bluuebunny/crossref_metadata_2025 huggingface dataset:
The rational use and disposal of drugs and the environmental and public health risks associated
Authors: Jorge MP , Caminada M L , Bocchiglieri M M , da Silva Paganini W
Published: October 2020

The rational use and disposal of medicines is a topic that has been discussed by researchers worldwide, aiming to minimize the consumption and indiscriminate use of these compounds. The objective of this work was to promote the study of rational use, informative and educational action and environmental risks due to inadequate disposal. The proposal for this study was forwarded to the Institution's Ethics Committee, linked to the study, and its realization was approved, CAAE: 91559018.9.0000.5490, Opinion Number: 2,751,853. Data collection was carried out through an interview, through a questionnaire, evaluating aspects, regarding the rational use and disposal of medicines, having been developed in the city of Jaguariuna-SP.

The research assessed the level of knowledge of a group, in relation to rational use, disposal of leftovers and expired medicines and knowledge about the potential effects on the environment and public health arising from these actions. It was found that almost all respondents have medicines at home, 50.93% of which are overdue, however the lack of information regarding the correct form of disposal, causes the population to proceed inappropriately. Among the main reported destinations, storage and disposal in common garbage prevails. Regarding awareness and responsibility, with regard to environmental contamination, more than 70% are aware of the problems caused in the environment and public health. Finally, regarding educational and informational actions in relation to the storage and disposal of medicines, 65.22% of the interviewees stated that they had not previously received any type of information on the proper storage and disposal of medicines.

The data demonstrate the interviewees: awareness of the environmental and public health problems that may eventually be triggered due to the aspects addressed. However, the lack of information and adequate posts makes it difficult to disseminate information.

Key messages

The lack of guidance on storage and disposal of medicines, as well as aspects related to rational use, was the main aspect observed. It is necessary to take effective action regarding the inappropriate disposal of drugs in the environment, given the potential risk to public health arising from this practice.
Advances in an integrated evaluation of Community health in Medellín (Colombia) during 2014-2019
Authors: Martinez-Herrera E , DA Hernandez  , Benach J C
Published: October 2020

Background

In accordance with the “Health in All Policies” approach, since 2014 the city of Medellín (Colombia) has implemented a community-based urban health model based on knowledge and action to strengthen community participation, social cohesion, and health equity.

Methods

A mix method design was carried out to effectively monitor planning actions, as well as specific socio-environmental interventions in two thirds of the communes of Medellín. A standardized operating procedure was built up: toolkit for diagnostic validation were developed; priorities and health needs identified; assets of social, community, institutional and social capital of the intervened communes analyzed and mapped; community capacities and social leadership in health strengthened; governance and intersectoral communication for change and social mobilization increased.

Results

45.07 (SD 19.77) was a measurement baseline of Community Social Capital in Health. The interrelation between community health assets was especially relevant in some communes. For example: In the Commune 1 Popular, women's leadership allowed the implementation of relevant salutogenic actions. The intersectoral actions of the Commune 15 Guayabal for child care were evaluated as a case of territorial governance. In the Commune 12 La América, social mobilization actions were evaluated as a case for social communication. By other side, the learning process of a community training program in social participation in health has generated relevant evidence to continue jointly reinforcing citizen empowerment in health decision-making.

Conclusions

There was a large overlap between the community health interests and the technical decisions for health planning designed by the city health authority, in that sense, assessing social participation in health as a process involves not only planning common actions but also designing and applying participatory knowledge with the community.

Key messages

Social interactions for social health transformations requires longitudinal process of observation. Implementation evaluation is useful 'just on time' for decision making process.
Perceptions of neighborhood environment on health in a Saudi Population in Kingdom of Saudi Arabia
Authors: Saddik B , Al-Masri S , Jradi H
Published: October 2020

There is increasing evidence to suggest there is a relationship between a person's neighbourhood environment and determinants of health outcomes, including obesity, diabetes and mental health depression. However, to date, no research in the Kingdom of Saudi Arabia has explored this relationship. We conducted a cross-sectional study to assess neighborhood perceived walkability, aesthetics, safety and connectedness, and their relationship with reported mental health status in the city of Riyadh, Saudi Arabia among Saudi males and females over the age of 18 years. We used validated Arabic versions of the Neighborhood Environment Walkability Scale (NEWS) short form and the (K10) scale. Data were analyzed using descriptive analysis for all study variables. Univariate and multivariate logistic regressions were conducted to estimate the likelihood of depression among the sample. A total of 493 residents in Riyadh-KSA, were included in the study. Most participants in the study responded negatively to statements on neighborhood walkability and aesthetics and did not perceive their neighborhood friendly in terms of providing adequate and accessible footpaths, natural reserves, attractive buildings or well-maintained walkways. Perceptions for walkability and aesthetics were lowest in comparison to safety, access to services and overall neighborhood satisfaction. Older individuals (>40 years) showed increased vulnerability to depression in univariate analysis (OR = 0.78; 95% CI: 0.6241-0.9649) whilst being employed significantly decreased the likelihood of depression by 42%, (OR = 0.58; 95%CI: 0.386-0.875). Perceived neighborhood safety and connectedness were significantly associated with reported depression (OR = 0.930, 95%CI: 0.90-0.962).

The results from this study demonstrate an association between neighborhood safety and connectedness with reported depressive symptoms among residents in Riyadh. Further research should focus on whether these observations are in fact causal.

Key messages

There is an association between perceived neighborhood safety and connectedness with reported depression. This study suggests that walkable built environments may decrease reports of psychological distress, whilst aesthetics and accessibility may improve both physical and mental health.
Comparison of effects of air pollution on children between urban and rural area in west Bengal, India
Authors: Umemura T , Terasaki H , Onishi K , Matsumi Y , Ueda K , Suzuki K
Published: October 2020

Background

Air pollution is a serious problem in India. According to World Bank's data in 2015, about 660 million people were categorized as poor (US$3.20 per day per capita) in India and the proportion to total the population was 50.4 %. Even though the number and proportion are large, the effects on the poor people have not been studied very well. We measured the effects of air pollution on children of the poor and compared between urban and rural area in West Bengal, India.

Methods

24 male students (12.5 ± 0.8 years) in urban area (Kolkata) and 20 male students (12.5 ± 0.5 years) in rural area (Jata) were recruited. We measured fractional exhaled nitric oxide (FeNO), which was index of airway inflammation and checked allergic symptoms. The survey was conducted in January (dry season) and August (rainy season) 2019 to confirm a seasonal difference. Air quality index (AQI) in each area was used for index of air pollution.

Results

Average AQI was 335 (Kolkata) and 155 (Haldia: near Jata) for 2 months from December 2018 to January 2019, while average AQI was 51 (Kolkata) and 38 (Haldia) for 2 months from July to August 2019. As for FeNO in dry season, the value in Kolkata was 24.9 ± 16.1 and the value in Jata was 11.7 ± 3.5. As for FeNO in rainy season, the value in Kolkata was 22.3 ± 17.5 and the value in Jata was 16.8 ± 6.7. The value of FeNO in Kolkata was higher than Jata in either season. Although a seasonal difference was not detected in Kolkata, the value in dry season was lower than in rainy season in Jata. The prevalence of allergic symptoms in dry season was higher than in rainy season in Kolkata. On the other hand, there was no difference in the prevalence between dry and rainy season in Jata.

Conclusions

Even though AQI and the prevalence of allergic symptoms decreased, the value of FeNO did not decrease in Kolkata. Because AQI decreased, indoor air pollution might have influenced on airway. It is supposed that prevention of indoor air pollution is important.

Key messages

Airway of children in urban area may be influenced on by air pollution more than in rural area. Indoor air pollution may influence on children of the poor more than outdoor air pollution.
The cost of violence: Assessing the economic cost of gender-based violence in Rwanda
Authors: Spence I
Published: October 2020

Background

Gender-Based Violence (GBV) is a health and legal issue of international concern. In 2006, the Rwandan Government passed new laws to address this issue. However, Rwanda still has a high prevalence of gender based violence in communities at a rate of around 35%. This poster explores the economic cost of Gender-Based Violence in Rwanda. It seeks to: (1) define and describe GBV in Rwanda and comment on the state of the economy; (2) examine the literature on existing studies of the cost of GBV with a focus on common methodologies used; and (3) calculate the minimum costs associated with GBV in Rwanda.

Methods

Existing data was reviewed to look at the definition of GBV with regard to law and policy. This included identifying the common causes of GBV in Rwanda as well as looking at the nature and prevalence. An examination of the current state of the Rwandan Economy was undertaken in order to identify the areas whereupon GBV could cause disruption. Subsequently, a narrative literature review was conducted which examined the common methodologies used in cost analyses of GBV across the globe. Lastly a basic costing exercise was performed which determined the minimum costs associated with GBV in Rwanda using government data and NGO reports.

Results

The results showed that GBV makes up a small percentage of GDP in Rwanda at 0.003%. Victim costs were measured at $10,355,812.97, whilst government costs were found to be $13,082,542.07 and civil society costs incurred amounted to $4,684,428.00.

Conclusions

Overall this study reveals that just taking basic costs into consideration, GBV imposes a significant financial burden on the country. In particular, it highlighted the burden felt by the government providing public services such as healthcare and legal services. Therefore it is likely there is an overconsumption of scarce resources by GBV cases, which will likely lead to economic strain at both a local and national level.

Key messages

Gender-based violence costs make up a small but recognisable percentage of GDP in Rwanda. More investment in preventative strategy is needed to reduce both the prevalence of GBV and the cost to the local and national economy.
Fighting excessive pharmaceutical prices: Evaluating the options
Authors: Den Exter A
Published: October 2020

Background

New treatment options for various cancer therapies have appeared extremely expensive and prices may increase further. The affordability and availability of life-saving medicines is therefore a key issue in national health policies of all countries. Fighting excessive pharmaceutical prices, this paper examined a 'toolbox' of price reducing measures, provided by international law (e.g., compulsory licensing, pharmacy's exemption, price transparency and mandatory disclosure, competition authorities' review unfair prices, crossborder purchasing medicines).

Results

Evaluating the options, states remain hesitant, if not reluctant to apply for compulsory licensing and or other regulatory options to curtail pharmaceutical prices. Instead, Cross-border collaboration on (price and cost) negotiation of selective medicines seems the most feasible remedy to create advantages of economies of scale, and thus providing access to affordable new medicines.

Conclusions

Despite some obstacles, voluntary cross-border purchasing arrangements are a meaningful option to safeguard access to affordable innovative medicines, particularly for small countries

Methods

Legal analysis treaty law, provisions, case law, and literature.

Key messages

Voluntary cross-border purchasing arrangements are a meaningful option to safeguard access to affordable innovative medicines. Particularly for small countries.
Regional support in the health regions of Rio de Janeiro state: a strategy for strengthening SUS
Authors: Cabral L M , Peres A M , Rodrigues P H , Caldas M , Magalhães M , Hill D , Silva D S , Rezende M F , Costa S I , Osório S
Published: October 2020

Brazil is one of the few countries in the world with more than 200 million inhabitants that has a universal public health system. In its 30 years of existence, the Unified Health System (SUS) has brought many advances to the Brazilian society. However, it still faces challenges to ensure health services in quantity and quality to the entire population. Federal, state and municipal government levels share the responsibility for its management and financing. In this governance scheme, it is the Municipal Health Secretariats (MHS) of the 5,596 Brazilian municipalities that are primarily responsible for providing and managing health services. Given the importance of this responsibility, Councils of Municipal Health Departments (COSEMS) and the National Council of Municipal Health Departments (CONASEMS) were created in 1986. Their role is to promote the articulation and negotiation of their interests with the federal and state levels. In Rio de Janeiro, a team of specialized professionals has been providing support for COSEMS-RJ since 2012. The team carries out activities in the nine regions of the state, which has 92 municipalities and more than 16 million inhabitants, the 3rd largest population in Brazil. Its activities are maintained by CONASEMS, the Ministry of Health and the State University of Rio de Janeiro (UERJ). The objetive of this report is to present the experience of the expert team of COSEMS RJ as a strategy for strengthening regional governance and intergovernmental relations. Providing specialized technical support for MHS has improved local management of SUS and has allowed for the establishment of regionalized health care networks in Rio de Janeiro.

Key messages

The project improves the participation of municipal managers and teams in regional spaces. It strengthens their capacity for intergovernamental decision-making and regionalization of the health system. The project qualifies the municipal management for fundraising, knowledge building, policy implementing and monitoring, as well as participatory planning.
The long-term effects of mandatory military on health outcomes
Authors: Cavalli N , Boccia S , Giraldi L , Mariani M , Ricciardi W , Nicodemo C
Published: October 2020

Introduction

In the past many young men spent a period of time in military service. To enter in the military service the person should pass a health visit where the physical and mental health conditions were verified. We focus our analysis on the Italian military service that was stopped to be mandatory in 2004, to explore if health visits during the military service have effects in preventing future illnesses. To do that we compare health outcomes of the cohort of Italian people born in 1985 and in 1987, i.e. before and after the suppression of the mandatory military service, respectively.

Methods

Data on demographic characteristics of men potentially enrolling the last compulsory military visit and the one after the abrogation were obtained from the Italian National Statistics Institute. For health outcomes, we obtained for the same population the health records of hospital admissions from 2007 to 2017. A difference-in-difference analysis was performed to calculate whether the probability of being differed among the two cohorts of people.

Results

A total of 215,081 males born in 1985 and 210,616 males born in 1987 were admitted to hospital in the period 2007-2017. A decreasing trend from 2007 to 2017 in overall hospitalization rates were observed for both cohorts of 1987 (1.26 to 1.15) and 1985 (1.22 to 1.13). The regression model showed a significant lower probability for the 1985 cohort, respect to the 1987, of being admitted for an infectious or parasite disease (coefficient -0.83; 95% CI: -1.15 - -0.51) and for tumours (coefficient = -0.83, 95% CI:-1.57 - -0.09)

Conclusions

To our knowledge, this is the first study that attempted to quantify the potential preventive impact in the male population of the physical examination during the mandatory military visit. With an age difference of 2 years between the 2 cohorts, the results show a significant reduction in terms of hospital admission for certain types of health conditions

Key messages

The mandatory military service was helpful in detecting certain diseases whose diagnosis would otherwise be delayed or undetected. Physical and mental examinations for mandatory military service, could see how a potential screening programme of prevention among young men.
The ethics of pandemic preparedness revisited - autonomy, quarantine, transferability and trust
Authors: Schröder-Bäck P , Schloemer T , Martakis K , Brall C
Published: October 2020

Background

The outbreak of SARS in 2002 lead to a public health ethics discourse. The crisis management of that time was ethically analysed and lessons to be learned discussed. Scholarship and WHO, among others, developed an ethics of pandemic preparedness. The current “corona crisis” also faces us with ethical challenges. This presentation is comparing the two crises from an ethical point of view and a focus on Europe.

Methods

An ethics framework for pandemic preparedness (Schröder et al. 2006 and Schröder-Bäck 2014) is used to make a synopsis of ethical issues. Ethical aspects of 2002 and 2020 that were discussed in the literature and in the media are compared. For 2020, the focus is on interventions in Italy, Germany, Switzerland, and the Netherlands.

Results

Topics that emerged from the 2002 crisis were, among others, revolving around aspects of stigmatisation and fair distribution of scarce resources (esp. vaccines, antivirals). Currently, most urgent and ethically challenging aspects relate to social distancing vs. autonomy: Isolation and quarantine are handled differently across Europe and the EU. Questions of transferability of such interventions prevail. Contexts vary vertically over time (2002 vs. 2020) and horizontally (e.g. between Italy and Germany at the same time). Furthermore, trust in authorities, media and health information is a key issue.

Conclusions

Ethical aspects are key for good pandemic preparedness and management. The context of the crises between 2002 and 2020 has slightly changed, also based on “lessons learned” from 2002. This has implications on ethical issues that are being discussed. New lessons will have to be learned from the 2020 crisis.

Key messages

Pandemic preparedness and outbreak management entail many ethical tensions that need to be addressed. Currently, questions of trust and transferability are key to the crisis management, further ethical issues could still emerge.
Body mass index and obesity in Italy: results of CUORE Project-Health Examination Survey 2018-2019
Authors: Donfrancesco C , Profumo E , Buttari B , Lo Noce C , Minutoli D , Di Lonardo A , Bellisario P , Giampaoli S , Strazzullo P , Palmieri L
Published: October 2020

Background

The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends to halt the rise of obesity by 2025. Obesity is largely preventable. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project to investigate if Italy can meet the WHO-NCD target.

Methods

Within the health examination survey conducted in 2018-2019, mean level of BMI and prevalence of obesity (BMI > =30 kg/m2) and overweight (25 < =BMI<30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (822 men and 869 women), from 8 Italian Regions in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. A standardized questionnaire was used to collect data on educational level that was used as a proxy of socio-economic status. The survey is funded by the Italian Ministry of Health-CCM.

Results

In this preliminary analysis, mean level of BMI was 26.8 kg/m2 (95% C.I. 26.5-27.1) in men and 25.9 kg/m2 (25.6-26.3) in women. Prevalence of obesity was 19% (16-22) in men and 22% (19-25) in women; prevalence of overweight was 45% (41-48) in men and 28% (25-31) in women. Obesity resulted significantly higher in persons with lower educational level (primary or middle school) vs those with higher education: 26% (20-31) vs 16% (13-19) in men and 33% (27-38) vs 17% (14-20) in women. Both in men and women prevalence of obesity was significantly higher in the Southern regions.

Conclusions

Preliminary data show that more than half of Italian adults are overweight/obese. However, in comparison to BMI measured in the CUORE Project 10 years earlier, the prevalence of people at normal weight is increasing, moving in the direction of the WHO-NCDs obesity target. Preventive actions at community level should be more incisive in the population at low socio-economic level.

Key messages

Mean BMI and prevalence of obesity in the Italian general adult population are still high. If confirmed, in the last ten years an increase of normal weight prevalence in the Italian general adult population seems to be occurred.
Dietary and lifestyle habits of secondary school students in Subotica
Authors: Kosic Bibic N , Berenji K , Kovacevic J
Published: October 2020

Dietary habits, alcohol use and physical activity initiated in childhood and adolescence are often maintained during later life. Study objective was to investigate high school students' behavior patterns and nutritional status.

The cross-sectional study involved 301 students (16 years old) from two secondary schools in Subotica, North Backa Region. Study took place in October 2019. Students anonymously filled out a modified national questionnaire consisting of 27 questions and covering the areas: free time, physical activity, alcohol use, eating habits. Anthropometric measurements (height, weight) were done in schools. Statistical data processing was done in SPSS.

Boys were more physically active than girls, both in regard to competitive sports (36.4% vs. 8.2%) and recreational sports or other physical activity for at least 4 hours per week (15.2% vs. 7.3%). This difference is statistically significant (χ2=40.534; DF = 3; p = 0.001). More than a half of the students (58%) admitted drinking alcohol occasionally in the last 12 months and every fifth student during weekends. Daily consumption of breakfast is present in 44% students, fresh fruits in 28.3% and vegetables in 25.9%. On the contrary, 31.6% of them eat sweets and 30.8% drink sweetened soft drinks daily. There is a statistically significant difference in type of used fats, with boys using more often “bad” fats (χ2=12.884; DF = 3; p = 0.005). Every third student (32.5%) is overweight or obese (>85th percentile).

The high percentage of students with BMI > 85th percentile, poor nutrition habits, lack of physical activity, frequent alcohol use, indicated a need for stronger implementation of interventions aimed at adolescents and younger age groups. Following the study, a comprehensive intervention program was implemented in the period October-December 2019. The program included educational seminars, peer education, demonstrational cooking workshops, stands for parents, preparing an e-cookbook, sports and recreation fair.

Key messages

The results obtained underline a need for youth empowerment and environmental interventions to support their lifestyle change. It is our obligation to help them find a way to enhance their health potential as early as possible.
Exploring the relation between methylxanthines and plasma lipids in two population-based studies
Authors: Petrovic D , Pruijm M , Ponte B , Ackermann D , Ehret G , Zhang Z , Thijs L , Staessen J , Bochud M , Guessous I
Published: October 2020

Background

Chronic intake of caffeinated beverages might be associated with plasma lipids via disturbed lipid metabolism. Previous investigations have been limited by the use of self-reported caffeine intake instead of measured caffeine, whereas the associations between plasma lipids and other methylxanthines (paraxanthine, theobromine, theophylline) are unknown. Here, we investigated the associations of plasma lipids with caffeine and its metabolites in plasma and urine in two European populations.

Methods

Individuals were selected from the general population of North Belgium (FLEMENGHO) and Switzerland (SKIPOGH). Total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were measured in plasma using standard enzymatic methods. Plasma and 24h urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured using ultra-high performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of methylxanthines with plasma lipids while adjusting for major confounders.

Results

Overall, 1946 FLEMENGHO participants (911 men, age 45.9±15.2 years) and 990 SKIPOGH participants (467 men, age 47.1±17.3 years) were included. Mean plasma total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in FLEMENGHO/SKIPOGH were 5.37/5.06, 3.12/3.12, 1.43/1.50, and 2.4/1.02 mmol/L. In both cohorts, adjusted mean total cholesterol, LDL cholesterol, and HDL cholesterol, increased with quartile of plasma caffeine, with stronger associations in men. Similar positive associations were observed for paraxanthine and theophylline. Similar associations were observed using 24h urine excretions in SKIPOGH.

Conclusions

Plasma and urinary caffeine, paraxanthine, and theophylline were positively associated with plasma lipids in men, whereas there were fewer meaningful associations in women. The increase in plasma lipids might mitigate the overall beneficial impact of caffeinated beverages on health.

Key messages

Caffeine constitutes one of the most widely consumed biological active substances. Plasma concentration and urinary excretion of caffeine and its derived metabolites is positively associated with plasma lipids.
Policy infrastructure and mechanism to Promote “Health by All” Movement for Overturning Obesity
Authors: Lord A , Pan W , Li G , Chen H , Peng K , Song L , Chu N , Liou T , Liou Y , Wang Y
Published: October 2020

Background

Obesity is a pressing pandemic. However, major policies have targeted individual responsibility and focused on “losing weight or lowering calories”. Such approach has limited effect and overlooks the hidden obesity.

Methods

Under auspices of NHRI Forum, Taiwan; the WAKE.TAIWAN Research Team analyzed the global trends of policies, strategies, and literatures to formulate guiding principles for a total solution. 1. Defining obesity should go beyond body weight and emphasize more on healthy body composition and muscle mass, etc. 2. Effective obesity control strategy should facilitate building healthy living environments, lifestyle, and culture for natural flow of healthy behaviors. 3. All sectorial leaders should be involved in engaging and promoting healthy lifestyle culture and environment.

Results

”Guidelines for Establishing a lifestyle and Culture of Healthy Body Build” has been published as a blueprint for policy reform and strategies development, which consists of three parts. Part I emphasizes the active roles, social responsibilities, influence, and opportunities confronted the leaders and experts in all sectors and how government may facilitate these societal engagements, “Healthy by All”. The crucial sectors should include academia, NGO/NPO, industry/business, workplaces, healthcare systems, educational sectors, media and press, etc. Part II details on community spatial planning and architectural designs for healthy lifestyles. Part III proposes governmental “Health in All” infrastructure and mechanism.

Conclusions

We anticipate that the Guideline may draw out expertise and volunteering in all sectors of the society and help guide the public to take initiative in building such a culture of healthy-body-build and achieving this goal in all aspects of daily life.

Key messages

Emphasize on healthy body composition rather than body weight. Propagate 'Health by all' movement to foster building 'healthy physique' culture.
Factors that antimicrobial resistance in food systems: a participatory modelling approach
Authors: Majowicz S , Lambraki I , Cousins M , Parmley E J , Carson C
Published: October 2020

Background

Antimicrobial resistance (AMR) emerges from a complex web of factors; understanding their dynamics is key to determining sustainable solutions. Thus, we aimed to create a model of the diverse factors influencing AMR in two food systems and model the impacts of interventions.

Methods

We built a causal loop diagram (CLD) of the factors driving AMR in the food chain via 4 participatory workshops (2 in Sweden; 2 in Malaysia) with diverse stakeholders. The CLD became the structure of a compartmental model, which was populated using data from multiple sources (e.g., interviews, surveillance data). Using fuzzy set theory, quantitative and qualitative data were converted to categorical variables. The compartmental model was created in AnyLogic and was used to test how expert-selected solutions (e.g., taxation) might impact AMR under different scenarios.

Results

Factors identified as influencing AMR across Europe and Southeast Asia clustered around key themes: on-farm (e.g., biosecurity); social (e.g., consumer demand); research (e.g., alternatives to antimicrobials [AMs]); economic (e.g., agricultural production levels); policy (e.g., trade agreements); and environment (e.g., waste management). Differences were identified between regions, for example, regulations and standards regarding imports or food safety were more relaxed in Southeast Asia than in Europe. Identified interventions included: AMR education in schools, training diverse stakeholders in AM stewardship, increased on-farm biosecurity measures to limit disease and the need for AMs, and taxing AM-containing products.

Conclusions

Our model captured a range of multi-level, interlinked factors that impact AMR in the European and Southeast Asian food system contexts. Preliminary findings suggest that different principles need to be cultivated (e.g., polycentric governance, cross-sector partnerships) to ensure that interventions addressing AMR are sustainable over time.

Key messages

Our study visually characterized the interlinked factors that impact AMR transmission and emergence in food systems. Our approach provides a tool to model impacts of potential interventions.
Listeria monocytogenes clones in Italian food products: virulence and environmental adaptation
Authors: Torresi M , Rinaldi A , Centorotola G , Di Domenico M , Cammà C , Di Pasquale A , Pomilio F , Acciari V A
Published: October 2020

Background

Food is the main source of Listeria monocytogenes (Lm) infection. Lm is a highly heterogeneous species composed of hypervirulent and hypovirulent clones. Understanding the distribution of Lm clonal complexes (CCs) in different food categories has strong implications for risk assessment. The aim of this work was to analyse collection of Lm strains of National Reference Laboratory (NRL Lm) in order to assess link between genetic profile and matrices and the level of pathogenicity of circulating strains based on CCs.

Methods

NRL Lm database actually consists of 906 sequenced strains isolated in 10 years from 5 food compartments (meat, fish, dairy, vegetables and composite dishes). Epidata were analysed to remove redundant strains based on the same epidemiological description. After that, WGS data from 465 Lm strains were investigated. In silico MLST was defined and Roary 3.12.0 was used to obtain a pan-genome profile. Genes were later uploaded to Pasteur Institute platform for characterization.

Results

In silico MLST identified 36 CCs and 6 singleton. CC9 (23.0%), CC8 (15.3%) and CC121 (13.3%) were the prevalent CCs. In particular, CC9 was present in 35.2% of meat samples and CC8 in 25.8% of fish samples. Pan genome profile revealed high prevalence (>98%) of genes related to biofilm formation and resistance to environmental stress in CC9 strains and genes involved in tolerance to quaternary ammonium compounds in CC121 strains.

Conclusions

Results, in particular for meat products, confirmed in Italy, the prevalence of hypovirulent Lm strains previously observed at European Union level. The high presence of stress resistance and disinfectant tolerance genes in these strains could make them able to persist in food-production environment and should be taken into account evaluating the health hazards. In fish product is also relevant the prevalence of CC8 strains which are potentially highly pathogenic and have been responsible of recent European multi country outbreak.

Key messages

Pangenome of Listeria monocytogenes isolated from Italian food revealed high presence of disinfectant tolerance and stress resistance genes in meat products and virulence genes in fish products. Listeria monocytogenes CC9 and CC121 prevalence in Italian meat product confirms occurrence of hypovirulent strains detected at European Union level.
Evaluation of a food safety training intervention in an asylum-seeking population in Rome
Authors: Pattavina F , Barbara A , Cruciani I , Calabrese A C , Mazzetta E , Sezzatini R , Tuti F , Laurenti P
Published: October 2020

The integration of asylum seekers is a public health issue in various contexts, including food, where they often work. According to European legislation, every food operator is obliged to follow training courses on food safety knowledge in order to prevent food-borne diseases. This study aims to evaluate a food safety training intervention in a population of asylum seekers in Rome through the use of a specific tool validated by the WHO, to introduce them in of catering.

The 'Five Key Points for Safer Food' manual was used to deliver the course. An evaluation test for participants to assess the impact of the food safety training is included, divided into 4 categories: General Information, Knowledge (11 items), Attitudes (10) and Behavior (10). The involved food handlers received the same test before and after training. In order to evaluate the effectiveness of the training intervention, the difference in the average of correct pre and post-test answers, overall and by category, was analyzed.

Overall, the 69 food handlers comprised 34 (49.3%) females and 35 (50.7%) males, from different continents (36.2% from Africa, 30.5% Central-South America and 33.3% Asia). The 57.3% has previously worked as cook or waiter. The average age was 36.6 (±12.5) with 11.4 (±3.9) years of education. Overall, the average of correct answers increases of 11.6% (from 76.4% to 88.0% correct answers pre and post-test; p < 0.0001). Knowledge pre test was 7.7 (±1.4), while post test was 8.9 (±1.7) (p < 0.0001). Attitude pre test was 8.3 (±2.2), post test was 9.6 (±0.9) (p < 0.0001). Behavior pre test was 7.7 (±2.2), post test 8.8 (±1.9) (p < 0.0001).

Despite cultural and linguistic differences, our training intervention has been effective in improving knowledge, attitudes and behaviors on food safety in the target population. The food safety in these contexts cannot be understood only as the fulfilment of a regulatory obligation, but also as an opportunity for aggregation and social integration.

Key messages

Food cooking represents a social integration tool: asylum seekers from the most disadvantaged countries could prepare safe multi-ethnic dinners based on the typical courses of their country of origin. WHO training intervention on food safety was effective in improving knowledge, attitudes and behaviors in the target population.
Store Environment Assessment (SEA) Tool: Design and validation of a food environment audit protocol
Authors: Jago E , Minaker L , Mah C L
Published: October 2020

Background

Unhealthy food environments are key factors in diet-related disease risk. Many audit methods have been designed for the retail food environment, but weaknesses of existing methods include: validity in study methods and design, and heterogeneity in adaptation and analysis methods. This paper describes the development and validation of a novel protocol for designing store audit instruments - the Store Environment Assessment (SEA) Tool.

Methods

This research involved four steps: 1. a scoping review of consumer food environment audit tools; 2. classify key variables from the literature; 3. use the variables to design a protocol for development of audit instruments tailored to local contexts and research questions; and 4. validate the protocol by designing and validating a sample audit tool based on Canada's Food Guide (2019).

Results

Variables from the literature included: Product (availability, variety, size, reference), Price, Promotion, Placement-accompanied by: definition, type of variable, range of values, scale of measurement, and measurement outcome. The protocol has seven steps: identify dietary guideline criteria; conduct content analysis; define setting; align research questions with scale and scope; variable selection; audit tool design; and validation strategy. The protocol was used to design a store audit instrument for Canadian jurisdictions, based on Canada's Food Guide, and validated against the gold standard, Nutrition Environment Measures Survey (NEMS).

Discussion

The SEA protocol can strengthen researchers and practitioners' capacity to use structured guidelines to develop geographically and socio-demographically relevant Store Environment Assessments, and avoid heterogeneity arising from ad hoc adaptations of tools such as NEMS. Our methodological approach can support greater consistency, feasibility, and rigour of food environment audits for diverse public health research and practice objectives.

Key messages

Researchers and practitioners will be able to utilize the SEA tool protocol, using jurisdictional food and nutrition criteria, to better assess 4Ps related to food, in retail food environments. The variables and measurement outcomes included in the SEA tool protocol will support public health practitioners in developing relevant interventions to support healthy consumer food purchasing.
Potential effects of a sugar-sweetened beverages tax on socioeconomic inequalities in health
Authors: Djojosoeparto S K , Eykelenboom M , Renders C , Olthof M R , van Stralen M M , Steenhuis I , Poelman M P , Kamphuis C B M
Published: October 2020

Background

Sugar-Sweetened Beverages (SSBs) taxes have been implemented in several countries, however, little is known on how an SSBs tax may impact on low and high socioeconomic groups differently. Therefore, the aim of this study was to gain insight into the perceptions of different stakeholder groups in the Netherlands on (1) the contribution of an SSBs tax to socioeconomic inequalities in diet and health and (2) the mechanisms via which an SSBs tax may influence these inequalities.

Methods

Semi-structured interviews were held in the Netherlands in March-May 2019 with 27 participants from the following stakeholder groups: health and consumer organisations, health professional associations, advisory bodies, scientists, trade organisations, policy makers, and politicians. Interview transcripts were analysed following a thematic content approach.

Results

Participants from all stakeholder groups indicated that an SSBs tax would have a larger impact on the budget and SSB consumption of lower socioeconomic groups. With that, an SSBs tax could have larger health benefits among lower socioeconomic groups as a result of cutting down on SSBs. A few participants - from science and a health professional association - discussed possible unwanted effects of an SSBs tax (e.g. lower socioeconomic groups may compensate their lower SSB consumption with other unhealthy behaviour). Some participants emphasised that an SSB tax should only be introduced when accompanied by other measures (e.g. educational efforts, offering healthy alternatives).

Conclusions

Our results imply that most stakeholders agree that an SSBs tax could contribute to a reduction of socioeconomic inequalities in diet and health. However, in order to be effective and to prevent that an SSBs tax leads to a widening of inequalities, it is important to carefully monitor behavioural changes of socioeconomic groups in response to an SSBs tax, and to implement an SSBs tax as part of a comprehensive policy approach.

Key messages

An SSBs tax could contribute to a reduction of socioeconomic inequalities in health, according to Dutch stakeholders. It is important to carefully monitor behavioural changes of socioeconomic groups in response to an SSBs tax, and to implement an SSBs tax as part of a comprehensive policy approach.
Factors affecting the intention of nutrition label use among selected adults in the Philippines
Authors: Sy D , Bullecer E
Published: October 2020

Background

Having an unhealthy diet is a risk-factor in the development of non-communicable diseases. Through the provision of sufficient nutrition information, nutrition labeling is one of the recommendations to increase awareness and promote healthy diets. However, there is still limited research in the Philippines that can be utilized in improving nutrition label use. With the Theory of Planned Behavior (TPB) as the study model, this study aimed to determine attitude, subjective norm and perceived behavioral control on nutrition label, and if the three constructs are associated with the intention of nutrition label use among adults in selected communities.

Methods

This analytic cross-sectional study conducted face-to-face interview using a developed questionnaire, among 440 adults (18 to 59 years old) in the top four communities with highest population in Los Baňos, Laguna, selected through a two-stage sampling design. Data were encoded using MS Excel and analyzed using STATA.

Results

The prevalence of positive attitude was 89.32% (95% CI: 86.06 - 91.89) and 96.82% (95% CI: 94.69 - 98.11) had high degree of subjective norms. With regards to perceived behavioral control, 61.36% (95% CI: 56.71 - 65.82) found nutrition labels as easy to understand, and 94.09% (95% CI: 91.45 - 95.95) had high intention of using it. Then, using multiple logistic regression, only having a perceived behavioral control on nutrition label of being easy to understand (OR 3.33; 95% CI: 1.47-7.54) was found to be associated with having high intention of nutrition label use.

Conclusions

Information and education on nutrition labels should be strengthened to improve the perceived understanding of the participants which showed significant association with having high intention of nutrition label use. Nonetheless, promotions are important to maintain positive attitude and subjective norms toward nutrition label use. The study also generated data that can serve as reference for future studies.

Key messages

Among the three constructs of TPB, only having perceived behavioral control on nutrition label of being easy to understand was found to be associated with having high intention of nutrition label use. Improving the nutrition label understanding of the study participants is significant in having high intention of nutrition label use.
An international lens on food: evaluating barriers to accessing culturally appropriate foods
Authors: Gnanapragasam J
Published: October 2020

Background

Phase one of this study explored how international students' cultural upbringing combined with knowledge of Canadian food landscapes impacted what they eat. The second phase was to develop and pilot programs and supports to help alleviate barriers uncovered in the research.

Methods

This research was structured as a community needs assessment, where data was collected by conducting semi-structured interviews, surveys and focus groups with newcomer students from various countries.

Results

Students prefer maintaining their ethnic dietary patterns. Barriers fell into four categories: planning meals, shopping, cooking and consumption. Social support was most effective in reducing barriers for students. In phase two, the major finding was that the most enjoyable aspect of the programming was socialization and making friends not developing food literacy.

Conclusions

Food is much more than a nutritious substance for international populations, it is an expression of identity, an anchor to community and family and can help with the adjustment process of immigration. As such communities with high international populations should invest time and resources into creating events where international populations can celebrate their food preferences. Replicating ethnic diets in a foreign country is a form of cultural sustainability and is highly valued among international populations. Lack of access to culturally relevant foods, lack of knowledge and lack of food literacy all contributed to creating barriers. Hence, programming that can address these barriers will allow international populations to eat healthier, which allows them to have better health outcomes overall. Creating programming that allows students to express their food identify and experiment with new foods together leads to student empowerment and social support. Social support was seen as the most salient protective factor in international students being able to overcome barriers to eating healthy.

Key messages

For international populations food is more than a nutritious substance; it identifies them and aids in their adjustment when immigrating. When we create social spaces where individuals are empowered to explore their connection to food we are engaging in cultural sustainability and creating social cohesion in our universities.