bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of child poverty and adversity on perceived family support in adolescence
Authors: Adjei N K , Russell Jonsson K , Straatmann V , Melis G , McGovern R , Kaner E , Wolfe I , Taylor-Robinson D C
Published: October 2023

Background

Emotional support from family members may have an important effect on adolescent health outcomes, and has been identified as a target for policy to protect against the impacts of poverty and adversity. However, few studies have assessed the extent to which poverty and adversity themselves influence the nature of emotional support that parents can provide to adolescents. We therefore aimed to investigate the impact of trajectories of poverty and family adversities on young people's relationships with their families and perceived emotional support received.

Methods

We analysed longitudinal data on 10976 children from the nationally representative UK Millennium Cohort Study. Exposure trajectories of poverty and family adversities were characterised using group-based multi-trajectory models. The outcomes were perceived emotional support and quality of family relationships, measured by the three-item Short Social Provisions Scale (SPS-3) and levels of parent-adolescent closeness and conflict, measured at age 14. ORs and 95% CIs were estimated using multivariable logistic regression models.

Results

At age 14 the overall prevalence of low perceived emotional support was 13%. Children of mothers with lower socioeconomic status (SES) were more likely to report low emotional support, with a clear social gradient. Compared with children exposed to low levels of poverty and adversity, children in the persistent adversity trajectory groups experienced higher odds of low emotional support and low-quality parent-adolescent relationship; those exposed to both persistent poverty and poor parental mental health were particularly at increased risk of experiencing poor family relationships and low perceived emotional support (aOR 2·2; 95% CI 1·7- 2·9).

Conclusions

Policies to improve levels of family support for UK adolescents should focus on improving modifiable determinants such as child poverty and family mental health.

Key messages

• Children of parents with lower socioeconomic status are more likely to experience low perceived emotional support in adolescence.

• Children who experience persistent poverty and poor parental mental health are at increased risk of poor family relationships and low perceived emotional support in adolescence.
2.A. Workshop: (Re)imagining food: representations of food to move towards more sustainable food cultures
Authors:   Organised by: EUPHA-LAW, EUPHA-GH, EUPHA-FN, EUPHA-ENV, University of Essex (UK), Dublin City University (Ireland),   Chair persons: Elena Petelos (EUPHA-HTA, EUPHA-GH)
Published: October 2023

How food is produced, sold and consumed reveals much about people, culture, policies and environments, and the relationships between them. Food has ‘meaning’. These meanings matter: they helps to express our values and what we are connected to. The various meanings of food in society are shaped by how food is represented. These representations develop and vary in time and between fields. Recent years have also witnessed growth food meanings developing in discourses on the environment. How food is represented in various fields - not least news media, social media, video games, accounts, policies and regulations, and popular culture - shape our views on health and sustainability. This workshop will explore contemporary policy and public debates about food and sustainability. It will uncover how societies approach and conceive the relationships between food, environment, and human health.

The workshop will explore several themes, including the following:

• Understanding representations of food and the natural environment in fields (eg science and technology) and in various media.

• How these representations create meaning.

• How these meanings become drivers of food and sustainability movements.

• How movements contribute to laws and policies which can support or undermine effective action on promoting sustainable consumption.

• How stakeholders - including consumers, journalists, governments and politicians, and commercial actors - can enhance narratives and their communication strategies towards a transition to a more sustainable food system.

With its interdisciplinary methodologies, this workshop will be of interest to a wide range of policy makers, practitioners and researchers working on reducing obesity and other diet-related non-communicable diseases while promoting environmental sustainability to preserve and improve the ability of generations to meet their own needs. Presentations will be short (5 minutes each) and will stimulate debates with the audience not only to disseminate knowledge but also develop policy recommendations.

Key messages

• Representations of food and the environment create meanings which, in turn, influence views, policies and strategies affecting health and environmental sustainability.

• Understanding how different actors construct representations can help enhance narratives and communication strategies to help transition towards a more sustainable food system.
Changing perceptions of ‘healthy’ food in the UK in the late 20th and early 21st century
Authors: Zhou X
Published: October 2023

My presentation examines changing public perceptions in the UK about what constitutes ‘healthy’ food in the late 20th and early 21st century. Over and above measuring the historical and cultural impact of the dichotomy of ‘healthy’ food as cure rather than food as the cause of disease as found in both public health claims as well as popular culture means engaging both lay people and scientists in understanding the impact of the meanings associated with food representations on food choice, the eating habits and nutrition. I shall also explore how foodways and food practices intersect with state public health goals as well as engaging, positively or negatively, cultural and religious practices dealing with food preparation and consumption. The corollary will also be discussed, the impact of ethnic foodways on UK nutritional practice and the claims of health and illness. Together with other presentations for this workshop, it will stimulate much needed discussions about appropriate and healthy diets as well as sustainable food culture.
Supporting drug and alcohol service users to cut down or stop smoking: review and evidence.gaps
Authors: Mc Callum A K , McKenna A , Pringle B , Gringras D , Fowler J , Martine M , Dobbie F
Published: October 2023

Background

Globally, drug and alcohol service users are underserved by smoking cessation and tobacco control services despite their high rates of smoking, smoking-related disease and interest in quitting or cutting down. DASHES (drug and alcohol users help to exit smoking) is developing and evaluating a tobacco harm reduction intervention with service users and staff of specialist third sector and NHS services, public health, and policymakers. It combines NHS Scotland behavioural change, pharmacotherapy, NRT delivered as vapes and tailored support. We sought evidence of approaches on which to build and assess our model.

Methods

Rapid review of smoking cessation interventions for drugs and/or alcohol service users. Papers screened by title and abstract, extracted using Covidence and appraised by 4 researchers using CASP guidance. Included papers were quality reviewed. We used PROGRESS-PLUS to assess consideration of equity. Narrative synthesis explored components of smoking cessation/reduction interventions.

Results

We quality reviewed 29 eligible studies. Heterogeneity and lack of power precluded meta-analysis and limited estimation of effect sizes. Some interventions fell short of existing, evidence-based practice. Despite funders and authorities requiring commitment to increasing equity and diversity of research participation, few studies monitored or addressed equity of participation, barriers to smoking cessation or provision of trauma-informed care explicitly. Promising interventions included designs and supportive features that mitigate healthcare inequities for other conditions.

Conclusions

Our review identified promising components for inclusion in DASHES but effective and equitable delivery of smoking cessation/reduction services for people using drug and alcohol services remains understudied. Lack of attention contributes to the ongoing burden of avoidable disease and death associated with tobacco-related harm in this population.

Key messages

• Smoking-related inequities will continue and drug and alcohol service users remain underserved by smoking cessation/tobacco control services until gaps in the evidence base are addressed.

• Action to assure equity in research participation, quality and design of interventions remains limited and must be addressed by policymakers funders, researchers and services.
Measuring resilience to misinformation: Development and Validation of an instrument in Portuguese
Authors: Rosário R , Martins S , Silva M J , Duarte A , Martins J , Lopes C , Augusto C
Published: October 2023

Background

A noisy information environment has led to an increase in people seeking health information; however, they may encounter and act upon misinformation that can be widely disseminated through social media. Currently, there is limited evidence regarding valid instruments for measuring resilience to misinformation in adults. We aim to develop and validate a resilience to misinformation instrument.

Methods

The development of the resilience to misinformation instrument followed standardized criteria (e.g., selecting and formulating items, scoring issues, pilot and field-testing). The items formulation was based on the examination of resilience instruments, such as the OCDE Study on Social and Emotional Skills. A panel of experts (n = 5) from the field of communication, psychology and health, and childreńs parents assessed the items for comprehensibility, relevance and completeness. A final instrument with 15 items was completed by 554 parents (82.3% mothers) with mean age of 38.7 years old (SD = 5.49). Participants were asked to indicate their agreement from ‘strongly disagree’ to ‘strongly agree’ for each item. Data were analysed using exploratory and confirmatory factor analysis to of the scale, while Cronbach's alpha and Omega MacDonald coefficients were estimated to assess its reliability.

Results

Exploratory factor analyses were conducted, and a two-factor model was obtained and tested using confirmatory factor analysis. The two factors identified (stress persistence and resistance) exhibited good internal consistency (α = 0.73; ω = 0.69).

Conclusions

The Portuguese version of the resilience to misinformation instrument demonstrated adequate psychometric criteria, indicating that it can be confidently used to assess resilience to misinformation. However, more studies are needed to provide valuable insights about resilience to misinformation among different target groups, and identify areas where further interventions are required.

Key messages

• Misinformation can be widely disseminated through social media.

• The Portuguese version of the resilience to misinformation instrument demonstrated adequate psychometric criteria.
Literacy and Attitudes Towards COVID-19 Vaccine in Cancer Patients
Authors: Ataoğlu B , Hıdıroğlu S , Alan O , Domruk ÖF , Aldağ Y , Save D
Published: October 2023

Background

Identifying motives of the patients’ decision to be vaccinated against COVID-19 and assessing their attitudes towards the vaccine will provide them acquire the most convenient health care. The aim of this study is to assess the cancer patients’ COVID-19 vaccine literacy and attitudes toward the vaccine.

Methods

This cross-sectional study included 198 participants who were submitted treatment from the oncology department of Pendik Training and Research Hospital in October 2022. The socio-demographic and clinical characteristics were examined, including the knowledge on COVID-19 infection and vaccination. COVID-19 Vaccine Literacy Scale and Attitudes Towards COVID-19 Vaccine Scale were evaluated. Mann Whitney U and Kruskal Wallis tests are used in SPSS 28. The statistical significance was set at 0.05 level.

Results

All of the patients had at least one malignancy history, and 88.4% (n = 175) of them had received at least one COVID-19 vaccine. Positive vaccination attitude was higher in those patients who are male (p < 0.05) or older than 60 years (p < 0.001). The vaccine literacy was higher in the male patients, those who had higher education, and those who had vaccination intention (p < 0.05, p < 0.05, p < 0.05). The ones who get influenza or pneumococcal vaccines were more likely to have the next COVID-19 vaccine (p < 0.05, p < 0.05). The male patients had higher scores in functional skills (p < 0.05). While functional skill scores were lowest in those aged 18 to 45 (p < 0.05), communication skill scores were highest (p < 0.05).

Conclusions

As with all infectious diseases, COVID-19 is an important public health concern. Identifying risk groups of the community based on the vaccine attitude would allow health practitioners and policymakers to be prepared for probable crisis situations such as pandemic.

Key messages

• Special groups such as cancer patients are needed to be specifically assessed about the possible outcomes of the vaccination.

• It is essential to provide vaccination consultation during pandemics due to the limited availability and accessibility of healthcare services.
The nexus of food and nutrition security in youth: linking a Canadian survey and administrative data
Authors: Webb N , Slater J
Published: October 2023

Background

Food insecurity is impacted by social determinants of health and is a risk factor for poor nutrition. Simultaneously, nutrition insecurity remains a pervasive public health concern in wealthy countries, especially for children. This study describes characteristics of youth that may increase risk of food and nutrition insecurity.

Methods

A cross-sectional study of grade nine students took place in 37 schools in Manitoba, Canada. Students completed a web-based survey on food security, diet, and nutrition-related behaviours. When consenting, parents/guardians could provide their child's health number. This sub-sample (n = 943) was linked with social and health variables through a de-identified data repository and used for this study. Bivariate associations explored relationships between sociodemographic information, diet quality, eating behaviours, mental health, and food security. A multivariable logistic regression model determined adjusted odds ratios and 95% confidence limits for food security, and a general linear model for diet quality. Significance was set at p < 0.05 for all analyses.

Results

Twenty percent of participants were food insecure and 70% had sub-optimal diets. Food security was positively associated with living in a rural area, in higher income neighbourhoods and eating family dinner more frequently, while living in a northern area or in social housing, were negatively associated. Food security was not significantly related to diet quality; however, better nutrition was associated with being female, higher self-rated health, absence of a mental health diagnosis, and more frequent breakfast consumption, while receiving social assistance and living in a northern area were negatively associated with diet.

Conclusions

While results show a socioeconomic and geographic vulnerability to food insecurity, the diet quality of most adolescents was low. A multidimensional public health approach is needed to resolve these connected yet different issues.

Key messages

• Food insecurity and nutrition insecurity are public health concerns that require distinct but related interventions.

• Scaling up income supports to resolve food insecurity is insufficient to improve dietary quality across adolescent populations.
Women's autonomy and completion of continuum of care in maternal healthcare
Authors: Jung S H , Kim R K
Published: October 2023

Background

In low- and middle-income countries, interventions to improve maternal health services throughout pregnancy, during labor, and after delivery are often targeted independently. For health optimization, it is important to adopt a more comprehensive approach and identify factors that hinder women's continuum of care (CoC) in maternal health services. This study aimed to assess the association between women's autonomy and completion of CoC in maternal health services in India.

Methods

Using the fifth National Family Health Survey, 25,515 women aged 15-49 years who had births in the past five years were analyzed. Women's autonomy was determined based on their control over decision-making (either by themselves or jointly with husband/partner) about healthcare utilization, large purchases, visits to family/relatives, and spending of money. Women were considered as having completed CoC in maternal health services if they received at least eight antenatal care visits, gave birth in health facility with skilled birth attendants, and received postnatal care within 24 hours of birth. Multivariable-adjusted logistic regression analysis was performed.

Results

Overall, 64.55% of women were identified as having autonomy and 13.68% had completed CoC in maternal health services. Women's autonomy was associated with significantly increased odds of completing CoC in maternal health services (AORs: 1.19, 95% CI: 1.05-1.36), after adjusting for demographic and socioeconomic covariates.

Conclusions

Despite substantial progress made on maternal health services, completion of CoC remains low in India. Fostering a social climate to promote women's autonomy should be considered in comprehensive interventions to ensure completion of CoC for healthy pregnancy.

Key messages

• In India, the percentage of women who received full completion of care (CoC) in maternal healthcare services remained low.

• Women's autonomy was significantly associated with higher CoC in maternal health services, highlighting the significance of women's participation in the household decision-making process.
The Transfer Patterns of Vulnerable Populations with Acute Cardio-Cerebrovascular Diseases
Authors: Choi E H , Jo J Y , Cho J H , Kwon K J , Yuk H S , Yeob K E , Park J H , Kim S Y
Published: October 2023

Background

In Korea, cardio-cerebrovascular diseases (CCDs) are the second leading cause of death. As providing appropriate treatment within the golden hour is crucial for managing acute onset CCDs, health outcomes vary depending on the accessibility of hospital. This study aimed to investigate the healthcare accessibility of vulnerable populations based on the transfer patterns with acute CCDs.

Methods

We analyzed the transfer times to final treatment hospital using the Korean National Health Insurance claim database from 2016 to 2021. We used multivariate logistic regression analysis on whether patients were transferred between hospitals after adjusting for age, gender, income level, and residence.

Results

The risk of transfer between hospitals was lower in socially vulnerable groups (elderly, low-income groups, and people with disabilities) compared to other groups (adjusted Odds Ratio [aOR]=0.65; 95% Confidence Interval [CI] 0.64-0.67 for people with disabilities vs people without disabilities), while it was higher in geographically vulnerable groups (rural) compared to other groups (aOR=2.05; [CI] 2.01-2.09 for rural vs metropolitan). Additionally, people with mild disabilities and those with visual, hearing, language, or physical disabilities showed higher transfer risk compared to other groups.

Conclusions

The risk of transfer showed opposite patterns between the two vulnerable groups with high mortality rates. The geographically vulnerable group had a higher risk due to absence treatable hospitals, while the socially vulnerable group might not have transferred even when it was necessary due to economic and physical constraints. The possibility of transfer was higher among the high-income group, which was assumed to be transferred to hospitals with better medical services. In fact, among patients hospitalized at teaching hospitals, 40% belong to the top 20% of income level. Efforts to improve accessibility for all in medical services should be continued.

Key messages

• The risk of being transferred between hospitals showed opposite patterns between socially vulnerable and geographically vulnerable groups with high mortality rates.

• Measures are needed to improve access to quality hospitals, and monitoring is necessary for situations where necessary transfers are not carried out.
Families’ social security and benefit needs when a child is diagnosed with cancer
Authors: Näsi E
Published: October 2023

When a child is diagnosed with cancer, the need for health and social services and benefits increases significantly within the family. Illness changes everyday life due to medical treatments, worry and financial challenges due to parents’ absence from work. Previous research shows that higher socioeconomic status correlates with better survival for cancer patients in Finland and abroad. The purpose of the study is to reveal the factors behind the disparate cancer outcomes among children from different backgrounds. Our aim is to build a comprehensive understanding of how families utilize services and mobilize their own social capital. The research approach is qualitative. Parents, whose child was diagnosed with cancer within 4 years, were interviewed. The interviews were analyzed with a narrative approach. The interview data was utilised in conjubction with participants’ data from the benefit register of the Social Insurance Institution of Finland (KELA). Thus, both subjective experiences and register data provide a holistic picture of families’ needs and benefit use. All families utilized more than one social benefit provided by KELA. In addition, families utilized social services and benefits provided by the municipality and patient organizations. Parents reported advice received from hospital social workers and rehabilitation counsellors very important. Social benefits and services cover only part of the families’ needs. In addition, parents reported need for concrete support such as help in household duties. The results allow for comparison among families and their social capital, e.g. the support they received from their relatives and friends. The study shows that families have a wide array of service and benefit needs when a child is diagnosed with cancer. The study helps benefit and service providers understand how families differ in their service and benefit needs and in their ability to mobilize support from their own network.

Key messages

• Families have a wide array of service and benefit needs when a child gets cancer.

• Families differ in how they mobilize support from relatives and friends during child's illness.
Being a woman or being a youth: what matters for young adults with chronic diseases?
Authors: Dauvrin M , Lenoble T , Samain T
Published: October 2023

Background

as the prevalence of chronic diseases increases with age, most interventions focus on ‘adults’ and neglect the growing proportion of chronically ill young people aged 15-24. Although they are no longer children, they are still in a period of transition towards autonomy and independence, particularly in industrialised countries. Moreover, health care for chronic patients is criticised for neglecting gender-specific needs. This exploratory collaborative study identified needs and preferences of youths living with a chronic disease with a gender lens.

Methods

we conducted 24 semi-directive interviews: 12 university students living with rare or chronic diseases; 12 health care professionals (doctors, nurses and allied health professionals). We conducted a group interview with an interdisciplinary staff in hospital and a group interview in an integrated primary care centre in 2022 in Brussels, Belgium. Alongside thematic analysis of the content of the interviews, we used the group analysis method with youths and professionals to co-construct recommendations: data were analysed and discussed in several collaborative meetings.

Results

youths insisted that professionals should listen more to youths and be more flexible. Youths stressed the need for psychological support currently absent, support regarding educational trajectory and warm environment of care similar to paediatric settings. Professionals expressed their concerns about being more gender-friendly and their lack of training regarding gender issues and other non-medical aspects of chronic diseases. Both youths and professionals consider gender-specific needs in a larger frame of patient-centred care focusing on the integration of patient preferences in a co-constructed dialogue.

Conclusions

to be youth-friendly, health services should better embrace the personalised health care planning, allowing for a better inclusion of what really matters for youths, be their age or their gender.

Key messages

• Personnalised health care planning supports gender-friendly health services.

• Personnalised health care planning supports youth-friendly health services.
Suicidal ideation in coronary heart disease patients: the role of ethnicity and lifestyle factors
Authors: Timková V , Husivargova A , Kundratova L , Nagyova I
Published: October 2023

Background

Suicidal ideation (SI) is more prevalent in people with coronary heart disease (CHD) when compared to the general population. However, studies on protective factors against SI in people with cardiovascular diseases are still lacking. Moreover, there is less known about risk factors, such as ethnicity or lifestyle factors in SI and suicidal behavior. Thus, we aimed to examine the associations between ethnicity, lifestyle factors and SI in people with CHD when controlled for sociodemographic and clinical variables.

Methods

We included 878 patients (60.0% male; 86.0% non-Roma; mean age 57.81±7.59 years; BMI 29.78±10.39 kg/m2) with CHD. All participants completed the 36-Item Short Form Survey, Food Frequency Questionnaire, Physical Activity Scale, and the General Health Questionnaire-28. Correlation analyses and multiple linear regressions were used to analyze the data.

Results

The prevalence of SI was higher in Roma people with CHD (12%) when compared to non-Roma (2.9%). Bivariate analyses showed significant associations between lower age, Roma ethnicity, lower education, lower income, poor mental health, consumption of smoked food, low consumption of fruit and vegetables, smoking, physical inactivity and SI. No association between functional status, physical quality of life and SI was identified. Multivariate analyses showed that lower age (β=-.06; p<.05), poor mental health (β=-.39; p<.001), smoking (β=.09; p<.05), and physical inactivity (β=.10; p<.01) were associated with higher SI in CHD, with an explained variance of 21.0% in SI.

Conclusions

A better quality diet and physical activity may have a positive effect on diminishing SI in CHD. A thorough understanding of the protective lifestyle factors, including physical activity, dietary habits, and being a non-smoker could facilitate the development of tailored intervention programs to improve mental health in people with CHD (Grant support: VEGA: 1/0748/22)

Key messages

• Interventions aimed at a healthy lifestyle may diminish the psychological burden in CHD patients.

• Ethnic disparities in mental health should be considered when designing public health interventions.
2.K. Skills building seminar: Nutrition: A Challenge For The Intervention Research And Health Promotion
Authors:   Organised by: French National Cancer Institute (France),   Chair persons: Jérôme Foucaud (France), Florence Cousson-Gélie (France)
Published: October 2023

Cancer is the leading cause of death in Europe, the second in North America and it's estimated that 40% of cancers are preventable. Among these cancers, it's estimated that 10,8% are attributable to unbalanced diet (5.4%) and overweight (5,4%), and in addition, a smaller proportion is attributable to lack of physical activity (0,9%). In France, it's estimated that one in two people is overweight and particular attention is paid to young people. It's recognised that the risk of cancer can be reduced when the risk factor is known and acted upon: experience has shown that this knowledge is necessary but insufficient to know how to act. Population health intervention research (PHIR), a “solutions” science, fills this gap. It's concerned with the design, implementation, evaluation, adaptation, transferability and sustainability of interventions aimed at improving the health of populations, in order to produce valid knowledge with high potential for social and health impacts. This scientific approach apprehends interventions as “events in systems” and challenges the methodological hegemony imposed for many years by the biomedical sciences and especially epidemiology approach. Finally, this approach follows to act and intervene with and for the targeted populations, particularly people in vulnerable situations.

Today, the development of PHIR in health promotion and in the field of cancer on the topic of nutrition, faces three major challenges:

- Political;

- Methodology;

- Transferability.

It's therefore proposed to give three complementary presentations directly addressing these issues on the topic of nutrition, each based on concrete examples of implementation in health promotion and in the field of cancer. The aim of this workshop is to offer a time for exchange and discussion on the challenges to be met in developing PHIR in health promotion - on the topic of nutrition - as an innovative model of research within an innovative paradigm shift. It will enable participants to clarify their conceptions of PHIR for the advancement of health promotion in oncology and to evolve these concepts in relation to these three key issues. An interactive format is proposed, including time for discussion based on participants’ perceptions and time for presentations.

Key messages

• PHIR: an effective scientific approach and a relevant tool for thinking about and developing health promotion policies on the topic of nutrition.

• New research paradigm in health promotion and the fight against cancers, particularly linked to unbalanced diet and overweight, based on intervention with populations to act on the determinants of health.
Sustaining health and well-being in the built environment
Authors: Kacel S , Altomonte S
Published: October 2023

Public health is strongly interconnected with the physical, social, and economic environment, and with people's needs, preferences, and behaviours. Physical factors affect human health and well-being (e.g., temperature, light, sound, air), as much as spatial qualities (e.g., physical activity, active communities), and feelings of safety and security (e.g., mental health, restoration). The design, operation and maintenance of the built environment can reduce health threats to inhabitants, allowing them to flourish and thrive. Yet, although human factors are starting to be implemented in building criteria and rating tools (e.g., Flourish Wheel, WELL Building Standard, etc.), comprehensive frameworks are needed to combine metrics and methods, and systematically evaluate health and well-being in buildings. This can allow to recommend guidelines and interventions that policy-makers can adopt to improve standards in the building stock, including housing that is today a crucial public health priority. This research critically consolidates existing metrics and methods to benchmark health and well-being in built spaces and proposes, through a wide interdisciplinary perspective, a robust and practical set of tools to support human experience and outcomes within the built environment. The study first elaborates on the common definitions of health and well-being in buildings. Through a systematic review, using the PRISMA and PICOC approaches, health and well-being metrics and methods are then identified. A framework and post-occupancy evaluation protocol are then developed, to be implemented within an interactive tool. The protocol can be used as a toolkit to, holistically, measure and benchmark health and well-being in buildings in use. The tool brings the evaluation toolkit together and provides recommendations. This study wishes to offer a valuable contribution towards securing public health, improving the qualities of the habitats that sustain a large part of our daily life.

Key messages

• Physical environment affect human health and well-being through physical factors, spatial qualities, and feelings of safety and security.

• Measuring and benchmarking health and well-being in buildings and providing recommendations contribute to securing public health of the inhabitants, and improving the qualities of the habitats.
After the 2021 Air Quality Guidelines (AQGs): a scoping review study protocol on air pollution
Authors: Monti M , Broccoli S , Angelini P , Giorgi Rossi P , Ranzi A
Published: October 2023

Background

Outdoor air pollution is a known risk factor for human health. In 2021, the World Health Organization (WHO) updated its former guidelines on air quality, considering the latest body of evidence (up to 2018) about health impact of different air pollutants. Yet, according to the WHO, some issues are well-covered, while others need further investigation. This scoping review is part of the “Air and Health” monitoring and research project promoted by Emilia-Romagna, a region of Italy located in the Po valley, the area with the highest concentration of air pollutants in Western Europe. It will summarize the literature produced after 2018 regarding long-term (LT) health effects of outdoor air pollution, describing whether recent studies are focused on reinforcing established results or on emerging topics.

Methods

The review follows the PRISMA extended for Scoping Reviews (PRISMA-ScR). We will conduct an online search on databases (Pubmed, EMBASE), reviewing the strings against the PRESS 2015 Evidence-Based Checklist. The eligibility criteria are: relation to outdoor air pollution and its LT effects on human health (excluding occupational setting), original research, any language (abstract in English), date of publication between 2019/01/01 and 2023/04/30. Further studies may be identified through reference crosscheck. Two authors will independently conduct the title/abstract screening, excluding the non-eligible reports via reference management software. In case of disagreement, a decision will be taken through consensus. Included articles will be summarized according to pollutant-outcome pairs investigated: confirmatory (pairs included in AQGs) or innovative (pairs not included in AQGs).

Results

The preliminary search string identified more than 1000 papers to be screened.

Conclusions

The review will provide an insight in recent literature directions, whether it is confirmatory or innovative, to find possible gaps in the light of research needs identified by AQGs.

Key messages

• Outdoor air pollution is a risk factor for human health, but uncertainties still remain.

• A review of the literature after the 2021 WHO global AQGs can orient future investigations.
Refreshed academic viewpoint on patient data ownership in digital health context
Authors: Mirchev M
Published: October 2023

Background

Digital health involves generating and communicating large sensitive patient data sets. There is significant potential in its applications, but also some impediments. Our previous study showed that ownership of patient data is a problem in digital health context, not fully understood and often neglected. However, in the last two years, increased attention to this issue is observed and we aim to find if the medical academic community changed its viewpoint on patient data ownership in the context of digital health.

Methods

Our previous study (2014-2020) identified 27 relevant to the problem articles. A comprehensive search of PubMed, ScienceDirect and Scopus, performed between January 2021 and April 2023, identified 21 appropriate full-text publications focused on patient data ownership (problem) in digital health (context). Research questions included scientific area of publication, perception and aspects of ownership, possible solutions.

Results

The publications are in medical and public health (43%), digital health and medical informatics (29%), technical (19%), law and ethics (9%) journals; 71% with impact factor; authored by 38% EU, 24% USA, 9% UK, 9% Brazilian academicians. The majority (86%) are in the area of medical research - access, control, patient data sharing and use, secondary and passive data use, registries, AI, wearables, sensors; ethical challenges to digital health; 90% still perceive ownership as a challenge, arising in relation to medical research and data generated from the IoT, wearables, sensors, apps and social media. All publications discuss ownership in ethical and legal aspects and find the solution in proper legislation.

Conclusions

Digital health with its huge amounts of generated data brings forward the overlooked issue of patient data ownership as a challenge to medical research. Academic attention is rising, and addressing this challenge requires the combined efforts of all stakeholders for suitable amendments in the legislation.

Key messages

• Ownership of patient data in the context of digital health is a problem, especially for medical research, that should not be neglected and needs a comprehensive attitude from all stakeholders.

• Proper legislation concerning patient data ownership may help in improving international academic medical and public health research, healthcare services, and the health of the population as a whole.
FeMFit: Feasibility of tracking the menstrual cycle using digital questionnaires and wearable devices
Authors: Lang A , Bruhn R , Fehling M , Heidenreich A , Khanyaree I , Henningsen M , Remschmidt C
Published: October 2023

Introduction

Despite its importance to female reproductive health and its impact on women's daily lives, the menstrual cycle and its effects on health remain poorly studied. Conventional clinical trials rely on infrequent in-person assessments. The aim of this study was to explore the technical feasibility of collecting longitudinal wearable and digital questionnaire data and its potential for gaining biological insights on the menstrual cycle.

Methods

This prospective observational cohort study was conducted online over twelve weeks using a digital study app and Fitbit inspire 2 devices. 42 individuals were recruited by their gynecologist in a practice in Berlin, Germany. Statistical analysis included descriptive statistics of user behavior and retention and comparative analyses of symptoms and sensor metrics at different phases of the menstrual cycle.

Results

We collected data of 114 ovulatory cycles from 33 participants, with nine out of 42 individuals dropping out within two weeks of study start. Participants reported a total of 2,468 symptoms during the luteal phase and menses. Despite difficulties with data completeness due to retention problems and drop-outs, the combined questionnaire and sensor data collection was technically feasible and produced interesting biological insights. Preliminary analysis of questionnaire and wearable data showed an increased heart rate in the mid and end luteal phase compared to menses and lower step count (mean 10,283 ±6,277) with strong symptoms of premenstrual syndrome (PMS, no/low PMS 11,694 ±6,458).

Conclusions

We demonstrate the feasibility of using an app-based approach for collecting combined wearable and questionnaire data on menstrual cycles. Dropouts showed that engagement efforts would need to be improved for larger studies. Despite the challenges faced in collecting wearable data on consecutive days, the collected data provided valuable biological insights that should motivate further research at large scale.

Key messages

• Using an app-based approach for collecting combined wearable and questionnaire data on menstrual cycles was technically feasible and delivered interesting biological insights.

• User engagement efforts need to be improved to reduce drop-outs and ensure consecutive data collection.
Territorial Coordination Centres and Telenursing: innovation and digitalisation of home care in Italy
Authors: Iodice M , Carini E , Scotellaro M , Martini L , Cosentino M , Roscio G , Borghini A , Mantoan D
Published: October 2023

Issue

After Covid-19, Italy approved the National Recovery and Resilience Plan (NRRP) to boost public health, sustainability and digital innovation, which promotes ecological and digital transition reforms. The strategic health reform redesigned territorial healthcare network by introducing new models of proactive care, as Territorial Coordination Centres (TCCs) and Telenursing.

Description of the problem

TCC is an innovative organisational model, that coordinates taking care by linking services and professionals involved in different care settings. In TCCs are involved nursing staff, that performs a telemedicine service called Telenursing, a way of delivering nursing care directly to the patient's home, through digital health tools. How will TCCs be implemented, using NRRP funds? How will Telenursing impact on home care?

Results

By 2024, 600 TCCs are planned to be implemented and fully operational, across the Country, financed by NRRP (280 bln €). The standard set by the NRRP reform is 1 TCC each 100,000 inhabitants, with 4-6 primary nurses involved (2,400-3,600 nationally). TCCs are organised to be interconnected with every healthcare network setting, including home care. Telenursing, within the TCCs, aims to guarantee proactive, personalised and proximity care, enhancing the home as a privileged place of care. Nurses of TCCs perform health monitoring, assessment, promotion, prevention and education by Telenursing, in order to reduce inappropriate hospital admissions and to increase patient satisfaction, safety and empowerment. By 2026, at least 200,000 people will be assisted through telemedicine tools, as planned in NRRP reform (funding 1 bln €).

Lessons

Italy, pursuing better health outcomes for the population, is investing in strengthening public primary care services and digitalization of services. New strategy aims to improve health of population and decrease health inequalities, while reducing geographical variations.

Key messages

• Telenursing performed by nurses working in TCCs is aimed at improving proactive, personalised and proximity care, supporting patients and caregivers at home.

• By 2024, TCCs will be fully operating to guarantee an innovative system of public primary care, that uses digital tools to manage population in home care, reducing inappropriate hospitalization.
Lung cancer mortality and soil content of arsenic and cadmium: an ecological study in 26 EU countries
Authors: Bartnicka J J , Dyba T , Yunta Mezquita F , Rodriguez Rasero F , Randi G , Jones A , Carvalho R
Published: October 2023

Background

Environmental risk factors, such as exposure to air pollution, are linked with lung cancer. However, potential health impacts of exposure to carcinogenic pollutants in soil are less defined. In this ecological study, we evaluated at a regional scale potential associations between lung cancer mortality and the soil content of two carcinogens: arsenic and cadmium.

Methods

Data on deaths from lung cancer were from EUROSTAT. Soil content of arsenic and cadmium were from the Land use/cover area frame (LUCAS) 2009 survey. Analysis covered 26 EU countries and 21,035 sampling points. Three socioeconomic indicators and seven lung cancer risk factors were included. Data were linked at the NUTS2 level (n = 219) and analysed by negative binomial regression.

Results

After inclusion of significant predictors, the ratio of lung cancer mortality rates in the population resident in the regions within the highest quantile of arsenic concentration in soil, compared to the rest of the dataset, was 1.062 for females (95% CI 1.024 - 1.101) and 1.037 for males (95% CI 1.020 - 1.074). In the regions within the highest quantile of cadmium in soil, compared to the lower quantiles, the ratio of the mortality rates was 1.062 for females (95% CI 1.019 - 1.101) and 1.075 for males (95% CI 1.033 - 1.117). When data were stratified by land cover, significant (p < 0.05) positive associations in males were only shown for cadmium sampled from agricultural land (cropland and grassland) but not from the non-agricultural land.

Conclusions

Higher rates of lung cancer mortality were reported in regions with high concentration of arsenic or cadmium in soil, relative to regions with lower concentration. Due to the ecological design, this study cannot prove causality but is in agreement with other reports linking exposure to arsenic or cadmium and lung cancer. This warrants future investigations at a finer geographical scale, focused on regions with high soil levels of arsenic and cadmium.

Key messages

• Higher lung cancer mortality rates were reported in regions with high concentration of arsenic or cadmium in soil, relative to regions with their lower concentration.

• There was an association between cadmium in soil and lung cancer mortality in males for the subset of sampling points from the agricultural land but not for the non-agricultural land.
Impacts of the COVID-19 pandemic on the breast cancer control pathway in Ireland
Authors: Tierney P A , McDevitt J , Brennan A , Zhang M , Mullooly M , Bennett K , Walsh P M , Murray D
Published: October 2023

Background

The COVID-19 pandemic caused unprecedented disruption to healthcare services worldwide including cancer services. The aim of this study is to assess the impact of the COVID-19 pandemic on aspects of the breast cancer control pathway in Ireland, including case counts, method of presentation, stage distribution, and treatment.

Methods

Analyses used data from the National Cancer Registry Ireland available as of April 2023. For assessments of case counts, 2020 data was compared to ‘expected’ case counts projected from a Joinpoint regression model of the last stable trend in breast cancer cases up to 2019. For assessments of method of presentation, stage distribution, and treatment, 2020 data was compared to equivalent 2019 data.

Results

There was a 23% reduction in number of breast cancer cases diagnosed in in Ireland in 2020 than expected from pre-2020 trends. Comparing methods of presentation, screen-detected tumours showed the largest reduction from 2019 to 2010. There was comparatively little change in numbers of breast cancers presenting through symptoms. Comparing cancer stage from 2019 to 2020, there was a significantly larger reduction in pT1 tumours than in pT2, or pT2-3, or pT2-4 tumours. Similarly, there was a larger reduction in Stage I than in any other stage and in Grade 1 than in Grade 2 or Grade 2-4 cancers. Investigation of breast cancer treatment showed a small reduction in the percentage of cases treated by surgery and by radiotherapy but no apparent change in the percentage of cases receiving chemotherapy/immunotherapy.

Conclusions

Patient behavioural changes, pauses in screening, and restricted healthcare access as a result of COVID-19 likely contributed to the observed reductions in case counts and screen-detection of breast cancer. The reduction in early stage breast cancers in 2020 is likely also related to screening disruption. Treatment modes may have been altered during the pandemic to reduce infection risk to cancer patient in hospitals.

Key messages

• The COVID-19 pandemic caused disruption to the breast cancer control pathway in Ireland.

• Case counts and screen-detection of breast cancer as well as the proportion of early stage breast cancers diagnosed were reduced in Ireland in 2020.