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The World Health Organization (WHO) defines an infodemic as the proliferation of false or misleading information that leads to confusion, mistrust in health authorities, and the rejection of public health recommendations. The devastating impacts of an infodemic on public health were felt during the COVID-19 pandemic. We are now on the precipice of another infodemic, this one regarding abortion. On June 24, 2022, the Supreme Court of the United States (SCOTUS) decision in Dobbs v. Jackson Women’s Health Organization resulted in the reversal of Roe v. Wade, which had protected a woman’s right to have an abortion for nearly 50 years. The reversal of Roe v. Wade has given way to an abortion infodemic that is being exacerbated by a confusing and rapidly changing legislative landscape, the proliferation of abortion disinformants on the web, lax efforts by social media companies to abate abortion misinformation, and proposed legislation that threatens to prohibit the distribution of evidence-based abortion information. The abortion infodemic threatens to worsen the detrimental effects of the Roe v. Wade reversal on maternal morbidity and mortality. It also comes with unique barriers to traditional abatement efforts. In this piece, we lay out these challenges and urgently call for a public health research agenda on the abortion infodemic to stimulate the development of evidence-based public health efforts to mitigate the impact of misinformation on the increased maternal morbidity and mortality that is expected to result from abortion restrictions, particularly among marginalized populations.

Background Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings. Methods A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data. Results The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden. Conclusions Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

EUREGHA's vision is to ensure that the local and regional perspective is represented in EU health policy because local and regional authorities are the natural interface between citizens and European institutions, being the bridging bodies between policies and practices and the closest organizations to the concept of communities. We are the only European network prioritizing the representation of local and regional health authorities at EU level, as they fulfil a key role in improving efficiency, quality, and accessibility of healthcare systems and services. EUREGHA understands their specific needs and works tirelessly to represent regional and local health authorities in EU health policy, to amplify their voices as a means to improve European public health and healthcare. Through advocacy, policy monitoring, profile promotion, partnerships, and project development, EUREGHA facilitates and promotes collaboration between its members, EU institutions, pan-European health networks and other healthcare stakeholders. Network activities and projects are implemented upon a strategic background of “ways to make things happen” such as value based healthcare, smart specialization strategies and skills for innovation and digital transformation - on one side - and along thematic and field objectives such as cross-border healthcare, cancer, obesity, mental health and ageing - on the other side. Lower Austria is a long-standing member and Vice-Chair of EUREGHA.

OBJECTIVES:To explore the reasons why women stop breastfeeding completely before their infants are six months of age and to identify the factors associated with cessation and the timing of cessation. METHODS:For all singleton live newborns born between January 1, 2008 and December 31, 2009 in two district health authorities in Nova Scotia, Canada, mother's self-reported breastfeeding status was collected at hospital discharge and at five follow-up visits until infants were six months of age. Mothers who stopped breastfeeding before six months were also questioned about the time of weaning and the reason they discontinued all breastfeeding. Eleven categories were created from the open-ended responses women provided. These data were linked with the Nova Scotia Atlee Perinatal Database in order to obtain information on maternal and neonatal characteristics. The relationship between maternal, obstetrical, and neonatal characteristics and each reason for stopping breastfeeding completely were examined. RESULTS:Of the 500 mothers who stopped breastfeeding completely before six months and provided a reason for discontinuing, the majority (73.6%) stopped within the first six weeks. The most common reasons cited were inconvenience or fatigue associated with breastfeeding (22.6%) and concerns about milk supply (21.6%). Return to work or school was associated with length of time that infants were breastfed: 20% of women who stopped after six weeks citing this as the reason. Most of the reasons, however, were not found to be associated with a specific duration of breastfeeding or with the examined maternal and infant characteristics. CONCLUSION:This study highlights factors associated with the reasons why women stop breastfeeding completely before six months and how these reasons varied with weaning age. The results will help inform future research aimed at identifying interventions to reduce early breastfeeding cessation.

Background The endogenous nature of healthcare expenditure means that instruments are often used when estimating the relationship between expenditure and mortality. Previous English studies of this relationship have largely relied on statistical tests to justify their instruments. A recent paper proposed that exogenous components of the resource allocation formula, used to distribute the national healthcare budget to local health authorities, be used as instruments. Objectives To estimate the relationship between healthcare expenditure and mortality by disease area for England from 2003/4 to 2012/13 using exogenous elements from the resource allocation formula as instruments for expenditure. To use these disease-specific estimates to calculate the marginal cost per quality-adjusted life year (QALY) for English NHS expenditure. To compare these estimates with those that relied on statistical tests to justify their instruments. Methods The two-stage least squares estimator is used to determine the annual relationship between mortality and healthcare expenditure by disease area across 151 local authorities. These disease-specific outcome elasticities are combined with information about survival and morbidity disease burden in different disease areas to calculate the marginal cost per QALY for English National Health Service (NHS) expenditure. Results The results suggest an annual marginal cost per QALY of between £5000 and £10,000. This is similar to that reported previously by studies that used statistical tests to justify their instruments. Conclusion These cost per QALY estimates are much lower than the threshold currently used by the UK’s National Institute for Health and Care Excellence (NICE) (£20,000 to £30,000) to assess whether a new pharmaceutical product should be funded by the NHS. Our estimates suggest that guidance issued by NICE is likely to do more harm than good, reducing health outcomes overall for the NHS. There may be legitimate reasons why such harms are deemed appropriate, but it is only through the type of empirical analysis in this paper that the reasons for these ‘harms’ are likely to be articulated and explicitly justified.

Ischemic heart disease (IHD) remains one of the leading causes of death in Estonia, especially among older adults and disadvantaged socioeconomic groups. While descriptive statistics inform retrospective trends, health authorities increasingly require predictive tools for more proactive planning. This project proposes a data science approach to forecasting IHD mortality, aiming to identify high-risk populations and support targeted public health interventions. We propose to develop a machine learning model trained on national health data to predict IHD-related mortality by region, sex, and age group over a 3-5-year horizon. Data will be sourced from the Estonian Health Insurance Fund, Statistics Estonia, the National Institute for Health Development, and international sources such as WHO and Eurostat. The modeling pipeline will include: data preprocessing (handling ICD-10/ICD-11 inconsistencies, missing values, and ill-defined deaths), exploratory analysis, and training using logistic regression, random forests, and gradient boosting methods. Fairness audits and explainability tools (e.g., SHAP) will ensure interpretability and equity. Ethical safeguards aligned with GDPR will be integrated throughout. Although results are forthcoming, we anticipate that this approach will enable dynamic risk stratification and scenario testing across Estonian regions. The model will be designed to update with new data and disaggregate outputs by subgroup characteristics, supporting equity-focused health policy decisions. This project introduces a scalable, data-driven method for predicting IHD mortality that bridges epidemiology and data science. By forecasting where and in whom mortality risks are highest, the model aims to help regional health authorities in Estonia allocate resources more effectively and intervene earlier. The framework may serve as a template for similar predictive analytics in other disease areas or countries. Key messages • Predictive modeling can support more timely and targeted public health responses to ischemic heart disease in Estonia. • Transparency, fairness audits, and stakeholder engagement are key to ensuring trust and utility in health-related machine learning applications.

The traditional vertical system of sharing information from sources of scientific authority passed down to the public through local health authorities and clinicians risks being made obsolete by emerging technologies that facilitate rapid horizontal information sharing. The rise of Public Health 2.0 requires professional acknowledgment that a new and substantive forum of public discourse about public health exists on social media, such as forums, blogs, Facebook, and Twitter. Some public health professionals have used social media in innovative ways: to surveil populations, gauge public opinion, disseminate health information, and promote mutually beneficial interactions between public health professionals and the lay public. Although innovation is on the rise, most in the public health establishment remain skeptical of this rapidly evolving landscape or are unclear about how it could be used. We sought to evaluate the extent to which public health professionals are engaged in these spaces. We conducted a survey of professorial- and scientist-track faculty at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA. We asked all available faculty via email to complete a 30-question survey about respondent characteristics, beliefs about social media, and usage of specific technologies, including blogs, Facebook, Twitter, and YouTube. A total of 181 (19.8%) of 912 professor- and scientist-track faculty provided usable responses. The majority of respondents rarely used major social media platforms. Of these 181 respondents, 97 (53.6%) had used YouTube, 84 (46.4%) had used Facebook, 55 (30.4%) had read blogs, and 12 (6.6%) had used Twitter in the prior month. More recent degree completion was the best predictor of higher usage of social media. In all, 122 (67.4%) agreed that social media is important for disseminating information, whereas only 55 (30.4%) agreed that social media is useful for their research. In all, 43 (23.8%) said social media was helpful for professional career advancement, whereas 72 (39.8%) said it was not. Only 43 (23.8%) faculty said they would employ a full- or part-time social media consultant, and 30 (16.6%) currently employed one. Despite near-universal appreciation of the potential for social media to serve as a component of public health strategy, a small minority are actually engaged in this space professionally, whereas most are either disinterested or actively opposed to professional engagement. Social media is seen by most as more useful for spreading information than obtaining it. As public discourse on a number of critical health topics continues to be influenced and sometimes shaped by discussions online from Twitter to Facebook, it would seem that greater discourse is needed about when and how public health professionals should engage in these media, and also how personal, institutional, and professional barriers to greater use of social media may be overcome.

Introduction Aging populations necessitate home care, but Italy's plan to increase coverage lacks implementation specifics alongside regional variability. Furthermore, there is no data on Italian GP's HC delivery. This study examines home care delivery by General Practitioners in Modena province. Methods A cross-sectional study was conducted involving 85 volunteer GPs (19% of the province's total GPs) from all seven districts of Modena province. Data were collected through a knowledge questionnaire on home care attitudes and analyzed alongside administrative data from December 2022, including active HC contracts, hospitalization rates, and emergency department access. Results 75% of respondent GPs were female, with an average age of 50 years. The average patient load per GP was 1362, with significant variability in age distribution. Most GPs worked in group practices (67%) and utilized support staff, including nurses (66%) and secretaries (86%). 44% of GPs reported conducting 3-5 home visits weekly, 58% activated HC contracts for less than half of their non-transportable patients. The main barriers in activating these contracts were a preference for need-based visits, time constraints, and bureaucratic hurdles. Contracts were mainly for Integrated HC (56%) and Planned HC (41%). GPs managed an average of 15 contracts each (range 2-44), with significant variability in contract types. Hospitalization rates for enrolled GPs (62.3 medical, 41.7 surgical per 1,000 patients) were lower than the provincial average (66.4 and 42.7, respectively). Conclusions The findings highlight the need for Local Health authorities to streamline processes to support HC services, addressing identified barriers and optimizing patient care. The study underscores the importance of providing a comprehensive description of home care services to inform healthcare reforms and improve evidence-based decision-making. Key messages • The study shows variations in home care delivery among GPs in the province of Modena, highlighting challenges and the impact of local healthcare organization. • Findings emphasize the need for streamlined processes and support to improve home care services, addressing barriers and optimizing patient care.

Background Access to quality Home Palliative Care (HPC) is a public health priority. This study analyzed HPC services in Piedmont, a large, diverse Italian region (4.3 million inhabitants), as a case study to understand organizational variations in complex settings and inform equity-focused policies. Methods A cross-sectional survey covered Piedmont's 12 Local Health Authorities (LHAs) and 35 districts. Pre-pandemic data for 2019 were collected in 2023 via in-person questionnaires and interviews with HPC managers/directors. Key structural, process, and outcome indicators were analyzed descriptively. 2022 data were collected for comparison. Results Substantial heterogeneity was found across LHAs in 2019. Formal Local Palliative Care Networks existed in only 8/12 LHAs. Dedicated HPC units were present in 11/12 LHAs, but with varying structures and staffing (physician Full-Time Equivalents, or FTEs, range 0.59-3.00 per 100,000 inhabitants; regional average 1.71, below standards). Nurse FTE data faced challenges. Care pathways showed fragmentation and coordination with emergency services were limited, but psychological support was guaranteed. Large disparities emerged in care intensity (ratio of actual assistance days to total care days range 0.09-0.64) and place of death for cancer patients (home deaths range 6.26%-44.03%). Fragmented data systems hindered monitoring. The 2019-2022 comparison showed improvements (hospital deaths decreased from 23.6% to 16.0%) but confirmed persistent heterogeneity. Conclusions Mapping revealed marked variability in Piedmont's HPC organization, resourcing, delivery, and outcomes. Key challenges identified include network gaps, resource disparities (esp. physicians), fragmented models/pathways, poor care continuity, and inadequate monitoring. Addressing these disparities requires understanding a complex, often poorly documented system lacking systematic data. This study offers a valuable methodology applicable in similar contexts. Key messages • Mapping regional Home Palliative Care reveals significant disparities in organization, resources, and outcomes, impacting equity of access and quality. • Detailed regional analysis provides an evidence base for targeted policies and standardized improvements towards equitable, high-quality HPC across Europe.

WKS 39: Engaging Peer Researchers in NCD Research: Insights, Challenges, and Opportunities from a Community-Based Mixed-Methods Study in Bidibidi Refugee Settlement, Uganda, B308 (FCSH), September 5, 2025, 10:15 - 11:15 Background Hypertension and type 2 diabetes are growing health concerns among forcibly displaced persons (FDPs). In Uganda, continuity of care is disrupted by mobility, limited resources, and fragmented services. This study explored factors influencing continuity and discontinuity of care for FDPs with these conditions in Northern Uganda. Methods The study was conducted in Bidibidi Refugee Settlement (Yumbe District) and Nyumanzi Settlement and Reception Centre (Adjumani District) using a community-based participatory design. Four trained peer researchers (two male, two female), Village Health Teams (VHTs), and health facility staff collaborated in data collection. Methods included surveys, point-of-care testing, interviews, and focus group discussions. An advisory board of district health authorities, humanitarian actors, and community representatives guided recruitment, tool adaptation, and referral pathways. Results Community engagement enhanced trust and facilitated culturally relevant tools and participant recruitment. VHTs, following hands-on training, successfully conducted point-of-care testing and data collection. Peer researchers contributed insider perspectives, offering deeper insights into the effects of mobility on care disruption. Key challenges included limited geographic coverage due to financial constraints, language barriers affecting data quality, and the need for extensive training and supervision. Conclusions Participatory approaches involving peer researchers and VHTs are feasible and valuable for chronic disease research in humanitarian settings. However, future studies should invest in sustainable capacity building, language mediation, and adequate resources to strengthen data quality and impact. Findings highlight the importance of embedding community engagement in non-communicable disease (NCD) research and practice to improve continuity of care among displaced populations. Keywords continuity of care, hypertension, type 2 diabetes, refugee health, Uganda, community engagement