bluuebunny/crossref_metadata_2025 huggingface dataset:
Early detection of exacerbation of the severe acute respiratory syndrome coronavirus 2 infection using Fitbit (DEXTERITY pilot study)
Authors: Yamagami K , Nomura A , Kometani M , Shimojima M , Sakata K , Usui S , Furukawa K , Takamura M , Okajima M , Watanabe K , Yoneda T
Published: October 2021

Some patients with coronavirus disease 2019 (COVID-19) experienced sudden death because of sudden symptom deterioration. Thus, an alarm system that could detect early signs of COVID-19 exacerbation beforehand, to prevent serious illness or death of patients while receiving outpatient treatment at home or in hotels is necessary. Here, we tested whether estimated oxygen variations (EOV), a relative physiological scale that represents users' blood oxygen saturation level during sleep measured by Fitbit, predicted COVID-19 symptom exacerbation. Study period was from August to November 2020. We enrolled 23 COVID-19 patients diagnosed by SARS-CoV-2 polymerase chain reaction-positive (mean age ± standard deviation, 50.9±20 years; 70% female), let each patient wore the Fitbit for 30 days; COVID-19 symptoms were exacerbated in 6 (26%). High EOV signal (a patient's oxygen level exhibits significant dip and recovery within the index period) had 80% sensitivity before symptom exacerbations, whereas resting heart rate signal only had 50% sensitivity. Coincidental obstructive sleep apnea syndrome confirmed by polysomnography was detected in a patient by consistently high EOV signals. This pilot study successfully detected early COVID-19 symptoms exacerbation by measuring EOV and may help to identify early signs of COVID-19 exacerbation.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): The investigational device used in this study, Fitbit Charge 3, was provided by Fitbit Japan. Summary of high EOV signals and eventsThe clinical course of COVID-19
Cost-effectiveness analysis of screening for first-degree relatives of patients with bicuspid aortic valve
Authors: Tessler I , Leshno M , Shmueli A , Shpitzen S , Durst R , Gilon D
Published: October 2021

Introduction

Bicuspid aortic valve (BAV) is the commonest congenital heart valve defect, found in 1% to 2% of the general population and associated with life-threatening complications. Given the high heritability index of BAV, many experts recommend echocardiography for first-degree relatives (FDRs) of an index patient. However, the cost-effectiveness of such cascade screening for BAV has not been fully evaluated.

Materials and methods

Using a decision-analytic model, we performed a cost-effectiveness analysis of echocardiographic screening of FDRs of BAV index cases. Data on BAV probabilities and BAV complications among FDRs were derived from our institution's BAV familial cohort and from the relevant literature on population-based BAV cohorts with long-term follow-up. Health gain was measured as quality-adjusted life years (QALYs). Cost inputs were based on list prices and literature data. One-way and probabilistic sensitivity analyses were performed to account for uncertainty in the model's variables.

Results and disscusion

Screening of FDRs was found to be the dominant strategy, being more effective and less costly than no screening, with savings of €208 and gains of 1.6 QALYs. Results were sensitive to the full range of reported BAV rates among FDRs across the literature, with the benefit gradually decreasing from the screening age of 55 years, with trend shifting at the age of 69.

Conclusions

This economic evaluation model revealed that echocardiographic screening of FDRs of BAV index case is not only clinically important but also highly cost effective and cost-saving. Health gains could be achieved from initiating screening program, along with costs saving. Sensitivity analysis supported the model's robustness, suggesting its generalization.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Center for Interdisciplinary Data Science Research fellowships grant
Multi-species transcriptomic data analysis reveal three candidate genes, responsible for the transition from compensated left ventricle hypertrophy to heart failure
Authors: Abreu M , Ferreira C , Baptista R
Published: October 2021

Introduction

Heart failure (HF) is the common final event for a wide spectrum of compensated left ventricle hypertrophy (LVH), including hypertrophic cardiomyopathy, hypertension, aortic stenosis and aortic coarctation. Despite its importance, the transition from hypertrophy to HF in humans is poorly understood. In this study, we aimed to find a molecular signature for the transition from compensated hypertrophy to decompensated HF conserved within species and disease induction methods.

Methods

Four datasets, containing gene expression data of hypertrophy and heart failure samples, were selected from GEO data repository. The selected datasets include three different species: Rattus norvegicus (GSE4286 and GSE47495), Canis lupus familiaris (GSE5247) and Cavia porcellus (GSE78077); with different models of left ventricle hypertrophy (pressure-overload, genetic, and both). The CEL files containing the expression data were analyzed using the Transcriptome Analysis Console 4.0 (TAC 4.0.2.15, Applied Biosystems). To identify differentially expressed genes a p-value cutoff of 0.05 was applied.

Results

The lists of DEGs obtained in the comparison hypertrophy versus HF, in each dataset, were uniformized to human identifiers and merged, resulting in a list containing 8307 genes. Most of the genes were differentially expressed in only one dataset (6252, 75.3%). DEGs present in two datasets were 1850 (22.3%), in three datasets 202 (2.4%), and finally, present in all datasets were only 3 genes. The first gene identified was CDKS1B, which belongs to a family of proteases related to the cell cycle. CKS1B upregulation activates the STAT3 and MEK/ERK pathways and promotes cell proliferation. Indeed, negative regulation of the MEK/ERK reduces cardiac hypertrophy induced by pressure overload. Secondly, type 2 phosphatidylinositol-5-phosphate 4-kinase (PI5P4K) converts phosphatidylinositol-5-phosphate to phosphatidylinositol-4,5-bisphosphate, and plays an important role in inflammatory response and autophagy. However, its role in the heart remains unknow. Lastly, the adipokine MEDAG was also differentially expressed in HF. Its role in myocyte metabolism is not defined but may parallel nutrient uptake role seen in adipose and reflect reliance on lipid oxidation.

Conclusions

We identified three genes that are differentially expressed in HF compared to compensated hypertrophy, involved in cell proliferation, autophagy, inflammation and lipid metabolism. This data requires confirmation in human studies. Such advance would be an important step toward identifying those risk factors, especially genetic variation, that predispose individuals to develop HF.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FCT Portugal
External validation of the HCM Risk-Kids model for predicting sudden cardiac death in childhood hypertrophic cardiomyopathy
Authors: Norrish Gabrielle , Qu Chen , Field Ella , Cervi Elena , Khraiche Diala , Klaassen Sabine , Ojala Tiina H , Sinagra Gianfranco , Yamazawa Hirokuni , Marrone Chiara , Popoiu Anca , Centeno Fernando , Schouvey Sylvie , Olivotto Iacopo , Day Sharlene M , Colan Steve , Rossano Joseph , Wittekind Samuel G , Saberi Sara , Russell Mark , Helms Adam , Ingles Jodie , Semsarian Christopher , Elliott Perry M , Ho Carolyn Y , Omar Rumana Z , Kaski Juan P
Published: October 2021

Aims

Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). The newly developed HCM Risk-Kids model provides clinicians with individualized estimates of risk. The aim of this study was to externally validate the model in a large independent, multi-centre patient cohort.

Methods and results

A retrospective, longitudinal cohort of 421 patients diagnosed with HCM aged 1–16 years independent of the HCM Risk-Kids development and internal validation cohort was studied. Data on HCM Risk-Kids predictor variables (unexplained syncope, non-sustained ventricular tachycardia, maximal left ventricular wall thickness, left atrial diameter, and left ventricular outflow tract gradient) were collected from the time of baseline clinical evaluation. The performance of the HCM Risk-Kids model in predicting risk at 5 years was assessed. Twenty-three patients (5.4%) met the SCD end-point within 5 years, with an overall incidence rate of 2.03 per 100 patient-years [95% confidence interval (CI) 1.48–2.78]. Model validation showed a Harrell’s C-index of 0.745 (95% CI 0.52–0.97) and Uno’s C-index 0.714 (95% 0.58–0.85) with a calibration slope of 1.15 (95% 0.51–1.80). A 5-year predicted risk threshold of ≥6% identified 17 (73.9%) SCD events with a corresponding C-statistic of 0.702 (95% CI 0.60–0.81).

Conclusions

This study reports the first external validation of the HCM Risk-Kids model in a large and geographically diverse patient population. A 5-year predicted risk of ≥6% identified over 70% of events, confirming that HCM Risk-Kids provides a method for individualized risk predictions and shared decision-making in children with HCM.
Addressing inequalities and research funding in the post-COVID-19 era
Authors: Whiting Edward
Published: October 2021

The panelist will provide insights on how a charitable foundation focused on health research assess priorities to tackle global health challenges. The Wellcome Trust is also a member of the Global Health Innovative Technology Fund (GHIT), which funds R&D for anti-infectives and diagnostics for diseases primarily affecting developing countries. COVID-19, related comorbidities, and their overall impact affect communities across the world. Global collaboration and real-time sharing on pathogen surveillance, sharing data/samples is key to ensure equitable access, particularly as the effects of COVID-19 are not be felt evenly across the world's population. Furthermore, the effects of mental health problems, escalating infectious diseases and COVID-19, can devastate communities for generations. It is important to consider both cross-country, as well as intra-country variations, and set clear priorities for LMICs, as well as for vulnerable groups and those most at risk in developed countries. Coalescing priorities and capturing narratives are key elements into brokering dialogue and establishing innovative partnerships to overcome long-standing and emerging challenges. At the time of the COVID-19 pandemic, and with more people living with its long-term effects, incl. suffering loss and trauma, and we need to both get infectious diseases under control, as well as to fund discovery research in a context-relevant manner. Beyond the current crisis, we also need to consider how to build resilience in our communities, factoring in the effects of other parameters, as for example, climate change. Moving forward, it is important to look at innovative models of collaboration, incl. for R&D, and to combine research to advocacy, whilst at the same time raising awareness to support the generation and implementation of evidence-informed policies.
Sleep and its effect on mental health among adolescent and adult population
Authors: Stranges S
Published: October 2021

The global prevalence of mental disorders is on the rise and sleep disorders have been recognized among one of the major contributors affecting well-being and longevity of both young and adult population. Sleep habits are multifaceted and arise from complex interactions between socio-environmental, behavioral, and psychological factors, and any disruptions in the balance of the previous may negatively alter sleep duration and sleep quality leading to sleep disorders, however this phenomenon may vary by age and sex. Emerging evidence suggest that adolescents entering pubertal development face many sleep changes due to biological factors like delay in circadian rhythm and decreased homeostatic sleep pressure as well as due to social factors which may lead to sleep disorders subsequently affecting adolescents' mental health. Sleep hygiene among young population is of primary importance especially as chronic sleep disruption may be a risk factor for mental disorders and multimorbidity along the lifespan, and importantly these association have been proved to be bi-directional. Thus, public health initiatives and guidelines to promote sleep hygiene should emerge in order increase the awareness of sleep disorders and their role in prevention and management of mental disorders.
Dietary factors affecting cognitive and sleep disorders
Authors: Godos J
Published: October 2021

Globally, there has been a substantial rise in the prevalence of mental disorders, including cognitive and affective disorders, having a considerable impact on sleep and life quality. Attributable to the lack of effective treatment of some of this conditions, lifestyle, behavioral and dietary factors gained a great attention given their modifiable nature and possible implication in the pathogenesis of mental disorders. A great body of evidence indicates that in the last decades an escalation of overnutrition as a consequence of the transition from traditional dietary patterns, based on fresh and plant-based foods, in favor to Western-like dietary patterns, rich in high-calorie processed and ultra-processed foods, has been observed. Unarguably, such diets, low in plant-based foods rich in bioactive compounds, shown to be beneficial for the central nervous system through modulation of various pathways controlling brain signaling and homeostasis, may have been one of the leading contributors to the sudden rise in the prevalence of mental disorders. Consistently, a greater intake of calorie-dense foods causing an alteration in hormonal homeostasis in the context of glucose metabolism and adiponectin regulation, has been recognized as a risk factor for mental health, as least partially mediated by the direct link to the global rise in the prevalence of obesity. Brain disorders are among leading causes of non-communicable diseases and shortened lifespan and therefore public health advocates need to address and apply the recent developments in food science to propose population guidelines for mental health prevention.
Digital health literacy among Greek students during COVID-19 pandemic
Authors: Sakellari E , Lagiou A
Published: October 2021

Background

Misinformation especially provided through internet is a serious public health threat, and during the COVID-19 pandemic this problem has even amplified, which became known as an information epidemic, a.k.a. infodemic. This is a common problem also in university students who access their information about health via Internet and social media. Digital health literacy (DHL) is an important skill to handle online information and make judgments about their quality and reliability. This study is part of the global COVID-HL survey, aiming at assessing DHL in university and their COVID-19 related health and information needs.

Methods

After receiving ethical approval, data was collected through an online questionnaire among students from one of the largest Universities in Greece. Descriptive statistics as well as bi- and multivariate analyses were conducted using SPSS.

Results

604 university students (mean age 24.3, 73.3% females) completed the survey. 28% indicated that they found it very difficult/ difficult to find the exact information they were looking for, 20.4% to make a choice across all information accessed, and 45.1% stated it is very difficult/ difficult to decide whether the information was reliable or not. According to the descriptive analysis, 25.6% of the students found it very difficult/ difficult to apply the information in their daily life, 23.7% to decide if the information they found is applicable to them and 16.3% to use the information they found to make decisions about their health. Greater satisfaction from information about COVID-19 was significantly associated with greater probability of having sufficient skills in “information search”, “evaluating reliability” and in “determining relevance”.

Conclusions

The results of the study indicate that there is a need to strengthen DHL among university students and develop skills for seeking information on the Internet through health education interventions.
Access to stroke care in Europe: results of a vignette approach
Authors: Quentin W
Published: October 2021

Background

Stroke is a major cause of death and disability in Europe. European guidelines for patients with ischemic stroke (about 85% of all strokes) recommend rapid access to hospital care and rehabilitation after discharge from hospital. Information on access to stroke care in Europe is limited.

Methods

A stroke vignette was developed reflecting typical patient characteristics and a recommended patient pathway: ambulance transfer to hospital, fast-track diagnostic work-up, thrombolysis and mechanical thrombectomy, stroke unit treatment, and inpatient rehabilitation. Experts in 12 countries were asked to complete a survey on service coverage, cost sharing, physical access (availability) and other barriers to access. Survey results were analysed and access to services was categorized into good, medium, bad before summarizing results across countries.

Results

Completed surveys were received from ten countries, including Bulgaria, Estonia, France, Germany, Lithuania, the Netherlands, Poland, Portugal, Slovakia, and the UK (England). Stroke patients in France, Germany, and the Netherlands have relatively good access, while substantial barriers exist in Bulgaria, Estonia, Poland, and Slovakia. In Bulgaria, rehabilitation is not covered by the National Health Fund; and rehabilitation capacity is very limited in Estonia, Poland, and Slovakia, leading to limited access. Almost all recommended services are formally covered by public financing schemes, but insufficient availability or organisational problems limit access to thrombolysis in Bulgaria, France, Lithuania, Poland, and Portugal or thrombectomy in Bulgaria and the UK (England).

Conclusions

While stroke related services are formally covered in almost all countries, considerable access problems exist in several countries. Future cross-country surveys of access to stroke care should collect quantitative data related to proportions of patients receiving particular services as well as qualitative data on access barriers.
Understanding access to palliative care for cancer patients in Europe: a vignette approach
Authors: Shuftan N
Published: October 2021

Background

Palliative care encompasses all treatment and care options available for people with serious illness, such as incurable, life-threatening cancer. The goal of palliative care is to improve and maintain quality of life for both patients and their families. It focuses on the assessment and management of pain and other symptoms, addressing caregiver needs, and coordination of care. It requires early identification and coordinated treatment of problems in the physical, functional psychological, social or spiritual dimension.

Methods

A palliative care vignette was developed reflecting typical patient characteristics and a recommended patient pathway for advanced lung cancer: chemotherapy to shrink tumors and alleviate symptoms, opioids for pain, benzodiazepines for breathlessness and anxiety, laxatives for constipation due to opioid use, psychosocial assessment followed by psychotherapy and/or antidepressants, and counselling for family carers. Experts in 12 countries were asked to complete a survey on service coverage, cost sharing, physical access (availability) and other barriers to access.

Results

The presentation will report on findings from a cross-country perspective for each of the categories mentioned above (work is currently ongoing). Individual country examples will be used to highlight outliers and draw policy lessons for the future.

Conclusions

Palliative care has received considerable socio-political support in recent years, due primarily to epidemiological developments. Depending on severity, life expectancy and the patients' personal circumstances, it can be delivered in a variety of settings, including private residences, assisted living facilities, acute and long-term care hospitals, hospice residences, correctional facilities, and homeless shelters. As a result, access barriers might be particularly complex to identify and overcome. Cross-country learning can be an important catalyst for future improvements.
Tool-HLCA: An intervention to promote the health literacy of school-aged children
Authors: Schulenkorf T , Okan O , Bauer U
Published: October 2021

Background

School-aged children are often exposed to health-related information from digital sources. However, there are no interventions in schools to help them deal with these appropriately. Installing health literacy in schools succeeds more easily if it can be linked to existing curricular requirements. This study aims to implement a toolbox to address (digital) health literacy of school-aged children (grades 7 and 8) in German secondary schools by combining existing media frameworks with health literacy.

Methods

Based on analysing a mandatory curriculum on media literacy in the state of North-Rhine-Westphalia in Germany and elaborating its commonalities with health literacy, we developed the toolbox for strengthening (digital) health literacy in school-aged children. Currently, the toolbox is being piloted in the school-setting in order to gain feedback from children and teachers.

Results

The mandatory media literacy framework for classroom teaching in German schools addresses the health literacy core competencies find, understand, appraise and use information. By using that framework and integrating health as a topic, this toolbox fits to the German core curriculum and will ensure that the toolbox is familiar and can be used with low thresholds by schoolteachers. The toolbox addresses digital health literacy including exercises to evaluate health-related information on different online platforms. It provides topic-specific tasks (e.g. coronavirus, vaccination, nutrition) and evaluation criteria for identifying mis- and disinformation.

Conclusions

The toolbox is an opportunity to enhancing (digital) health literacy in school-aged children by highlighting the intersections of the mandatory curriculum on media literacy and the core competencies of health literacy. In the long term, this kind of curriculum analysis serves as a methodological blueprint for educationalists to integrate health literacy into schools in many ways.
My body, my decision: the lived experience of young people with a variation in sex characteristics in New Zealand
Authors: Steers D , Andrews G
Published: October 2021

Background

Young people born with a variation in sex characteristics (VSC), or disorders of sex development (DSD) face numerous challenges in navigating issues relating to identity and to their lived and embodied experience. There is limited research amplifying the voices of young people with a VSC in the literature, especially in Aotearoa/New Zealand. There has been issues raised from a Humans Rights perspective which public health forums are yet to address.

Methods

This original qualitative study provides an up-to-date picture of the lived experiences of 10 young people with a VSC in Aotearoa/New Zealand using face to face interviews and thematic analysis. The research was conducted in collaboration with the advocacy group, Intersex Youth Aotearoa, and explored the level of support provided by health services, peers and advocacy groups in relation to the ways the participants viewed themselves and their bodies, and their health related decision-making.

Results

Our research reveals the pressure on young people with a VSC to conform to cultural and societal norms, specifically, heteronormative and traditional constructs of how male and female bodies should look prevalent within Aotearoa/NZ society. Such views, often held and perpetuated by health professionals and parents, contributed to the complexities surrounding identity, agency and acceptance of difference experienced by these young people. Young people wanted the right to bodily autonomy.

Conclusions

Implications of these findings are: better public education of VSC, development of resources for parents and young people and advocacy for psychological and peer support systems for young people.
Common Agricultural Policy (CAP) from a Public Health Perspective
Authors: Erklavec U , Birt C , Pushkarev N
Published: October 2021

European Common agricultural policy (CAP) can impact several health outcomes like increased antibiotic resistant infections, poor health of farm workers and unhealthy diets which lead to several non-communicable diseases. Rapid literature review of public health recommendations for a new CAP covers several topics from environment, pesticides, livestock and antimicrobial resistance (AMR) to diet, food systems and others. Recommendations on pesticides are to periodically upgrade minimum standards of pesticides, reduce or abandon the use of pesticides and sustainable management of water quality in agriculture. In relation to livestock and antimicrobial resistance, EU should dedicate financial resources for programmes aimed at decreasing animal numbers, stop support for industrial livestock production through CAP subsidies and adopt low-antibiotics farming methods. To ensure better diet and food systems we need sustainable dietary guidelines, food labelling schemes, public procurement of healthy, local and seasonal foodstuffs, food education and campaigns, promoting food systems thinking at all levels, increase productivity of fruit and vegetable cultivation and social innovation in food supply chains. Other recommendations state that CAP should end support for wine sector and that CAP should include training, payment of adequate wages and health and safety standards, and lastly implementation of Health impact assessment of CAP. Agricultural policy is a very complex field with many stakeholders and consequently also implications on many levels. To make health a more visible and important objective, we need more public health experts to take part in advocacy for healthier CAP.
E-Cigarette-Only and Dual Use among Adolescents: Emerging Behaviours with Different Risk Profiles
Authors: Bowe A , Doyle F , Stanistreet D , Durcan M , Major E , O'Connell E , Kavanagh P , O'Donovan D
Published: October 2021

Background

E-cigarette-only use and dual-use are emerging behaviours among adolescent nicotine product users which have not yet been sufficiently explored. This study examines the epidemiology of, and the factors associated with, nicotine product use in adolescence, specifically defined as e-cigarette only, conventional cigarette only and dual-use.

Methods

This is a cross-sectional analysis of the 2018 Planet Youth survey completed by 15-16 year olds in the West of Ireland. Current nicotine product use, defined by use at least once in the past 30 days, was categorised as e-cigarette only, conventional cigarette only, and dual-use. The characteristics and risk factor profiles of the population are described, according to nicotine product use, using chi-square tests for categorical data and t-tests for continuous data. A main effects multinomial logistic regression model was used to compare the association between potential risk and protective factors across categories of use.

Results

Among 4422 adolescents 22.1% were current nicotine product users, consisting of 5.1% e-cigarette only users, 7.7% conventional cigarette only users, and 9.3% dual-users. Risk factor profiles differed across categories of use. Frequent participation in team sport significantly reduced the odds of conventional cigarette and dual use but had no association with e-cigarette only use (Cig only: adjusted odds ratio (AOR) 0.63, 95% confidence interval (CI) 0.44-0.90; Dual-use: AOR 0.63, 95% CI 0.43-0.93, E-Cig only: AOR 1.31, 95% CI 0.87-1.97, p = 0.199). Similarly, having higher value for conventional social norms reduced the odds of conventional cigarette and dual use but not e-cigarette only use.

Conclusions

This is the first study to show, among a generalisable sample, that dual-use is the most prevalent behaviour among adolescent nicotine product users in Ireland. Risk factor profiles differed significantly across categories of use with important implications for youth tobacco control policy.

Key messages

This is the first study to show that dual use of conventional and electronic cigarettes, an under-researched behaviour, is the most prevalent form of nicotine product use among adolescents in Ireland. Risk factor profiles of e-cigarette only, conventional cigarette only, and dual users differ significantly, and this has important implications for prevention initiatives and tobacco control policy.
Mental health policy response to COVID-19: lessons learned
Authors: Jakubauskiene M
Published: October 2021

Background

Good mental health is critical to the functioning of society and recovery from COVID-19 pandemics. Corona pandemics is considered as crisis, causing uncertainty and unpredictability resulting in fear and high levels of psychological distress in populations. Mental health impacts occur as an impact of the virus or as the consequences of physical isolation. Mental health of other specific (vulnerable) populations affected by the COVID-19. Mitigating the hazardous effects of COVID-19 on mental health is an international public health priority. The aim of the study is to review mental health policy responses to COVID-19 crisis internationally and present successful examples as well as learned lessons.

Methods

A rapid clustered review of evidences reflecting mental health policy responses in the face of COVID-19 pandemics has been conducted.

Results

COVID-19 pandemics is an indisputable emergency for health systems and challenge for mental health care. Major mental health policy response measures should be based on whole of society approach and include access to remote mental health service provision as well as emergency mental health and psychosocial services especially to vulnerable populations in order to strengthen social cohesion and social support. COVID-19 crisis, on the other hand, might also be considered as an opportunity to improve the scale and effectiveness of mental health services and increase funding to mental health care and psychosocial services. It raised concerns and stimulated discussion about the re-shifting institutional long term care more into community based service approach.

Conclusions

Ensuring preparedness and planning of mental health service is an important for staying ahead of mental health impacts that will be long term, complex, and may take time to fully emerge. Further transdisciplinary research on mental health system, policy and COVID-19 epidemics prevention, preparedness, responses and impacts is needed.
Climate Change and the need of a One Health Approach – from science to policy
Authors: Viegas S
Published: October 2021

Climate change is having a detrimental impact on the environment and on the animals and humans health. Recent research has highlighted the negative impact that climate change has on the social and environmental factors that determine human health, such as clean air, food security and safety, water quality, and much more such as the possible increase of infectious diseases and zoonoses. Climate change is indeed a global health problem, causing several health negative impacts that could be largely prevented in many cases if sufficient action is taken. However, to obtain the results needed we need a multi-sectorial approach and the preventive actions need to be developed in different sectors in a coherent manner. Threats to public health resulting from climate change need to be anticipated to allow adaptation and allow a proper answer. The One Health approach, which recognizes the interconnection between health in people, animals, plants, and their shared environment is a fundamental pillar of prevention. Several examples of climate change adaptation in different scenarios will be presented and discussed aiming to support multi-sectorial policy actions. The identification and implementation of policies that will bring co-benefits to human and animal health and environment should be the drivers for the next years. We need to act now and promote the mainstream of health into all policies, strategies and programmes.
Transforming health and care systems on the political agenda of the EU Presidency of Slovenia
Authors: Albreht Tit
Published: October 2021

In the second half of 2021, Slovenia will assume the Presidency of the Council of the European Union. As part of a trio, Slovenia will join Germany, which held the presidency in the second half of 2020, and Portugal in the first half of 2021. The EU Presidency aims to contribute to an open, fair and sustainable Europe in the world, which is a call to action for us all. Faced with a public health crisis, it is important to join hands to increase public support for a European Union that puts global solidarity, the Agenda 2030 for Sustainable Development, development cooperation, human rights, and the inclusive participation of civil society at the centre of its work. The presentation will reflect on the future Parthership in the context of the Presidency, with a particular focus on the operational level of establishing linkages between a Partnership and exsisting public health initatives, closely related to current recovery and reconstruction plans.
Ambient particulate matter exposure interacts with abdominal obesity to increase blood triglycerides
Authors: Gaio V , Roquette R , Matias Dias C , Nunes B
Published: October 2021

Background

Blood lipids levels dysregulation represent potential mechanism intermediating the adverse cardiovascular effects of ambient particulate matter (PM) exposure. The present study aims to estimate the effect of particulate matter (PM10) exposure on blood lipid levels (TC, Total Cholesterol; HDL-C, High-Density Lipoprotein Cholesterol; LDL-C, Low-Density Lipoprotein Cholesterol; TG, Triglycerides) in the adult Portuguese mainland population and to assess the potential mediation and/or modification action of abdominal obesity on this effect.

Methods

We used data from 2390 participants of the 1st Portuguese Health Examination Survey (INSEF, 2015) with available data on blood lipids parameters and living within a 30km radius of an air quality monitoring station with available PM10 measurements. PM10 concentrations were acquired from the air quality monitoring network of the Portuguese Environment Agency. Generalized linear models were used to assess the effect of 1-year PM10 exposure on blood lipids values. An interaction term was introduced in the models to test the modification action of abdominal obesity.

Results

We found an association between long-term exposure to PM10 and non-fasting blood TG levels after adjustment for age, sex, education, occupation, lifestyles related variables and temperature but only in participants with abdominal obesity (1.84% TG increase per each 1 µg/m3 PM10 increment, 95% CI: 0.02%; 3.69%) which is well supported by the sensitivity analysis.

Conclusions

Our study demonstrate that even at low levels of exposure, long-term PM10 exposure interacts with abdominal obesity to increase blood TG levels. To the best of our knowledge, this is the first study showing the modification action of abdominal obesity regarding the PM10 effect on a blood lipid parameter. Our findings suggest that reducing both abdominal obesity prevalence and PM10 below current standards would result in additional health benefits for the population.

Key messages

Long-term PM10 exposure interacts with abdominal obesity to increase non-fasting blood triglycerides levels by about 2% per each 1 µg/m3 PM10 increase. Reducing both abdominal obesity prevalence and PM10 below current standards would result in additional health benefits for the population.
Analysis of the current situation with water, sanitation and hygiene (WASH) in rural hospitals
Authors: Omarova A
Published: October 2021

Background

During the COVID-19 pandemic, the implementation of Sustainable Development Goals (SDG) 6 and SDG 3 in rural areas of Kazakhstan is a huge problem that the state must address as soon as possible. Therefore, it is necessary to examine the state of the infrastructure and the quality of water, sanitation and hygiene (WASH) services in rural hospitals.

Methods

The study was descriptive and included an analysis and assessment of the current situation on the ground. The analysis of the situation was based on the official data. The current services were assessed using an observational cross-sectional study based at the hospital of Abay district (49°37′52″ N 72°50′17″ E, 6725 km2) of Central Kazakhstan.

Results

The hospital in Abay district do not have a set of agreed WASH standards. When such standards exist, their implementation is limited by the lack of necessary conditions, sufficient funding or the interest of authorities. The budget of public health service is usually categorized by a disease group and covers expenditures for drugs and vaccines. The quality of WASH infrastructure in the hospital is poor due to deterioration or initial non-compliance with safety requirements. Investing in WASH infrastructure and its maintaining require effective intersectoral collaboration and financial resources. Another problem is the lack of motivation for improving WASH services among staff and managers of the hospital. If the former have no desire and knowledge in WASH due to their high workload, the latter often consider this problem insoluble and therefore do not want to spend their limited resources on it.

Conclusions

Thus, rural residents are at high risk of contracting and spreading COVID-19 due to deterioration of WASH infrastructure, non-compliance with requirements and insufficient funding of rural hospitals.

Acknowledgement

This research is funded by the Science Committee of the Ministry of Education and Science of the Republic of Kazakhstan (Grant No. AP09058465).

Key messages

The lack of data on WASH services in hospitals by region and on a nationwide scale is currently an obstacle to an effective response to the COVID-19 pandemic in Kazakhstan. Fatal outbreaks and epidemics will continue until the WASH infrastructure and hygiene skills of the population improve at both the household and hospital’s levels.
Comparison of admissions for Acute Coronary Syndrome between 2020 and two control periods in Abruzzo
Authors: Cedrone F , Di Giovanni P , D'Addezio M , Di Martino G , Meo F , Scampoli P , Staniscia T
Published: October 2021

Background

The coronavirus epidemic has put unprecedented strain on health services, threatening hospital capacity in facing such a high number of Covid-19 patients in need of treatment. The aim of this study is to compare the hospitalization rate for acute coronary syndrome (ACS) in the first nine months of 2020 with the same period of 2018 and 2019.

Methods

This is a retrospective study of hospital discharge records. The pathologies of interest were coded as follows: all the hospitalizations with main discharge diagnosis as ICD-9-CM 410.xx, 411.xx, 413.xx for Acute Coronary Syndrome (ACS); 410.xx was used in all diagnoses except in codes 410.7x or 410.9x for acute ST-elevation myocardial infarction (STEMI); 410.7x was used in all diagnoses except 410.9.x for acute non-STEMI. Hospitalization rate ratios (HRR) comparing the study period with each of the control periods were calculated using Poisson regression.

Results

During the study period there was a statistically significant decrease in hospitalizations for ACS both vs 2018 (HRR 0.80;95%CI 0.80-0.81; p < 0.001) and vs 2019 (HRR 0.85;95%CI 0.84-0.86; p < 0.001). A decrease also affected STEMI vs 2018 (HRR 0.91;95%CI 0.90-0.92; p < 0.001) and vs 2019 (HRR 0.87;95%CI 0.86-0.88; p < 0.001) and NSTEMI vs 2018 (HRR 0.76;95%CI 0.75-0.77; p < 0.001) and vs 2019 (HRR 0.79;95%CI 0.78-0.80; p < 0.001).

Conclusions

This report shows a significant decrease in ACS-related hospitalization rates across the Region during the study period. General out-of-hospital mortality need to be further investigated, as to focus on patients died of ACS without receiving adequate assistance from the emergency network.

Key messages

Hospitalizations for acute coronary syndromes, STEMI and NSTEMI underwent a statistically significant decrease. During the pandemic, some health needs related to fatal emergencies were not met by the health services.
The willingness to be vaccinated against SARS-CoV-2 in the Italian population
Authors: Contoli B , Minardi V , Possenti V , Lana S , Luzi P , Masocco M
Published: October 2021

Background

Italy was one of the earliest countries to experience a severe Covid-19 epidemic and vaccination is essential to controll it. The willingness to be vaccinated against Covid-19 was investigated by the Italian ongoing ;surveillance systems PASSI (18-69yy) and PASSI d'Argento (65+) with a Covid module added in August 2020.

Methods

To measure the prevalence of hesitancy and refusal to receive the COVID-19 vaccine, we used a sample collected between August and December 2020, before starting the Covid-19 vaccination campaign. Sample was appropriately weighted to take into account the regional number and the composition by gender and age. Using a multinomial regression model, a specfic analysis on elderly data were provided to examine the association between demographic and medical characteristics and Covid-19 attitudes.

Results

Among adults, 67% answered to be likely accepting the vaccine (one half not hesitating at all and the other half very likely in any way); younger individuals, aged 18-34, are highly incline (76%). On older sample, 55% would accept vaccination and 16% would likely refuse; the remaining 29% were categorized as hesitant. Compared with the acceptance group, the hesitancy group identified several risk factors in common with the refusal group, including not having gotten a flu vaccine during the previous flu season (hesitancy: RRR=2.0; 95% CI 1.4-2.9, refusal: RRR=12.1; 95%CI 7.6-19.37) and lower risk of having had a death from Covid-19 among family or friends (hesitancy: RRR=4.8; 95%CI 2.0-11.4, refusal: RRR=15.4; 95%CI 3.7-64.5). Hesitancy group has also lesser awareness and experience with the disease, a lower perception of being personally at risk and lower trust in the ability of health units to manage the pandemic situation.

Conclusions

Results show the importance of establishing and maintaining ongoing contact among the preventive services, primary care providers and the population since trust is difficult to establish during an emergency.

Key messages

On of the most important finding for public health prevention efforts was the importance of influenza vaccine in predicting COVID. Having an agile system that can monitor changing attitudes will be important to altering the messaging and identifying changes in the characteristics of those hesitant or unwilling to be vaccinated.
Ability of Nutri-Score to discriminate the nutritional quality of prepacked foods in Slovenia
Authors: Hafner E , Pravst I
Published: October 2021

European Commission recognised the benefits of front-of-package labelling (FOPL) with the proposal for a harmonised FOPL, which should be implemented by the end of 2022. Many European scientists support the implementation of Nutri-Score, a 5-colour nutrition labelling scheme. However, Nutri-Score is currently implemented mainly in Western Europe, and data for Central Europe are limited. This study aimed to evaluate the ability of Nutri-Score to discriminate the nutritional quality of prepacked products from the Slovenian food supply, and to compare results of nutrient profiling with national dietary recommendations, based on previously implemented WHO profile. Analyses was done using the Composition and Labelling Information System (CLAS), which contains labelling information on prepacked foods in Slovenia. We investigated the distribution of products across five Nutri-Score categories and investigated the agreement between Nutri-Score and nationally adapted WHO Europe profile. Results show that Nutri-Score has a high ability to discriminate food products based on their composition. Food categories that are more desirable in our diet (e.g., fruits, vegetables) have a better Nutri-Score when compared with less desirable categories such as sweets and animal fats. This ability was also shown within each subcategory. Nutri-Score overall showed a moderate agreement with the WHO Europe profile (0.57). The agreement was almost perfect for Cereals and cereal products, and lower for Edible oils and emulsions. Our results showed that the Nutri-Score is a relevant tool to discriminate the nutritional quality of products across different food groups and is in most cases consistent with national recommendations. This study gives additional information about Nutri-Score and can support policymakers in making evidence-based decisions about the implementation of harmonised FOPL in Europe.

Key messages

Results show that the Nutri-Score is a relevant tool to discriminate the nutritional quality of products across different food groups. Nutri-Score is in most cases consistent with Slovenian nutritional recommendations.
What makes COVID-19 dashboards actionable? Lessons learned from international and country-specific studies of COVID-19 dashboards and with dashboard developers in the WHO European Region
Authors: Barbazza E , Ivankovic D
Published: October 2021

Although COVID-19 dashboards may be widely accessible, their effective use to modify the course of the pandemic through the translation of data to information, information to opinions, and opinions to decision-making is determined by their actionability. To be actionable, the information should be both fit for purpose-meeting a specific information need-and fit for use-placing the right information into the right hands at the right time and in a manner that can be understood. Recognizing the sustained importance of COVID-19 dashboards as a tool for pandemic reporting, studies to describe this landscape and take stock of experiences are of critical importance for better preparedness in future public health crises. Since early 2020, the international network of healthcare performance intelligence researchers-HealthPros-in collaboration with partners including the WHO Regional Office for Europe, have worked to systematically study the actionability of COVID-19 dashboards by comparatively studying their composition, changes over time and development process.

 

In this presentation, results from this series of research will be summarized. Topics to be covered include:

A summary of seven key features constituting actionable dashboards resulting from a descriptive assessment and scoring of 158 dashboards from more than 53 countries worldwide. Insights into changes to dashboards over the course of 2020-21 from country-specific studies in Canada, the Netherlands and Italy. Lessons learned from the perspective of COVID-19 national, governmental dashboard developers in the WHO European Region, including key enablers and barriers to the development, maintenance and evolution of dashboards over the course of the pandemic.