bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional health and social inequalities in Bulgaria
Authors: Tsanova D , Georgieva S , Kamburova M , Mineva-Dimitrova E , Ivanova B , Seizov A , Vitkova T
Published: October 2023

Background

The administrative division of Bulgaria divides it into 28 regions, which differ significantly in terms of both socioeconomic development and a number of demographic indicators. The death rate is an indicator according to which our country has been at the top of the world rankings for several years. Cardiovascular diseases stand out among the leading causes of death and they are one of the most important problems facing our society and health system. The study aims to analyse the relationship between the death rate due to CVD in different regions in Bulgaria with the average annual salary of employed persons as an indicator for the socioeconomic development of the regions.

Methods

The regional differences in the death rate due to CVD and the average annual salary of employed persons were analysed based on the National Statistical Institute data. Analysis and calculations were performed by MS Excel 2019.

Results

The death rate due to CVD in Bulgaria varies widely - from 1739.7 per 100000 in region Vidin, 1685,2 in region Montana to 878.0 in the city of Sofia, with a national average of 1163.2 /2021/. At the same time, Vidin and Montana regions are also among the regions with a very low average annual salary of employed persons - respectively 12 855 and 13 983 BGN, which is much lower than the average for the country - 21 128 and than the capital Sofia - 25 724 BGN /2021/.

Conclusions

The regional health inequalities in Bulgaria are very important in order to control and decrease the level of mortality in the country, especially the death rate due to CVD. Bulgaria is among the counties that have the most serious challenges related to high cardiovascular deaths and should be among the priorities of public policy. The profound regional differences that were found impose permanent monitoring and directing the regional social and public health policies to avoid their unfavourable effects. Society should be making major and cost-effective efforts to reduce mortality.

Key messages

• The elimination of regional inequalities in the country is one of the possible ways to deal with the difficult demographic situation which occurred in the years after the democratic changes.

• Regional health inequalities create the need for a long-term health policy that will improve the population's health status and the effective functioning of the healthcare system in our country.
Assessing Vulnerability to Health Impacts of Climate Change in French Municipalities
Authors: Pereira Barbosa H , Roué-Le Gall A , Thomas M-F
Published: October 2023

Background

Climate change significantly threatens human health, particularly in vulnerable municipalities. Multiple climatic, environmental, and socioeconomic factors influence municipal vulnerability. To effectively reduce this vulnerable, evidence-based tools for local decision-makers are needed. This study aims to present the development and application of a multicriteria decision analysis (MCDA) model to assess vulnerability to the health impacts of climate change in French municipalities.

Methods

We selected 59 municipalities to develop and apply the model. The development of the MCDA model involved a literature review on climate change and health, as well as active participation from an interdisciplinary committee composed of members from academic, associative, and professional sectors. This led to identifying 38 indicators to characterize vulnerability based on three components: climatic exposure, environmental and socioeconomic sensitivity, and adaptive capacity. These indicators were used as input to the MCDA model, which applied an outranking method to rank municipalities from most to least vulnerable.

Results

The MCDA model generated partial rankings by the components of vulnerability, as well as a complete ranking that integrated the three components. The results revealed the main indicators that explained the rankings and allowed for a typology of municipalities. The results helped prioritize interventions by identifying the indicators that have the greatest impact on the vulnerability of each municipality studied.

Conclusions

This study highlights the importance of considering multiple criteria and their interdependencies when assessing vulnerability. The results of the MCDA model provide an evidence-based tool to support decision-making processes at the local level. The MCDA model is a valuable tool for identifying and prioritizing effective interventions to reduce vulnerability in the studied municipalities.

Key messages

• The developed MCDA model is a valuable tool for local decision-makers to prioritize interventions and reduce vulnerability.

• The developed MCDA model provides a robust evidence-based tool to support decision-making processes.
Joint effects of US area-level social mobility & income inequality on mortality: an ecological study
Authors: Igelström E , Brydon R , Dunn J R
Published: October 2023

Background

Income inequality and its relationship with health has been extensively studied. Intergenerational income mobility (IGIM) has received less attention, but may be an important independent mechanism explaining health inequalities.

Methods

We conducted ecological analyses of the effects of IGIM and income inequality on mortality across commuting zones (CZ) in the US. IGIM was measured using rank-rank slope, i.e. the correlation between household income rank at age 15-19 and own income rank at age 29-30. We used CZ-level IGIM data from the Opportunity Insights project, Gini index of inequality from the American Community Survey, and mortality rates from CDC WONDER. Cross-sectional and longitudinal (CZ fixed effects) regression models were fitted adjusting for mean income and weighted by population.

Results

CZs with higher IGIM between 1995-2001 and 2011-12 had lower age-standardised mortality in 2009-2013, with 53.9 (95% CI: 48.9-58.9) fewer deaths per 100,000 for a standard deviation (SD) increase in IGIM (adjusting for mean income and Gini index in 2009-2013). This equates to 778 (773-783) deaths at the lower quartile vs. 710 (705-715) at the upper. Income inequality had a negligible association at 1.1 (-5.0, 7.3) deaths per SD increase. Longitudinal analysis across three 5-year periods confirmed that within-CZ changes in infant mortality were predicted by changes in IGIM (32.0 [12.7-51.2] fewer deaths per SD increase) but not income inequality (4.5 [-12.0, 20.9] deaths per SD increase).

Conclusions

Preliminary evidence suggests IGIM is a more important indicator for population health than income inequality. European researchers and public health bodies should further research and monitor IGIM, which may require improved availability of intergenerationally linked income data. Policy measures that improve social mobility, such as education and early-years interventions, may have greater health effects than policies only aiming at resource redistribution.

Key messages

• Differences in intergenerational income mobility accounted for substantial differences in mortality across US commuting zones, while income inequality appeared relatively unimportant.

• European policymakers should put greater emphasis on social mobility as an economic determinant of health, and facilitate research using intergenerationally linked income data.
Assessing the mental health among adolescents using a two continua model approach
Authors: Söderqvist F , Uvhagen L
Published: October 2023

The latest World mental health report states that mental health is an integral component of health and well-being and is more than the absence of pathology. Indeed, the view of mental health is slowly shifting to an emphasis on positive health indicators as national authorities around the world are increasingly adopting the two continua model of mental health (TCM). Adopting the TCM has several important implications for public health practice. One is that the epidemiological surveillance will have to include measures of both mental illness and mental well-being. The purpose of this presentation is to illuminate the conceptual and practical use of the TCM in the analysis of adolescent mental health. The presentation will be limited to a focus on the theoretical underpinnings and methodological considerations made to operationalize and categorize mental health according to the TCM. It will consider the added value of the TCM to epidemiological surveillance as well as its implications for public health practice when it comes to meeting population needs with appropriate interventions. To construct the model, data from population-based regional public health surveys among adolescents including validated measures of both mental ill health and mental well-being was used. The Kessler 6 scale was used to estimate the proportion of adolescents with or without probable serious mental illness (SMI, >13) and the Mental Health Continuum - Short Form was used to estimate the proportion of adolescents with flourishing (FMH), moderate (MMH) or languishing (LMH) mental health according to the original categorization developed by Keyes. Combining these two dimensions of mental health and their respective categories will yield six mental health status groups: Complete mental health = FMH without SMI, Vulnerable = MMH without SMI, Most vulnerable = LMH without SMI, Symptomatic but content = SMI with FMH, Troubled = SMI with MMH, and Most troubled = SMI with LMH.
Challenges in communicating evidence and policies in relation to the COVID-19 pandemic – experiences from Denmark
Authors: Krasnik A
Published: October 2023

Early during the COVID-19 pandemic health authorities and media in the Scandinavian countries identified an increased incidence of infections among migrants compared to the majority population. Specific neighbourhoods and communities were presented as having high incidence rates, hospitalisations and mortality. These populations were profiled by country of birth - in Denmark often categorised as non-Western immigrants which is a broad label generally presented in policy debates and by Statistics Denmark. The public discourse quickly associated this category with common Danish concepts such as parallel societies or ghetto's - the latter being a label that officially was used recently to identify communities with many immigrants and social challenges. The debate signified a frequent view that these population groups were less caring about their health, more suspicious or less motivated to comply with information from public authories and with little interest in engaging in testing and preventive activities- thereby representing a risk for the further spread of the disease and an additional burdon for health care. Only after intensive interference from migrant health experts and initiatives from the National Health Authority a more nuanced public communication gave room for description of housing and working characteristics that were common in some of the migrant communities.This slowly created more insights and acceptance of real causes of the disparities and a platform for more respectful, inclusive and efficient preventive interventions. The presentation will report on the process involved and the way the change of language had an impact on the public health policies and practice during the pandemic in Denmark.
Monitoring the nutrient content of packaged food: Design of the German product monitoring
Authors: Gréa C , Dittmann A , Kondula V , Krüger K , Roser S , Storcksdieck genannt Bonsmann S
Published: October 2023

Introduction

To review ongoing reformulation efforts and identify further leverage points for reducing the sugar, fat, or salt content in packaged food, an overview of the nutrient content of nationally available packaged food is essential. This can be achieved through a regular product monitoring, as it is conducted in Germany.

Methods & Data Analysis

In Germany, the product monitoring started in 2016 with a market overview of the energy and nutrient content of 19 food groups. Since 2019, it has been continued as an annual monitoring of selected frequently consumed food groups. A special emphasis within each food group lies on products targeting at children. Product information such as mandatory nutrition declaration and ingredient list is predominantly gathered manually from manufacturers’ websites and managed with FoodCASE. To facilitate data collection, a system to extract and organise the relevant food product information from websites automatically is currently being developed in a separate research project. The system combines web-scraping, artificial intelligence, generic and rule-based approaches to compile and compare data over time. Analyses of the energy and nutrient content are done on the level of food groups and subgroups. Range, mean, median, and quartiles are calculated and shown in tables and boxplots. A monitoring interval of 2-3 years allows analysing for significant changes over time by using Welch's t-test or -ANOVA. Furthermore, monitoring data is introduced into the EU Joint Action Best-ReMaP, which aims to implement a standardized monitoring system across the EU to better evaluate different national reformulation efforts.

Conclusions

Continuous product monitoring as done in Germany is an essential and effective tool to assess and guide ongoing reformulation efforts. Steps towards more harmonized monitoring across Europe will help to compare nutrient content of packaged food between different countries and identify best practices in reformulation.
Improving health and wellbeing through health-centred, evidence-based urban planning methodologies
Authors: Ruszanov A , Weller E , Jevtic M
Published: October 2023

Issue/problem

The relationship between urban design and human health has been repeatedly established. In fact, research has shown that urban design can influence the greatest challenges to communities’ physical, mental and social well-being around the globe. One of today's biggest health burdens is related to non-communicable diseases, and a facilitating factor in the development of these non-communicable diseases is the design of urban spaces. Currently, urban planning and revitalization are based dominantly on profit criteria with routinized methodologies, with little focus on health and wellbeing.

Description of the problem

HEART is a collaborative EU-funded project that addresses this issue by upgrading the conventional approach to urban planning towards integrated nature-based methods and concepts with emphasis on health, societal and environmental aspects through the unique concept of Health Centred Planning Methodology. The project aims to improve urban health and reduce health disparities through an innovative Blue-Green-Solutions-based implementation mechanisms of urban planning that embraces and promotes health and wellbeing as a key-planning criterion. To achieve this, HEART is engaging local communities to map the needs and challenges and to express their expectations and preferences so that delivered solutions are co-created and embraced by citizens. It also collects data from three demo sites in three cities - Athens, Belgrade, and Aarhus - to implement nature-based solutions that will address pre-identified socio-cultural, health, and well-being issues. HEART also uses medical evidence in clinical and non-clinical setting to produce evidence proving the effects of various Blue-Green Solutions on public health and wellbeing.

Lessons

Evidence generated by HEART can be used by stakeholders - such as policymakers and city and health authorities - in their decision-making process around urban planning.
On the application of AI in ethical decision-making in research ethics and ethics education
Authors: Anov A , Aleksandrova-Yankulovska S , Stateva A , Seizov A , Statev K
Published: October 2023

Background

ChatGPT is tested everyday by millions of users with different use cases. Exploring the gap between theoretical and practical ethical problems and how it is affected by the ongoing development of ChatGPT is one of these cases. The aim of this report is to present the results of testing ChatGPT in ethical decision-making in research ethics and its applicability in ethics education.

Methodology

The tests were conducted between February and April 2023 with 3 updates of ChatGPT in this period. GPTZero AI detector was used to test whether the AI generated text can be detected as not written by human. For ethical decision-making a 4-step model developed in Medical University - Pleven was applied to the Tuskegee experiment case.

Results

Two tests were conducted, in February and in April. In both cases ChatGPT was given a simple task to analyse the Tuskegee experiment by applying a methodology for case analysis. In February it used a 6-step method and in April it used a 4-step approach. In both cases ChatGPT managed to identify ethical problems regarding informed consent, human rights, harms. With more detailed instructions ChatGPT managed to follow them to some degree. It identified the issue of vulnerability and the relevance of Nuremberg code and Declaration of Helsinki but it couldn’t interpret them without additional plugin. Given a simple instruction ChatGPT produced a content that was detected by GPTZero as written by AI. By instructing ChatGPT for creating content with high degree of burstiness and perplexity and more detailed instructions about the methodology it produced a content of which two-thirds were detected as written by AI.

Conclusions

Given the task ChatGPT can identify ethical issues at basic level. Even with more detailed instructions it can’t go into detailed ethical reasoning. It wouldn’t be sufficient for professional ethical decision-making. It could help in ethics education but with certain limitations.

Key messages

• ChatGPT is still not able to go into detailed ethical reasoning and researchers should be careful if they plan to use it in their scientific work.

• Educators should always check whether the content of their students’ work is developed by AI and have ethical guidelines for using AI in education.
Free School Meals Extension to all 4-11 year olds in primary education in Wales
Authors: Green L , Emmerson C
Published: October 2023

There were 272,339 primary age students in Wales in April 2021, of whom 63,614 (23%) were entitled to free school meals. Free school meals (FSMs) are currently means tested in Wales. Estimates suggest around 40,000 children in primary education may be currently living in poverty but are not eligible for a free school meal .Free school meals have been available to all children in Reception, Year 1 and Year 2 in England since 2014. Wales does not currently have universal provision to children in any school year. However, Welsh Government committed to this for 2023/4. Steered by a Task and Finish Group, a comprehensive mixed-method HIA was conducted over a six month period in 2022-23. A comprehensive database search of peer-reviewed and grey literature published in the ten years to 2021 identified evidence relating to the impacts on health, educational attainment and household socioeconomic outcomes of making school meals free to all primary age children compared with no or means-tested provision. Routine data sources and school census data were analysed to contextualise evidence in relation to Wales. This evidence was supplemented with interviews and data provided by cross sector stakeholders. The HIA identified significant potential impacts across the determinants of health, including impacts across population groups such as children in working families on low incomes, mental well-being and food behaviours. School food policy and provision, length of lunchtimes and implementation were identified as key pathways for health impacts. For example, a strong theme was that current provision is often experienced as stressful, with requirements for rapid turnaround limiting opportunities to socialise and enjoy meals and wider opportunities to play during lunch hours constricted. The report was used to inform the Health and Education ministers who approved the extension and the implementation of the offer. The unique HIA has transferrable learning for others.

Key messages

• This work has demonstrated the value of evidence based HIA on government policy and has enhanced implementation plans.

• Free school meals for children can promote better health and educational and mental wellbeing outcomes.
Period effects in the risk of labour market marginalization among refugees in Sweden: cohort study
Authors: Kirchner S , Amin R , Niederkrotenthaler T , Cullen A E , Gémes K , Helgesson M , Mittendorfer-Rutz E
Published: October 2023

Background

Changes in Swedish national insurance policies over time and/or migration-related health inequalities may influence the risk for labour market marginalization (LMM) in refugees as compared to the Swedishborn host population. This study aimed to investigate potential period effects in the association between refugee status and the risk of LMM and explore any differences by country of birth, age and duration of residence.

Methods

Using national registers, three cohorts including all Swedish residents during 1999, 2004 and 2009 were followed for 4 years (cohort 2000, 2005 and 2010). Cox regression models were used to examine associations between refugee status and LMM defined as long-term unemployment (>180 days annually) and disability pension. The analyses were adjusted for socio-demographic factors, morbidities and labour market-related factors. Stratified analyses were run for age, country of birth and duration of residence.

Results

Across the cohorts, hazard ratios (HRs) were higher for long-term unemployment [2000: HR = 1.98; 95% confidence interval (CI): 1.96-2.01; 2005: HR = 2.30; 95% CI: 2.27-2.33; 2010: HR = 2.78; 95% CI: 2.75-2.81] for refugees compared to Swedish-born but not for disability pension. HRs for long-term unemployment were highest among refugees aged 25-34 and 35-44 years, from Somalia, Afghanistan and Iraq and refugees with a shorter duration of residence.

Conclusions

The risk of long-term unemployment appears to have increased for refugees over time. Particularly some refugee subgroups experienced more difficulties. These findings highlight ongoing disparities for refugees and implicate on a broader scale that changes in policies such as stricter regulations in the insurance or healthcare system might adversely affect them.

Key messages

• A period effect for long-term unemployment among refugees as compared to Swedish-born could be observed, and increases in the risk estimates were particularly pronounced for specific subgroups.

• Refugees seem to face increasing challenges and difficulties over time to access the labour market and changes in policies might adversely affect this situation.
Alcohol-related morbidity and mortality by fathers’ parental leave: A quasi-experimental study
Authors: Honkaniemi H , Juárez S P
Published: October 2023

Background

Fathers’ parental leave has been associated with decreased risks of alcohol-related morbidity and mortality. Whether this is attributable to parental leave's health protections (via stress reduction or behavioral changes) or selection effects (via better pre-existing health) remains unclear. Based on the quasi-experimental variation of a Swedish reform that incentivized fathers’ leave use, this study aims to assess whether fathers’ parental leave influences their alcohol-related morbidity and mortality.

Methods

Using total population registers, we identified fathers of children born in Sweden from 1992 to 1997 (n = 220,412). Exposure was indicated by fathers’ reform eligibility (i.e., childbirth after January 1995) and parental leave uptake. Outcomes included rates of alcohol-related hospitalizations with acute (intoxication, mental and behavioral disorders) and chronic alcohol-related diagnoses (other diseases), as well as alcohol-related mortality, up to two, eight and eighteen years after childbirth. Interrupted time series and instrumental variable analyses were used to measure the association of fathers’ reform eligibility and leave uptake, respectively, with alcohol-related health.

Results

In interrupted time series analyses, exposure to the reform was associated with decreases in fathers’ overall and acute alcohol-related hospitalization rates up to two, eight and eighteen years after birth (e.g., two-year rates: Incidence Rate Ratio [IRR] 0.66, 95% CI 0.51-0.87), with no changes in related mortality. Instrumental variable analyses suggested that alcohol-related hospitalization decreases were driven by fathers’ leave uptake (e.g., two-year rates: IRR 0.16, 95% CI 0.03-0.84).

Conclusions

Findings suggest that fathers’ parental leave eligibility and uptake may protect against their alcohol-related morbidity in the short and long term. Parental leave incentives could be an effective public health instrument to reduce alcohol-related harms in society.

Key messages

• Parental leave could be protective for fathers’ alcohol-related health by reducing stress and discouraging risk behaviors, although selection into leave use may confound this association.

• Utilizing the quasi-experimental variation of a Swedish fathers’ parental leave policy, this study highlights the beneficial effects of leave use for fathers’ alcohol-related outcomes.
Health4EUKids project and best practices against obesity
Authors: Vantarakis A , Velissari J , Brouma M
Published: October 2023

“Health4EUkids” aims at the implementation to a broader level and a number of European countries in the field of health promotion and prevention of non-communicable diseases, indicating best practices and specific risk factors from research results on child obesity that have already developed from previous research actions. The “Health4EUkids” specific objectives are to:

1. Increase data and survey the requirements and prerequisite for each Member State to implement proposed best practices

2. To strengthen a cooperative approach in tackling childhood obesity by facilitating the exchange of knowledge and learning skills among Member States and the best practice providers;

3. To select and implement actions according two best practices Gruanu moves and Smart life that provide the best opportunity to tackle childhood obesity among participating Member States;

4.To improve the planning and development of the policies to tackle childhood obesity in MS at the European, national, regional and local level using either of best practices;

5. To acilitate transferability and sustainability of Best Practices to member states
‘Grunaus moves’ implementation as a best practice in tackling child obesity
Authors: Peiro Pérez R , Donat Castello L
Published: October 2023

Grunau moves targets children (4-12) and their environmental and living conditions and related actors, focus on deprived district (reduction of health inequalities). It aims at creating health promoting settings, environments to promote physical activity and healthy diet in children and families. This best practice confirmed differences in nutrition and opportunities for physical activity for children between advantaged and disadvantaged districts (health inequity).
Sustainability and transferability of good practices for children's health promotion, obesity and NCDs prevention and responsive parenthood
Authors: Giusti A , Cattaneo C , Scardetta P , Palermo V , Zambri F
Published: October 2023

A review has been conducted on the relevant results of previous European initiatives to capitalize on the outcomes of other Joint Actions addressing children's health promotion, responsive parenthood, obesity and Non-Communicable Diseases (NCDs) prevention. The aim of this review is to gather knowledge, lessons learned, tools, and recommendations. Additionally, a survey is being conducted involving the Health Authorities of EU countries to assess the current state of policies and programs. This survey provides a structured description of national systems and initiatives, while identifying barriers and facilitators. Special attention is given to the emerging needs of children associated with the Covid-19 pandemic and to the healthcare response. Based on this context analysis, recommendations will be provided and discussed with the workshop participants to guide the transferability and sustainability of good practices for children's health promotion, responsive parenthood, obesity and NCDs prevention in the involved Countries. Objective is to share and discuss with the workshop participants the preliminary recommendations to guide the transferability and sustainability of good practices for children's health promotion, obesity and NCDs prevention, and responsive parenthood.
Loneliness is associated with health behaviour: A Danish population study of 122.258 individuals
Authors: Jensen M M , Friis K , Maindal H T , Hargaard A S , Knudsen M G , Lasgaard M
Published: October 2023

Background

Loneliness is steadily being recognized as a public health concern due to its association with increased morbidity and mortality. Health behaviour has been proposed as a key mechanism that influences this association. The objective of the present study is to provide a comprehensive account of the relationship between loneliness and adverse health behaviour, including daily smoking, alcohol consumption, physical inactivity, unhealthy dietary habits and obesity.

Methods

We conducted a cross-sectional study using data from the 2017 Danish National Health Survey. Loneliness was assessed using a Danish version of the Three-Item Loneliness Scale. We analysed the association between loneliness and multiple forms of adverse health behaviour in 122.258 individuals aged 16 years and older using logistic regression models adjusting for sex, age, educational attainment, country of origin and cohabitation status. Stratified analyses was conducted to investigate potential differences by sex and age.

Results

Loneliness was associated with a greater risk of smoking (AOR=1.30; 95% CI: 1.21-1.40), physical inactivity (AOR=1.87; 95% CI: 1.75-1.99), unhealthy diet (AOR=1.58; 95% CI: 1.47-1.70), and obesity (AOR=1.60; 95% CI: 1.49-1.72). Conversely, loneliness was associated with a lower risk of weekly alcohol consumption (AOR=0.91; 95% CI: 0.83-0.98).

Conclusions

Our study provides evidence that loneliness is associated with an increased risk of adverse health behaviour, such as smoking, physical inactivity and unhealthy dietary intake, across the life span. These results suggest that adverse health behaviors may influence the association between loneliness and poor health. Longitudinal studies are needed to clarify causal relationships underlying these associations.

Key messages

• Loneliness is strongly associated with adverse health behaviour across the life span.

• Our study supports the theory that health behaviour is a key mechanism on the relationship between loneliness and morbidity.
Psychiatric disorders following the clustering of family disadvantages in previous generations
Authors: Li B , Almquist Y B , Liu C , Berg L
Published: October 2023

There is a lack of research investigating to what extent mental health is informed by the transmission of multiple disadvantages across previous generations. This study aims to investigate how family socioeconomic and psychosocial disadvantages (SP) cluster and accumulate over grandparental and parental generations, and how this might be associated with grandchild psychiatric disorders in Sweden. We studied three generations of Swedes, centered around 11,327 individuals born in 1953 (parental generation), their 22,654 parents (grandparental generation), and 24,900 children (grandchild generation). Using latent class analysis with the Bolck-Croon-Hagenaars (BCH) corrections, we first grouped SP into latent classes among the grandparental and parental generations at the family level, separately, and second, we examined the associations between the identified latent classes and grandchild psychiatric disorders. Third, latent transition analysis with BCH corrections was used to estimate the probability of transitioning from grandparental classes to parental classes, as well as the probability of grandchild psychiatric disorders for each unique transition pattern. Five distinct latent classes were identified for grandparental and parental generations, respectively. The highest probability of psychiatric disorders was found for grandchildren in grandparental class with medium-level SP, and in parental class with high-level SP, respectively. The grandparental classes with medium- and high-level SP were more likely to transition to the parental class with high-level SP. The transition pattern - constantly in high-level SP across grandparental and parental generations - has been found to predict particularly high probability of psychiatric disorders among grandchildren. Findings from this study suggest the transmission of high-level SP over grandparental and parental generations, and this is associated with particularly high likelihood of psychiatric disorders in grandchildren.

Key messages

• There is a transmission of high-level family socioeconomic and psychosocial disadvantages over grandparental and parental generations.

• The intergenerational transmission of high-level family socioeconomic and psychosocial disadvantages is associated with particularly high likelihood of psychiatric disorders in grandchildren.
COVID-19 mortality and use of intensive care among ethnic minorities – a Danish register study
Authors: Nørredam M , Islamoska S , Holm Petersen J , Benifeld T
Published: October 2023

Background

Migrants and ethnic minorities are disproportionately affected by the Coronavirus Disease 2019 (COVID-19) pandemic compared to the majority population. Therefore, we studied mortality and use of mechanical ventilation (MV) by country of birth and migrant status in a nationwide cohort in Denmark.

Methods

Nationwide register data on all cases hospitalized for > 24-hours with COVID-19 between February 2020 and March 2021. Main outcome measures were mortality and MV within 30 days of hospitalization for COVID-19. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by region of origin and migrant status using logistic regression analyses, adjusting for age, sex, comorbidity and sociodemographic factors.

Results

Of 6,406 patients, 977 (15%) died and 342 (5%) were treated with mechanical ventilation. Immigrants (OR:0.55;95%CI: 0.44-0.70) and individuals of non-Western origin had a lower odds (OR: 0.49; 95% CI: 0.37-0.65) of death upon admission with COVID-19 compared to Danish born individuals. Immigrants and descendants (OR: 1.62; 95% CI: 1.22-2.15) as well as individuals of non-Western origin (OR: 1.83; 95% CI: 1.35-2.47) had a significantly higher odds of MV compared to Danish born individuals. Outcomes of individuals with Western origin did not differ.

Conclusions

Immigrants and individuals of non-Western origin had a significantly lower COVID-19 associated mortality compared to individuals of Danish origin after adjustment for sociodemographic factors and comorbidity. In contrast, the odds of MV was higher for immigrants and individuals of non-Western origin compared to individuals of Danish origin.

Key messages

• Immigrants and individuals of non-Western origin had a significantly lower COVID-19 associated mortality compared to individuals of Danish origin.

• Risk of technical ventilation was higher for immigrants and individuals of non-Western origin compared to individuals of Danish origin.
Assessment of Diet Quality and Associated Environmental Impacts in Ireland
Authors: Leydon C L , Harrington J M , McCarthy S N
Published: October 2023

Background

Suboptimal diets continue to be a major contributor to the global burden of disease, while food production contributes to climate change and environmental degradation. Food systems account for >30% of anthropogenic global greenhouse gas emissions (GHGE), and around 70% of freshwater use. Research on healthier diets having lower environmental impacts has been inconsistent. This study aimed to explore the association between environmental footprints and diet quality among older Irish adults.

Methods

The Mitchelstown Cohort was a cross-sectional study conducted between 2010 and 2011 in County Cork, Ireland. Dietary data was available for 1,862 participants. Adherence to three a priori defined diet quality metrics (Dietary Approaches to Stop Hypertension (DASH), Mediterranean diet (MD), and the Healthy Eating Index 2015 (HEI-2015)) were measured. Those in quartile four (Q4) of each metric were the most adherent to the respective dietary recommendations. Environmental impact of foods was quantified by linking food items to GHGE and blue water (BW) use impact factors, based on life cycle assessment (LCA) literature.

Results

The median daily diet in Ireland was associated with 6.8 kg CO2-equivalents per day and 425.1 litres of blue water. Males had significantly higher dietary GHGE but a lower water footprint compared to females (P < 0.001). Higher diet quality was inversely associated with GHGE according to the DASH and MD diet (adjusted for age, sex, and energy intake). Adherence to the DASH and MD diet was positively associated with BW use. No association between the HEI and GHGE and BW use was found in the adjusted model.

Conclusions

Irish dietary patterns are unhealthy and unsustainable. Higher quality diets reduced GHGE but increased water use. Future research must focus on identifying culturally-acceptable, optimised dietary patterns, where health and impact indicators align to curtail environmental burdens potentially transferring.

Key messages

• The healthiness of a diet is dependent in part on the constructs and scoring criteria of the diet quality metric used. The metrics have conceptual differences which may explain heterogeneous findings.

• The sustainability of diets is dependent on the environmental indicator(s) assessed. Future dietary patterns must be healthy, culturally-acceptable, equitable, and align across multiple indicators.
Validation of Globorisk in Turkish people and development of a new model for cardiovascular diseases
Authors: Emecen A N , Siyve N , Unal B
Published: October 2023

Background

Cardiovascular diseases (CVD) is a major cause of death globally, and accurate risk assessment is important for identifying high-risk individuals. This study aimed to validate the laboratory-based Globorisk score for predicting CVD in the Turkish population and to develop a Turkish population-specific model.

Methods

We analyzed data from Turkey's Chronic Diseases and Risk Factors study, which examined CVD incidence from 2011 until 2017. After excluding those with prior CVD history, a total of 7239 individuals aged 40 to 80 years were included in the analysis. The performance of Globorisk in predicting CVD was assessed using the C-index. With demographic, dietary, anthropometric and Globorisk variables; we used backward stepwise logistic regression to select the final model (Turkish CVD-TCVD). Lastly, the TCVD model was internally validated and calibrated with 200 bootstrap replicates.

Results

Out of 7239 participants (mean age: 53.9±10.3), women: 52.3%); 766 developed CVD within six years (cumulative incidence rate: 10.6%). The C-index of the Globorisk was 0.72 with sensitivity and specificity being 68.2% and 67.3%. In the final TCVD model, backward stepwise selection identified age (odds ratio-OR: 1.06, 95% Cl: 1.05-1.07), diabetes (OR:1.83, 1.47-2.28), body mass index (OR:1.02, 1.01-1.04), high waist-hip ratio (OR:1.37, 1.13-1.66) and systolic blood pressure (OR:1.01, 1.00-1.01) as significant predictors for CVD. C-index was 0.73 with sensitivity and specificity being 72.9%, and 62.9%. Examination of the calibration plot showed signs of overprediction when the actual CVD probability was >20%.

Conclusions

Laboratory-based Globorisk score had a good fit in the Turkish population. TCVD model had better sensitivity than Globorisk. Adding of waist-hip ratio to the Globorisk score could improve predictive CVD models in the Turkish population.

Key messages

• External validation of laboratory-based Globorisk showed good predictive accuracy in the Turkish population.

• Although more challenging to measure, adding of waist-hip ratio to the laboratory-based Globorisk score could improve predictive cardiovascular disease models in the Turkish population.
Digital public health in Romania
Authors: Brînzac M
Published: October 2023

The Romanian digital public health story is far from the end or its highest point. As in all cases, the digital public health advancements were led by the COVID-19 pandemic and the need to move everything into a digital format. This came, of course, with its hiccups and trials and errors, but in the end, it all led to considerable advancements in the public health system. One of the most significant achievements in recent years is the settlement of telemedicine services for family doctors. Initially, this was approved for the duration of the lockdown as a measure to limit the spread of the virus. Still, this measure was extended after pressure from professional associations and civil society. Another national digital public health agenda point is using electronic health records. The project was launched several years ago with the National Health Insurance House insurance card. It was now continued, with the work underway for its development. This would be a significant achievement as it would alleviate the public health system quite a lot, and it would allow health surveillance for chronic conditions with longitudinal data. Additionally, it could potentially reduce health spending as it would reduce unnecessary or doubled investigations and tests. Romania presented numerous initiatives on digital public health, but unfortunately, many were limited or renounced. A characteristic of the Romanian digital public health ecosystem is the presence of grass-root initiatives led by innovators and system disruptors, small private entities with a strong desire to solve systemic issues. This presentation will highlight how the COVID-19 pandemic enabled Romania to move forward with its digitalization and will advocate for continuous and sustainable future development of the national digital public health system.
The challenges of measuring: mapping and understanding resilience metrics in the context of a climate change shock
Authors: Haywood P , Ginnane J , Zimmermann J , Levy N , Karanikolos M , Cylus J
Published: October 2023

During this presentation, discussion will be held around several of the decisions made for the sample climate change scenario, suggested indicators and their implications. This provides the audience with an example process of how to put together a shock scenario and prepare a resilience test given the tools and methodology the resilience testing project provides. There is increasing evidence of climate change and its associated health risks. Whilst resilience is required against a multitude of threats, resilience to climate change induced health risks will be essential for health systems in the future. This scenario focuses on a heat wave that is complicated by a follow-on shock, the collapse of the electrical grid. Deliberate choices were made to include two shocks, the integration of heat warning systems, suggestions to increase the demand for health services and how to include considerations of vulnerable groups. These will be discussed in the context of how to customise a scenario to a country context including the current functioning, replacing the shock mechanism of heat wave with other shocks such as flood or fires, and including the lessons of previous experience of environmental shocks. Resilience testing tools, such as the resilience testing manual, other sample scenarios and peer-to-peer scenario repository website will be demonstrated in practical application. This shock initially has an impact on the service delivery and resource generation functions of the health system performance assessment (HSPA) framework but the impacts flow into the other functions. The workshop will go through the combined framework, indicators that are useful to assess health systems resilience and questions that are proposed to the guide the discussion of the resilience testing exercise. From the discussion participants will be better prepared to implement resilience testing in their countries, understanding how to customise the shock of a heat wave to their local context.
The effects of a mindfulness-based programme on quality of life and social support in older people
Authors: Juraga D , Rukavina T , Marinović Glavić M , Roviš D , Bilajac L , Knežević M , Raat H , Vasiljev V
Published: October 2023

The importance of mindfulness in promoting mental health and well-being has been increasingly recognised in recent years. As a result, mindfulness-based interventions have been introduced to improve various aspects of life, including quality of life and social support. The aim of this study was to examine the effectiveness of a seven-week mindfulness-based workshop programme in improving quality of life and social support among participants in the intervention compared to a control group.

A total of 257 participants (65+) were recruited and assigned to either the intervention group, which participated in the seven-week mindfulness-based workshop programme, or the control group, which received no intervention. The workshop programme combined two evidence-based programmes: The Chronic Disease Self-Management Programme (CDSMP) and the Mindfulness-based Living Programme. Participants completed two questionnaires (EQ-5D-5L and OSSS-3) to assess quality of life and social support before and after the intervention. Data were analysed using appropriate statistical tests to compare pre- and post-intervention outcomes between groups. The intervention group showed significant improvement in quality of life (p<.001) and social support scores (p = 0.002) after the seven-week mindfulness-based workshop programme. The control group, on the other hand, showed no significant changes in these measures. The significant improvement indicates the effectiveness of the mindfulness-based workshop programme. The results of this study show the positive effects of a seven-week mindfulness-based workshop programme on the quality of life and social support of older people. The results suggest that mindfulness-based interventions can be an effective tool for improving mental health and well-being by promoting quality of life and strengthening social support networks.

Key messages

• The seven-week mindfulness-based workshop programme improves the quality of life and social support of older people, which can have an impact on overall mental health and well-being in general.

• The results of this study can ensure a sustainable impact on achieving better health outcomes and saving resources in the health care system through reduced and more effective use of services.