Public Health Officials Research Articles

The Role of the Public Health Workforce in Securing Political Commitment for Tackling Childhood Obesity in Local Government

Local government is well placed to provide leadership for the national ambition in England to halve childhood obesity by 2030 and has delegated authority for many policies thought necessary for effective action. However, with currently constrained local government finances, resources may not be prioritized for the wide range of policies and interventions necessary. Thus, local political commitment is vital for directing local government investment to tackle the issue. This qualitative study investigated how political commitment has been demonstrated in local government, the strategies used to build such political commitment, and the role of the public health workforce. Public health staff from 13 local authorities participated in semi-structured telephone interviews using questions informed by a conceptual framework composed of five previously defined levels of political commitment: rhetorical, institutional, operational, embedded, and system-wide. Thematic analysis showed that public health officers secured a political commitment by framing childhood obesity in line with existing priorities to build support among councillors in a position to advocate for the issue. Public health officers also engaged with multiple stakeholders, gathering data and insights to develop operational and embedded commitment. The study shows that effective health promotion practice requires a skilled and committed public health workforce, acting as policy entrepreneurs to secure system-wide political commitment in local government by proactively navigating local governance and policy processes, to build in opportunities for feedback and accountability.

Advancing Indoor Epidemiological Surveillance: Integrating Real-Time Object Detection and Spatial Analysis for Precise Contact Rate Analysis and Enhanced Public Health Strategies

In response to escalating concerns about the indoor transmission of respiratory diseases, this study introduces a sophisticated software tool engineered to accurately determine contact rates among individuals in enclosed spaces—essential for public health surveillance and disease transmission mitigation. The tool applies YOLOv8, a cutting-edge deep learning model that enables precise individual detection and real-time tracking from video streams. An innovative feature of this system is its dynamic circular buffer zones, coupled with an advanced 2D projective transformation to accurately overlay video data coordinates onto a digital layout of the physical environment. By analyzing the overlap of these buffer zones and incorporating detailed heatmap visualizations, the software provides an in-depth quantification of contact instances and spatial contact patterns, marking an advancement over traditional contact tracing and contact counting methods. These enhancements not only improve the accuracy and speed of data analysis but also furnish public health officials with a comprehensive framework to develop more effective non-pharmaceutical infection control strategies. This research signifies a crucial evolution in epidemiological tools, transitioning from manual, simulation, and survey-based tracking methods to automated, real time, and precision-driven technologies that integrate advanced visual analytics to better understand and manage disease transmission in indoor settings.

International intercomparison of Radon 222 activity concentration calibration facilities

The Coalition of International Radon Associations (COIRA) organised an inter-comparison of Rn-222 (radon) activity concentrations reported by calibration laboratories. A set of three AlphaGUARDs were used as transfer reference instruments against which to compare reported Rn-222 activity concentrations. Rn-222 activity concentration calibration facilities (sometimes termed chambers) from seven countries (Australia, US, Czech Republic, Spain, England, Sweden, Canada), and three continents participated in this project. The objective of the study was to provide information useful to calibration chamber operators and public health officials in the improvement of measurement and control systems, the maintenance of performance standards for measurements, and regulatory requirements for calibrations. This work builds upon and expands previous interlaboratory comparisons and provides data for estimating and using calibration uncertainty values as part of overall field error estimates and limits. A simple proportional difference between laboratories is presented here, calculated as the average for N hours of each hour’s difference between the laboratory’s concentration and the average of the three reference instruments. This percent difference ranged from less than 0.5% to just less than 8%. This work demonstrates that the ANSI/AARST standards limit of 8% for the estimated unexpanded (one sigma) individual calibration estimated uncertainty for continuous radon monitor calibration facilities in the US is achievable. However, given the few standards regarding calibration of Rn-222 activity concentration measurement instruments that themselves are often used to calibrate secondary and tertiary Rn-222 calibration facilities, there is a great need for continued interlaboratory comparisons to harmonise and document the calibration of Rn-222 activity concentrations.

Global trends in ischemic stroke burden attributable to high BMI.

We aimed to assess the worldwide burden of ischemic stroke (IS) associated with high body mass index (BMI) using data from the Global Burden of Disease 2019. This study examined the impact of high BMI on IS-related age-standardized death rates (ASDR) and disability-adjusted life years (DALYs). Estimated annual percentage changes (EAPC) is estimated annual percentage change. Trends were assessed using EAPCs. Over the past 3 decades, there has been a declining trend in the global burden of IS associated with high BMI, especially in Western Europe (EAPC = -3.09 for DALYs) and high-income Asia Pacific (EAPC = -4.6 for ASDR). However, certain developing regions, notably Southeast Asia, have experienced significant increases in ASDR (EAPC = 3.7) and age-standardized DALY rates (EAPC = 3.64). The most substantial increase in burden was observed in Southeast Asia for both males (EAPC = 3.85) and females (EAPC = 3.53). Importantly, the burden was most pronounced in regions with low to middle sociodemographic index. The rising disease burden linked to high BMI is largely due to insufficient medical infrastructure and ineffective public health policies in the region. Urgent action is needed from decision-makers to improve these areas and implement effective interventions. This study reveals a consistent global decline in IS related to high BMI, with a more significant burden observed in males under the age of 65, particularly in Southeast Asia, where increases in IS associated with high BMI are notable. Public health officials and global policymakers need timely and reliable quantitative data. This information is essential for implementing effective behavioral interventions, such as monitoring diet and physical activity, to address identified risk factors and reduce the burden of high BMI.

Comparison of document-based and on-site inspections of hospitals based on medical law: A case report from Osaka City during the COVID-19 pandemic

Objectives On-site inspections of hospitals were conducted in Osaka City during fiscal years 2018 and 2019, whereas document-based inspections were performed during the COVID-19 pandemic in fiscal year 2021. This case report aimed to compare the outcomes of these two methods and provide a good indication of the method that should be selected in case of a pandemic.Methods For on-site inspections, documents, including checklists, were sent to 351 hospitals from the Osaka City Public Health Office, and responses from each hospital were returned. On-site inspections were conducted, and the written instructions that indicated inadequate aspects and guidance were mailed to hospitals.For document-based inspections, documents were sent to 176 hospitals, and responses were returned. For hospitals that answered "incomplete" regarding the categories of medical safety management systems and hospital-acquired infection control, public health physicians called to confirm and instruct their inadequate responses, and the same step as the on-site inspection was executed. We compared and examined the outcomes of the on-site and document-based inspections.Results In the on-site inspections, 12 of the 351 hospitals (3.4%) were recognized as inadequate because of a shortage of healthcare workers. In the document-based inspections, eight out of 176 hospitals (4.5%) were identified, and there was no significant difference.Regarding the medical safety management system, 95 of the 351 hospitals (27.1%) on on-site inspection and 21 of the 176 hospitals (11.9%) on document-based inspection received written instructions. The proportion of hospitals that received written instructions was significantly higher for on-site inspections than for document-based inspections (P < 0.001).For hospital-acquired infection control, 65 of 351 hospitals (18.6%) on on-site inspection and 17 of 176 hospitals (9.7%) on document-based inspection got written instructions. The proportion of hospitals that received written instructions was significantly higher for on-site inspections than document-based inspections (P = 0.007).Conclusion Document-based inspection can easily unify the guiding criteria with fewer public health physicians. However, because of the limited amount of information available without checking the documents retained in hospitals, it is difficult to monitor the matters that need instructions. Thus, on-site inspection is preferable. However, if onsite inspection is difficult, inspection combined with online methods should be considered.

Prevalence of Prescribing Macrolides and Aminoglycosides Among Dentists in Aden, Yemen. A cross-sectional Survey

This study assessed the understanding of dentists regarding the appropriate prescription of aminoglycosides and macrolides in Aden, Yemen. We carried out a cross-sectional study, enlisting a total of 150 licensed dentists from both public and commercial dental clinics. The data was gathered throughout the period of October to December 2023. Out of the 150 participants, 57% were men, and 47% had less than 5 years of experience. According to the poll, a large majority of dentists, 72%, use macrolides on a regular basis in their practice. In addition, azithromycin was the most commonly prescribed macrolide, accounting for 18% of total prescriptions. By comparison, aminoglycosides account for only 21% of all prescriptions, and neomycin is quite rare. 13% of persons with penicillin allergies were administered streptomycin, underscoring the necessity for safer alternatives. Dentists typically follow the prescribed time frame of 3-5 days to ensure the appropriate administration of macrolides. The findings indicated that individuals should get instruction on the proper utilization of aminoglycosides and macrolides, be provided with comprehensive information to enable them to make well-informed decisions on their treatment alternatives, and be obligated to adhere to guidelines grounded in empirical evidence from real-life scenarios. Effective antibiotic stewardship practices in Yemeni dentistry require collaboration among dentists, microbiologists, and public health officials. It is recommended to undertake additional research to expand the study's scope and include observational studies and interviews with dentists.

“If government is saying the regulations are important, they should be putting in funding to back it up.”- An in-depth analysis of local authority officers’ perspectives of the Food (Promotion and Placement) (England) Regulations 2021

BackgroundAs part of the UK government’s obesity strategy, the Food (Promotion and Placement) (England) Regulations 2021 were implemented in October 2022 to restrict the prominent placement of products high in fat, sugar, or salt (HFSS) in most retail settings. Local authority (LA) officers have been tasked with enforcement of these regulations. This qualitative study examined the perspectives of LA officers including, trading standards, environmental health, and public health officers to understand enforcement approaches and requirements to optimise business compliance with the regulations.MethodsSemi-structured interviews were conducted via MS Teams with a purposive sample of LA officers across England. Data were analysed using inductive thematic analysis.ResultsThe 22 participants comprised 13 officers from Trading Standards, six from Environmental Health, and three from Public Health teams. The key messages include the following: (i) the regulations are complex and do not align with existing enforcement approaches, (ii) officers’ professional background will result in variable enforcement practices, and (iii) compliance assessment is an arduous task. LAs are facing resource and workforce constraints and have to prioritise regulations addressing high health risks (e.g., allergens). Therefore, officers will mostly apply a light touch approach to enforcement, raising awareness and engaging with businesses rather than issuing notices. To develop a consistent enforcement approach across LAs, officers asked for (i) further leadership from central government in the form of funding, training, and tools to determine in-scope businesses and products, (ii) cross-departmental collaboration to raise the regulations’ priority at local and regional levels, and (iii) greater consumer demand for healthier retail environments.ConclusionIt is crucial to address both structural challenges such as resource allocation, workforce, and prioritisation issues as well as the inherent complexity of the regulations to strengthen enforcement efforts. Our findings highlight the necessity of supporting enforcement activities at national and regional government levels to avoid potential false conclusions about ineffectiveness of regulations.

Political and Community Logics of Emergent Disease Vaccine Deployment: Anthropological Insights from DRC, Uganda and Tanzania

With a growing number of emerging infectious diseases and the rapid development of vaccines during epidemics and pandemics, public health officials at the global and national level have reported concerns about vaccine hesitancy, often attributing this to a problem of misinformation and poor understanding of risk. However, social scientists have found that vaccination perceptions are complex and multi-faceted. By focusing on the historical, cultural and political influences that affect vaccine acceptance, as well as social justice questions that examine the fair distribution of vaccines, we explore the political and community logics of vaccine deployment using a case study approach. We found differing logics depending on the vaccine and the context and argue that political and community logics come to the forefront during outbreaks as vaccine strategies often are imposed—in different ways—by the Global North. We suggest that, prior to the development and deployment of new vaccines for emergent diseases in the Global South, political level and community logics must be acknowledged and engaged with.

Pediatric Adenotonsillectomy Opioid Prescriptions Before and After Practice Guidelines and American Academy of Pediatrics Challenge.

The opioid epidemic continues to concern the CDC and public health officials but recent trends in opioid prescribing rates following common pediatric otolaryngology surgeries are unexplored. This retrospective cohort study queried the TriNetX Research database from January 1, 2010, through December 31, 2023, for pediatric patients who underwent tonsillectomy and/or adenoidectomy and received oral opioids within 5 days of surgery. Prescription trends from 2010 to 2017 were compared to 2022 to 2023, after the publication of multiple clinical practice guidelines (CPGs). Of 286,572 surgeries, 29% of patients received postoperative opioids. Comparing the 2 time periods, a significant decrease was observed in the risk of postoperative opioid prescriptions following 2022 (RR 0.87, CI95% 0.86-0.88). Prescribing rates decreased between 2018 and 2023 from 34% to 24%. Publication of CPGs were associated with a decrease in opioid prescribing rates and may have contributed to an encouraging trend in opioid stewardship.

The effects of ventilation layout on cough droplet dynamics relating to seasonal influenza

The primary aim of this paper is to investigate airborne virus transmission in a typical meeting room relating to the heating, ventilation, and air conditioning (A.C.) systems. While the installation of 4-way cassette A.C. systems in offices and meeting rooms has become increasingly common, their efficiency in mitigating short-range airborne virus spread remains poorly understood. Addressing this gap is critical in the post-pandemic era, where understanding the limitations of various ventilation systems is paramount for public health. We systematically compare the performance of the 4-way cassette A.C., various configurations of mixing and displacement ventilation systems, and natural ventilation in controlling the spread of respiratory viruses. Our research uniquely integrates evaporation models to accurately simulate cough clouds' multiphase behavior under both quiescent and thermally influenced conditions. The study benchmarks these systems against two widely recognized ventilation standards (i.e., 5 air changes per hour and 10 l/s per person), offering evidence-based insights applicable across diverse indoor settings. Our findings reveal significant thermal effects in the quiescent case, resulting in 32.3%, 54.3%, and 8.0% changes in the axial, vertical, and lateral spread of the virus-laden droplets, respectively. Notably, the 0.5 m/s 4-way cassette A.C. system demonstrated superior performance, reducing the axial spread by 29.6% compared to other mechanical ventilation configurations. Furthermore, the role of exhaust outlets or doors was found to be critical in shaping the spread pattern in natural ventilation scenarios. This work can offer practical guidance to office workers, engineers, and public health officials on enhancing indoor airborne infection control.

Medicaid expansion and medications to treat opioid use disorder in outpatient specialty care from 2010 to 2020

IntroductionMedications for opioid use disorder (MOUD) are considered the first line treatment for opioid use disorder. As states expanded Medicaid beginning in 2014 under the Affordable Care Act, policymakers and public health officials were interested in the potential for expansion to increase access to MOUD. This study examined whether there were changes in MOUD use within outpatient admissions to specialty treatment facilities in Medicaid expansion states beyond the initial expansion period. MethodsAnalyses were conducted using 2010–2020 data from the Treatment Episode Data Set – Admissions. For states that expanded Medicaid prior to 2015, a difference-in-differences analysis was conducted to evaluate whether expansion was associated with an increased proportion of MOUD treatment comparing the initial 2014–2017 period and the 2018–2020 period to 2010–2013. We then conducted a difference-in-differences analysis to examine the overall effect of Medicaid expansion on outpatient MOUD using all states that passed expansion at any point during the study period. ResultsAmong outpatient treatment episodes for OUD in states that expanded Medicaid in 2014, there was a 9.5 percentage point (95 % CI: 0.7–18.2) increase in the probability of receiving MOUD during the initial expansion period from 2014 to 2017 compared to 2010–2013 period, and a 7.5 percentage point (95 % CI: −8.1 –23.1) increase in 2018–2020 (compared to the 2010–2013 period) after adjusting for individual-level covariates. After incorporating states that expanded Medicaid between 2015 and 2020, there was a 6.4 percentage point (95 % CI: −0.01–13.0) increase in the probability of receiving MOUD among individuals receiving care after expansion (compared to the pre-expansion period). During the study period, there was variability among states in the change in probability of receiving MOUD from prior to after Medicaid expansion from an almost 30 percentage point increase in New York to an almost 20 percentage point decrease in Washington, DC. ConclusionsMedicaid expansion increased the probability of receiving MOUD in outpatient settings across states from initial expansion through 2020. However, these results were not statistically significant. Additionally, significant variability between states warrants further study and suggests that improving access to MOUD will require additional state and local strategies.

Legal Protection For Consumers Related To The Circulation Of Hard Drugs By Unlicensed Drug Stores In Indonesia

One of the aspects of welfare that must be achieved in line with the national aspirations of Indonesia is public health, which is acknowledged as a fundamental right governed by the 1945 Constitution. However, there is a growing risk of hard drug misuse due to people's inclination to self-medicate without a prescription. Government Regulation Number 51 of 2009 and Law Number 17 of 2023 stipulate that only pharmacists with a prescription from a doctor are authorized to administer hard substances. Nonetheless, it is still common for illicit drug outlets to offer strong pharmaceuticals to customers without a prescription, which puts their health at risk. This study employs a normative juridical methodology that combines a case-based and statutory approach. Despite the legal protections for consumers regulated in Law Number 8 of 1999 (UUPK), many consumers do not understand their rights and obligations, so they are vulnerable to fraud and health risks. The findings of this research indicate the need for increased public awareness and stricter law enforcement to protect consumers from the misuse of hard drugs. As well as supervision by BPOM and the Public Health Office as an effort to control the circulation of hard drugs without a doctor's prescription, which are sold in drug stores that do not have a business license.

Detection of Hepatovirus A (HAV) in wastewater indicates widespread national distribution and association with socioeconomic indicators of vulnerability.

Wastewater-based epidemiology, which seeks to assess disease occurrence in communities through measurements of infectious disease biomarkers in wastewater, may represent a valuable tool for understanding the occurrence of hepatitis A infections in communities. In this study, we measured concentrations of Hepatovirus A (HAV) RNA, in samples from 191 wastewater treatment plants spanning 40 US states and the District of Columbia from September 2023 to June 2024 and compared the measurements with traditional measures of disease occurrence. Nationally, 13.76% of the 21,079 wastewater samples were positive for HAV RNA, and both concentrations and positivity rates were associated with NNDSS hepatitis A case data nationally (Kendall rank correlation coefficient = 0.20, concentrations; and 0.33, positivity rate; both P < 0.05). We further demonstrated that higher rates of wastewater HAV detection were positively associated with socioeconomic indicators of vulnerability including homelessness and drug overdose deaths (both P < 0.0001). Areas with above average levels of homelessness were 48% more likely to have HAV wastewater detections, while areas with above average levels of drug overdose deaths were 14% more likely to have HAV wastewater detections. Using more granular case data, we present a case study in the state of Maine that reinforces these results and suggests a potential lead time for wastewater over clinical case detection and exposure events. The ability to detect HAV RNA in wastewater before clinical cases emerge could allow public health officials to implement targeted interventions like vaccination campaigns.IMPORTANCEDespite the existence of a highly effective vaccine for hepatitis A, outbreaks in vulnerable populations remain common. The disease can be asymptomatic or subclinical, and disproportionately impacts populations with inadequate access to healthcare, leading to a severe underestimation of the occurrence of this viral infection. This study investigates the potential for wastewater measurements of biomarkers of the causative agent of hepatitis A (HAV RNA) to provide insights into disease occurrence. Results highlight the potential for wastewater-based epidemiology to be a complementary tool to traditional surveillance for monitoring and controlling HAV transmission.

Context dependent preferences in prestige bias learning about vaccination in rural Namibian pastoralists

Extensive work in the social sciences suggests that vaccination decisions are subject to incentives, biases, and social learning processes, including prestige bias transmission. High status figures, like doctors and public health officials, can be effective messengers for vaccination information and uptake under certain conditions. In communities where there is significant medical mistrust and less interaction with markets and formal medical systems, prestige bias social learning may operate through different channels. Here, we examine the role of prestige bias on vaccine decisions in two ethnic groups (Himba and Herero) with varying levels of market integration and experiences with formal healthcare systems. Participants completed a ranking task, comparing the influence of four prestigious individuals on vaccine decisions and a survey on medical mistrust. Using Plackett-Luce models, we compare the influence of location, ethnic affiliation, and other covariates on rankings. A multi-level model compared the influence of those within and outside one's ethnic group, as well as specialist (doctor/healer) and generalist (chief/governor) prestige figures. Results indicate changes in the rank of prestigious individuals across the rural-urban gradient. Our results demonstrate significant variability in prestige-biased social learning about vaccine decision making. Medical mistrust did not impact rankings. Contrary to previous work, we find that whether a prestigious individual is locally prominent is more important than their expertise in the relevant domain (health and healing). These findings emphasize the need for more context-specific studies of prestige bias, which can improve our understanding of healthcare decision-making and guide public health messaging across diverse contexts.

The Effect of a Tailored Educational Flyer on Colorectal Cancer Screening Among Rural Residents: Lessons Learned from a Pilot Randomized Trial.

Background/Objectives: Stool-based tests, such as the fecal immunochemical test (FIT), have been widely used for increasing colorectal cancer (CRC) screening. Small media, such as printed materials or flyers, are known to be an effective intervention to increase CRC screening by fecal tests. However, more evidence is needed to determine whether such small media are effective in improving screening uptake of a mailed FIT intervention targeted at rural populations in the USA. Methods: In this randomized study, 1230 FIT kits were mailed from July to December 2022 to rural Nebraskans aged 45-74 who were not up to date on CRC screening. Half of the participants (n = 608) also received a tailored, one-page, gender-specific educational flyer created based on focus groups with rural residents. Logistic regression was used to determine predictors of returning the FIT. Results: Study participants were predominantly female (76%), non-Hispanic White (83%), and within the age group of 55-64 (43%). Overall, 192 (15.6%) kits were returned (16.1% from the flyer group; 15.1% from the no-flyer group). However, we found no significant differences between the flyer and no-flyer groups (Adjusted Odds Ratio [AOR]: 1.21; 95% CI: 0.88-1.66). Females (AOR: 1.78; 95% CI: 1.19-6.14) and the oldest (65-74) age group (AOR: 5.03; 95% CI: 2.78-8.47) were more likely to return FIT kits than males and the youngest (45-54) age group. Conclusions: A tailored educational flyer was not effective in improving the CRC-screening-rate-by-mailed-FIT approach for rural populations. Future research should explore the content, timing, and mode of delivery of educational interventions as well as other multi-component strategies to improve screening rates. Public health officials might also consider developing strategies targeted at males and younger (45-54) age groups.

Sleep difficulties as a universal risk factor for injury among adolescents in 46 countries

Abstract Background Poor sleep is common among adolescents and associated with unintentional injuries. The current evidence base is limited by differences in measures of sleep and injury implemented across studies. We examined the potential universality of the relationship between poor sleep and injury cross-nationally using self-reports from 229,589 adolescents in 46 countries that were collected using common procedures and measures. Methods A cross-sectional study was conducted using records from the 2017/18 Health Behaviour in School-aged Children (HBSC): World Health Organization cross-national study. The prevalence of sleep indicators (difficulties in falling asleep, insufficient sleep, social jet lag) and medically treated injuries (overall, multiple) were described across countries and by gender. Multivariable modified Poisson regression analyses were conducted within and across countries to test the consistency of the association between poor adolescent sleep and injuries. Results Overall, indicators of poor sleep were reported by nearly half of adolescents, and varied by gender and across countries. Country-level analyses found consistently positive associations between indicators of poor sleep and injuries. Pooled (multi-country) analyses further demonstrated a universality of these relationships across sleep indicators and injury outcomes. The strength of relationships varied by gender, with more robust associations detected among girls compared to boys. Conclusions Poor sleep is a robust and mainly consistent risk factor for injury among adolescents across countries and regions. Public health officials and policymakers should therefore recognize adolescent sleep as a health priority. The promotion of sleep hygiene may represent a novel target for injury prevention at regional and national levels. Key messages • Poor sleep, in the form of sleep difficulties, insufficient sleep, and social jet lag, were robust and mainly consistent injury risk factors among adolescents across 46 countries. • Public health officials should recognize sleep hygiene as a novel focus for adolescent injury prevention.

Reflective model assessment of adherence to COVID-19 non-pharmaceutical interventions

Abstract Background Non-pharmaceutical interventions (NPIs) decrease COVID-19 transmission. We identified behavioral factors that affected NPI adherence according to Normalization Process Theory (NPT) in medical students, travel seekers, and people with substance use disorder using reflective model measurement, which previously had not been conducted. Public health officials should consider factors that influence adherence to create preventive strategies for COVID-19. Methods In a cross-sectional design, medical students and people with substance use disorders in treatment comprised a probabilistic sample, and travelers and COVID-19 suspected persons comprised a convenience sample. Participants were from Split-Dalmatia County (n = 656) in the Mediterranean and consented to self-administered surveys in 02/2021. Sociodemographic data, locus of control (LoC), and moral behavior were collected. Partial least squares structural equation modeling (PLS-SEM) was used to measure reflective assessment of NPI adherence according to NPT. Results PLS-SEM reflective model assessment provided two-group specific factors in inverse relationships which determined NPI adherence with excellent goodness of fit (χ2=1.292, df = 1; p = 0.297). Significant negative factors covariance estimate (-0.716) revealed an increase in adherence to the first factor, NPIs and internal LoC [0.640], as the second factor, age (≤25) and highest education level (1.362), decreased. LoC was the mechanism by which sex (MLsex=-0.017, SE = 0.007, p &amp;lt; 0.016) and being a student or person with substance use disorder (MLgroup=-0.008, SE = 0.003, p = 0.015) showed indirect effect on NPI adherence. Conclusions Students and people with substance use disorders more adhered to NPIs. Higher-educated younger adults with a tendency toward external LoC facilitated the normalization. Public health interventions could encourage these subgroups to act as promoters to increase NPI adherence in similar settings. Key messages • COVID-19 non-pharmaceutical interventions and psychological factors of students and people with substance abuse disorder influenced adherence. Targeted interventions could promote adherence. • Public health officials should consider that preventive strategies may be more effective in highly educated adults younger than 25 years of age.

General Practitioner Availability and Accessibility in Serbia Before and During the Pandemic

Abstract Background During the COVID-19 pandemic in Serbia, state-owned primary health centres’ general practitioners (GPs) served as the first point of care for adults (the population aged 19 years and older) and gatekeepers of the health system. The study highlights changes in the overall availability, accessibility, and workload of GPs during the pandemic. Methods We used routine health facility data at the national level to describe the changes in GPs over the past three years, before the pandemic (2017-2019) and during the pandemic (2020-2022). Specifically, we looked at the total number of GPs, the percentage of specialists, the average number of citizens per GP, the services used per capita, the average number of visits per GP, and the leading causes of morbidity. Results The study found a decrease in the total number of GPs in both periods (before: -10%, during: -9%) and in the number of specialists (before: -2%, during: -3%). During the pandemic, the average number of citizens per GP varied. In 2022, the average number of visits per GP decreased noticeably to 3557 GPs, of which 37% were specialists. In the same year, each GP received 6661 annual visits and served 1509 citizens on average. However, these figures exhibit considerable regional and geographical differences. Circulatory and respiratory diseases were the most common reasons for visiting a GP (about 14% and 13% of all visits, respectively). Up to 10% of all visits resulted in either a diagnosis of external factors that influence health status or in ill-defined symptoms, clinical and laboratory findings. Conclusions This study’s findings underscore the critical reductions in availability, accessibility, and workload of general practitioners in the Serbian public sector and emphasize the importance of strengthening the primary healthcare system to better respond to future challenges. Key messages • Public health officials should prioritize the development of effective strategies and policies that focus on improving the quality and accessibility of primary health care services in Serbia. • A greater investment in general practice is necessary to ensure it can effectively meet the population’s needs during health emergencies.

7.X.1. Providing BoD estimates on a regional level – necessity in assessing health inequalities

Abstract Burden of disease indicators, such as Disability-adjusted life years (DALY), Years lost due to disability (YLD) and Years lost due to death (YLL) have become standard indicators in public health reporting systems. Due to the combination of morbidity and mortality, the DALY provides valuable information on the burden due to specific diseases. These tools are employed by policymakers to devise intervention programs with the objective of enhancing the collective health of the population. Studies at the subnational level offer a greater added value to the public health information systems. Identifying variations in health outcomes and disease burden across different regions is a key factor when introducing targeted interventions and allocating resources. Health inequalities persist also in countries with good health systems and well-developed welfare state. There are notable contrasts in the political, economic and social environments across Europe. Moreover, the European countries are at different stages of the epidemiological transition, which encompasses a range of factors influencing health and modifiable risk behaviours. These differences are determined by socioeconomic inequalities at national and sub-national level, such as municipalities, counties and others. It is therefore imperative to provide BoD indicators at the most possible detailed regional-level and to link this information with further indicators such as deprivation indexes or Gini coefficients. Obtaining regional-level data for BoD analysis and health inequalities is not straightforward and can pose many challenges. Data availability is usually scarce and may involve significant resources in collecting it. Data quality and data completeness can also pose challenges in the reporting systems, which can result in under-reporting of certain diseases and overlooking health problems in the population. Also, countries with smaller populations are confronted with the challenge of a limited number of cases, which poses difficulties in obtaining regional estimates. The following workshop presents examples from European BoD studies, that have analysed health inequalities at regional level. The first presentation shows a country comparison study of the overall YLL and their association with socioeconomic and geographical inequalities. The second is from an Estonian study, representing a country with a small population that has developed its own methodology for assessing regional health issues. The third presentation from the German BoD study presents results on 96 spatial planning regions, which have been combined with the German index of socioeconomic deprivation. The final presentation brings example from Norway, where the association between YLL and education and income is examined at municipality level. Key messages • By comparing BoD estimates at the regional level, policymakers and public health officials can identify areas with higher disease burdens, indicating potential health inequalities. • Linking information on BoD indicators with data on regional and socioeconomic inequalities is essential when monitoring developments and tailoring strategies in public health outcomes.

Climate change and health vulnerability assessments to increase regional climate resilience

Abstract Background The impacts of climate change on health and healthcare systems exhibit complex interrelationships, varying across time and space. Population groups already disadvantaged due to their demographics, health, socioeconomic status, or geographical location tend to be particularly vulnerable to climate-related health risks. Our work aims to develop a method for a systematic quantitative vulnerability assessment to make regional vulnerabilities comparatively measurable. Methods Building on the WHO framework on Climate Change and Health Vulnerability and Adaptation Assessment (2021) a data mapping process was carried out to identify and validate vulnerability factors and quantitative indicators on a small-scale spatial resolution for the five dimensions: demographic, socioeconomic, biological/health, sociopolitical, and geographic/climate. Regional vulnerability scores for each indicator were calculated and visualized as geographic maps and circular barplots to allow for easily understandable interpretation. Results A set of 25 quantitative vulnerability indicators from a multitude of data sources - combining register data, survey data, and geospatial data - was compiled. Main challenges were the identification of sociopolitical vulnerability factors suitable for Austria and data availability on a small-scale level. The indicator set was used to identify regions that are particularly vulnerable due to their population composition, disease burden, and geographical location (e.g. regions in Eastern Austria with high shares of persons &amp;lt; 65 years of age, unemployment, and heat days). Conclusions Systematically assessing vulnerabilities in key dimensions is central to identifying regionally specific pressure points, allowing for a quantitative baseline to derive adequate and tailored climate change adaptation measures to sustain future health. Systematic assessment provides essential insights for policymakers, public health officials, and disaster management agencies.