bluuebunny/crossref_metadata_2025 huggingface dataset:
Food additive emulsifiers and cancer risk: results from the French prospective NutriNet-Santé cohort
Authors: Sellem L , Srour B , Chazelas E , Debras C , Chassaing B , Huybrechts I , Pierre F , Coumoul X , Deschasaux-Tanguy M , Touvier M
Published: October 2022

Background

Food additive emulsifiers are found in thousands of industrial foods and may exert deleterious effects on gut microbiota and carcinogenesis according to experimental studies. However, their associations with cancer risk has not been investigated yet. This study aimed to investigate these associations in a large population-based prospective cohort.

Methods

This study included 102,485 French adults from the NutriNet-Santé cohort (42.1y [14.5], 78.8% female, 2009-2021). Food additive emulsifier intakes were estimated using repeated 24h dietary records linked to brand-specific food composition databases on food additives. Associations with incident cancer risk were assessed using Multivariable Cox models.

Results

3,511 incident cancer cases were diagnosed during follow-up (1,026 breast, 431 prostate, and 279 colorectal cancers). Intakes of sodium citrate (E331, HR = 1.12 [1.02-1.23], p-trend=0.009), xanthan gum (E415, HR = 1.11 [1.02-1.21], p-trend=0.02), and mono- and diglycerides of fatty acids (E471, HR = 1.17 [1.06-1.28], p-trend=0.001 and total: E471, E472a-b-c-e, HR = 1.11, [1.02-1.22], p-trend=0.02) were associated with increased overall cancer risk. Higher intakes of E331 (p-trend = 0.046), sodium stearoyl-2-lactylate (E481, p-trend=0.01), total lactylates (E481-482, p-trend=0.01), total celluloses (E460-468, p-trend=0.03), carob bean gum (E410, p-trend=0.01), and E471 (p-trend=0.006) were associated with increased overall breast cancer risk. Higher intakes of carrageenan (E407, p-trend=0.04), E415 (p-trend=0.02), and triphosphates (E451, p-trend=0.03) were associated with increased post-menopausal breast cancer risk.

Conclusions

These results are the first to investigate and report direct associations between cancer risk and exposures to seven individual and three groups of food additive emulsifiers. If replicated, they may have an important public health impact, considering the omnipresence of these additives in industrial foods globally.

Key messages

• This study is the first to precisely assess exposures to food additive emulsifiers in a population-based study.

• Intakes of food additive emulsifiers were associated with increased risk of cancer.
SARS-CoV-2 Seroprevalence in Germany: results from the second wave of the RKI-SOEP study
Authors: Mercuri E , Poethko-Müller C , Schaffrath Rosario A , Schmid L , Schlaud M , Gößwald A ,   RKI-SOEP-2-study group
Published: October 2022

Introduction

The first wave of the “Corona Monitoring bundesweit” (RKI-SOEP) study showed that shortly before the start of the German vaccination program only about 2% of adults (> 18 years) had already experienced SARS-CoV-2 infection and more than half of these cases had been detected and notified. The objectives of the second wave of this study are to further investigate the spread of SARS-CoV-2 in Germanýs population aged over 14 years. It aims to determine the seroprevalence of infection- and vaccine-induced IgG antibodies against SARS-CoV-2. Finally, it examines health, demographic and socioeconomic risk and protective factors for infection and vaccine acceptance.

Methods

From November 2021 to February 2022, the second wave of this cross-sectional study collected biospecimens (capillary blood samples) and interview data, including information on infection and vaccination, from a nationwide population sample drawn from the German Socio-Economic Panel (SOEP). The dried self-collected blood samples were then analyzed for the detection of SARS-CoV-2 IgG antibodies by Euroimmun ELISA assay.

Results

Based on preliminary, unweighted data of around 11,000 participants aged >14 years (52% response rate), we expect the final seroprevalence of SARS-CoV-2 antibodies to be in the range of 80 to 90%. Thus, around 10 to 20% of the German population may still be susceptible to a severe disease progression because they are neither infected nor vaccinated. Final results, weighted for non-response and adjusted for test sensitivity and specificity, will be presented.

Conclusions

The RKI-SOEP-2 study will be pivotal in both, contributing to an improved understanding of SARS-CoV-2 propagation in different regional and sub-group settings and in identifying vulnerable target groups that need to be protected against future infections.

Key messages

• Dried blood self-sampling in a nationwide sample is a robust tool to estimate seroprevalence at a population level.

• As of February 2022, presumably 80 to 90% of the German population has previously been infected and/or vaccinated against SARS-CoV-2.
Health impact Assessment practice in Wales: factors conditioning its success
Authors: Green L
Published: October 2022

Historically, Public Health Institutes (PHIs) were formed to address emergency public health and environmental health related challenges for example, infectious disease outbreaks and sanitary conditions which will affect health. The COVID-19 pandemic has demonstrated the importance and value of PHIs and the specific knowledge and expertise sat within them in the 21st century in relation to critical health issues. However, PHIs have also the potential expertise to look at the wider determinants of health and how they might affect population health and inequalities. In doing so, they play a critical role to advocate for Health in All Policies (HiAP) and Health Impact Assessment (HIA) by engaging with decision makers from health and non-health sectors and providing evidence and health intelligence. Public Health Wales (PHW) has conducted very complex studies as the HIA of the impact of Brexit on the population of Wales, which was praised as very useful by the Welsh Government and local decision makers at a time when, otherwise, little robust evidence-based information was available. Other positive HIA experiences are the recently published HIA about impacts of climate change or COVID-19 pandemic. Those achievements were possible thanks to the establishment of a specific unit dedicated to HIA within PHW, and to the political support and resources. This has built awareness raising and trust in HIA as a tool to support decision making from all sectors in Wales, enabled also by much training and stakeholder participation.
How multimorbidity and socio-economic factors affect Long Covid: Evidence from European Countries
Authors: Wilk P , Ruiz-Castell M , Moran V , Noel Pi Alperin M , Bohn T , Fagherazzi G , Suhrcke M
Published: October 2022

Introduction

An increasing number of individuals continue reporting symptoms following the acute stage of Covid-19 infection. Few studies have investigated the factors related to Long Covid. Our aim was to assess how multimorbidity, socio-economic factors (immigration, education, employment, and income), and country of residence affect the presence and number of persistent symptoms attributable to Covid-19 illness in Europe.

Methods

We used data from the SHARE Corona surveys collected in 2020 and 2021. The sample included 4,004 respondents aged 50 years and older who were affected by the Corona virus. The outcome was the number of persistent symptoms attributable to Covid-19 illness, including: fatigue; cough, congestion, shortness of breath; loss of taste or smell; headache; body aches, joint pain; chest or abdominal pain; diarrhoea, nausea; and confusion. We conducted a multilevel analysis for a hurdle model with negative binomial distribution.

Results

Overall, 73% of respondents were estimated to have at least one persistent symptom associated with Covid-19 illness and, on average, they had 2.73 symptoms. However, there were some statistically significant across country differences in the presence and number of symptoms. Respondents who were employed were more likely to report at least one symptom (OR = 1.40) and those with higher levels of education were less likely to report any symptoms (OR = 0.67). Respondents with multimorbidity had an increased risk of experiencing an additional symptom (RR = 1.12) while respondents who were employed had a decreased risk of experiencing an additional symptom (RR = 0.85).

Discussion and conclusions

Presence and number of persistent symptoms associated with Covid-19 illness was highly prevalent and varied significantly across European countries. Evidence from the present work underscores the need to target high-risk groups and those with multimorbidity to reduce long-term health consequences of Covid-19.
The European response and transformation towards healthy energy
Authors: Matkovic V , Anne S
Published: October 2022

The EU Green Deal is the framework to achieve carbon neutrality by 2050, and decarbonisation and sustainability in the main economic sectors. This includes a revised greenhouse gas reductions goal of at least 55% for 2030, as well as commitments on zero pollution, healthier agricultural production, sustainable mobility and energy. Moreover, as part of the EU Green Deal, the European Commission has established a Just Transition Mechanism (JTM), to ensure that the transition towards a climate-neutral economy happens in a fair way, leaving no one behind. The aim is to mobilise at least €100 billion over the period 2021-2027 for carbon-intensive industries. But health costs of pollution are absent in Just Transition considerations. The Green Deal includes all the right “buzz words” and commitments for a healthy planet for healthy people. However, policy-makers also need to walk the talk when it comes to adopting the right laws and measures. The science and the acceleration of the climate change, environmental and health crises show us that we need to step up. HEAL believes a zero pollution- and health-based approach can be the overarching principle to deliver on these ambitions. The war in Ukraine as the latest crisis has brought up once again the need for the swift, without any delay, phase-out of all fossil fuels. In Europe, the recently proposed RePower EU plan aims to set a pathway for increased renewables, energy savings and diversification well before 2030. However, with a holistic view of the problem under a health lens, it is clear that in this transition from fossil fuels inequalities and social considerations need to be placed central. Of particular importance is to not give space for false solutions such as replacing Russian imports with fuels from other authoritarian regimes or economies which will only continue to perpetuate Europe's energy dependence, or to build up infrastructure that will continue the pollution (gas and biomass included).
How much global climate adaptation finance is targeting the health sector?
Authors: Alcayna T , O'Donnell D
Published: October 2022

Climate change seriously threatens health and wellbeing with projected health burdens estimated to cost USD 2-4 billion a year by 2030. Adaptation in the health sector is critical to keep pace with the ongoing consequences of the climate crisis and the impacts projected to occur in the next decade and beyond. Yet estimates by the WHO indicate that climate finance targeting the health sector to date is extremely low: less than 0.5% of multilateral climate adaptation funding has targeted the health sector. In this study, we trace and quantify the amount of adaptation financing targeting the health sector from both multilateral and bilateral sources using publicly available information on the OECD-DAC database and Climate Funds Update. We find that between 2009-2019 only 0.39% of multilateral and bilateral climate adaptation funding targeted health-related efforts specifically. Despite the relatively higher number of health-related projects in Sub-Saharan Africa compared to other regions, a smaller amount of funding is allocated per project compared to other regions. Regional variations in funding are concerning as the countries with the most vulnerability to the climate crisis coincide with regions getting the least amount of funding per project. There is a significant gap in globally financed adaptation efforts in the health sector. Swift and committed remediation is needed to minimise the spiralling risk of high negative health outcomes.

Key messages

• Between 2009-2019 only 0.39% of multilateral and bilateral climate adaptation funding targeted health-related efforts specifically.

• The countries with the most vulnerability to the climate crisis coincide with regions getting the least amount of funding per health project.
Sexual health inequalities among women aged 16-24
Authors: Solomon D , Gibbs J , Burns F , Mohammed H , Migchelsen SJ , Sabin CA
Published: October 2022

Introduction

Gonorrhoea is the second most commonly diagnosed sexually transmitted infection in England, and diagnoses among young women increased 31% between 2018 and 2019. Understanding the patterns of testing and diagnosis among young women is likely to aid prevention among the most vulnerable segments of this population.

Methods

Data on gonorrhoea diagnoses at sexual health services among women aged 16-24 in England were obtained using the GUMCAD STI Surveillance System. We investigated the relationship between two exposure variables (deprivation and ethnicity), and two outcome variables (number of gonorrhoea tests and number of gonorrhoea diagnoses). Poisson regression was used to calculate rate ratios for the relationship between the exposure and outcome variables. The testing analysis was offset for the size of the population, and the diagnosis analysis was offset for the number of tests within the population.

Results

Between 2012 and 2019, gonorrhoea testing and diagnosis rates were highest among women living in the most deprived areas. The rate of testing in the least deprived 10% of neighbourhoods was significantly lower than that seen in the most deprived 10% of neighbourhoods (rate ratio (RR) 0.79; 95% confidence interval 0.79 - 0.80), and the rate of diagnosis in the least deprived 10% of neighbourhoods was around a third of that seen in the most deprived 10% of neighbourhoods (0.35; 0.33 - 0.36). When compared to White British women, the rate of gonorrhoea diagnosis was lower among Bangladeshi (RR 0.89; 0.75 - 1.05), Indian (0.76; 0.68 - 0.84), Pakistani (0.87; 0.77 - 1.00) and Chinese women (0.60; 0.51 - 0.71) and was highest among Black Caribbean (2.26; 2.18 - 2.33) and Black African (1.40; 1.34 - 1.45) women.

Conclusions

This analysis found inequalities in the distribution of gonorrhoea among young women in England that may indicate structural barriers to STI prevention that are affecting Black women and those living within the most deprived populations.

Key messages

• Gonorrhoea testing rates among young women in England are highest among women from deprived areas and Black women.

• Gonorrhoea diagnosis rates among young women in England are highest among women from deprived areas and Black women.
How can school-based interventions reduce health inequalities? Results from two reviews
Authors: Moor I , Schneider A , Niederschuh L , Winter K , Richter M
Published: October 2022

Background

Even in young people the chances to grow up healthy are unequal, depending on their socioeconomic position (SEP). In order to reduce these health inequalities, the school is an important field of action for health promotion. However, the evidence is limited regarding interventions focusing on health inequalities. Thus, the aim of the current research is to investigate 1) which school-based interventions contribute to the reduction of socio-economic inequalities in health and health behaviour of children and adolescents and 2) how and under what conditions they are successful.

Methods

A systematic and a realist review were conducted. Some steps of the methodological approach were used synergistically for both reviews: development of the search strategy, selection of the databases (MEDLINE, SSCI, SCIE, DoPHER and TRoPHI) and some inclusion and exclusion criteria. The search covered the years 2000-2020. The screening and subsequent steps were applied specific to each review design.

Preliminary results

The search resulted in 10,524 hits of which 37 publications were included for the systematic review. Most of the interventions focused on nutrition (14), followed by mental health (8) and substance use (5). The results indicate that structural preventive interventions are more likely to reduce health inequalities compared to behavioral preventive interventions. For the Realist Review 7 studies were included. Intrapersonal, interpersonal, and institutional factors were extracted that are relevant for school-based interventions focusing on adolescents with low SEP.

Conclusions

The systematic review showed that school-based interventions are able to reduce health inequalities, but also to increase them. Structural preventive measures seem to be helpful in increasing health equity. The Realist review identified mechanisms of interventions which help to address students with lower SEP.

Key messages

• The evidence regarding interventions with focus on health inequalities is limited. We present two reviews analysing what interventions are needed and how and why they work.

• Structural preventive measures seem to be helpful in increasing health equity. Factors on the intrapersonal, interpersonal, and institutional level are important to address students with low SEP.
Stronger together: Community participation, structural stigma, and depressive symptoms of sexual and gender minority individuals living across 28 European countries
Authors: Ünsal B , Demetrovics Z , Reinhardt M
Published: October 2022

Background

Although previous studies demonstrated that structural stigma (i.e., discriminatory state laws, public policies, and attitudes) predicts adverse mental health outcomes among sexual and gender minority (SGM) populations, less is known how protective factors interact with structural stigma. Thus, we aimed to examine the associations between structural stigma, community participation, and depressive symptoms in a large sample of SGM adults.

Methods

Discriminatory laws, policies, and attitudes affecting SGM people were assessed to measure each country's structural stigma levels (i.e., sexual and gender). Data from the 2019 EU-LGBTI-II-Survey assessing community participation levels and depressive symptoms of sexual minority men (n = 62.825), women (n = 38.912), and gender minority adults (n = 15.801) in 28 European countries were analyzed by using multilevel models.

Results

The results demonstrated that structural stigma was positively, and community participation was negatively associated with depressive symptoms of sexual minority men (β = .147, p < .001; β = -.020, p < .05), women (β = .149, p < .01; β = −.040, p < .01), and gender minority adults (β = .085, p < .05; β = -.088, p < .001), respectively. Unlike sexual minority women and gender minority adults, for sexual minority men, a statistically significant interaction was found (β = .018, p < .05) such that participating to the community predicted lower depressive symptoms only in lower-stigma countries.

Conclusions

The results highlight the need for changes in discriminatory laws, social policies, and negative attitudes that impact depressive symptoms of SGM individuals. Although community participation protects individuals from depression, these findings suggest that sexual minority men in higher-stigma countries benefit less from community participation. Thus, interventions aiming to increase SGM individuals’ community participation should consider structural factors and gender differences.
What are the drivers of waiting times, waiting lists and backlog during and following the COVID-19 pandemic?
Authors: Siciliani L
Published: October 2022

The COVID-19 pandemic put a halt to the number of patients being treated thus generating larger excess demand and a greater mismatch between demand for health care services and the supply of services provided. This presentation will provide a conceptual framework for understanding the dynamic interrelation between waiting times, waiting lists and the backlog over time. Data from different countries will be used to illustrate and rationalise how waiting times, lists and volumes evolved over time. It will then discuss factors driving the demand and supply of care during Covid, and emphasise the critical role of supply in absorbing the backlog and reducing the waiting list under different scenarios, as well as factors on the demand side both in the short run and the long run. Supply determinants include the availability of health workers as key factor to “bounce back”, their productivity and provider capacity (hospital beds, operating theatres), the cost of providing treatment in a safe environment, financial capacity to fund additional supply both by public and private providers, interventions to minimise staff exhaustion and burnout, payment systems which are aligned with higher volumes, and technologies and digital solutions. Demand determinants include ageing and rising chronic conditions, and multi-morbidity patients (including long-COVID patients), increasing expectations, new technologies, prioritisation protocols, but also fear of infection which can leading to a temporary or permanent reduction in demand but an increase in unmet need. The framework will be used to discuss policy options both on the demand and the supply side to deal with the backlog, but also to improve the resilience and efficiency of health systems.
Life expectancy in multimorbid older adults: Why it matters for preventive care
Authors: Gastens V , Chiolero A , Anker D , Feller M , Bauer DC , Rodondi N , Del Giovane C
Published: October 2022

Multimorbidity is highly prevalent among older adults and associated with a shorter life expectancy. Many guidelines recommend tailoring preventive care of multimorbid people according to life expectancy. Indeed, there is a time lag between a preventive care intervention and the expected potential benefit, and patients with a relatively short life expectancy might not have the time to benefit from the preventive care intervention. Further, both patients and health care providers tend to overestimate benefits and underestimate risks of interventions. It is therefore necessary to have a valid index for mortality prediction in multimorbid patients, but there is no life expectancy estimator designed and recommended for this population. The paper describes the development and internal validation of a new life expectancy estimator. In this presentation, we focus on the importance of life expectancy estimation in multimorbid older adults: Why does it matter in this population? What is the time lag to benefit of a preventive intervention, e.g., cancer screening? What is the state in this field, in research and clinical practice? How could tailoring preventive care to life expectancy improve patient outcomes?
Leveraging Citizen Science to Improve Urban Public Health
Authors: Hotting J , Clemens T , Guinto R , Commers M , Brand H , Czabanowska K , Elands RJJ
Published: October 2022

Background

Mobile health approaches in community based participatory projects keep the promise to encourage sustainable behavior in citizens by engaging communities in data collection and connecting their individual level behavior to larger level community health. This review evaluates the effectiveness of the implementation of citizen science for health promotion of non-communicable diseases in urban community-based participatory research projects.

Methods

A scoping review was conducted using PRISMA-ScR. Pubmed and Web of Science were searched for citizen science studies. We included research 1.) conducted in an urban setting, 2.) related to environmental sustainability, 3.) focused on non-communicable diseases, and 4.) applied citizen science methodology.

Results

32 community-based participatory research projects were identified using the following data collection technologies: mobile applications (n = 7), photovoice (n = 6), Stanford Healthy Neighborhood Discovery Tool (n = 6), monitoring (n = 6), mixed-methods (n = 4) and sensors (n = 3). The Stanford Healthy Neighborhood Discovery Tool was most effective at delivering real time data collection, exploring new communication and dissemination opportunities for remote and marginalized communities, and at offering a flexible and cost-effective approach to identify health promotion interventions. Studies that implemented photovoice tools and mobile applications had challenges with regard to recruitment and retention of participants as well as privacy concerns.

Conclusions

Mobile health technologies in community-based participatory research projects may be a promising way to uncover unknown local risk factors, raise awareness and identifying targeted policy solutions to promote healthy and sustainable environments in urban spheres. The effectiveness of mobile health applications for health promotion of non-communicable diseases may vary between community-based participatory studies by data collection method.

Key messages

• Mobile health technologies in communities may be a promising way to promote healthy and sustainable environments by raising awareness and offering targeted policy solutions in urban spheres.

• The effectiveness of mobile health applications for health promotion of non-communicable diseases may vary between community-based participatory studies by data collection method.
Association between worries about climate change and mental health in Norwegian adolescents
Authors: Dahhlen Granrud M , Bonsaksen T , Lien L
Published: October 2022

Background

Climate change has a great impact on the future of children and young people. Since the global climate strike movement, many adolescents expressed worries about climate change. But do these worries lead to declined mental health and future optimism? Thus, we aim to explore associations between prevalence of worries about climate change, leisure activities and mental health problems in a representative sample of Norwegian adolescents.

Methods

In 2021, the youth survey Ungdata collected data from 139,841 Norwegian adolescents, which corresponds to a response rate of 75%. Descriptive analysis was used to calculate the prevalence of worries about climate change cannabis use and bi- and multivariate logistic regression analysis to examine the association between worries about climate change and mental health, leisure activities and alcohol and cannabis use, controlled for sociodemographics.

Results

Around 37% of Norwegian adolescents are worried about climate change. Worries increased with age and are more prevalent among girls. There is a relationship between mental health problems and worries about climate change (OR = 1.80 (CI:1.75-1.86)) still after adjusting for sociodemographic variables, leisure activities and alcohol and cannabis use (OR = 1.71 (1.10-1.42)).

Conclusions

The results indicate a real connection between mental health problems and worries about climate change, but the causal relationship needs further study. This knowledge makes it important for all profession, working with adolescents, paying special attention to possible negative effects of worries about climate change on the mental health of young people.

Key messages

• Worries about climate change has an impact on mental health of young people.

• Adolescent’s worries about climate change should be taken seriously.
Measuring health literacy and its associations with health behaviors of adolescents in Germany
Authors: Loer A , Domanska OM , Jordan S
Published: October 2022

Background

The questionnaire “Measurement of Health Literacy Among Adolescents Questionnaire” (MOHLAA-Q) was developed and validated in a multi-stage process to measure generic health literacy among 14- to 17-year-olds. The MOHLAA-Q combines subjective and objective measurements, consisting of four scales. The instrument was applied to explore associations between generic health literacy and different health behaviors among adolescents in Germany. The data should contribute to the age-appropriate development of health promotion interventions.

Methods

We carried out a nationwide cross-sectional online survey with 1,235 adolescents aged 14-17 years in Germany in 2019. Data on generic health literacy were collected using the four scales of the MOHLAA-Q and data on health behaviors were collected using single established single-item questions on sports, diet, alcohol consumption, and smoking. Bivariate and multiple analyses were performed for investigating associations between generic health literacy and health behaviors, adjusted for age, gender, education and self-efficacy.

Results

Not consuming fruit and vegetables daily was associated with lower health literacy levels in all examined scales. Doing no sports as well as smoking showed positive associations with low levels in “health-related communication and interaction skills” and “attitudes toward one's own health and health information”. No associations were found between risky alcohol consumption and health literacy.

Conclusions

The results indicate that strengthening health literacy should be part of health promotion activities for increasing physical activity and healthy diet among adolescents. The MOHLAA-Q allows us to identify which specific dimensions of health literacy might be addressed in order to promote different health behaviors.
Accounting for vaccines specificities in the Joint Clinical Assessment (JCA): a proposal for guiding principles
Authors: Beck E , D'Agostino P , Chapman R , Largeron N , Louette L , Sabale U , Schaible K , Quilici S
Published: October 2022

Issue/problem

Vaccines are an important public health intervention protecting the population against infectious diseases. The value of vaccines is broad ranging from individual to societal as achieving community immunity protects the unvaccinated, minimizes the risk of outbreaks, reduces the emergence of antimicrobial resistance, and leads to broader societal benefits.

Description of the problem

Vaccines’ market access processes are characterized by the development of recommendations by NITAGs followed by the assessment of health technology assessment (HTA) bodies in less than half of 27 EU member states. Despite that HTA for therapeutic drugs is well established, there is very limited experience in applying HTA methodologies to vaccines, especially for clinical assessments, as HTA methods and frameworks are traditionally geared toward therapeutics. However, following the adoption of the EU regulation on HTA, Joint Clinical Assessments (JCAs) of vaccines are expected.

Results

To support a discussion on how to account for vaccine specificities in the JCA, Vaccines Europe has performed a project which aimed at developing a proposal for high-level guiding principles on processes and methodologies for clinical HTA for vaccines. The proposal is informed by findings of literature reviews on currently applied processes, methods, and clinical assessment frameworks of vaccines as well as the outcomes of an advisory board with scientific experts.

Lessons

A proposal for high-level guiding principles for clinical HTA for vaccines is being developed based on both evidence and the advice from scientific experts which focuses on processes (e.g., horizon scanning, early advice, consideration of vaccine-specific expertise) and methods (e.g., unmet need, safety, efficacy/effectiveness, real-world evidence and technical characteristics of the technology). Lastly, the implementation of vaccines specificities in JCA represents a call for action.
Changes in healthcare utilization after mass trauma: A register-based study of young survivors’ utilization of primary care and mental health services before and after the Utøya attack in Norway
Authors: Stene L , Thoresen S , Wentzel-Larsen T , Dyb G
Published: October 2022

Introduction

Using register-based data, this study had a unique possibility to investigate how young survivors’ use of primary care and mental health services (MHS) changed after a terrorist attack.

Methods

We analyzed data on consultations with primary care physicians (PCP) and MHS among 255 survivors (48% female) of the 2011 Utøya youth camp attack in Norway three years before and after the attack, and their reason for encounter with the PCP according to the International Classification for Primary Care (ICPC-2).

Results

The majority of survivors consulted PCP both before and after the attack, with a marked increase in psychological reasons for encounter after the attack. Few consulted MHS before the attack, while most survivors did after the attack. In total, 93% of female survivors and 88% of male survivors consulted PCP in the three years before the attack, compared to respectively 98% and 96% in the three years after the attack. Moreover, 17% of female survivors and 11% of male survivors consulted MHS in the 3 years before the attack, compared to respectively 80% and 65% in the 3 years after the attack. From the year before to the year after the attack, the mean yearly consultation rates (CR) increased two-fold for PCP and nearly 8-fold for MHS in female survivors, and more than two-fold for PCP and nearly 12-fold for MHS in male survivors. Both before and after the attack, the consultations rates for PCP and MHS were higher for female than male survivors. The levels of posttraumatic stress, depression and anxiety symptoms and somatic symptoms were also higher in female survivors both early and at long-term after the attack.

Conclusions

Our study demonstrated that both PCP and MHS played important roles in providing healthcare for psychological problems in young survivors of terrorism in Norway. Potential implications for public health preparedness to mass trauma will be discussed in the presentation.
Comparative Effectiveness in terms of Understanding of Nutri-Score and NutrInform in Spain
Authors: Fialon M , Babio N , Salas J , Galan P , Kesse-Guyot E , Touvier M , Sarda B , Hercberg S , Nabec L , Julia C
Published: October 2022

Background

Interpretive Front-of-Pack Labels (FoPLs) are supported by WHO as a key policy tool to promote healthy diets. At present, various FoPLs formats co-exist in the European Union (EU). However, as part of the Farm to Fork strategy, the European Commission stated it would adopt a single mandatory FoPL in 2022. The aim of this study was to analyze Spanish consumers reactions to Nutri-Score and NutrInform, two FoPLs that are currently the subject of debate in EU, testing preference through subjective understanding and perception but also performance through objective understanding of the FoPLs.

Methods

The experimental study was conducted in 2021 on a representative sample of 1026 Spanish adults (50% women, mean age±SD = 46±14 years), through an online randomized questionnaire where participants were exposed to Nutri-Score or NutrInform. Performance of and preference for these two FoPLs were assessed in three food categories (Breakfast Products, Breakfast Cereals and Added Fats). Performance was tested using multivariate logistic regression while preference using principal component analysis and t-tests.

Results

In terms of objective understanding, Nutri-Score was significantly associated with an increase in consumers’ ability to identify healthier food products across all food categories compared to NutrInform (OR = 19.1 [14.2-25.7], p < 0.0001). On the preference dimension, Nutri-Score was perceived as significantly easier to use and was more liked than NutrInform (standardized PCA dimension resp. 0.32±1.58 vs. -0.29±1.66, p < 0.0001 and 0.080±1.18 vs. -0.072±1.17, p = 0.039) and participants found Nutri-Score more helpful to discriminate the nutritional quality of Breakfast Products and Breakfast Cereals (resp. 1.32±1.00 vs. 1.14±1.02, p < 0.01 and 1.33±1.00 vs. 1.00±1.03, p < 0.0001).

Conclusions

Results of this study provide new evidence to support Nutri-Score in comparison with the NutrInform battery, on both performance and preference aspects.

Key messages

• Nutri-Score better helps participants identify healthier food products than NutrInform.

• European Commission should consider results of this study in its decision on a harmonized Front-of-Pack Label.
Calculation of Purchasing Power Parities for Pharmaceutical Products via EURIPID database
Authors: Habl C , Zuba M
Published: October 2022

Background

Purchasing power parities (PPPs) are indicators of price level differences for all goods and services across countries. Their calculation follows the ÉKS method (https://ec.europa.eu/eurostat/cache/metadata/en/prc_ppp_esms.htm). Prices of pharmaceuticals are collected by national statistical offices using different methods, from asking prices in pharmacies to retrieving scanner data. The sample is limited to 150 top-selling medicines, which are not available in all countries. Consequently, the PLIs (price level indices) and PPPs derived are sometimes based on only 50 pharmaceuticals. In a cooperation between Eurostat and EURIPID the PPP calculation was alternatively done with the EURIPID database for 28 countries.

Methods

The study compared the PLIs/PPPs derived from the E20-2 “Furniture and health” survey (aka CGS) with those from EURIPID for 2018-2020. The main challenge was to identify comparable products from the 224,448 products in EURIPID. For this we grouped those that shared the same 1) ATC, 2) active substance(s) & strength(s), 3) pack size group and 4) dosage form group (e.g., oromucosal) resulting in 157,186 distinctive products compared to 1,928 included in CGS. We used the Gross Retail price (GRP) as defined in the Eurostat PPP manual.

Results

The ranking of PPPs was similar in both approaches, with Switzerland and Iceland in the lead and Poland and Hungary in the end. Only for some countries, e.g. the Netherlands deviations were identified. The Pearson correlation between the 2020 PLI for the Euripid subsample using the asterisk method with all products marked as representative and the CGS results was 0,946.

Conclusions

Results from EURIPID show the same trend as the CGS. It is possible to replace the national data collection by a central source. This would reduce the data collection burden on the statistical offices and allows a closer monitoring of the evolution of pharmaceutical prices (bi-annual PPP publication instead of current 3-year interval)

Key messages

• To monitor affordability of medicines for all citizens it is important to compare prices on a regular basis with a simple tool as e.g. some products prices differed by 1000-times across countries.

• The EURIPID database (www.euripid.eu) allows detailed analysis of pharmaceutical prices in Europe and is available for free to non-commerical researchers.
Network analysis of a COVID-19 outbreak in the west of Ireland in February 2021
Authors: Timoney C , Smyth B
Published: October 2022

Notification and contact tracing systems of COVID-19 hold a vast amount of information on transmission chains of the virus. It can be hard to gain an understanding of these due to the number of individuals involved. Network analysis can be used as a method of visualising these systems, gaining understanding of transmission chains and as a potential tool for monitoring outbreaks. It can link cases together and show how far reaching initial infections were. Here, a system developed in the programming language R links the Irish infectious disease notification system and contact tracing system together and creates a network representation of the result. The system finds any cases or close contacts linked in any manner to the known cases. The result is a network from the earliest found case to the latest found case or contact related to the outbreak. A large outbreak of COVID-19 occurred in the student population in the West of Ireland in February 2021 with 449 cases linked to it by the Department of Public Health at the time. Using the system, 192 further positive cases were found to be linked to the outbreak. A total of 1,431 individuals were linked in some manner to it with 68% in the 19-24 age group and less than 1% in the 65+ age group. This takes a matter of seconds to run and highlights clusters within the outbreak, the largest of which had 96 cases and 121 not detected close contacts. Visualising the transmission chains also showed that there were no other large clusters outside of the outbreak at the time. A system such as this can link cases to outbreaks not previously linked, dramatically reduce the time taken to link cases together and visualise transmission chains to gain a deeper understanding of what is happening. This automated system frees up resources to allow for deeper investigation into cases and situations of concern. It also has the potential to link outbreaks together and spot previously unnoticed situations of concern.

Key messages

• Network analysis is beneficial for the monitoring of the spread of an infectious disease like COVID-19.

• Here, 192 cases were found to be linked to an outbreak that was thought to have 449 cases in it.
Lessons and long-term implications of the covid-19 response in Denmark from a resilience perspective
Authors: Vrangbæk K
Published: October 2022

The paper focuses on crisis responses and resilience within hospitals. The study is based on structured expert interviews with medical directors in selected hospital departments in two of the five regions of Denmark and primary care physicians in the same regions. We investigate stage 3 (Shock impact and management) and stage 4 (Recovery and learning) within hospital organizations using Denmark as case country, and we pay particular attention to issues of “organisational learning”, “purchasing flexibility and reallocation of funding”, “distribution of human and physical resources” and “motivated and well-supported workforce”. Particular attention is paid to care for patients with chronic care needs and lessons for the long-term resilience building in the health system. The study highlights strategic choices and lessons for the long-term resilience within hospitals. It demonstrates, how the initial strategy of organizing specific COVID-19 response units was abandoned relatively early, as it appeared more efficient to integrate COVID-19 patients in the regular specialized department structure. Emergency wards experienced increasing pressure during the pandemic as primary care clinics were referring (too) many patients suspected of COVID-19. This raises questions about capacity and relations between primary and specialized care in crisis situations. Management of human resources is crucial. While the initial phases of the pandemic response were characterized by flexibility and “team-spirit”, there has been a negative long-term impact particularly among the nursing staff, where burnouts and attrition are major issues. Pandemic crises place significant strain on health systems and personnel. This raises issues about communication of strategies and principles for organizing efforts. The Danish health system managed the crisis adequately, but there are also lessons that should be learned regarding long-term implications and preparedness for future crises.
From COVID-19 to Health System Reform: Qualitative Insights on Resilience and Lessons Learned from Finland
Authors: Tynkkynen L-K , Kihlström L , Keskimäki I
Published: October 2022

The pressure of COVID-19 on health system functioning has made policies to strengthen health system resilience a major theme of research. Accordingly, crises like COVID-19 can be seen as windows of opportunity for health system reforms to enhance health system resilience. In Finland, COVID-19 arrived on the eve of a major health system reform. In 2023 running health and social services will be transferred from 309 municipalities to 22 counties. While the reform was framed before the pandemic, we explore how lessons from COVID-19 matter for the future reform. Our results come from interviews of 53 top managers and civil servants in the year one of COVID-19, representing municipalities, municipal healthcare authorities and state agencies. The results offer a lookout to how national and local healthcare leaders view pandemic responses in connection to the future reform. Finland fared well in the pandemic compared to many countries e.g. in terms of excess deaths. However, our results reveal a tension between major issues in managing COVID-19 and implementing the reform. While the data suggest that dealing with a prolonged crisis proved challenging due to lack of trust, communication, and transparency between national and subnational actors in the health system, the dominant lessons learned and needs for reform among the interviewees build upon obvious fixes, such as ensuring supply of PPEs and ICU beds for the next pandemic. While being important in preparedness, these can build a legacy not tackling the root causes of lacking resilience and can be inconsistent with reform goals. The pandemic provides an opportunity to analyse the reformed system from a new viewpoint and may reveal weaknesses not considered in reform planning. Reforms can impact health system resilience in positive and negative ways. While different shocks may open new avenues for system transformation, they can also create path dependencies weakening the systems’ ability to prepare for unknown threats.
People, places and the climate emergency – the Scottish Place Standard Tool with a climate lens
Authors: Hasler K , Whitmore S , Wolstenholme R , Payne C , Hutton A , Fingland C , Tarvit G
Published: October 2022

Since the launch of the Place Standard tool (PST) in Scotland in 2015 awareness has increased of the critical impact of the climate emergency on health and equity. A 2019 review of the PST, informed by emerging evidence and community and stakeholder feedback, confirmed the need to strengthen its contribution towards place-based climate action. This was partly achieved by integrating enhanced prompts within the PST itself, however with the increased focus of policy and action around climate adaptation and mitigation a knowledge and resource gap remained. So in 2020 PST partners* began work with experts from environmental organisations (Sniffer, Sustainable Scotland Network) and other partners to develop a “Place Standard with a climate lens” (PST CL). The PST CL toolkit was created through an iterative process integrating feedback from 10 pilot projects chosen to represent the varied communities, scales, landscapes and placemaking projects being undertaken across Scotland. It provides a suite of materials to use alongside existing PST resources to help placemaking conversations consider how climate change might play out in a local area. This ensures that local responses to climate change are designed holistically, delivered collaboratively, and helps achieve on other local priorities such as health, wellbeing and equity. This presentation will provide a brief overview of the project background, describe the Scottish PST with a climate lens, share case study examples from the piloting phases, and enable exploration of the learning from Scotland around the value of integrating health and climate in place-based approaches. While the Place Standard tool was not originally designed as a climate change tool, it is an effective method to support the design of local responses to the climate emergency. A “climate lens” can help us to plan the future of our places to maximise the health benefits and minimise the negative consequences of a changing climate.