bluuebunny/crossref_metadata_2025 huggingface dataset:
Funding agencies’ complicity in advancing or impeding equity in and through global health research
Authors: Dixon J , Plamondon K , Elliott S , Graham I , Nixon S , Curty Pereira R , Khan S , Nunbogu A
Published: October 2023

Background

In Global Health Research (GHR), funding policies inform how health research is approached and structured, serving to distribute power and resources in ways that can either reinforce or take action on inequities. In essence, these policies incentivize the focus of GHR and are therefore among the political/structural determinants of health. Despite broad recognition of the need for equity in GHR, the role of funders receives relatively little scrutiny. We sought to better understand the place of equity across the international landscape of GHR funders.

Methods

Publicly accessible, current strategic (those that set the vision, mission and goals of funding) and operational (those that set the implementation rules and compliance requirements for funded research) policies were harvested from 23 purposely selected Global North and philanthropic funding agencies. Content and discourse analysis were used to examine the portrayal of GHR in inequitable contexts, declarations of equity intentions, and to assess alignment to the six CCGHR equity-centred principles.

Results

Funding agencies across the Global North made clear declarations on the importance of equity in GHR; however, operationalization was largely absent or incompatible with the best scientific evidence on advancing health equity. Most philanthropic funding agencies failed to make policies public meaning equity action remains unclear. Alignment with equity-centred principles presented in different forms from varying agencies, though no single agency demonstrated good alignment to all six principles.

Conclusions

Funder discourses suggest equity is a central priority in GHR. Given that funder policies are themselves determinants of equity, stronger alignment between strategic policies, intentions, and action on inequity (e.g., investing in interventional research that acts on upstream determinants) are critically needed for funders of GHR, specifically, and public health research, broadly.

Key messages

• Funding policy can determine equity possibilities, both in research processes and outcomes.

• Coherence between strategic intentions and operational policies is possible, and would promote more equity-advancing research.
Strengths and weaknesses of the South-South Learning Exchange: the experts’ perspectives
Authors: Triulzi I , Kabra R , Allagh K P , Kiarie J
Published: October 2023

Background

South-South learning exchange (SSLE) refers to an interactive learning process where peers exchange knowledge and experience to work towards a beneficial change. Despite organizations having recently increased the opportunity to run SSLEs, the SSLE processes are not well documented in the scientific literature. This study explored experts’ perspectives on SSLEs’ strengths, weaknesses and mechanisms leading to outcomes.

Methods

We conducted a qualitative study using semi-structured interviews on the experience of participants and organizers of SSLEs. Data were collected between 1st September 2021 to 26th November 2021. All data were digitally recorded, transcribed verbatim, and analysed. In the analysis, we adopted an inductive approach derived from thematic analysis.

Results

Sixteen experts who have participated in or facilitated one or more SSLEs were interviewed. Experts’ accounts demonstrated an appreciation of participants’ empowerment, positive peer-to-peer “mind change” and convincing and powerful hands-on learning of this approach as strengths in the successful implementation of the SSLE. Being resource-heavy, participant reluctance and the absence of a validated methodology emerged as the main weaknesses of the South-South learning approach, which could impair the effectiveness of this scheme.

Conclusions

The SSLE is a promising approach to exchange knowledge and experience to work toward a desired change. However, to enhance its effectiveness and credibility, it would benefit from adopting a validated and systematic methodology that supports all stages of the exchange process, including monitoring and evaluation (M&E).

Key messages

• South-South learning exchange is a promising approach to exchanging knowledge and experience among countries from the Global South.

• A robust and systematic methodology is likely to increase evidence on SSLE and demonstrate its success.
The impact of socio-economic status on infant deaths: a case-control study from Istanbul
Authors: Girgin S , Ayvaz I , Bakir Keser N , Gemici E , Sezerol M A , Batman M , Karabacak O , Davun S , Hidiroglu S , Ay P
Published: October 2023

Background

Socioeconomic disparities continue to impact child health. This study aimed to determine the association between socioeconomic status (SES) and infant mortality (IM) in a district in Istanbul.

Methods

This is a case-control study conducted in a district of Istanbul. The cases were all infants born alive who died before reaching the age of one between January 1, 2021, and December 31, 2022. The controls were randomly selected children who were born and survived their first year. The sample size was calculated as 83 cases and 166 controls assuming low SES doubled IM, with 80% power and an alpha error of 0.05. Data were obtained through health records and telephone interviews. SES was evaluated through a validated index that used parents’ education and occupation, households’ vehicles and ownership of electrical devices, house ownership, and the land value of the living area. SES was categorized into three groups: low, middle, and high. Logistic regression was used in the analysis.

Results

The response rate was 51.8%, with 42 cases and 87 controls. The multivariate model included mothers’ age, smoking status, presence of maternal chronic diseases and anemia, multiple gestations, antenatal visits (≥4 vs. <4), premature membrane rupture, mode of delivery, parental consanguinity, baby's gender, and the SES index. When high SES was the reference category, low (OR:4.34, 95%CI:1.18-15.92) and middle SES (OR:1.59, 95%CI:0.49-5.13) increased the risk of IM. Having <4 antenatal visits (OR:80.84, 95%CI:8.84-738.98), presence of maternal chronic diseases (OR:4.03, 95%CI:1.25-12.94), and anemia (OR:2.39 (95%CI: 0,86-6,64) also increased IM.

Conclusions

Low SES continues to be the root cause of IM. Infants of mothers who had <4 antenatal visits, anemia, and chronic diseases were at increased risk for mortality. To address IM, it is essential to highlight why pregnant women underutilize antenatal care since these services are free.

Key messages

• Achieving equity should be the main target for decreasing infant mortality.

• There is a need to address underutilization of antenatal services for decreasing infant mortality.
A mixed methods study about health problems and drug use in Belgian prisons during 2021-2022
Authors: Plettinckx E , Harth N , Damian E , Degreef M , Dirkx N , De Smet S , Gremeaux L
Published: October 2023

Negative effects of imprisonment on quality of health and drug use are well known. Although the interference between social- psychological- and physical aspects of health seem obvious, in many prison settings an overall approach with respect to drug use is lacking. A mixed methods study collected data during 2021-2022 in five Belgian prisons. People in prison were randomly invited for a quantitative survey about drug use, violence, social contacts, loneliness, anxiety, depression and sleep. The survey was carried out in 13 languages using tablets. In total, 280 responses were analysed. Next, respondents of the survey that used illicit drugs were invited for an in-depth interview about personal insights on support needs of drug use and social-, physical- and emotional well-being (N = 38). Besides, persons released less than 1 year ago and who used illicit drugs (N = 12) were interviewed. Drug use and symptoms of anxiety, depression, sleep problems, loneliness, suicidal attempts and violence are 2 to 8 times higher in prison compared to community. Drug use inside prison was more prevalent (p < 0.05) among people with a prison history. Respondents also mentioned the negative influence of drug use on physical, social and emotional health. Severe depression symptoms and the occurrence of suicide attempts were more reported among people who used drugs in prison in the past month. Although most respondents indicated having received visits during the past month, lack of social contacts and dependence on others were strongly present during the interviews. The results suggest that the prison context affects the interconnection of biopsychosocial health aspects as a whole to such an extent that the likelihood of drug use increases. This finding is essential to address the needs of people in prison in a more holistic way. Enlarging this scope in prison policy and more specific treatment initiatives enables increasing equity in care and will improve both security and health outcomes.

Key messages

• The results support an expansion of treatment initiatives that have been already implemented but in which the interconnection of the biopsychosocial health aspects with drug-use should be integrated.

• This study supports the idea to develop a more holistic prison policy by adding drug use, physical, social and mental health to the main concern of security.
Association of HDL subfraction profile with the progression of insulin resistance
Authors: Pikó P , Kósa Z , Sándor J , Kovács N , Seres I , Paragh G , Ádány R
Published: October 2023

Background

Type 2 diabetes mellitus (T2D) is a major global public health problem, as it is associated with increased morbidity, mortality, and healthcare costs. Insulin resistance (IR) is considered to be a condition characterized by disturbances in carbohydrate and lipid metabolisms that precede T2D. The correlation between IR and high-density lipoprotein cholesterol (HDL-C) levels is known, but the underlying mechanisms are not fully understood. The present study aimed to investigate the association between HDL subfraction profile and the development of IR.

Methods

The progression of IR was assessed using the Homeostatic Model Assessment for IR index (HOMA-IR), and IR was defined as those with a HOMA-IR greater than 3.63. The HDL-C was separated using the Lipoprint system, which identifies ten subfractions (HDL-1-10) and three classes: large- (HDL-L), intermediate- (HDL-I), and small-HDL (HDL-S). All analyses were performed on samples of 240 control subjects and 137 individuals with IR from the Hungarian general and Roma populations.

Results

The HDL-1 to -6 and the HDL-L and -I showed a significant negative association with elevated HOMA-IR and the presence of IR. Among them, HDL-2 (β = 42.2, p = 4.1 × 10-12) and HDL-L (β = 15.5, p = 2.2 × 10-10) showed the strongest correlation with the IR progression. The optimal cut-off value was found to be 0.264 mmol/L for HDL-L and 0.102 mmol/L and above for HDL-2. The risk of IR is 5.1 times higher for HDL-L levels below the cut-off (p = 2.2 × 10-7), and 4.2 times higher for HDL-2 (p = 3.0 × 10-6). Furthermore, the risk of early manifestation of IR are significantly higher in individuals with both HDL-L (HR = 3.5, p = 3.2 × 10-7) and HDL-2 (HR = 3.19, p = 2.0 × 10-6) levels below the cut-off.

Key messages

• HDL-2 and -L levels are strongly associated with the development of insulin resistance.

• Elevated risk of early onset of insulin resistance is associated with HDL subfraction profile.
Exercise as medicine: Physicians’ perceptions of physical activity and exercise for chronic diseases
Authors: Syrou N , Fatouros I G , Metsios G , Jamurtas A Z , Draganidis D , Angelopoulos , TJ , Loules G , Mastorakos G
Published: October 2023

Background

Although physical activity and exercise (PAE) offer several health advantages in the management of non-communicable diseases (NCDs), its systematic implementation in medical practice remains questionable. The aim of the study was to investigate Greek physicians’ knowledge, attitudes, intentions, abilities, and behavior (KAIAB) towards PAE in the management of NCDs.

Methods

A nationwide, cross-sectional, online study was conducted (October 2022 - March 2023) in Greece via a new questionnaire, which was developed and pilot-tested at an earlier stage of the study. The questionnaire's link was distributed to participants by email through their Medical Association. We computed physicians’ KAIAB total scale score as the sum of their responses. The three levels of Bloom's cut-off points were modified and were used to classify physicians’ KAIAB levels towards PAE.

Results

The physicians’ KAIAB levels in PAE were expressed as mean values (MV) and standard deviations (SD) respectively (MV/SD), as follows: 11.5/3.32 (low knowledge), 134.8/17.20 (moderate attitudes), 33.8/5.63 (high intentions), 19.48/5.76 (low abilities), and 30.81/7.23 (moderate behavior). Cronbach's alpha varied from 0.796 to 0.930 to achieve a high internal consistency to the scales of the new questionnaire.

Conclusions

Greek physicians definitely are willing to advise and prescribe PAE and demonstrate moderate attitudes and behavior on these issues that need further improvement. However, their knowledge and self-reported abilities are apparently low, particularly on PAE prescription. These results suggest that, in order to include PAE in medical practice, are needed future policies to develop strategies to promote physicians’ education and training to improve their knowledge and skills on PAE, the adoption of exercise prescription strategies, and the integration of PAE into health care services as an alternative way of preventing and treating chronic diseases and promoting public health.

Key messages

• The Greek physicians’ level of Knowledge and abilities in physical activity and exercise is low rendering their implementation in medical practice difficult for patients with non-communicable diseases.

• Empowerment of physicians is crucial in order to integrate physical activity and exercise prescription into the standard medical care of non-communicable diseases and thus promote public health.
Strengthening One Health through Health Management: Lessons and Opportunities
Authors: Rusanov A , Weller E , Jevtic M
Published: October 2023

Background

The One Health approach recognises the interconnection between human, animal, and environmental health, and emphasises collaboration and integration across these domains. While the “One Health” approach is increasingly being implemented in the health sector, the role of health management is still overlooked.

Objectives/Methods

Health management plays a critical role in facilitating the adoption and implementation of the One Health approach. In fact, health management provides the framework for planning, implementing, and evaluating One Health interventions, including the identification of priorities, resources allocation, and monitoring and evaluation of outcomes. Health managers also play a critical role in developing cross-sectoral partnerships. Through a literature review and focus group discussions with experts from the health, animal, and environmental sector, case studies and best practices were collected on the role and opportunities for health management to further strengthen the One Health approach.

Results

Results suggest that greater emphasis should be placed on incorporating the One Health approach into health management education curricula, building capacity for health management through life-long learning, strengthening interdisciplinary collaborations, and establishing effective communication channels to exchange best practices.

Lessons

Recognising the role of health management and fostering multi-stakeholder collaboration will create the proper conditions for the successful implementation of the One Health approach and will help create long-term, sustainable solutions.

Key message

• Health management plays a critical role in facilitating the adoption and implementation of the One Health approach and developing cross-sectoral partnerships.

• The role of health management can be strengthened through life-long learning, interdisciplinary collaboration and integrating the One Health approach into education curricula.
Complications associated with Type 2 Diabetes and concerns about treatment: a quantitative approach
Authors: Pedro A R , Avelar F G , Raposo B , Cunha A S , Cordeiro J V , Martinho H , Couceiro J , Pardal M , Bernardo F , Raposo J F
Published: October 2023

Background

Type 2 Diabetes (T2D) is a multidimensional disease with a major impact on quality of life and its associated complications influence these people disease management. This study aimed to analyse the main concerns about T2D treatment management in adults with and without reported T2D complications.

Methods

Cross-sectional study conducted through an online survey addressed to people with T2D followed-up in Portugal. Concerns regarding “T2D treatment” were compared between people with (n = 231) and without (n = 203) reported complications associated with T2D. The mean + SD concern was calculated from semantic differential scale ranging from 0 (not at all concerned) to 3 (very concerned). Statistical analysis and the Mann-Whitney U test were performed at 5% significance level.

Results

A total of 434 responses were analyzed. Respondents had a mean age of 62 years, and 53.2% (n = 231) have mixed complications associated T2D. Regarding the reported complications, 50.2%(n = 116) had more than 2 mixed complications, being the most common: sexual disfunction (n = 127;55.0%), eye (n = 98;42.2%), and vascular complications (n = 63;27.3%). Regarding the concerns about treatment, the items ‘side effects of medications'(p = 0.004), ‘the fact that some medications are injectable'(p = 0.029), and ‘start of insulin'(p = 0.018) showed divergence. Particularly, T2D-related complications ‘side effects'(2.02±0.76 vs. 1.75±0.91-no complications) and ‘being injectable'(1.30±1.05 vs. 1.08±1.08-no complications) showed a higher mean, as ‘like insulin initiation’ (2.27±0.99 vs. 2.01±1.08-with complications).

Conclusions

Concerns related to the treatment itself are higher in people with complications, particularly in the therapeutic management of multiple medications and associated side effects. The management of disease with complications is more difficult and problematic. Demystifying insulin initiation can be a challenge to be added to the healthcare process and an important intervention strategy.

Key messages

• Concerns related to the treatment itself are higher in people with complications, particularly in the therapeutic management of multiple medications and associated side effects.

• Demystifying insulin initiation can be a challenge to be added to the healthcare process and an important intervention strategy.
Exploring the Burden of Colorectal Cancer in Georgia: A Population-based Cancer Registry Analysis
Authors: Nonikashvili M , Kereselidze M , Beruchashvili T , Toidze O
Published: October 2023

Background

Colorectal cancer (CRC) is a significant public health issue in Georgia, with high incidence and mortality rates. CRC screening rates in Georgia have improved over time, but are still low. This study aims to assess the distribution of CRC in the Georgian population through an analysis of the national cancer registry.

Methods

Data from the national cancer registry was analyzed for 795 adults diagnosed with CRC in 2021. Univariate and bivariate descriptive statistical analysis were performed using contingency tables and the Pearson chi-square test.

Results

Among the study sample, 50.57% (n = 402) of CRC cases occurred in males and 49.43% (n = 393) in females. Only 5.40% of CRC cases were detected through screening uptake. Malignant neoplasm of the rectum was the most commonly detected subsite, with localized stage being the most common stage at diagnosis. CRC subsite was significantly associated with TNM stage (X2= 31.24; p < 0.008). The mean age of patients was 65.89±11.27 years.

Conclusions

The study highlights the need for increased CRC screening efforts in Georgia to facilitate the transition from curative to preventive cancer care. Improved screening rates could aid in the early detection and prevention of CRC.

Key messages

• Malignant neoplasm of the rectum was the most commonly detected subsite, with localized stage being the most common stage at diagnosis.

• Improved screening efforts could aid in the early detection and prevention of CRC, facilitating the transition from curative to preventive cancer care.
Eye & Diabetes in Morocco: Where are we from the global screening guidelines?
Authors: El Harrak Y
Published: October 2023

In Morocco, the prevalence of diabetes in the adult population is 12.4% (WHO). Diabetic Retinopathy (DR) is the 2nd cause of blindness. Nearly 1 million people worldwide are blind due to diabetes. The aim of our work is to study the epidemiological profile of patients with diabetes in ophthalmology and to determine the observance of the follow-up guidelines. This is a descriptive study carried out at the Vision Clinic of Tetouan-Morocco, including all diabetic patients who presented to the ophthalmology consultation of the same doctor, between June 2022 and December 2022. The study involved 500 patients, including 217 men and 283 women, with an average age of 62 years. The average duration of diabetes was 11.5 years. 1 out of 3 diabetic patients was unaware that diabetes was a blinding disease and 3 out of 4 patients did not follow a specific diet. 1 out of 8 patients has an annual ophthalmological check-up. 55% of the patients have a screening every 2-5 years, when 7% haven't had their eyes checked in the last 10 years. Visual complaints accounted for 58% of the motivations for all consultations, while diabetes only accounted for 30%. Depending on the duration of the condition, diabetes represents 60% of the reasons for consultation among new diabetics (1 year) whereas it represents only 20% among diabetics over 10 years old. Eye examinations revealed a proliferative DR in 24% of the cases and a non proliferative DR in 22%. In 31%, there was no sign of DR and in 23%, the fundus was inaccessible due to cataract. The prevalence of proliferative DR increases with years of diabetes, reaching 40% in diabetics over 20 years old. The results of this work prove that diabetes is still underestimated by the Moroccan population. This is probably related to a lack of information of the target population. Thus, health professionals should strengthen their education in order to establish a better monitoring and screening policy aimed to reduce the occurrence of an avoidable blindness.

Key messages

• Less than one Diabetic out of 3 consults an ophthalmologist for their diabetes & Only one diabetic out of 8 consults annually in ophthalmology.

• The older the diabetes, the less regular is the consultation in ophthalmology & One out of 4 diabetics will already have proliferative diabetic retinopathy at their ophthalmological consultation.
Integrating One health into public policies: a One health policy screening tool
Authors: Bekker M , Bron B , van Zeben J , Siebenga J , van de Poel W
Published: October 2023

The One Health High Level Expert Panel in 2022 issued a new international consensus definition of One health: ‘One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent. The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development.’ From a democratic public policy perspective, One Health is aimed at weighing the values, interests, issues and partial solutions of interdependent components of a complex adaptive ecosystem, and seeking a balance in trade-offs between them. The One Health policy screening tool provides an overview as input to the political designation of balanced policy priorities that is the responsibility of EFA. The aims of the tool are (1) to inform a reconsideration of the government's weighing of One Health aspects, as well as (2) to assess the policy proposal's integrative capacity for One Health. The tool supports the identification of potential policy impacts or lacking consideration of a range of One Health core aspects, and a rapid appraisal of the current integrative level of One Health aimed policies. The purpose is a desktop screening by EFA policy advisors based on existing information to be completed within a few days. Following the OHHLEP 2022 definition, the tool offers a relative quick, non-exhaustive overview of the broad One Health spectrum, and references to existing open access impact assessment frameworks, global or EU databases of core aspect composite country indicators, and policy guidance resources.
DALY attributable to air pollution associated with tracheal, bronchus, and lung cancer in Europe
Authors: Vojvodic K , Todirovic J , Terzic-Supic Z
Published: October 2023

Background

The evidence of the impact of air pollution on respiratory health is present in recent studies and evaluated in the WHO 2021 Air Quality Guidelines. Air pollution is connected with DALYs associated with tracheal, bronchus, and lung cancer attributable to air pollution especially in low- and middle-income countries. is an avoidable risk factor.

Methods

We analyzed Disability-Adjusted Life-Years (DALY) rates associated with tracheal, bronchus, and lung cancer per 100,000 among all ages attributable to air pollution. Estimates were taken from the Global Burden of Disease Study 2019, for ten countries with the highest DALY rates per 100,000 of tracheal, bronchus, and lung cancer in 2019: Monaco, Hungary, Montenegro, Serbia, Poland, Bosnia and Herzegovina, Bulgaria, Greece, Netherlands, and North Macedonia.

Results

The highest DALY rate per 100,000 attributable to tracheal, bronchus, and lung cancer was in Monaco (3210.03), followed by Hungary (2196.24), Montenegro (2108.75) and Serbia (2020.06). The highest DALY rate of tracheal, bronchus, and lung cancer attributable to air pollution was in Serbia (388.22), Bosnia and Herzegovina (380.64), Montenegro (378.26), and North Macedonia (331.63). The highest percentage of DALY of tracheal, bronchus, and lung cancer attributable to air pollution was in Bosnia and Herzegovina (22.15%), North Macedonia (21.59%), Serbia (19.23%) and Montenegro (17.94%).

Conclusions

Air pollution is a significant contributable factor in the prevalence of tracheal, bronchus, and lung cancer. In the ten observed countries with the highest DALY rates of respiratory cancers, the highest percentage of DALY of tracheal, bronchus, and lung cancer attributable to air pollution was in four Ex - Yugoslavia countries. These countries are in emerging need of public health regulations and policies in order to reduce air pollution.

Key messages

• The highest DALY rate of tracheal, bronchus, and lung cancer attributable to air pollution was in four Ex - Yugoslavia countries.

• There is an emerging need for public health regulations and policies in order to reduce air pollution and its consequences.
The role of time in healthy living environment networks: current research and future directions
Authors: Janssen LMS , Bekker M , van der Steen M
Published: October 2023

Background

Societal challenges in the context of healthy living environments are complex, requiring networked collaboration from heterogenous actors. As it takes time before environmental investments accrue health effects, long-term networks emerge with dynamics that are unpredictable. Recent literature gives reason to believe that time plays an important role in managing networks, and can potentially help understand the dynamics in healthy living environment contexts. This study aims to identify gaps in how the literature reports on the role of time in healthy living environment networks. We identify avenues for future research.

Methods

A scoping review of the literature yielded 27 papers published between 2012 and 2022 about collaborative practices for a healthy living environment. We collected data on general characteristics, and references to time in relation to the context, collaborative process, and outcomes of networks described in each paper.

Results

The majority of the literature does not report on temporal dimensions in networks for a healthy living environment. In the literature that does include references to time, temporal dimensions remain an implicit and passive variable. For example, studies describe the evolution of environmental or health problems and their time horizon. If temporal dimensions are manifest in descriptions of the collaboration itself it mostly concerns the evolution of processes, their time horizon, and references to tempo. Strategic use of timing and adaption, as well as realizing long-term impact are the most important dimensions in terms of network actions.

Conclusions

No studies systematically analyze the role of time. Future research should fill this gap to enrich our understanding of how, when, and why time shapes networked governance and outcomes for a healthy living environment. Applying these concepts further can help to develop new steering tools for practitioners involved in collaboration.

Key messages

• The role of time in governance of healthy living environment networks remains limitedly studied.

• Future research should study the (strategic) role of temporal dimensions in healthy living environment governance.
(Re)-discovering rivers benefits in the City: a One Health approach
Authors: Porcherie M , Giroux G , La Cann P , Glorennec P , Thomas M F
Published: October 2023

In the context of climate change and increasing urbanization, urban bathing is emerging in France and elsewhere, thus bringing us to question how we can maximize the benefits for the health of populations and minimize the risks. The multidisciplinary URB-bain project studies the feasibility of bringing bathing back to the urban environment. In a One Health approach, it combines 1/ the study of health risks associated with the chemical and microbiological analyses quality of the water of two potential bathing sites (Metz, France) and 2/ a socio-historical and political approach to the use of urban bathing in France, Europe, and Canada. This paper will present the first results of axis 2. Two types of qualitative data were collected: semi-structured interviews and documentation. Interviews were conducted with technicians, decision-makers, and NGOs. Eighteen interviews were performed (10 in Metz, France, 3 in Paris, and 5 in Quebec, Canada), recorded, transcribed, and analyzed (N'Vivo 12©). Other sites were documented (Copenhagen, Berlin). The causality model between urban bathing and health developed within the framework of the project and the principles for operationalizing the One Health concept (collaboration, coordination, communication, capacity building) guided the analysis. Documentation analysis showed a renewed interest in urban bathing in France since the 1990s, culminating in 2017 in Paris with the opening of a pool in the Canal de la Villette under pressure from citizens and motivated by the hosting of the Olympic Games in 2024. In France, health considerations focused on regulatory issues based on bacteriological quality for the institutions. The water bodies’ ecological and chemical status is neither a concern nor a One-health approach. Social accessibility and gender equity in the public space are important issues. The analysis of the interviews, still in progress, will help to put the initial results into perspective with the other sites studied.

Key messages

• Urban bathing is a public health issue in a context of climate change.

• Urban bathing is a one-health issue.
The relationship between neighborly social capital and health outcomes
Authors: Maykrantz S A , Kost J E , Neck C B , Houghton J D
Published: October 2023

Background

There is increasing interest in understanding the relationship between social capital and undesirable health outcomes. Social capital theory suggests that better health outcomes may result from certain “neighborly” aspects of social capital.

Methods

This study used secondary data from the Social Capital Index. Bivariate correlations were calculated between neighborly social capital and health outcome variables. Next, neighborly social capital variables were entered as predictors of health outcomes in a series of stepwise regressions. Regional comparisons were conducted across four U.S. regions. Comparisons of the regression model structures were conducted by applying a model derived from one region to the data from another region and contrasting the resulting crossed R2 with the original direct R2 to identify differential regression weights across the four regions that warrant interpretation.

Results

The correlation and regression analyses showed significant negative relationships between three neighborly social capital variables (% who do favors for their neighbors, % who worked with neighbors to improve something, and % who trust all or most of their neighbors) and health outcomes including: % in fair/poor health, premature mortality rate, % diabetic, and % obese. In regional comparisons, only the South region had a direct and crossed R2 significantly different from other regions, with this difference largely attributable to an unexpected positive relationship between trusting neighbors and negative health outcomes in the South.

Conclusions

Interventions to increase neighborly social capital may help to alleviate negative health outcomes in the U.S. Anomalously, in the South, trusting neighbors may be related to worse health outcomes.

Key messages

• Being neighborly may enhance positive health outcomes in most parts of the U.S.

• Strong social support impacts urban health.
Understanding the complex systems of climate change and NCDs: A Causal Loop Diagram
Authors: Hunter R , Garcia L , Dagless S , Whiting S , Racioppi F , Wickramasinghe K
Published: October 2023

Background

WHO has identified climate change as one of the greatest health threats of the 21st century. At the same time, noncommunicable diseases (NCDs), including cardiovascular diseases, diabetes, chronic respiratory disease and cancer, are the leading cause of death globally and in the WHO European Region, are responsible for around 90% of deaths and 84% of years lived with disability each year. However, the complex relationships between climate change and NCDs are not well understood.

Methods

The aim of this research was to identify, discuss and map the linkages between factors and policy actions designed to prevent NCDs and address climate change. Objectives included to: discuss and clarify the pathways of how NCDs and climate change relate to each other and the co-benefits to addressing both using Group Model Building methods; to identify key multi-sectoral actors and priority actions for international collaboration and national responses to NCDs and climate change. We co-designed and created a Causal Loop Diagram (CLD) with local stakeholders, following the principles of Group Model Building.

Results

29 participants were involved in the workshop included WHO staff and experts in NCD prevention and/or climate change and health and health emergencies. The CLD was meaningful to the stakeholders as a consensual and co-produced understanding of the problem, as well as forming the basis of a tool to explore the future impact on how sectoral and multi-sectoral public policies to address these complex challenges are shaped and implemented. Participants identified a range of priority actions that, in their view, could impact and help reshape the system and influence NCDs and climate change in Europe.

Conclusions

The CLD was reflective of the various stakeholders’ experience, knowledge, perceptions, and views about the factors, and the inter-relationships between these factors, by which climate change influences NCDs and NCD risk factors in Europe.

Key messages

• Climate change is one of the greatest threats of the 21st century.

• Systems thinking approaches can help identify ‘win-win’ solutions to complex issues.
Active recreational and silvicultural co-use of forested areas: an innovative forest management study
Authors: Haugset A S , Sollid-Bolås T , Myhr A
Published: October 2023

Issue

Forests are crucial in the sustainability transition to a biobased modern society. However, forests may also be recreational sites, and positively affect human health and well-being. Modern silvicultural harvesting practices alters the landscape overnight, and hence may affect the recreational and public health promoting use of it.

Description of the problem

Municipalities, as owners of urban forest areas, may actively support inhabitants’ recreational use of near-by forested areas by 1) allocate resources to local voluntary organizations who facilitate for recreational users and 2) actively facilitate for continuous recreational use while practicing modern silviculture. In 2020-2022, an innovative integrative forest management approach was tested in a municipality in mid-Norway. This study explores how the local forests are used for recreational purposes, and how potential conflicts in land use can be mitigated or prevented.

Results

The forest areas are mostly used for health-promoting activities like exercise, walking, general recreation, and seasonal harvesting of wild berries and mushrooms. Half of the users get to the forest by foot or bicycle. Easy access, closeness to home, free parking arrangements and access to maps of the areas is important to users. Most users were well-informed about local forest-based businesses and carbon sequestration in wood and held that forests should be harvested and regenerated. They showed a high tolerance for forestry if the footpaths were cleared immediately. However, three out of four users want to be informed before harvesting. A small share of users wants educational posters about forest ecosystems.

Lessons

A pre-existing low conflict level between modern forestry and recreational forest use may be maintained by quite simple and modest means. In this municipality information posters were placed by the footpaths and an arena for discussions, information and co-creation of recreational facilitation was established in 2022.

Key messages

• Near-urban forests are frequently used for exercise and recreational activities, especially if easily accessible.

• Harmonious co-use of forest areas, even in times of timber harvesting, is supported by rapidly recovering the footpaths and by notifying inhabitants in advance.
Asthma prevalence and environmental exposure in children and adolescent in Slovenia – a pilot study
Authors: Rejc T , Kukec A , Mlakar A , Carli T , Krivec U , Zver A
Published: October 2023

Background

The last data on asthma prevalence (13.9 and 17.4%) in children in Slovenia is from 2002. The aim is to assess the asthma prevalence and environmental risk factors in two selected schools in Slovenia, as a pilot study for a national cross-sectional survey.

Methods

We conducted a cross-sectional pilot study in two primary schools in Slovenia. Observed population were children and adolescents aged 6-7 and 12-13 years. Observed outcome was current asthma diagnosed by a physician, reported by parents. To get the desired information we formulated a new questionnaire which was content validated. In the School 1 teacher distributed the questionnaires for parents to fulfill it. In the School 2 the questionnaires were delivered to parents at the parental meeting together with the presentation of the study and short lecture. We calculated the response rate, the prevalence of asthma, asthma symptoms, allergy, genetic background and exposure to environmental risk factors.

Results

Response rate in the School 1 was 24%, in the School 2 was 100%. We got data about 53 out of 127 children and adolescent. None of the parents reported a diagnosed asthma in their child or adolescent, 17% reported symptoms of asthma, 11% wheezing, 8% allergic rhinitis, 40% of children were living within 200 meters of a busy road, 34% were exposed to moisture and mold, 9% had chronic respiratory infection in their early childhood and 13% mothers smoked during pregnancy.

Conclusions

Newly developed questionnaire efficiently acquired information about exposure to environmental risk factors and asthma or allergy symptom. To get higher response rate, delivering the questionnaires at the parental meeting was more effective. Considering the reported symptoms of asthma in undiagnosed cases, further investigation of health records is needed to recognize the potential undiagnosed asthma cases. The latter suggests the benefits of the HIS / HES (Health Interview / Examination Survey) methodology.

Key messages

• HIS (Health Interview Survey) and HES (Health Examination Survey) design type methodology ensure us the quality data on asthma prevalence.

• To efficiently assess the asthma prevalence, the adherence to medical guidelines and unification of the methodology to diagnose asthma in children by pediatricians is of an extreme importance.
Exposure to surrounding greenness and well-being in Portugal, a cross sectional study
Authors: Resendes D S , Uva M S , Morgado P
Published: October 2023

Background

Positive mental health effects of nature have been studied before with relevant associations between the two easily found in literature. However, there is still a lack of population based studies that focus on the effect that the amount of surrounding greenness might have on well-being.

Objectives

This study aims to evaluate the effects of exposure to surrounding greenness in the residential area with well-being based on the Mental Health Inventory 5-items (MHI-5) score from 0-100 (less to more well-being).

Methods

We used data from participants of the 2015 National Health Examination Survey (INSEF) which uses complex sampling methods to represent the Portuguese population and includes 4911 participants. Data regarding socioeconomic status, urbanization level, education, sex, age, postal code and well-being score was extracted. We then calculated the average surrounding greenness using the Normalized Difference Vegetation Index (NDVI) in a 300m and 1km buffer around each participant's residency and divided it by tertiles (from less green to most green). Log linear regression models controlling for confounder effects were applied.

Results

For the 300m buffer living in the 2nd tertile of greeness compared to the 1st tercile decreased the average well-being score by around 4% (ExpB=0.969, 95% p < 0.05). Living in the 3rd tercile (most green) had less to almost no effect (ExpB=0.989, 95% p < 0.05). Sensitivity analysis in a 1km buffer and the stratified analysis for sex and urbanization, also show a 4% decrease in well-being in the 2nd tertile and little to no effect in the 3rd.

Discussion

This study has found an association that is contrary to most literature on this subject, the study design might be subject to selection biases and misclassification of exposure. Further analysis should be done with relation to qualitative aspects of green space, accessibility to green areas and the roles of social cohesion and physical activity.

Key messages

• Population based study done in Portugal regarding the association between well-being and surrounding greenness.

• Findings point to a negative association between increased surrounding greeness and well-being.
Intervention Research in Health Promotion: Methodological Issues
Authors: Cousson-Gélie F
Published: October 2023

Population health intervention research focuses on the actions carried out by researchers in partnership with those involved in the intervention: health professionals, patients, caregivers, public policy makers and population communities. The diversity of actors shapes PHIR projects, testifies to the richness of this research and gives it a privileged place to analyze and intervene as precisely as possible in different contexts and populations. It also implies the need for a better understanding of how to intervene by taking into account the determinants of health in these interventions. The PHIR in health promotion in the field of cancer therefore proposes a paradigm shift, with a focus on the intervention and not the description of the problem and its causes. PHIR bases its theoretical foundations on the one hand on contributions and models of public health, and social sciences, and on his own contributions to theorize and build his own theoretical and methodological corpus. This presentation aims to clarify this paradigm shift and four methodological challenges of PHIR: 1/ the imperialism of epidemiology as a research model; 2/ the challenges of evaluating interventions through the complexity of the objects studied; 3/ issues related to partnerships between researchers and actors in the field without which research cannot be conducted; and finally, 4/ the challenges of publishing and exploiting this type of research. Through concrete examples, participants will be invited to understand the challenges of the PHIR methodology, and to analyse different concrete perspectives to address them. The first part will focus on four methodological issues cited and the PHIR's progress to address them. The second part will identify the participants’ representations on the methodological difficulties of PHIR through their own feedback. This discussion will link directly to the next presentation which will focus on the presentation of an intervention on nutrition.
The correlation of climate change and mortality: climate change as a factor for health inequalities
Authors: Murau L
Published: October 2023

Recent research has found robust evidence that climate change is often negatively impacting on human health. These impacts are distributed spatially unequal both across the countries of the world and within the countries. While research has clearly outlined this unequal distribution on the country level, for instance with the recently added non-optimal temperature risk factor of the Global Burden of Disease 2019 dataset, thereby acknowledging the impact of unfavorable average temperatures on health, the spatial differences in climate change impacts on health on the subnational level is hardly researched. By operationalizing climate data for a climate change trend analysis of various climate change parameters in GIS, and by applying mortality data for different high-, low-, and middle-income countries on administrative area level 2 for both an Ordinary Least Squared (OLS) and Geographically Weighted (GWR) regression analysis, the proposed article is analyzing the unequal impact of climate change on health inequalities within different countries. Under the assumption that climate change-induced changes of local climate-related conditions affect those areas that already are in a disadvantaged position when it comes to health inequality, the paper is expected to show that inequality gaps are further widening due to climate change, not only but especially in low- and middle-income countries that are more affected by climate change than most of the high-income countries. Therefore, it will have to be discussed, how these increasing health inequalities can be dealt with in a just way and under consideration of already existing vulnerabilities in the most affected areas of climate change.

Key messages

• Climate change directly influences mortality in all analyzed countries with a bigger impact on low- and middle-income countries.

• Climate change contributes to widening health inequalities on a subnational level and especially in low- and middle-income countries.