bluuebunny/crossref_metadata_2025 huggingface dataset:
HIA on lockdown and social distancing to contain the COVID-19 pandemic in Austria – results and lessons learned
Authors: Antony G , Antosik J , Weigl M , Marbler C , Laschkolnig A
Published: October 2021

The COVID-19 pandemic and the measures taken created opportunities in various areas of life, but also created new challenges or increased existing ones, which can also have a (direct or indirect) impact on health and well-being of the population or certain population groups. This health impact assessment (HIA) was commissioned to provide an overview of these effects. The foundation of gathering information for the impact assessment was a national literature research and analysis combined with an online survey. In addition, a search of international literature was conducted by the European Observatory on Health Systems and Policies. The impact assessment and an initial collection of recommendations for action were carried out together with relevant stakeholders in the context of several thematically merged online assessment workshops. Positive and negative - direct as well as indirect - impacts on health in different areas of life could be identified, with the negative impacts predominating in proportion. In addition to identifying the impacts, the HIA also identified groups that were particularly affected by the pandemic. In the course of this HIA, it became clear that the direct in indirect health impacts in many areas of life are interrelated (e. g., job loss, family climate, social inclusion, and psychological well-being) and that a separate discussion often fell short. This HIA provides an overview of various impacts and allows first impressions on actions for future measures in regard to the pandemic in various areas of life, according to the HiAP approach.
Assessing the health impact of staying at home, social distancing and lockdown measures during the Covid-19 epidemic
Authors: Chiesa V , Antony G , Wismar M , Rechel B
Published: October 2021

Objectives

To systematically review the evidence published in systematic reviews on the health impact of staying at home, social distancing and lockdown measures.

Study design

We followed a systematic review approach, in line with PRISMA guidelines.

Methods

In October 2020, we searched the databases Cochrane Database of Systematic Reviews, Ovid Medline, Ovid Embase, and Web of Science, using a pre-defined search strategy.

Results

The literature search yielded an initial list of 2172 records. After screening of titles and abstracts, followed by full-text screening, 51 articles were retained and included in the analysis. All of them referred to the first wave of the COVID-19 pandemic. The direct health impact that was covered in the greatest number (25) of systematic reviews related to mental health, followed by 13 systematic reviews on healthcare delivery(1-13)(1-13)(1-13), and 12 on infection control. The predominant areas of indirect health impacts covered by the included studies relate to the economic and social impacts (15 and 7 articles respectively. Only 3 articles mentioned the negative impact on education.

Conclusions

The focus of systematic reviews so far has been uneven, with mental health receiving the most attention. The impact of measures to contain the spread of the virus can be direct and indirect, having both intended and unintended consequences.
After Action Reviews to assess COVID-19 hospital responses
Authors: Sorbello S , Bossi E , Zandalasini C , Carioli G , Pleet A , Signorelli C , Ciceri F , Ambrosio A , Odone A
Published: October 2021

Introduction

After-Action Reviews (AARs) are healthcare management tools applied to evaluate responses to public health emergencies, identifying best practices and challenges. They are included in the International Health Regulations (IHR) and recommended by the World Health Organization (WHO). The aim of this study was to adapt the WHO AAR guidelines to assess the response during the COVID-19 first epidemic wave (February 22nd-May 3rd, 2020) at San Raffaele Scientific Institute, a large university hospital in Milan, Italy. The hospital treated 951 patients and underwent massive re-organization.

Methods

We developed a hospital-oriented AAR based on the key-informant interview format. After establishing an AAR planning and analysis team, an ad-hoc questionnaire was designed to explore four areas: i)Staff management; ii)Logistics and supplies; iii)Diagnosis and clinical management; iv)Communication. The questionnaire was used to support 36 semi-structured interviews of professionals with executive, clinical, technical and administrative roles within the hospital.

Results

The hospital response was rated as overall effective and sufficiently prompt. Participants stressed the key roles played by: i)strong governance and coordination; ii)readiness and availability of healthcare personnel; iii)multidisciplinary model of care based on levels of intensity. Major challenges concerned communication strategies and staff training. In addition, participants highlighted the need for greater collaboration among hospitals and primary care services.

Conclusions

This study represents one of the first applications of an AAR to the COVID-19 emergency and to the hospital setting. The tool provided San Raffaele's hospital management with a multi-layered analysis of the emergency response that informed the critical planning for next phases of the pandemic response. The tool can be adapted to other settings to pursue continuous operational improvement.

Key messages

After-action reviews are healthcare managements tools used to to evaluate a country or government’s response to infectious disease outbreaks, environmental or natural disasters and societal crises. After Action Reviews can be adapted or scaled for other settings to pursue continuous operational improvement and support preparedness strategies for future public health emergencies.
Impact of COVID-19 on healthcare waste generation: correlations and trends from a tertiary hospital
Authors: Garlasco J , Canepari A , Giacobone G , Funicelli G , Cotroneo A , Zotti CM
Published: October 2021

Background

COVID-19 has represented an emergency not only for the sanitary issues, but also from the environmental and operative perspective, with largely increased waste disposal due to non-reusable personal protective equipment and packaging. This study aimed at estimating the increase in healthcare waste (HW) generation during the outbreak, based on data from a tertiary hospital.

Methods

From the purveying office statements of “SS Antonio e Biagio e Cesare Arrigo” Hospital of Alessandria (Italy), monthly data on HW generation from January 2015 to March 2021 were retrospectively retrieved. Trend analyses were performed through linear regression and the impact of COVID was evaluated following the Interrupted-Time Series regression model. Moreover, HW generation data were compared to the proportion of patient-days and admissions due to COVID (out of respective totals) through Pearson's correlation test.

Results

HW generation rose from a baseline of 35.9 ± 3.8 tons/month (2.4 ± 0.2 kg per patient-day, kg/PD) in 2015-2019, to 46.3 ± 6.0 tons/month (3.3 ± 0.6 kg/PD) during the outbreak (2020-2021), with a peak in March-April 2020. Segmented regression showed that the already increasing trend was not appreciably modified as for its slope, whereas a significant level change could be detected between baseline and outbreak period (+0.6 kg/PD, corresponding to a 28.6% increase compared to baseline intercept, p < 0.001). HW generation was significantly correlated to the proportion of admissions (p = 0.005, R2=0.70) and patient-days (p = 0.006, R2=0.69) related to COVID-19.

Conclusions

The study showed a significant rise in HW generation in 2020-2021, reasonably due to the COVID-19 outbreak. Moreover, this happened without affecting the generally increasing trend. These results underline the effect of the pandemic on the amounts of waste generated by healthcare facilities, with noticeable impact on the environment and higher costs associated with HW management and disposal.

Key messages

Due to extensive use of disposable equipment and packaging, COVID-19 strongly impacted on healthcare waste generation, with an average 28.6% increase compared to baseline levels (+0.6 kg/patient-day). The generally increasing trend in healthcare waste generation, along with the remarkable increase due to COVID-19, results in high environmental impact and management costs for healthcare facilities.
Public health impact of COVID-19 pandemic on the emergency healthcare system: a region-wide analysis
Authors: Stirparo G , Oradini-Alacreu A , Migliori M , Villa GF , Botteri M , Fagoni N , Signorelli C , Sechi GM , Zoli A
Published: October 2021

Background

The Lombardy region has been one of the Italian regions most affected by the COVID-19 pandemic in 2020, with 22.7% of total Italian cases and 33.9% of total deaths. The emergency healthcare system was under deep stress throughout the period under consideration due to the admission of COVID-19 patients to the Emergency Department (ED) and had to be thoroughly reorganized.

Methods

We performed a retrospective descriptive analysis of patients admitted into the ED recorded in the Lombardy online regional portal called EUOL. We compared the data registered in the EUOL with the patients admitted to the EDs from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020.

Results

The number of admissions to the ED decreased by 32.5% in 2020 compared to 2019, reaching the lowest number in March and April. However, the percentage of patients hospitalised after ED significantly increased in 2020 compared to 2019 (OR 1.47, p < 0.0001), reflecting the management of patients with a more severe clinical condition. Indeed, the number of patients classified as red or yellow codes at hospital admission was significantly higher in 2020 than in 2019 (p < 0.0001). Moreover, more patients arrived at the ED by ambulance in 2020 (21.7% in 2020 versus 15.1% in 2019. OR 1.56, p < 0.0001), with more than 35% of patients transported by ambulance in March and April 2020.

Conclusions

Our results showed, on the one hand, inappropriate visits to the EDs by non-emergency and low complex cases in 2019 before the pandemic and, on the other hand, they also highlighted that patients in critical condition were reluctant to visit the ED due to the fear of getting infected. This analysis showed that EMS played a crucial role in the overall public health impact of the COVID-19 pandemic, increasing the percentage of patients transported to the hospital with a severe clinical condition, reorganizing and allocating resources to the areas that were most affected during the pandemic.

Key messages

This is a descriptive analysis of the public health impact of the COVID-19 pandemic on the admission to Emergency Departments in 2020. Our results underline the need to monitor the pandemic’s evolution in order to reorganize the hospitals that admitted the COVID-19 patients.
2.K. Round table: Everything you always wanted to know about (COVID-19 and) EU-health policy
Authors:   Organised by: European Observatory,   Chair persons: Matthias Wismar (European Observatory)
Published: October 2021

Objective

There is no European Union (EU) health system but there is an EU health policy and this health policy is rapidly changing due to the COVID-19 responses of the EU and Member States. The aim of this panel discussion is to analyze and put into context the rapid evolvement of EU health policy during the pandemic. This panel discussion will therefore focus on 1) EU public health policy 2) EU action for health 3) the EU Market shaping health 4) the fiscal governance 5) the institutions, processes and powers.

Background

EU health policy has often been overlooked and was never on the political agenda. COVID-19 and the pandemic response, however, changed this dramatically. EU-health policy has become centre stage followed by bold investments and new regulatory initiatives. Obvious examples are the EU4Heatlth programme, the Recovery and Resilience fund, the new agency HERA, the new remit for the European Medicines Agency and the European Center for Disease Control. There are also new European Commission mechanisms with regards to the purchase of personal protective equipment, supplies, medicines including vaccines and medical technologies. But will the new EU health policy strengthen health systems of Member States or just focus on stronger emergency responses? Will the constitutional asymmetry between health and internal market be addressed? Will EU-health policy remain after the crisis a centre-piece of European Integration? This panel is based on the COVID-19 update of the EU-health policy handbook ‘Everything you always wanted to know about European Union health policies but were afraid to ask'

Interactivity

There will be a high level of interactivity. After an introductory presentation, attendees can use the chat-box to choose specific topics from the aforementioned five themes. These topics will be presented in a table. The chair will then pass the questions and topics to the panelists.

Speakers/Panelists

Sarah Rozenblum University of Michigan, Ann Arbor, USA Holly Jarman University of Michigan, Ann Arbor, USA Nick Fahy University of Oxford, Oxford, UK Anniek de Ruijter University of Amsterdam, Amsterdam, Netherlands Eleanore Brooks University of Edinburgh, Edinburgh, UK

Key messages

The European Health Union will be one of the most important constitutional and policy outcomes of the pandemic. It is essential that the European Health Union is not only strengthening emergency planning and response but also accessibility, equity and resilience of health systems.
Introduction to the Expert Panel on Effective ways of investing in health (EXPH) and its mandate
Authors: Barros Pedro Pita
Published: October 2021

EXPH members and Opinion collaborators

The Expert Panel on Effective ways of investing in health (EXPH) is an interdisciplinary and independent group established by the European Commission to provide non-binding independent advice on matters related to effective, accessible and resilient health systems. The mandate from the European Commission asked EXPH to address the following questions: 1. What are the specific factors influencing mental health (MH) of the health workforce and essential workers? 2. What interventions could be effective in addressing MH support needs of health workers and essential workers, including those with preexisting MH conditions? Using existing data, assess the cost of MH problems in the health workforce and the cost-effectiveness of MH interventions. What are the conditions for the delivery of these interventions in a cost-effective, affordable and inclusive manner? 3) How can the EU address these concerns?
Recommendations to support the mental health of the health workforce
Authors: Zaletel Jelka
Published: October 2021

EXPH members and Opinion collaborators

The Opinion concludes with eight evidence-based recommendations, complemented by action points with EU-wide and Member-State relevance. The recommendations are addressed to policy makers and managers, as well as with mental health and occupational health practitioners. The focus of these recommendations to support the mental health of the health workforce is on fostering their mental wellbeing and the need to treat mental wellbeing as an organisational responsibility within the workplace. The recommendations address the roles of stakeholders at several levels (organisations, national authorities and EU). The action points detail the general principle described in each recommendation. Specifically, there is the need for appropriate guidance frameworks to be established, in some cases deserving legal status, to clearly establish mental wellbeing as an important workplace responsibility within organisations. This requires awareness and competencies by the leadership of organisations, which can be facilitated via education and training. To support promotion of mental wellbeing in SMEs, the use of common digital tools (to be developed) can be advantageous. In addition, workplaces must develop adequate mechanisms for early identification of factors influencing mental wellbeing and for referral to professional help when preventive efforts are not effective. The organisation, as opposed to the individual worker, is to be held accountable for worker wellbeing. Building and sharing knowledge on interventions that work via the creation of learning communities is recommended. The identification of best practices that are cost-effective require further evidence, which should be developed by overcoming methodological challenges. Lastly, a common EU-wide view of mental health care and its re-organisation is needed with emphasis on prevention and support of mental wellbeing in not only the health workforce, but the general population as a whole.
How genetics and epigenetics can improve cardiovascular risk prediction: examples from the Moli-sani and Moli-family studies
Authors: Gianfagna F , Iacoviello L
Published: October 2021

One of the goals of personalized medicine (PM) is to use the ever-growing understanding of biology to provide a higher level of precision in disease prevention and patient care. The simultaneous study of the risk markers and epigenetic factors may have the desired discriminatory accuracy to distinguish between high-risk and low-risk subjects. The presentation will illustrate how genetics and epigenetics can improve cardiovascular risk (CVD) prediction in Italian adults from the general population. A subcohort of 1160 subjects (55.3±11.7 years; men 47.7%) was randomly selected from the Moli-sani cohort study (N = 24,325, yrs:2005-2010) and compared in a nested case-cohort design with incident CVD events (N = 592 validated myocardial infarctions or strokes), identified in a median follow-up of 9.2 years. DNA samples were used to genotype 14 tag SNPs in the genes NMU (encoding for Neuromedin U, a hypothalamic peptide), NMUR1 and NMUR2 (receptors) and NMS (Neuromedin S) and to quantify methylation levels at 17 CpG sites of two NMU regions through pyrosequencing. ELISA tests on circulating NMU levels are on-going. The associations between variants and incident CVD events using classical CVD risk factors as covariates and prediction metrics using standard risk alogrithms as reference were calculated. Four SNPs in NMU and NMUR1 genes and 6 NMU CpG sites showed a statistically significant association with events (p from 0.037 to < 0.0001), independently from classical CVD risk factors. Combined epigenetic and genetic variants in genes from the NMU pathway are associated with increased CVD risk and could have a potential clinical utility when added to current CVD risk algorithms for CVD prediction.
Research methodologies to assess the impact of COVID-19
Authors: Nogueira PJ , Forjaz MJ , Rodriguez-Blazquez C , Diaz-Franco A , Unim B , Palmieri L , Carcaillon-Bentata L , Makovski T , Feteira-Santos R
Published: October 2021

Background

PHIRI WP5 aims at identifying the research approaches, data uses, pathways, indicators, and new methodologies to assess the impact of COVID-19 on Population Health.

Methods

Based on a collaborative work of researchers from 20 European institutions, several literature reviews were planned using automatized strategies to map the research methods analysing the impact of COVID-19 and data pathways: i) a scoping literature search to identify indicators of direct and indirect impact; ii) systematic literature reviews on determinants of severity for short and longterm health outcomes; and iii) a systematic literature review and meta-analysis to determine the effectiveness and impact of tracking COVID-19 patients using digitals tools.

Results

In November 2020, more than 73,000 papers about COVID-19 were published. About 16,000 (22%) reported data aspects, and approximately half reported both data aspects and methodologies. The most used indicators of direct impact are incidence and prevalence, mortality, severity and sequelae. To explore the etiological and prognostic effects of frailty, multimorbidity and socioeconomic status, the main identified outcomes were: infection, hospitalization, ICU admission, mortality by COVID-19 (etiological); as well as ICU admission, hospitalization, survival, functional decline, quality of life, disability, mental health difficulties and work absence (prognostic). The search generated 10,139 records. The initial literature search about mobile applications and electronic devices for tracking of COVID-19 patients yielded 2500 records.

Conclusions

The use of machine learning tools to synthesize the research about methods and data pathways on COVID-19 impact is feasible, as the amount of published evidence is very large. The vast amount of available literature on COVID-19 requires specific methods of literature search and synthesis, and an integrated effort of an extensive network of researchers.
Dietary factors and non-communicable disease risk in Europe: evidence for European nutritional guidelines?
Authors: Grosso G , Di Cesare M
Published: October 2021

Findings from large global studies support the hypothesis that Europe is suffering from a double burden of malnutrition, affecting food security, undernutrition and nutrition deficiencies on one side, and overnutrition and higher risk of obesity and chronic diseases on the other. Data from the NCD Risk Factor Collaboration (NCD-RisC) and the Global Burden of Disease (GBD) Study as well as meta-review from the scientific literature provides insight on the burden of nutritional risk factors on non-communicable diseases in Europe. Over the last 40 years, obesity prevalence has increased threefold in several European countries, reaching over 50% of individuals having weight problems. However, obesity prevalence levels and trends vary substantially by gender and between European countries, with Malta and Eastern European countries having higher overweight and obesity rates. At European level, it has been estimated that over 950,000 deaths and over 16 million DALYs are attributable to dietary risks due to unhealthy diets. The main causes of death attributable to dietary risks include cardiovascular diseases (817,302), neoplasms (101,477) and diabetes and kidney diseases (32,009). The most important dietary factors contributing to cardiovascular diseases were diet high in sodium, sugar sweetened beverages, and processed meat, while metabolic disorders are also affected by low whole grain, fruit, nuts and seeds intake. Neoplasms affected by dietary risk factors involve the upper aerodigestive and low digestive tracts, and may be due to low intake of fiber, calcium and milk. Although similar, some differences across countries can be observed due to different dietary habits and food preferences. The presented findings emphasize the need of common guidelines that could be applied to all people living in Europe. While advocating for healthier dietary habits, policy orientation is needed to improve nutrition and prevent non-communicable diseases.
Sex differences in functional limitation level and the role of socioeconomic factors
Authors: Bloomberg M , Dugravot A , Landré B , Britton A , Steptoe A , Singh-Manoux A , Sabia S
Published: October 2021

Background

Women are more likely to have functional limitations than men, partly due to socioeconomic disadvantage. As much of this research is based on dichotomised measures of limitation, how sex differences vary by level of limitations remains unclear. The aim of our study was to examine sex differences in functional limitations in people born between 1895 and 1960, with attention to the role of socioeconomic factors and level of limitations.

Methods

Longitudinal data on limitations in basic/instrumental activities of daily living (ADL/IADL) and mobility activities were drawn from studies in 14 countries. For ADL, IADL, and mobility activities, participants were grouped into limitation levels based on number of limited activities (0, 1, 2, or ≥ 3). Sex differences in limitations in four birth cohorts (1895-1929, 1930-1938, 1939-1945, 1946-1960) were analysed before and after adjustment for socioeconomic factors using mixed effects ordinal logistic models.

Findings

Among 62,375 participants, sex differences in IADL and ADL limitations (≥1) were minor after adjustment for socioeconomic factors (sex difference in probability of limitations (female - male) age 75, 1895-1929 cohort for IADL=3.7% (95% CI 2.6, 4.7) before and 1.7% (1.1, 2.2) after adjustment; ADL=3.2% (2.3, 4.1) before, 1.4% (0.9, 1.8) after). Sex differences remained for mobility (16.1% (14.4, 17.7) before, 14.3% (12.7, 15.9) after). At older ages, women were more likely to have ≥3 IADL or mobility limitations, while men were more likely to have 1 to 2.

Conclusions

Socioeconomic factors explain the majority of sex differences in IADL and ADL limitations but not mobility, with women reporting greater mobility limitations than men starting in middle age. Our findings suggest sex differences in mobility limitations from middle age might be important targets for future study and interventions.

Key messages

Sex differences in disability vary considerably between disability measures. Comprehensive assessment of sex differences in disability should consider disability severity across different measures. Findings suggest there may be fewer sex differences in disability in the future with progressively decreasing socioeconomic disparities between men and women.
Trends in ionizing radiation exposure of healthcare workers in France (2009-2019): the EXPERTS study
Authors: Baudin C , Vacquier B , Partarrieu I , Ducou Le Pointe H , Mora S , Feuardent J , Leuraud K , Bensefa-Colas L , Bernier MO
Published: October 2021

Background

Health workers exposed to ionizing radiation (IR) account for +50% of workers exposed to artificial IR in France. Over the last 10 years, the use of IR in medicine has developed due to the introduction of new practices. The EXPERTS study aims to evaluate and characterize the trends in IR exposure of health workers in France between 2009 and 2019.

Methods

The study includes all health workers with at least one dosimetric record in the System for occupational dosimetry registration (SISERI) database for each of the years 2009, 2014, and 2019, in the 6 hospitals included in the study (in Paris & Bordeaux). Individual passive external doses, professional activity, age and gender were collected via SISERI and occupational medicine units. Doses were estimated from badges worn at chest level under the lead apron.

Results

1,999 workers were included. Mean Hp(10) doses significantly decreased between 2009 and 2019 (-0.004 mSv/year; p < 0.05). Workers in Bordeaux hospitals were more exposed than those in Paris in 2009 and 2014, while trend was reversed in 2019 (p > 0.05). Doses in men were significantly higher than women's doses in 2009 and 2014 (p < 0.02), but were similar in 2019 (p = 0.99). Physicians had the highest mean IR doses between 2009 and 2019 (0.14mSv ±1.09), and more specifically surgeons and cardiologists, but their exposure tended to decrease in recent years. Radiological technologists have similar mean doses (0.14mSv ±0.38), relatively stable over the study period - the most exposed in the nuclear medicine unit (0.60mSv ±0.58).

Conclusions

IR exposure of health workers in France decreased significantly between 2009 and 2019, despite an increase in practices using IR - this decrease was partly recorded in orthopaedic surgeons. This may be related to radiation protection rules' application. However, badges may not always be worn properly. This study could be extended to other healthcare centres to study local specificities and to adapt radiation protection policies

Key messages

Despite the increase in medical practices using ionising radiations (IR), the average exposure of health workers to IR has decreased over the 10 last year, mainly in Bordeaux hospitals. Differences in average IR exposure were found by occupation, gender, health care units, and hospitals. Policies should use these results to promote radiation protection rules.
Barriers to the preceptor’s role in interprofessional education: scoping review
Authors: Silva CM , Mazzi NR , Duarte TCR , Leonello VM
Published: October 2021

Background

With the expansion of interprofessional health education, preceptors are increasingly working with learners from several professions to promote collaborative practice. It is unclear what are the challenges toward interprofessional education in preceptor's learning environment. A scoping review was conducted to map the barriers to preceptorship role in interprofessional health education. The following research question was formulated: What are the barriers to preceptor's role in interprofessional education?

Methods

The research question was defined with the framework PCC: Population - preceptors; Concept - barriers to preceptorship role; Context - interprofessional health education initiatives. A systematic search in 8 databases was conducted in April 2020 to identify primary research studies published in Portuguese, Spanish or English. Independent screenings of titles/abstracts followed by full texts were performed using pre-defined criteria. This review followed the Institute Joanna Briggs Manual of Evidences (2020) and the PRISMA-ScR guideline.

Results

A total of 28 studies from the United States, Brazil, Canada, Australia, Sweden and the United Kingdom remained to extract barriers. Barriers were summarized in five main aspects: limited resources, preceptorship regulation, patients participation, teaching-service integration, local culture for interprofessional teamwork and preceptor development. Some of the barriers were: lack of coordination between educational institutions and health services, hierarchical relationship among professionals, unfavorable working environment for interprofessional collaboration, unclear professional roles and need of preceptor development.

Conclusions

Many barriers have been identified at the macro and microstructural levels of health systems. Discussing and analyzing such barriers is fundamental for advancing the debate on the skills and roles of preceptors, with a view to strengthen the Interprofessional Health Education.

Key messages

Preceptorship is important to development interprofessional collaboration. The results make it possible to plan strategies that contribute to professional recognition and professional development.
The importance of mental health literacy in times of crisis: Adolescent mental health during the COVID-19 pandemic
Authors: Tullius J , Beukema L
Published: October 2021

Many adolescents do not seek appropriate help when they experience mental health problems (MHP). Especially during the COVID-19 pandemic, this has become an increasingly pressing public health problem as more adolescents experience MHP due to social isolation, problematic home environments, and lack of future outlooks. Strengthening adolescents' competencies to cope with MHP (so called mental health literacy (MHL)) has the potential to prevent worsening of problems and delayed help-seeking. However, the implementation of MHL interventions remains absent or short-lived. To stimulate its implementation, this study explored attitudes of adolescents regarding mental health, help-seeking, and MHL interventions. We used a mixed-methods design including online focus group discussions and interviews, and surveys. Data collection took place since April ‘20. Participants were recruited online, through social media. So far, 58 adolescents (ages 13 and 19) attending secondary school in the Netherlands participated in this study. The data collected includes mental health status pre-, during, and post-lockdown as well as attitudes on mental health support and education. Our qualitative data analysis follows the principles of thematic analysis. We found that adolescents experience a lack of attention for mental health in secondary education as well as stigma and negative attitudes towards mental health treatment and help-sources, in general and during COVID-19. The participants voiced that they would like to know more about mental health and illness, help-sources and normalize the conversation of mental health. The attitudes of adolescents aided in shaping ideas for the implementation of mental health education. Our preliminary findings suggest that MHL and its related competencies are necessary to be able to (self-)manage one's own and others mental health especially in situations of crisis (e.g. COVID). This may decrease the disadvantageous characteristics of long-term MHP.
Climate change and the effects on environment and exposure to chemicals
Authors: Vicente JL
Published: October 2021

European citizens are exposed to a variety of potentially hazardous chemicals through the environment, consumer products, food, drinking water and at work in their daily lives. Human Biomonitoring (HBM) detects traces of chemicals in our bodies, aiming to improve public health. This is why human exposure is the focus of the HBM4EU initiative, a 5-year European programme funded by Horizon 2020 involving 30 European countries aimed at coordinating and advancing human biomonitoring in Europe while providing evidence that supports policymaking. Climate change can influence the persistence, mobility and other aspects of chemicals/toxins in the environment and with this influence human exposure and health effects related. HBM is the tool we use to measure the internal burden of exposure. Some papers have been published that recognize that climate change can influence human exposure to chemicals/toxins by different means. But more research is necessary to assess the impact on contaminant behaviour and toxicity due to the altered patterns of distribution that results in differences in human exposure and, consequently, in the associated health effects. Changes in the population's exposure pattern (type and intensity) to mycotoxins (a food contaminant fungi) could be a good indicator of climate change since crops infection by fungi and their own metabolism are very much dependent of climatic parameters.
Climate change and health impact: is food missing in the equation?
Authors: Assunção R
Published: October 2021

It has been generally recognized by researchers and regulators that climate change constitutes an important driver affecting the food sector, representing a public health issue that deserves particular attention. Climate change is associated with increasing temperatures and more extreme rainfall; it alters relationships among crops, pests, pathogens, and weeds; and it exacerbates several trends including declines in pollinating insects, increasing water scarcity, increasing ground-level ozone concentrations, and fishery declines. In one hand, climate change threatens our ability to ensure global food security, eradicate poverty and achieve sustainable development. Agricultural productivity is affected by changing rainfall patterns, drought, flooding and the geographical redistribution of pests and diseases, with consequent implications in food availability, a key requirement for food security. On the other hand, despite less debated, climate change could also affect food safety, namely through the occurrence of food safety hazards at various stages of the food chain, from “farm to fork”. The tendency to increase the use of agrochemicals to balance the effects of more frequent extreme weather events and water scarcity in some regions could become more frequent. In addition to pesticide residues, both chemical and microbiological risks are expected to impair food and feed safety as a consequence of climate change: in particular mycotoxins, marine biotoxins (phycotoxins), trace metals, among others. Here, all these concepts will be discussed and integrated, to highlight the potential impact of climate change in food systems, focusing particularly on the contribution to human health especially in what concerns food safety.
Burden of disease of dietary exposure to aflatoxins in European countries
Authors: Martins C , Viegas S , Assunção R
Published: October 2021

Aflatoxins (AFTs) are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In 2015, WHO estimated the burden of disease associated with exposure to AFTs and concluded that this exposure corresponds to 636,869 Disability-adjusted Life Years (DALYs) at global level. Particularly for Portugal and recently, there were estimated 0.08-0.30 DALYs/100,000 considering consumption and occurrence in food data, and 1.7 DALYs/100,000 based on human biomonitoring data. The present study considered the exposure data presented in the EFSA scientific opinion “Risk assessment of aflatoxins in food” where data from occurrence of AFTs in food and from food consumption were gathered to estimate the exposure to AFTs in 19 European countries. A deterministic and a bottom-up approach was developed to estimate the health impact of the exposure to AFTs for adult population through the calculation of DALYs associated to the number of estimated extra-cases of hepatocellular carcinoma (HCC). Results showed similar values for all the 19 European countries considered. For adult population and considering the data provided by EFSA using the upper-bound approach (worst-case scenario), the estimated number of DALYs ranged from 0.32 (Spain) to 1.10 (United Kingdom) DALYs/100,000. A total of 11.76 DALYs/100,000 was globally estimated for the considered European countries. The highest burden was estimated for the United Kingdom, that together with The Netherlands, Ireland, Czech Republic, and Austria were the highest contributors to the global estimated European burden associated to the exposure to AFTs. The present study generated reliable and crucial data to characterize the burden associated to exposure to AFTs in the European population. The obtained results constitute an important contribution to define priorities and support the need for further policy actions to protect European citizen's health.
Digital health literacy and COVID-19 pandemic: Results of a nationwide survey in Germany
Authors: De Santis KK , Jahnel T , Sina E , Wienert J , Zeeb H
Published: October 2021

Background

Digital health literacy is important for interpreting information and making health decisions in an increasingly digitised world. We investigated the perceived digital health literacy and the attitudes towards digital information on the COVID-19 pandemic using a nationwide survey.

Methods

We conducted a cross-sectional, computer-assisted telephone survey in October 2020 using a panel sample of Internet users selected from the general population living in Germany. Responses on items regarding the COVID-19 pandemic and the eHealth Literacy Scale (eHEALS; total sum score of 8=minimum to 40=maximum perceived digital health literacy) were analysed using descriptive statistics and a linear regression analysis.

Results

Of the 1014 Internet users, 928 (92%) completed the eHEALS. The respondents were 52% female, aged 14-93 years (mean±SD of 55±17 years), 66% with up to secondary education and 45% with up to average household income. The responses on eHEALS were consistent (Cronbach's α=.88). While the perceived digital health literacy was high (mean±SD eHEALS score of 31±6), less than half of respondents (43%) were confident in using digital information for health decisions. Higher digital health literacy was associated with younger age (β=-.22, p<.001), higher household income (β=.21, p<.001) and more education (β=.14, p<.001). About half of respondents (52%) reported that they sometimes or often come across inaccurate digital information on the COVID-19 pandemic. The majority (78%) were confident in their ability to recognise inaccurate digital information on the COVID-19 pandemic and 43% installed the contact-tracing app.

Discussion

Internet users in Germany report high perceived digital health literacy but low confidence in making health decisions and low trust in digital information on the COVID-19 pandemic. Factors contributing to such low confidence in the general population need to be investigated.

Key messages

Despite high digital health literacy, the confidence in making health decisions is low in the general public. The trust in digital information on the COVID-19 pandemic is low.
Infographics in support of decision-making of well-being and health promotion
Authors: Hätönen H , Tolonen H
Published: October 2021

The promotion of population well-being and health is a complex phenomenon. Extensive information is needed for the related decision-making in order to understand the current state, to determine objectives, to agree measures and to assess the impact of decisions. Evidence-based and informed decision-making has been discussed for a long time. The rapid growth in the availability and quantity of information has challenged the perception of knowledge and expertise. Increasing the amount of information in decision-making is no longer the solution to solve various societal phenomena. A new kind of thinking and new practices are needed to ensure that the information used in decision-making continues to be reliable and understandable. In Finland, the knowledge base and use of it in the decision-making of the promotion of well-being and health, have been identified as an important development area. In the Government resolution “Promotion of well-being, health and safety - 2030” one priority is to improve the effectiveness of decision-making. The goal is that, policymakers promote well-being, health and safety and reduce inequality. In order to achieve this, actions will be directed towards decision-making tools as well to ensuring information is up-to date, reliable and understandable. Infographics have become more common and are able to respond in many ways to the development needs of the information used in decision-making. The greatest benefit of infographics is in situations where there is a need to raise a complex phenomenon to the discussion or to present it to the decision-maker closely and quickly. Dialogue is also needed in order to build a common understanding and utilization of information. For that infographics provide an excellent tool. The presentation describes practical examples of use of infographics in supporting decision-making. However, it is also recognized that traditional text-based memoirs, reports and similar documents are still needed.
Early cognitive ability and emotional-behavioural development in childhood
Authors: Bowe A , Staines A , Murray D
Published: October 2021

Background

Children with below average cognitive ability represent a substantial yet under-researched population for whom cognitive and social demands, which increase in complexity year by year, may pose significant challenge. This study compares trajectories in emotional-behavioural development for children with and without below average cognitive ability and examines the independent association between cognitive ability and clinically significant emotional-behavioural difficulty (EBD) in childhood.

Methods

Participants consist of 7,000 children and caregivers from the Growing Up in Ireland survey. Cognitive ability was measured at age 3 using the Picture Similarities Scale. A t-score 1-2 standard deviations below the mean was categorised as below average cognitive ability (n = 767), and scores above this as average/above (n = 6418). EBD was measured using the Strengths and Difficulties Questionnaire (SDQ) at age 3,5 and 9 years. A generalised linear mixed model with repeated measures was used to examine the relationship between cognitive ability and SDQ. Logistic regression examined the independent association between cognitive ability and clinically significant EBDs between age 3-9 years.

Results

The change in mean total SDQ score over time differed significantly between the cognitive ability groups (F(2)=8·817, p < 0·001). Between 5-9 years, there was no change in SDQ for those with average/above cognitive ability. For those with below average ability there was a significant increase of 0·48 points (95% CI 0·34 - 0·62, p < 0·001). After adjustment, the odds of a clinically significant EBD between age 3-9 were 1.4 times higher for those with below average cognitive ability (AOR 1.39, 95% CI 1.17-1.66, p < 0.001).

Conclusions

Children with below average cognitive ability are at higher risk of EBD in childhood. A scalable method of early identification should be a research priority for public health, enabling early intervention for cognitive and adaptive outcomes.

Key messages

Children with below average cognitive ability experience higher mean emotional-behavioural difficulty scores throughout childhood compared to those with average or above cognitive ability. Early life is a critical period for cognitive development. Public health research must focus on the early identification of at risk children to enable cognitive and adaptive functioning interventions.
Good perception of own lifestyle associated with poor attendance at Diabetic RetinaScreen Programme
Authors: Syed S , Fitzpatrick P
Published: October 2021

Background

Untreated diabetic retinopathy is the most common cause of sight loss in people of working age. The Diabetic RetinaScreen programme (DRS) is the national diabetic retinopathy screening programme in Ireland which commenced in 2013 with aim to prevent diabetic retinopathy and subsequent blindness, through free screening and ophthalmology services. High uptake is crucial for the effectiveness of the programme. This study aimed to determine the sociodemographic, lifestyle and healthcare factors associated with attendance at the DRS programme in Ireland, using data from a national cohort study, the Irish Longitudinal Study on Ageing (TILDA).

Methods

The TILDA wave-4 dataset (anonymised) was utilised for the current study. Questions on DRS invitation and attendance formed part of the wave 4 study questionnaire. Multivariate logistic regression was used to examine independent factors associated with attendance. SPSS was used for analysis.

Results

418 respondents (7.3%) were invited to DRS and 373 (89.2%) attended. Among all those who were invited to DRS, 244 (58.4%) were male and 174 (41.6%) were female. The mean age was 69.8 years (53-84 years). Following multivariate logistic regression, following a good diet/taking exercise (OR = 0.29, 95% CI 0.10-0.82) was negatively associated with attendance, after adjustment for age, male gender, higher education and medical card.

Conclusions

Recognising factors linked with uptake is important to develop goal directed strategies. Interestingly those who stated they followed a good diet & took exercise and were compliant with DM prevention were less likely to attend DRS. Previous research has also indicated that a higher physical activity level is associated with higher self-perceived health status

Key messages

Persons with DM with good compliance to diet and exercise were found to have poor attendance at the DRS programme. Targeted advertising is required to raise awareness of diabetic retinopathy.