bluuebunny/crossref_metadata_2025 huggingface dataset:
Designing a bilingual health prevention website: challenges of using a participatory approach
Authors: Jaroof S , Cordel H , Badoro B , Felix B , Rolland M , Bourovali-Zade C , Cailhol J
Published: October 2022

Issue/problem

For some migrants, specific health information tools are needed in order to counterbalance lack of access to information both in countries of origin and of destination.

Description of the problem

Migrants originating from Pakistan and newly arrived in France are highly affected by for instance hepatitis C. Many of them have a low level of litteracy, including health litteracy. We decided to create a bilingual Urdu/French website, to provide information on hepatitis C, but also on sexual and mental health. The project was conceptualized in a participary manner, in order to fit the targeted population needs. The project started in June 2021 and the website is expected to be launched by September 2022. We report here some of the key challenges which emerged when working with such hard-to-reach community.

Results

The participatory approach involving community members consisted of 3 steps. In step 1, we confirmed content needs, and assessed preferences in terms of type of media to be used and media styles. About 30 themes were prioritized and the preferred media was video with formal style. After writing scripts, we organized focus-groups discussions to create culturally-appropriate messages. A third and last step will be the selection of titles and keywords for internet search, after shooting videos.

Lessons

Despite working closely with a Pakistani cultural association and urdu-speaking health professionnals, recruitment of community members for participating in the website design happened to be extremely difficult. Despite initial enthusiasm, interests in the project tended to decrease according to sometimes hidden motivations. Focus groups dynamics were at times affected by significant differences in social situations between participants. Despite these challenges, the participatory process allowed us to reshape part of the content according to the community's communications codes, in order to enhance the efficiency of the messages.

Key messages

• Working with socially disadvantaged community members is crucial in order to reduce social inequalities in health.

• However, caution is needed to anticipate and decrease unfulfilled expectations.
Effect of a client-accessible record on autonomy of parents and adolescents in Dutch care for youth
Authors: Benjamins J , Haveman-Nies A , de Vet E
Published: October 2022

Background

In the Netherlands, since 2015, a paradigm shift towards client-centred ‘care for youth’ initiated a focus on client autonomy, enabling clients to make informed decisions in their care process. Client autonomy is assumed to positively correlate with mental and physical health and can be strengthened by autonomy-supportive behaviour from professionals. Aiming for client autonomy, three organizations developed an electronic health record (EPR-Youth), accessible for parents and adolescents. Although research shows that patient-accessible records contribute to patient autonomy, limited research is available about use of such records among adolescents. We investigated whether use of EPR-Youth in ‘care for youth’ contributed to experienced autonomy among adolescents and parents, and what role professional autonomy-supportive behaviour played.

Methods

A mixed methods design combined baseline and follow-up questionnaires with focus group interviews, over a two-year period. Clients completed a questionnaire about experienced autonomy and portal use at baseline (1202 parents, 202 adolescents) and after one year (914 parents, 89 adolescents). Professionals completed questionnaires about autonomy-supportive behaviour at baseline (N = 100), after 5 months (N = 57) and 24 months (N = 110). After 14 months, focus group interviews were held with a purposive sample of parents (N = 8), adolescents (N = 4) and professionals (N = 12).

Results

Twelve months after introducing EPR-Youth, higher autonomy scores were found among parents (Δ = 0·23; 95%CI=0·18-0·28; p < 0·001) and adolescents (Δ = 0·53; 95%CI=0·34-0·73; p < 0·001). Portal users showed higher scores than non-users. Focus group members reported a positive effect of portal use on client autonomy, which was strengthened by professional autonomy-supportive behaviour.

Conclusions

The use of EPR-Youth was associated with increased autonomy among parents and adolescents. Autonomy-supportive professional behaviour enhanced this effect.

Key messages

• The possible contribution of EPR-Youth to client autonomy is promising, but follow-up research is needed to strengthen evidence.

• Implementation of client-accessible records with the aim to enhance client/patient autonomy needs to address autonomy-supportive professional behaviour to increase impact.
Diabetic ketoacidosis among patients admitted to a general hospital in Ethiopia: a spatial analysis
Authors: Paiola E , Sartorello A , Andreani G , Tsegaye A , Tardivo S , Manenti F , Benoni R
Published: October 2022

Non-Communicable diseases are rapidly increasing in low- and middle-income countries. The number of patients with diabetes is estimated to reach 4.7 million in Ethiopia by 2045. Ensuring access to care is critical to improving the management and clinical outcome of diabetic patients. The study describes the characteristics of patients with diabetic ketoacidosis (DKA) and evaluates the relationship between the severity of clinical presentation and the travel time to the hospital. A retrospective cohort study was conducted on the charts of patients admitted for DKA at St. Luke Catholic Hospital (SLCH), Wolisso, Oromia Region (Ethiopia), between 01/01/2021 and 31/08/2021. Demographic and clinical data were collected. Negative binomial regression was used to explore the relationship between the incidence of admissions for DKA and travel time to the hospital. Logistic regression was used to estimate the odds of insulin treatment. Results were presented with 95% confidence intervals. During the study period, 651 patients were admitted, including 77 (11.8%) for DKA (33 females (42.9%) and 44 males (57.1%)), with no differences based on diabetes type (p = 0.258). The mean age was 35 years (IQR 19.0-52.0). Mean BMI was 18.4 kg/m2 (IQR 15.6-19.5), with no differences based on diabetes type (p = 0.639). Cumulative incidence of hospitalizations was significantly correlated to travel time to the hospital (p = 0.039) with an Incident Rate Ratio of 1.01%[1.00-1.02]. The cumulative incidence ranged from 7.0%[4.5-10.3] in Wolisso to 30.8%[14.3-51.8] in Ameya, the most distant district. The relative probability of insulin treatment was higher with increasing time to SLCH (OR 1.11[1.02-1.21] p = 0.027). The hospitalization rate for DKA was significantly correlated with the travel time to the hospital. Access to care is therefore a key factor for health that should be taken into account by improvement programs and the spatial analysis of travel time could help focus on priority areas.

Key messages

• Spatial analysis can be a robust tool to tailor population healthcare needs on its own topography.

• Health policies must consider that accessibility can influence the severity of clinical presentation.
health service utilization among older population in a terai region of nepal
Authors: Subedi B
Published: October 2022

Introduction

The world is heading towards a larger proportion of older population, indicating an increased risk of diseases, disability, and advanced ageing before death as well as the demand for the health system.

Methods

This study is a community based cross-sectional study, total 329 older people aged 60 years and above were surveyed. Two stage cluster-sampling technique was used. Semi structured questionnaire was used for data collection.

Results

Current study showed that 63.3% of the older population have utilized health services in the past one year. Multivariate analysis showed that, respondents with basic education and secondary education are 0.3(AOR: 0.31, 95% CI: 0.17-0.56) and 0.14 (AOR: 0.14, 95% CI: 0.83-0.26) times less likely to utilize health services, respectively. Similarly, respondents reporting current personnel income above forty thousand are 2.8 (AOR:2.81 95% CI:1.84-4.31) times more likely to utilize health services. Respondents at risk of malnutrition are 2.1(AOR: 2.18, 95% CI: 1.14-4.17) times more likely to utilize health services, similarly undernourished respondents are 3.3 (AOR:3.35,95% CI:1.50-7.51) times more likely to utilize health services as compared to respondents with normal nutritional status. Respondents with chronic disease condition are 11.8 (AOR: 11.89, 95% CI: 6.81-20.74) times more likely to utilize health services as compared to those with no chronic disease condition when holding other variables constant.

Conclusions

There is urgent need to highlight the problems faced by the older population as regards health service utilization and dealing with the identified factors associated with health service utilization among the older population should receive high priority.

Key messages

• Municipality and health facilities should create enabling environment for older population to get necessary health services.

• Awareness program targeting the underprivileged ethnic groups and poor houses are recommended.
COVID-19 vaccination hesitancy in Kazakhstan
Authors: Mergenova G , Rosenthal S , Zhussupov B , Izekenova A , Alekesheva L , Izekenova A , Iskakova B , Myrkassymova A , Bukharbayeva A , Davis A
Published: October 2022

Background

COVID-19 vaccine hesitancy is a major problem worldwide that impedes vaccine uptake. We explored factors associated with vaccine hesitancy in Kazakhstan.

Methods

We conducted a cross-sectional face-to-face survey of 991 adults in Kazakhstan in July 2021, using quota sampling of respondents over 18 years old reflecting the distribution of gender, age, residence type, and geographical regions of Kazakhstan, according to the 2020 census.

Results

Over two third (68.4%) of the sample was vaccine hesitant; 22.11% - received a vaccine (18.6%-Sputnik V, 2%-Hayat-Vax, 0.9%-QazCovid and 0.6%- CoronaVac). We used logistic regression to explore factors that were associated with vaccine hesitancy, adjusting age, education, employment, type of residence, self-reported COVID-19. The odds of not being vaccine hesitant were higher among those who had a higher perception that the COVID-19 vaccine was important for health OR = 2.66 (95%CI:2.24,3.17), higher belief in vaccine safety/effectiveness OR = 3.16 (95%CI:2.57,3.89), higher trust in government/health providers OR = 3.32 (95%CI:2.72,4.05), higher trust in official sources of information OR = 1.16 (95%CI:1.12,1.21), higher adherence to preventive measures OR = 1.05 (95%CI:1.03,1.08), knew someone diagnosed with COVID-19 OR = 1.36 (95%CI:1.01,1.82), or who died of COVID-19 OR = 1.47 (95%CI:1.04,2.08), had been ever tested for COVID-19 OR = 1.75 (95%CI:1.30,2.35), had ever received flu vaccine OR = 2.16 (95%CI:1.62,2.88), among health professionals OR = 2.76 (95%CI:1.38,5.51), and who had lower vaccine conspiracy beliefs OR = 0.48 (95% CI:0.40,0.58).

Conclusions

Vaccine accepting individuals held positive beliefs about the COVID-19 vaccine, had greater trust in government/official sources of information/health care workers, had greater exposure to COVID-19. Interventions aimed at reducing vaccine hesitancy need to address sources people find credible and may need to target individuals who have had limited exposure to the risks of COVID-19.

Key messages

• Strategies to increase trust in government/ health care workers and official sources of information can be an effective approach to reduce COVID-19 vaccination hesitancy.

• Interventions to reduce COVID-19 vaccination hesitancy should target individuals who have had limited exposure to the risks of COVID-19.
A dynamic transmission model to calculate vaccination coverage needed to control COVID-19 in Germany
Authors: Waize M , Scholz S , Schmid-Küpke N , Koch J , Vygen-Bonnet S , Harder T , Wichmann O
Published: October 2022

Background

Control of the 2019 coronavirus disease (COVID-19) pandemic in Germany and return to pre-pandemic behaviour can only be achieved through natural or vaccine-induced immunity. Sufficient vaccine capacity promotes interest in the necessary and feasible target vaccination coverage.

Methods

An age and risk group stratified SEIR transmission model was used to assess the impact of vaccination coverage ranging 65%-95% for 12-59-year-olds and 90%-95% for ≥ 60-year-olds on COVID-19 incidence and intensive care unit (ICU) utilization between 01.07.2021-31.03.2022. Separate implementation of licensed vaccines allows to consider different efficacies, delivery rates and age-specific national vaccination recommendations. The analysis was conducted under different assumptions about contact behaviour during summer, reduction of daily contacts with increasing number of cases, daily vaccination uptake and the dominant variant. Data from the COVIMO study (N = 3004, data collection: 17.05.-09.06.2021) were used to define the population percentage willing to be vaccinated.

Results

The COVIMO study indicates an achievable vaccination compliance rate of 83.9% among 12-59-year-olds and 94.8% among those ≥ 60-year-olds. Maximum incidence or ICU utilization during observation period decreases from 385 to 61 and 6220 to 2800, respectively, with an increase in vaccination coverage from 65% to 95% of 12-59-year-olds, 90% vaccination rate among ≥ 60-year-olds, compared to pre-pandemic reduced contact behaviour in summer and reduction of contacts as case numbers increase.

Conclusions

The vaccination campaign should be continued at high intensity until at least 85% of 12-59-year-olds or 90% of ≥ 60-year-olds are fully vaccinated against COVID-19. Based on the population's willingness to be vaccinated, this goal seemed feasible.

Key messages

• Mathematical modeling was used to determine an evidence-based target vaccination coverage of ≥ 85%.

• Expertise in modeling should be further strengthened.
Case-case study on comparative vaccine effectiveness against Delta and Omicron SARS-CoV-2 infections
Authors: Kislaya I , Peralta-Santos A , Vieira L , Sousa C , Ferreira B , Pelerito A , Gomes JP , Pinto Leite P , Nunes B ,   PT COVID-19 group
Published: October 2022

Introduction

Vaccination is the primary pharmacological measure to reduce SARS-CoV-2 transmission and its complications. Timely information on vaccines effectiveness in a context of novel variants of concern (VOC) emergence is essential for public health policies. This study aimed to provide a measure of comparative vaccine effectiveness between Omicron (BA.1) and Delta (B.1.627.2) VOC according to vaccination exposure (complete primary regimen or booster dose) for Portuguese population aged 12 or more years old using routinely collected data from electronic health records.

Methods

We used a case-case study design linking national electronic vaccination registry and surveillance data on 13,134 SARS-CoV-2 RT-PCR laboratory-confirmed cases notified in Portugal during weeks 49-51 of 2021. Notified cases were classified as Omicron or Delta based on whole-genome sequencing or S-gene Target Failure (SGTF) status using the RT-PCR TaqPath™ Covid 19 CE IVD Kit (Thermo Scientific™) assay. The odds of vaccination was compared between Omicron cases and Delta cases using logistic regression adjusted for age group, sex, region and week of diagnosis and laboratory of origin.

Results

The odds of vaccination were higher in laboratory-confirmed cases infected by Omicron (BA.1) VOC compared to Delta (B.1.627.2) VOC for both complete primary vaccination (Odds ratio (OR)=2.1; 95% Confidence Interval (95%CI): 1.8 - 2.4) and booster dose (OR = 5.2; 95%CI: 3.1 - 8.8), indicating vaccine effectiveness reduction against Omicron.

Conclusions

We found significantly higher odds of vaccination in Omicron cases compared to Delta, suggesting lower effectiveness of the primary vaccination and the booster dose in preventing infections by Omicron. Case-case study design has proven to be feasible approach to rapidly compare vaccine effectiveness between VOC in context of novel VOC emergence to timely inform public health stakeholders.

Key messages

• Reduction of vaccine-induced protection against SARS-COV-2 infection with the Omicron compared to Delta after primary and booster vaccination.

• Continuous monitoring of COVID-19 vaccine effectiveness is essential to support public health policies in context of novel VOC emergence.
The impact of conscientious objection on voluntary abortion in Italy in the last two decades
Authors: Charrier L , Bo M , Koumantakis E , Zotti CM
Published: October 2022

Background

Italian Law 194/1978 legalized voluntary abortion during the first 90 days of pregnancy. Healthcare professionals can claim conscientious objection (CO), but regional governments must guarantee women's rights. In recent years, international human rights authorities argued that access to safe abortion was limited in Italy due to widespread CO.

Methods

An ecological study was conducted using 1997-2019 ministerial data on the number of gynecologists registered as conscientious objectors, the proportion of abortions performed timely (within 14 days of the request), and within 8-10 weeks of pregnancy. The extra workload for non-objecting gynecologists was calculated as the ratio between the workload for non-objectors and the (theoretical) workload for each gynecologist on duty. The correlation between the extra workload for non-objectors and the proportion of abortions performed within 14 days of the request or beyond 21, as well as the correlation between waiting time and gestational age at the time of the procedure. Data were analyzed for Italy and stratified for its 21 Regions.

Results

CO among gynecologists turned out to be stable around an average of 70% (median 69%, IQR 64-71%) in the last decades, with 62% of abortions performed within 14 days and 82% of procedures performed by the 10th week of pregnancy. In 13 regions (statistically significant in 5) the increase in workload for non-objectors was inversely correlated with abortions performed within 14 days, and directly correlated with those performed later than 21 days. In all regions (statistically significant in 18) a direct correlation was found between procedures performed timely and those performed within 8 weeks of pregnancy.

Conclusions

Data from the last 20 years confirm previous findings and CO still seems to have a strong impact on women's right to access safe and timely abortion in Italy. More efforts are needed to narrow the gap between the provisions of the law and its implementation.

Key messages

• A high proportion of objecting staff makes it difficult to guarantee women’s rights to access timely and safe abortion.

• Effective organizational strategies and a proper legal framework are needed to cope with the high percentage of conscientious objectors among health professionals.
Factors influencing the first thousand days of life
Authors: Capitani E , Lorenzini C , Biuzzi A , Alaimo L , Messina G , Nante N
Published: October 2022

Background

The first 1000 days are crucial for the health of the baby and the well-being of the mother-baby dyad, which forms a single complex organism with its co-metabolism expressed through sophisticated neurobiological, epigenetic and microbiome development mechanisms. This study aims to investigate how much social support can influence the path of pregnancy and motherhood.

Methods

The retrospective observational study was conducted on a sample of mothers enrolled through social networks who were administered a questionnaire from July to September 2021. The questionnaire consisted of 37 questions: 11 analyzed sociodemographic variables, 20 were on current / any previous pregnancies and breastfeeding, and 6 were used to calculate the Maternity Social Support Scale (MSSS-Webster et al.). STATA 14 was used for statistical analysis.

Results

Our sample consisted of 3447 women. 88.0% wanted the pregnancy, and 63.5% planned it. The average of the Maternity Social Support Scale (MSSS) was 23.91 points. A low MSSS score correlates with a higher risk of cessation of breastfeeding before 6 months of age, a higher risk of not having spontaneous labour, a higher risk of cesarean section and a higher risk of not having a spontaneous birth. On the other hand, a higher MSSS total score is a protective factor concerning breastfeeding duration, which is more likely to be longer-lasting (>6 months), to have spontaneous onset labour with a higher probability of spontaneous delivery.

Conclusions

The results showed that most of our sample have good friends who support them, can often count on their family, and receive help from their partner/husband. The outcomes of pregnancy, childbirth and motherhood are strongly influenced and conditioned by the social context in which they occur and the support the woman can receive. The presence or lack of this support can affect the health of newborns.

Key messages

• The first 1,000 days is a vulnerable phase in which parents, institutions and health professionals should create early interventions for the proper development and promotion of good health.

• the outcomes of pregnancy, birth and motherhood are strongly influenced and conditioned by the social context, but especially by the presence or lack of support that can affect the health of newborns.
11.A. Workshop: Leveraging meso-level data to advance population health in Europe: further directions
Authors:   Organised by: Montpellier University Hospital (France),   Chair persons: Gregoire Mercier (France)
Published: October 2022

Health services and public health researchers provide timely and critical evidence to answer real-world policy questions and work extensively with policymakers at the macro, meso and micro levels of government. One goal shared by researchers and policymakers is to foster evidence-informed policy and program development to ensure that policy initiatives provide the greatest benefit possible to individuals and society. Among other sources of data, meso-level datasets are usually comprising contextual data aggregated at various geographical areas such as cities, counties, and regions. Although meso-level data are sometimes used as proxies for individual level data, they can also be used to explore complex questions at the population level. This workshop aims to provide a unique, interprofessional, European conversation about how to translate meso-level research evidence into meaningful insights or recommendations. It brings together a group of high-level people from academia, think tanks, and companies who are involved in generating, transferring, or using meso-level evidence to inform public health and health care policy in Germany and France. In the first presentation, Schüttig et al. use district-level data from Germany to suggest that increased spending and improved continuity of care may be effective ways to reduce the rate of potentially avoidable hospitalizations among patients with type 2 diabetes. Then, Mercier et al. analyze department (district)-level data from France to quantify the impact of the population-based prevalence of diabetes and psychiatric conditions, of air pollution, of socio-economic variables, and of meteorological factors on the spread of COVID-19 during the first lockdown. Rodts et al, in a collaboration between a think tank and a small company, use a broad set of district-level variables to classify French ‘departements’ into homogeneous clusters in terms in needs and explore the discrepancies between total health care spending and needs at the population level. Finally, Mâlatre-Lansac et al. build on these studies to discuss how data can be used to inform public health and health care policy making in Europe. In addition, they suggest future directions to improve meso-level data-driven policy at the local, national, and European levels. Beyond methodological points, the discussion will address ethical issues in the use of meso-level data, and how to improve the availability of data, and the ability of local, regional, and national policymakers to use research evidence efficiently. It is designed as a regular workshop with 4 presentations (10 minutes each), ample audience interaction through Q&A after each presentation and one freehand poll in the introduction of each presentation.

Key messages

• Meso-level data can be efficiently leveraged to inform health care policy.

• Further efforts need to be taken to address the information needs of policymakers.
Trans fatty acid intake and risk of type 2 diabetes in the NutriNet-Santé prospective cohort
Authors: Wendeu-Foyet G , Bellicha A , Chajes V , Huybrechts I , Debras C , Srour B , Sellem L , Fezeu L , Deschasaux-Tanguy M , Touvier M
Published: October 2022

Type 2 diabetes (T2D) is one of the most common noncommunicable diseases worldwide, with an increasing prevalence and a considerable global health burden. Substantial evidence has linked consumption of trans fatty acids (TFAs) to an increased risk of cardiovascular disease. However, the effects of T2D remain unclear. We aimed to investigate the associations between different types of TFAs (total, ruminant, industrial and corresponding specific isomers) and risk of T2D in the NutriNet-Santé prospective cohort. Overall, 105,551 participants aged 18 years or older from the French NutriNet-Santé cohort (2009-2021) were included (mean age at baseline=42.7y (SD = 14.6y), 79.2% women). Dietary intake data, including usual TFA intake, were collected using repeated 24-hour dietary records (n = 5.7 [SD = 3.1]). Associations between sex-specific quartiles of dietary intake of TFAs and type 2 diabetes risk were assessed using multivariable Cox proportional hazard models adjusted for known risk factors. A total of 969 incident type 2 diabetes cases occured during follow-up. Total TFAs was associated with higher T2D risk (HRfor quartile 4 versus 1=1.38; 95% CI = 1.11-1.73; Ptrend<0.001). This association, specifically observed for industrial TFAs (HR = 1.45; 95% CI = 1.15-1.83; Ptrend<0.001), was mainly driven by elaidic acid (HR = 1.37; 95% CI = 1.09-1.72; Ptrend<0.001) and linolelaidic acid (HR = 1.29; 95% CI = 1.04-1.58; Ptrend=0.07). In contrast, ruminant trans fatty acids were not significantly associated with the risk of T2D. In this large prospective cohort, higher dietary intakes of total and industrial TFAs were associated with increased T2D risk. These findings support WHO's recommendation to eliminate industrially-produced TFAs from the food supply worldwide. As such, consumers should be advised to limit the consumption of food products containing partially hydrogenated oils (main vector of iTFAs) as this, specifically, may contribute to lower the substantial global burden of T2D.

Key messages

• Higher dietary intakes of total and industrial trans fatty acids were associated with increased type 2 diabetes risk.

• Our findings support WHO’s recommendation to eliminate industrially-produced TFAs from the food supply worldwide.
Anemia in children aged 6 to 59 months attending a quaternary health facility in Maputo, Mozambique
Authors: Maulide Cane R , Keita Y , Varandas L , Craveiro I
Published: October 2022

Background

Globally, anemia prevails as a public health issue, being also a concern in Mozambique, where about two-thirds of children 6-59 months of age are affected by anemia. We carried out this study to estimate anemia prevalence and evaluate structural determinants and hematological parameters association among children aged 6 to 59 months attending pediatric inpatient and outpatient services in a Quaternary Health Facility in Maputo City Province, Mozambique.

Methods

From August 2021 to January 2022, we conducted a cross-sectional study at the ‘Maputo Central Hospital’ where we collected data from 397 inpatients or outpatients who attended pediatric consultations. The cut-off values for anemia were: mild (10g/dL≤Hb≤10.9g/dL), moderate (7g/dL≤Hb≤9.9g/dL), severe (Hb < 7.0g/dL). We used SPSS 28.0 software to perform descriptive analyses and Chi-Square tests.

Results

Our preliminary findings show that the total rate of positive cases was 30.0% moderate anemia (119/397), 23.9% mild anemia (95/397), and 7.3% severe anemia (29/397). Anemia frequencies were higher in male patients unregarding the type (54.2% moderate, 62.1% mild, 67.9% severe). Anemia prevalence was higher among children aged 24-59 months (41.2% moderate, 47.4% mild, 51.7% severe; p < 0.05). The rate of all anemia types was higher in children from rural areas and Maputo City province relative to those from urban areas and other country provinces. The level of education of the child's companion to the consultations was associated with anemia (p ≤ 0,05), with higher rates observed in secondary level education. We observed no association between iron or serum ferritin values to anemia.

Key messages

• Children aged 24-59 months, children from rural areas, and who are male are more vulnerable to suffering anemia than their peers, thus needing more monitoring during their growth.

• Nutritional-anemia-specific interventions targeting the first 1000 days of life may be helpful to its reduction in children.
Childhood trauma, depression, and the risk of incident prediabetes in young adults: findings from the Lifelines Cohort Study
Authors: Deschenes S , Nearchou F , McInerney A , Schmitz N , Nouwen A
Published: October 2022

Background

Childhood trauma and depression have been shown to increase the risk of type 2 diabetes. However, many studies have focused on middle-age and older adults, with less known on the role of these variables in early glucose dysregulation. The goal of the study was to examine childhood trauma, depression, and their interactions, as risk factors for the onset of prediabetes in young adults.

Methods

Data were from the Dutch Lifelines Cohort Study. N = 8,650 adults (61% female) between 18-35 years without prediabetes/diabetes at baseline (2007-2014) were included. Childhood trauma was assessed using the Childhood Trauma Questionnaire. Depression was assessed using the Mini International Neuropsychiatric Interview. Prediabetes at follow-up (2014-2017) was considered by haemoglobin A1c levels between 5.7%-6.4%. Logistic regressions examined associations between depression and childhood trauma with the risk of incident prediabetes. Odds ratios (OR) and 95% confidence intervals (CI) for unadjusted analyses and analyses adjusted for age, sex, education, ethnicity, body mass index, smoking, and alcohol use (reduced adjusted sample size; n = 7,186) are presented.

Results

244 participants (2.8%) developed prediabetes. In univariate analyses, childhood trauma (OR = 1.02, CI = 1.01-1.03, p=.006) and depression (OR = 2.08, CI = 1.01-4.29, p=.048) predicted incident prediabetes. When childhood trauma subscales were examined, only sexual abuse significantly predicted incident prediabetes. In adjusted analyses, only childhood trauma, specifically sexual abuse, significantly predicted incident prediabetes (OR = 1.06, CI = 1.01-1.12, p=.021). No multiplicative interaction between depression and childhood trauma was found.

Conclusions

Young adults who have experienced childhood trauma, particularly sexual abuse, may be at risk of glucose dysregulation in early adulthood. Early targeted preventive care may help attenuate or halt glucose dysregulation and the development of type 2 diabetes.
Health literacy among migrants in Germany – results of the quantitative cross-sectional HLS-MIG study
Authors: Berens E-M , Klinger J , Carol S , Schaeffer D
Published: October 2022

Background

Health literacy (HL) is considered an important prerequisite for health. HL research often identifies migrants as vulnerable for low HL. However, in-depth data on HL among migrants and its determinants are still scarce, especially in Germany. Therefore, the analysis presents first time data on HL among migrants in Germany, specifically in the domains of health care, disease prevention and health promotion, considering migrant-specific and universal factors, such as social and psychological aspects.

Methods

Around 1.000 first- and second-generation adult migrants from two of the largest migrant groups in Germany, from Turkey and former Soviet Union (FSU), were interviewed face-to-face in German, Turkish or Russian in late summer 2020. HL was measured using the HLS19-Q47 instrument. Bi- and multivariate statistical analyses were conducted.

Results

More than half of the migrants have limited general HL on average. HL in disease prevention and health promotion was lower than in health care. Low social status, financial deprivation, low literacy skills and low self-efficacy were negatively correlated with each HL domain. Social integration, by contrast, goes along with a higher HL. Duration of stay in Germany and country of origin were only partly associated with HL.

Conclusions

Our study goes beyond existing studies by analyzing HL in its domains and including the explanatory power of self-efficacy and social integration for migrants’ HL. Moreover, we reveal that migrants can't generally be considered as vulnerable, as oftentimes outlined. There is need for targeted interventions, e.g. enhancing usability of health information, for the abovementioned subgroups regarding differences in domains.

Key messages

• HL among migrants varies across domains and is only partly linked to migrant-specific features but mainly associated with universal aspects.

• Measures to increase HL should consider differences in domains and address vulnerable subgroups including targeted interventions, respectively.
Exploring the involvement of representatives of migrant groups in health research
Authors: Lampa E , Sarkadi A , Osman F , Tökés A , Johansson N , Warner G
Published: October 2022

Background

Public involvement in research is increasingly utilised, but has been problematised for lack of diversity. Involving representatives from seldom-heard groups, such as the migrant population, has the potential to transform health research for some of Europe's most disadvantaged groups.

Methods

We have explored involvement of migrants in health research projects in Sweden, through a three-year longitudinal qualitative study with migrant contributors involved in a child mental health trial, and a series of behavioural observations of research meetings in several projects with migrant contributors.

Results

The migrant contributors were initially hesitant to trust the researchers. However, through relationship-building and time, mutual trust was established. The contributors gained a social network in each other and the researchers, and their motivation for involvement changed over time, from focussing on individual benefits to societal change. They viewed their role as sharing their experiences, but saw researchers as in control of the final research decisions. Behavioural observations identified barriers to contributors’ access to information in the meetings, such as academic terminology and difficulties in language interpretation. Enabling factors included balancing the presence of experts in the meeting as well as flexibility towards contributors’ needs and initiatives. Additionally, transparency around the research process and providing feedback to the contributors functioned as enablers for involvement.

Conclusions

This longitudinal qualitative inquiry paired with behavioural observations, revealed that when involving migrants as public contributors in research, time and resources should be focused on relationship building, to increase mutual trust and understanding, and careful planning undertaken to make the research process transparent and accessible for the contributors.

Key messages

• Involving migrants in research has great potential – but requires careful planning and consideration.

• Awareness of barriers and enablers can assist researchers in attaining meaningful involvement.
Public knowledge of chronic kidney disease in Portugal: a quantitative approach
Authors: Pedro AR , Avelar FG , Raposo B , Boleu A , Silva S , Henriques S , Martinho H
Published: October 2022

Background

Chronic kidney disease (CKD) has increased progressively worldwide, however evidence on public awareness highlights gaps for a comprehensive public health strategy. This study aims to evaluate public knowledge and possible lack of awareness about CKD in Portugal.

Methods

Cross-sectional study conducted through community based online survey (n = 1209). It was applied the CKD Knowledge Questionnaire and a score was calculated from 24 items categorized in 5 dimensions. Bivariate analyses was performed using one-way ANOVA and independent T-tests, at a 5% significance level, to compare the effect of independent variable and score.

Results

A total of 1209 respondents with mean age 50 years (±15.1), 74.1% of female, 62.6% married or living with a partner, 55,7% at least university level. The mean (SD) public knowledge of CKD score was 14.30 (±3.4). The dimension “Functions of kidneys perform in the body” presented the lowest percentage of correct answers (48.9±19.5) while “Following are commonly used to determine health of the kidney” the highest percentage (71.3±22.4). Results of the bivariate analysis showed significant associations with gender (p < 0,001), marital status (p = 0,019), education (p < 0,001), high blood pressure (p = 0,020), personal history of kidney disease (p < 0,001), familiar history of kidney disease (p < 0,001), access to healthcare (p = 0,049), follow-up with a healthcare professional (p = 0,023), use of urgent care or hospital urgency (p = 0,020) and use of medical specialty appointments (p < 0,001).

Conclusions

People living in Portugal revealed a middle knowledge level. Knowledge higher scores were observed in female, people with higher level of education, with experience imposed by health condition (e.g., risk factors or history disease), and access to health services. Future health education focused on ‘Functions of kidneys perform in the body’ might be an important contribution to increase health literacy about CKD.

Key messages

• Social vulnerabilities may be associated with lower levels of public knowledge of Chronic Kidney Disease.

• The evaluation of population’s knowledge about CKD is an important instrument for public health policy-making.
Diversity competence: what should be prioritised in an online course? An adapted delphi study
Authors: Sorensen J , Michaëlis C , Møller Olsen JM , Krasnik A , Bozorgmehr K , Ziegler S
Published: October 2022

Background

Population diversity is a reality in our societies and requires health systems and health professionals to adapt to the needs of diverse patient groups, including migrants and ethnic minorities. This study aims to investigate topics and methods that should be prioritised in an online course on diversity competence in healthcare delivery to improve health care encounters and provide health services that meet the unique needs of all patients in order to reduce health disparities.

Methods

The study uses an adapted Delphi method including two rounds, combining some open-ended questions with pre-defined items, asking 31 European academic experts and health professionals within the field of migrant health to rate training content and teaching methods. Consensus for training topics was set to 80% and for teaching methods 70%.

Results

The only item reaching 100% consensus as being important or very important to include was ‘health effects of migration (pre-, mid- and post-migration risk factors)’. Other high-scoring items were ‘social determinants of health’ (97%) and ‘discrimination within the healthcare sector’ (also 97%). A general trend was to focus more on reflective practice since almost all items in the reflection section reached consensus. ‘Reflection on own stereotypes and prejudices’ reached the highest consensus in this section (97%).

Conclusions

Experts’ prioritisations of teaching content and methods for diversity training can help the design of short online trainings for health professionals and reduce extensive course content, thereby fostering professional development and enabling diversity competence trainings to be implemented in cases of scarce resources.

Key messages

• Trend toward more focus on ‘diversity’ and less focus on ‘culture, and the inclusion of social determinants of health and awareness of stereotypes and bias in training of health professionals.

• Diversity competence training should use reflective exercises and activities as teaching methods in online training.
Reactive surveillance of suicides during the COVID-19 epidemic in France, 2020- March 2022
Authors: Fouillet A , Martin D , Pontais I , Caserio-Schönemann C , Rey G
Published: October 2022

Background

Mitigation actions during the COVID-19 pandemic, in particular lockdowns and curfews, may impact mental health and suicide in general populations. We aimed to analyse the evolution in suicide deaths from January 2020 to March 2022 in France.

Methods

Using free-text medical causes in death certificates, we built an algorithm, which aimed to identify suicide deaths. We measured its retrospective performances by comparing suicide deaths identified using the algorithm with deaths which had either an ICD10 code for ‘intentional self-harm’ or for ‘external cause of undetermined intent’ as underlying cause. The number of suicide deaths from January 2020 to November 2021 was then compared with the expected number estimated using a generalized additive model. The analysis was stratified by age group and gender. Analysis from December 2021 to March 2022 was conducted using electronic death certificates only.

Results

The free-text algorithm demonstrated high performances. From January 2020 to November 2021, suicide mortality declined during France's three lockdowns, particularly in men, and remained quite comparable with expected values between and after both of the country's lockdowns. Provisional results based on electronic death certificates suggest that suicide mortality remained stable until March 2022.

Conclusions

Monitoring suicide mortality is possible in France with a 4-month delay; this will be reduced to two days when electronic death certification is fully deployed. This study highlighted the absence of an increase in suicide mortality during France's COVID-19 pandemic, and a substantial decline during lockdowns periods, something already observed in other countries. Further studies are required to explain the factors for this decline.

Key messages

• In the absence of reactive coding of medical causes of deaths, the study proposed an approach to reactively identify suicide based on free-text medical causes from death certificates.

• Our findings provide reassurance that the COVID-19 pandemic has not had a negative impact on the general population in terms of suicide in France from March 2020 to September 2021.
The global burden of neglected zoonotic diseases: current state of evidence
Authors: di Bari C , Venkateswaran N , Pigott D , Flastl C , Devleesschauwer B
Published: October 2022

The majority of emerging infectious diseases are zoonoses, most of which are classified as “neglected”. By affecting both humans and animals, zoonoses pose a dual burden. The disability-adjusted life year (DALY) metric quantifies human health burden using mortality and morbidity. This review aims to describe and analyze the current state of evidence on the burden of neglected zoonotic diseases (NZDs) and start a discussion on the current understanding of the global burden of NZDs. We identified 26 priority NZDs through consulting the CDC One Health Zoonotic Disease Prioritization Exercise, the Joint External Evaluation reports, and the WHO roadmap for NTDs. A systematic review of global and national burden of disease (BoD) studies for these priority NZDs was conducted using pre-selected databases. Data on diseases, location and DALYs were extracted for each eligible study. A total of 1887 records were screened, resulting in 72 eligible studies (58 national or sub-national, 12 global, and 2 regional studies). The highest number of BoD studies was found for non-typhoidal salmonellosis (23), whereas no estimates were found for West Nile, Marburg and Lassa fever. Geographically, the highest number of studies were found in the Netherlands (11), China (5) and Iran (4). The number of BoD studies retrieved mismatched the perceived importance in national prioritization exercises. For example, anthrax was considered a priority NZD in 73 countries, but only one national estimate was retrieved. By summing the available global estimates, these diseases would cause at least 10 million DALYs in total. The burden of NZDs at the global level remains scattered, and trends were challenging to identify. There are several priority NZDs for which no burden estimates exist, and the number of BoD studies does not reflect national disease priorities. To have complete and consistent estimates of the global burden of NZDs, these diseases should be integrated into larger global BoD initiatives.

Key messages

• There is a mismatched between the estimated retrieved in the search and the perception of the importance of these disease. This amplify the need for a comprehensive program.

• No complete list of zoonoses exist, and the definition used is vague. A stricter definition of zoonoses and what defines them will help provide a clear view of dealing with and controlling them.
Comparison between recommended and mandatory vaccine uptake during adolescence in Italy
Authors: Caracciolo MR , Angelillo S , Ficara F , Venturi D , Licata F , Bianco A
Published: October 2022

Background

Immunization programs are key preventive interventions and have largely contributed to reducing the burden of infectious diseases and decreasing related morbidity, mortality and healthcare costs. The study aimed to investigate coverage regarding diphtheria, tetanus, and acellular pertussis (dTap) - Inactivated Poliomyelitis Vaccine (IPV) and Human Papilloma Virus (HPV) vaccine and attitudes towards vaccinations among undergraduate university students in Southern Italy.

Methods

This cross-sectional study was conducted among 327 students through an anonymous online questionnaire and included socio-demographic characteristics, attitudes towards vaccinations overall and specifically on dTap-IPV and HPV, reasons for having received or not vaccinations and willingness to receive vaccinations.

Results

One third of the students were concerned about serious adverse effects of vaccines and 95% believed that vaccines for uncommon diseases are useless. During adolescence, 89% of the sample received the mandatory dTap-IPV vaccine booster. Among unvaccinated students, 45% were unwilling to get vaccinated against dTap-IPV because they believed not to be at risk of infection (59%) and had lack of recommendation (35.3%). Regarding vaccination against HPV, 67% had received the recommended schedule. Among those who did not receive it, 34% were unwilling to get vaccinated because they did not feel at risk of HPV infection (41%). Interestingly, 16% of the sample disclosed some barriers to access vaccination centers. Moreover, 30% declared that HPV vaccination was discouraged by healthcare professionals (HCPs).

Conclusions

Vaccination uptake is worryingly low and national objective coverage seems not still achieved. Likewise, risk perception of vaccine-preventable diseases was low and it seems negatively impact on the intention to get vaccinated. Improving vaccine confidence among HCPs is crucial as they have been shown to have the potential to influence patient vaccination uptake.

Key messages