bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex differences in sudden cardiac death: a nationwide study of 54,028 deaths in Denmark
Authors: Skjelbred T , Rajan D , Svane J , Lynge T H , Winkel B G , Tfelt-Hansen J
Published: October 2021

Background

Sudden cardiac death (SCD) is a leading cause of death. SCD is more common among males. In women SCD is, however, still the leading cause of death. The SCD epidemiology among women is less studied.

Purpose

The aim of this study was to examine how incidence rates, clinical characteristics and causes of SCD vary between males and females.

Methods

All deaths in Denmark in the 2010 (54,028) were included in the study. Autopsy reports, death certificates, discharge summaries and nationwide health registries were reviewed to identify cases of SCD. Sex and age specific SCD incidence rates in the general population were calculated, and age-adjusted clinical characteristics were compared using logistic regression.

Results

A total of 6,867 SCD cases were identified, of which 3,859 (56%) were males and 3,008 (44%) were females. Incidence rates increased with age and was higher for males across all age groups in the adult population. Average age of SCD was 71.3±14.3 years among males compared to 79.4±13.3 among females (mean ± standard deviation, p<0.0001). The greatest difference in incidence between males and females was found among the 35–50-year group with an incidence rate ratio of 3.7 (95% confidence interval: 2.8–4.8). Although the males were younger, males more often had cardiovascular diseases and diabetes mellitus prior to SCD. Among autopsied cases, coronary artery disease (CAD) was the leading cause of death among both sexes. Structural causes of SCD, other than CAD, were more common among women (p<0.01).

Conclusion

In this nationwide study of sex differences in SCD across all age groups, the differences in incidence rates between males and females were greatest among young adults and the middle-aged. Incidence rates of SCD among older females approached that of the male population, despite significantly more cardiovascular disease and diabetes mellitus in the male population in the 10 years prior to SCD.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Potential low-density lipoprotein cholesterol, cardiovascular risk and costs reduction with evolocumab: a simulation in patients with a recent myocardial infarction in Spain
Authors: Escobar-Cervantes C , Fernandez-Delgado M , Roldan C , Sicras-Mainar A , Villa G
Published: October 2021

Background/Introduction

FOURIER included 5,711 patients with a recent myocardial infarction (MI) and a median low-density lipoprotein cholesterol (LDL-C) of 90 mg/dL. Reducing LDL-C with evolocumab reduced the risk of major cardiovascular (CV) events by 2.1%, in absolute terms, over 2.3 years. Further research may be conducted to understand the potential benefits of evolocumab in the real world.

Purpose

Simulate the potential LDL-C, CV risk and costs reduction among a cohort of patients with a recent MI in Spain.

Methods

We considered data from a retrospective observational study using the BIG-PAC database, with anonymized electronic medical records from 1.9 million inhabitants from 7 regions in Spain. Eligible patients were adults, hospitalized for an MI (index date) between January 2015 and December 2017, treated with high-intensity lipid-lowering therapy, and with LDL-C available at baseline and at the end of follow-up (up to 18 months). For each patient, we 1) predicted their CV risk using the REACH equation; 2) simulated their LDL-C reduction based on FOURIER and assessed whether they had achieved the 2019 ESC/EAS LDL-C goals; 3) simulated their relative CV risk reduction (RRR) based on the key secondary endpoint in FOURIER and calculated their absolute CV risk reduction (ARR) over 2 years. Costs (direct and indirect), excluding medication, were computed based on achieved LDL-C categories, before and after evolocumab treatment. We conducted separate analyses for patients with LDL-C ≥100 mg/dL (current reimbursement recommendation in Spain) and LDL-C ≥70 mg/dL.

Results

LDL-C, CV risk and costs, before and after evolocumab treatment, are presented in Table 1. We included 1,941 patients with LDL-C ≥100 mg/dL and 3,725 patients with LDL-C ≥70 mg/dL. Median absolute LDL-C reduction was 73 mg/dL and 59 mg/dL for patients with LDL-C ≥100 mg/dL and LDL-C ≥70 mg/dL, respectively. 53% and 65% of the patients achieved LDL-C <55 mg/dL, respectively. Median ARR was 3% and 2% over 2 years, respectively. Mean costs were reduced by 1,565 EUR and 1,296 EUR, respectively.

Conclusions

The sub-cohort of evolocumab users with LDL-C ≥70 mg/dL had similar baseline LDL-C and CV risk than patients enrolled in FOURIER, and therefore CV risk reduction was also consistent. Evolocumab reduced LDL-C, CV risk and costs in the two sub-cohorts analysed, but the clinical and economic benefit was larger in patients with LDL-C ≥100 mg/dL.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Amgen
Characterization of cholesterol efflux capacity in diabetic and non-diabetic patients with coronary artery disease: comparison between acute coronary syndrome and stable coronary artery disease
Authors: Funabashi S , Kataoka Y , Ogura M , Kuyama N , Otsuka F , Asaumi Y , Noguchi T
Published: October 2021

Introduction

Type 2 diabetic patients more likely exhibit a lower high-density lipoprotein (HDL) level. Given a greater glycation and oxidative stress in diabetic subjects, these atherogenic characteristics could cause dysfunctional HDL including a reduced cholesterol efflux capacity (CEC), which may account for an increased risk of diabetic macrovascular disease including acute coronary syndrome (ACS). However, it remains to be fully elucidated characteristics of HDL-mediated CEC in type 2 diabetic patients, in association with clinical presentation of coronary artery disease (CAD).

Purpose

To characterize CEC in CAD subjects with type 2 diabetes mellitus.

Methods

The current study prospectively analyzed 87 statin-naive patients with CAD. CEC was measured by using the collected apolipoprotein B-depleted serum. Liquid scintillation counting (Perkin-Elmer Analytical Sciences, MA, US) was used to quantify the efflux of radioactive cholesterol from J774 cells. Clinical characteristics and CEC were compared in diabetic and non-diabetic subjects.

Results

The averaged HbA1c in diabetic patients was 6.7±1.2, and 66.7% of them achieved HbA1c <7.0%. Diabetic subjects more likely exhibited a history of hypertension and dyslipidemia, and multi-vessel disease (Table). Moreover, a lower CEC level was observed in diabetic patients, accompanied by a lower HDL-C and apolipoprotein A-I levels with a higher level of triglyceride (Table). HDL-C (r=0.62, p-value<0.01) and Apolipoprotein A-I (r=0.70, p-value <0.01) were associated with CEC, whereas there was no significant difference in CEC between subjects with HbA1c <7.0% vs. ≥7.0% (0.74±0.07 vs. 0.78±0.08, p=0.22). On multivariate analysis, type 2 diabetes mellitus was an independent contributor to CEC <0.79 (median) (HR=2.75, 95% CI: 1.11–6.82, p=0.03). Interestingly in particular, CEC was substantially lower in diabetic patients with ACS compared to those with stable CAD (Figure). By contrast, clinical presentation of CAD did not affect CEC in non-diabetic subjects (Figure).

Conclusions

A lower CEC level was observed in subjects with type 2 diabetes mellitus. In particular, this HDL functionality was profoundly diminished in those presenting ACS. Our findings suggest functionality of HDL as a potential therapeutic target in diabetic patients experiencing ACS.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1
Cardiac rehabilitation in COVID-19 pandemic period
Authors: Costa J C , Mouici I , Bichon-Treulet L , Nazeyrollas P , Metz D
Published: October 2021

Background

The current COVID-19 pandemic constitutes a challenge in cardiovascular disease (CVD) management. Little is known on how the virus impacts cardiac rehabilitation (CR) programs (CRP) safety and efficacy.

Aim

To evaluate the efficacy of basic sanitary procedures to limit the risk of virus spreading in patients undergoing cardiac rehabilitation in ambulatory setting.

Methods

From august to October 2020, all patients admitted in a single ambulatory CR program were screened for COVID-19 infection before and after CR. Negative naso-pharyngeal swab through RT-PCR was mandatory within seven days before starting the program, and advised after leaving the program. Serologic tests were also advised before and after the CRP. Number of patients were reduced from 9 to 4 in each group, 2 meters distancing respected, and all patients and staff had to wear surgical mask during sessions. Regular hand washing and hydro-alcoholic solutions use were mandatory for both patients and health professionnals. Material disinfection was systematic before and after each session.

Results

Among the 81 patients included, 63 (76%) were male, mean age was 57±11 years (see table). Sanitary protection measures were well applied and tolerated, especially use of surgical mask during exercice sessions. After RT-PCR on nasal swab, none (0%) were positive before entering CR and only 2 (2.7%) were tested positive after CR. These two patients were asymptomatic. The other patients in the same group as those having positive nasal test after CR were tested negative and were asymptomatic. According to serological analysis, the same 3 patients (3.8%) had anti-bodies against SARS-COV-2 before and after participating CR (see graph). These 3 patients were negative on nasal swab before and after CR. No seroconversion was observed. Mean delay between first and second RT-PCR on nasal swab and serological analysis were 30±15 and 32±15 days, respectively. In total (before and after CR), 5 patients (6.0%) were tested positive with SARS-COV-2. Those 5 patients were younger (mean age 51 years old versus 58, p=0.2), with better functional capacity before and after CR: respectively 7.1 METs (versus 5.2 METs, p=0.014) and 8.3 METs (versus 6.3 METs, p=0.03). In COVID+ patients, improvement of functional capacity was similar to COVID− patients: respectively 0.8 METs (p=0.9) and 15 Watts (p=0.9).

Conclusion

During COVID-19 pandemic, cardiac rehabilitation is not associated with risk of infection with SARS-CoV-2, provided that basic sanitary measures are stricly applied. It is also associated with functionnal capacity improvement, especially in patients who previously had COVID-19.

Funding Acknowledgement

Type of funding sources: None. Patients baseline characteristics in CRPatients COVID-19 status in CR
Atrial fibrillation in patients with a history of cancer and risk of bleeding complications associated with antithrombotic therapy
Authors: Chu G , Van Rein N , Huisman M V , Pedersen L , Klok F A , Cannegieter S C , Sorensen H T
Published: October 2021

Background

Up to one in four patients with atrial fibrillation (AF) has a cancer diagnosis. It is largely unknown to which extent a prior cancer diagnosis affects major bleeding and thromboembolic risk in AF patients. Moreover, data on major bleeding rates per antithrombotic treatment type are lacking in these patients.

Purpose

To examine the incidence rates of major bleeding per antithrombotic treatment in AF patients with prior cancer and to examine whether cancer type and the time-interval between AF and cancer influence major bleeding and thromboembolic risks.

Methods

This nationwide population-based cohort study included incident Danish AF patients aged ≥50 years between 01–01–1995 and 31–12–2016. Data on prior cancer, major bleeding and thromboembolisms (i.e. arterial and venous) were obtained from Danish health registries via International Classification of Diseases 10th Revision codes. We stratified according to prior cancer and by time between the AF and cancer diagnosis (i.e. <1 year, 1–3 years, >3 years), and cancer type. Data on antithrombotic exposure (e.g. no anticoagulant treatment, platelet inhibitors, vitamin K antagonists, direct oral anticoagulants, or combination of antithrombotic drugs) were evaluated as a time-dependent variable. We computed incidence rates per 100 patient-years and adjusted hazard ratios in a Cox regression model.

Results

We identified 39,178 AF patients with a prior cancer diagnosis. Bleeding risk increased with increasing number of antithrombotic drugs and was higher in AF patients with a history of cancer compared to those without, across all exposure categories (Figure 1). The increased bleeding risk was similar across different time intervals between cancer and AF diagnosis. The increased thromboembolic risk steeply declined with increasing time intervals between AF and cancer diagnosis (Figure 2). Prior gastrointestinal, intracranial, haematological, respiratory and urogenital cancers were associated with an increased bleeding risk. The two latter cancer types were also associated with increased thromboembolic risks.

Conclusion

We showed that patients with atrial fibrillation and a prior history of cancer experience higher rates of bleeding than those without cancer. Both respiratory and urogenital cancers had the highest rates of bleeding and thromboembolisms.

Funding Acknowledgement

Type of funding sources: None.
Renal decline in patients with atrial fibrillation treated with rivaroxaban or warfarin: a population-based cohort study in the United Kingdom
Authors: Garcia Rodriguez L A , Balabanova Y , Saez M E , Brobert G , Gonzalez-Perez A
Published: October 2021

Background

A recent observational study (1) has suggested that renal decline among patients with non-valvular atrial fibrillation (NVAF) could be faster in users of warfarin vs. rivaroxaban.

Purpose

To estimate renal decline in patients with NVAF and preserved renal function who started oral anticoagulant (OAC) therapy with rivaroxaban 20 mg or warfarin.

Methods

Using primary care electronic health records (EHRs) from the United Kingdom (UK), we identified patients with NVAF who initiated rivaroxaban (20 mg/day, N=5338) or warfarin (N=6314) from January 2014–March 2019. Patients were excluded if they had no estimated glomerular filtration rate (eGFR) or serum creatinine (sCr) values recorded in the year before OAC initiation, a history of end-stage renal disease (ESRD), or baseline eGFR <50 ml/min/1.73m2.

We identified three renal decline outcomes during follow-up: a) doubling of sCr levels, b) ≥30% decline in eGFR (confirmed by a subsequent measurement), and c) ESRD (code for ESRD/stage 5 CKD/chronic dialysis, or eGFR <15 ml/min/1.73m2 confirmed by subsequent measurement). To identify incident cases of each outcome, we followed patients from OAC initiation to the earliest of a renal decline event, death, or the end of the study period (September 2019). Cox regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome with rivaroxaban vs. warfarin use, overall and among heart failure and diabetes patient subgroups. We estimated the average eGFR slope using a mixed model regression among the subset of individuals with at least two eGFR measurements during follow-up, where the first was recorded within 120 days of the start of follow-up, and the last was recorded >180 days after the first eGFR measurement (rivaroxaban n=2054, warfarin n=2464).

Results

After a mean follow-up of 2.5 years, the number of incident cases was: doubling sCr (n=322), ≥30% decline in eGFR (n=1179), and ESRD (n=22). As shown in the Table, after adjusting for age, sex, baseline renal function and comorbidity, HRs for the renal outcomes with rivaroxaban vs. warfarin users were: doubling sCr, 0.63 (95% CI: 0.49–0.81); ≥30% decline in eGFR, 0.76 (95% CI: 0.67–0.86); ESRD, 0.77 (95% CI: 0.29–2.04). Similar results were observed among patients with diabetes or heart failure. Estimated mean loss in renal function during the study period was 2.03 ml/min/1.73 m2 per year among warfarin users and 1.65 ml/min/1.73 m2 among rivaroxaban initiators (p=0.03).

Conclusion

The risk of renal decline events and rate of decline in renal function among patients with baseline eGFR >50 ml/min/1.73m2 was lower in patients using rivaroxaban 20 mg vs. warfarin. As residual confounding could have been present, further research is needed to confirm/refute our findings.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Bayer AG
Quantifying preload alterations using a sensitive chest-mounted accelerometer
Authors: Schmidt S E , Kristensen C B , Soerensen K , Soegaard P , Mogelvang R
Published: October 2021

Seismocardiography (SCG) is a technology where the chest wall vibrations from the beating heart are measured using a highly sensitive accelerometer. SCG offers continuous measurement of cardiac function and potential applications include remote monitoring, diagnostic assessments, prognostic health checks and biventricular pacemaker optimization.

Aim

In the current study we examined how changes in preload influence SCG time intervals, by acute saline infusion.

Methods

We included twenty-six subjects, sixteen subjects with cardiac disease such as hypertrophic cardiomyopathy, dilated cardiomyopathy, aortic valve disease or ischemic heart disease (age 45.8±17.7 years and 93% male) and ten subjects without known cardiac conditions (age 42.1±14.4 years and 70% male). SCG was recorded from the xiphoid process using a custom-made sensor before and after acute infusion saline (median 2.0 L). The SCG signals were sampled with 5000 samples per second in 60 seconds, the individual heartbeats were identified using a dedicated segmentation algorithm and an average SCG beat was computed and used for the data analysis. Using a recently proposed nomenclature the following SCG fiducial points was identified: Es which coinciding with mitral valve closure, Gs which to some degree coincides with aortic opening, Bd coinciding with aortic valve closure and Fd coinciding with mitral valve opening [1]. The Es-Gs time interval was used as a measure of isovolumetric contraction time (IVCT), the Gs-Bd time interval was used as an estimate of ejection time (ET) and the Bd-Fd time interval as an estimate of isovolumetric relaxation time (IVRT). Paired t-test was used to test for significant response after infusion, while a two sample t-test was used to test for a significant difference in the observed response in subjects with or with our cardiac disease.

Results

For two subjects SCG after infusion was not obtained thus, twenty-four subjects were included in the final data analysis. In the whole group, acute saline infusion shortened the IVRT (Bd-Fd) from 91.0±15.3 ms to 82.7±15.3 ms (p=0.004) and prolonged the ET (Gs-Bd) from 329.4±35 ms to 343.4±33 ms (p<0.001). There was no significant change in IVCT (Es-Gs) which was 39.5±15.1 ms at baseline and 38.1±14.9 ms post-infusion (p=0.88). There was no significant difference in response between subjects with or without cardiac disease.

Conclusion

Increase in preload shortened the SCG time intervals related to the isovolumetric relaxation period and prolonged the period related to ejection time. SCG time intervals capture changes in preload, which demonstrates that the SCG is a potential modality for quantification of cardiac dynamics.

Funding Acknowledgement

Type of funding sources: None.
Association between metabolic syndrome and incident colorectal cancer in young adults: analysis of a nationwide epidemiological database
Authors: Seki H , Kaneko H , Yano Y , Itoh H , Morita K , Kiriyama H , Kamon T , Fujiu K , Michihata N , Jo T , Takeda N , Morita H , Yasunaga H , Komuro I
Published: October 2021

Background

Colorectal cancer (CRC) is still increasing in young adults. Metabolic syndrome is reported to be associated with CRC incidence in middle-aged and elderly subjects. However, whether this association exists in young adults remains unclear. We sought to clarify whether metabolic syndrome was associated with incident CRC in young adults (aged<50 years).

Methods

We studied 902,599 participants (Median age=41 [37–45] years; 55.4% men) enrolled in the JMDC Claims Database during 2005 and 2018. Participants who had a history of CRC, colorectal polyps, Crohn's disease, or ulcerative colitis were excluded. Study participants were categorized into two groups according to the presence of metabolic syndrome based on the Japanese criteria (waist circumference ≥85 cm for men and ≥90 cm for women, and ≥2 metabolic parameters including elevated blood pressure, elevated triglycerides, reduced high-density lipoprotein cholesterol, or elevated fasting plasma glucose).

Results

Metabolic syndrome was seen in 58,561 individuals (6.5%). Over a median follow-up of 1,008 (429–1,833) days, there were 1,884 CRC diagnoses. After multivariable adjustment, the hazard ratio (HR) of metabolic syndrome for CRC events was 1.26 (95% confidence interval [CI]=1.07–1.49). Cox regression analysis after multiple imputation for missing values showed that metabolic syndrome was associated with CRC incidence (HR=1.35, 95% CI=1.17–1.56), and metabolic syndrome was associated with a higher incidence of CRC in individuals with a follow-up period of ≥365 days (HR=1.33, 95% CI=1.10–1.60). This association was also observed when metabolic syndrome was defined according to the International Diabetes Federation criteria (HR=1.30, 95% CI=1.09–1.49) and the National Cholesterol Education Program Adult Treatment Panel III criteria (HR=1.39, 95% CI=1.12–1.72).

Conclusions

Metabolic syndrome was associated with a higher incidence of CRC among individuals aged <50 years. These results could be informative for risk stratification of subsequent CRC among young adults.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141)
Research Electronic Data Capture (REDCap): tackling data collection, management, storage, and privacy challenges
Authors: Van Bulck Liesbet , Wampers Martien , Moons Philip
Published: October 2021

Data are the basis of research; without data, there is no research. However, growing internationalization of research, increased complexity of study designs, and stricter legislation make high-quality data collection, management, and storage more important, but also more challenging than ever. This article provides an overview of common challenges clinical researchers face when collecting, managing, and storing data and how REDCap, Research Electronic Data Capture, can be a possible solution to address these challenges.
The response to COVID-19 and legal determinants
Authors: Lingri Dimitra
Published: October 2021

The panelist will focus on the distinction between ethics, law and on requirements towards building progressive alternatives from the legal perspective. It will also examine the impact legislative and regulatory framework and jurisprudence have on the enjoyment of the right of health during COVID-19. During the pandemic many national frameworks used emergency law in order to introduce containment and mitigation measures into society. Most of these were enacted as emergency legislation, and this poses certain additional challenges in terms of the rule of law, given the often limited impact assessment or the absence of judicial review. These key characteristics that carry an element which can only be deemed appropriate given temporal limitations. From divergent national responses to combat COVID-19 to broader multilateral agreements on global health security, inequities have come to the fore. Assessing the proportionality of measures adopted to achieve legal aims necessitates an interdisciplinary and cross-sectoral collaboration and examination, as well as embedding mechanisms to systematically monitor broader implications for global health, and societal cohesion and resilience. Law is a part of interdisciplinary collaboration needed to achieve efficient commitments in order to combat the COVID-19 pandemic effectively. Even though law itself is not a panacea, remedying broader societal inequities, it is an essential step needed towards implementation of effective health policies into society. Indicative examples on aspects of interest and steps taken by payers to ensure equitable access for all will be elaborated upon. An overview on the implications of dynamics between developed and developing countries will also be presented, with due emphasis on the future of both European and global health and partnerships for accessibility and accountability.
Child health and wellbeing in a changing climate
Authors: Sripada K
Published: October 2021

Children are one of the most sensitive groups to climate change, along with the elderly and those in small island developing states, according to the Intergovernmental Panel on Climate Change. UNICEF estimates that more than half a billion children are estimated to live in extremely high flood risk areas. Children are vulnerable to both the sudden events linked to climate change (e.g., flooding, heatwaves, and wildfires) as well as slower-onset impacts (e.g., water scarcity, shifting agricultural zones, rising sea levels, and increasing disease-vector ranges). Climate change has enormous potential to undermine development gains and livelihood options for today's children. This presentation will provide an overview of impacts on child health and development of both the sudden climate change effects, including extreme weather events, extreme heat, and effects on natural systems; and consequences of the changing climate, such as displacement, migration, and social instability. The trauma of living through a climate-related disaster can have substantial mental health impacts on children and youth. Some key challenges towards to studying and modelling these impacts will be shared. Finally, action and commitments to protect children from climate change will be highlighted.
1.K. Workshop: New working environments, occupational risks and socioeconomic inequalities during covid-19 pandemic
Authors:   Organised by: EUPHA-INJ, EUPHA-SSWH,   Chair persons: Maria Papadakaki (EUPHA-INJ), Gunnel Hensing (EUPHA-SSWH)
Published: October 2021

Working from home has been mandated in many parts of the world as a temporary public health measure. Transition to such alternative working forms and environments have required new working arrangements and alternative working plans for job functions and tasks that were not fully anticipated by company policies, national laws and regulations. Risks arising in the new remote workspaces need to be identified to safeguard workers' health and mental well-being, especially among the most vulnerable workers. Workers' ability to carry out the tasks, their living arrangements, family responsibilities, and health conditions or disabilities need to be considered. Confidentiality, security, and an anti-harassment policy are also critical in remote working. Workplace policies and clear guidelines have been deemed necessary to address these challenges. Many countries around the world have begun legislating aspects of remote working to grant legal certainties and specify rights and responsibilities for both employers and workers. The workshop will attempt to map the work patterns that emerged during the covid-19 pandemic and to highlight the opportunities, challenges and risks arising from the new working environments. Health, economic and social impacts of new employment arrangements will be discussed with emphasis on systemic and structural factors increasing inequalities. Social protection gaps will be highlighted in line with human rights and international labour standards. The workshop will further discuss how to take advantage of the extensive potential of innovative tools and forms of work with regard to employee health and safety. Public policies, legislative initiatives and innovative ways of responding to the challenges will be presented. The workshop will conclude with policy recommendations taking into account the future of work that will be shaped due to COVID-19. Overall, the workshop will promote a discussion on emerging working environments, occupational risks and access of workers to social protection and social rights. It will further discuss the factors that increase workers' vulnerability, practice standards and organisational principles and policies as well as innovative ways to mitigate risks at individual, company and system level.

Key messages

Map new trends, risks and opportunities in the transition from traditional working environments to working from home and identify systemic and structural barriers to safe employment. Review public policies, legislative initiatives and innovative ways of responding to the challenges of new ways of working.
Vaccine adhesion before and after Vaxzevria suspension in a Local Health Unit of Piedmont - Italy
Authors: Catozzi D , Belliggiano D , Poli A , Bonino R , Pompili E , Scaioli G , Minniti D , Siliquini R
Published: October 2021

Introduction

The Oxford-AstraZeneca vaccine Vaxzevria is a viral-vector vaccine developed to prevent COVID-19 infection. Two doses scored 81.3% efficacy against symptomatic infection and 100% against hospitalization. In Italy, Vaxzevria use started in February. After two deaths among the Army, Italian Medicines Agency withdrawn the vaccine batch involved. News about fatal thrombosis increased, together with population concern. On March 14th, the Piedmont Region suspended another batch following a new time-related death. The following day, several European states suspended Vaxzevria administration waiting for indication from an EMA meeting on March 18th. The aim of Authors was to study the effect of suspension on adhesion among general population.

Methods

Authors registered vaccine adhesion of vaccination centers offering Vaxzevria. To access vaccination, people was requested to express willingness through a website. Then, access was granted with a summoning SMS or e-mail. Vaxzevria target populations were members of law enforcement agencies and school personnel of any age. Data from February 25th to April 12th form a Local Healthcare Unit in Piedmont Region (Italy).

Results

Vaccine adhesion ranged from 95 to 100% from February 25th to March 12th (mean 97%). During March 13th it decreased to 73%, then 48% on March 14th, the day of local withdraw of all Vaxzevria doses in Piedmont Region. Activity restarted on March 19th with a 65% of adhesion, and a mean of 75% (69-81%) in the following days. From March 24th-31th adhesion recovered, with a mean 89%. April 1st-12th recorded a plateau: 81-100%, mean 91%. From March 13th a total of 1478 people out of 8339 (17.7%) did not receive their scheduled vaccination.

Conclusions

Both news and official statements had an impact on trust and vaccine adhesion among population and dramatically slowed the COVID-19 vaccine campaign, with a possible effect on infection spreading. Further data and analysis will be provided in the following months.

Key messages

Vaxzevria temporary suspension had an impact on vaccine adhesion. Vaccine adhesion took one month to go back to previous values.
Knowledge and attitudes of young women regarding preconception health-An Italian survey
Authors: Zace D , Orfino A , Viteritti AM , Diakanthos M , Di Pietro ML
Published: October 2021

Introduction

Preconception care is a public health issue, concerning aspects that could have repercussions on pregnancy or child's health. Despite the importance, often there is a lack of knowledge among women, especially younger ones, who are at higher risk for unplanned pregnancies and less healthy lifestyles. In this context, the aim of this study is to explore knowledge and attitudes of young women regarding preconception health.

Methods

A cross-sectional study was conducted from July 2020 until April 2021, including women 18 to 25 years old. A questionnaire was created based on a systematic review and was shared via social media and different channels of high schools and universities. It collected information on physical, reproductive and mental health, vaccination and lifestyle (diet, smoke, alcohol, physical activity). T-test and analysis of variance (ANOVA) were used to determine if there was a statistically significant difference in knowledge mean score among different groups.

Results

A total of 337 women answered the questionnaire. 47.5% of participants had never heard of preconception health and 84% had never asked their gynaecologist/general practitioner about this topic. Only 15.9% of women were currently taking folic acid. The knowledge mean score was 67.5% (SD = 18.1). It was higher in subjects with Italian nationality (p < 0.001), those who had a job (p < 0.001), and those that had healthcare professionals as main font of preconception information compared to social media (p = 0.001). Knowledge mean score was significantly associated with seeing a mental health professional (p = 0.0006), however not a general practitioner or gynaecologist, during the last year.

Discussion

Identifying preconception health needs of women could assist in designing and implementing personalized interventions, to enhance the level of knowledge and promote healthy behaviours, in order to prevent eventual woman's and child's health problems.

Key messages

Women 18-25 years in the sample had relatively poor knowledge on preconception health, almost half had never heard of this topic and the vast majority had never asked their doctor about it. There is a need to enhance the level of knowledge and promote healthy behaviours and attitudes regarding preconception health, to prevent eventual woman’s and child’s health problems.
COVID-19 surveillance robot: rapid innovation for public health pandemic management
Authors: Arnott JM , Sneyd N , Cross C , Russell M
Published: October 2021

Background

COVID-19 surveillance added a significant workload to the eight HSE-Departments of Public Health in Ireland. HSE-HPSC rapidly developed a fit-for-purpose robot to navigate the national infectious disease reporting system (CIDR) to automate three manual processes; laboratory records, notifications and contact-tracing data; which takes a surveillance scientist 26 minutes per case on average.

Methods

HSE-HPSC managed and delivered a multidisciplinary project team to develop the rapid solution. The robot was designed to operate the CIDR system using an agreed set of rules, developed through business process analyses of the ‘first wave', stakeholder engagement and technical collaboration. Development began in April 2020, and went live in August 2020 after phases of testing, piloting, and hyper-care.

Results

Successful integration: The robot aligned COVID-19 surveillance data across three national HSE information systems. Degree of automation: The robot processed greater than 80% of cases just like a human. The remaining 20% are flagged by the robot for data quality checks by the regional public health teams. Time-saving: The robot operates quicker than a human, 3.3minutes per case compared to 26minutes. Therefore for every 100 cases, the robot saves 38hours per day. Out-of-hours capacity: Robots currently operate for 22hours per day, resulting in overtime cost-savings for the HSE. Surge capacity: The automation was expanded to 42 robots for ‘third-wave' surge capacity. Sustainable change in surveillance system: Robots can be expanded for surveillance of other notifiable diseases.

Conclusions

The robot:

delivered a fit-for-purpose pandemic resource relieved the underfunded public health system of the administrative burden of COVID-19 surveillance delivered timely data for epidemiological reporting by the HSE-HPSC to the National Public Health Emergency Team.

Key messages

Through rapid collaboration, the robot successfully delivered a fit-for-purpose public health resource that aligned COVID-19 data across HSE information systems and achieved time/cost savings. The robot strengthened the public health surveillance response in Ireland.
Individual level lifestyle changes during the COVID-19 pandemic – A Finnish population-based study
Authors: Jääskeläinen T , Sääksjärvi K , Pietilä A , Ristiluoma N , Lundqvist A , Koponen P
Published: October 2021

Background

The COVID-19 pandemic containment measures may affect lifestyle. We aimed to examine the changes in key lifestyle factors based on the data from same individuals before (2017) and during (2020) the COVID-19 pandemic.

Methods

The study is based on the FinHealth 2017 Study representing the Finnish adult population, and its follow-up questionnaire conducted in autumn 2020. A total of 4814 individuals aged 25 and older at baseline answered the same questions on lifestyle in both years. Regular leisure-time physical activity (LPA), daily use of vegetables and/or fruits, experience of adequate sleep, daily use of nicotine products and high-risk use of alcohol, were dichotomized (yes/no) for the analysis. Weighted prevalence (no/favorable/unfavorable change) for three age groups (25-49, 50-69, 70+ years) was analyzed using multinomial logistic regression, sampling design and non-response acknowledged.

Results

In general, the prevalence of total changes observed varied 6 − 27% between lifestyle factors. The changes were both unfavorable and favorable for health. About 14% (95% CI 11,17) and 12% (95% CI 9,16) of older women and men, respectively, had LPA in 2017 but not in 2020. Corresponding prevalence for favorable change in LPA were smaller, 6% (95% CI 4,8) in older women and 7% (95% CI 4,9) in men. In older women, the results concerning daily use of vegetables and fruits were parallel. In contrast, in older women the changes observed in the experience of adequate sleep were mainly favorable. In all age groups, high-risk use of alcohol slightly decreased especially in men but the changes in use of nicotine products were minor.

Conclusions

The results highlight unfavorable changes in LPA and vegetable consumption especially in older women during the COVID-19 pandemic. Part of the unfavorable changes may be explained by aging, but the pandemic containment measures may have accelerated them indicating the need for health promotion actions among the elderly.

Key messages

The lifestyle changes observed during COVID-19 pandemic were complex, varying by sex and age groups and being both favorable and unfavorable for health. Special attention should be given to promotion of physical activity in the elderly during and after the pandemic.
Climate and health adaptation: evidence needs for policy (Stakeholder mapping in Europe)
Authors: de'Donato F , Kovats S , Otto I , Turner G , Hoeben A , Hajat S , Aunan K
Published: October 2021

Introduction

In recent years, both the EU Commission and the Belmont Forum have funded projects focusing on health and climate change with the aim of expanding research and evidence and improving intersectoral cooperation. The EU-funded ENBEL project is developing tools to streamline climate and health research to support policies and strategies and improve response and resilience.

Methods

Within ENBEL a stakeholder analysis is being carried out for Europe to identify key decision makers involved in climate change and health adaptation, understand interlinkages and identify areas for action to promote collaboration and uptake. Semi-structured interviews with key institutions and stakeholders at different levels (International, European, national and local) will help identify key evidence needs and research gaps and findings will be used to define knowledge tools and policy briefs to enhance adaptation. Furthermore, current policies on adaptation in Europe and how health issues are addressed, especially taking into account the Next Generation EU (NGEU) funding in support of COVID-19 recovery as well as Green Deal and Climate Action, will be reviewed to ensure ENBEL products fit the EU policy agenda.

Conclusions

ENBEL offers an opportunity to produce targeted research syntheses for decision makers as well an ensuring health becomes a key aspect in climate change policy decision making. The ENBEL project will engage with key decision makers involved in climate change and health adaptation across Europe, providing knowledge, understanding interlinkages and identifying areas for action to promote climate policies that enhance health benefits.
Adversity in Infancy and Childhood Cognitive Development: Evidence from four developing countries
Authors: Manalew WS , Lee J , O’Connell B , Quinn M
Published: October 2021

Background

The effects of early life experiences on adult outcomes manifest through the childhood years. Since adult outcomes take many years to appear, and less amenable for policy, investigating the relationship between early life experiences on childhood outcomes is more relevant for policy. This study, by examining the association between adverse experiences in early infancy (AEI) on childhood cognitive development, provides early actionable evidence on how early environment of children can be manipulated to make a tangible difference in their cognitive development during childhood to achieve better outcomes later in life.

Methods

A total of 8,000 children followed over three rounds from age 1 to 8 years (2002 to 2009), as part of the Young Lives study in Ethiopia, India, Peru and Vietnam were included. Childhood cognition was measured with the Peabody Picture Vocabulary Test (PPVT) administered in round 2 and round 3, at average ages of 5 (PPVT-5) and 8 (PPVT-8), respectively. The primary independent variable was adverse experience in infancy (AEI) score, constructed using measures on child's weight, exposure to adverse household, economic, and environmental shocks as reported by a parent or a care giver in round 1 (age 1). The AEI scores were classified as 0, 1, 2, 3, 4, or > =5, with smaller numbers representing less severe adversities. Ordinary least squares (OLS) regression model was used to estimate the association between the AEI at age 1, PPVT-5, and PPVT-8, controlling for key demographic and socioeconomic factors.

Results

Both PPVT-5 and PPVT-8 were significantly lower for children who were exposed to adverse experiences at age 1. As the AEI score (range: 0-5) rose from 0 to 1, 2, 3, 4 and > =5, the PPVT-5 score decreased by 0.6, 1.3, 1.2, 1.4, and 1.5 points, and PPVT-8 decreased by 0.9, 0.8, 5.4, 5.6, and 9.3 points.

Conclusions

Early life adversities negatively impact cognitive development as soon as in early and mid-childhood.

Key messages

Adversities in early infancy may determine childhood development. Since adulthood outcomes are directly related to childhood development, addressing early adversities before they get worse may help to successfully manage a society’s future.
Digital Health and the Climate Change: Introductory key concepts and Research Topics
Authors: Lapao V
Published: October 2021

Starting with telemedicine movement 50 years ago, digital health has been changing slowly the healthcare paradigm since. Now with COVID-19 Epidemics has raise the bar and pushed for digital health across the healthcare services. Likewise, public Health should be more engaged on studying future impacts of climate change on health care and look for the opportunities that digital health can bring. At the same time, European Public Health should propose new models for healthy living in the line with sustainable circular economy. Digital health is about health service delivery but it is much more about patients' behaviour and participation in the healthcare process. Digitalization is enabling a change in the role of patients in the healthcare value chain, moreover considering the new European strategy of Health Data Space combined with the European Green Deal. We will present a set of European and American case studies already showing the positive impact of digital health in mitigating climate crises factors, by reducing transportation and materials costs and improving health professionals efficiency, among others. An overview of the recent trends will be discussed and links to public health will be addressed. A special attention will be drawn to a digital public health framework to tackle the climate change future's public health threats.
Oral health promotion and labour market prospects among socially disadvantaged, unemployed citizens
Authors: Sigsgaard AM , Bolvig I , Øzhayat EB
Published: October 2021

Background

Poor oral health do not only affect individuals' general health and quality of life but can also have a devastating impact on employability. Few studies indicate that poor teeth may constitute a barrier for labour market success in unemployed citizens. This study examines if an oral health promotion (OHP) intervention has an effect on economic self-support (ESS) and proximity to the labour market (PLM) among socially disadvantaged and unemployed citizens.

Methods

From April to June 2018, we enrolled 273 recipients of cash benefits in a randomised controlled trial. Participants were allocated to either control (n = 159) or intervention (n = 114), which consisted of information and individual help to attend a dentist and apply for dental care subsidy. Ten participants were excluded, leaving 263 participants (intervention n = 110, control n = 153) for analyses. A national register was used to assess ESS and PLM within 1.5 years post intervention. Information on health and socio-demographics were obtained from a questionnaire and national registers. Logistic- and multiple linear regression models were performed.

Results

Overall, higher frequencies of ESS and PLM was found in the intervention group, although no significant results were seen for ESS alone. Adjusted models revealed significantly higher odds (odds ratio (OR)=1.852, 95% CI 1.084 to 3.166) in the intervention group of achieving PLM after 12 months. After 18 months, the intervention group had on average obtained 5 more weeks (95% CI 0.015 to 9.994) with PLM.

Conclusions

Overall, the OHP intervention had a positive effect on labour market prospects in the intervention group, especially within the first year of the study. Our findings highlight the potential of oral treatment in social rehabilitation and for reducing inequality. This is relevant for decision-makers, who should consider oral health promotion among socially disadvantaged citizens when allocating resources and providing services.

Key messages

Receiving information and individual help to attend dental care increased the odds of enhancing labour market prospects among socially disadvantaged unemployed persons. The effect of the OHP intervention was greatest within the first year of the study and facilitated better labour market prospects sooner in the intervention group compared to the control group.