bluuebunny/crossref_metadata_2025 huggingface dataset:
Variations in access to acute care services by immigrant background and sociodemographic factors
Authors: Hussaini L , Damgaard Skyrud K
Published: October 2024

Background

The Emergency Medical Communication Center (EMCC) plays a vital role in the medical emergency response system by triaging contacts, notifying local physicians, and providing medical advice. The utilization of acute care services and the subsequent care pathway by individuals with immigrant background remains unclear in the Norwegian context. This study aims to investigate whether disparities exist in the acute care pathway for patients with different sociodemographic background who use ambulance services.

Methods

We examined all code red ambulance dispatches for life-threatening emergencies in 2021 in Norway. These ambulance dispatches were linked to primary health care and specialist health care contacts to trace patient pathways and outcomes. Statistical analyses were conducted using linear regression models, adjusted for patient characteristics, such as immigrant background, age, sex, municipality of residence, living condition, socioeconomic status, comorbidity and cause of emergency contact.

Results

Preliminary crude findings indicate that patients with immigrant background are overrepresented in the groups receiving acute primary care only and underrepresented in the groups transferred directly to specialist health care, within 8 hours after ambulance arrival at the patients’ location.

Conclusions

The preliminary results suggest challenges for the EMCC in triaging patients with immigrant background, but further research is needed to explore potential systematic differences. This study aims to improve understanding of disparities in access to acute care and inform targeted interventions to optimize resource allocation in emergency departments.

Key messages

• This study may improve understanding of disparities in access to acute care in Norway.

• This study can inform targeted interventions to improve resource allocation in emergency departments.
COVID-19-related worries: A longitudinal study comparing migrants and non-migrants in Norway
Authors: Benavente Velando P , Fadnes L T , Sandal G M , Mæland S , Lehmann S , Diaz E
Published: October 2024

Background

Health- and economic-related worries during the COVID-19 pandemic contributed to worsening of mental health, particularly affecting migrants in vulnerable situations. However, this differential impact was only clear some months into the pandemic, and there is little evidence about any differences in health and economic worries between migrants and non-migrants as the pandemic developed. To close this knowledge gap, we assessed the changes in COVID-19-related worries reported by migrants compared to non-migrants in Norway throughout the pandemic.

Methods

Our study analyzed data from three time points (April-20, January-21, March-22) for 25,305 participants of the Bergen in Change study, including 509 (2%) migrants from Asia, Africa, or Latin America (LATAM), and 1250 (5%) migrants from other regions. Worries were assessed using questions on COVID-19 infection fear, job security, and economic stability. Analysis methods included descriptive analysis, chi-squared, Sankey plots, and logistic regression, adjusting for age, gender, education, and type of work.

Results

Migrants from Asia, Africa and LATAM reported health worries more often than non-migrants [OR (95%CI) 1.9 (1.3-2.8)] without clear changes over time, 0.9 (0.7-1.3). Migrants from Asia, Africa, and LATAM, as well as from other regions, also reported economic worries significantly more often than non-migrants [3.1 (2.5-3.9) and 2.1 (1.8-2.4) respectively] at baseline. Each additional year into the pandemic increased the odds of economic worries by a factor of 1.3 (1.0-1.6) for migrants from Asia, Africa, and LATAM compared to non-migrants. The odds ratio for migrants from other regions over time was stable, 1.0 (0.9-1.1).

Conclusions

Migrants, especially those from Asia, Africa, and LATAM, reported more pandemic- related worries than non-migrants, and this persisted over time. Identifying and understanding these worries could guide preventive measures to enhance mental health in migrant population.

Key messages

• Throughout the pandemic, migrants reported more COVID-19-related worries than non-migrants, a trend that persisted over time and was greater among migrants from Asia, Africa, and Latin America.

• Identifying the differential impact of COVID-19 on migrants’ groups and understanding the factors involved is essential for guiding healthcare interventions to improve migrant health.
Roma mothers of infant children in the health system - a qualitative study
Authors: Mihailova N , Dokova K , Feschieva N
Published: October 2024

Background

The Roma in Bulgaria constitute the third largest group - 4% of the population. Data on demographic processes by ethnicity are scarce. A national survey in 2003 found significant differences in infant mortality - 9.9‰ for Bulgarian, 18‰ for Turkish, and 28‰ for Roma infants. Poverty among Roma children, risk of poor education, especially for girls, barriers to accessing health services remain high. We aim to reveal the cultural specificity in prenatal behavior and infant care among Roma mothers in the context of the role of the Bulgarian health service.

Methods

In-depth interviews with Roma mothers of infants up to 1 year were utilized for data collection. To ensure heterogeneity among the interviewees, several “nests” with varying socio-cultural status in the Varna district were identified in advance for participants recruitment. A list of interview themes concerning respondents’ relationships with the public health system with an emphasis on the experiences of mothers was drawn up.

Results

Ten interviews with mothers having between 1 and 7 children were conducted in 2023. The mothers recounted discriminatory experiences during their interactions with certain health facilities (maternity wards), which act as barriers to accessing and utilizing health services. Maternity and infant counselling services are highly esteemed with favorable influence on child health outcomes. There has been a positive shift away from early marriage and childbirth towards prioritizing education for Roma girls. Mothers prioritize their children, and there is no neglect in their care. Family relations and support are being upgraded, with Roma fathers becoming involved in child care. Respondents express their educational needs and hopes for community-based support to better cope with their roles as mothers.

Conclusions

Ethno-cultural factors shaping the mother’s role maintain traditional family support, while also reflecting significant modernization that needs societal support.

Key messages

• A glimpse into people’s experiences of the healthcare system - a clue to its effectiveness.

• Тhe ethno-cultural factors in Roma are subject to modernization.
Determinants of health and pregnancy and birth outcomes: an overview
Authors: Falcone V , Nisticò F , De Luca A , Arniani S , Messina G , Nante N , D’Urso A
Published: October 2024

Introduction

This study examines the influence of health determinants on pregnancy and birth outcomes. The aim is to provide a clear and updated view of the overall framework characterizing the birth experience, with crucial implications for clinical practice, research, and health policy.

Methods

Data analysis pertains to the Certificate of Assistance for Birth (CAP) concerning residents in the territory of AUSL South-East Tuscany in the years 2021 and 2022. The number of women of childbearing age in Tuscany in 2022 is 150,959, while the number of births analyzed in the study is 9,053. The study conducts multivariate analysis between factors and pregnancy-related outcomes.

Results

Controlling for age, citizenship and others factors, the risk of cesarean section is significantly higher (p < 0.05) among mothers: over 40 years old (OR = 2.09), with education levels of lower secondary (OR = 1.21) and upper secondary (OR = 1.23) compared to a degree, not employed (OR = 1.25) and homemakers (OR = 1.45) compared to employed, overweight/obese (OR = 1.41), with gestational diabetes (OR = 1.16), smoking during pregnancy (OR = 1.27), with gestational hypertension (OR = 2.81). Controlling for age, citizenship and others factors, the risk of term low birth weight is significantly higher (p < 0.05) among mothers: over 40 years old (OR = 1.76), not employed (OR = 1.76) and homemakers (OR = 1.34) compared to employed, smoking more than 3 cigarettes daily during pregnancy (OR = 1.31) not significant, with gestational hypertension (OR = 5.57), nulliparous (OR = 1.42). Controlling for age, citizenship and other factors, the risk of premature birth is significantly higher (p < 0.05) among mothers: with gestational hypertension (OR = 5.22), nulliparous (OR = 1.89), smoking during pregnancy (OR = 1.59).

Conclusions

The results underscore the importance of carefully monitoring and managing these risk factors during pregnancy to improve outcomes for both mother and baby.

Key messages

• Understanding the determinants that influence birth outcomes plays a fundamental role.

• The importance of Early Childhood Development and early interventions can improve children’s health and well-being.
Green and blue spaces residential exposure over childhood and multimorbidity in adolescence
Authors: Santos S , Bruns C V , Pereira R , Araújo B , Ribeiro A I , Barros H
Published: October 2024

Background

Previous studies have explored associations of exposure to natural spaces with specific adverse health outcomes over childhood. However, knowledge is lacking on its effects on multimorbidity, defined as the co-occurrence of two or more diseases in the same individual. We aimed to assess the associations between exposure to green and blue spaces, at multiple time points and through trajectories over childhood, with multimorbidity in early adolescence.

Methods

In 2388 children from the Generation XXI birth cohort, we assessed, at birth, 4, 7 and 10 years, the residential greenness through the Normalized Difference Vegetation Index (NDVI), the distance from the child’s residence to the closest green and blue space, and the presence of green and blue space (>5,000m²) within 300m distance from the child’s residence. We identified, from birth to 10 years, longitudinal trajectories of exposure to green and blue spaces, using latent class mixed models. At 13 years, participants were classified as having 0, 1 or ≥ 2 cardiometabolic, respiratory and/or neurodevelopmental adverse health outcomes. Adjusted multinomial logistic regression models were used.

Results

The prevalence of multimorbidity at 13 years was 43%, with overweight/obesity (35%), allergies and asthma (30%), and dyslipidemia (26%) as the most common adverse health outcomes. We observed that the presence of green spaces > 5,000m² within a distance of 300m at birth, 4, 7, and 10 years was associated with lower odds of developing multimorbidity (Odds Ratio (OR) [95% CI] 0.55 [0.32-0.95]; 0.52 [0.32-0.84]; 0.51 [0.32-0.82]; 0.51 [0.32-0.80], respectively). No other significant associations were observed.

Conclusions

Green spaces around the child’s residence seem to have a protective effect on the development of multimorbidity at 13 years. These findings reinforce the importance of urban design, and the creation of green spaces close to residential areas to optimize health across childhood and adolescence.

Key messages

• The prevalence of multimorbidity at 13 years is high and worrying.

• Increasing accessibility to green spaces might decrease the risk of multimorbidity in adolescence.
“We must make sacrifices” - coping among left-behind adolescents in Georgia after parental migration
Authors: Antia K , Winkler V , Berner Rodoreda A
Published: October 2024

Background

Adolescence is challenging, particularly for those left-behind in their countries of origin while parents out-migrate for work. The Eastern European country Georgia has one of the highest percentages of left-behind children and adolescents worldwide, yet how they cope with migratory separation remains unknown. This study is the first to explore strategies of Georgian left-behind adolescents to cope with parental absence.

Methods

From December 2021 to January 2022, we conducted 29 narrative interviews with left-behind adolescents aged 12-18 in Georgia. We purposively sampled participants from a relatively large public school in the Samegrelo region, the second-largest region of Georgia. Interviews were audio-recorded, transcribed, and coded using NVivo 12. Resilience theory underpins this study, and reflexive thematic analysis is applied to identify main themes and sub-themes.

Results

Under the overarching theme of coping and resilience, we identified the following four main themes: (1) the time dimension (2) family connectedness (3) positive attitudes and self-care (4) social interactions beyond the family. Our findings revealed that adolescents whose parent(s) migrated when they were toddlers coped well, while children aged 6-10 felt heavily affected and vulnerable. Closeness with the migrant parent, siblings, caregivers, and other family members was crucial for children’s coping. Self-care, self-encouragement, and positive attitudes helped them overcome negative emotions related to parental absence. Awareness of parents’ motivation to migrate and appreciation of material benefits positively contributed to adolescents’ coping and resilience. In addition, those with many friends coped better and were more resilient than socially less active peers.

Conclusions

Self-motivation, positive attitude, supportive family, and social interactions help left-behind adolescents to cope with negative emotions related to parental absence.

Key messages

• left-behind children especially at the age of 6-10 need support to cope with migratory separation.

• Interventions are needed to strengthen family ties and support children in intensifying social interactions beyond family.
Long-Term exposure to NO2 and Stroke Mortality in Portugal: an ecological study from 2001 to 2021
Authors: Morgado J , Martins C , Martins R , Jardim B
Published: October 2024

Background

Air pollution is an important contributing factor for many pathologies, including stroke. Nitrogen dioxide (NO2), an air pollutant, has been associated in multiple studies with strokes’ mortality.

Aim

This study aims, for the first time, to estimate the number of deaths by stroke due to long-term, ambient exposure to nitrogen dioxide in Portugal for the years 2001-2021.

Methods

An ecological study was considered, including data for NO2 outdoor concentration from Portugal. Mortality data by stroke was obtained divided in 5-year groups. It was also obtained life expectancy for each year to calculate the years of life lost (YLL). The hazard ratio (HR) was obtained from literature (1.009, CI 1.003-1.016). The population attributable fraction (PAF) of YLL by stroke due to ambient NO2 long-term exposure was calculated.

Results

The annual average NO2 concentration in Portugal decreased from its peak in 2001 of 29.4 to 12.2 µg/m3 in 2021. The YLL by stroke decreased from an estimated 57452 to 31204 from 2001 to 2021. The PAF of YLL by stroke due to ambient NO2 long-term exposure reached its peak in 2001, when an estimated 5.2% of all the YLL by stroke, corresponding to 3029 YLL, were due to NO2 exposure and a bottom in 2021, when 2.2%, corresponding to 682 YLL, where due NO2 exposure.

Conclusions

The policies and legislation implemented to curb down NO2 seem to have had an effect in Portugal. A reduction in NO2 emissions was achieved, having a significant impact on YLL by stroke in Portugal, suggesting that curbing the NO2 emissions down had a positive effect on mortality by stroke in Portugal. To further enhance our knowledge on the real impacts of NO2, further studies must be conducted to estimate the morbidity associated with NO2 on stroke as well as in other diseases.

Key messages

• Pollution by nitrogen dioxide decreased significantly from 2001 to 2021.

• Around 20000 years of life were lost just in Portugal due to nitrogen dioxide between 2001 and 2021.
Factors Affecting Household Health Expenditures: Evidence from Iran
Authors: Jalili F , Akbari A , Karami Matin B , Soofi M
Published: October 2024

Background

Productivity plays a crucial role in driving economic growth, and its primary determinant is human capital. Human capital, in turn, is influenced by health and education investments, leading both households and governments to allocate substantial resources toward these sectors. Understanding the factors influencing health expenses is vital for designing effective policies.

Methods

This study investigates the factors affecting health costs by analyzing data from various provinces in the Islamic Republic of Iran, spanning from 2006 to 2019. The data, sourced from the Statistics Center of Iran, was analyzed using the panel data approach to uncover the relationships between health expenditure and several key variables.

Results

The analysis revealed significant disparities in health expenditure among provinces. Sistan & Baluchestan had the lowest health expenditure per household, while Tehran reported the highest. Inflation emerged as a significant factor, having a negative impact on health expenses due to its influence on purchasing power. Conversely, the education and salary of household heads had a positive impact on health expenditure. Notably, economic growth did not exhibit a significant relationship with health expenses.

Conclusions

The study highlights the importance of education and income levels in shaping health expenditures, while inflation can curtail spending on health due to reduced purchasing power. Policymakers should consider these factors to ensure equitable and effective allocation of health resources.

Key messages

• Improving health and well-being, essential for comprehensive progress and human development, relies significantly on household health expenditure.

• The efforts to enhance human capital should focus on reducing inflation.
Burden of disease due to road traffic noise in Flanders, Belgium
Authors: Pauwels A , De Clercq E M , Demoury C , Devleesschauwer B
Published: October 2024

This study estimates the disease burden of ischemic heart disease (IHD), stroke and diabetes mellitus attributable to road traffic noise in the Flemish Region (Belgium) for the year 2020, expressed in disability-adjusted life years (DALYs). The research proposes an approach to stratify population exposure to noise according to age and sex, which allows to examine internal differences in noise burden related to both varying risk and baseline burden. Stratification of population exposure to noise is achieved by (1) linking modelled noise exposure to age- and sex-stratified population data at small area-level, (2) dividing the prevalence in each exposure class proportionally over the strata, and (3) aggregating the small areas to a Flemish total per stratum. Annual day-evening-night level exposure is translated into the fraction of attributable burden relying on relative risks (RR) from the WHO’s Environmental Noise Guidelines and more recent studies. Baseline burden for the three outcomes is sourced from the Belgian National Burden of Disease Study. The lower and upper bound of the RR’s 95% confidence interval (CI) are used to calculate the uncertainty range on the burden estimates. The total noise DALYs estimated are 1092 (95% CI: 135, 2061) for IHD, 761 (379, 1017) for stroke, and 671 (486, 918) for diabetes. Noise burden rates rise steeply with age for all outcomes, although the wide CIs on the IHD estimates prevent to ascertain a significant trend. The IHD burden is twice as high in men as in women, while both sexes are almost equal for the other outcomes. The variations between age and sex groups are largely explained by differences in baseline burden, as exposure is fairly constant across strata. This study estimates age- and sex-stratified disease burden attributable to noise traffic in Flanders, Belgium. As differential exposure between the population subgroups is limited, any variation in noise DALYs is mainly related to stratum-specific baseline burden.

Key messages

• Road traffic noise is responsible for hundreds of healthy life years lost in Flanders, Belgium.

• The noise burden for stroke and diabetes rises sharply with age, and the burden for ischemic heart disease is twice as high in men as in women.
Prevalence of potentially inappropriate medication use in the older population living in Germany
Authors: Sarganas G , Grams D , Ordoñez-Cruickshank A , Fuchs J , Neuhauser H , Gaertner B , Thuermann P
Published: October 2024

Background

Potentially inappropriate medications (PIM) are medicines for which the risks for adverse events (AEs) usually outweigh the clinical benefits in older adults. PIM is associated with an increased risk of AEs, hospitalizations, mortality and higher health care costs. This analysis presents the prevalence of PIM use and associated factors in people aged 66+ years living in Germany.

Methods

Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter (OTC), in the 7 days before the interview were classified into anatomical therapeutic chemical codes. PIM use was identified based on the PRISCUS 2.0 list. Weighted prevalences and associated factors for PIM use are presented.

Results

96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. The prevalence of PIM use was 29% (95% CI: 26%-32%), 23% took 1 PIM and 6% 2+. There were no sex differences but a significant increase with age: 23% in the age group 66-74, 33% in the age group 75-84, and 39% in the age group 85 + (29% 1 PIM and 10% 2+). People with a low educational level had a PIM prevalence of 32% compared to 21% in those with a high educational level. Among those reporting having chronic diseases, the PIM prevalence was 34% compared to 19% among those not reporting them. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. The most frequently used PIM in this sample was ginkgo biloba leaf extract (plant-based antidementia drug) followed by diclofenac (non-steroidal anti-inflammatory drug), and then by tricyclic antidepressant drugs (opipramol and amitriptyline).

Conclusions

PIM use was higher than suggested by prescription data analysis. It was associated with higher age, chronic diseases, polypharmacy and a low educational level.

Key messages

• PIM use was common, affecting more people with chronic diseases, older age groups and people with a low educational level.

• Strategies to promote and monitor appropriate medication use are needed.
Exploring the dynamics of alcohol use, poverty and the role of social context in Athens, Greece
Authors: Kyriakidou S , Temenos C , Henry C , Paparrigopoulos T , Triantafyllou K
Published: October 2024

Background

A body of research conducted across diverse national context, including the United Kingdom, Russia, Denmark and Norway, shows a robust link between poverty and increased alcohol related harm, even after accounting for different drinking patterns. This paper examines the unexplored relationship between poverty and alcohol use in Athens, Greece, focusing on alcohol’s impact related to the familial and social life of individuals and whether this system is affected by poverty.

Methods

This is a 2021 cross-sectional study, with 300 adult participants of mean age 45.8. We administered four questionnaires. The participants were equally distributed above and below the poverty threshold, sampled randomly. The latter were beneficiaries of social services. The data analysis established two scoring variables: the level of dysfunction from alcohol use and the level of strength of family ties. We computed their correlation and multiple linear regressions to assess their relationships.

Results

Individuals not residing in poverty exhibit a higher frequency of alcohol use (81.9%) than their counterparts (57.1%), however, those living in poverty tend to consume greater quantities of alcohol per occasion (p < 0.001) and reported elevated levels of dysfunction within familial and social interactions.

Conclusions

This study indicates that different consumption patterns are tied to diverse socioeconomic strata, with binge drinking behaviours specifically linked to financial hardship. Also, alcohol related dysfunction and family and social dynamics are affected by poverty. Our findings show that as dysfunction attributed to alcohol use increases, participants socialize less and report lower levels of well-being. In contrast those with balanced family ties and social encounters exhibit the opposite trend. This study warrants further exploration in cities in Southern Europe.

Key messages

• To mitigate alcohol use, policies empowering social and familial connections are of high importance.

• Uncovering poverty as a factor for binge drinking can inform prevention strategies.
Optimizing Colorectal Screening in Portugal with Process Mining
Authors: Monteiro H , Oliveira M , Reis J , Tavares F
Published: October 2024

Background

Efficient healthcare screening programs management influences patient outcomes. Process mining has emerged as a powerful tool to enhance these programs by refining complex workflows and pinpointing operational deviations.

Objectives

This study utilizes process mining techniques to analyze the colorectal cancer screening program in Northern Portugal, focusing on detecting deviations and performance bottlenecks in process models.

Methods

This screening program started in March 2018, but process mining was only used on data posterior to 2020. Over 1 million case observations from administrative data were included in the process model analysis, involving more than six key process activities and numerous resources. We used new software and statistical tools for process mining to rapidly compute observations and filter for different operational needs and monitor interventions.

Results

The discovery analysis identified deviations, such as unexpected performance issues and irregular activity sequences. Although over 100 traces were identified, fewer than five traces accounted for more than 90% of all case paths, indicating the most common traces that have a true impact in participation rates, referral rates, and treatment rates. Notable differences in resource performance during specific periods, such as COVID-19 or seasonal events, were also observed. These findings provided insights for adjusting resource allocation and improving coordination, with impact in minimizing seasonal phenomena or peak production periods.

Lessons

Process mining offers actionable insights for effective health program coordination, enabling the monitoring and timely response to process deviations. With key areas for action identified in a more timely and precise manner, we can enhance efficiency, and expand population coverage and treatment referral. Future initiatives will focus on further process optimization and national coverage expansion using these management tools.

Key messages

• Process mining revolutionizes healthcare by enabling the strategic management of complex oncological screening program workflows.

• Comprehensive data analysis across the patient pathway enhances program efficiency and expands treatment access.
Associations of adolescent academic performance, sports, disordered eating, and menstrual dysfunction
Authors: Moro S , Holopainen E , Kosola S
Published: October 2024

Background

Regular menstruation is a crucial indicator of comprehensive well-being in adolescents. We aimed to assess risk factors associated with menstrual cycle dysfunction in a population-based cohort of high school students, focusing on academic performance, sports participation, and disordered eating.

Methods

In 2022, we recruited 1161 female first-year students from 21 diverse high schools in the capital region of Finland. They completed an online survey comprising questions about menstrual cycle, academic achievement, sports involvement, disordered eating and school burnout.

Results

Of 935 (81%) participants (mean age 16) not using hormonal preparations, 336 (37%) reported irregular menstruation. Adolescents with irregular menstruation showed higher middle school grade point average (GPA) (OR 1.4, 95% CI 1.1-1.8), lower body mass index (OR 2.2, 95% CI 1.3-3.5), and more disordered eating symptoms (OR 2.1, 95% CI 1.4-3.0) than adolescents with regular menstruation. While overall physical activity showed no significant correlation with irregular menstruation, casual exercisers with irregular menstruation exhibited both higher GPAs (OR 1.4, 95% CI 1.4-1.9) and more disordered eating symptoms (OR 2.6, 95% CI 1.6-4.1) than competitive athletes, whereas competitive athletes with irregular menstruation showed higher school burnout scores than casual exercisers but no disordered eating.

Conclusions

We recommend the use of screening tools to recognize disordered eating and school burnout among female high school students facing menstrual irregularities.

Key messages

• A third of adolescent females had irregular menstruation. Casual exercisers with irregular menstrual cycle were at risk of eating disorders and competitive athletes at risk of school burnout.

• Screening of disordered eating and school burnout among adolescent females facing menstrual irregularities could be beneficial.
Review of national climate change risk assessment methods for impacts on health and health systems in WHO European Region
Authors: Turner G , Kovats S , Hajat S , Wan K
Published: October 2024

Background

Climate change poses significant risks to health and health systems. The European Union climate adaptation strategy sets out the pathway to become climate resilient by 2050 and supports the development of adaptation strategies across all levels of governance. Whilst many European countries have published climate change risk assessments (CCRA), it is unclear to what extent health outcomes have been quantified or prioritised. There is a need to improve methods for CCRA methods to support decision making on adaptation and better quantify future impacts on health. The aim of this study is to review the methods used in national CCRAs for impacts on health and health systems in the WHO European region.

Methods

National and European level CCRAs were identified from national government websites and European document databases e.g. Climate-ADAPT. The most recently published CCRA from each country was included. Data extracted from CCRAs included climate scenarios used, modelling data, outcomes, types of evidence evaluated, stakeholder involvement, health information, methods for prioritization of adaptation options and urgency scoring. Data extracted from each document was grouped by climate risk or outcome.

Results

Nearly all WHO EURO countries have conducted a formal assessment of climate risks and over half specifically include risks to health. All countries assessed the urgency to adapt to heat and flooding however, less than half consider the health related risks related to disrupted water supply and quality as well as impacts on food supply and security. The key reported health outcomes identified across countries were mortality, infectious disease, chronic diseases and mental health.

Conclusions

There is varying progress in the quantification and prioritization of health risks from climate change across Europe. To support better public health decision-making, CCRAs should integrate sub-national and local information for targeted adaptation action.
Measuring functioning and disability in Korea: comparing general and dedicated surveys using the ICF
Authors: Kim J , Selb M , Cho Y T , Kim W H , Sabariego C
Published: October 2024

Background

Functioning is the third health indicator besides mortality and morbidity. Although Korea periodically collects functioning information, the functioning indicator has not been generated yet. This study aimed to evaluate how functioning information is currently collected in Korea’s health and disability surveys, especially in terms of comparability and comprehensiveness, using the International Classification of Functioning, Disability and Health (ICF) as a reference framework.

Methods

Data sources included three health and disability surveys in Korea (Population and Housing Census, Korean National Health and Nutrition Examination Survey, Survey on the Living condition of Persons with Disabilities) and two international ICF-based surveys (International Spinal Cord Injury Survey, Model Disability Survey). Functioning information was linked by category to the ICF Generic-30 Set utilizing the ICF linking rules.

Results

Three ICF categories (walking, washing oneself, dressing) were covered by all the data sources. Excluding the Census, which inherently differs from the other data sources, all the surveys addressed six ICF categories-b152 emotional functions; b280 sensation of pain; d240 handling stress and other psychological demands; d450 walking; d510 washing oneself; d540 dressing. Despite of the common ICF categories, important differences in the operationalization of questions and response options were found.

Conclusions

The overlap of content of health and disability surveys in Korea enables interoperability with other data sources. Available functioning data can be used for estimating the functioning indicator and metric, as recommended by WHO, which can serve as a valuable epidemiological indicator for complementing mortality and morbidity indicators and for estimating and monitoring rehabilitation or long-term care needs of the Korean population.

Key messages

• Korea’s health and disability surveys periodically collect functioning information at the national level, and the level of overlap across surveys enables interoperability with other data sources.

• This study can contribute to generate a Korean common health metric based on functioning that can serve as a valuable epidemiological indicator by utilizing the international standard ICF.
Quality of Life among the Sámi Population
Authors: Nilsen T , Torheim L E , Gulseth H , Tvedten H M
Published: October 2024

Introduction

The Sámi, indigenous to Northern Europe, maintain rich traditions like reindeer herding and unique languages. Continuous efforts are made to preserve their cultural identity and practices. Systemic barriers, including cultural marginalization and environmental challenges, exacerbate these inequalities, impacting their ability to preserve traditional lifestyles. It is not known, until now, how this impacts Quality of Life (QoL).

Aims

Describe QoL in the Sámi population in Norway

Methods

In 2019/20, the three northernmost Counties in Norway took part in the Norwegian Counties Public Health Surveys (NCPHS), which also has a comprehensive QoL module (comprises subjective and objective measures, Cantril scale). NCPHS is an internet-based survey. On average 25 % of the adult population was invited to participate in the NCPHS.

Results

Being Sámi was through self-identification, n = 3312. Satisfaction with Life was 7,34 versus 7,41 for the general population. For Loneliness, 15,9 % percent of the Sámi were characterized as lonely (score 6-10) versus 13,3 %, and for positive emotions, there was no difference, with a score of 6,69 for both groups. Sex, age and educational gradients are similar to the general population, for all measures. Minor differences were found according to if one lived in a Sámi-majority municipality or not.

Conclusions

Overall, being Sámi is associated with slightly lower QoL on several measures, but effect sizes are general small to insignificant. Due to lack of data on the Southern Sámi population, findings cannot be generalized to all Sámi.

Key messages

• Overall, being Sámi is associated with slightly lower QoL on several measures, but effect sizes are general small to insignificant.

• Due to lack of data on the Southern Sámi population, findings cannot be generalized to all Sámi.
Reporting social inequalities in health dashboards: data source mapping of 14 European countries
Authors: Peña S , Francis M , von Wright T , Lindell E , Kestilä L
Published: October 2024

Background

Monitoring health inequalities is an essential public health task. This includes reporting social inequalities using data dashboards to inform citizens and policy-makers. To date, there is a dearth of evidence on the extent of health inequality reporting and which equity dimensions are being reported in European countries. The aim of the study is to systematically map data sources and identify the equity dimensions reported in national and subnational data sources in 14 European countries.

Methods

Study design is a cross-sectional data source mapping in 14 European countries (Bulgaria, Estonia, Finland, France, Germany, Greece, Hungary, Italy, Iceland, Malta, Norway, Portugal, Slovenia, Spain). We will conduct a survey among more than 400 collaborators of the EU-funded Joint Action to Prevent NCDs (JAPreventNCD) to identify existing population health dashboards at national and subnational levels. On a second stage, we will carry out a structured content audit to identify inequality dimensions and health indicators in each dashboard. The dashboard content audit will be done in duplicate by native speakers using keyword search and annotated navigation. Inequality dimensions will be categorised using PROGRESS-plus categories. We will pre-register the protocol in OSF prior to data collection and analysis. Data analysis will use a modified version of the template developed by the World Health Organization. Data analyses will be conducted in R. Work is under development but given the resources committed to JAPreventNCD, results will be ready by November 2024.

Key messages

• Reporting social inequalities using data dashboards to inform citizens and policy-makers is an essential public health task.

• Systematic data source mapping can be a reliable, efficient method to monitor the routine reporting of health inequalities.
Data dashboards in health inequalities monitoring - A qualitative study of subnational policy-makers
Authors: von Wright T , Peña S , Francis M , Lindell E , Kestilä L
Published: October 2024

Background

Despite sustained improvements in life expectancy and health during past decades, substantial health inequalities persist. Subnational jurisdictions are increasingly recognised for their pivotal role in addressing health inequalities. While data dashboards offer a promising solution for monitoring health inequalities, their utilisation in supporting local policies to reduce inequalities remains largely unexplored. This study examines the utilisation of health equity data and data dashboards (i.e. Sotkanet, Sotekuva, Tietotarjotin and Hyvinvointivajemittaristo) for health policy-making in Finnish wellbeing services counties, identifies barriers in using existing dashboards and determines the data needs for improved health inequalities monitoring.

Methods

A qualitative case study design with reflexive thematic analysis will be used. The study will be pre-registered in the OSF framework. Semi-structured interviews will be conducted with policy-makers involved in health policy development. Data analysis will involve open and axial coding to identify themes in participants’ responses. Themes will be organised into a coding framework, and the analysis will continue iteratively until data saturation is achieved. The study will include a pre-approved interview guide and peer debriefing sessions. Findings will be reported according to the Consolidated criteria for reporting qualitative research (COREQ) guidelines, with thematic diagrams illustrating key themes and sub-themes. The study is expected to reveal varying levels of utilisation of data and data dashboards among local policymakers, along with specific challenges and gaps in their current use. Policymakers may express needs for additional data or new features in dashboards to better monitor health inequalities. The study will conclude with recommendations for improvements in current data dashboards. Work is under development but by funders requirement the results will be ready by November 2024.

Key messages

• Data dashboards offer a promising solution for monitoring health inequalities, but their utilisation in supporting local policies to reduce inequalities remains largely unexplored.

• This study examines the utilisation of data dashboards for health policy-making subnationally, identifies barriers for use and determines the data needs for improved health inequalities monitoring.
Monitoring the Public Health and Safety Impact of the Groningen Gas-Extraction Crisis
Authors: Dückers M , Berends S , Boendermaker M , D’Amore C , Kanis B , Van der Molen J , Rozema M , Scherpenzeel A
Published: October 2024

Background

Gas extraction in the Dutch province of Groningen began in 1963 and was initially seen as an economic boon for the nation. Yet, it turned into a significant burden for the region, leading to earthquakes, damage to houses and property, complicated compensation processes, recovery, and reinforcement programs, as well as a lack of recognition. In 2016, the research group Gronings Perspectief (GP) was established with the objective of independently monitoring the public health and safety impact of the gas-extraction crisis from the residents’ perspective.

Methods

Monitoring activities take place in dialogue with sounding boards comprising residents, professionals, scientists, and local and national governments. GP employs a longitudinal mixed-methods approach, combining qualitative and quantitative research methods. Representative panel surveys are conducted yearly among residents in the provinces of Groningen (twice) and Drenthe (once). Additionally, 20 in-depth interviews are carried out each year, alongside a survey among households in the reinforcement program. GP analyses the periodic health monitors conducted by municipal health authorities. All reports are publicly accessible.

Results

Since 2016, monitoring consistently points to a profound and enduring effect of housing damage on health and well-being, subjective safety, risk perceptions, trust in governments and agencies among residents. The impact of the procedural burden imposed by governments and institutions, is as significant as the effects of earthquakes and housing damage.

Conclusions

GP’s findings were included in a parliamentary inquiry, which concluded in 2023 that the interests of residents were persistently neglected in favour of economic gain. New risk reduction and reconciliation programs are introduced. Despite the recent decision to end the gas extraction, continuation of GP is needed to monitor further developments.

Key messages

• GP’s stakeholder-driven monitoring approach made the impact of the gas-extraction crisis visible.

• Enduring public health and safety risks, beyond the gas extraction, require continuing monitoring.
Did the pandemic change behaviours in Italy? An analysis on the main NCDs behavioural risk factors
Authors: Asta F , Minardi V , Contoli B , Casigliani V , Gallo R , Possenti V , Masocco M
Published: October 2024

Background

The indirect effects of the COVID-19 pandemic on healthy living behaviours are multiple and complex to assess. The aim of the study is to assess the impact of the COVID-19 pandemic in Italy on: smoking, alcohol, fruit and vegetable consumption, and sedentary lifestyle, through the Italian Behavioral Risk Factor Surveillance System (PASSI) data.

Methods

PASSI 2008-2022 data refer to a sample of 497,223 18-69-year-olds residing in Italy. For each behaviour, from the monthly prevalence data, the 2008-2022 time series was estimated with LOWESS regression and an interrupted time series (ITS) analysis was conducted, using the generalized least squares (gls) model, taking into account autocorrelation (ARMA matrix) and considering March 2020 (start of WHO-declared pandemic) as the month of ‘interruption’ of the series, to show the difference between what was observed and what was expected under the assumption that the pandemic had not happened (‘counterfactual’ scenario).

Results

In December 2022 the share of people who consume at least 5 servings of fruits and vegetables per day is lower than the counterfactual scenario (6.7% vs 9.1%), while the share of higher-risk alcohol users is significantly higher (19.5% vs 16.9%). In contrast, the share of sedentary people (according to WHO guidelines) is significantly lower than the counterfactual (27.9% vs 31.8%). The pandemic does not seem to have had a significant impact on smoking.

Conclusions

These results show a worsening impact of the pandemic on alcohol consumption and fruit and vegetable consumption. Sedentariness shows better data at the end of 2022 and smoking remains mostly unchanged. It will be necessary to continue monitoring the impact of the pandemic over longer periods to confirm the findings.

Key messages

• Understanding changes in lifestyle indicators is critical to design ad hoc interventions to reduce the burden of noncommunicable diseases, and especially during health emergencies such as pandemics.

• Through this work it is possible to clearly observe how the pandemic has impacted lifestyle habits.
Adverse Drug Reactions to β-Lactam Antibiotics: A Portuguese Pharmacovigilance Database Analysis
Authors: Silva M , Fernandes J P , Ribeiro Parracha E , Gamboa A , Lima Alves C
Published: October 2024

Background

The β-lactam antibiotics are one of the most relevant drug classes globally. They accounted for the largest share of systemic antibiotics consumption in Portugal across both community and hospital settings. Due to their significance, continuous monitoring of adverse drug reactions (ADR) associated with β-lactams is fundamental.

Aim

To analyse and characterise cases related to β-lactam antibiotics received by the Portuguese National Pharmacovigilance System.

Methods

Retrospective analysis of cases containing at least one medicinal product classified as suspect under the Anatomical Therapeutic Chemical (ATC) code J01C or J01D, reported to the Portuguese Pharmacovigilance System between 2014 and 2023. Characterisation of cases considered patient demographics, reported suspected medicines, MedDRA Preferred Term (PT), seriousness and type of reporter.

Results

A total of 3557 cases were identified (54.0% females; median age = 42.0 years; interquartile range = 52.2), with 95.9% originating from spontaneous reporting and 93.5% being reported by healthcare professionals. The most frequently reported medicines were those belonging to ATC J01CR. Around 70% of cases were classified as serious, with 38.7% being related to situations of disability or other criteria of greater seriousness. Most frequently reported PTs were related to skin disorders. Anaphylactic reaction was the most reported Designated Medical Event term. The PTs “Drug ineffective” and “Off label use” were reported in 5.2% and 2.4% of the cases, respectively.

Conclusions

Despite the majority of cases are serious, most of the ADR identified are related to already known hypersensitivity reactions. To improve the knowledge regarding these medicines and to generate evidence to address emerging public health issues it is of paramount importance to strength the Portuguese Pharmacovigilance System. This can be achieved through enhancing spontaneous reporting and implementing active pharmacovigilance programs.

Key messages

• Monitoring the efficacy and safety profile of β-lactams in a real-world context is crucial to mitigate the impact in public health and associated economic burden.

• Enhancing the surveillance systems improves data collection and evidence generation, supporting tailoring treatment approaches and implementation of public health policies.