ social integration through Italian language and job orientation courses. On arrival at a facility, migrants undergo diagnostic and lab tests to highlight potentially infectious diseases; among these, tuberculosis is one of the most frequently encountered. Therefore, the objective of the study is to estimate the prevalence of Latent Tuberculosis Infections (LTBIs) among migrants hosted in CAS centers. Methods From May-December 2023, Amiata Senese, Val d’Orcia and Valdichiana Senese Public Health Unit staff, according to national and departmental guidelines, implemented a number of health surveillance protocols, with close attention to latent tuberculosis infection. This protocol includes the Mantoux TB skin test at the CAS: in case of positivity, subjects are directed to further exams (chest X-ray, TB-IGRA blood test, infectious disease specialist consultation) in order to implement a therapy. Results From May-December 2023, 259 migrants (241 males and 18 females) received the TB skin tests. Average subject age was 26. Pakistan was the most represented nation of origin with 130 migrants (50%), followed by Bangladesh (9.7%) and Ivory Coast (7.3%). 77 migrants showed a positive TB skin test result (29.7%): of these 56 (i.e. 21.6% of the migrants screened) were also positive to the TB-IGRA blood test and treated for LTBI. Conclusions The high prevalence of LTBIs found in the referenced CAS indicates the need to continue/extend these surveillance protocols. Implementing successfully this procedure requires the involvement of a range of professionals from the socio-health sector within a process necessarily coordinated by the Disease Prevention Department. Key messages • Screening and surveillance of infectious diseases among migrant population represent a major public health issue for European health systems. • Detection and treatment of Latent Tubercolosis Infections require a multiprofessional and integrated approach, coordinated by the Disease Prevention Department.