bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical and mental health among citizens with chronic disease in the Capital Region of Denmark
Authors: Elsborg P , Goltermann Toxværd C , Andreasen A H , Eliasen M H , Grønkjær M
Published: October 2023

Background

Chronic disease is a significant problem affecting those living with them, and often also leading to negative effects on other areas of health. This study aims to investigate if individuals with chronic disease have a higher prevalence of poor physical and mental health compared with the general population in the Capital Region of Denmark, and to compare mental and physical health among those with different chronic diseases.

Methods

Data from the Danish Capital Region Health Survey 2021 among individuals (≥16 years) in the Capital Region of Denmark in 2021 (N = 56,245, response rate=54.9%) were used to obtain information on physical and mental health status (SF-12), stress (Cohens’ Perceived Stress Scale), and loneliness (Three-Item Loneliness Scale). Information from national registers on hospital diagnoses and medical treatment were used to identify individuals with chronic diseases. In the presentation, results from several diseases will be presented, but in this abstract, heart disease is used as an example.

Results

Preliminary results show that individuals with heart disease have a higher prevalence of poor physical health compared to the general population in the Capital Region. For example, 42% of individuals with heart disease reported poor general health (Capital Region: 16%), while 38% had low score on the physical health scale (Capital Region: 9.1%), and 50% were greatly affected by pain or discomfort in the musculoskeletal system (Capital Region: 29%). However, there were also health indicators (such as stress and loneliness) where there was no or only a minor difference between individuals with heart disease and the general population.

Conclusions

Among individuals with heart disease, there are two to four times as many with poor physical health on certain indicators compared with the general population in the Capital Region. It is important to be aware that individuals with chronic disease often also have other health challenges.

Key messages

• Individuals with heart disease have a significantly higher prevalence of poor physical health compared to the general population in the Capital Region.

• Healthcare professionals and other professionals should incorporate knowledge in their work about the other health challenges that citizens with specific chronic diseases often face.
'But we survived': Older adults’ strategies to cope with the lockdowns due to the COVID-19 pandemic
Authors: Jarego M , Tasker F , Costa P A , Pais-Ribeiro J , Ferreira-Valente A
Published: October 2023

Background

Older adults are one of the most vulnerable groups to severe illness associated with the SARS-COV-2 virus. Therefore, it would be expected that the elderly would suffer great impact of the COVID-19 pandemic on their mental health. However, it seems not to be the case, possibly due to contextual aspects and the strategies used by them to deal with the COVID-19 pandemic. Our study aimed at exploring the strategies older adults in Portugal deployed during the mandatory lockdowns in 2020 and 2021 to protect their mental health.

Methods

A total of 22 older adults were interviewed and included in this study (36% women; age range between 66 and 92 years old). Qualitative data was collected through semi-structured interviews between Jan-Sept 2020 and analysed according to codebook thematic analysis.

Results

Three main themes were identified. The first theme - ‘finding things to do and activities that can protect me’ - referred to behavioural coping strategies adopted to deal with the pandemic (e.g., preventing behaviours to avoid COVID-19 infection, social support). The second theme - ‘identifying how my thoughts can protect me’ - encompassed cognitive coping strategies, such as engaging in meaning-making processes to make sense out of the circumstances. Finally, the third theme - ‘counting myself lucky: me and my home advantages’ - included aspects perceived as beneficial to the wellbeing of participants during lockdowns (e.g., being healthy, living in a rural area).

Conclusions

The thematic strategies identified by older adults to manage the pandemic and lockdown-related stresses could be linked to meaning-centred coping and could be further developed via existential therapy.

Key messages

• As older adults with health problems and living in urban areas may be at a disadvantage when facing lockdowns, they should be identified by government health entities and forward to psychologists.

• The efficacy of preventing behaviours to avoid COVID-19 dissemination, distraction, social support, and meaning-making processes during health hazards should be targeted by treatment programmes.
Coverage and associated factors with cervical cancer screening in Spain
Authors: Marín Caba E , Pérez de Rojas J , Soler Iborte E , García Blázquez Pérez C-M , Luque Martínez A , Homar Regnault de Maulmin T , Jiménez Moleón J
Published: October 2023

Background

Cervical cancer is a preventable cancer due to vaccination and screening. In Spain 80% of new cases of cervical cancer are women that haven't ever participated in screening programmes. It is outlined if this participation is properly done and if cervical cancer screening is still a challenge for public health in Spain. Our aims are to estimate cervical cancer screening coverage, distinguishing female participation ever and participation every three years according to current recommendations, and to identify the associated factors with participation in the screening.

Methods

An analysis from a subpopulation of the European Health Survey in Spain in 2020 was conducted. Women between 25 and 65 years old that answered the Adult and Home questionnaires were included. Our main variables were “not participating ever in cervical cancer screening”, and “incorrect participation”. A descriptive analysis of the variables and logistic regression models were developed to identify the determinants for the participation in cervical cancer screening.

Results

6924 women fulfilled the selection criteria. The percentage of not participating ever in cervical cancer screening was 11.7%. The percentage of incorrect regularity of participation was 18.0%. Young and elderly women, low socio-economic educational level, sedentary lifestyle, absence of private health insurance, good self-perceived health and working as informal carer were associated with deficient women's participation in screening.

Conclusions

Despite high percentage of participation in cervical cancer screening, the frequency of women that participate correctly can be improved. Socio-economic factors, health perception and assurance, lifestyle, and informal care, have an influence in producing disparities in women's participation and regularity in cervical cancer screening. Future studies are needed to analyse the association among lifestyles, role of carer women and coverage of cervical cancer screening.

Key messages

• Impact of social determinants of health have been recognised in cervical cancer screening.

• Specific programs for vulnerable women are needed to improve their participation in cervical cancer screening.
Making sense of ‘implementation gaps’ as a governance problem of antimicrobial resistance
Authors: Jeleff M , Haddad C , Kutalek R
Published: October 2023

Background

Antimicrobial resistance (AMR) is a pressing global health issue. National Action Plans on AMR (NAP-AMR) are key to mitigate AMR, however, effective translation of action plans has been a governance challenge worldwide. This study explores the implementation gap in Austria by examining experiences of experts involved in domestic AMR policy.

Methods

This study was guided by grounded theory. Data were collected through qualitative interviews, a focus group, and participation in AMR symposia. Overall, 13 participants were identified through theoretical sampling. Data collection and analysis took place until theoretical saturation was achieved.

Results

Experts identified the following central themes affecting AMR mitigation: absence of a binding legal framework, paucity of AMR data, low risk perception among decision makers, lack of funding, and insufficient incentive systems for people dedicated to AMR stewardship.

Conclusions

The interpretation of these findings suggests policy fragmentation, scattered responsibilities, agenda conformity and a lack of recognition as core features which impede a sustainable and effective AMR-related governance. The results should alert policymakers to sustainable public health interventions in the following areas:

a) Institutional responsibilities need to be restructured to prioritize AMR stewardship as a guiding principle.

b) Investments are necessary for nationwide implementation of AMR stewardship and surveillance systems.

c) Financial and symbolic incentives for people dedicated to AMR mitigation are imperative.

Key messages

• There is a tension between local efforts to make adjustments to mitigate AMR and the current approach of ‘superimposing’ reforms on existing structures.

• Effective measures to address AMR require that priority be given to mitigating AMR.
Climate and Health Toolkit for Public Health Registrars
Authors: Ralph A , McGushin A , Booth H , Cullum R , Harpur A , Sahare P
Published: October 2023

Background

The UK Faculty of Public Health (FPH)'s Climate and Health Strategy vision is for the public health (PH) workforce to “lead on strategies to protect health and wellbeing for current and future generations”, and the UK PH curriculum requires registrars to “demonstrate leadership in environmental sustainability” (ES). However, UK PH training currently provides limited opportunities and support for ES work: a 2022 survey of 18 PH registrars in the East of England found that most (78%) had never or infrequently incorporated ES into past projects, due to uncertainty of appropriate sustainability measures or limitations of supervisory knowledge or support. The majority (89%) felt building ES into their future work was “very important” or “important”, and that a toolkit to support this would be useful (89%).

Methods

Formulation of this ES toolkit for UK PH registrars is embedded within the FPH's Sustainable Development Special Interest Group (SIG)'s 2023 workplan. The working group comprises current registrars recruited from diverse UK training locations. To inform toolkit contents, previous registrar projects incorporating ES were collected, via national and regional registrar networks, and through interviews with SIG contacts. Usefulness and accessibility will be evaluated following toolkit dissemination to UK registrars.

Results

The toolkit, structured by placement type, will include: advice on incorporating ES into common placement projects and topics; wider placement activities registrars can undertake to promote greater sustainability; and case studies exploring lessons learned from previous registrar projects that incorporated ES.

Conclusions

Formulation of a practical toolkit will enable PH registrars to develop knowledge and expertise in ES, equipping the next generation of PH professionals with the leadership skills to champion ES in our climate-changing world.

Key messages

• It is imperative that public health registrars gain the skills to tackle the health effects of climate change, but additional support for building these skills is required.

• This practical toolkit will support UK PH registrars to incorporate ES into their work, thereby building knowledge, expertise and leadership skills around climate and public health.
Risk factors associated with falls among older adults with diabetes
Authors: Alsayed Hassan D , Chivese T , Syed M , Al-sayed G , Sharshani H , Al Muraikhi M
Published: October 2023

Background

Globally, falls are a major public health concern and it is the second leading cause of death due to unintentional injury. The prevalence of falls in older adults with diabetes is unknown in many parts of the world. This study aims to explore the association between diabetes-related comorbidities and falls among older adults with diabetes. The study aims to provide evidence and advice for the preventing falls among this vulnerable population.

Methods

This is a cross-sectional study of all older adults with diabetes aged 60 years or older with at least one encounter with the primary health care centers in Qatar during the period 2017-2022. Data on documented falls, demographic variables, and medical comorbidities were extracted from all primary care centers in Qatar. Descriptive and inferential statistics were used to address the aim of the study.

Results

A total of 38,285 older adults with diabetes had at least one encounter with the primary care clinics. The median age was 68.0 years, 56.8% were males, and 40.6% of Qatari nationality.The prevalence of falls was 8.9% (95% CI 6.6 - 6.9). Age, gender (female), nationality, diabetes retinopathy, neuropathy, dyslipidemia, and hypertension were independently associated with increased prevalence of falls.

Conclusions

Given a growing population of older adults in the MENA region, the prevalence of falls is a public health concern. The risk factors identified in this study suggest the need for active screening for risk of falls and preventive interventions in this region.

Key messages

• Prevalence of falls among older individuals with diabetes is relatively high and requires public health attention.

• Females, and older adults with diabetes retinopathy, neuropathy, dyslipidemia, and hypertension are at a higher risk for falls in our sample.
Gambling consumption and gambling harm: evidence from three British surveys
Authors: Kesaite V , Wardle H , Greenwood C
Published: October 2023

Background

Commercial gambling has increased rapidly, with attendant concerns about impact. A critical policy question is whether increased provision and consumption leads to greater levels of harm. The Total Consumption Model posits that that there is a close link between mean consumption and excessive levels of harm in a population, and has been used to justify population level interventions to reduce harm. Using data from three British studies, we assess whether the TCM applies to gambling behaviour.

Methods

Three independent British datasets from 2015 to 2020 were used to analyse the association between gambling consumption and gambling harm by comparing associations across several sub-samples (eg, area deprivation; region). To assess the shape of the risk curves for gambling consumption and risk of gambling-related harm, we used lowess curves, and moderation effects were assessed by interacting gambling consumption measures with sociodemographic groups.

Results

The results from sub-groups analyses in all datasets show that higher mean consumption corresponds to greater levels of harm. The risk curves for the three datasets suggest that gambling harm increases with levels of consumption, however the extent of harm varies by type of gambling activity, with greater levels of harm observed among online gambling and electronic gambling machines. Moderation analyses suggest that men, younger age groups, those from the most deprived communities, in manual employment, and without university degree are more likely to experience greater levels of harm.

Conclusions

In conclusion, the findings support the application of the Total Consumption Model to gambling in Britain. This provides evidential support for population-level intervention that reduce population consumption. This is especially true for certain forms of gambling, like online gambling or gambling on electronic gambling machines.

Key messages

• The first rigorous analysis showing support for the TCM in Great Britain.

• An important question that remains is whether the TCM applies to changes over time, which can only be tested using longitudinal data.
Enhancing the Lives of Older Adults in the WHO European Region: Assessing the Implementation of the UN Decade of Healthy Ageing
Authors: Yon Y , Östlin P
Published: October 2023

The WHO European Region has one of the world's highest median age with many countries having the longest life expectancies. However, the COVID-19 pandemic highlighted the challenges faced by older adults in Europe, leading to excess deaths and highlighting the need to improve their lives. The UN Decade of Healthy Ageing (2021-2030) aims to enhance the lives of older people, their families, and communities. The Decade focuses on four action areas to improve older people's health and wellbeing, combat ageism, ensure age-friendly environments, provide integrated care, and ensure access to long-term care. There are four enablers for the Decade: connecting stakeholders, strengthening research and innovation, engagement, and leadership. A process evaluation survey to assess the implementation of the Decade has been conducted with 48 out of the 53 Member States of the WHO European Region. The survey assessed countries’ policies, regulations, guidelines, strategies, and data on healthy ageing. Preliminary analysis shows that when compared to baseline data, there are more countries with national policy and strategy on ageing with more countries reporting national programme on age-friendly communities, policies to support comprehensive needs assessment of older people and national population-based survey on ageing. Analyses were also conducted based on indicators related to national focal points, multistakeholder forum and legislation on age-discrimination. The UN Decade of Healthy Ageing provides a framework to address the challenges faced by older adults. By focusing on the four action areas and enabling factors, we can enhance the health and wellbeing of older people, their families, and communities. This presentation highlights the importance of the Decade and provides evidence of its early impact, demonstrating the potential to create positive change for the ageing population in Europe.
3.N. Skills building seminar: Publishing and disseminating your research: How to get published, and what then?
Authors:   Organised by: EUPHA,   Chair persons: Monica Brînzac (EUPHAnxt)
Published: October 2023

Getting your public health research published can be a real challenge, and the publishing process is not always clear. Often it takes a lot of time, effort and perseverance. In this skills-building workshop, participants will be able to learn the ropes from the Editor-in-Chief and the Publisher (OUP) of the European Journal of Public Health (EJPH), EUPHA's scientific Journal. The EJPH is a well-established multidisciplinary, Open Access journal that covers a broad scope of public health topics. It's 2021 impact factor is 4.424. The workshop will have the format of an interactive clinic and will start with short presentations by the Editor-in-Chief of the EJPH and the Publisher, on how to write, how to disseminate your findings and tools the publisher has for helping promote your research for the best impact. The Editor-in-Chief will focus on what makes manuscripts attractive to editors and reviewers, while the publisher will give an overview of the publishing process, important aspects of the wider publishing industry (including Open Access) and give authors tips of how to promote their articles post-publication. After that, there will be ample time for participants to ask their questions to the panellists. This skills-building workshop will be of interest to anyone who would like to increase their chances of getting published and who would like to learn more about creating impact with their publications. The session should in particular be helpful for young researchers who do not have a lot of publishing experience yet.

Key messages

• Think about relevance to public health, and what your research adds to science and policy.

• Think about what tools you can use to disseminate your findings.

Speakers/Panelists

Peter Allebeck

Karolinska Institute, Department of Global Public Health, Stockholm, Sweden

Rachel Moriarty

Oxford University Press, Oxford, UK
Avoiding school toilets in the Netherlands; should we worry?
Authors: Jansen D , Illy K
Published: October 2023

Background

one can assume that toilet use by young people is not a problem in the Netherlands because there are sufficient toilets available at all schools. However, international research shows that a substantial number of young people avoid school toilets. It is unknown to what extent Dutch young people avoid school toilets.

Methods

from spring 2023 we recruited young people between the ages of 16 and 25 (all school levels) throughout the Netherlands. Young people who agreed to participate in the study were asked to complete an online questionnaire with questions about their toilet visits during their secondary school period (did they avoid school toilets or not), reasons for avoiding school toilets and the absence/presence of physical, mental and concentration problems during their secondary school period. We analysed our findings. Data will be analysed descriptively by means of a regression analysis.

Results

results are not yet available, but we expect - based on previous study - that at least one in four young people avoid using the toilet at their secondary school period, that girls avoid school toilets more than boys and that older teenagers avoid school toilets more than younger teenagers. We expect the following reasons for avoiding school toilets: feeling unsafe in the school toilets, lack of toilet hygiene, lack of privacy, limited access to the toilet during classes and shame. We also expect that young people that avoid school toilets have more physical, mental and concentration problems than young people that don’t avoid school toilets.

Discussion

We will give insight into the extent to which avoiding school toilets is also relevant in the Netherlands. We will advise schools on how they can adapt schools so that young people use school toilets more often. In addition, this study may show the need for general practitioners, paediatricians, and youth health care physicians to be aware of health problems related to this public health problem.
Adolescent psychiatric inpatient treatment and subsequent labor market trajectories
Authors: Pitkänen J , Junna L , Martikainen P
Published: October 2023

Background

Adolescent psychiatric disorders are associated with subsequent labor market disadvantage, including unemployment, disability pensions, and not being in education, employment or training (NEET). However, most current research has focused on cross-sectional outcomes measured at single time points, which clouds the dynamics involved in the realization of early labor market careers.

Methods

The study is based on longitudinal register data on all individuals born in Finland in 1980-1984 and residing in the country between ages 10-20 (N = 316,526). We followed the study subjects from age 20 to 34 and used multistate models to model transitions between advantaged and disadvantaged labor market states. Labor market disadvantage was defined as being either unemployed, NEET or on disability pension. We examined differences in labor market trajectories by adolescent psychiatric inpatient episodes, measured using hospital discharge data from ages 10-19. Separate analyses by diagnostic groups were conducted.

Results

Individuals who had psychiatric inpatient episodes in adolescence (3%) started their labor market careers in disadvantaged labor market states twice as often as their peers. They were also more likely to transition from advantaged states to disadvantaged states (HR among men: 2.93; 95% CI: 2.85, 3.02) and less likely to experience the opposite transition (HR among men: 0.47; 95% CI: 0.46, 0.48). In total, individuals with a history of psychiatric episodes spent 1.7 to 6.7 more years in disadvantaged states than their peers, depending on sex, baseline state and diagnostic group. The associations were slightly stronger among men than among women.

Conclusions

The results suggest that adolescents with severe mental health problems are highly vulnerable in terms of labor market outcomes throughout their early adulthood. Supportive measures at the start of employment trajectories as well as during later labor market stages are required.

Key messages

• Psychiatric inpatient episodes in adolescence are associated with labor market disadvantage at the start of work careers and with disadvantageous transitions throughout subsequent trajectories.

• To ensure that adolescents facing severe mental health problems are able to realize their full potential, supportive measures at different stages of work careers are required.
Migration and mental health over the past 20 years: how has the situation evolved?
Authors: Duveau C , Lorant V , Smith P
Published: October 2023

Background

Poor mental health is heavily stigmatized, even more when it comes to migrant and ethnic minority groups (MEM). Belgium, with its long history of immigration, is a good case study for analysing mental illness (MI) prevalence and how it has evolved over time across ethnic groups. This paper aims to shed light on the prevalence of MI among MEM in Belgium, between 1997 and 2018. Its objective is to describe the potential disparities in MI prevalence over time by ethnicity.

Methods

The study used data from the six cross-sectional waves of the Belgian Health Interview Survey from 1997 to 2018 to assess the prevalence of MI among five major ethnic groups in Belgium, and to analyse potential disparities over time using logistic and linear regression models. The 12-item General Health Questionnaire was used to measure mental illness (score≥4), and the minimal clinically important difference (MID) was also calculated for MI severity.

Results

From 1997 to 2008, the proportion of people with MI was similar across ethnic groups. However, in 2013 and 2018, there was a significant increase in MI prevalence among Moroccan and Turkish respondents compared to Belgians. The study also found that Turkish respondents had a higher score of mental distress than Belgians from 2013 onwards. In 2018, having a mother born in a non-EU country was found to increase the risk of MI (β = 1.38, CI95%= 0.71;2.05), even after controlling for age, sex and education level.

Conclusions

Mental health inequalities between ethnic groups are on the rise in Belgium, particularly among the Moroccan and Turkish populations. Specific interventions and policies must be implemented to prevent the increase of MI among MEM, and ensure that high-quality mental health care is accessible to all, regardless of ethnicity. Additionally, we recommend better data collection in future research on ethnic mental health, especially on the country of birth of respondents and their parents.

Key messages

• This study describes the evolution of the prevalence of mental health risk among the migrant population in comparison with the native population in Belgium.

• The results of this study can help us to understand the evolution of mental health risk since 1997 and to develop appropriate policies and interventions.
4.A. Workshop: Public health interventions to counteract unhealthy diets towards a better consumer knowledge
Authors:   Organised by: EUPHA-LAW, EUPHA-FN, EUPHA-HL, EUPHA-ETH,   Chair persons: Els Maeckelberghe (EUPHA-ETH), Orkan Okan (EUPHA-HP)
Published: October 2023

Unhealthy diet represents the most important risk factor for chronic non-communicable diseases in Europe. It has been estimated that about half EU citizens are overweight and obese, with over a million deaths yearly are due to dietary risk factors. The growing share of energy-dense nutrient-poor unhealthy foods seem to be, at least in part, responsible for inadequate diet quality, especially among the younger population. While the current situation is already dramatic, future projections on the burden of non-communicable diseases are truly alarming if prevention control is not put in action today. However, public health interventions to improve the impact of sub-optimal quality food are challenging and require a multifaced call to action to counteract the exposure to this obesogenic environment. The transition to healthy and sustainable diets should be facilitated by policy interventions, such as adoption of front-of-pack nutrition labelling for food that would make healthy food easier to choose. The nutritional and non-nutritional content of products in the food market is driven by the industry, thus not necessarily in the best interest of the consumer. While there is consistent scientific evidence on this matter, there is still no action taken from policy makers. Empowering the consumer by improving health literacy could be another strategy to drive EU citizens toward health-conscious dietary choices. However, current efforts from a public health perspective are just shyly raising and are far from optimal nor are getting any actual results. The EUPHA Public health and law, EUPHA Food and nutrition, EUPHA Health literacy, and EUPHA Ethics Sections aim to propose this workshop to discuss about the current status of scientific evidence on the role of products in the food market and health in Europe, public health actions (such as front-of-pack labels) and missed opportunities from the EU Commission to put into practice the retrieved knowledge. Strategies for a better involvement of the citizens and explore new perspectives to counteract the burden of diseases associated with suboptimal diets will be also discussed.

Key messages

• The food market is most entirely regulated by food industry, with poor quality control from a public health perspective.

• Adequate information of consumers may represent a key to counteract unhealthy diets.
Advantages of harmonised front-of-pack nutrition labelling for stakeholders
Authors: Garde A
Published: October 2023

The adoption of a harmonised front-of-pack nutrition labelling (FoPNL) scheme has significant advantages from at least four perspectives. From the perspective of consumers, effective FoPNL can help inform them on the nutritional composition of the food they purchase and consume. From the perspective of economic operators, a harmonised FoPNL scheme results in a level playing field, increased legal certainty and reduced labelling costs. From the perspective of Member States, a mandatory, EU-wide scheme will contribute to policies intended to reduce the prevalence of obesity and diet-related diseases, and will facilitate compliance with the commitments they have made at international level to promote healthier food environments. From the perspective of the EU itself, a harmonised FoPNL scheme will promote the proper functioning of the internal market in line with the EU's mandate to ensure a high level of consumer and health protection in all its policies.
The Irish National SARS-CoV-2 Whole Genome Sequencing Surveillance Programme
Authors: Brehony C , Murphy N , McGarry S , Liddy E , Mellotte N , Cotter S , Petty-Saphon N , Dean J , Stapleton P , O'Connor L
Published: October 2023

Issue

In response to the COVID-19 pandemic in Ireland, a national SARS-CoV-2 Whole Genome Sequencing (WGS) Surveillance Programme was set up in 2021 to track the molecular epidemiology of SARS-CoV-2 in Ireland to inform and enhance the urgent public health response to the COVID-19 pandemic.

Description

The Programme is a ‘hub and spoke’ model, led by the Health Protection Surveillance Centre with the National Virus Reference Laboratory (hub) and seven acute hospital laboratories (spokes), representing Ireland's six Regional Health Areas and Children's Health Ireland Hospitals. The two streams within the Programme's surveillance strategy are: 1. National surveillance of SARS-CoV-2 variants, including samples from GP sentinel sites and severe acute respiratory infection (SARI) surveillance, vaccine effectiveness studies, hospital in-patient, intensive care cases and deaths. 2. Targeted surveillance of risk groups e.g. outbreak cases, cases with unusual epidemiological/clinical characteristics.

Results

As of 30/03/2023, 103,258 COVID-19 cases (6% all notified cases in Ireland) have been sequenced since week 51, 2020. Data produced contribute to: public health policy in Ireland; local/national clinical and public health action; tracking variants nationally and variant shifts over time; the global community through reporting of WGS data to ECDC, WHO and global repository (GISAID).

Lessons

The hub and spoke model is an efficient and sustainable design for a laboratory public health programme. It is scalable, allowing addition of new spokes where needed. It ensures regional equity and builds capacity both nationally and regionally, increasing resilience and expertise throughout the country.

Key messages

• WGS will be key component of future epidemic/pandemic preparedness.

• Programme successfully implements sustainable nationwide WGS surveillance and will expand to include other pathogens.
Inequitable distribution of mortality between persons with and without disabilities
Authors: Park J E , Kim S Y , Park J H
Published: October 2023

Background

People with disabilities (PWD) experience avoidable health inequalities throughout their lives, which can lead to disparities in end-of-the-line health outcomes, such as death. We compared the trends in mortality between PWD and those without disabilities (PWOD) over the past decade and assessed the mortality gap for PWD based on health determinants.

Methods

We linked the National Health Insurance Database, which includes the entire Korean population, with National Disability Registration Database and Cause of Death Database. Crude mortality rate (CMR) and age- and sex-standardized mortality rate (SMR) for PWD and PWOD were calculated using data from over 50 million individuals per year from 2008 to 2017. Sociodemographic and health variables including age, sex, income, place of residence, and Charlson comorbidity index (CCI) were considered.

Results

All-cause CMR increased for both PWD and PWOD from 2008 to 2017, but the upsurge was greater among PWD (+11.2% vs. +7.3%). PWD continuously had higher CMRs (2668.3 vs. 412.9 per 100,000 in 2017) and SMRs (768.0 vs. 252.9 per 100,000 in 2017) than PWOD. However, the ratio of the mortality rate for PWD to PWOD intensified among less vulnerable groups in the population, including those who were younger, had higher incomes, or had no comorbidities. Compared to PWOD, the odds of death for PWD increased by 1.40-fold (95% CI = 1.38-1.41). The association between disability and death was stronger in the young age group (OR = 8.34, 95% CI = 7.20-9.65 for <20 years) than in the older age group (OR = 1.10, 95% CI = 1.08-1.11 for ≥80 years). Greater disparities were also observed in groups with higher income or no comorbidities.

Conclusions

These findings suggest that macro-level social barriers, such as institutional discrimination against PWD in health care and inaccessible public health interventions, may contribute to the mortality disparities for PWD in a broader and more profound manner.

Key messages

• Disability was associated with an increased risk of mortality, and a larger mortality gap compared to the general population was observed, particularly among less vulnerable groups in the population.

• Fundamental policies are required to mitigate inequalities in mortality among persons with disabilities.
Social gradient in quality of life according to microscale neighbourhood features, Limassol, Cyprus
Authors: Middleton N , Kleopa D , Kouta C , Panayiotou A
Published: October 2023

Background

Beyond indices of socio-economic disadvantage (SED), not standard practice in Cyprus, neighbourhood audits provide information about environmental inequity not captured by other methods. Lack of spatial thinking often leads to attributing geographical differences to socio-demographic composition.

Methods

A random sample of 45 neighbourhoods along the SED continuum were audited using the Cyprus Neighborhood Observational Tool (CyNOTes). SED was defined according to a purposefully developed postcode level index (N = 124), by factor analyzing a set of census indicators. A sample of 10 residents aged 45-64 per neighborhood responded to a door-to-door SF-36 quality of life (QoL) survey (N = 450). Associations of QoL with SED and audit scores, organized in 9 domains, were explored in random-effect regression models adjusting for gender, age, education and income.

Results

The SED index captured a stepwise decrease across tertiles with increasing disadvantage in both Physical (-1.79 95% CI -2.84, -0.73; p < 0.001) and Mental (-1.42 95%CI -2.46, -0.59; p = 0.008) SF-36 Component Scores. Associations attenuated but remained statistically significant after adjusting for person-based social position. Re-classifying neighbourhoods according to audit ratings also revealed a social gradient for most CyNOTes domains. The domain with the strongest association with both Physical (-1.84 95%CI -2.88, -0.80; p < 0.001) and Mental SF-36 Scores (-1.88 95%CI -2.83, -0.93; p < 0.001) was “Pedestrian and Cycling Environment”. Associations persisted in adjusted models and appeared similar, if not stronger, to associations with the SED index.

Conclusions

The study depicted the social gradient in quality of life among late working-life residents across Limassol neighbourhoods. Other than the expected patterning according to SED, audit indicators of environmental inequity also captured a social gradient, linking micro-scale neighborhood features to the residents’ quality of life.

Key messages

• A social gradient in quality of life was demonstrated along the socio-economic and environmental disadvantage in Limassol.

• Depicting neighborhood microenvironment inequity can trigger and contextualize conversations about health and place among the local Public Health research and policy community.
Diet-related greenhouse gases emissions according to individual readiness to reduce meat consumption
Authors: Reuze A , Baudry J , Méjean C , Brunin J , Péneau S , Touvier M , Kesse-Guyot E , Allès B
Published: October 2023

Background

Reducing greenhouse gases emissions (GHGe) requires drastic changes in dietary patterns, notably reducing meat consumption. As the process of change can be experienced as stages, we might wonder what actual changes in diet-related GHGe result from each stage of meat reduction. We therefore aimed to describe levels of diet-related GHGe and their change over time according to the individual readiness to reduce meat consumption.

Methods

Food consumptions of 13,635 non-vegetarian French adults participating in the NutriNet-Santé Cohort were assessed using a food frequency questionnaire at two time points, in 2014 and 2018. Diet-related GHGe were assessed using life cycle assessment. A questionnaire in 2018 allowed us to characterize participants by their level of readiness to reduce meat consumption, using the stages of change from the transtheoretical model: precontemplation, contemplation/preparation, action, maintenance. Energy-adjusted diet-related GHGe were compared according to stages in 2014 and 2018 using ANCOVA and compared over time using Student test. Dietary intakes and their contribution to diet-related GHGe were also described.

Results

Individuals in the maintenance stage had the lowest diet-related GHGe, with an average of 3.73 kg CO2eq/day (SEM=0.02) in 2018, representing a difference of -26% compared to the precontemplation stage. Only participants in the action and the maintenance stages decreased their diet-related GHGe over time (both p < 0.0001). Specifically, GHGe from ruminant and monogastric meat (e.g. pork, chicken) decreased over time for the last two stages (all p < 0.0001), while their GHGe from cheese increased.

Conclusions

The last two stages of meat reduction resulted in a reduction of diet-related GHGe. As this reduction is not sufficient to meet GHGe reduction objectives, further efforts are needed and new levers, combined with public health guidelines must emerge to enhance the transition.

Key messages

• Individuals with higher readiness to reduce meat consumption actually reduce their overall GHGe, mostly due to reduced consumption of ruminant meat, but also pork and poultry.

• Observed reduction in diet-related GHGe is not yet sufficient to meet GHGe reduction objectives and further efforts are required.
Life-course socioeconomic status and its impact on functional health of Portuguese older adults
Authors: Henriques A , Ruano L , Fraga S , Soares S , Barros H , Talih M
Published: October 2023

Background

Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive, and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socioeconomic status (SES) and different dimensions of functional health in older adults.

Methods

Data on 821 Portuguese adults aged 50 and over in 2013-2015 were analyzed. Life-course SES was computed using participants’ paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm+nm), upward (m+nm), downward (nm+m), stable low (m+m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health.

Results

Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β=−9.75; 95%CI: -14.34;-5.15; SF-36 mental health: β=−7.33; 95%CI: -11.55;-3.11; handgrip strength: β=−1.60; 95%CI: -2.86;-0.35; walking time, highest tertile: OR = 5.28; 95%CI: 3.07;9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95%CI: 0.96;3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95%CI: 1.78;11.95).

Conclusions

A disadvantaged life-course SES impacts older adults’ physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health.

Key messages

• Overall, stable high SES leads to better functional health, but for mental health functioning, handgrip strength and walking speed, it is possible to overcome the initial social disadvantage.

• These results reinforce that even though health disparities may start early in life, they are mutable and capable of changing through the improvement of socioeconomic conditions.
Transferable lessons learned from improving health literacy responsiveness in Dutch rheumatology care
Authors: Bakker M M , Putrik P , Boonen A
Published: October 2023

Background

Health literacy difficulties among (groups of) individuals represent a significant public health challenge. Improving health literacy responsiveness of systems and services could reduce health inequalities in communities and patient populations.

Methods

We conducted a mixed-methods study to improve health literacy responsiveness in three Dutch rheumatology centres, using the OPtimising HEalth LIteracy and Access (Ophelia) approach. Patients and health professionals were involved in an inclusive needs assessment (n = 895 and 39, respectively) and co-design consultations to identify local solutions (n = 14 and 38, respectively). Based on all steps, we formulated transferable lessons learned (outcome-related or process-related) for public health and health care.

Results

Outcome-related lessons: a mixed-methods Ophelia approach was successful in identifying health literacy challenges and 175 potential solutions. Challenges are similar between disease groups and centres, but require solutions specific to the local context. Recognising challenges at the point of care is difficult. For a healthcare service to be responsive to health literacy needs, increased awareness alone is not enough; it will require a conscious actions and systemic change at multiple levels, including training. Process-related lessons: prerequisites for a successful health literacy responsiveness project include using multidimensional measurements, an inclusive participatory approach with all stakeholders, collaboration with experts in a community of practice, and strong project governance.

Conclusions

The Ophelia project in rheumatology care was successful in its aims of finding solutions to improve health literacy responsiveness. Public health and healthcare organisations should consider improving their health literacy responsiveness using a grassroots co-design approach. However, project success will depend on the quality of its governance; future programmes should follow a systematic approach.

Key messages

• Using a grassroots co-design approach such as Ophelia can help identify locally relevant solutions to health literacy challenges and support organisational efforts to reduce health inequalities.

• Successfully improving health literacy responsiveness requires, at minimum, inclusion of people with most complex health literacy challenges, strong project governance, and stakeholder engagement.
The association between maternal prenatal vitamin B12 intake and child cognitive development
Authors: Hrezova E , Ksinan Jiskrova G , Pikhart H
Published: October 2023

Background

Nutrient deficiencies in diet during pregnancy may have an adverse effect on the development of offspring. The association between prenatal vitamin B12 intake and cognitive functioning in children is unclear. Therefore, we examined such association in Czech children.

Methods

Czech part of European Longitudinal Study of Pregnancy and Childhood is a population-based prospective longitudinal birth cohort study of pregnant women and their children enrolled in 1991-1992. Dietary data was measured at 32 weeks of gestation using 145 items self-reported food frequency questionnaire. Parents reported on their child's speech and language development at 18 months, 3, 5, and 7 years of age (outcomes ranging from n = 1891 to n = 2362), from which single scores for vocabulary, language, early communication, understanding, and intelligibility were calculated. Higher scores indicate better speech and language development. Data were analysed using multiple ordinal and logistic regression models.

Results

Higher prenatal vitamin B12 intake was associated with higher speech and language test scores in fully adjusted models. Children of mothers with higher B12 intake had increased likelihood of higher scores in vocabulary (OR = 1.06, 95% CI: 1.01; 1.11), language (OR = 1.05, 95% CI: 1.01; 1.10), early communication (OR = 1.06, 95% CI: 1.01; 1.11) and understanding (OR = 1.09, 95% CI: 1.04; 1.14) at 18 months of age. Furthermore, they were more likely to get maximum points in the intelligibility test at age 3 (OR = 1.08, 95% CI: 1.02; 1.14) opposed to children of mothers with lower B12 intake. There were no associations at 5 and 7 years.

Conclusions

We found consistent and significant associations between prenatal vitamin B12 intake and early speech and language development. The results suggest that a diet during pregnancy low in vitamin B12 may negatively affect children's cognitive development. Thus, a healthy pregnancy diet with sufficient vitamin B12 should be promoted.

Key messages

• A diet low in vitamin B12 during pregnancy may have negative effects on the cognitive development of offspring, according to a longitudinal birth cohort study.

• Adequate prenatal vitamin B12 intake is important for cognitive development, particularly speech and language development.