bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of hepatitis C from 2015 to 2022 in a central Italian region: the OPT-HepaC project
Authors: Tramonti Fantozzi M P , Ceccarelli L , De Vita E , Petri D , Colombatto P , Stasi C , Rossetti B , Agostini A , Tavoschi L
Published: October 2024

Background

Chronic hepatitis C virus (HCV) infection is a major global public health problem. This study investigated the evolving landscape of HCV in Tuscany (Italy) from 2015 to 2022, considering demographic shifts, clinical profiles, treatment regimens, and outcomes.

Methods

The study was conducted in order to characterize HCV-positive patients who started treatment between 2015 and 2022 in Tuscan prescribing centers. The study was part of OPT-HepaC, a project funded by Regional Health Service. Data on demographics, clinical history and outcomes were collected. Three different temporal eras were analysed: the period before andfter the universal availability of direct-acting antivirals (DAA) and the COVID-19 era. Treatment’s effectiveness was evaluated by the Sustained Virological Response (SVR12), assessed 12 weeks after the end of treatment. Outcomes included SVR12, non-SVR12 and lost to follow-up (LTFU). ANOVA, Kruskal-Wallis test and multinomial logistic regression were used for statistical analysis.

Results

6882 HCV patients (age: 58.88±14.21) were treated by the centres participating at the study. Males (56.4%) and Italian (91.8%) were predominant. Sociodemographic and variable characteristics vary across the time. While the overall SVR12 remained stable over time (χ2(2)=0.357, p = 0.837), the LTFU rate significantly increased during the COVID-19 era. Facilitating factors for the non-SVR12 and LTFU outcomes were male gender (Odds Ratio (OR)=2.134, p = 0.006)/cirrhosis (OR = 1.713, p = 0.040)/HIV co-infection (OR = 3.251, p = 0.005) and DAA treatment of third generation (OR = 4.187, p = 0.006), respectively.

Conclusions

The study provides a comprehensive view of the HCV landscape, highlighting demographic changes, treatment regimens and outcomes. The COVID-19 pandemic affected service delivery, delaying HCV diagnosis/treatment and influencing the LTFU rate. Despite challenges, the region maintained high SVR12 rates, emphasizing the importance of sustained efforts in HCV care.

Key messages

• The study highlights the dynamic nature of HCV management in Tuscany.

• The study emphasises the need for continuous adaptation to public health challenges, providing insights for future public health strategies.
Characterizing a syndemic: STI symptoms, substance use & violence among incarcerated Peruvian women
Authors: Hashemi E , Cyrus E , Turpin R , Cornejo Bazo A , Morgan-Lopez A , Scheidell J , Leon S , Altice F , Sciaudone M , Dyer T
Published: October 2024

Background

Despite increasing rates of incarceration and sexually transmitted infections (STIs) among women globally, STI epidemiological data for this vulnerable at-risk population is limited. We therefore characterized patterns of STI symptoms and explored covariates and drivers of STI symptoms among incarcerated women in Peru.

Methods

Among 249 incarcerated women surveyed on substance use, depression, sexual behavior, STI symptoms and violence, univariate and bivariate analysis informed a latent profile analysis (LPA) and logistic regression assessing for syndemic associations between violence, substance use, and STI symptoms.

Results

Most participants were Peruvian (93.5%), in their late 30s (median=37; range:18-70 years), sentenced to < 5 years (86.6%) and had completed high school (78.7%). 36.9 had ≥2 STI; A minority were pregnant (2.6%), had children residing with them in prison (7.2%); symptoms. The LPA model with the best fit revealed the largest (39%) group with a ‘syndemic’ profile involving co-occurrence of multiple STI symptoms, substance use, and experiences of interpersonal violence (IPV); 86.6% of this latent class were <50 years old. The substance use and violence ‘syndemic’ profile was associated significantly higher likelihood of having multiple STI symptoms (2+ symptoms: PR = 1.88 (95% CI 1.18, 2.99) or 3+ symptoms PR = 2.55 (95% CI 1.32, 4.93).

Conclusions and Recommendations

The syndemic of younger incarcerated women with substance use and IPV with STI symptoms portends a group at substantially higher risk for HIV and given the structured setting of prisons, should be routinely screened for and treated for STIs. Moreover, these settings can and should screen for and address substance use and IPV and intervene before these women are released to community settings to not only improve individual but public health needs.

Key messages

• In line with syndemic theory, incarcerated women presenting with multiple STI symptoms (≥2) were more likely to be engaged in substance use (illicit drug use and/or alcohol) and experience violence.

• Post-hoc analysis also revealed the rate of substance use was higher among women who engaged in commercial sex work (CSW) pre-incarceration compared to those who were not engaged in CSW.
Investigating Transmission Patterns and Genome Sequencing of SARS-CoV-2 in University College Dublin
Authors: Kumawat J , Codd M , Loughrey J , Scrivener A , Coulahan P , Gormley E , Wall P
Published: October 2024

Background

This study describes the investigation and management of multiple outbreaks of SARS-Cov2 during the second and third wave of the pandemic at University College Dublin, Ireland from September 2020 to September 2021.

Methods

Relevant data were gathered as part of the public health outbreak investigations led by the UCD Internal Covid Control Team (ICCT) in collaboration with the public health teams of the Health Service Executive (HSE). Results are presented for PCR (polymerase chain reaction) confirmed cases and their close contacts, reported to the UCD ICCT between September 2020 to September 2021.

Results

There were 214 cases notified to ICCT. Among these, 153 cases were in residence on-campus cases. 73 epidemiologically linked clusters identified, where the number of cases linked with each cluster varied between 1 to 27. Additional cases during this period had no obvious epidemiological link to the identified clusters. Of 902 close contacts with PCR test results, 31.5% (n = 284) tested positive. 77% (n = 219) self-reported with mild to moderately symptoms while 23% (n = 65) self-reported as asymptomatic. Retrospective Whole Genome Sequence (WGS) analysis was undertaken after the outbreaks had subsided. The test positive cases were grouped into 6 clusters, and it was shown that many of the apparent sporadic cases were included in these clusters.

Conclusions

The proportion of close contacts testing positive varied significantly throughout the pandemic, with testing policy and type of exposure having the greatest impact. Whole genome sequencing can give a better understanding of webs of transmission to complement epidemiological investigations. It is now possible to undertake sequencing in real time where it can make a contribution to outbreak control and resolution. Public Health professionals should become familiar with WGS and bioinformatics as useful tools in their armory for the control of all communicable diseases not only SARS-CoV-2.

Key messages

• Combined epidemiological investigations and Whole Genome Sequencing (WGS) provide crucial insights into campus COVID-19 outbreaks, guiding effective control measures.

• WGS integration enhances understanding of transmission patterns, identifies clusters, and equips public health professionals with data-driven approaches for outbreak management beyond SARS-CoV-2.
Culinary medicine in type 2 diabetes management: co-designing the Cook2DIAbeat training program
Authors: Kouvari M , Dalma A , Zota D , Zioga E , Goni L , Acilu A , Chang B , Arrizabalaga-López M , Patsea M , Ruiz-Canela M
Published: October 2024

Background

Type 2 diabetes (hereinafter diabetes) stands among the top ten drivers of disease burden. Globally, more than 59 million adults are living with diabetes with a projection of 15% increase by 2045. The Cook2DIAbeat project aims to develop a tailor-made nutrition training program based on culinary medicine, for patients with diabetes to achieve lifelong dietary changes. The aim of the present work was to reveal potential drivers and barriers related to lifelong dietary modifications.

Methods

The study was implemented in February-July 2023 in Spain, Belgium, Greece, and Cyprus. A mixed-method co-design methodology was conducted: co-creation sessions with individuals with diabetes, family members, and healthcare professionals, and an online survey with patients with diabetes.

Results

In total, 23 health professionals and 25 patients and family members participated in the co-creation sessions, and 212 patients in the online survey. Patients and health professionals recognized the added value of the culinary approach for diabetes management. The main perceived barriers for changing dietary habits included difficulties accessing reliable and non-conflicting information, lack of time, emotional and psychological issues, and limited social support. Individuals at an advanced age and of low socioeconomic status seem to demand specific educational approaches addressing the actual challenges of their daily life.

Conclusions

The study indicated that training should provide reliable information and address psychosocial aspects. The translation of the dietary guidelines through the culinary medicine approach seems to be well-received by the target group. Last, the content needs to be tailored to suit the specific age group and socioeconomic background of the patients.

Key messages

• Reliability, practicability are three key characteristics of a nutrition training program in diabetes management.

• Cultural and socioeconomic barriers needs to be taken into consideration.
The transition towards a healthy and sustainable food system at local level: the Brussels City case
Authors: Lorenzo i Sunyer N , Vandevijvere S
Published: October 2024

Despite the European Union’s political efforts to promote healthier and more sustainable food systems, challenges persist, with these systems not yet achieving sustainability and still exacerbating health inequalities. The EU-funded FEAST project aims to catalyse this transition through different actions including by focusing on mapping factors shaping food environments in five European cities, including Brussels. This study focuses on mapping existing policies and initiatives by the city government supporting healthier and more sustainable food systems in Brussels City. Policies were then categorized based on Food-EPI domains, types of policies (i.e. financial incentive) and role of the government (i.e. policy development). Results indicated that while Brussels City has a clear strategy (Good Food Strategy) and objectives (Climate Action Plan) to support the transition, there is a notable emphasis on sustainability over health which could be explained by the absence of a dedicated public health expert in the local government. While there are numerous policies focused on improving the school environment (i.e. healthy and sustainable canteens, banned sodas and snack provision, forbidden advertising inside and nearby of unhealthy foods), there is a lack of corresponding measures for public spaces. Furthermore legislative policies are practically inexistent possibly due to jurisdictional barriers from higher governmental levels. Stakeholder interviews will be conducted in the next phase to delve deeper into these issues and to explore potential facilitators and barriers faced in the development and implementation process of these policies. Overall, this research sheds light on the policy landscape in Brussels City, highlighting both progress, areas for improvement and policy gaps in advancing towards healthier and more sustainable food systems.

Key messages

• Despite EU political efforts to prioritise more sustainable food systems, relevant barriers are still present at local level in Brussels City, hampering the development and implementation of policies.

• In Brussels relevant policies for healthier and more sustainable food systems have been implemented, especially in the school environment, but health seems to be overshadowed by sustainability.
Food depiction in posts of the most popular Lithuanian influencers on Instagram and Facebook
Authors: Basijokas R , Austys D
Published: October 2024

Background

Considering that content published in social networks might act as risk factor to health, we aimed to assess the prevalence of posts depicting food published by Lithuanian influencers on Facebook and Instagram.

Materials and methods

All publicly available posts (6425 in total) created by 21 most popular Lithuanian influencers on Facebook and Instagram in 2022 were included. The content analysis of the posts was performed and information about food and other health-related factors was registered. Distribution of the posts depicting food was assessed according to social networks, gender, age, and number of followers of influencers.

Results

Every fourth (22.6%) post presented foods. Among these posts, fast food was presented in 10.2%, sweets - in 35.5%, vegetables - in 59.5%, fruits and berries - in 40.7%, cereals - in 39.2%, dairy products - in 36.8%, meat - in 26.6%, sea food - in 12.1%. Overall, women, older influencers, influencers with higher number of followers more frequently posted posts depicting vegetables (respectively, 21.0% vs 5.5%, 18.6% vs 6.7%, 18.3% vs 9.3%), fruits and berries (respectively, 14.5% vs 3.8%, 12.0% vs 6.4%, 11.4% vs 8.3%), cereals (respectively, 13.7% vs 4.7%, 12.2% vs 5.6%, 11.2% vs 8.2%), dairy products (respectively, 13.0% vs 3.2%, 11.0% vs 5.0%, 10.8% vs 6.3%), meat (respectively, 8.6% vs 4.1%, 7.9% vs 4.4%). Women and older influencers more frequently depicted sweets (respectively, 13.3% vs 7.1%, 12.6% vs 7.1%), sea food (respectively, 4.4% vs 1.5%, 3.8% vs 2.0%). More posts portraying food in general, fast food, vegetables, milk and dairy products were posted on Instagram (respectively, 27.5% vs 19.8%, 3.4% vs 2.1%, 16.6% vs 13.4%, 10.0% vs 8.3%) (p ≤ 0.05).

Conclusions

Every fourth post depict food, more frequently on Instagram. Healthy and unhealthy foods are presented with similar frequency. Female influencers, older influencers and influencers with higher number of followers more frequently depict foods.

Key messages

• Both healthy and unhealthy foods are presented with similar frequency on social networks – this might lead to the overconsumption of unhealthy foods.

• Differences in depiction of foods between social networks and influencers with different gender, age and number of followers should be taken into account when implementing public health interventions.
Compliance of eating model of individuals with metabolic syndrome with Bulgarian dietary guidelines
Authors: Radionova Z , Birdanova V
Published: October 2024

Background

The incidence of metabolic syndrome progressively increases among the urban population of Europe. About 1/3 of the Bulgarian adults have metabolic syndrome. Changing the dietary pattern can be a modern approach to control it. The aim of the study is to investigate the eating model of people with metabolic syndrome according to the Bulgarian dietary guidelines.

Methods

Two hundred individuals with metabolic syndrome aged 54.6±10.5 y. were randomly selected from general practitioners’ practices in Pleven region, Bulgaria. A Food Frequency Questionnaire method was applied to assess the eating pattern of the respondents. The frequency of food consumption of different foods was compared with the dietary guidelines for the Bulgarian population over 18 years of age. Data were processed with IBM SPSS v. 25.

Results

Grain consumption met the recommendations in almost all respondents. Only 29% consumed fresh fruits and 42% had intake of milk and milk products according to the requirements. Women ate more fresh vegetables and fruits and dairy products than men (p = 0,032). Risk meat consumption, 2-4 times a week, was found: men preferring more red meat (45%) and women - chicken and poultry (56%). Fish consumption met recommendation (once a week) in only 14.7% of the respondents. The food intake of eggs, vegetables, legumes and nuts were low. The preferred oils were sunflower and olive (once a day by 86% and 15% respectively), and butter (21% - 2-4 times a week). The intake of table salt corresponds to the recommendations in two thirds of the participants. One third consumed confectionery every day. Half did not drink alcohol, but 16% used concentrates once a day.

Conclusions

Foods that increase the nutritional risk for the development of metabolic syndrome and type 2 diabetes - high consumption of confectionery and red meat, low consumption of vegetables, fish and legumes were found. Unbalanced eating model requires new public initiatives to prevent metabolic syndrome.

Key messages

• Men with metabolic syndrome have a higher consumption of unhealthy foods than women.

• Modern Bulgarian dietary guidelines are an important tool for prevention of metabolic syndrome.
Mediterranean diet adherence and food waste among university students
Authors: Gianfredi V , Stacchini L , Catalini A , Passeri C , Romano N , Villa M , Ferranti R , Nucci D
Published: October 2024

Introduction

The Mediterranean diet (MD) is widely acknowledged as both a nutritious and sustainable dietary option. Growing research indicates that dietary habits can impact the amount of food waste produced. The aim of the study was to assess the correlation between adherence to the MD and food waste behavior among university students.

Methods

A cross-sectional study employing a validated, anonymous, online questionnaire was conducted among students at the University of Milan. Food waste was measured using the Italian version of the Household Food Waste Behavior (HFWB) questionnaire, while adherence to the MD was assessed through the Medi-Lite questionnaire. The questionnaire was developed in Microsoft Forms. Data were collected between July and October 2023. Responses to the HFWB were scored from 1 for disagreeing responses to 7 for agreeing resposes. Pearson correlation (ρ) between MD adherence and anti-waste behavior, stratified by gender and for the overall population was calculated.

Results

A total of 2,617 students (70% females, age 18-23 years 52%) completed the questionnaire. The average MD adherence score was 10.2 (± 2.2), with 65% of the sample being adherent to the MD. MD score was higher among female (10.4), compared to males (10.1, p < 0.001). Females show a more anti-waste behavior (score=5.3±0.8) compared to males (score=5.2±0.7, p < 0.001). MD adherence statistically significant correlated with anti-waste behavior in the overall sample (ρ = 0.27; 95% CI 0.24-0.31, p < 0.001) and within each gender group (Females: ρ = 0.27; 95% CI 0.22-0.35, p < 0.001; Male: (ρ = 0.28; 95% CI 0.22-0.35, p < 0.001)

Conclusions

This study provides evidence of the weak, positive correlation between adherence to the MD and household food waste behavior. Advocating for the MD could enhance health while simultaneously lowering food waste levels, which may have beneficial effects on environmental sustainability and the management of food resources.

Key messages

• Adherence to the Mediterranean diet linked to lower food waste among university students.

• Mediterranean diet promotes health and less waste, aiding environmental sustainability.
Enabling effective knowledge sharing through a Knowledge Hub
Authors: Pavlickova A , Henderson D
Published: October 2024

The objective of the THCS Knowledge Hub is to facilitate and implement effective knowledge sharing and capacity-building activities for the transformation of health and social care systems in Europe, tailored to the users’ needs and local context in order to prepare the ground for the transformation of health and social care systems. The Hub acts as personalised and interactive “matchmaking” platform which will allow the potential users to (a) access, provide and search for personalised and tailored resources generated in the THCS community but also beyond, reflecting the local maturity and conditions enabling the transformation of health and social care systems; (b) facilitate a support for the potential adaptation and transferability of these resources across the European health and social care settings through the functional use of THCS Innovation Transferability Framework; (c) enable the policy dialogue and capacity-building support for policy-makers in order to enhance their skills, knowledge and experience in health and social care transformation; (d) access and engage with THCS community of experts and ecosystems in order to maximise the access and use of the exiting knowledge and expertise for the transformation of health and social care systems; (e) signpost to existing evidence and resources related to health and social care transformation to enable effective knowledge sharing (educational webinars, peer review activities, study visits, training workshops), exchange of good practices and experience in transforming health and social care systems.
Food insecurity and fruit and vegetable consumption in Belgium
Authors: Berger N , Lebacq T , Vandevijvere S , De Ridder K , Le Dieu E , Van Campenhout E , Vasquez M S , Bel S , Moyersoen I
Published: October 2024

Background

Food insecurity is a substantial and growing concern in many high-income countries. Yet, representative data on the extent of the issue in the general Belgian population is lacking. This study aims to assess the extent of food insecurity in Belgium, identify those at risk of food insecurity, and explore the relationship between food insecurity and fruit and vegetable consumption.

Methods

We used data from the Belgian National Food Consumption Survey 2022-2023, a representative sample of the Belgian population aged 3 years and older (n = 2,800). Food insecurity was assessed using the 3 screening questions derived from the USDA Household Food Security Survey Module. Frequencies of fruit and vegetable consumption were obtained from a food propensity questionnaire. Prevalence of food insecurity was estimated using post-stratification weights. Logistic regression models were used to determine the association between frequency of fruit and vegetable consumption and food insecurity, adjusting for gender, household composition, educational attainment, and income.

Results

Preliminary results indicate that 12.6% of population experienced some form of food insecurity. Those who experienced food insecurity consumed fruit and vegetables less frequently than others, after adjustment for other socio-economic variables (ORs>4.00, p-values>0.05).

Conclusions

This study confirms that food insecurity is a substantial concern in Belgium. Food insecurity should be routinely monitored at the national level. Experiencing food insecurity appears to be negatively associated with the consumption of healthy foods such as fruits and vegetables and thus with the overall quality of the diet. Further research should be supported to identify effective strategies to reduce food insecurity in Belgium. Policy attention should be given to ensure financial accessibility to healthy foods and their attractiveness, especially for people experiencing food insecurity.

Key messages

• Food insecurity is an major concern in Belgium and should be routinely monitored.

• Financial accessibility to healthy foods should be improved, especially for those facing food insecurity.
Perception of fatphobia and pesocentrism within medical consultation
Authors: Chávez Castillo S D , Cordero García P , Abonce Bautista K A , Pérez Villanueva M , Morales Morales D K , Hernández Valenzuela D , León Barroso O D , Villegas-Dominguez J E
Published: October 2024

Background

About 42% of adults living with overweight or obesity suffer a marked pattern of stigmatization and thanks to this discrimination the risk of death has increased up to 60%.

Objectives

To identify the factors that contribute to the perception of fatphobia and pesocentrism within the first level of medical care.

Methods

A prospective cross-sectional study was carried out. Statistical analysis was performed with X2 test and 95% confidence interval (OR/CI95%).

Results

104 participants with obesity and overweight were included. The factors associated with the perception of pesocentrism were, started eating plans before the age of 10 years (3.38/1.12-10.7); being denied consultation for being a fat person (0.27/-0.16-0.46); perceiving mistreatment by the physician regarding weight (0. 2/0.13-0.3); perceiving physical harassment by the physician (0.23/0.16-0.82); perceiving discomfort on physical examination (0.44/0.23-0.82); perceiving fat-phobic behaviors by the physician (5.45/3.24-9.16). Factors associated with perceived fatphobia were, started eating plans before the age of 10 years (4.89/1.71-14.01); being denied consultation for being a fat person (0.19/-0.08-0.44); perceiving mistreatment by the physician regarding weight (0. 07/0.04-0.15); perceiving physical harassment by the physician (0.11/0.06-0.19); perceiving discomfort on physical examination (0.28/0.11-0.67); perceiving weight-centered behaviors by the physician (0.05/0.01-0.23). All with p value <0.05.

Conclusions

Factors such as the beginning of eating plans in childhood, refusal of consultation for being a fat person, mistreatment regarding weight, physical harassment by the physician, discomfort during physical examination are associated with and favor the perception of both fat-phobia and weight-centeredness in the medical consultation.

Key messages

• It is of vital importance to know more about the concepts of fatphobia and pesocentrism, in order to promote non-discrimination around them.

• Fatphobia and pesocentrism are still little known issues within the medical community, the perception of them is due to discriminatory behaviors that have been normalized.
Realising the health benefits of City Development Plan in Ireland: The process and influence of HIA
Authors: Kenny T , O’Mullane M , Nash K , Harris-Roxas B , Kavanagh P , McHugh S , Green L
Published: October 2024

Background

The built environment is a major determinant of health. This research examined the process of implementing a health impact assessment (HIA) of a city development plan, using HIA guidance developed by Institute of Public Health Ireland. HIA is an established approach to facilitate a Health for All Policy approach and is a practical tool used to appraise the potential health effects of a policy, programme or project prior to implementation.

Methods

This mixed methods study underpinned by action research and implementation science frameworks, explored the process and experiences of undertaking an HIA on the Cork City Development Plan (2022-2028). A total of 36 stakeholders across a variety of institutions, sectors, and including members of the public, were involved in the HIA.

Results

We found there was an appetite for HIA’s use to facilitate cross sectoral working to identify, mitigate, and address health inequalities. Data derived from interviews, surveys and workshops indicate that while most stakeholders involved saw the value HIA could bring to their work, further efforts are required to realise the benefits of HIA as a decision-support tool. Barriers included lack of familiarity of HIA across sectors, and for those involved in carrying out the HIA, lack of adequate training, time and access to local data.

Conclusions

HIA can contribute to embedding a Health for All Policies approach, however, greater effort from the public health professionals is required to advocate for HIA as a tool to influence policy. Our results suggest that its practical application requires (i) intersectoral training on HIA that supports a broader understanding of the social determinants of health, (ii) knowledge of the purpose and remit of the policy, plan or programme being appraised and (iii) ensuring a broad range of relevant expertise and experience on the steering group tasked with leading the HIA.

Key messages

• HIA can contribute to embedding a Health for All Policies approach.

• Stakeholders do see the value that HIA can bring to their work, however, further efforts are required to realise the benefits of HIA as a decision-support tool.
Impact Assessments - existing procedures and potentials for health and health equity
Authors: Gruber G , Weigl M , Ecker S , Haas S , Antony D
Published: October 2024

Impact assessment tools are used in policy making all over Europe, some have a legal foundation, others were performed voluntarily for certain measures. Usually, impact assessment procedures are dedicated to specific policy areas or political fields. As policies often have impacts in more than one political area, an interlinkage of impact assessments would be appropriate - also to foster co-benefits of policy making. To follow this approach of a more integrated way of impact assessment, it is necessary to gain an overview and understanding of different procedures in place on national level. As policy making is important for designing healthy living environments, a specific task in the EU Joint Action Prevent NCD is focussing on fostering health and well-being through impact assessment procedures. Therefore, an assessment of the existing impact assessments in the participating member states will be performed in 2024. By using a document analysis of guiding material like guidelines, standards or web applications for the specific impact assessment types, it will be investigated how health and health equity aspects are already included. A qualitative comparison of the results can deliver similarities and differences but also promising practices in the member states. The preliminary results of this analysis will be presented. By learning about the different impact assessment procedures in place, potential synergies and entry points for health and health equity could be found. In a next step, a comprehensive checklist for health and health equity should be developed and piloted in the member states. The final version of checklist should be a guiding material that could be included in various Impact Assessment procedures.

Key messages

• Impact assessment procedures are important for policy making and can foster co-benefits in various political fields.

• By learning about the different impact assessment procedures in place, potential synergies and entry points for health and health equity could be found.
Objective and subjective physical activity assessment in obese patients with eating disorders
Authors: Wiesinger H-P , Bannert B , Kaiser E , Riffer F , Kutschar P
Published: October 2024

Background

Discrepancies between objective and subjective measures of physical activity have been reported in healthy populations but remain unexplored in adults with obesity and psychosomatic disorders. Exercise is key for reducing these disorders, yet physiological and psychosomatic factors may complicate valid activity assessments in this population. Here, we compare self-reporting with actigraph data in a clinical setting.

Methods

Over two years, 27 obese patients (21 female, 6 male; 43±14 yrs; 41.3±5.7 kg·m−2) with eating disorders (EDE-Q) were recruited from an Austrian Psychosomatic Center. Total physical activity was assessed using the metabolic equivalent (MET min/w) and sitting time (min/d). Objective data were collected using the SenseWear® wristband (SWA) during weeks 3-4 of patients’ clinical stay. SWA was worn for ≥18 h/d on ≥ 4 days, including one weekend day. Patients self-administered the International Physical Activity Questionnaire (IPAQ-SF) in alignment with the ∼7 days of SWA wear. Concurrent validity - SWA as a criterion - was assessed using regression analyses, and proportional bias was examined with regression and equality line similarity analyses.

Results

Comparison showed an overestimation of total activity (+45%; p<.001) and underestimation of sitting time (-28%; p<.001) with IPAQ-SF vs SWA. Within-patient correlations were poor for MET (r=.92, p<.001) and impractical for sitting time (r=.27, p=.018), with a proportional bias for both outcomes (p≤.001). Converting objective to subjective measures yielded typical errors of 232 (total activity) and 90 min (sitting time).

Conclusions

The observed disparities emphasize the need to integrate sensor-based assessment of physical activity into clinical practice or tailored public health initiatives for adult obesity and psychosomatic disorders. However, further research is needed to evaluate the long-term impact of incorporating accurate SWA data on intervention efficacy in this vulnerable group.

Key messages

• There was strong evidence for meaningful differences in objective vs subjective physical activity assessments in obese patients with eating disorders.

• Integrating objective measures into treatment seems crucial to improve exercise-guided interventions and address the global obesity and psychosomatic disorders pandemic.
A cross-country comparison of the organisation and reimbursement of intensive care in Europe
Authors: Berger E , Rödiger H , Busse R
Published: October 2024

Background

During the pandemic, intensive care capacity was a heavily discussed topic in Europe. Many European countries have increased their intensive care capacities to ensure treatment of all COVID-19 patients. A study, however, revealed that organisational characteristics, among other factors, were associated with in-hospital mortality. Our study thus aimed at reviewing international models for the organisation and reimbursement of intensive care.

Methods

Based on a scoping review, a number of European countries (Denmark, England, France, Germany, Italy, the Netherlands, Sweden) was selected for a questionnaire-based expert survey.

Results

In most countries, intensive care is defined by law, while the definition in two countries has a recommendatory character and/or is driven by reimbursement. In line with the European Society of Intensive Care Medicine’s recommendations, the majority of countries has organised intensive care around 2-3 different (heterogeneously defined) levels of care for which reimbursement sometimes differs according to the level. For most countries, the number of physical (i.e., number of operable beds) as well as human resources (i.e., nurses) in intensive care is unknown. Many countries have an intensive care register which, in the case of Germany, was only implemented as a response to the pandemic. However, comparability is limited due to differences in indicators used. Although promising telemedical approaches in intensive care do exist, their use is not yet formalized in most countries.

Conclusions

Most countries rely on a level-based organisation of intensive care, even though clear evidence on their effect is missing. Heterogeneity of definitions as well as quality monitoring makes a comparison difficult. Further research is needed to better understand best practices and thus increase resilience as well as pandemic preparedness. Telemedical interventions could elevate (access to) high-quality care, especially in times of crises.

Key messages

• Further research is needed to better understand best practices and thus increase resilience as well as pandemic preparedness.

• Telemedicine could elevate (access to) high-quality intensive care, especially in times of crises.
Preparing for future public health crises by fostering a conducive environment
Authors: Lionis C , Petelos E , Roumeliotaki T , Briggs S , Papadakis S , Anastasaki M , Angelaki A
Published: October 2024

Vaccination is considered one of the most cost-effective public health interventions. Zoonotic diseases, which are transmitted from animals to humans, represent an escalating global health concern. Environmental degradation, wildlife trade, and intensified farming practices have disrupted natural ecosystems. This has not only heightened the risk of pathogens crossing species barriers but exacerbated the migrant crisis and deepened global inequalities, as vulnerable populations disproportionally bear the environmental and health burdens. Despite decades of awareness about these risks, the COVID-19 pandemic highlighted our lack of preparedness. At the same time, vaccination hesitancy has been revealed as an important factor in implementing universal vaccination coverage at the population level. Urgency drove innovation. Within months, new multidisciplinary and interdisciplinary approaches were implemented that enhanced our capacity to understand, treat, and protect against the virus. This led to deploying novel technologies, curbing the crisis, and even opening the door to emerging health technologies across a wide spectrum of innovation, from new medicinal products, including vaccines, to evidence synthesis tools, including for modelling and forecasting. Shifting from emergency measures to long-term management of COVID-19, there lies a critical opportunity to strengthen resilience and to increase preparedness against future health threats. The EUVABECO project seeks to harness this momentum by initiating pilot projects that test innovative vaccination tools in evidence-based selected reference practices. These pilots are planned to use suitable theoretical frameworks and consensus meetings to design and develop comprehensive implementation plans that will be shared with EU MS, thereby enhancing Europe’s preparedness and response capabilities against communicable diseases.
Right-Siting Care and Decongesting Specialist Outpatient Clinics - A Singapore Case Study
Authors: Chong CZY , Chong RJR , Chng JJH
Published: October 2024

Issue

Globally, Specialist Outpatient Clinics (SOCs) face a growing burden due to rising chronic diseases. This strain on resources leads to long appointment wait times (LAWTs), delaying diagnoses and treatments. This is particularly of concern in countries with rapidly ageing populations such as Singapore.

Description

The Right-Site Care Program is a healthcare transformation initiative implemented by individual healthcare clusters within Singapore to improve access to timely SOC care by directing patients to the most appropriate care level (right-siting). This transitions stable chronic disease patients to primary care providers (PCPs) for ongoing management. A standardised approach utilises evidence-based guidelines for patient selection, followed by identification and transfer of suitable patients to PCPs. This multi-center program offers a real-world example of healthcare system optimisation for chronic disease management.

Results

A multi-source data analysis, including program reports and peer-reviewed studies from participating healthcare clusters, was conducted to evaluate program impact. The analysis focused on LAWTs, patient outcomes and implementation challenges. Right-siting yielded mixed results across various conditions. Right-sited patients had better survival rates, likely due to closer monitoring and management of chronic conditions with higher total outpatient attendance frequencies. (1) Improvements were particularly significant for diabetes mellitus patients who successfully transitioned to PCPs. (2) However, challenges such as patient scepticism about PCP competence and a preference for specialist care have been identified. (3)

Lessons learned

Right-siting care can improve patient outcomes for certain chronic diseases. The program’s impact varied across different chronic diseases, highlighting the need for tailored strategies. Educational interventions addressing patient concerns can facilitate smoother patient transitions and program success.

Key messages

• Right-siting care shows promise, with improved patient outcomes for conditions like diabetes mellitus.

• Patient education is crucial to overcome patient scepticism and preference for specialists.
Barriers to young people’s use of sexual and reproductive health services in Asia-Pacific
Authors: Riabroi W , Gregory B , Mackay D , Germeni E
Published: October 2024

Background

Qualitative literature extensively documents young people’s barriers to accessing sexual and reproductive health (SRH) services in Asia-Pacific countries. However, efforts to synthesise this research for practical use in healthcare policy and practice are lacking. This systematic review aims to systematically review and synthesise published qualitative literature focusing on young people’s utilisation of SRH services and understanding common access barriers.

Methods

We systematically searched five electronic databases from inception until 24 June 2022: MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science. Google Scholar and reference lists of all included studies were also searched. We used the Critical Appraisal Skills Programme (CASP) checklist for appraising the quality of included studies and analysed the data using a thematic synthesis approach.

Results

We included 31 papers reporting the experiences of over 1800 young people from 16 Asia-Pacific countries. Thematic synthesis identified several factors affecting adolescents’ utilisation of SRH services, which were grouped into six descriptive themes: navigating puberty; lack of SRH knowledge; embarrassment and confidentiality concerns; low decision-making autonomy; traditional practices and religious beliefs; and socio-cultural norms. Our overreaching analytical theme highlighted the role of shame as a key emotion hindering young people’s utilisation of SRH services.

Conclusions

Direct communication about SRH issues is crucial for teenagers. Embarrassment, privacy concerns, and stigma significantly affect their service utilisation decisions. Inclusive interventions for both youth and their communities by addressing socio-cultural factors are essential for optimising service accessibility and guiding evidence-based interventions and policies across diverse cultural contexts.

Key messages

• Understanding young people’s SRH service barriers in Asia-Pacific countries: Socio-cultural norms are highlighted as crucial for optimising service utilisation among young individuals in this area.

• Inclusive interventions and policies are needed for enhanced accessibility.
GIS and statistics to analyze scale change consequences on medical desert classification in France
Authors: Padilla C , Bonal M , Chevillard G , Lucas-Gabrielli V
Published: October 2024

Background

Accessibility is a crucial way to overcome geographical restrictions and provides a path for alleviating the medical desert. Less attention has been paid to the choice of spatial unit in the effect of healthcare multi-accessibility. Inside the OASES European program, the France team proposes to create medical desert classification at the municipality level. The contribution of this study is to highlight the consequences of the choice of spatial scale on spatial distribution and the discrepancies between medical desert classifications.

Methods

Analyses were carried out in metropolitan France and overseas departments, at the commune scale and two other supra-communal scales used by public policies in France. For each spatial unit, a multidimensional and professional classification has been conducted using a three-step method: scores, principal component analysis and clustering. To demonstrate the presence of spatial dependence and to measure homogeneity between classifications joint count autocorrelation indicators and Theil’s indexes were applied.

Results

Our results present 7 classes of municipalities, and 5 classes of EPCI or living territories according to their level of healthcare accessibility, the dynamic of supply, and the needs of the population. Spatial representation of the classification demonstrates greater variability at the municipality level than other supra scales. Informative contrasted classes at the municipality level disappeared in favor of the middle class in all accessibility at supra scales. The results demonstrate that spatial dependence between areas at the municipality level reduced the scale effect.

Conclusions

Spatial approaches have become increasingly popular since they enable decision-makers to identify priority areas and allocate resources. Recognizing the instability across various scales is therefore crucial for thinking about the optimal unit of data aggregation when investigating the medical desert.

Key messages

• Choice of the scale is a mix between public policy decisions and data availability.

• Contiguity constraint is a way to reduce the loss of information after aggregation.
Rehabilitation delivery models to foster healthy ageing - a scoping review
Authors: Maritz R , Seijas V , Fernandes P , Bernard R M , Lugo L H , Bickenbach J , Sabariego C
Published: October 2024

Background

Rehabilitation is crucial for healthy ageing among older adults, who face heightened risks of non-communicable diseases, infections, injuries, and mental health issues. Yet, understanding tailored rehabilitation for this demographic remains limited. To fill this gap, we conducted a scoping review to identify rehabilitation delivery models targeting older adults’ functioning and healthy ageing.

Methods

We systematically searched Medline and Embase (January 2015 to May 2022) for English-language studies on rehabilitation approaches for older adults. Three authors independently screened records for eligibility and synthesized findings through quantitative and qualitative analysis.

Results

Among 6,933 records, we assessed 585 articles, identifying 283 studies with 69,257 participants. Six main rehabilitation delivery models emerged, with outpatient (24%) and telerehabilitation (22%) being predominant. Multidisciplinary teams (31.5%) often followed integrated care principles (30.4%). However, most studies adopted a disease-centric approach (59.0%), neglecting prevalent issues like pain, sensory impairments, incontinence, and sexual dysfunctions. Therapeutic exercises (54.1%) and self-management education (40.1%) were common interventions.

Conclusions

Our scoping review outlines diverse rehabilitation delivery models for older adults, highlighting gaps in addressing prevalent issues and emphasizing evidence-based strategies to promote healthy ageing. It underscores the need for systematic functional assessment and expansion of rehabilitation programs to cover prevalent health concerns. While limitations include reliance on published research and not assessing model effectiveness, this review lays groundwork for future research and innovation in rehabilitation and healthy ageing.

Key messages

• The scoping review identifies six rehabilitation delivery models for older adults.

• The scoping review advocates for evidence-based strategies for enhancing healthy ageing through rehabilitation.