bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic disparities in growth trajectories of Chinese children and adolescents during 1991-2015
Authors: Gao M , Wells J , Li L
Published: October 2021

Backgrounds

Socioeconomic (SEP) disparities in growth of children from low-/middle-income countries are not well understood, especially in countries experiencing rapid economic growth. We investigated how SEP disparities in child growth in China have changed over time.

Methods

Using the longitudinal data of 5,118 children and adolescents (7-18y) from China Health and Nutrition Survey (10 sweeps, 1991-2015), we derived four cohorts born in 1981-95, 1986-90, 1991-95, 1996-2000. We applied random-effects fractional polynomial models to estimate mean height and BMI trajectories for each gender separately, by socioeconomic position (SEP) for each cohort. SEP disparities were estimated as differences between high and low SEP groups (by community-level urbanization index, household income/capita, parental education, and occupational class). We also examined whether SEP disparities in nutritional status (stunting, thinness, overweight/obesity) have changed over time.

Results

Mean height and BMI increased across cohorts, with differences being greatest in adolescence. The increasing trend for height was similar in high and low SEP groups, thus positive SEP differences in mean height persisted across cohorts (e.g. for boys at 10y, were 3.8cm in the earliest and 2.9cm latest cohorts at by urbanization index, and were 3.6cm and 3.1cm by HH income). For BMI, the increasing trend was much faster in high (vs low) SEP groups, thus SEP differences in mean BMI increased across cohorts (e.g. for boys at 10y, increased from 0.5 to 0.8kg/m2 by urbanization index, and 0.4 to 1.1kg/m2 by HH income). Findings for stunting and overweight/obesity were consistent with those for height and BMI. No significant association was found between SEP and thinness.

Conclusions

Short stature is associated with lower SEP, whereas high BMI is associated with higher SEP among Chinese youths. Between 1991-2015 in China, inequalities in childhood BMI increased while those for height remained fairly constant.

Key messages

Short stature is associated with lower SEP, whereas high BMI is associated with higher SEP among Chinese youths. Between 1991-2015 in China, inequalities in childhood BMI increased while those for height remained fairly constant.
Shaping health together: practice from the project I-CARE-SMART
Authors: Loeffler K , Pettinger V
Published: October 2021

Issue

In Austria 28% of the total population are over 60 years. In 2050 this number will increase up to 34%. Considering the growth of the elderly population, their needs should be include in the development of products and services from the beginning using co-creation methods. In the ongoing EU-funded project I-CARE-SMART the aim is an implementation of co-creation in product and service development for elderly people. Therefore a service should be built in the region to support start-ups, companies and service providers using co-creation. This service will be validated collecting patterns of seniors needs that are the basis of regional pilot actions.

Description

The project worked with a mixed approach of qualitative and quantitative methods. The results from a literature research were used as a basis for a co-creation approach with seniors discussing their needs for a self-determined life by using the Value Proposition Canvas. Additionally, journal entries were used describing their daily challenges in living self-determined at home. All results were resumed in a Design Thinking Workshop with experts to define 4 use cases/personas describing specific needs of seniors for the regional pilot actions.

Results

The 4 use cases were used in a regional and international call for proposals for businesses, start-ups and service providers. The winners of the call are offered a platform to work on social innovation for and with elderly people in a ongoing co-creation process for several months from 04/2021 to 09/2021 to develop customer-oriented solutions.

Lessons

Effects that can be achieved by means of co-creation in public health should not be underestimated. Not only the promotion of self-determination and satisfaction, but also cost savings for the health care system have already been demonstrated. Co-creation should be part of public health, the development of assistive technologies for patients and seniors as well as in the further development of health services.

Key messages

Co-Creation services should be part of research, design and development of solutions for elderly people. The idea of co-creation in health care is by no means new, but it is definitely forward-looking and has experienced a new upswing with the movements around co-creation of health.
Food business operator risk categorization
Authors: Colarusso G , Mazzone P , Peirce E , Pellicanò R , Della Rotonda M , Di Loria G , Baldi L , Mandato D
Published: October 2021

Issue

EU Reg 625/2017 establishes that all Food Business Operator FBO needs to be categorised based on risk. The risk rating is obtained by summing the scores of the non-conformities and risk factors checked.

Description of the problem

In the past, various categorisation systems have been used but due to many FBO present in the regional territory, a new system of categorisation rapid and efficient is required.

Results

The system classifies the risk of FBO in two phases: the first, based on static criteria (type and volume of production, market areas), in which a default category is established; the second, based on dynamic and technical criteria (provisions and scores of official control, structural and productive features), in which a definitive category is established. When a FBO is set up, it presents a declaration of start-up that included the static criteria: a preliminary risk category is determined. The authorities assign a definitive rating by a complex inspection, during which specific check-lists of the dynamic and technical criteria are completed. Each element is assigned a percentage weight, which contributes to the risk assessment, and so to the frequency of controls. A value >70% means high risk and 1 control per year; a value of 69.9-50% means medium risk and 1 control every 2 year; a value of 59.9-30% means low risk and 1 control every 3 years, and a value <29.9% indicates a negligible risk and controls on demand. In the period between 2 inspections, the score will be updated by the outcomes of any other official controls. The rating is updated according to favourable or unfavourable outcome.

Lessons

In addition to being efficacious and efficient, this new system of categorisation optimises the work of the authorities.

Key messages

This new categorisation system makes risk-based controls simpler and more efficacious. The project involves various Italian regions and the OECD, thereby enabling official controls to be standardised at the European level.
The most challenging COVID19 phases and the skills healthcare leaders need to face the pandemic
Authors: Scarpis E , Bravo G , Cocconi R , Brunelli L
Published: October 2021

Introduction

Coronavirus disease 2019 (COVID19) pandemic is the most significant public health threat of the century, a crisis that have been challenging healthcare systems around the world. Assessment of leadership skills is needed in order to identify attributes of successful leadership during public health emergencies. This study aims to highlight the critical role played by healthcare leaders during this pandemic, assessing the most challenging and demanding phases of the health crisis and the characteristics required for a healthcare leader.

Methods

A cross-sectional survey was carried out between October and November 2020, using online questionnaires, involving medical and nursing leaders working in the healthcare organizations of the Friuli-Venezia Giulia Region (Northeast of Italy). Professionals from hospital, community setting and regional level were asked about the two most challenging phases of the current pandemic among: crisis early recognition, peak of the emergency phase, declining epidemic, long tail. The most important healthcare leaders' skills were investigated among competence, awareness, communication, decision-making, inspiring trust and data interpretation.

Results

A total of 48 healthcare leaders participated. Women were 56.3%. Mean age was 53.4±7.9. According to the leaders interviewed, the two most challenging phases of such crisis were crisis early recognition (45%) and the peak phase (31%). Lesser important phases were recognized in the declining epidemic (15%) and the long tail phases (8%). Concerning healthcare leaders' skills required to manage with pandemic, the most reported were communication (35%) and decision-making (26%); while lower importance was identified in inspiring confidence (5%).

Conclusions

The two most challenging phases identified by this study suggested the importance of public health surveillance and monitoring systems. Communication appeared a critical success factor for leaders in public health emergencies.

Key messages

Early recognition of the crisis and the emergency peak management are considered the most challenging phases of the COVID19 pandemic by healthcare leaders. Ability to communicate and decision-making emerged as the two most important crisis skills, and should be included among public health leaders core competencies.
Primary care health actions to homeless people during covid-19:an experience report
Authors: Schettino R , Simim D , Soares S , Almeida S , Castro V
Published: October 2021

Objective

Experience report by professionals from Basic Health Care Centers working with homeless people during COVID-19 pandemic.

Methods

Descriptive and reflexive study by professionals and Nursing professors and academics.

Results and discussion

Professionals experience challenges when facing the pandemic considering the life conditions and misinformation of homeless people about COVID-19.Brazil's Unified Public Health System needs to take some measures to promote social distancing, access to toilets, mask and food distribution. Meetings with health teams and clinic on the street teams were held to organize care according to local reality, infrastructure, and users' flow. In a similar vein, intra and intersectoral articulations for joint actions on the street were articulated to provide access to health care and social assistance, and to accommodate and care for those presenting respiratory symptoms till improvement of the condition. Reorganizing actions is a dynamic process because each epidemiological stage demands new strategies as the pandemic advances or recedes. Attendance at Basic Health Care Centers was defined as priority:suspected COVID-19 cases and people with mental suffering or chronic disease.These people were identified to have face-to-face consultations or teleconsultations. In this sense, therapeutic interruption and worsening of conditions were avoided. Some management challenges are listed:information dynamics, the need to publicize, to qualify professionals and to articulate the network;care with the health team, keep away professionals from the group of risk and COVID-19 confirmed cases;training demands, input assurance, and agendas;electronic means to share information and to keep collegiate management.

Conclusions

To face COVID-19 and to work with homeless people it becomes fundamental to share challenges and caring strategies to minimize impacts.Health professionals perform to sensitize users according to their life experiences and singularities.

Key messages

The caring process is built through dialog and reflection. It is of utmost importance to make the population aware of the COVID-19 prevention.
Pediatric outpatient care during the COVID-19 pandemic: Results of a qualitative interview study
Authors: von Sommoggy J , Grepmeier EM , Curbach J
Published: October 2021

Background

Pediatric outpatient care in Germany is significantly affected by the COVID-19 pandemic. The study aims at exploring the subjective views of pediatricians on changes in their routine healthcare work during the COVID-19 pandemic.

Methods

19 qualitative semi-standardized telephone interviews were conducted with pediatricians in Germany. The interviews were audio-recorded, transcribed verbatim and analyzed based on qualitative content analysis (Kuckartz 2012) using QDA software (Atlas.ti, V8).

Results

COVID-19 infection protection measures induce substantial changes in the pediatricians' work, e.g. separating infectious and non-infectious patients, re-structuring appointments and practice setting and wearing PPE. Some interviewees emphasize that re-structuring measures have set positive impulses for the future. Wearing face masks is difficult when communicating with infants and children with psychosocial issues. Pediatricians feel well-informed on COVID-19-related health information but find it challenging to constantly re-adjust their professional position based on the rapidly changing official recommendations. This also makes it difficult to communicate COVID-19-related information to their often insecure patients. The pediatricians are concerned about a changed (degree of capacity) utilization: Preventive appointments are utilized almost as before, however, parental fear of visiting the practice and infection protection measures in the children's living environments have led to a significant decline in utilization for mild infections. While some pediatricians appreciate this as a relief of workload, others experience severe financial distress.

Conclusions

The decline in healthcare utilization for mild infections and the resulting financial distress call for health policy measures in order to ensure comprehensive pediatric care in the future. Positive experiences regarding the pediatric practice should be spread as “best practices”.

Key messages

Pediatricians in outpatient care in Germany experience substantial changes in their routine work due to the COVID-19 pandemic, e.g. practice organization and infection protection measures. They are especially affected by rapidly changing official recommendations and a changed (degree of capacity) utilization.
The COVID-19 policy response in Spain and Portugal: a study of measures to slow down infection rate
Authors: Nogales Crespo K , Muniz Rocha J , Vázquez M , Ricoca Peixoto V , Dias S
Published: October 2021

Background

The COVID-19 global pandemic triggered massive policy responses worldwide. Measures taken during the pandemic differed across countries and time. Governance systems may influence the capacity of countries to respond promptly and mobilize the necessary resources in time. Identifying measures and when they appeared are critical questions to assess emergency response strategies. The objective of this study was to analyze the policy response to slow down the infection rate of COVID-19 cases in Portugal and Spain according to timing (related to death rates) and stringency.

Methods

A descriptive comparative study of non-pharmaceutical interventions was conducted through a content analysis of policies and records review of official government sources. Portugal and Spain were selected considering the similarities between national health systems, but different government organization and epidemic impact. The Autonomous Community of Madrid was also included as example of subnational systems. Death rates were retrieved from daily statistics of open secondary sources.

Results

Results show that countries responded with a complex mix of measures across policy sectors, following dynamic patterns established by the epidemic evolution and governance systems. Policies aimed to reduce the spread of the virus, enable individuals and businesses to comply with restrictions, and reinforce National Health System's capacity. The declaration of state of emergency was a critical tool to organize actions under clear leadership, especially in devolved contexts.

Conclusions

Our findings suggest that, in early epidemic phases, a centralized command can be more effective at timely enacting nationwide stringent measures. Evidence from this study contributes to the argument that a fast, robust, and early response might have been more effective at containing spread at the initial stages of the pandemic.

Key messages

The policy response included measured to reduce spread of infection, enhance adherence and strengthen health systems capacity to deal with the pandemic. The declaration of state of emergency was essential to ensure an organized, coherent, timely, and robust response, especially in devolved contexts.
The association between face mask use and SARS-CoV-2 RNA viral clearance: A cohort study in Tunisia
Authors: Ben Nasrallah C , Zemni I , Charrada I , Dhouib W , Ben Hassine D , Abroug H , Ben Fredj M , Kacem M , Bouanene I , Belguith Sriha A
Published: October 2021

Background

The outbreak of coronavirus disease (COVID-19) continues to constitute an international public health concern. Scientific evidence showed that community mask wearing is an effective nonpharmacologic intervention to reduce the spread of this infection. However, few data are available about the effect of face masking on the duration of the disease. We aimed to study the association between recovery time among a Tunisian cohort of COVID-19 confirmed patients and mask wearing.

Methods

A prospective cohort study was conducted from March to July 2020 including patients with COVID-19 admitted to the Tunisian national containment center. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the association between recovery time and face masks use.

Results

Among the 264 patients included, the median duration of viral clearance was 20 days (interquartile range (IQR 17-32days)). The median time to RNA viral conversion was 18 days (IQR 16-21 days) when using masks versus 23 days (IQR17-36 days) without wearing masks. Face masks use was significantly associated with an accelerated RNA clearance of SARS-CoV-2 (HR 2.006, 95% CI 1.247-3.228) (p = 0.004).

Conclusions

With the emergence of new variants, it is important to adopt widespread mask wearing to avoid SARS-CoV-2 infection and accelerate RNA negative conversion, until effective levels of vaccination are achieved nationally.

Key messages

Face masking was associated with accelerated RNA clearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Promoting community mask wearing during COVID-19 pandemic is crucial.
Viral shedding in asymptomatic versus symptomatic patients with COVID-19
Authors: Zemni I , Ben Nasrallah C , Dhouib W , Maatouk A , Ben Hassine D , Ben Fredj M , Abroug H , Kacem M , Bouanene I , Belguith Sriha A
Published: October 2021

Background

An outbreak of coronavirus disease 2019 (COVID-19) is becoming a public health emergency. Data are limited on the association between a prolonged viral shedding in patients with COVID-19 and having symptoms. We aimed to study the association between the presence of symptoms and recovery time of COVID-19 confirmed patients.

Methods

We conducted a prospective cohort study of COVID-19 patients admitted to the designated national COVID-19 center in Monastir, Tunisia from March to July 2020. Kaplan-Meier survival curve and Cox proportional hazards regression models were used to assess viral shedding in asymptomatic versus symptomatic patients with COVID-19.

Results

Among the 264 patients included in the study, symptoms such as anosmia, dry cough, and fatigue were reported by 34.4% (n = 75) of cases. The median time to RNA viral conversion was 24 days (IQR 18-36 days) for symptomatic patients versus 20 days (IQR 16-30 days) for asymptomatic patients. Having symptoms was significantly associated with a prolonged viral shedding (HR 0.600, 95% CI 0.401-0.897) (p = 0.013).

Conclusions

Our findings revealed that having symptoms delayed viral clearance among COVID-19 patients. Therefore, symptomatology should be taken into consideration in isolation strategy for infected patients.

Key messages

Having symptoms was associated with a delay in SARS-CoV-2 RNA clearance. The presence of symptoms should be taken into consideration for patient’s isolation strategy.
Life expectancy loss due to the COVID-19 pandemic exemplified by Moscow
Authors: Zubko AV , Sabgaida TP , Evdokushkina GN , Kulikova VA , Ivanova AE
Published: October 2021

There is high excess mortality against the background of the pandemic in Moscow (an increase of 36.2% against 18.1% on the national average). According to preliminary data, the loss of life expectancy is 3.1 years for Muscovites (from 78.9 years in 2019 to 76.2 years in 2020) and 1.9 years for the Russian population (from 73.4 to 71.5 years). As in other countries, elderly people suffering from chronic diseases were the most affected. The age-specific mortality rates in 2020 are significantly higher than those of 2019 in the age interval of 45 years and older as well as among children 10-14 years old and young people 25-29 years old. The maximum increase in mortality was recorded in age groups over 80 years old in males and 25-29 years in females. At the same time, infant mortality in Moscow has significantly decreased which is associated with a sharp decrease in the share of births among nonresidents (it exceeded a quarter of all births in the capital in 2019). The reduction in labor migration due to the closure of borders has led to a decrease in births among nonresidents. Using the decomposition method, it was shown that the greatest negative contribution to the loss of life expectancy in both sexes was made by mortality in the age group of 70-74 years which reduced life expectancy by 0.36 years for men and 0.27 years for women. Life expectancy decreased by 0.25 and 0.19 years due to death of men and women aged 75-79 years and by 0.09 and 0.02 years due to death of people aged 25-29 years. Reducing infant mortality yielded a life expectancy gain of 0.15 years for men and 0.11 years for women. These results changed the assessment of the significance of shifts in mortality in age groups. Analysis of changes in age-specific mortality and evaluation of its impact on changes in life expectancy shows different perspectives of the problem, which is important for making adequate decisions in health.

Key messages

The reduction in labor migration due to the closure of borders has led to a decrease in births among nonresidents. Analysis of changes in age-specific mortality and evaluation of its impact on changes in life expectancy shows different perspectives of the problem.
Individual level changes in body weight among Finnish adult population during the COVID-19 pandemic
Authors: Sääksjärvi K , Jääskeläinen T , Ristiluoma N , Pietilä A , Lundqvist A , Koponen P
Published: October 2021

Background

The indirect effects of COVID-19 pandemic are yet undefined, but behavioral and lifestyle consequences of the containment measures may cause weight changes, with different concerns across demographic groups. Our aim was to determine weight changes based on the data collected from same individuals before (2017) and during (2020) the COVID-19 pandemic.

Methods

Participants aged 25+ years, from the nationally representative FinHealth 2017 Study and its follow-up survey in autumn 2020, with information on self-reported weight in both years were included (n = 4770). Weight maintenance was defined as < ± 5% change in body weight for each individual (i.e. weight loss = ≥5% loss; weight gain = ≥5% gain). Prevalence was estimated using inverse probability weights, acknowledging sampling design and non-response.

Results

Overall, two thirds of the population maintained weight during follow-up, but prevalence rates for weight change differed by age and sex. Prevalence of weight loss was highest among 70+ year olds (22% in men, 95% confidence interval (CI) 17-27; 26% in women, 95% CI 22-30), while they rarely experienced weight gain. Among 50-69 year olds weight gain was as common as loss, being around 15% for both indicators and sexes. Prevalence of weight gain was highest among 25-49 year olds (20% in men, 95% CI 18-23; 36% in women, 95% CI 33-40). Men with lowest education had gained weight more often (24%, 95% CI 19-30) than those with middle (16%, 95% CI 14-19) or high (14%, 95% CI 12-16) education, while for women no differences emerged, the prevalence ranging between 20-24% by education.

Conclusions

The weight loss among 70+ year olds seems worrying, but might be age related. Moreover, younger women and men with low education gained weight, groups known to be vulnerable for weight gain. Further analyses are required to evaluate whether containment measures related to COVID-19 pandemic have caused additional change compared to ageing and time related change.

Key messages

Few weight changes were observed in the Finnish adult population. As weight gain/loss may take longer time to develop, further studies are needed to address the long term effects of COVID-19 pandemic. To avoid increasing health inequity after pandemic, public health promotion should stress obesity prevention among young women plus men with low education. Weight loss is a concern among the elderly.
Attitudes towards COVID-19 preventive measures: an Italian cross-sectional study
Authors: Scampoli P , Di Giovanni P , Cedrone F , D'Addezio M , Di Martino G , Meo F , Staniscia T
Published: October 2021

Background

The outbreak of COVID-19 was declared Public Health Emergency of International Concern on the January 2020. During an infectious disease outbreak, non-pharmaceutical interventions are essential to delay an epidemic peak and to flatten the epidemic curve, in order to wait for vaccine development. Perception or beliefs may be essential in determining adherence to official recommendations. The aim of this study was to assess whether perceptions of COVID-19 and awareness of preventive strategies effectiveness were associated to behavioural changes.

Methods

Web-based survey was performed in Italy between the 9 and the 15 March 2020. The survey contained six sections: subject's demographics, subject's behaviours during the latest three weeks, subject's behaviours during the latest 24 hours, perceived efficacy of behaviours, awareness raised by the government-led prevention campaign for COVID-19 and co-occurring anxiety.

Results

1912 participants were enrolled in the study. 48.1% of the participants (n = 919) reported to perform at least 7 preventive behaviours. Most people reported a change in the frequency of their hand-washing (94.7%), an increment in the frequency of surface cleaning and disinfecting (58.9%), and a reduction in the use of public transport (92.5%). Behavioural changes were related to an increase in the anxiety level (OR 1.47; 95%CI 1.16-1.87). After adjusting for personal characteristics and anxiety, an association resulted between clear perception of COVID-19 high infectiousness (OR 1.25; 95%CI 1.00-1.59) and of its severe consequences (OR 1.29; 95%CI 1.05-1.59), clearness of communication about the virus (OR 1.41; 95%CI 1.17-1.71), and increased likelihood of performing the recommended behavioural changes.

Conclusions

To better protect people against future epidemics, health-promotion efforts should be aimed at increasing the level of awareness towards infectious diseases and at implementing and encouraging non-pharmaceutical interventions.

Key messages

Clear perception of COVID-19 high infectiousness and of its severe consequences are associated with an increased likelihood of performing the recommended behavioural changes. Health promotion strategies should be a critical part of infection prevention and control program.
COVID-19, Mental health and intervention-priorities among Northern Italian University students
Authors: Patrono A , Placidi D , Calza S , Brunelli P , Cagna G , Manco A , Renzetti S , Rota M , Moncada S , Lucchini R
Published: October 2021

During the first wave of COVID-19 pandemic, the most affected area in Italy was the southeast part of the Lombardy region. The University of Brescia is one of the largest in Northern Italy. The aim of this study is to investigate the psychological and somatic symptoms driven by lifestyle changes due to the lockdown among the students of the University of Brescia.15261 University students were enrolled through institutional email;14302 were Master's and Bachelor's Degreestudents,724 were Residents and 235 doctorates.3553 students (23.28% of total),aged on average 22 years, completed the survey. Physical health, dietary and sleep habits, physical activities, economic and social issues were investigated through an anonymous, online ad hoc form, available until July 2020 and approved by the local Ethic Committee. Five psychosomatic outcomes were assessed: digestive disorders, headache, panic-anxiety crises, depression-sadness, fear od COVID-19.Factor analysis was applied to reduce the number of variables while logistic and ordinal logistic regression models were used to test the association between the latent variables and each outcome. Female gender, medium-intensive use of telephone, worsening of sleep quality, mnemonic difficulties and performance reduction were associated with all the outcomes. Low physical activity, increased time spent watching television and the worsening of dietary habits represented a significant risk factor for at least three of the outcomes. Despite the relatively low compliance, the survey clearly identified few priorities of intervention to prevent psychological and somatic effects of pandemic in the next future: circadian rhythm, nutritional habits, physical activity, use of media, gender issues. The results of this study show the psychosomatic effects of social isolation and the pandemic on a population at risk of young adults and can promote interventions to minimize the occurrence of psychosomatic consequences on young adults.

Key messages

Analysis of the main risk and protection factors in a population of young adults in the development of psycho-physical symptoms during the period of isolation due to the covid-19 pandemic. Support the need to implement public health services also to reduce health costs with possible methods of intervention, in harmony with the findings.
Impact of COVID-19 on women's life: their health, quality of life and lifestyle
Authors: Zembala-John J
Published: October 2021

COVID-19 has affected all aspects of life of men and women. However, women are considered to be hit the hardest by the pandemic. The aim of the study was to determine the impact of COVID-19 on women's lifestyle and quality of life (QoL). A questionnaire was developed consisting of sociodemographic data, health condition (presence of chronic condition, BMI, COVID-19 status), selected lifestyle components, stress level (Perceived Stress Scales, PSS-10) and QoL (sense of security/social relationships/mental and physical wellbeing/health care access/financial situation/work satisfaction) in comparison to pre-COVID times. The questionnaire was distributed via social media from April 2-9th, 2021 (peak of 3. COVID wave in our country). 195 women (mean age 40.1, range: 20-71 years) were enrolled in the study. 63.6% were married, 10.3% single, 60% were parents. Mean BMI was 24.8 (range: 16.7-45.7). 57.4% women had a correct BMI, 26.2% were overweight, 12.8% obese. 30.3% had a chronic condition. 36.9% had COVID-19, 23.8% not sure about undergoing SARS-CoV-2. 41.5% women declared gaining weight during COVID-19, 23.6% - eating healthier than before pandemic. 46.7% reported lower physical activity, 12.9% greater alcohol intake and 7.2% smoking more in comparison to pre-COVID. 33.8% have worked more; 44.6% have had additional everyday tasks related to taking care of a family member. 51.8% experienced high stress, 30.8% - moderate. 63.1% declared their overall QoL has deteriorated, 76.4% - their mental wellbeing, 55.9% - physical. 30.2% declared their family relations has worsen and 40.5% - relationship with friends in comparison to pre-COVID times 53.3% believed their work satisfaction worsen, 22.6% - financial situation. In 78.5% cases sense of security was worse comparing to before pandemic. COVID-19 has had a great impact on women's life. It has affected their health and wellbeing; changed their health behaviors. It has also led to increased stress level and decreases QoL.

Key messages

Although COVID-19 has affected both sexes, women are hit the hardest by the pandemic. Special attention should be paid aftermath to the long-term impact of coronavirus on this group. We may not be able to control all aspects of pandemic; what we can and should do, is to take our health in hand, care more about health, pay greater attention to prevention and healthy lifestyle.
Trends in alcohol consumption during COVID-19 lockdowns: systematic review
Authors: Acuti Martellucci C , Martellucci M , Flacco ME , Manzoli L
Published: October 2021

Background

The spread of SARS-CoV-2 required virtually all governments to employ non-pharmaceutical infection containment measures such as quarantine and generalised lockdowns. Several authors raised warnings about potential negative changes in alcohol-related behaviours due to the lockdowns. The objective of the present systematic review was to summarise available evidence on trends of alcohol consumption temporally associated with COVID-19 lockdowns.

Methods

We performed a systematic review in PubMed, Scopus, Web of Science and EMBASE, using the search terms ‘coronavirus', with either ‘alcohol drinking', ‘alcoholism', ‘alcoholic beverages', and ‘alcohol intoxication'. Studies were included if they evaluated the change in alcohol consumption prevalence or frequency both before and during the lockdowns, or if they assessed changes in alcohol use retrospectively. The outcomes were changes in prevalence of alcohol consumption, or in its frequency.

Results

A total of 128 records were retrieved, and 24 studies met eligibility criteria. Most samples were drawn from either the general population (e.g. social media users), university students, or regular drinkers. The outcomes measurements varied widely, and multiple scales were also used for the assessment of harmful alcohol use. The majority of the studies found that alcohol consumption prevalence increased during lockdowns (e.g. +25.7% in UK). Also, increased frequencies were reported by 14.0% in Poland and 32.1% in China. Finally, one study from Australia observed no overall changes, while one from Cyprus reported decreased alcohol consumption frequency.

Conclusions

Understanding the impact of lockdowns on alcohol consumption is essential for countering possible increases in harmful use, and a consensus should be reached for performing standardised and comparable assessments.

Key messages

Alcohol consumption increased in many countries during the COVID-19 lockdowns, with local variations. Assessments used a great variety of outcomes, hindering a comprehensive assessment of this phenomena.
How can tobacco policy models quality be assessed: a systematic review
Authors: Huang V , Head A , Hysen L , O’Flaherty M , Buchan I , Capewell S , Kypridemos C
Published: October 2021

Policy simulation models (PSMs) have been used extensively, both to shape health policies before real-world implementation and to evaluate post-implementation impact. However, an accepted quality assessment framework for simulation models is lacking. This systematic review aimed to develop a novel quality assessment framework for tobacco control PSMs. We searched five databases to identify peer-reviewed tobacco control PSMs that projected tobacco-use and tobacco-related outcomes from smoking policy scenarios. We extracted information on modelling inputs, structure and outputs. Using our proposed quality assessment framework, we scored models on nine dimensions: representativeness of population, policy effectiveness evidence, simulated smoking histories, simulated smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. We then compared the model score with the number of cited papers using each model. The results were narratively presented. After screening 5046 candidate papers; 145 papers were included and categorised into 25 PSMs. After scoring the models using our proposed framework, we observed that seven models were given seven and more points. The higher-scored models were generally those with a higher number of publications. While all included models had been subject to sensitivity analysis, other best practices were often lacking. Nine models did not explicitly consider smoking-related diseases. Smoking histories were commonly collapsed into crude smoking status categories rather than reflecting smoking intensity or quitting history. Furthermore, only four models estimated policy equity impact. Our systematic review revealed a variety of modelling techniques used in tobacco control. Our novel quality assessment framework offers a potential quality measure for tobacco control policy simulation models. It may guide health decision modellers and inform health policymaking.

Key messages

All nine framework dimensions were observed in two tobacco control PSM, suggesting the framework relevance and feasibility. However, few models achieved high scores in all dimensions. This novel quality assessment framework aims to support the development and sharing of good modelling practice and thus promote better health policy decision-making.
Factors associated with PSA testing in men ≥ 50 years in Ireland
Authors: O'Donovan R , Fitzpatrick P
Published: October 2021

Background

Ireland has among the highest rates of prostate cancer in the EU, primarily due to widespread PSA screening. PSA screening is not recommended for asymptomatic men. Due to the potential for harm to the patient, and the economic and clinical repercussions for the healthcare system caused by inappropriate screening, this study aimed to investigate associations between PSA screening and sociodemographic, lifestyle, and health-related factors in men ≥50 years in Ireland.

Methods

A cross-sectional study was completed using data from Wave 4 of The Irish Longitudinal Study on Aging (TILDA), a nationally representative sample of community dwellers ≥ 50 years in Ireland. Participants self-reported having or not having a PSA test to screen for prostate cancer in the previous two years. Variables were entered into a multivariable logistic regression to estimate adjusted odds ratios (OR) for associations between PSA testing and the factors of interest.

Results

There were 2,426 male participants, with 68% reporting a PSA test in the previous two years. In adjusted analysis, older age (OR 1.78, 95%CI 1.32-2.31), third level education (OR 1.34, 95%CI 1.07-1.69) and a higher household net income (OR 2.14, 95% CI 1.52-3.02) increased the likelihood of PSA testing. Health-related factors positively associated with PSA testing screening were private health insurance (OR 1.89, 95%CI 1.52-2.35), blood pressure measurement in the previous year (OR 8.80, 95%CI 6.06-12.77) and a positive family history of cancer (OR 1.42, 95%CI 1.13-1.78).

Conclusions

High rates of prostate cancer screening are taking place in Ireland, despite the absence of a population-based screening programme. Men of older age, higher socioeconomic status and who demonstrate health-protective-behaviours have an increased risk of PSA screening. This subgroup of the population should be targeted to increase awareness of the potential benefits and harms of PSA testing.

Key messages

Rates of PSA screening remain high in Ireland, despite the absence of a population-based screening programme. Increased awareness of the potential harms and benefits of PSA screening is needed.
e-Health Literacy among medical students
Authors: Moretti V , Valdi G , Brunelli L , Arnoldo L , Conte A , Masoni M , Guelfi MR , Anelli F
Published: October 2021

Background

The struggle against fake medical news, nowadays widely spread by web sources, is a main issue in public health especially in a pandemic period. Even among medical students, there is a lack of eHealth literacy (eHL) skills to solve medical problems. The Italian Medical Doctors Federation (FNOMCeO) promoted a Web source as a first-aid communication kit for basic notions in health hot-topics named “dottoremaeveroche” (DMVEC). This study aims to evaluate its effectiveness in improving eHL.

Methods

Between April and November 2019, medical students from the University of Firenze (Italy) joined a cross-sectional web-based survey before and after accessing the DMVEC Web source. The 8-item self-assessment tool (IT-eHEALS) was used to examine subject's eHL, in addition to questions on source's features and its quality. All responses were rated on a 5-points Likert scale. Changing of abilities' perception was assessed using Wilcoxon test.

Results

A total of 329 joined the survey, 42% male, mean age of 20.6±2.1. Participants felt moderately confident in eHL, in fact the initial eHEALS overall mean score was 3.6± 0.7. Students had a good perception on how to find helpful health resources (mean score 3.9±0.8) and how to use the Internet to answer health questions (mean score 3.8±0.9), but their ability in using this information to make health decisions was low (mean score 2.9±1.1). All items improved after the use of DMVEC, with overall mean score of IT-eHEALS increasing to 4.3±0.6 (p < 0.0001). Regarding source's quality, mean score related to transparency of sources, an aspect underestimated at first, increased from 3.5±1.2 to 4.7±0.7 (p < 0.0001).

Conclusions

Low levels of eHL can damage public health efforts, as seen during COVID19 pandemic. DMVEC effectiveness in medical students demonstrated that the scaling up to the general population of online educational interventions, with further implementation, could help in tackling infodemic and fake news spreading.

Key messages

Moderate levels of eHL among medical students could reflect lower levels in general population, highlighting this as critical issue in public health. Educational programs addressed to Health professionals could be adapted and empowered considering general population as target.
A study of commercially available complementary foods for infants and young children under 36 months
Authors: Santos M , Matias F , Vaz R , Castanheira I , Rito A , Loureiro I , Assunção R
Published: October 2021

Background

Commercially available complementary foods (CACFs) have been assuming an important proportion of infants and toddlers' diets in high-income countries, despite the concerns regarding their nutritional content and potential problematic marketing strategies used to promote these products. In 2016, the WHO guidance on ending the inappropriate promotion of foods for infants and young children (IYC) was approved (1) to support countries to take action on this issue. To implement this Guidance, a draft Nutrient Profile Model (NPM) (2) was developed to drive decisions regarding the identification of foods which are inappropriate for promotion.

Aim

To support the implementation of the NPM at National Level, studying the availability, composition, and marketing of CACFs for IYC in Portugal.

Methods

Three phases were considered: 1) collect data on CACFs products targeted at IYC (0-36 months); 2) compare composition of these products with WHO guidance; 3) compare methods used to promote these products with WHO Guidance.

Results

A total of 209 products were sampled. The most common products were soft-wet spoonable, ready-to-eat foods (n = 129), dry, powdered and instant cereal/starchy foods (n = 61) and dry finger foods and snacks (n = 16). Twenty-five products (11%) were marketed as being suitable for infants under the age of 6 months. For infants between 6-8 months 78% of the products were marketed as being suitable. For the age group 12 months and over, 11% of the products were marketed as being suitable.

Conclusions

This study provides valuable insights into the CACFs at the national level and reinforces that action is needed to improve the implementation and operationalization of WHO guidance on ending the inappropriate promotion of foods for IYC.

Key messages

NPM can support countries identifying products that can/cannot be promoted for IYC. It is a key opportunity to build policy measures, ensuring children healthy growth and development.
Trans fatty acids policy analysis to prevent non-communicable diseases in Tunisia
Authors: Rejaibi S , Cherif I , Chemli H , Ati J El , Buse K , Hawkes S , Aounallah-Skhiri H
Published: October 2021

Background

Despite the widely published international guidelines for a better implementation of health policies promoting healthy eating habits; the epidemiological situation regarding most weighing heavily non-communicable diseases (NCDs) on global health, is still alarming. We aimed to analyze Tunisian health policies targeting trans fatty acids (TFA) consumption to prevent and control NCDs.

Methods

Based on in-depth policy content analysis and stakeholder interviews, Tunisian policies related to promoting healthy diets and restricting unhealthy consumption of TFA, were identified. Four sub-components of WHO best-buys were assessed: goal to eliminate industrially-produced TFA, legislation to ban their use in food chain, TFA labeling and fiscal policies, and mass media campaign to promote healthy diet and reduce TFA intake. Findings were analyzed based on three main axes of the “policy cube approach”: comprehensiveness of policy content, policy effectiveness and respect of equity principles. For each axis, final assessment was performed based on a Likert scale: low, moderate and high.

Results

Although (3/4) WHO best-buys are covered by the national strategies for NCDs and obesity prevention for 2018-2025 and 2013-2017 respectively. This analysis has revealed moderate level for comprehensiveness of policy content, because ofthe absence of specific mention regarding legislation. A moderate level in policy salience and effectiveness was also highlighted (weak accountability mechanisms and no budget line for effective implementation for all WHO best-buys). A very low respect to equity principles was also underlined with no specific attention regarding vulnerable populations.

Conclusions

Main weaknesses in TFA policies concerned legislation, budget allocation and accountability mechanisms. “Legislation measures” to ban trans-fats use in the food chain and resource mobilization for “nutrition labeling and mass-media campaigns” effective implementation, are recommended.

Key messages

Several weaknesses in TFA policies have been highlighted, mainly related to: legislation, budget allocation, accountability mechanisms and low respect to equity principles. Legislation reinforcement and efficient resource mobilization for “nutrition labeling and mass-media campaigns” effective implementation, are strongly recommended.