Public Health Strategies Research Articles

An Irish public health policy research team: impact and lessons learned, one year on

Abstract Issue In 2023, in Ireland, a public health policy research team was established in the Health Information and Quality Authority to conduct evidence syntheses and provide evidence-based advice to inform national decision-making, at the request of the Department of Health. One year on, we reflect on the impact of this team and outline lessons learned. These findings may support other countries in creating and developing public health policy research teams. Description of the problem We aim to answer the following questions: What impact can a public health policy research team have and what are the lessons learned, one year on? Projects completed by the team in 2023 were reviewed for stakeholder engagement (such as expert and public and patient involvement) and impact (feedback from policymakers, resulting public health actions or policies and online report downloads). Results Seven public health projects were completed in 2023, in areas including: Long COVID, public health reform, rapid multiplex testing, and medical countermeasure stockpiling. National and international stakeholders were engaged with via expert advisory group membership, document review and project presentations. Patient representatives were included from Long COVID Advocacy Ireland and Rare Diseases Ireland. Project reports were downloaded a total of 281 times. Positive feedback was received from all stakeholders. Project findings were presented to policymakers to inform national public health and rare disease strategy development, and the Long COVID model of care in Ireland. Lessons Early and ongoing stakeholder engagement is key when translating research to practice, via policy. Innovative methods of engagement, including public and patient involvement, can ensure meaningful collaboration. Adapting methodologies to meet stakeholder needs, such as rapid evidence synthesis, enhances impact. Lastly, research impact on policy takes time, and an understanding of national policy development is required. Key messages • A public health policy research team provides impactful evidence synthesis to advise national policymakers. • Stakeholder engagement is key to developing impactful policy advice.

1.C. Round table: Navigating the 17th European Public Health Conference: A Guide for First-Time Attendees

Abstract Are you attending the European Public Health Conference for the first time? If yes, this session is for you. Join us for an engaging session tailored specifically for first-time attendees of the 17th European Public Health Conference in Lisbon, Portugal. This session aims to provide newcomers with valuable insights and strategies to maximize their experience and effectively navigate the conference. Our seasoned conference veterans will share practical tips on a range of topics, including, but not being limited to: 1. Conference Navigation: Learn how to navigate the conference programme, the venue efficiently, locate sessions of interest, and make the most of your time between sessions. 2. Networking: Discover the importance of networking in the field of public health and gain strategies for initiating meaningful conversations, building professional relationships, and expanding your professional network. 3. Session Selection: Gain insights into selecting sessions and workshops that align with your interests, career goals, and areas of expertise. Learn how to prioritize your schedule and make the most of concurrent sessions. 4. Poster Presentations: Understand the significance of poster presentations and how to effectively engage with presenters. Discover techniques for synthesizing information and asking insightful questions. 5. Self-Care: Explore strategies for maintaining physical and mental well-being throughout the conference, including tips for managing fatigue, staying hydrated, and finding moments of relaxation amidst the hustle and bustle. Whether you’re a student, researcher, practitioner, or policymaker, this session will equip you with the tools and knowledge needed to navigate the 17th European Public Health Conference with confidence and make the most of this invaluable opportunity for professional development and networking. Key messages • First-time attendee at the European Public Health Conference? Don’t miss this tailored session for essential insights and strategies to maximize your experience in Lisbon. • Join seasoned veterans for practical tips on navigating the conference, networking effectively, selecting sessions, engaging with poster presentations, and prioritizing self-care. Speakers/Panelists Robert Klarecki EPH Conference Office Jinane Ghattas Sciensano, Brussels, Belgium

Regional variation of age-related blood pressure trajectories and their association with blood pressure control rates, disability-adjusted life years and death

Abstract Background/Introduction While the relationship between blood pressure (BP) changes and increasing age is well described, age-related BP trajectories may vary substantially across different populations and associated with differential CV risk and outcomes. Purpose The dataset of the May Measurement Month (MMM) international campaigns enables a unique investigation of regional, socio-economic and sex differences in age-BP trajectories and their association with major public-health outcomes. Method Global BP data from more than 4,5 million adult (≥18 years) screenees obtained during the cross-sectional MMM campaigns in 2017, 2018, 2019, and 2021 were used for analysis. Average BP and slopes of BP changes across age groups were calculated within regional, socio-economic and sex strata. BP slopes of individuals between 30 and 70 years of age were derived from adjusted linear regression models, along with baseline BP estimates at young age. These BP slopes were correlated in regression models adjusted for baseline BP at young age with country-specific all-cause rates of DALYs (Disability-Adjusted Life Years), death (both from Global Burden of Disease Study 2019), life expectancy (World Bank data SP.DYN.LE00.IN 2019) and BP control rates (NCD Risk Factor Collaboration). Results Age-related BP changes differed distinctly across global geographic regions, income levels, and between sexes. The steepest increase in BP with age was observed in populations from Africa and Europe, whereas a more gradual rise in BP with increasing age was seen in South-East Asian populations. Women had lower BP levels than men at younger ages (twenties and thirties), but subsequently experienced a more pronounced age-related BP increase resulting in diminishing sex differences across older age groups. Geographically divergent age-related BP trajectories were significantly associated with major national public health indicators. Globally, the steeper the age-related BP slope, the stronger the association with poor BP control (β = -0.46 [95% CI: -0.74; -0.19], p=0.001), increased DALY’s (β = 66155.68 [95% CI: 44847.0; 87464.36], p<0.001) and death rates. (β = 1017.3 [95% CI: 351.72; 1682.89], p=0.003). Conclusion Age-related BP trajectories vary considerably across global populations and contribute considerably to the variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of lifestyle and other factors contributing to adverse BP trajectories to improve health outcomes.Average blood pressure by ageAssiciations with public health metrics

Breastfeeding knowledge, attitudes and practices of HIV-positive women in Africa, a systematic review

Abstract Background Breastfeeding (BF) is essential to ensure the health and survival of children, especially in regions where diarrhoea, pneumonia and malnutrition are common causes of child mortality. The WHO currently recommends, along with antiretroviral treatment, exclusive BF (EBF) for the first six months and mixed BF for the next six months and extending it to 24 months. In sub-Saharan Africa, more than one million HIV-positive women face the challenge of infant feeding due to limited access to treatment and safe water. The aim of this study was to understand the knowledge, attitudes, and practices of HIV-positive mothers in Africa to provide evidence for public health strategies. Methods We conducted a systematic review of studies on Knowledge, Attitudes and Practices of BF among HIV-exposed children in African countries, following the principles of the PRISMA statement and identified by searching major databases of records published between 2013 and 2023. Results Of the 498 articles identified, 21 met the inclusion criteria. 70% of the studies were conducted in Ethiopia, South Africa, and Kenya. 95% of the studies were conducted in health care facilities. Mothers showed good knowledge, attitudes and practices regarding EBF of HIV-exposed children, but low knowledge and fear of continuing to practice BF later on. The HIV-positive mothers mentions a range of recommendations received from health workers, identified as their main source of information. Stigma against mothers who practice EBF was found. The primary reason for early cessation of BF was due to work. Conclusions Knowledge, attitudes, and practices of the infant feeding currently recommended by WHO for HIV-positive mothers was weak. There is little evidence of what happens in other African countries and in women with limited access to the health system. Public health policies need to be strengthened to ensure that health workers are trained in the current guidelines to improve HIV-positive women’s BF. Key messages • HIV-positive mothers are afraid to continue breastfeeding their babies after 6 months. • More studies about the breastfeeding practices of children of HIV-positive mothers with limited access to health services are needed.

Risks of high temperature exposure on infectious diseases in Portuguese hospitals

Abstract Background The convergence of climate change and infectious diseases presents a growing public health challenge. As global temperatures continue to climb, the geographical spread of climate-sensitive diseases is shifting, underscoring the necessity for comprehensive early warning systems grounded in a One Health framework. Methods This retrospective observational study analyzed daily maximum temperature from May to September, between 2000 and 2018, in mainland Portugal, at a county level, obtained from a European-level gridded observations dataset. Hospital admissions with a primary diagnosis of infectious and parasitic diseases were sourced from the Hospital Morbidity Database. A distributed lag non-linear model was developed to estimate the immediate and lagged relative risks (RR) of temperature exposure on admissions, focused on a lag of 10 days. Results Our research reveals a 16% (95% CI: 9% - 23%) rise in the RR of hospital admissions due to infectious and parasitic diseases after exposure to extremely high temperatures (39 °C). This elevated risk persists for up to 2 days following exposure, with the second day exhibiting the largest increase at 53% (31% - 80%). Furthermore, our findings indicate a subsequent resurgence in RR, reaching 6% (2% - 11%) 9 days after exposure. Conclusions Our results highlight a short-term effect of extreme temperature exposure on infectious and parasitic disease admissions. This data provides valuable insights to guide policymakers in identifying critical periods of vulnerability and implementing this knowledge into heat early warning systems, contributing to developing effective public health strategies against climate change. Acknowledgments The authors thank Fundação para a Ciência e a Tecnologia (FCT, Portugal) for research grant UIDP/04923/2020 and NOVA National School of Public Health for access to the Hospital Morbidity Database made available for research purposes by Administração Central do Sistema de Saúde, IP (ACSS). Key messages • Exposure to extremely high temperatures increases the risk of admission due to infectious and parasitic diseases by 16%, with a peak occurring two days after exposure. • This data is essential for policymakers to identify and integrate vulnerable periods into early heat warning systems, enhancing effective public health strategies against climate change.

Enhancing literacy among the elderly on sexually transmitted infections: an educational intervention

Abstract Issue Sexually transmitted infections (STIs) pose significant public health concerns across different settings and countries, especially in elderly populations, in which recent increases have been noted. This project aimed to target STIs literacy among the elderly, addressing a crucial gap in public health education. Description of the problem This project focused on improving STIs literacy among elderly residents in a municipality in Northern Portugal. Using innovative methods such as tailored materials and interactive sessions, the intervention aimed to evaluate their effectiveness through pre-, post-, and one-month follow-up STD-KQ questionnaire assessments (composite score of total correct calculated as average, ranged from 0 to 27). Statistical analysis used SPSS IBM for Mac OS® v29. Descriptive statistics: mean ± standard deviation for continuous, proportions (%) for categorical variables. Analysis included only individuals with complete data. ANOVA with Bonferroni post hoc tested intervention impact on STD-KQ scores. Results Fifty-one individuals participated in this study, with an average age of 70,89 ± 5,10 years old, and 64,7% female. The average STD-KQ score increased by 151.54% immediately after, 11.39 ± 5.66 (p < 0,01), and by 122.54% after one month, 10.08 ± 5.35 (p < 0,01), compared to pre-intervention, 4.53 ± 3.96 (p < 0.01). The score at one month follow-up remained similar to post-intervention (p = 0.39), presenting a significant improvement in STIs knowledge. Lessons This pioneering project, to the best of our knowledge the first of its kind, demonstrates the effectiveness of tailored educational interventions in improving STIs literacy among the elderly, with sustained effects after one month. This innovative approach can be adapted and scaled up for broader use in different settings and countries. Key messages • Tailored educational interventions can be a powerful public health strategy to effectively enhance long-term STI literacy among elderly populations. • Assessing knowledge about STIs can be a crucial initial step for physicians to provide or refer for comprehensive education on safe sexual practices in this age group.

The association between screen use, psychological distress and sleep among adolescents in Norway

Abstract Background Today’s adolescents dedicate a significant portion of their time to screens. Concerns have arisen regarding the lasting impact of screen use on adolescent health, making it a crucial public health topic. Previous studies have presented both positive and negative outcomes associated with screen use. Further insight is required into various forms of screen use and the influence on adolescent health. The objective of this study is to examine the relationship between gaming, social media use, psychological distress, and sleep among adolescents. Methods This study is based on cross-sectional data from the Ung-HUNT4-study, a health study conducted among adolescents 13-19 years old in Trøndelag municipality in Norway from 2017-2019 (n = 8066). Binomial logistic regression was used to analyse the association between gaming, social media, psychological distress and sleep. Analysis was controlled for gender, age, family economy and having friends. Results Preliminary results showed that the odds for having psychological distress were higher for those who spent more than 3 hours on social media after school (OR: 1.31, 95% CI: 1.10-1.57), and on weekends (OR: 1.45, 95% Cl: 1.22 - 1.73), and on gaming in weekends (OR:1.30 Cl: 1.08-1.55) compared to those who spent 3 hours and less. The odds for sleeping < 8 hours per day on weekdays were higher for those who spent more than 3 hours on gaming after school (OR: 1.27 Cl:1.07-1.52), and more than 3 hours on social media after school, (OR:1.41 Cl:1.20-1.67) or on weekends (OR:1.39 Cl: 1.19-1.62), compared to those who spent 3 hours or less. Conclusions More than 3 hours spent on social media after school and on weekends was associated with significantly higher odds for psychological distress and less sleep on weekdays. More knowledge about the impact of different types of screen use on adolescents’ health is needed, and new public health strategies to secure safe screen use should be developed. Key messages • Screen use is associated with psychological distress and less sleep. • Awareness on various types of screen use and its influence on health in adolescence, is important in public health policy and practice.

Factors associated with type 2 diabetes control in hard-to-reach communities in Esmeraldas, Ecuador

Abstract Background The rising prevalence of type 2 diabetes mellitus (T2DM) and its detrimental effects on population health make it an urgent public health concern. Maintaining blood glucose control is crucial for avoiding complications; however, there are notable socioeconomic disparities in disease management, especially in low- and middle-income settings. We aimed to examine the factors associated with controlled fasting capillary glucose in a difficult-to-access rural setting of Esmeraldas, Ecuador, and to examine the role of social support in this context. Methods Between October 2020 and May 2022, we conducted a cross-sectional study of T2DM adult patients in Esmeraldas’ Eloy Alfaro health district. We collected data on socio-demographic and clinical patient characteristics using a questionnaire and measured Fasting Capillary Blood Glucose levels. We estimated the prevalence of controlled glycaemia and used logistic regression to calculate odds ratios (OR) with 95% confidence intervals. Results Only 18.1% (95%CI: 14.9-21.8) of the 476 study participants had controlled glucose levels, with a significantly higher percentage in men (28.2%) compared to women (13.8%). Participants reported moderate perceived social support (median=2.33, on a scale of 1 to 4), without significant impact on glycaemic control. Women in urbanised areas were more likely to have controlled glucose levels compared to those in rural areas (aOR=2.34, 95%CI: 1.23-4.44) after adjusting for family support. In contrast, unemployed and older men had non-significant trends towards better odds of achieving controlled fasting glycaemia. Conclusions The complex interplay of factors affecting diabetes management and glycaemic control highlights the need for targeted, context and gender-specific public health strategies to address diabetes disparities in vulnerable populations. Key messages • The majority of individuals with T2DM residing in the remote communities of Eloy Alfaro district in Esmeraldas (Ecuador) have uncontrolled glycaemia, showing notable gender-specific disparities. • Participants reported a moderate level of social support, with family as the most important source. Yet, this perceived support may not effectively overcome contextual barriers in T2DM management.

Boosting influenza vaccination rates through policy gamification: the ‘Let’s Control Flu’ project

Abstract Background Influenza remains a public health challenge globally, leading to substantial morbidity and mortality, particularly among vulnerable groups. Despite the benefits of vaccination, achieving the desired vaccination coverage rates (VCR) proves challenging across Europe. The ‘Let’s Control Flu’ (LCF) tool emerges as a new contribution, merging gamification with epidemiological data and public health policies to help increase influenza VCR. Methods The LCF tool, developed from an extensive literature review and validated by a National Advisory Board, initially showcased its capabilities in Sweden. Offering an interactive simulation, it allows stakeholders to explore the outcomes of implementing 13 targeted public health policies (PHP) on influenza VCR and health outcomes such as infection rates, hospitalizations, and mortality. This approach simplifies epidemiological complexities, paving the way for informed decision-making. Results Following its success in Sweden, the LCF tool was extended to Germany and Czechia, underlining the value of gamified tools in public health decision-making. The application across these new countries not only resulted in paths to improve VCR but also provided insights into the tool’s scalability and adaptability different landscapes. Conclusions The LCF project underscores the efficacy of integrating gamification into health policy decision-making, offering a replicable model for enhancing influenza vaccination uptake across Europe. With the tool now successfully applied in multiple countries, its potential for broader European and global application is evident. This initiative aligns with WHO’s objectives, spotlighting gamification as a relevant component in improving vaccination strategies and readiness for influenza and other preventable diseases, thereby reinforcing the importance of innovative approaches in public health policy development. Key messages • The LCF tool integrates gamification with public health strategies to help effectively raise influenza vaccination coverage. • By merging gamification and epidemiological insights, the LCF tool also serves as a scalable model for Europe, supporting WHO’s goals to improve vaccine strategies and preparedness.

Influencers as a new source of health information: Insights from an Austrian youth survey

Abstract Background Social media influencers (SMIs) have become the dominant source of health information for youth. While some SMIs may share valuable content, critics raise concerns that they lack expertise, have commercial motives, or hold personal biases. Yet, little is known about the epidemiology of the health influencer phenomenon. This study offers first insights into the reach of SMIs among Austrian youth, informing public health strategies to promote positive health behaviors in young populations. Methods A cross-sectional study was conducted with a representative sample of 1003 Austrian adolescents and young adults aged 15-25. Key research questions focus on the epidemiology of health influencers, engagement with SMIs, prevalent health topics, advertising, and perceived impact of SMIs on health. Preliminary results Participants estimate that over 51% of social media posts they see are from SMIs, and 75.37% follow at least one SMI. Additionally, 37.19% follow SMIs who specifically share health content, and 30.91% have purchased health products recommended by them (e.g., foods, supplements, beauty products). Moreover, 40.27% trust their followed SMIs for health information, similar to trust in traditional media (43.47%). Finally, over a third find SMI content beneficial for health (32.34%), while 29.20% find it harmful, and 33.83% neither. Conclusions The study provides first insights into the epidemiology of health influencers, revealing their extensive reach and positive reception among young people. Despite concerns about conflicts of interest or expertise, SMIs are perceived as trusted sources for health information and product purchases. This research enhances our understanding of influencers’ impact and informs public health strategies aimed at promoting positive health behaviors among youth. The insights from Austrian youth can inform future studies across Europe, deepening our understanding of the health influencer phenomenon and its implications for public health. Key messages • This cross-sectional study shows the high reach of social media influencers among youth and their important role as emerging sources of health information. • The study breaks new ground by investigating adolescents’ engagement with health influencers, offering insights for public health to promote positive health outcomes among young populations.

One Health in Europe: from concept to practice

Abstract The One Health concept is a comprehensive approach that highlights the interconnectedness of human, animal, and environmental health. Understanding these interrelationships is essential for effectively managing and mitigating emerging health threats. This approach emphasizes that health issues arise from a complex web of interactions involving humans, animals, and ecosystems. Emerging health threats, such as zoonotic diseases (e.g., mpox, Ebola, avian influenza), antibiotic resistance, and environmental degradation, pose significant risks to global health. Zoonotic diseases, which are transmitted between animals and humans, highlight the direct links between animal and human health. The increase in antibiotic resistance, driven by overuse in both human medicine and livestock farming, leads to the rise of resistant pathogens. Environmental issues like climate change, deforestation, and pollution further exacerbate these threats by altering habitats, disrupting ecosystems, and affecting disease vectors. Addressing these interconnected challenges requires a unified approach that integrates human, animal, and environmental considerations. For example, climate change can shift the distribution of disease vectors like mosquitoes, leading to the spread of diseases such as malaria and dengue fever. Likewise, deforestation can heighten the risk of zoonotic spillover by bringing humans into closer contact with wildlife. 1. To tackle these complex challenges, several measures are crucial: • Integrated surveillance systems Developing systems that monitor human, animal, and environmental health data collectively can improve early detection of outbreaks. Sharing information across sectors is a prerequisite for effective identification of emerging threats. • Strengthening veterinary and public health collaboration Joint research, surveillance, and outbreak management efforts can lead to a more coordinated approach to health emergencies. • Promoting One Health education and training Educating professionals in various fields fosters a collaborative approach to health issues. Training programmes can build a shared understanding of health interconnections. • Implementing sustainable environmental practices Adopting sustainable practices to address environmental degradation helps reduce risks associated with habitat destruction and pollution. • International collaboration and agreements facilitate resource sharing, information exchange, and best practices. 2. To enhance public health strategies within the One Health framework: • Enhance interdisciplinary research Promote research on the intersections of human, animal, and environmental health to understand how changes in one area affect others and to develop more effective interventions. • Foster community engagement Engage communities to improve the adoption of preventive measures and build resilience against health threats through public awareness and community-based programs. Leverage technology and innovation Innovations can offer valuable insights such as data analytics, remote sensing, and genomic surveillance. In our upcoming plenary session, experts from veterinary and public health sciences will present practical examples on One Health collaboration in Europe and discuss how to address challenges in implementing the approach. Moderator Ricardo Mexia Chair of the 17th EPH Conference 2024, President EUPHA Infectious diseases control section Keynote speaker Lorena Boix Deputy Director-General, Directorate General for Health and Food Safety (DG SANTE), European Commission Speakers/Panellists Stef Bronzwaer Cross-Agency One Health Task Force, European Food Safety Authority (EFSA) Barbara Häsler Royal Veterinary College, UK Susana Guedes Pombo Chief Veterinary Officer, Portugal, President World Organization for Animal Health (WOAH) Eva Zažímalová Member of European Commission's Group of Chief Scientific Advisors, Professor of Plant Anatomy and Physiology, Charles University, Czech Republic

Co-administration of COVID-19 and flu vaccines in healthcare workers: results from three campaigns

Abstract The COVID-19 pandemic, along with seasonal influenza, highlights the need for innovative public health strategies. Co-administering COVID-19 and influenza vaccines offers advantages for healthcare workers (HCWs), streamlining vaccination efforts and enhancing public health resilience. Recent evidence supports the safety and efficacy of this approach, endorsed by health authorities worldwide. However, its acceptance remains a concern. This study explores HCWs’ acceptance of vaccine co-administration in three campaigns post the introduction of the anti-SARS-CoV-2 vaccine. During three consecutive flu seasons from October 2021 to January 2024, a cross-sectional study was conducted in a large Italian teaching hospital. Data for 2021/2022, 2022/2023 and 2023/2024 were compared, focusing on healthcare workers present in all datasets. McNemar’s test examined changes in acceptance of co-administration. In addition, a conditional logistic regression model was designed to assess the determinants of co-administration through the vaccination campaigns in the three years. During these vaccination campaigns 7457 HCWs were observed (62.78% women, median age 43). Co-administration surged, particularly in 2022/2023, showing a 280.71% increase, consistent across all professional categories (p < 0.001). Controlling for gender and professional category, acceptance of coadministration showed a significant association respectively with “open days” twice a month (OR 2.9 CI [2.7; 3.6]) and a hospital vaccination clinic two days a week on weekdays (OR 4.5 CI [4.1; 5.4]) compared to conducting vaccinations at a clinic open everyday during the campaign period; no association was highlighted with age. This study investigates a facet of an increasingly significant topic, demonstrating that co-administering vaccines for SARS-CoV-2 and influenza is emerging as an effective strategy in annual vaccination campaigns, thanks to its safety and the streamlining of logistical and organizational processes. Key messages • The co-administration of vaccines offers a promising strategy to enhance vaccination rates among healthcare workers. • By identifying factors influencing acceptance, it aims to inform targeted interventions for maximizing vaccine uptake and public health resilience.

Revisiting COVID-19 Maps with Bayesian Hierarchical Modelling: Socioeconomic Insights from Istanbul

Abstract Objectives This study explores the spatial disparities in COVID-19 incidence across neighborhoods in Uskudar, Istanbul, and examines the relationship between these disparities and neighborhood-level socioeconomic status. Methods This ecological study analyzed cumulative COVID-19 case data for 33 neighborhoods in Uskudar, collected up to 31 December 2020. Socioeconomic status was assessed using the Socioeconomic Development Index (SEDI) scores from Istanbul Metropolitan Municipality. Spatial analysis included Moran’s I statistics and Local Indicators of Spatial Association (LISA) cluster analysis. Bayesian Hierarchical Modeling with the Besag-York-Mollie (BYM) model was employed to decompose spatially structured and unstructured variations, adjusting for SEDI scores and their sub-components. Model validation involved convergence diagnostics and Monte Carlo error assessments. Results A total of 29,834 COVID-19 cases were identified, with an incidence rate of 56.1 per 1000 residents. Spatial analysis revealed significant clustering of high incidence rates in peripheral and inner city neighborhoods. Moran’s I statistic for COVID-19 incidence was 0.331 (p = 0.003), indicating positive spatial autocorrelation. SEDI scores were also spatially autocorrelated (Moran’s I = 0.293; p = 0.005) and negatively correlated with COVID-19 incidence (r = -0.570; p = 0.001). Bayesian hierarchical models confirmed the association between lower socioeconomic status and higher COVID-19 incidence, even after adjusting for spatial autocorrelation. Conclusions The study highlights significant spatial and socioeconomic disparities in COVID-19 incidence in Uskudar, Istanbul. Lower socioeconomic status is associated with higher COVID-19 incidence, underscoring the need for region-specific public health strategies that consider socioeconomic factors. These findings can guide future interventions to mitigate the impact of the pandemic on vulnerable populations. Key messages • Study reveals COVID-19 incidence in Uskudar is significantly influenced by socioeconomic status, highlighting need for targeted health interventions. • Positive spatial autocorrelation found in COVID-19 cases and socioeconomic index suggests clustering in specific Uskudar neighborhoods.

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.

Loneliness and Social Isolation in Older Adults in Latvia and Iceland During COVID-19

Abstract Background The COVID-19 pandemic has significantly impacted the mental health and wellbeing of older populations across Europe, exacerbating feelings of loneliness and social isolation, known risk factors for poor physical and mental health outcomes. This study aims to understand the extent and implications of these changes in Latvia and Iceland, providing essential insights for targeted public health interventions. Methods This comparative study utilized data from two key sources: the Survey of Health, Ageing, and Retirement in Europe (SHARE) for Latvia and the HL20 study for Iceland, focusing on individuals aged 67 and above. Both quantitative surveys were conducted during the pandemic, offering data on health status, loneliness, and social isolation. A novel approach was applied in analyzing older populations to standardize comparisons between the two distinct datasets. This methodological innovation is part of a bilateral EEA initiative FM2021/23 aimed at strengthening research collaboration between Latvia and Iceland. Descriptive statistics and the Pearson Chi-square test were used to compare outcomes between the two countries and within demographic subgroups. Results The study revealed stark differences between the two countries: 80% of Latvian older adults reported social isolation compared to 42.7% in Iceland. Similarly, 45% of Latvians experienced loneliness versus 30% of Icelanders. Significant associations were found between social isolation, loneliness, and deteriorating mental and physical health, with worse outcomes noted in socially isolated individuals. Conclusions Our findings demonstrate a clear link between social isolation and adverse health outcomes among the older adults, exacerbated by the COVID-19 pandemic. The study supports the need for proactive public health measures in Latvia and Iceland, including the development of community engagement programs and mental health support services tailored to the needs of older adults. Key messages • Study shows significant health impact of social isolation among older adults in Latvia and Iceland, highlighting urgent need for targeted public health interventions. • Effective public health strategies and innovative digital outreach can mitigate adverse effects of loneliness and isolation observed in older populations.

Exploring the use of meal delivery services in Belgium

Abstract Background Ready-to-eat meal delivery services have become commonplace in recent years and their growth accelerated during the COVID-19 pandemic. However, the potential ramifications on dietary habits and subsequent health outcomes remain largely unexplored. Given the well-established links between unhealthy dietary patterns and chronic diseases such as obesity, type II diabetes, and cardiovascular diseases, understanding the determinants and public health implications of ready-to-eat meal delivery services use is imperative. This study aims to investigate the determinants associated with the use of ready-to-eat meal delivery services and their implications for health behaviours and outcomes. Methods This cross-sectional study is conducted amongst adults residing in Flanders or Brussels, Belgium. A quantitative online survey commenced in April 2024 and is scheduled to conclude by June 2024. Structural equation models will be used to assess determinants and implications of ready-to-eat meal delivery services use. Latent class analysis will be used to identify user profiles and subsequent structural equation modelling will assess determinants of these profiles and their associated health (behaviour) outcomes. Results Preliminary results suggest meal delivery usage was higher in younger and middle-income users. Main reasons of use amongst users (n = 139) were more time for leisure activities (66%) and supermarket avoidance (64%). Main reasons for non-use amongst non-users (n = 69) were not wanting to spend money with meal delivery services (70%) and preference to cook own meals (81%). Data collection is currently ongoing. Further analysis is planned, and full results will be available by November 2024. Conclusions This study will provide a better understanding of drivers of meal delivery services use in Belgium and their potential impact on public health. It will also help inform public health strategies targeted at improving dietary habits. Key messages • Recognising that meal delivery services will become ever present in the future, insights into why people order meals for delivery and the potential health implications of such services are essential. • The use of advanced statistical techniques highlights the potential of the study to offer novel insights into determinants and ramifications of meal delivery services usage.

4.K. Scientific session: The realm of the information ecosystem and its public health impact

Abstract Workshop background As a field of science, study, practice, and policy, infodemic management has emerged during the Covid-19 pandemic but has since been emancipated and can be translated to any topic where information ecosystems play a vital role. In particular relevant to public health, infodemic managers have grown in the ranks of institutes of public health, academic institutions, UN agencies and civil society organizations, tackling outbreaks and public health issues as wide as mpox, Marburg, teen mental health, chronic diseases, seasonal influenza, Ebola and routine immunization. Aiming at improving public health strategies, they are responsible for exploring and investigating personal and organizational (health) information ecosystem, generating evidence, identifying patterns of communication and information flow, tackling the onset and distribution of circulating mis- and disinformation, better understanding information voids, and respond to citizen needs concerning information demands around emergencies. In this workshop, we will focus on several common challenges associated with implementing whole-of-society interventions and strategies for resilience to health misinformation. Solving these challenges, which often are too big just for the health system to solve, will sometimes require creativity, out-of-the-box thinking as well as cross-disciplinary perspectives and new partnerships. Infodemics are also a global challenge that can easily cross borders, which is why country-to-country discussions of experiences by participants is encouraged-while no previous infodemic management experience is required. Workshop objectives The workshop will be organized as a research symposium with five speakers from infodemic management, health information, and health literacy. They will provide a solid introduction to infodemic management from different perspectives and angles. (i) The first presentation will introduce a study on health information seeking and health literacy in midwife-led care and the modern information environment. (ii) The second presentation will discuss how fact-checking organizations can partner within public health for a healthier internet. (iii) The third presentation will focus on unravelling misinformation by investigating the associations between health literacy and resilience. (iv) The fourth presentation will present a novel web-platform for credible health information and tackling misinformation. (v) The fifth presentation focuses on the impact of misinformation on social media in the context of natural disasters. The format of this workshop will be 5x8-minute presentations, including Q&A with the audiences, followed by a 20-minute panel discussion, reflecting the relevance of the results to public health research, practice and policy. Key messages • Infodemic management seeks to quickly understand the public’s information and health needs improve future public health responses, especially during emergencies. • Whole-of-society approaches are needed to address and mitigate harms caused by infodemics by developing closer partnerships and understanding between health systems and the public.

Loneliness in Baltic-Nordic Older Adults Amid COVID-19

Abstract Background The study investigates loneliness among older adults in the Baltic-Nordic region, particularly in the context of the COVID-19 pandemic. It aims to understand how loneliness varies across cultural and socio-economic contexts in these areas, which is critical for developing public health strategies tailored to the specific needs of older populations. Methods We employed a comprehensive comparative analysis, leveraging data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the HL20 study from Iceland, focusing on individuals aged 67 and above. The study encompassed a diverse sample from Sweden, Denmark, Estonia, Lithuania, Finland, Latvia, and Iceland, totaling 5,313 participants. This research is part of a bilateral EEA FM2021/23 initiative to enhance methodological approaches to analyzing older populations by coding and standardizing variables for comparability across different countries. Results Significant regional differences in loneliness were observed. The Baltic regions reported a higher prevalence of loneliness compared to the Nordic countries, which displayed lower levels, attributed to strong social welfare systems and community engagement. Factors such as employment, marital status, and educational attainment varied across regions, affecting loneliness levels. Conclusions The findings highlight the importance of considering regional cultural and social contexts in public health interventions aimed at reducing loneliness among older adults. The study underscores the need for targeted strategies that address the unique social dynamics of the Baltic and Nordic regions. Innovative public health actions, such as community engagement programs and policy development, are recommended to alleviate loneliness in these populations. Key messages • Significant regional differences in loneliness in the Baltic-Nordic region underscore the need for tailored public health interventions. • Employment and social welfare are key factors in mitigating loneliness among older adults, highlighting the importance of socio-economic support systems.

School teachers’ perceptions of intersectoral working with health in the COVID-19 pandemic

Abstract Background The COVID-19 pandemic highlighted the challenge for teachers to integrate protective health measures into their academic daily responsibilities. The aim of this abstract is to analyse how school teachers’ views on intersectoral collaboration with health professionals during COVID-19 vary by country, seeking insights for future directions. Methods In 2021, an online survey was conducted in 6 languages with education and health professionals, followed by optional online semi-structured interviews. We explored the: 1-effect of the pandemic on schools/pupils/teachers; 2-reorganisation of schools; 3-experience of implementing infection control measures in schools; 4-intersectoral working; 5-important resources for keeping schools open. Interviews were transcribed verbatim and translated into English. Analysis of a survey question seeking professionals’ rating of intersectoral working led to a directed content analysis of transcripts and free-text survey responses regarding intersectoral working experiences. Results Data were analysed from 1046 school teacher survey responses from 6 countries/territories and 21 follow-up interviews. Ratings varied considerably across countries. A large majority of teachers in Taipei (83%) reported excellent or good collaboration with health professionals, about half in China (53%) and Portugal (51%), and far fewer in Brazil (38%), Morocco (29%) and France (15%). Taipei respondents cited the key role of school nurses as a positive factor; others added clear national guidelines and local protocols. Negative ratings related to health professionals’ rare visits or absence. Conclusions The direct support of health professionals in schools was offered as explanation for teachers’ positive ratings of intersectoral working in the pandemic. Policy and practice varied geographically; thus, understanding contextual factors that influence the effectiveness of intersectoral working in schools is crucial to orient future public health strategies. Key messages • This highlights the importance of understanding contextual factors that influence the effectiveness of intersectoral working in implementing protective health measures in schools. • This suggests that policy support and the presence of dedicated health personnel within schools play a pivotal role in ensuring effective collaboration between the education and health sectors.

High-resolution modeling and projection of heat-related mortality in Germany under climate change

Abstract Heat is a leading cause of premature deaths during summer months. Understanding the relationship between high temperatures and excess mortality is crucial for designing effective prevention and adaptation plans. Traditional statistical methods have been repeatedly applied to analyze heat-related mortality. However, spatially and temporally high-resolution analyses are challenging due to fragmented data archives across different agglomeration levels, especially for mortality data. We propose a neural network-based model to estimate heat-related mortality. This approach allows for high temporal and spatial resolution estimations, such as regional heat risk during specific heatwaves. Using Germany as a case study, we calculated heat-related excess mortality rates at the district level and visualized the dynamics of local health risks within a heatwave. Overall, we estimated a total of 48,000 heat-related deaths in Germany over the last decade (2014-2023), with most occurring during specific heatwave events. For example, in 2023, the heatwave from July 7-14 contributed approximately 28% (1100 deaths) to the total of about 3,900 heat-related deaths for the entire year. This estimation is consistent with previously published reports from the Robert Koch Institute (RKI), considering the resolution differences in the input data. In addition, we combined our model with shared socio-economic pathways (SSPs) of future climate change, assuming a static population and baseline mortality rate. The results suggest that heat-related risk in Germany could further increase by a factor of 2.5 (SSP245) to 9 (SSP370) without adaptation to extreme heat. Our approach is a valuable tool for the monitoring of regional heat-related risks as well as scenario-based risks projections for the future. The results of the model can help develop climate-driven public health strategies, aiding in the identification of local risks during heatwaves and in long-term resilience planning. Key messages • High-resolution modeling of heat-related mortality helps us to develop targeted adaptation and prevention plans. • The majority of heat-related mortality occurs during heatwaves in summer.