bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge, attitudes, practices on hepatitis C and HCV screening: an Italian cross-sectional study
Authors: Lo Moro G , Scaioli G , Frattin R , Guastavigna L , Vola L , Bert F , Siliquini R
Published: October 2022

Background

Hepatitis C has the highest burden in the Eastern Mediterranean Region and European Region. This study aimed to explore knowledge, attitudes and practices towards hepatitis C and HCV screening, which has been large-scale implemented in Italy recently.

Methods

An online nationwide cross-sectional survey was conducted (Italy, December 2021). Five outcomes were used: HCV knowledge (from 0 to 100%: 100% represents the lowest knowledge); not being aware of the screening; wrong attitudes in case of contact with positive people (from 0 to 5: 5 represents more wrong attitudes); having performed an HCV test; sharing of blood-contaminated objects. Multivariable regressions were run.

Results

Participants were 813 (74.7% females; mean age 37 years, SD 12.4). The median score of HCV knowledge was 20% (IQR 16-24). There was a positive correlation between poor knowledge and wrong attitudes (p = 0.001). People who underwent an HCV test were less likely to have poor knowledge (p = 0.040). The 23.2% was not aware of screening existence. People who had a postgraduate degree were less likely of not being aware (p = 0.004). Investigating attitude score, the median was 0 (IQR 0-1). Increasing age was associated with wrong attitudes (p = 0.020). The 43.4% underwent an HCV test. This likelihood was greater for: residence in a municipality with more than 50000 inhabitants (p = 0.032); having at least one child (p = 0.009); considering oneself at risk (p = 0.004); being informed about HCV (p < 0.001). The 31.8% shared objects. Increasing age was associated with reduced odds of sharing (p = 0.033). The 72.4% would like to receive more information on HCV, preferring brochures and short videos.

Conclusions

This study showed good knowledge and attitudes, with a substantial frequency of individuals who never underwent an HCV test or shared contaminated objects. It also suggested brochures and short videos may be the most acceptable ways to implement awareness campaigns in comparable European contexts.

Key messages

• Italian general population had good knowledge and attitudes towards hepatitis C and its screening, while it showed poor practices.

• Most of participants were willing to receive more information on HCV, especially through brochures and short videos.
Combined Overview on Diverticular Assessment:a new score for the management of diverticular disease
Authors: Nasi G , Tursi A , Di Mario F , Lammert F , Poskus T , Reichert MC , Regula J , Bonovas S , Sapienza M , Brandimarte G
Published: October 2022

Background

Diverticulosis is increasing worldwide as a public health problem. The Combined Overview on Diverticular Assessment (CODA) score, merging Diverticular Inflammation and Complication Assessment (DICA) and few clinical parameters, may reliably predict the occurrence of acute diverticulitis and surgery due to complications. Thus, the aim of the study is to confirm the value of DICA classification and to develop and validate the CODA endoscopic-clinical score.

Methods

A number of 2198 patients, at the first diagnosis of diverticulosis/diverticular disease were enrolled in a multicentre, prospective, international cohort study. Participants were scored according to DICA classifications. A 3-year follow-up was performed. Survival methods for censored observation were used to develop and validate the CODA score for predicting diverticulitis and surgery.

Results

The 3-year cumulative probability of diverticulitis and surgery was ≤4%, and ≤0.7% in CODA A; <10%and <2.5% in CODA B; >10%and >2.5% in CODA C, respectively. The 3-year cumulative probability of diverticulitis and surgery was of 3.3% (95% CI 2.5% to 4.5%) in DICA 1, 11.6% (95% CI 9.2% to 14.5%) in DICA 2 and 22.0% (95% CI 17.2% to 28.0%) in DICA 3 (p < 0.001), and 0.15% (95% CI 0.04% to 0.59%) in DICA 1, 3.0% (95% CI 1.9% to 4.7%) in DICA 2 and 11.0% (95% CI 7.5% to 16.0%) in DICA 3 (p < 0.001), respectively. The CODA score showed optimal discrimination capacity in predicting the risk of surgery in the development (cstatistic: 0.829; 95%CI 0.811 to 0.846) and validation cohort (c-statistic: 0.943; 95% CI 0.905 to 0.981).

Conclusions

DICA endoscopic classification was confirmed to have a significant predictive value in terms of acute diverticulitis occurence/recurrence and risk of surgery. CODA score could provide a new risk stratification tool useful for everyday clinical practice and also with a significant public health impact in terms of treatment effectiveness and decision making.

Key messages

• DICA endoscopic classification of diverticular disease is a clear predictor of the outcome of diverticulosis/diverticular disease.

• The CODA score, combining DICA and few clinical parameters, may reliably predict the occurence of acute diverticulitis and surgery due to complications.
Higher VTE in a Roma population attributed to raised genetic risk and gene-environmental interaction
Authors: Natae S , Sándor J , Ádány R , Fiatal S
Published: October 2022

Background

Interactions between genetic and environmental risk factors (GxE) contribute to an increased risk of venous thromboembolism (VTE). Understanding how these factors interact provides insight for the early identification of at-risk groups within a population and creates an opportunity to apply appropriate preventive and curative measures.

Objective

To estimate and compare GxE for VTE risk in the general Hungarian and Roma populations.

Methods

The study was based on data extracted from a database consisting the results obtained previously in a three pillars complex health survey. DNA was genotyped for rs121909567 (SERPINC1), rs1799963 (F2), rs2036914 (F11), rs2066865 (FGG), rs6025 (F5), and rs8176719 (ABO) polymorphisms. Multivariable linear regression analysis was applied to test the impact of GxE on VTE risk.

Results

Interestingly, the rs121909567 (SERPINC1) SNP was not present in the general population, however the risk allele frequency was 1.4% among Roma, which might suggest a founder effect in this minority. The risk of VTE was higher among depressive Roma subjects who carried the risk variant of rs2036914 (β = 0.819, p = 0.02); however, not for the general subjects. The joint presence of high level of LDL-C and rs2066865 increased the VTE risk only among Roma (β = 0.389, p = 0.002). A multiplicative interaction between rs8176719 and cancer was identified and higher for the Roma population (β = 0.370, p < 0.001). The VTE risk increased in the Roma population (β = 0.280, p = 0.001) but was higher in the general population (β = 0.423, p = 0.001) as a result of the multiplicative interaction between CAD and rs2036914 (F11).

Conclusions

rs121909567 (SERPINC1) was confirmed as a founder mutation in the Roma population. As a result of higher genetic load and GxE interactions, the minority Roma population is at higher risk of VTE than the general Hungarian population.

Key messages

• Our study revealed some evidence on the burden of the joint presence of genetic and environmental risk factors on VTE.

• A marginalized and segregated Roma community could need due attention for the prevention and control of CVDs.
HBM4EU feasibility studies: Lessons learned in combining health and human biomonitoring studies
Authors: Elonheimo HM , Uusitalo K , Moore S , Andersson A-M , Wirkner K , Kolossa-Gehring M , Stewart L , Lermen D , Tolonen H
Published: October 2022

Background

The European Human Biomonitoring Initiative (HBM4EU) is a program protecting humans from the health effects of chemicals. The goal of HBM4EU is to make use of human biomonitoring (HBM) to assess human exposure to chemicals in Europe to better understand the associated health effects for citizens and to improve chemical risk assessment. Harmonisation and sustainable implementation of the HBM programme across Europe are important aims. In parallel to HBM studies, health examination surveys (HESs), dietary surveys, and disease specific health surveys are conducted in many European countries. In HESs, information collected by questionnaire(s) is supplemented with physical examinations and analysis of biomarkers from biological samples. HBM and HES use similar sample and data collection methods and infrastructures hence combining the two is being explored.

Methods

Within HBM4EU, three feasibility studies (Finland, Germany, and UK/England) were conducted to evaluate opportunities and obstacles in combining HBM and health studies. We describe the contents and differences of these feasibility studies, and discuss the matters of shared benefits, obstacles, and lessons learned.

Results

Benefits of combining HBM and HESs include the use of shared infrastructures, participants receiving additional health information from HES, and higher participation rates. Obstacles can be encountered when obtaining ethical approval and during time-consuming and complicated preparatory phases. Recruitment of participants and low participation rates are common concerns and designing participant-friendly questionnaires is important. Unexpected events such as the COVID-19 pandemic can cause challenges to studies. Furthermore, experiences from several countries demonstrated that long-term funding for combined studies can be difficult to obtain.

Conclusions

In the future, incorporating HBM modules into HESs can provide a feasible and cost-effective method to conduct HBM studies.

Key messages

• The European Human Biomonitoring Initiative (HBM4EU) protects humans from the health effects of chemicals in Europe. HBM4EU uses human biomonitoring (HBM) to evaluate human exposure to chemicals.

• In addition to HBM studies, health examination surveys (HESs) are conducted. In the future, incorporating HBM modules into HESs can provide a feasible and cost-effective method to conduct HBM studies.
Temperature related infectious disease mortality among infants and seasonality in Sweden, 1868-1892
Authors: Junkka J , Hiltunen M
Published: October 2022

Background

Climate conditions, such as ambient temperature, are crucial to infants’ vulnerability to infectious diseases. However, little is known about how climate conditions, such as temperature and seasonality, affects infectious disease mortality among infants in high mortality settings. The aim was to investigate the association between ambient temperature, seasonality and cause-specific infant mortality.

Methods

We applied a retrospective study design using parish register data from Sweden covering the period 1868-1892 in combination with daily temperature data. Population data and temperature data were combined in a time-series dataset, accounting the number of deaths per day by age group. Mortality due to water- and foodborn diseases, airborne infectious diseases, and other causes were modelled as a function of temperature exposure in the previous 14 days using distributed lagged non-linear models.

Results

We found that airborne infectious disease mortality was not related to cold temperatures but rather to seasonality. At the 1st of february IIR was 2.98 (CI 1.30 - 6.85). The summer mortality peak due to water- and foodborne infections were associated with high temperatures and not with seasonality. At + 20 °C (the 99th percentile temperature exposure) IRR was 5.52 (CI 3.13-9.74).

Conclusions

The increased vulnerability to infectious diseases of infants at high temperatures is a significant future risk, given the expected global warming in the coming decades.

Key messages

• Airborne infectious disease mortality was related to seasonality while water- and foodborne infectious diseases were related to high temperatures.

• The increased vulnerability to infectious diseases of infants at high temperatures is a significant future risk, given the expected global warming in the coming decades.
Education in Urban Health: the experience of Public Health residents in an Italian high school
Authors: Cadeddu C , Zjalic D , Lanza TE , Nachira L , Perilli A , Paladini A , Lombardi GS , Di Russo M , Ricciardi W , Damiani G
Published: October 2022

Background

Urban health has become an increasingly important aspect of Public Health curriculum for residents as people living in urban areas will substantially rise in the next 30 years so will their impact on health. Residents are both contributors and partners in creating sustainable solutions for their growing cities and can be involved in this aim as individual learners and also educators for younger students.

Objectives

A group of 15 Italian residents in Public Health were involved in creating and delivering 4 lessons on urban health to 319 students at Nomentano High School in Rome during spring 2022. After the 4th lesson, semi-structured interviews were conducted with the residents in order to assess perceptions, acceptance, barriers and facilitators of the experience. Data was gathered anonymously and analyzed using standard qualitative methods.

Results

All the residents answered the interview. Almost all reported the experience as highly impactful for training, team building, and increase in accountability. Most of residents also felt more confident on the topic of urban health and more involved in concrete actions for tackling pollution and climate change after delivering the lessons. Most perceived barriers mentioned were difficulties interacting with students, especially during the first two lessons, and their compliance. The opportunity to give lessons in the high school setting facilitated direct contact with students and better feedback was received.

Conclusions

Giving responsibility and leadership roles to Public Health residents and involving them in the education of younger students could improve their self-confidence and feelings of value and helpfulness, especially for urban health and climate change issues sensed by youth. Further experiences in other settings, specialties, and countries could be valuable to notice differences related to age groups and personal involvement.

Key messages

• The involvement of Public Health residents in education on urban health is highly impactful and well perceived for their personal growth.

• This kind of experience is applicable to other relevant topics in Public Health.
Safer school with near-UVA technology: novel applications for Environmental Hygiene
Authors: Bosco R , Amodeo D , De Palma I , Cevenini G , Messina G
Published: October 2022

Background

Schools are crowded places where outbreaks can occur. Systems capable of disinfecting air and surfaces could reduce the risk of transmission of infectious diseases.

Aim

to evaluate the effectiveness of a near-UVA (nUVA) LED ceiling lamp in improving environmental hygiene.

Methods

This cross-sectional study was conducted for 2 weeks between November and December 2020 in a kindergarten in Siena, Italy. Four ceiling lamps with LED wavelength of 405 nm were mounted on the room ceiling. The distance of the lamps from the floor was 2.70 m and 2.0 m from the desks. We preliminary selected 12 points in different sites of the room by measuring their irradiance values. We randomly sampled between 8 and 12 pairs of Petri Dishes (PD) daily during the study, incubated at 22 and 36C°, at different irradiation times: 8, 12 or 36 hours. Paired controls were used before using the lamps (at time T0), which were automatically switched ON overnight and compared with treatment (at time T1). Air sampling was also performed at T0 and T1. Statistical analysis was performed with Stata 14. Significance was set at 95% (p < 0.05).

Results

520 PDs were used in the study: 130 PDs at T0 matched at T1 incubated at 36 °C and as many at 22 °C. The mean level of contamination at T0 was respectively 249 CFU (95 % CI 193.1 - 305.0) at 36 °C and 535.2 CFU (374.3 - 696.1) at 22 °C. The reduction was significant (p < 0.05) at T1: we had 87.4 CFU (56.3 - 118.6), equal to 65%, at 36C° and 149.6 CFU (83.7 - 215.4), equal to 72%, at 22C°. Different values were recorded stratifying for dose (irradiance per exposition time). A significant mean percentage reduction of air contamination was 95.3% (98.4 - 92.3).

Conclusions

The system was able to improve the environmental hygiene of the kindergarten. The advantage of using this technology in the presence of people is very important in the context of controlling environmental contamination.

Key messages

• Near-UVA are efficient in reducing the contamination level significantly in a real-life context, on the surfaces and of the air.

• Crowded places favour germ outbreaks. Hygiene control is essential to reduce the risk of transmission of infectious diseases.
Digital coping of parents in conflict-affected communities: a path to maintain health and well-being
Authors: Shapira S , Yeshua Katz D , Braun-Lewensohn O
Published: October 2022

Background

Mobile apps such as WhatsApp have become significant resources for information and social support in times of crisis. Little is known about the role WhatsApp groups play in the context of living in conflict-affected regions. Living in such areas is associated with myriad mental health impacts, and recent studies have identified parents of young children as highly vulnerable in this regard. The study’s aim was to examine parents’ digital coping with political violence in southern Israel.

Methods

In-depth interviews were conducted with 21 parents of young children (<17) residing in communities near the Israel-Gaza border and who are members of local online parents’ groups on WhatsApp. Data were analyzed to answer questions regarding the benefits and disadvantages that parents assign to online groups; and regarding the role of digital communication in maintaining health and well-being.

Results

The findings reveal that online groups are often discussed as a shared and ubiquitous coping resource that supports mental health and well-being. Parents report they use the group to share ways to deal with the situation effectively and exchange social support, and as a space that facilitates community cohesion. Furthermore, during escalations, members perceived the group as the most trustworthy source of information. The groups’ continuous availability had drawbacks as well. Some participants pointed to digital stress caused by the fear of missing out on information, or by information overload.

Conclusions

Our results demonstrate the effectiveness of digital environments in helping parents cope with a collective stressor: a particularly worthy goal given that social media apps now constitute the primary online connection for most individuals. This has broad impacts on health promotion efforts for mental health issues related to political violence as well as other large-scale health crises such as the COVID-19 pandemic.

Key messages

• Digital environments can serve as a platform for successful coping with collective stressors.

• Health practitioners should consider drawbacks when planning digital support efforts.
The development of new Electronic Health Record Exchange Format Use Cases - an evaluating perspective
Authors: Trunner K , Leuprecht E , Stradner A , Pinto C , Franconi S , Melgara M , Boumpaki A , Soares F , Liapi G
Published: October 2022

The EU-funded X-eHealth project aims to lay the foundations for a common framework for medical imaging, discharge letters, laboratory results and rare diseases to advance an interoperable Common European Health Data Space for citizens and healthcare providers in accordance with privacy and cybersecurity regulations. To ensure sustainability of the project, it is crucial to assess whether X-eHealth is achieving its planned objectives and delivers tangible results. A key challenge in evaluating project outcomes lies in the partial lack of visibility of direct impacts due to a time lag of effects or attribution problems (i.e., identifying the main cause of a particular impact). In X-eHealth, we address this problem by defining a framework of Key Performance Indicators (KPI) that allows the monitoring of project outcomes. In addition, qualitative interviews with a focus on the following questions are conducted towards the end of the project to complement the evaluation:

• Does X-eHealth advance the integration process of eHealth services in Europe?

• Will X-eHealth lead to increased use of the new European Electronic Health Record Exchange Format (EEHRxF) specifications?

Although final results are not yet available, we expect X-eHealth to have a positive impact at all stakeholder levels by accelerating the implementation of EEHRxF through the harmonisation of health data, thus providing patients, health professionals and institutions with increased quality, safety and efficiency. There is little evidence to analyse the impact of eHealth policy interventions. For this reason, the present evaluation makes a significant contribution to impact research in this area. X-eHealth highlights the importance of international cooperation in creating a common framework for the future development of digital health in the EU. The continuous evaluation, moreover, facilitates a more efficient management of resources through KPI observance and the implementation of project results.

Key messages

• X-eHealth aims to accelerate the implementation of the European eHealth Record exchange Format (EEHRxF) through the standardisation and harmonisation of health data.

• By evaluating and monitoring the project processes, it is possible to ensure the progress of the project and to measure the potential impacts of the outcomes on stakeholders and other target groups.
Trauma support in your pocket
Authors: Thell M , Edvardsson K , Warner G
Published: October 2022

Background

Research indicates that technological approaches to the delivery of trauma-based support can help address structural and perceptual barriers. Yet, there is a lack of research on digital trauma support for children and adolescents. A systematic review of trauma apps identified 2 of 69 were for children, of which neither were evidence based. The aim of this project was to develop a trauma support app, co-designed with and for children and young people, based on a community-based group support program called Teaching Recovery Techniques.

Methods

In a series of workshops utilising the Design Studio method, a team of 7 young people between 14-20 years (3 boys and 4 girls) co-created the app. The team were recruited via youth organisations and self-reported having experienced (undisclosed) trauma. The techniques presented in the manual have been prioritised via stepwise consideration of content session by session. Prototypes were developed based on the generated ideas and shared with the team for feedback.

Results

Contributions of the young people to the design can be considered in three categories: mechanics, dynamics and aesthetics. Mechanics are the rules and interactions that inform the structure of the app. Dynamics refers to what the user can actually see, e.g. the outcome when the user presses a button. Aesthetics relate to the desirable emotional responses evoked in the user when they interact with the app. Beyond influence on basic aesthetics, such as fonts and symbols, the young people actively contributed to the user experience and gave great consideration to the emotional responses that could be evoked.

Conclusions

Young people with personal experience of trauma can actively engage in the development of a digital trauma intervention. Design Studio was an effective method for the co-creation process, enabling the generating and converging of young peoples’ ideas.

Key messages

• Co-creating an app for trauma support with youth with experience of trauma was a feasible process for both researchers and youth.

• Using Design Studio, a collaborative workshop method, facilitated the co-creative process, allowing the youth to contribute to the mechanics, dynamics and aesthetics factors of the app.
Technology-aided community engagement for exercise promotion: a mixed-methods systematic review
Authors: Raspolini GM , Riccardi MT , Damiani G
Published: October 2022

Background

This review aims to provide an overview of evidence on feasibility and effectiveness in diverse populations of eHealth physical activity (PA) community engagement (CE) interventions. Increasing global PA levels would have a substantial positive impact on population health. Given their diffusion, eHealth technologies may address certain barriers to PA and reach wide audiences. The most recent Italian guidelines on PA highlight inequalities in health, which can be addressed using CE models. The potential scalability of successful eHealth CE interventions and the scarcity of previous reviews on the topic are reasons which convinced us to work on this paper.

Methods

This mixed-methods systematic review utilized the Joanna Briggs Institute methodologies. Primary quantitative outcome measures were minutes of PA per week. Qualitative outcome measures included self-efficacy and user engagement. Data were processed using a segregated convergent design. A narrative summary and a meta-aggregation were performed for synthesizing quantitative and qualitative data respectively. Only the interventions where CE principles were fulfilled were analyzed.

Results

Quantitative evidence supported effectiveness and feasibility of interventions to improve PA outcomes and related proxy indicators across studied populations. Qualitative findings suggest the utility of peer-support and that from other health care providers.

Conclusions

Implementing CE in future PA interventions will be critical for producing an effective digital application with the potential for considerable impact in the real world. If supported by central governments and the European Union, entities such as primary care hubs and local health units with their professionals and CE capabilities may play the key role in implementing evidence.

Key messages

• eHealth PA CE interventions work better when peer support takes place.

• Health systems could pursue these prevention strategies for population health gains.
Communication on analgesia and sedation: parents’ opinions in six pediatric ICU in northern Italy
Authors: Martinato M , Fazio PC , Sagredini R , Pagano G , Ferrario S , Conio A , Monaco E , Gregori D , Amigoni A , Mondardini MC
Published: October 2022

Introduction

Communication between healthcare professionals and parents regarding analgesic and sedative treatments for seriously ill children is challenging. Although appropriate information may help parents during admission to the pediatric intensive care unit (PICU), some areas of communication may be missed.

Objectives

To explore and describe the opinions of parents of children admitted to PICU about analgosedation, information received about it and its potential adverse effects, and suggestions for improving the comfort of hospitalized children.

Methods

Parents’ opinions were collected in six PICUs in northern Italy. Parents of children who were hospitalized for more than 48 hours and required analgesia and sedation were asked to provide opinions on the quality of information with respect to the treatments used, possible short- and long-term sequelae, satisfaction with efficacy, environmental factors perceived as disturbing, and suggestions for improving children’s comfort.

Results

Forty-eight parents participated. Information about analgosedation was rated, as was its effectiveness. Parents pointed out some interesting suggestions to improve their children’s comfort during their hospitalization in PICU. On the other hand, it was found that information about possible complications, withdrawal syndrome, delirium, or difficulties in obtaining the desired level of sedation was often provided poorly or inadequately. In addition, wide differences were found between centres, particularly with regard to analgosedation side effects and withdrawal syndrome.

Conclusions

Parents should receive early explanations of these potential complications. Even considering the limited number of participating PICUs, distributed exclusively in northern Italy, and the small number of participants, this is the first data collection focused on communication between health professionals and parents of children undergoing analgosedation treatment in pediatric intensive care units.

Key messages

• This is the first data collection focused on communication between health professionals and parents of children undergoing analgosedation treatment in pediatric intensive care units.

• Information about possible complications, withdrawal syndrome, delirium, or difficulties in obtaining the desired level of sedation was often provided poorly or inadequately.
Can YouTube be used as a credible source of information for COVID-19 vaccination in Italy?
Authors: Ancona A , Godoy M , Bertuccio P , Gentile L , Odone A , Signorelli C
Published: October 2022

Background

The COVID-19 pandemic led to an ‘infodemic', as defined by the WHO, which made it difficult to be accurately informed on public health topics. For this purpose, many people use social media as a source of information, mainly YouTube. Given the great resonance of this platform, our study aims at assessing quality and reliability of its content regarding the COVID-19 vaccination.

Methods

During March 2022, six searches were performed on the Italian YouTube platform using the following terms: “Covid vaccination”, “Covid vaccine”, “Coronavirus vaccination”, “Coronavirus vaccine”, “Sars-Cov-2 vaccination” and “Sars-Cov-2 vaccine”. A total of 329 videos were analysed, after removing 271 duplicated videos, and classified in seven types of channel. The reliability of the content was evaluated through the HoNCode score, while quality was tested using the validated DISCERN tool.

Results

The most frequent category was ‘Internet Media’ (33%), while the less frequent one was ‘Educational Medical’ (7%). The content reliability (i.e. HoNCode score) resulted higher for videos produced by medical healthcare workers than non-medical ones. Concerning the quality, the DISCERN score resulted significantly higher for the Educational channels (median 46.0 for medical and 41.3 non-medical ones) as compared to Internet Media (26.5) and New Agencies (24.3).

Conclusions

Although YouTube has implemented a policy against misinformation related to the COVID-19 vaccination, the study highlights that there is extreme heterogeneity in reliability and quality of videos. Content produced by non-medical users, especially “Internet Media” and “News Agencies” categories should be evaluated with attention by users, as their quality is not appropriate to the importance of the topic.

Key messages

• Because of to the heterogeneity of its content, YouTube should be evaluated carefully when used as a source of information for Covid-19 vaccination.

• Content produced by non-medical users, is generally of poor quality, not appropriate to the importance of the topic.
Socioeconomic Inequalities in pediatric Metabolic Syndrome: mediation by parental health literacy
Authors: Lepe A , de Kroon MLA , Reijneveld SA , de Winter AF
Published: October 2022

Background

Parental health literacy may explain the relationship between parental socioeconomic status (SES) and pediatric metabolic syndrome (MetS). For this reason, we assessed to what extent parental health literacy mediates the relationships between parental SES and pediatric MetS.

Methods

We used data from the prospective multigenerational Dutch Lifelines Cohort Study. Our sample consisted of 6,683 children with an average follow-up of 36.2 months (SD 9.3) and a mean baseline age of 12.8 years (SD 2.6). We used natural effects models to assess the natural direct, natural indirect, and total effects of parental SES on MetS.

Results

On average, an additional four years of parental education, e.g. university instead of secondary school, would lead to cMetS scores that were 0.499 (95% confidence interval (CI) 0.364; 0.635) units lower, which is a small effect (d 0.18). If parental income and occupational level were one standard deviation higher, on average cMetS scores were 0.136 (95%CI 0.052; 0.219) and 0.196 (95%CI 0.108; 0.284) units lower, respectively; these are both small effects (d 0.05 and 0.07, respectively). Parental health literacy partially mediated these pathways; it accounted for 6.7% (education), 11.8% (income), and 8.3% (occupation) of the total effect of parental SES on pediatric MetS.

Conclusions

Socioeconomic differences in pediatric MetS are relatively small, the largest being by parental education. Improving parental health literacy may reduce these inequalities. Further research is needed into the mediating role of parental health literacy on other socioeconomic health inequalities in children.

Key messages

• Parental socioeconomic status (SES) has a small inverse relationship with pediatric metabolic syndrome (MetS), which is partially mediated by parental health literacy.

• Targeting parental health literacy may reduce inequalities in pediatric MetS. It may also influence other pediatric socioeconomic health inequalities, but further research is needed.
The impact of the SARS-CoV-2 pandemic on cause-specific- mortality: a systematic literature review
Authors: Sanmarchi F , Esposito F , Adorno E , Fantini MP , Golinelli D
Published: October 2022

Background

Although investigating the patterns of COVID-19 excess mortality (EM) is relevant, understanding the effects of the pandemic on cause-specific mortality is even crucial and should also be assessed, as this metric allows for a more detailed analysis of the true impact of the pandemic. The aim of this systematic literature review is to estimate the impact of the pandemic on different causes of death, providing a quantitative and qualitative analysis of the phenomenon.

Methods

We searched MEDLINE to identify studies that reported cause-specific mortality during the COVID-19 pandemic. We adopted several inclusion criteria: original article; assessed at least one cause-specific mortality during the pandemic; assessed causes of deaths using the ICD-10 classification; reporting of at least one of the following outcomes: cause-specific mortality estimates or cause-specific EM; full-length articles. Several relevant data were extracted (e.g. publication year, data stratification, territory, country income level, all-cause EM, and cause-specific mortality, etc.).

Results

The search identified 548 articles. After title, abstract and full-text screening, we extracted relevant data from the final set of 14 articles. Cause-specific mortality was reported using different units of measurement. Only 9 studies reported the statistical significance and/or confidence intervals. The most frequently analyzed causes of death were cardiovascular diseases (n = 11), cancer (n = 7), diabetes (n = 6), and suicide (n = 5). We found very heterogeneous patterns of cause-specific mortality, for all the specific causes of deaths, except for suicide and road accident.

Conclusions

The impact of the pandemic on cause-specific deaths has been very heterogeneous and the analyses conducted so far are not exhaustive. We advocate for the urgent need to find a consensus to define uniform methodological approaches to establish the true burden of the COVID-19 pandemic on non-COVID-19 mortality.

Key messages

• We reviewed the body of literature to estimate the impact of the COVID-19 pandemic on different causes of death, and to provide a quantitative and qualitative analysis of the phenomenon.

• We did not identify unique patterns of cause-specific mortality due to too varied approaches in terms of disease classification and coding, and methodologies used for estimating mortality.
Acute Alcohol intoxication in Belgian adolescents: a retrospective hospital chart study
Authors: van Roozendaal HE , Van Hal G , van der Lely N
Published: October 2022

Background

Binge drinking by adolescents in Belgium is an increasing problem, according to emergency physicians who have recently alerted society about the increasing numbers of adolescents admitted to hospital due to acute alcohol intoxication (AAI). Until now, only estimations of the prevalence of AAI in adolescents are known and research about potential risk factors has not yet been conducted in Belgium.

Methods

To gain more insight into the prevalence, medical characteristics, and context of AAI, a retrospective study in hospitals in the city of Antwerp was conducted. Medical charts of 10 to 18-year-old patients admitted with AAI between 2015 and 2021 were investigated and analysed.

Results

Between 2016 and 2021, 547 adolescents with AAI were admitted to 5 of the 8 hospitals in Antwerp. In the University Hospital of Antwerp (n = 177) mean age at admittance was 15.9 years. Older patients had a significantly higher BAC than younger patients (U:2357, 1, p-value: <0.001). In 10% of the patients combined drug use was proven and in this group, BAC was significantly lower (U:209, 1, p-value: <0.001). 60% of the patients were transmitted to the hospital by ambulance and in 31% the ambulance was assisted by specialised medical care. In 18% of the cases, the police were involved. The results of the other hospitals are not yet known at the time of submission but will be presented at the EPH conference.

Conclusions

According to the data so far, younger patients and patients with comorbid drug use are admitted with a lower BAC, which could be seen as a potential risk factor. This should be considered in developing preventive measures like sensitization. Moreover, in a noteworthy percentage, ambulances, specialized care, and police are involved, which contributes to high medical and social costs. However, data addressing demographics and the context of AAI were mostly missing. Therefore, prospective research is required to further investigate potential risk factors for AAI.

Key messages

• A significant amount of adolescents with AAI are admitted in the city of Antwerp every year, with a mean age of 15.9 years old, which is below the legal alcohol age.

• Considering the high prevalence of AAI and the major impact it has on adolescents health and medical and social costs, it is necessary to decrease the prevalence of binge drinking in adolescents.
Impact of BMI on breast screening participation: a data linkage study
Authors: McBride K , Munasinghe S , Sperendei S , Page A
Published: October 2022

Background

Regular mammographic screening can reduce breast cancer morbidity and mortality. Participation rates are suboptimal in Australia’s fully funded biennial breastscreening program (BreastScreen) for women aged 50-74. Despite obesity being a well-established risk factor for post-menopausal breast cancer, cross sectional data suggests obesity may be a risk factor for non-participation in recommended screening, due to adverse screening experiences. This research aimed to ascertain the link obesity and non-participation by using data linkage of routinely collected data.

Methods

Data for women age eligible for breast screening were linked between the NSW Cancer Registry and the Australian Longitudinal Study of Women’s Health (ALSWH) to create a cohort of women who either participated in screening as recommended or not. Women from the 1946-1951 ALSWH birth cohort were included in the study. These women reported BMI via 8 survey waves. The primary outcome was adherence to breast screening measured by frequency of screening over the follow-up period (1998-2016). Unadjusted risk ratios were calculated using mixed-effects logistic regression for the association between BMI and screening participation.

Results

The study included 2804 linked records of age eligible women (mean age of 52.37[SD 5.47]). 22.8% of the cohort were obese (BMI>30kg/m2). Obesity was significantly associated with non-recommended screening participation (screening within 3 years of last breast screen); odds ratio 1.63 (95% confidence interval 1.32 to 2.00, p < 0.0001).

Conclusions

Obesity has a significantly impact on recommended participation in a nationally provided breast screening program, despite obesity being a risk factor for post- menopausal breast cancer. Optimising participation among higher risk and under-screened women in under utilised breast cancer screening programs is warranted. Development of targeted interventions to increase screening participation among these higher risk women is needed.

Key messages

• Women living with obesity and less likely to participate in recommended breast screening.

• Targeted interventions are needed to optimise participation in breast screening to ensure these higher risk women are not at higher risk of adverse outcomes due to breast cancer.
Nonmedical use of anxiolytics among Tunisian students: Connecting the dots from 2013 to 2021
Authors: Silini A , Rejaibi S , Zid M , Zoghlami N , Ben Slema I , Mallekh R , Zribi M , Ben Youssef S , Ben Salah N , Aounallah-Skhiri H
Published: October 2022

Background

Nonmedical use of prescription drugs such as sedatives and anxiolytics is a fast growing public health threat in several countries. In Tunisia, although several studies have investigated the prevalence of nonmedical use of anxiolytics among school-age students, there is a gap in knowledge regarding trends in anxiolytics misuse. We aimed to determine the prevalence of nonmedical use of anxiolytics and examine trends between 2013 and 2021.

Methods

Pooled data from three Mediterranean school surveys on alcohol and other drugs (MedSPAD I-2013, MedSPAD II-2017, MedSPAD III-2021) were used. Based on three-stage stratification sampling method, teenagers in first and second grades of secondary education, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire. We studied weighted lifetime nonmedical use of

prescription anxiolytics and performed global and by gender trend analysis. Epi data software was used for data entry and all statistical analysis, were performed with STATA software.

Results

A total of 14.723 students were enrolled with sex ratio (Male/Female) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of nonmedical anxiolytics’ use increased from 2.1% to 3% then to 8.4% for 2013, 2017 and 2021, respectively. Global and by gender trends analysis concluded to significant increase from 2017 to 2021 (p < 10-3). However, a non-significant increase was revealed from 2013 to 2017.

Conclusions

Our study is the first to confirm a significant increasing trend in non-medical use of anxiolytics among Tunisian adolescents. These findings emphasize the urgent need for early detection of psychological vulnerability among adolescents in order to prevent their engagement in such risky behaviors.

Key messages

• Decision makers should be sensitized regarding the alarming increasing trend in non-medical use of anxiolytics, among Tunisian adolescents.

• The state control of these substances accessibility and early detection of psychological vulnerability, are highly required.
Cannabis use in Tunisian adolescents: Alarming trends from 2013 to 2021
Authors: Rejaibi S , Zribi M , Silini A , Zid M , Zoghlami N , Mallekh R , Ben Slama I , Ben Youssef S , Ben Salah N , Aounallah-Skhiri H
Published: October 2022

Background

Cannabis is the most widely used illicit psychoactive substance worldwide. In Tunisia, the prevalence of cannabis use and its association with other risky behaviours were reported in several publications interesting mainly early adolescence. However, no publications exploring trends based on national epidemiological data are available yet. Our purpose was to determine cannabis prevalence in Tunisian high school adolescents and assess significant trends from 2013 to 2021.

Methods

Pooled data from Mediterranean school surveys on alcohol and other drugs conducted in 2013, 2017, and 2021, were used. Based on three-stage stratification sampling method, first and second grade secondary education students were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Self-administered standardized questionnaire was used in data collection. We studied weighted lifetime prevalence of cannabis use and chi square test for trend was used for global, by gender and by sector (private/public) trends assessement. STATA software was used for statistical analysis.

Results

A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of cannabis use increased from 1.4%, to 3.8% then to 7.9% for 2013, 2017 and 2021 respectively. Trend assessement concludes to significant increase in overall cannabis use (p < 10-3). Besides, there was a significant increase in both public and private schools, and among both boys and girls. However, the greatest increase was among male students (3.5% in 2013, 9.2% in 2017 and 16.1% in 2021) (p < 10-3).

Conclusions

Despite the reinforcement of restrictive legislative measures, the prevalence of cannabis use among Tunisian high school adolescents is significantly increasing. Moreover, it’s important to further investigate problematic cannabis use and its effects on adolescents’ physical and mental health.

Key messages

• Trend assessement confirmed the significant increase in lifetime cannabis use in high school adolescents in Tunisia, for both sexes and for both private and public sector.

• This alarming public health issue requires urgent legislation review and close multisectoral collaboration to control supply and demand.
Letters from Mars. Soft law under scrutiny of ethics during crisis. Responsibility and accountability
Authors: Morard S , Guinoiseau S
Published: October 2022

Like most of western countries France has been severely hit by the first wave of covid during Spring 2020. France managed to get through it thanks to a confinement, full dedication of health and << first line >> workers and of course the excellency of its bureaucracy. France is now famous for its digitalized self-made one-hour-walk certificate. It is however less-known for its MARSes, acronym for << message d'alerte rapide sanitaire >> or quick sanitary warning messages that got usually sent to hospitals and nursing homes... on Friday nights or weekends. Some lawyers saluted the method as an innovative and modern process that adapted quickly the response to the evolution of the situation shifting from hard rules written in the due process of law to an era of properly crafted regulations. Professionnals were less enthusiastic regarding this matter. It was less an issue of professional curtesy expected form a central state towards civil servants than one related to the content of the messages. Quality varied depending on the news. Some messages imposed very clear and strict rules such as: << no visit under any circumstances in nursing homes >> or later when tests were available, << should any cluster appear, all residents must be tested. >> However, all messages ended the same and ritual way: << Provisions included in this message must be performed and adapted under direction supervision and adapted to the context of the institution >>. Interestingly enough the way the text was written rose questions: If the rule is clear, why should it be adapted? The rule enters in conflict with other preexisting rules. Which one should apply? Classical legal and political theory are of great help sorting formal issues. Hume’s non ethical cognitivism and Kant’s categorical imperative were used redesigning the working frame. Since accountability was for direction to bear, so was it for it to draw fair and acceptable solutions in due respect of democratic principles.

Key messages

• Limit cases prove that rules are unsufficient in decision making.

• Balanced decisions require collegiality to overstep limited rationality.