bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of COVID-19 outbreak on emergency department attendances in an Italian academic hospital
Authors: Poletto M , Perri G , Malacarne F , Bianchet B , Doimo A , Deroma L , Lattuada L
Published: October 2020

Background

Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was discovered during the 2019 outbreak in Mainland China and the first cases were reported in Italy on February 21, 2020. This study evaluates the emergency department (ED) attendances of an academic hospital in northern Italy before and after media reported the news of the first infected patients in Italy.

Methods

Adult attendances in ED in February 2020 were analysed dividing the period into 4 weeks (days 1-7, 8-14, 15-21, 22-28) compared with the same periods in 2019. The visits were analysed separately according to the Italian colour code of triage: white (non-critical), green (low-critical), yellow (medium critical), red (life-threatening). The mean weekly number of attendances was compared with t-test.

Results

February 2020 total ED attendances compared with February 2019 were 4865 vs 5029 (-3.3%), of which white codes were 834 vs 762 (+9.4%), green 2450 vs 2580 (-5.0%), yellow 1427 vs 1536 (-7.1%), red 154 vs 151 (+2.0%). February 2020 weekly mean ED attendances compared with February 2019 had statistically significant difference only in the fourth week (days 22-28) for green codes (75 vs 92, p = 0.007) and yellow codes (41 vs 52, p = 0.047), not for white (27 vs 26, p = 0.760) and red codes (5 vs 5, p = 0.817). The first three weeks of February 2020 compared with 2019 showed no statistically significant difference in weekly mean ED attendances.

Conclusions

There was a significant reduction of green and yellow codes attendances at ED in the fourth week of February 2020, corresponding to the initial phase of Italian COVID-19 outbreak. The fear of contracting SARS-CoV-2 by attending the ED probably acted as a significant deterrent in visits, especially for low and medium critical patients. Additional data are required to better understand the phenomenon, including the behaviour of non-critical attendances.

Key messages

A reduction of green and yellow codes attendances was reported during initial phase of COVID-19 outbreak in an Italian academic hospital. Fear of contracting COVID-19 infection in a hospital setting could impact on emergency department attendances.
Beyond COVID-19: a cross-sectional study in Italy exploring the Covid Collateral Impacts
Authors: Gualano M R , Corradi A , Voglino G , Bert F , Siliquini R
Published: October 2020

Background

The COVID-19 pandemic is a calamity affecting many aspects. In particular healthcare services (HCS) are facing a great stress-test worldwide. The present work aims to explore what were health needs, beyond COVID, not covered among Italian citizens, due to fear, lockdown measures and overload of HCS, also in order to understand if there are specific subgroups of populations that will need urgent access to health services in the next future.

Methods

COCOS (COvid COllateral impactS) is a cross-sectional study performed during the Italian lockdown between April and May 2020. A forty-nine items online questionnaire was filled by the respondents. Participation was voluntary and without compensation. Informed consents were obtained. Descriptive, univariable and multivariable (logistic regression models) analyses were performed: results are expressed in ORs.

Results

Totally, 1,515 questionnaires were collected. Median age was 42 years, 65.6% were females. Around 22% declared to suffer from chronic diseases. Interestingly, 32.4% of the sample faced a delay of a scheduled Medical Service (MS) by provider decision, while 25.6% reported that this issue hit a family member. More than 13% refused to access scheduled MS for the fear of contagion, and the 6.5% avoided HCS even if having an acute onset issue: this behavior was associated with scarce trust in physicians (AdjOR 0.75); alarmingly, 1.5% avoided Emergency Department when in need and 5% of the sample took medications without consulting any physician: patients suffering from chronic conditions resulted to be more prone to self-medication (AdjOR: 2.16; 95% C.I.: 1.16-4.02).

Conclusions

COVID-19 immediate effects are just the tip of the iceberg. Large groups of population suffered delays and interruptions of medical services, and the most vulnerable were the most affected. To estimate the effects of the pandemic on non-COVID-19 patients is required, leading to aimed efforts, to reduce the backlog that HCS incurred in.

Key messages

COVID-19 biggest toll on public health is still to come if not prevented, due to temporary but widespread suspensions of scheduled medical services and the avoidance of these for fear of contagion. The most in need are the most vulnerable: older patients and those with chronic conditions are the most affected by suspension of medical services and will potentially pay the greatest cost.
Exposing the tactics of alcohol companies
Authors: Moore AM M
Published: October 2020

Background

The alcohol industry has taken a page from the tobacco industry play book in an attempt to resist regulation through delay, self-regulation and effective lobbying. The global alcohol industry is constantly seeking to increase sales of harmful products through widespread marketing, the targeting of young people, and resisting regulatory action.

Methods

An assessment of the number of lobbyists engaged in one form of another to influence members of Parliament in Australia is being conducted to provide an insight into the attempts to influence alcohol policy. This follows a scan of the lobbyists' register by Daube et al in 2018 that found the while the tobacco industry had 20 direct lobbyists and 14 indirect, the junk food industry 33 direct and 13 indirect, the most dominant was the alcohol industry with 43 direct and 23 indirect. A careful re-examination of the register in 2020 is expected to reveal an increase in these numbers. There will also be an examination of the State and Territory registers in an attempt to understand the overall numbers of people specifically attempting to influence governments.

Discussion

This particular examination is focussed on the Australian Parliament/s. However, the message will be similar world-wide. Companies such as Diageo have a significant share of the world market with net sales, for example, being 25% of scotch, 16% of beer and 11% of vodka. Their “Drinkiq” website claims “Diageo is committed to preventing and reducing alcohol abuse around the world”. However, other business websites illustrate that their prime objective is to sell more alcohol.

Presentation

The presentation will focus on the importance of countering the efforts of industry in increasing availability of alcohol. It will also provide a series of steps that public health advocates can take in order to persuade governments of the importance of protecting community health through appropriate regulation of the marketing and sales of alcohol.

Key messages

The alcohol industry seeks to increase sales while arguing it is protecting health. Public health advocates do have the tools to counter approaches by alcohol companies.
Changes in industry interference in policy in the United Kingdom 2017-2020
Authors: Chamberlain P , Gilmore A , Silver K , Zatoński M , Laurence L , Alebshehy R
Published: October 2020

Background

The Tobacco Industry Interference (TII) Index evaluates the implementation of FCTC Article 5.3. The first edition of the Global TII Index was published in 2019, included 33 countries, and covered the years 2017-2018. A second edition, covering 2018-2019, is scheduled to be published in October 2020. This paper reports on findings of the Index for the UK, the changes observed between 2017 and 2020, and the resulting policy recommendations.

Methods

The UK Index was based on a questionnaire covering different forms of tobacco industry interference. Lower scores indicate better compliance with Article 5.3. In order to complete the questionnaire, an expert consultation was conducted with UK's leading tobacco control specialists. This was supplemented by a scoping review of academic literature, media websites, government websites, and the Tobacco Tactics resource.

Results

In the 2019 Index the UK has achieved the lowest score among 33 countries surveyed. Strengths of the UK system included the exclusion of TI from government bodies that set public health policy and from FCTC COP delegations; the obligation of the government to publish information on all meetings with TI; and guidelines stipulating that its diplomats must not engage on behalf of TI. Nevertheless, weaknesses were also identified; including only partial implementation of the above obligations, the absence of an effective lobbying register, and the ongoing involvement of parliamentary consultative bodies, individual politicians and political parties with TI and affiliated organisations.

Discussion

The change of government in the UK in 2019, the shifting policy framework resulting from Brexit, and the increasing use by the tobacco industry of third parties to access policymakers, bring new challenges to the maintenance of robust Article 5.3 compliance. The presentation will analyse how this has affected the change in the UK's performance between the 2019 and the 2020 Tobacco Industry Interference Index.

Key messages

The need to strengthen transparency regulations for policymakers. A need for continued monitoring against an agreed framework in the light of very fluid political developments.
Moving out of the silos: from nursing homes clinical narratives to salient features of care
Authors: Delespierre T , Sabbar H , Haÿ P-E
Published: October 2020

Background

Korian® group is specialized in care and support for fragile people. Its professional data warehouse (DWH) is operational today in 300 French nursing homes (NH). The transmissions' table, daily-fed by caregivers, contains key data about residents' care and health. Thanks to long-term stays and substantial available data, we can build residents' life trajectories. In the past, we designed syndromes such as falls, flu, acute gastro enteritis and emergency calls by using the standard query language (SQL) but now we want to go further, analyzing the caregiver's feelings about residents' health. We will show here that our method involving syndromes' approach and then, sentiment analysis can improve residents' life prediction and achieve transparency and interpretability of the whole data flow process.

Methods

First, we selected all residents with at least one transmission over the last six weeks of 2014. Second, we extracted among them those having at least one transmission over the last six weeks of 2018, the 'survivors', and those found dead before, the 'deceased'. Third, we extracted both groups' transmissions over a 60 days period, removed the 'syndromic' ones and gave small subsets of the remaining ones, after anonymization and random sampling, to the Korian® physicians' network to classify into four features. Then, we completed this qualitative data with scores such as the autonomy level (AL = 1-6 higher the better), to build sentiment analysis but also new 'opinion' syndromes with SQL.

Results

We found, among 12,278 residents living in 155 NH in 2014: 3,075 survivors with 82% women (mean age = 85.3, AL = 3), 18% men (mean age=79.7, AL = 3.2) with 9,687 syndromes among 84,416 transmissions.2,900 deceased with 72% women (mean age = 88.7, AL = 2.3), 28% men (mean age=86.5, AL = 2.3) with 11,305 syndromes among 109,073transmissions.

Conclusions

We are confident that our interdisciplinary sentiment analysis will deepen the quantitative aging process understanding.

Key messages

After SQL procedures to extract syndromes, we moved health-transmissions data out of the silos and gave it to our physicians’ network for further analysis designing a truly interdisciplinary approach. The transmissions’ table with its nursing care narratives textual content can help us track every resident through time and space, define health features and deepen residents’ aging process knowledge.
Home and workplace neighborhood SES and behavior-related health: a within-individual analysis
Authors: Raza A , Hanson L M , Westerlund H , Halonen J
Published: October 2020

Background

Although the influence of individual and home neighborhood socioeconomic status (SES) on health-related behaviors has been widely studied, majority of the evidence is from cross-sectional studies. Moreover, studies on associations of workplace SES with health-related behaviors are almost non-existent.

Objective

To investigate associations between home and work neighborhood SES and behavior-related health in gainfully employed individuals.

Methods

Participants were from the Swedish Longitudinal Occupational Survey of Health with response to minimum two surveys between 2012 and 2018. We had 13163 individuals with complete data on exposure and covariates with total of 36925 observations. Neighborhood SES was determined as an index using mean income, education attainment, and unemployment rate within a 500 m buffer around home and workplace address. We used fixed effects method with conditional logistic regression to investigate longitudinal within-individual associations for home, workplace and their weighted summary neighborhood SES with self-reported obesity, physical activity, smoking, excessive alcohol consumption, sedentary lifestyle, and sleep problems. We included age, marital status, individuals' occupational position, presence of children, chronic disease, depressive symptoms, and work strain as covariates.

Results

The workers were more likely to consume alcohol excessively when their workplace was located in the highest SES area compared to time when their workplace was located in the lowest SES area (adjusted odds ratio 1.98; 95% confidence interval 1.12-3.49). Contrarily, socioeconomic status of home neighborhood was observed to be associated with low alcohol consumption. We observed no associations for other behavior-related health outcomes.

Conclusions

These within-individual comparisons suggest that having workplace in a high SES area may be favorable for excessive alcohol consumption.

Key messages

Workplace in a high socioeconomic area may be favorable of excessive alcohol consumption, while such association were not observed for home neighborhood. Consideration of work neighborhood SES along with home neighborhood SES and individual variables can enhance our understanding of the influence of environments on health behaviors.
Alcohol-related mortality in Czechia in a comparative view of European countries
Authors: Kulhánová I , Kážmér L , Lustigová M
Published: October 2020

Background

Alcohol consumption is an important risk factor of mortality. Czechia is a country with one of the highest alcohol intake in Europe. The severity of the alcohol-related consequences depends on the volume of alcohol consumption over time, the pattern of drinking and the quality of alcoholic beverages. The aim was to analyse the temporal changes of premature mortality related to alcohol in Czechia and compare these changes with other European countries.

Methods

Mortality data by sex, age and cause of death were obtained from the Czech Statistical Office and the WHO Mortality Database for the years 1999-2016. The main alcohol-related causes of death investigated in this study were alcoholic psychosis, dependence, and abuse, alcoholic liver cirrhosis, accidental poisoning by alcohol, and alcoholic cardiomyopathy. We calculated the age-standardized mortality rates (per 100,000) using the European Standard Population. The analysis was limited to the age group of 25-64 years.

Results

Relatively stable rates of premature mortality related to alcohol were observed in the last decade in Czechia. With respect to gender, mortality rates of alcohol-related causes were about three times higher among Czech males, as compared to Czech females. Alcoholic liver disease accounted for more than half of the alcohol-related mortality in both sexes.

Conclusions

Compared to other European countries, Czechia has high burden of alcohol-related mortality. However, it follows similar patterns as other central and eastern European countries. In order to reduce this burden, it is necessary to strengthen alcohol-related policies to decrease the alcohol consumption in Czechia.

Key messages

The high intake of alcohol in Czechia implies the high alcohol-related mortality. The alcohol-related mortality remained stable in Czechia over the observed period.
Education, experienced harm from others’ drinking and personal alcohol consumption
Authors: Berg-Beckhoff G , Stock C , Bloomfield K
Published: October 2020

Background

Risky alcohol consumption is associated not only with harm to the drinker, but also to those in the drinker's environment. Recent research has begun to examine the extent of such harm from others' drinking. In this study, we examined whether education functions as an effect modifier on the association between experienced harm from others' drinking (EHFOD) and risky alcohol use.

Methods

Data from the 2011 Danish national alcohol and drug survey (n = 5133) were linked with data from Statistics Denmark. Survey response rate was 64%. Data on various alcohol use indicators were collected via internet questionnaires or telephone interviews. EHFOD was based on 8 indicators of harm from drunken people (e.g. being insulted, property damaged, being physically harmed). We grouped EHFOD into hassles, harassment or harm/damage. Multiple logistic regression was used to examine the association between EHFOD and own drinking behavior, stratified by sex and education. Covariates included age, employment status, rural residence, income and civil status.

Results

One-year prevalence of EHFOD was 50%. We found a positive and significant relationship between own alcohol consumption and harassment as well as harm/damage. Effect modification of education was significant for harassment. Odds ratios for risky drinking behavior and harassment was 5.50 (95%CI: 3.49-8.65) in low educational group among men, and 1.42 (95%CI: 0.98-2.07) in the high educational group among men.

Conclusions

Our study confirms an overall positive relationship between EHFOD and drinking behavior but varies by type of EHFOD. Furthermore, education modified this effect, but only for harassment. More research is necessary to better understand how drinking patterns diverge between low and high educational groups, and how this differentially affects risk for alcohol-related harms including the experience of harm from others' drinking.

Key messages

One-year prevalence of experienced harm from others’ drinking is high (50%) in Denmark. There is positive relationship between EHFOD and drinking behavior but it varies by type of EHFOD; education is an effect modifier.
Strengthening Lao TPHI
Authors: Kounnavoung S
Published: October 2020

With support from the European Union, the Lao Tropical and Public Health Institute developed policy advice in the area of reproductive health and rights and in the area of nutrition. The institute published its findings in a special edition of the journal Global Health Action in July 2020. The institute was able to communicate with decision-makers in government to improve policies in nutrition and reproductive health. The institute was also able to work together with youth groups to improve their understanding. The Lao TPHI organised meetings, conferences and produced policy briefs, which contributed to the exchange.

Most important lesson learned: more emphasis on knowledge translation in the institute was an important step forward in improving the dialogue between researchers and policy makers and non-governmental stakeholders.
Roadmap for Universal Health Coverage
Authors: Ssengooba F
Published: October 2020

With support of the European Union, the Makerere School of Public Health in Uganda developed the SPEED project in collaboration with local (civil society) organisations and research institutes. In the project the partners developed the Roadmap for developing a strategy for Universal Health Coverage in Uganda. Through conferences, workshops, social media, policy briefs the researchers interacted with decision makers. The Ministry of Health Adopted to Roadmap as the guidance for further strategic development of UHC.

Most important lesson learned: collaboration between academics, administrators, and activists can have a positive impact on health policy development, if built on trust and mutual understanding.
Use of artificial intelligence to estimate population health indicators in France
Authors: Haneef R , Fuentes S , Hrzic R , Fosse-Edorh S , Kab S , Gallay A , Cosson E
Published: October 2020

Background

The use of artificial intelligence is increasing to estimate and predict health outcomes from large data sets. The main objectives were to develop two algorithms using machine learning techniques to identify new cases of diabetes (case study I) and to classify type 1 and type 2 (case study II) in France.

Methods

We selected the training data set from a cohort study linked with French national Health database (i.e., SNDS). Two final datasets were used to achieve each objective. A supervised machine learning method including eight following steps was developed: the selection of the data set, case definition, coding and standardization of variables, split data into training and test data sets, variable selection, training, validation and selection of the model. We planned to apply the trained models on the SNDS to estimate the incidence of diabetes and the prevalence of type 1/2 diabetes.

Results

For the case study I, 23/3468 and for case study II, 14/3481 SNDS variables were selected based on an optimal balance between variance explained and using the ReliefExp algorithm. We trained four models using different classification algorithms on the training data set. The Linear Discriminant Analysis model performed best in both case studies. The models were assessed on the test datasets and achieved a specificity of 67% and a sensitivity of 62% in case study I, and a specificity of 97 % and sensitivity of 100% in case study II. The case study II model was applied to the SNDS and estimated the prevalence of type 1 diabetes in 2016 in France of 0.3% and for type 2, 4.4%. The case study model I was not applied to the SNDS.

Conclusions

The case study II model to estimate the prevalence of type 1/2 diabetes has good performance and will be used in routine surveillance. The case study I model to identify new cases of diabetes showed a poor performance due to missing necessary information on determinants of diabetes and will need to be improved for further research.
I am a psycho if I need to take pills: Stigma experience in Russian youth with affective disorders
Authors: Cantarero-Arévalo L , Kingod N , Bakshinskayte M
Published: October 2020

Background

Living with an affective disorder is often a cause for stigma and self-stigma. Mental health problems among adolescents and young adults is a problem in Russia but little is known on young Russian adolescents' perceptions and attitudes living with affective disorders.

Methods

This study is based on online observations of 11 Russian social media communities combined with semi-structured telephone or Skype interviews. Finally, 16 Russian-speaking men and women aged 17-25 who live with affective disorder were recruited. The data were coded into two overall themes of 'self-stigma' and 'enacted stigma' with sub-themes such as 'relationship with doctor', 'relationship and support from friends', 'relationship and support from family', 'attitudes towards medicines', 'side effects', and 'coping with the illness'.

Results

The fear of negative reactions and labelling from the social surrounding where seen as a factor that both stopped informants from seeking out timely help or forced them to leave the treatment regime when finally diagnosed. The fear of stigma where often related to the psychiatric diagnosis, and although symptoms of mental illness often had been prevalent years before the informants got their diagnosis, it was a shocking event to be diagnosed with a mental health condition such as bipolar disorder.

Conclusions

By exploring in-depth the perceptions that Russian-speaking young people have on the stigma and self-stigma when living with an affective disorder, we have been able to better understand how stigma affects their everyday lives.
5.M. Workshop: Sexual minorities' mental health and their experiences of stigma and minority stress across settings
Authors:   Organised by: EUPHA Sexual and gender minority health, EUPHA Public mental health section,   Chair persons: Arjan van der Star – EUPHA-SGMH, Jutta Lindert – EUPHA-PMH
Published: October 2020

Over the past decades, public health research has started to examine the higher risk of mental health concerns among sexual minorities (e.g., lesbian, gay, or bisexual individuals) when compared with heterosexual individuals. Until more recently, most of this research has been coming from North America and focused on theories of stigma and minority stress in their attempt to explain these elevated rates of mental health problems.

Minority stress theory posit stigma to be a root cause of the higher risk of mental health problems among sexual minorities and that stigma results in victimization, discrimination, internalized homonegativity, and identity concealment, which erodes mental health.

Exposure to such minority stressors may differ across structural climates, based on population attitudes, discriminatory legislation, and unequal policies. In this way, such structural forms of stigma toward sexual minorities may foster increased exposure to minority stressors and elevated levels of mental health problems among sexual minorities. However, the evidence on these mechanisms remains limited as they have only recently become a topic of research.

This workshop includes five empirical presentations from various structural contexts. It focuses on the elevated risk of mental health problems among sexual minorities across these settings, on identifying minority stressors in high-stigma countries, and on linking country-level structural stigma to experiences of minority stressors to explain poor mental health among sexual minorities. First, Michal Pitonak will present results from the first Czech population-based study showing higher rates of substance use, psychological distress, and low life satisfaction among sexual minorities compared to heterosexual individuals. Second, Giuseppina Lo Moro will present results from Italy showing a higher likelihood of depressive symptoms and mental health treatment among sexual minority medical students compared to their heterosexual peers. Next, Guillermo Martínez-Pérez will present findings on experiences of minority stress among Senegalese bisexual men and linkages to mental health. Finally, Arjan van der Star will extend these findings with data showing how the mental health effects of structural stigma and minority stress may be related to time both before and since migrating among migrant sexual minority men in the low-structural-stigma context of Sweden.

Key messages

Sexual minorities across the globe are at an increased risk for mental health problems and stigma-based minority stress experiences compared with heterosexual individuals. Structural forms of stigma, such as country-specific negative societal attitudes and discriminatory laws, may drive this elevated risk depending on length of exposure.
Digital maternal health booklets – do they help reaching migrant populations
Authors: Zysset A , Dratva J
Published: October 2020

Background

Societies and health systems are increasingly digitally transformed. Digital communication is considered a means to reach persons in vulnerable contexts, such as migrant families. We performed a scoping literature review to evaluate the assumption in the context of maternal and child health (MCH) and validate results qualitatively.

Methods

Jan. 2020 a literature search was conducted (Web of Science, MEDLINE, CINAHL) using synonyms for migrants, health, digital media and information seeking, limited to publications in English. Two researchers independently rated titles and then abstracts for suitability, obtaining consensus at each step. Primary target group, health topic and related life phase, country of data origin, and primary study question were extracted from remaining manuscripts. Data on digital health information seeking (impact, reasons, barriers, context) will be extracted from full texts and discussed. A focus group with mothers with migrant background in Switzerland will be held in Sept. to validate findings.

Results

After title and abstract screening 41 from 315 articles remained. 25 articles focused primarily on migrant populations and information seeking behavior. Dominant populations were Latinos, Hispanics and Asians. Studies were performed in North America (n = 32), Europe, Asia and Australia (each n = 3); seven were on MCH, four on child and adolescent and 30 on adult health (mainly general health and health access). Further results extracted from manuscripts and focus group validation results will be presented at the conference.

Conclusions

Few studies on health information seeking behavior of migrants and MCH exist. Evidence on digital information seeking overall is scarce. The many North American studies indicate an advanced digital transformation of health promotion and care. The discussion will focus on the generalizability of literature findings and potential of digital health promotion via MCH in vulnerable populations.
Digital support systems to improve child health and development in low income settings
Authors: Wallenborn J , Mäusezahl D , Castellanos A , McCoy D , Zhang C e , Fink G
Published: October 2020

About 250 million children under age five are at risk of not reaching their developmental potential due to continued exposure to ill health, malnutrition and lack of appropriate learning environments. A large number of initiatives have been launched in recent years to support early childhood development, with home visiting programs increasingly being recognized as a key strategy for improving child wellbeing. However, the most effective ways to reach families in low income settings remain unclear due to the large expense associated with personal family visits. In this project, we assess the effectiveness and equity of a newly developed digital platform designed to deliver evidence-based, individualized parenting support through automated services. The Afinidata platform uses state-of-the art machine learning algorithms to allow caregivers to get answers to questions about child health and development, while also identifying and promoting age- and development-appropriate activities for parents to support their children. We will collaborate with partners in Peru to rigorously assess the reach, impact and cost effectiveness of this digital platform in a poor rural population through a randomized controlled trial. Our work will follow a mixed-methods evaluation approach with repeated feedback into the Afinidata system. A total of 2,400 newborns will be enrolled in a randomized controlled trial in San Marcos, Peru, and followed up for two years. The primary study outcome will be children's healthy development at 24 months of age assessed through the Bayley Scales of Infant and Toddler Development (BSID-III). Secondary outcomes will be systems utilization, program coverage and cost-effectiveness, as well as caregiver satisfaction. If proven effective, this innovative digital platform may increase global access to low-cost parental support -a widely recognized key strategy for improving child well-being.
6.D. Workshop: Climate change, energy issues and air pollution – as a triad of health priorities
Authors:   Organised by: EUPHA Environment and health section,   Chair persons: Peter Van Den Hazel – EUPHA-ENV, Marija Jevtic - EUPHA -ENV
Published: October 2020

As well known, climate change changes weather patterns, producing far-reaching effects on the environment, the economy and society as a whole, endangering global livelihoods, health, food and energy security, and water resources.

Climate change, although globally threating to the human population and biocenosis, yet has some positive sides if the unity achieved through the Green Deal (GD) can be named so.

It is difficult to prioritize among many present-day challenges and many health threats. This document strongly confirms the path to be navigated. What is the role of health professionals and what is the possible contribution of public health?

This European Commission document envisages Europe as the first climate-neutral continent while strengthening its economy, taking care of and improving its inhabitants' health. The GD insists on the care for nature and a clear view that no one should be left out and left behind.

This workshop points out that, even we have large regulatory framework on clean air, air pollution in the European Union continues to be the top environmental threat to health, leading to approx. 400,000 early deaths annually and high health costs. Over 20 of the 27 EU countries fail to keep air quality standards, which for key pollutants are already less strict than what the World Health Organization (WHO) recommends.

There were several possible scenarios, out of which two were considered: one based on collaboration and the other, on conflict. Several dimensions were examined to address both cooperation instruments and the consequences of non-cooperation: Energy production (e.g., conventional versus renewable) and use; water resources and food security; the environment (air quality) and the impact on health; Population and migration flow.

The Energy issues in the world demand new innovative ways of providing us with energy. Innovations sometimes go faster than the health sector can study the disadvantages for health. The burden of disease might change due to new forms of energy.

It is important to note that health sector has an opportunity to not only prevent further damage from the air pollution and climate crises, but also to improve health outcomes by decarbonizing, building climate resilience, and amplifying the message around the interdependency between climate change and human health. This workshop will present a framework, co-developed by WHO and Health Care Without Harm, for climate-resilient, sustainable health facilities.

Key messages

The public health sector should consider the GD as an argument for achieving goals at national levels, and align national public health policies with the goals of this document. Achieving goals requires the education process for healthcare professionals covering all of topics of climate change, energy and air pollution to a much greater extent than before.
Food industry influence on public health policy, research and practice in Latin America
Authors: Mialon M , Perez E , Corvalan C , Monteiro C , Jaime P , Baeza Scagliusi F
Published: October 2020

One of the key barriers to the development of public health policies, such as restrictions on marketing of unhealthy foods to children, is the influence of corporations, also known as corporate political activity' (CPA). This project aimed to identify the CPA of the food industry in Brazil, Colombia and Chile, over a 2-year period.

This research consisted of a document analysis of publicly available information triangulated with interviews. It contributed to, and was based on methods developed by INFORMAS (International Network for Food and Obesity / non-communicable Diseases Research, Monitoring and Action Support), which aims to monitor food environments.

In all three countries, the food industry lobbied against public health policies and had direct access to high ranking officials and policy makers. It also shifted the blame away from its products in the obesity and non-communicable diseases epidemic onto individuals and their lack of education. In Brazil, the food industry was active against a new front-of-pack labeling, setting up its own website to promote an alternative model and self-regulation. In Colombia, the food industry captured the media and had strong ties with the government, including through nutrition programmes. Public health advocates felt unsafe when speaking against the industry or its products. In Chile, despite advances with the introduction of public health policies to limit the sales and marketing of unhealthy products, the food industry, including the sweeteners industry, which was not affected by the recent legislation, was still influencing policy, research and practice.

Food industry actors, including local companies and transnationals, used several CPA strategies in Latin America to try and influence public health policy, research and practice. It is urgent that policy makers, academics and other individuals in public health are aware of these practices and equipped with solutions to address undue influence by the food industry

Key messages

In Latin America, the food industry used several CPA practices, which collectively could have a negative influence on public health policy, research and practice. These practices could delay efforts to protect and promote public health in the region.
Media's mixed messages on trans fat and sodium reductions during the policy making process
Authors: James L
Published: October 2020

Background

During the mid-2000's, reductions in the population intake of trans fat and sodium were commitments of the Government of Canada to reduce population risk for chronic disease. During the policy making process, various stakeholders interpreted and applied evidence in a range of ways to suit their interests. Media as a stakeholder has a powerful role in shaping both political will and public opinion.

Methods

A media analysis was conducted from 2004 - 2013 to access how trans fats and sodium reduction was portrayed in the Canadian media. Qualitative thematic analysis captured key subject areas including political ideology, personal responsibility/freedoms, industry tactics, evidence updates/disputes and health harms. Overall tone was assessed to be neutral, opposed or in favour of policy regulation. The number of quotes from key stakeholders contributed to the tone classification. Quantitative assessments compared the tone between trans fat and sodium cases.

Results

Trans fat and sodium were portrayed very differently by the media. Preliminary results show that trans fat was depicted as a harmful industry ingredient, used to extend profits at the expense of public health. On the other hand, communications around sodium research and evidence was not consistent. Media often pitted members of the scientific community against each other and reported on new studies that were outliers to the evidence base.

Conclusions

The media has an important role to play in shaping public perspectives on nutrition issues and related policy development. The media's mixed messages on sodium reduction may have contributed to the lack of political will and government's policy inaction. Public health practitioners and researchers should consider building in knowledge translation strategies into nutrition advocacy campaigns and research releases. Without these important strategies, the media's framing of nutrition issues could be counter-intuitive to public health aims.

Key messages

Media seems to have played a key factor in the the development of both trans fat and sodium reduction policies in Canada. Framing of nutrition research results and advocacy messages should align with public health policy goals.
Public acceptability of a sugar-sweetened beverages tax and its associated factors in the Netherlands
Authors: Eykelenboom M , van Stralen M M , Olthof M R , Renders C M , Steenhuis I H M
Published: October 2020

Background

Public acceptability of a sugar-sweetened beverages (SSBs) tax is important for governments in the decision-making process. Therefore, the aim of the present study was to investigate the level of public acceptability of an SSBs tax and its associated factors.

Methods

Dutch adults representative of the Dutch population for age, sex, educational level and location (n = 500) completed an online self-administered questionnaire. The acceptability of an SSBs tax was measured on a 7-point Likert scale. Associations between acceptability and sociodemographic factors, body mass index, SSB consumption, and beliefs about effectiveness (9 items, e.g. 'An SSBs tax would reduce people's SSB consumption'), appropriateness (7 items), socioeconomic and economic benefit (5 items), implementation (1 item) and trust (3 items) were assessed using multivariable linear regression analyses.

Results

Of the participants, 40% supported and 43% opposed an SSBs tax in general. Moreover, 42% supported (43% opposed) an SSBs tax as a strategy to reduce overweight and 55% supported (32% opposed) an SSBs tax if revenue is used for health initiatives. Participants with a low educational level (B=-0.82;95%CI = [-1.31,-0.32]), overweight (B=-0.49;95%CI = [-0.89,-0.09]), moderate or high SSB consumption (B=-0.86;95%CI = [-1.30,-0.43] and B=-1.01;95%CI = [-1.47,-0.56], respectively) and households with adolescents (B=-0.57;95%CI = [-1.09,-0.05]) reported lower acceptability of an SSBs tax than their counterparts. Beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust were associated with acceptability (P < 0.001).

Conclusions

Public acceptability of an SSBs tax tends to be higher if revenue is used for health initiatives. Sociodemographic factors, body mass index, SSB consumption and several beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust are associated with acceptability.

Key messages

It should be considered to include a recommendation to use revenue for health initiatives in global guidelines for SSBs taxes. Targeting population subgroups with low levels of support might be an effective strategy for communication campaigns.
Forecasting health prior to state pension age – projections for the Netherlands 2040
Authors: van der Noordt M , Polder J J , Plasmans M H D , Hilderink H B M , Deeg D J H , van der Lucht F
Published: October 2020

Objectives

In many Western societies, the state pension age is being raised to stimulate prolonged working. In the Netherlands, the raise of the state pension age is linked to the remaining life expectancy at age 65 with a factor of 2/3rd, and is expected to be 68 years in 2040. It is not yet well understood whether health of the 60+ permits this increase. In this study, health of Dutch adults aged 60 to 68 is forecasted up to 2040.

Methods

Data are from the Dutch Health Interview Survey (HIS) 1990-2017 (N≈280.000) and the Dutch Public Health Monitor (PHM) 2016 (N≈460.000). Health is operationalized using binomial scores of 1) self-rated health and 2) limitations in hearing, seeing or mobility. Categories are: good health (healthy on both items), moderate health (healthy on one item) and poor health (unhealthy on both items). First, based on the HIS, health status in 5-year age categories was modelled up to 2040 using logistic regression analysis in R. Second, the growth factor from 2016 to 2040 was applied to the health level from the PHM 2016.

Results

In 2016, 63% of men aged 60-65 had good health, 25% had moderate health and 12% had poor health. Among women, this distribution was 64%, 22% and 14%, respectively. In 2040, the health distribution among men aged 60-68 is estimated to be 63-71% in good health, 17-28% in moderate health and 9-12% in poor health. Among women this is estimated to be 64-69%, 17-24% and 12-14%, respectively.

Conclusions

Health of Dutch cohorts nearing the state pension age in the future is estimated to remain the same or improve up to 2040. This development in health is not an obstacle to raising the state pension age. However, due to the increasing state pension age and the baby boom generation reaching age 60+ in the coming years, the absolute number of people aged 60+ in poor and moderate health that participates in labor will increase. Policy aiming at sustainable employability will therefore become increasingly important.

Key messages

Health of Dutch cohorts nearing the state pension age is estimated to remain the same or improve in the future. The development in health is not an obstacle to raising the state pension age. Although health is estimated to remain the same or improve, the absolute number of people aged 60+ in poor and moderate health that participate in labor will increase due to an aging population.
Belgian population norms for the EQ-5D-5L, 2013 and 2018
Authors: Van Wilder L , De Smedt D , Beutels P , Cleemput I , Bilcke J , Speybroeck N , Van der Heyden J , Van Oyen H , Charaffedine R , Devleesschauwer B
Published: October 2020

Background

Health-related quality of life outcomes are increasingly used to monitor population health and health inequalities, and to assess the (cost-)effectiveness of health interventions. The EQ-5D-5L has been included in the Belgian Health Interview Survey (BHIS), providing a new source of population-based self-perceived health status information. The aim of this study is to estimate Belgian population norms for the EQ-5D-5L by sex, age, and region, and to analyse its association with educational attainment.

Methods

The BHIS 2013 and 2018 provided EQ-5D-5L data for a nationally representative sample of the Belgian population. The dimension scores and index values were analysed using logistic regression and linear regression, respectively, taking into account the survey design.

Results

The majority of respondents reported problems of pain/discomfort, while over a quarter reported problems of anxiety/depression in both surveys. The average index value was 0.81 in 2013 and decreased significantly to 0.79 in 2018. Women reported more problems on the dimensions, but particularly on anxiety/depression and pain/discomfort, resulting in significantly lower index values. Problems with mobility, self-care, and usual activities showed a sharp increase after the age of 80 years. Consequently, index values decreased significantly by age. Lower education was associated with a higher prevalence of problems for all dimensions except pain/discomfort in 2013 and anxiety/depression in 2018, and with a significantly lower index value.

Conclusions

This paper presents the first nationally representative Belgian population norms using the EQ-5D-5L. Inclusion of the EQ-5D in future surveys will allow monitoring over time of self-reported health, disease burden, and health inequalities.

Key messages

This study is the first to provide Belgian population norms for the EQ-5D-5L and consequently increases the evidence base regarding country-specific population norms. Our results help policy makers in understanding and monitoring the self-perceived health status of the Belgian population according to age, gender, and educational attainment.