bluuebunny/crossref_metadata_2025 huggingface dataset:
Do the pollution related to ozone pose a real health threat to the population in Upper Silesia?
Authors: Kobza J , Geremek M , Grajek M
Published: October 2023

Background

Air pollution is a leading environmental factor, that influences human health. Although Ozone plays crucial role in the screening Earth's surface and lower atmosphere layers from the ultraviolet radiation, the troposphere ozone is proved to have negative effect on human body. Long-term exposure to a higher ozone concentration is related to a decrease in life expectancy.

Objectives

The objective of this study was the measurement-based assessment for determining whether the concentrations of ozone is within admissible limits or exceeded in Silesia province (5 million agglomeration) and therefore pose a threat to the local population together with the levels of PM2.5 and PM10 significantly exceeded at the same time.

Material and methods

The data provided by the Voivodship Inspectorate for Environmental Protection in Katowice for period 2015-2022 was used in the statistical analysis. The received data constitutes the result of 8-hour concentrations of ozone in selected air monitoring stations of Silesian province. The locations of 3 monitoring stations were found useful for the aim of this research; one site is situated in rural background area, another one is located in medium - sized city and the Katowice station is representative for urban background situation.

Results

The alarm level hasn't been exceeded in indicated measurements stations in Silesian Voivodship in period 2015-2022 (averaging time 1 hour: 240 µg/m3 four 3 hours). The target level has been exceeded in 2015-2017, in all three measurements stations and in the following years in one station (in Zloty Potok - 2018 and in Katowice -2019). Each year the largest number of exceedances occurred in August.

Conclusions

The results clearly indicate lack of hazards for general population health in terms of increased concentrations of ozone in the city centres and outside in Upper Silesia agglomeration and the situation even improved in last years. We identified the main sources of ozone.

Key messages

• The troposphere ozone is proved to have negative effect on human body, long-term exposure to a higher ozone concentration is related to a decrease in life expectancy.

• The results clearly indicate lack of hazards for general population health in terms of increased concentrations of ozone in the city centres and outside in Upper Silesia agglomeration.
Anti-racism praxis in an emerging community-academic approach to environmental and climate justice
Authors: LeBron A , Reyes A , Lopez M , Saxon L , Bloom J , Taylor Lucas C
Published: October 2023

Background

Racial injustices, environmental and climate threats, and COVID-19 inequities that disproportionately affect communities of color have contributed to social reckoning with racism. Public health is grappling with how to strengthen collaborative processes, research, and practice to be grounded in an understanding of racism as a public health issue and incorporate a structural racism lens into strategies to promote health equity. We describe a process for strengthening anti-racism praxis for an emerging academic center focused on community-academic collaborative approaches to advancing participatory action research for environmental and climate justice.

Methods

University-based faculty and staff and popular education designers and facilitators collaborated to design an anti-racism process for an emerging environmental and climate justice academic research center. The anti-racism process focused on building leadership and action through deep discussion, reflection, narrative generation, and visioning. This process involved clarifying the Center's purpose, anticipated short- and long-term outcomes, collaborative processes, and theories of change.

Results

The anti-racism process focused on building deep connections and capacity to practice and advance racial justice within the administrative, research, teaching, and practice spheres of academic and community participants identified as active and passive allies on the Spectrum of Allyship. Dialogues illuminated the centrality of storytelling for listening to and learning from a range of lived experiences and envisioning processes and ways of working together. We discuss themes, facilitating factors, and challenges that emerged from our dialogic process.

Conclusions

This case highlights the importance of anti-racism processes as a collective experience to inform racial justice approaches within emerging and sustained public health units - large and small - and in participants’ spheres of influence.

Key messages

• As the field of public health grapples with racism as a driver of health inequities, anti-racism approaches are critical to public health practice and research.

• Anti-racism approaches that engage narratives have potential to inform guiding approaches for public health units committed to health equity.
Exposure to green and blue spaces and depression in older adults: Findings from the EPIPorto cohort
Authors: Behlen M , Henriques A , Severo M , Santos C J , Ribeiro A I
Published: October 2023

Background

Portugal is amongst the European countries with the largest share of older adults and highest prevalence of depression. Natural environments may play an important role promoting population-level mental health. We investigated the associations between the exposure to green and blue spaces and depression among older adults from Porto (Portugal) and the mediation role of social interactions and physical exercise.

Methods

This study included data from the fourth wave (2017) of the EPIPorto cohort, which included only participants aged ≥60. The presence of depressive symptoms was measured using the Geriatric Depression Scale (GDS). Using the residential locations, we computed the Normalized Difference Vegetation Index (NDVI), and the shortest distance to the nearest urban green space and blue space. We fitted crude and adjusted negative binomial regression models. Associations were expressed using relative risks (RR) and 95% intervals (95% CI). We used structural equation modelling to assess mediation.

Results

We included 639 participants, from which 27.2% presented depression (GDS ≥5). In the adjusted models, we found statistically significant associations between having more NDVI within 50 and 100 meters and lower GDS (RR = 0.78 [95%CI 0.65-0.94] and RR = 0.81 [95%CI 0.67-0.97], respectively). Most of the association between NDVI and the GDS was direct, being only slightly mediated by the time spent with family, although both the direct and indirect effects did not reach statistical significance. No significant associations with the remaining variables of exposure were identified.

Conclusions

We observed a direct association between living in areas with more vegetation and less depressive symptoms in older adults in Porto.

Key messages

• Our results suggest that the provision of green space may be an effective strategy to promote mental health in late life.
'I just can't stand being there anymore': Places of contention for older Americans during COVID-19
Authors: Finlay J , Guzman V , Meltzer G , O’Shea B , Yeh J
Published: October 2023

Background

The COVID-19 pandemic has posed new and widespread challenges to experience the health and well-being benefits associated with person-place attachment, particularly among populations identified as vulnerable, such as older people. The aim of this study was to explore how individuals ageing-in-place have perceived and (re)negotiated their sense of place and place identities since the pandemic onset.

Methods

We thematically analysed open-ended responses (n = 1171) collected between April to June 2022 in the COVID-19 Coping Study, a national longitudinal study of the impacts of the pandemic among aging adults living in the US.

Results

Participants were on average 68 years old, with a majority of participants identifying as female (71%), non-Hispanic white (93%), living with others (72%), and retired (66%). We identified five themes, four regarding why particular places were challenging since the pandemic onset: (1) fear of viral exposure, (2) frustrating regulations, (3) uncomfortable and hostile social dynamics, and (4) ‘out of place’ negative emotions; and one regarding how participants addressed pandemic place-based challenges: (5) adjustments made to reframe expectations and behaviours. These findings prompt a critical exploration of how experiences taking place in micro and macro spaces have shifted during the pandemic and the potential wide-ranging and long-term implications they hold for participants’ later-life health and well-being.

Conclusions

Evidence emerging from this analysis highlights the potential of large well-ventilated public spaces that offer diverse opportunities to engage in educational, artistic, and recreational activities as a vehicle to (re)build disrupted place identities for older adults living through increasing social tensions and polarization regarding public health measures.

Key messages

• Changes to built and social environments driven by the COVID-19 pandemic and public health strategies are having lasting impacts on how older people engage with health promoting and enabling places.

• Older people have addressed place-based challenges through antimicrobial precautions, daily routine adjustments, choosing online and outdoor activities, and/or withdrawing from places altogether.
Opponents of vaccines in Israel and their justifications to operating and spreading their position
Authors: Inchi L , Rottman A , Zaretzki C
Published: October 2023

Background

One of the things the world was waiting for during the COVID-19 epidemic was the development of a vaccine. However, there was also a growing fear of this expressed in the lack of compliance and even active resistance to the vaccine. Identifying and analyzing the justifications for resistance to vaccines could lead to a significant reduction of it, which would contribute to public health.

Aim

To examine the justifications that guide vaccine opponents, not only in not getting vaccinated, but also in spreading their opposition.

Methods

Qualitative research using text analysis of three central public websites, covering the spectrum of positions re- vaccines:

1. The Ministry of Health - identified as an ‘objective’ website.

2. Midaat - Science and Information for Family Health - identified as a website ‘in favor’ of vaccines.

3. PECC - Health, Science, Truth - identified as a website ‘against’ vaccines.

Findings: According to the Health Belief Model (HBM, 1956), the perception of being affected by the disease and the perception of the severity of the disease are low and therefore the threat perception is also low, as is the cost-benefit perception. The barriers to change perception expressed internal barriers, such as fear of a new vaccine and fear of foreign substances in the body; and external barriers, first and foremost a lack of trust in the government in general and the health system particularly, in addition to development of conspiracy justifications claiming that the vaccines are a mechanism of the government to control the population. Another justification related to the pharmaceutical industries’ financial interests, i.e., their attempts to get rich by ‘inventing a disease’ and providing a vaccine

Conclusions

Public trust has been significantly compromised as a result of conflicting and changing instructions, especially during lockdowns. Fake news were distributed on social networks. Necessitating a national confrontation with the issue.

Key messages

• It is important to identify the justifications vaccine opponents use, so that explanations focus on all concerns and developments of false agendas that damage public trust and hence public health.

• Israel should not take fake news lightly. The government must understand the negative consequences of it, and act to eradicate it through supervision, as is customary in other countries.
Vaccination, health information seeking, and ICT use among Estonians aged 50+ during COVID-19
Authors: Paimre M
Published: October 2023

Background

Vaccination is one of the most effective ways to protect oneself against Coronavirus. However, many people, including older adults, have refused to receive the vaccine. The study aimed to analyze relationships between vaccination intention, socioeconomic indicators, health status, choices in health behavior, health information (HI) seeking, and acceptance of ICTs for health purposes.

Methods

After the end of the first lockdown in 2020, a cross-sectional survey was conducted among 500 Estonians aged 50 and over.

Results

More than half (53.5%) of respondents were in favor of vaccination, less than a third (30.5%) were hesitant, and sixteen percent (16%) were opposed. There was a significant correlation between being male and having a higher education level with vaccination readiness. As the respondent felt the need for HI more often and searched the internet for HI more recently, the more likely they were to agree to be vaccinated (rho = .14, p <.05). It was found that vaccination readiness and the need for a digital health application were positively correlated (rho = .25, p .01): the more such an application was needed, the more people agreed to be vaccinated. Uninterested and hesitant respondents used fewer HI sources than those interested in vaccination. Improved health behavior choices did not increase willingness to get vaccinated (e.g., eating healthier and exercising more). Vaccination readiness was also unrelated to health status.

Conclusions

At least in Estonia, many upper-middle-aged and older people use the internet and smart devices to get HI during a crisis. However, why these people don't make other health-conscious choices should be investigated. Planning health campaigns and vaccinations and/or tackling new health crises should consider the differences between people aged 50 and older.

Key messages

• In a time of crisis, the internet broadens the range of sources of health information.

• It is important for health campaigns to take into account the growing tendency of 50+ people to obtain HI from the internet.
E-health to improve integrated care for older people: communication insights from ValueCare
Authors: Raat H , Bally ELS , Vasiljev V , Zanutto O , Cheng D , Roozenbeek B , Dippel DWJ , van Grieken A , Mao Y
Published: October 2023

Background

Population aging poses challenges to high quality health and social care for older people in Europe. The Horizon 2020 ValueCare project (www.projectvaluecare.eu) develops, implements and evaluates an Information and Communication Technologies (ICTs) supported integrated health care solution. ValueCare aims to increase health-related quality of life of older people in Europe by a co-designed digital solution with end users. The project has seven pilot sites with unique social and cultural backgrounds: Athens, Greece; Coimbra, Portugal; Cork/Kerry, Ireland; Rijeka, Croatia; Rotterdam, the Netherlands; Treviso, Italy; and Valencia, Spain.

Methods

Taking this innovative practice as an ongoing research case, we will share important lessons learned in the designing, operationalization, and coordination of such a multidisciplinary project from a communication perspective. We will discuss the insights on the challenges and opportunities of designing and implementing innovative and robust digital solutions in various social contexts with different regulations.

Results

Recruiting participants was the most challenging task, especially during the pandemic. Different communication strategies were used to reach diverse participants to ensure inclusivity and diversity of the participants. We will discuss the communication aspects of ValueCare that can inspire future projects to consider communication perspectives in public health research and solutions.

Conclusions

The co-design approach increased the participation of end-users during the phase of development and implementation. Intense communication strategies were applied to engage older people and professionals in using the new care approach. ICT supported outcome-based integrated care has the potential to benefit the larger society in an equitable way.

Key messages

• Co-design may be applied to increase involvement of end-users during development and implementation of new care strategies.

• Intense communication strategies are needed to engage older people, informal caregivers and care professionals in the development and use of new care strategies.
Can we make better use of our operating theatres?
Authors: Peruzzi V , Campanile G , Maccari A , Cevenini G , Nante N
Published: October 2023

Background

The utilisation rate of operating theatres is one of the indicators of efficient management in a Hospital. Our analysis focuses on the percentage of room utilization for planned activity. The aim is to compare the results of the manual planning carried out by the Surgical Scheduling Office (SSC) with the one carried out automatically by the testing of a Decision Support System (DSS) management application based on the automatic analysis of factors involved in the creation of surgical scheduling.

Material and Methods

The study took place at the Hospital ‘Alta Valdelsa’ in Poggibonsi, Tuscany, Italy. It first saw the collection and cataloguing over a period of one month (Nov 2022), for each speciality, of the operating notes made by the SSC, taking into consideration the indications of the respective referring surgeons. From the surgical work pathway management system (ORMAWEB), the actual average operating times over the same period were then collected for each specialty. Finally, for comparison, the DSS worked out the best room scheduling according to an algorithm based on waiting lists, priorities, and operator surgical times.

Results

Following the manual planning of 143 scheduled operations, the planned utilization of the operating theatres was in most cases confirmed by the reality of the occupied room times extrapolated from ORMAWEB, with slight differences due to patient-dependent modifications. Out of a total of 350 hours available for surgical specialties, the manual operating notes predicted room occupancy for only 196 hours and 40 minutes, with a utilization rate of 56.3%. The DSS application, on the other hand, produced a possible schedule with a room occupancy of over 90%.

Conclusions

The study shows that the efficiency of the operating theatre could be significantly increased if the SSC were supported by a DSS application that uses totally objective criteria in the selection of patients to be operated on the waiting list.

Key messages

• The use of new applications in surgical path management can improve the efficiency of the operating theatre.

• Increased utilisation of surgical rooms results in better rationalisation of available resources of the Hospital.
Designing Dynamic Informed Consent For Public Health Research
Authors: Miranda P , Kaur J , Morita P P
Published: October 2023

Background

Current dynamic consent software available is not all tailored for public health research and lacks the appropriate data governance framework and mechanisms to be compliant with public health research requirements. This paper presents the UML modelling of the Dynamic Consent for Public Health (DC4PH), a dynamic consent platform being designed for the Canadian public health domain

Methods

The proposed platform incorporates data governance and public health stakeholders’ requirements into its design and is based on state-of-the-art standards and solutions. Diagrams created in UML reflect the mapped requirements and demonstrate the capabilities of our dynamic consent proposed data structure. We also incorporated private ledger entities in our modelling to provide an immutable log of dynamic consent for stakeholders and improve transparency and trust between them.

Results

A series of UML assets were created based on previous mapping of the public health research domain, public health principles, and data governance requirements. Use case diagrams for each type of user of the platform, state diagrams of key business objects vital for the platform's enhancement of traditional consent, and state diagrams of the actor's possible states. Flowchart of the core platform's functionalities, such as the dynamic consent approval process. And a class diagram of the proposed platform that incorporates all the previously mentioned domain mapping and binds it with optional private ledger properties.

Conclusions

This work offers a comprehensive and extensible UML design that is being used to develop the DC4PH platform. The paper concludes that the design has the potential to improve the efficiency and efficacy of informed consent collection in public health research projects of small or large scales while also being capable of complying with data governance requirements, healthcare standards, and ledger technologies.

Key messages

• Dynamic informed consent still lacks appropriate scrutiny over the underlining data structures utilized to store and manage dynamic consent.

• Our work proposes a design in Unified Modelling Language (UML), of dynamic informed consent based on public health's domain mapping, data governance and public health research requirements.
Leisure-time physical activity and gastric cancer risk: a pooled study within the StoP project
Authors: Pires Marafon D , Pastorino R , Mariani M , Osti T , Pelucchi C , La Vecchia C , Boccia S
Published: October 2023

Background

Although physical activity (PA) has been recognized as a favourable factor in the prevention of various diseases, including certain forms of cancer, the relationship between PA and gastric cancer (GC) is not yet fully comprehended. For this reason, this study aims provide data from a pooled analysis of case-control studies within the Stomach cancer Pooling (StoP) Project to estimate the association between leisure-time PA and the occurrence of GC.

Methods

Six case-control studies from StoP project collected data on leisure-time PA, for a total of 2,343 cases and 8,614 controls. Subjects were classified into three leisure-time PA categories, either none/low, intermediate or high, based on study-specific tertiles. We used a two-stage approach. Firstly, we applied multivariable logistic regression models to obtain study-specific odds ratios (ORs) and corresponding 95% confidence intervals (CIs) then, we used a random-effect models to obtain pooled effect estimates. Heterogeneity was assessed using Q and I2 statistics. We performed stratified analyses according to demographic, lifestyle and clinical covariates.

Results

The meta-analysis showed ORs of GC with no significant differences between intermediate vs low and high vs low PA level (OR 1.05 [95%CI 0.76-1.45]; OR 1.23 [95%CI 0.78-1.94], respectively). GC risk estimates did not strongly differ across strata of selected covariates except for age ≤ 55 years old (high vs low level: OR 0.72 [95%CI 0.55-0.94]).

Conclusions

An association between leisure time PA and GC, apart from some suggestion of decreased risk below age 55, was not found. This may reflect specific characteristics of GC at younger age, or the presence of a cohort effect mediating and interacting with socioeconomic determinants of GC.

Key messages

• An association between leisure time PA and GC, apart from some suggestion of decreased risk below age 55, was not found.

• GC risk estimates did not strongly differ across strata of selected covariates except for age ≤ 55 years old.
Life's Simple 7 for cardiovascular health is associated with cancer risk in the Moli-sani Study
Authors: onaccio M B , Di Castelnuovo A , Costanzo S , Martinez C F , Panzera T , Cerletti C , Donati M B , de Gaetano G , Iacoviello L
Published: October 2023

Background

Cardiovascular disease and cancer share modifiable risk factors and, potentially, molecular mechanisms of disease, as postulated by the “common soil” hypothesis. We examined whether the American Heart Association's Life's Simple 7 (LS7) metrics to assess and promote cardiovascular health, is associated with cancer risk, defined as first hospital admission for any cancer obtained through record linkage with hospital discharge forms.

Methods

Longitudinal analyses on 21,705 apparently cancer-free participants (mean age 55.2±11.6; 51.9% women) at cohort entry in the Moli-sani Study (2005-2010). Components of the LS7 include cigarette smoking, physical activity, diet, body mass index, blood pressure, cholesterol and glucose: each ideal CV health metric was assigned 2 points, and all points were summed to compute a CV health score ranging between 0 to 14 points. CV health scores were then classified as poor (0 to 6), average (7 to 9), and ideal (10 to 14).

Results

Over a median follow up of 13 y, a total of 1,918 hospital admissions for any cancer were recorded. The proportion of poor, intermediate and ideal CV health were respectively 33.2%, 47.6%, and 19.2%. In a multivariable-adjusted COX analysis controlled for known risk factors, participants in the ideal CV health category experienced 29% lower risk of cancer hospitalization (HR = 0.71; 95%CI 0.61-0.83) compared with the poor CV health category. These associations tended to be stronger in men (HR = 0.60; 95%CI 0.48-0.76) than in women (HR = 0.80; 95%CI 0.64-0.99), but were of the same magnitude in both the elderly (aged ≥65 y; HR = 0.74; 0.55-0.99) and younger participants (aged <65 y; HR = 0.75; 95%CI 0.63-0.90).

Conclusions

Results from this large cohort of middle-aged and elderly Italians suggest that improving cardiovascular health could also reduce the future burden of cancer, supporting the hypothesis of a common soil of underlying risk factors for these two groups of diseases.

Key messages

• The Life’s Simple 7 metric initially developed to promote cardiovascular health is associated with future cancer risk in a large population of middle-aged and elderly Italians.

• These findings reinforce the notion of a “common soil” of underlying risk factors for cardiovascular disease and cancer, and support common public health strategies for prevention.
An increased risk for ischemic stroke in the short-term period following COVID-19 infection
Authors: Keinan Boker L , Libruder C , Hershkovitz Y , Ben Yaish S , Tanne D , Binyaminy B
Published: October 2023

Background

The association disclosed between COVID-19 infection and ischemic stroke (IS) raises concern. The exact risk periods, which were not consistent between studies, require further investigation.

Methods

We linked between two national databases: the national COVID-19 database and the Israeli National Stroke Registry. The self-controlled case series method was used to estimate the association between COVID-19 infection and a first IS. The study population included all Israeli residents who had both a first IS event and a first COVID-19 diagnosis during 2020. The date of the PCR test served to define the day of exposure, and the 28 days following it were categorized into three risk periods: days 1-7, 8-14, and 15-28. A relative incidence (RI) with a 95% confidence interval (95% CI) was calculated based on the incidence rate of events in a post-exposure period, compared to the incidence rate in a control period.

Results

From 01-January-2020 to 31-December-2020, 308,015 Israelis aged 18+ were diagnosed with COVID-19 and 9,535 were diagnosed with a first IS. Linking between the two databases, 555 persons had both diagnoses during 2020. The mean age of the study population was 71.5±13.7, 55.1% were males, 77.8% had hypertension, 73.7% had hyperlipidemia, 51.9% had diabetes, 28.5% had ischemic heart disease and 25.6% had atrial fibrillation. Comparing between the risk period and the control period, we found a very similar distribution of the cardiovascular risk factors. The risk for an acute IS was 3.3-fold higher in the first week following COVID-19 diagnosis, compared with a control period (RI = 3.3; 95% CI 2.3-4.6). The RI among males (RI = 4.5; 95% CI 2.9-6.8) was 2.2-fold higher compared to females. The increased risk did not last beyond the first week following exposure.

Conclusions

Physicians should be aware of the elevated risk for IS among patients experiencing COVID-19, particularly among men with high burden of cardiovascular risk factors.

Key messages

• Risk for an ischemic stroke is elevated in COVID-19 patients upon infection.

• This finding was particularly evident in men with cardiovascular risk factors.
Social inequality in mortality associated with neurodegeneration: a population-based study in Belgium
Authors: Dinneweth J , Gadeyne S
Published: October 2023

Background

Worldwide, population is ageing, leading to a growing burden of neurodegenerative diseases (NDDs) such as Alzheimer's Disease (AD), Parkinson's Disease (PD). Socioeconomic position (SEP) has shown a persistent negative relationship with mortality over the last decades. The most common indicators of SEP such as income, education, and occupational class have shown to significantly impact life expectancy and other mortality indicators. However, studies on the association between SEP and NDD mortality are rather scarce. Therefore, the aim of this study is to assess whether SEP is associated with NDD mortality, which is crucial in understanding and developing preventive interventions for these diseases.

Methods

A comparative analysis on SEP - in terms of income and education - and deaths associated with dementia and parkinsonism was performed, using log linear Poisson regression. Data consisted of the 2011 Belgian census linked to mortality data for the period 2011-2016.

Results

During the 2011-2016 study period, 34,700 Belgian inhabitants aged 65 or older died from an NDD (N = 1,883,182). We observed significantly higher mortality in the lowest educational- and income groups. Education had the strongest association in women, with 1.29 (CI 1.21-1.38) times the MRR in the lowest educated group compared to the highest. In men, income showed the strongest association with 1.11 (CI 1.04-1.18) times the MRR in the lowest income group compared to the highest. The biggest disparities were found in dementia mortality, generally negative association with SEP. For income, we observed a strong negative association on parkinsonism mortality, while we found a reversed pattern with education.

Conclusions

Our study provides evidence supporting the existence of socioeconomic disparities in mortality due to neurodegeneration. We found a strong negative association between SEP and NDD mortality, which varies between men and women and between several NDDs.

Key messages

• NDDs are rapidly becoming a major public health issue worldwide.

• Mortality from these diseases vary between different social groups, differentiated interventions are needed in order to reduce inequalities.
Mortality around the anniversary of a sibling’s death. Findings from Swedish register-data
Authors: Rostila M , Hiyoshi A , Berg L , Grotta A
Published: October 2023

Background

Studies have found that the death of a sibling is associated with adverse health in bereaved siblings. Anniversaries may trigger grief reactions and contribute to an acute deterioration of health and are exogenous to shared intergenerational characteristics and may provide an indication of a causal effect of bereavement. Previous studies have found anniversary effects following the loss of a child and parent. We examined whether mortality increases among adult siblings around the anniversary following sibling death.

Methods

This case-crossover study used Swedish register-based longitudinal data from 1990 to 2016, based on the entire population. Participants included all adults aged 18 to 65 years who experienced sibling death and subsequently died. Conditional logistic regression was used to quantify the association between the anniversary (or preanniversary and postanniversary periods) and mortality, controlling for time-invariant confounding. All analyses were stratified by sex of the bereaved. Further analyses will also be stratified by socio-demographic characteristics such as the sex of the deceased sibling, time since sibling death, age, marital status and cause of sibling death.

Results

The results show that the anniversary of a siblings’ death is not associated with an increased mortality risk in bereaved siblings. We rather found somewhat reduced mortality risks around the anniversary dates in men (OR 0.78 95% CI 0.55-1.10 for the period ranging from 2 days before up to the anniversary) and women (OR 0.44 95% CI 0.20-0.97 for the anniversary). Further analysis will scrutinize whether anniversary effects are found when the analysis are stratified by socio-demographic characteristics and cause of sibling death.

Conclusions

Anniversaries following sibling death might not trigger grief to the same extent as anniversaries following the death of a parent or child. Sibling bereavement may still have health consequences although not during anniversaries.

Key messages

• Anniversaries following sibling death might not trigger grief to the same extent as child and parental bereavement.

• Sibling bereavement may still have health consequences although not around anniversaries.
Impact of PFAS exposure on immune-mediated diseases and immune transcriptome in Czech adults
Authors: Rudzanová B , Vlaanderen J , Kalina J , Vespalcová H , Martyniuk C , Piler P , Zvonař M , Klánová J , Bláha L , Adamovský O
Published: October 2023

Background

Per- and polyfluoroalkyl substances (PFASs) are emerging environmental contaminants with multiple hazardous properties including immunomodulation potency. We aimed to investigate 1) the association between PFAS exposure and immune-mediated diseases (IMDs) and 2) the expression of genes associated with PFAS exposure in a population of Czech adults.

Methods

This study involved 309 adults from the Czech CELSPAC:YA cohort. The associations of serum concentrations of 9 PFAS with 9 IMDs were assessed by logistic regression. Furthermore, Bayesian kernel machine regression (BKMR) was used to estimate the effect of the PFAS mixture on IMDs. In cases of a statistically significant interaction of PFASs and sex, sex-stratified analyses were performed. To identify transcriptomic profiles, isolated RNA from peripheral mononuclear blood cells was sequenced (QuantSeq) and analysed. Significantly expressed genes associated with multiple PFASs (at least with 4 PFASs) were employed for enrichment analysis by Pathway Studio. All analyses were adjusted for relevant confounders (i.e., sex, age, BMI, smoking, education, and family history of IMDs).

Results

PFOA, PFOS, and PFUnDA were negatively associated with allergies. Similarly, BKMR modeling showed a negative tendency in the overall effect of PFAS mixture on IMDs. Results of the stratified analysis suggest sex to be an effect modifier in the association of PFOS and atopic eczema. Regarding transcriptomic analysis, 166 statistically significant genes were associated with multiple PFAS exposure. Enrichment analysis of these genes showed involvement of B cell signaling, specifically mechanisms involved in the production of antibody-secreting plasma cells.

Conclusions

Our results contribute to the body of literature that observes the immunomodulatory effect of PFAS exposure on the level of disease prevalence and further brought new information about underlying deregulatory mechanisms.

Key messages

• Our study showed an immunosuppressive effect of PFAS exposure on the level of prevalence of immune-mediated diseases, both for PFASs individually and as a mixture.

• Genome-wide transcriptomic analysis revealed the involvement of plasma cells as a potential key event of PFAS-induced immunomodulation.
Link between COVID-19 Vaccination Attitudes and Support for Mandatory Childhood Vaccinations
Authors: Chamova R , Pancheva R , Rohova M , Ivanova E , Hadjieva S , Mikhailov N , Kolarova M , Radeva N , Paunov T
Published: October 2023

Introduction

Despite vaccines being a proven intervention over time to limit the spread of infectious diseases, in recent decades there has been fluctuation among parents regarding the mandatory immunization calendar in Bulgaria.

Aim

This study aimed to investigate the impact of the COVID-19 pandemic on parents’ decisions regarding mandatory immunizations for children in Bulgaria.

Methods

A total of 1200 Bulgarian citizens participated in the cross-sectional study, which included questions related to socio-demographic indicators, COVID vaccination status, attitudes towards mandatory immunization, beliefs in personal doctors, rumors about vaccines, and the desire to vaccinate their own children against COVID-19. Data was analyzed using Jamovi software, and a chi-square test for association was used to investigate the relationship between COVID-19 vaccination status and attitudes towards mandatory childhood vaccinations.

Results

The study found that 93% of the 1133 participants who expressed an opinion on mandatory childhood vaccinations had a positive attitude. Respondents who were vaccinated against COVID-19 and had a positive attitude towards mandatory COVID vaccination were more likely to support mandatory childhood vaccinations – 98.8% vs 1.2% (χ2=27.6; p < 0.001). Those who perceived moderate to high benefits of COVID vaccines were also more likely to support mandatory childhood vaccinations (χ2=43.4; p < 0.001). Participants who had not heard of or did not believe in rumors about COVID vaccines and those who had trust in primary care physicians were more likely to support mandatory childhood vaccinations.

Conclusions

The study indicates that attitudes towards COVID vaccination could influence parents’ decisions on mandatory vaccines for children in Bulgaria. If parents distrust the safety and effectiveness of COVID vaccines, they may also be hesitant towards mandatory vaccinations for children.

Key messages

• Implementation of a proper vaccination policy is necessary to protect public health and limit infectious diseases.

• The COVID-19 pandemic has raised questions about the possibility of including mandatory vaccination against COVID-19 in Bulgaria's immunization calendar.
A&F effectiveness in reducing avoidable health differences: Equity issues & COVID 19
Authors: Tullio A , Valent F , Deroma L
Published: October 2023

Background

Healthcare equity aims to ensure that everyone can access affordable, culturally competent healthcare since everyone has a fair and just opportunity to attain their highest level of health. Italian National Health Service is characterized by the principles of universality and equality with the aim of the progressive overcoming of inequalities and social and territorial imbalances. The development of the principle of equality has made it possible to focus on three different areas in which the corollary of equity must find concrete implementation: access to health benefits and services, health outcomes for individual subjects, and the allocation of resources and services as needed. Key performance indicators (KPIs) are described as essential in studying and enhancing healthcare performance.

Methods

Within the network project EASY-NET (NET code 2016-02364191), we carried out an A&F study in Friuli Venezia Giulia region, Italy, over 4 years, evaluating the equity of emergency healthcare access. We calculated 6 KPIs investigating gender, education, residence, and nationality using administrative health databases. We calculated and compared 2019, 2020, and 2021 KPIs.

Results

We observed a reduction in emergency care access during the pandemic, greater among women than among men, as reported in the literature, and an increase in access among citizens with ‘not detected/no qualification’ scholarship level and citizens with non-EU or not detected country of birth.

Conclusions

Consistently with the literature, since the beginning of the pandemic, the population turned less to emergency health services, above all women. On the other hand, and contextually no-level-of-schooling citizens and non-EU-birth citizens turned more compared to the rest of the population. While healthcare systems were focused on COVID-19, a worrying reduction in access to care was observed, bringing attention to the issue of healthcare equity both during and post COVID.

Key messages

• We observed a reduction of healthcare access in the emergency context, above all for women, since the pandemic began.

• Non-EU-birth citizens and citizens with no level of schooling had more frequent access to emergency health services than the rest of the population in the pandemic context.
Commentary: Finnish health and social care reform in the European perspective
Authors: Wismar M
Published: October 2023

In the commentary, the Finnish health and social care reform and its objectives to foster integrate health and social services are addressed in terms of current European health system reform trends. The focus is on the challenges facing the Finnish government in the large structural reform and lessons to be learnt by other European countries.
Bulgarian bioethicists on patients’ responsibility as a basis for prioritisation in healthcare
Authors: Yankulovska S , Anov A , Veskov L , Mihaylova A , Bakova D , Grigorova A , Mirchev M , Saleva M
Published: October 2023

Background

Patients’ responsibility as a criterion for setting priorities in healthcare has been widely discussed in the academic literature recently while the empirical knowledge is still limited.

Methods

We investigated perceptions of bioethicists within the Bulgarian Association of Bioethics and Clinical ethics (BABCE) on the relevance of patient's responsibility for priority setting in Bulgarian healthcare context through focus group interview. Discussions were recorded and transcribed verbatim. Conceptually driven thematic analysis was used.

Results

The findings suggest that members of BABCE supported the concept of patients’ responsibility but were reluctant to the application of the life style contract as a basis for prioritization in health care. The life style contract was seen as not corresponding to Bulgarian cultural particularities. The existing similar mechanisms in the field of social assistance in our country had proved to be ineffective. The main precondition for introduction of patients’ responsibility was the building of supportive environment on the side of the society and the government. The concept of prospective responsibility was seen as more acceptable than the retrospective responsibility. The participants distinguished other dimensions of personal responsibility such as intentional damages of healthcare facilities, misuse of resources, violence towards health professionals that were considered as deleterious to the healthcare system as the life style induced diseases.

Conclusions

The acceptance of patients’ responsibility as a criterion for prioritization in health care in Bulgaria needs to be studied further among wider professional community and the general public. A field study in the real national conditions would contribute to the development of specific tools to deal with resource allocation issues in our context.

Key messages

• Prioritisation in healthcare is inevitable and patients’ responsibility could be an acceptable criterion under certain conditions.

• National particularities should be studied to find the most appropriate tools to deal with resource allocation issues.
Application of personalized medicine implementation framework: a multi-country analysis
Authors: García Sanz P , Aguilera-Cobos L , Rosario-Lozano M P , Blasco-Amaro J A
Published: October 2023

Background

Personalized medicine (PM) is a rapidly evolving field, and its implementation varies widely across different countries. Some countries have invested significantly in PM research and development, while others still need to adopt these approaches.

Methods

To create a visual map of the PM implementation current state between countries. A framework was applied to determine the PM implementation level. The necessary information was identified and gathered from various sources, including policy documents, national guidelines, websites of major governmental agencies, research organizations, and health technology assessment agencies such as NICE, CADTH, AHRQ, and RedETS.

Results

Our search retrieved 184 full-text documents to fulfill the framework, generating a PM implementation country map. The map reflects the variability between countries based on different factors, particularly social-economic development.

Conclusions

Our PM framework was applied in a multi-country context, ranking countries based on their implementation levels. Our findings can reflect the adoption of best practices to improve implementation efforts. Policymakers, healthcare professionals, and researchers can use our framework to assess PM implementation in their respective regions. Further research is needed to evaluate the framework's challenges, limitations, and performance in different contexts.

Key messages

• Our PM framework was applied in a multi-country context, ranking countries based on their implementation levels.

• Policymakers, healthcare professionals, and researchers can use our framework to assess PM implementation in their respective regions.
The impact of covid-19 pandemic on Albanian health emergency operation centre
Authors: Giusti M , Vannini I E , Caldes M J , De Luca M , Persiani N
Published: October 2023

During the COVID-19 pandemic, each State adopted different health emergency strategies to face this new challenge. After the first hospital centred answer, these strategies promoted the strengthening of the territorial health assistance as better response to population health needs at worldwide level. This approach was especially important in the countries in transition, where the hospital systems are weaker. This research aims to assess the impact of these new health policy strategies on health emergency operation centre (HEOC) in a country in transition. Country case study was found to be the most effective methodology. Albania was a significant case study due to its ongoing efforts to align its national healthcare system with European health standards being in pre-adhesion to the European Union. Moreover, this country has recently implemented a modern national HEOC (2018). The data shows that at the beginning to COVID-19 pandemic, the response by HEOC was limited and mainly hospital-centred. In 2020 only 8% of the calls for COVID-19 to the HEOC had an intervention, that was in the 49% a transport in hospital. Medical consultations and treatments on site were only the 4%. In 2021, the issue of guidelines aimed at giving priority to the territorial health assistance brought to a relevant reduction of calls (-64%). It allowed the HEOC to enlarge its response until to give a response to the 34% of calls. The 15% of calls were managed by medical consultations and 18% by treatments on site. The cases transported in hospital were always the 50% but they decreased off -63% in absolute value. In Albania the implementation of national health policy strategies that have enhanced the territorial response to COVID-19 pandemic, relieved the pressure on HEOC by calls’ reduction. In this way, HEOC focused its efforts on the applications of territorial responses instead of hospitalization, according to national health policy strategies, increasing its responsiveness.

Key messages

• The enhancement of the territorial response to COVID-19 pandemic has eased the pressure on the Albanian HEOC.

• The territorial response to COVID-19 pandemic by the Albanian HEOC especially focused on mainly the provision of medical consultations and treatments on site.