bluuebunny/crossref_metadata_2025 huggingface dataset:
Collaborative development of open-source outbreak detection tools: Needs, concept and implementation
Authors: vom Felde genannt Imbusch P , Vietor A , Ullrich A , Markus I , Diercke M
Published: October 2024

Issue

The early detection of infectious disease outbreaks through surveillance is critical to initiate targeted public health interventions. Automated outbreak detection helps to identify trends and unusual events. Yet, there is no overview of how many EU countries use outbreak detection systems and what factors hindered their implementation.

Description of the problem

One aim of the Joint Action UNITED4Surveillance (U4S) is to identify EU countries’ requirements for outbreak detection, and based on these, develop and deploy a tool for the timely and accurate detection of outbreaks. Through surveys, interviews and an in-person workshop involving public health experts, we identified uses cases, collected functional and technical requirements for a tool. Subsequently the tool development started in August 2023 as an open-source software process on GitHub.

Results

Despite high interest, only three of the 21 countries that took part in the survey have implemented outbreak detection tools, even though national surveillance systems offer the potential for their use. Reasons for this are limited resources and low prioritization. Experts identified gastrointestinal diseases as one major potential use case and emphasised the necessity of flexible outputs. Tailored to these requirements, data scientists from five European public health institutes developed an open-source R package for signal detection. The tool generates signals based on national surveillance data and enables the user to analyses these results using a dashboard with flexible exploration and generation of a report. The tool is now being piloted locally by ten European public health authorities and its use will be evaluated.

Lessons

There is a need to use automated outbreak detection tools for routine surveillance of infectious diseases in EU countries but often lack resources. Projects like U4S can bring together expertise to build sustainable tools and supporting material that can address the identified needs.

Key messages

• Collaborative and open-source development leads to tools that are well tailored to the needs of the community and foster a high uptake in the usage of these tools.

• The tool enhances surveillance and outbreak detection in countries without the capacities to develop and implement outbreak detection methods for their surveillance systems.
Developing a trustworthy national health data space: public needs and policy implications
Authors: Daniore P , Zavattaro F , Gille F
Published: October 2024

Background

The ongoing development of a national health data space in Switzerland presents an opportunity to transform health delivery and care by enabling large-scale secondary health research. Central to this development is the Health2030 strategy, which calls for the establishment of public trust in the reliability and security of data collection, storage, and exchange.

Methods

We conducted four focus groups across the German, French and Italian-speaking regions of Switzerland to inform the development of the Swiss health data space that fosters public trust. To inform Swiss policy, we held a panel discussion with patient experts and healthcare professionals to translate the focus group findings into governance and public communication requirements. We synthesized our findings using a thematic analysis approach and proposed a guiding health policy strategy.

Results

Citizens perceive the health data space as trustworthy conditional on the delivery of its promised higher levels of transparency, security, and lower risk compared to other data sharing initiatives. To ensure its trustworthiness, citizens call for the provision of value-based consent to control data access based on the actors involved and research purposes, alongside implementing accountability measures for data misuse. Governance framework requirements entail establishing an advisory group for the health data space with sufficient representation of the Swiss population, including members of the public, patient advisory groups, and researchers. Public communication requirements call for ongoing monitoring of public opinion on health data space, alongside establishing public engagement initiatives, such as public fora, to inform ongoing progress.

Conclusions

Policy efforts should prioritize the meaningful involvement of relevant stakeholders throughout all stages of the health data space development to foster trust. Central to these efforts is balancing public expectations with their practical implementation.

Key messages

• For the health data space to be trustworthy, citizens require transparency on their data use and the security measures taken, value-based consent for data access, and accountability measures.

• Diverse representation in governance and continuous public involvement are key policy measures to build public trust in the development of national health data spaces.
One Health Perspectives on Food System Transformation: Insights from the InsectERA Agenda
Authors: Assunção R , Quinteiro P
Published: October 2024

Background

One Health framework recognises the interconnectedness of human, animal, plant and environmental health. With this understanding, it becomes imperative to address challenges such as those posed by food systems through a One Health lens. Food systems pose significant public health challenges, particularly in terms of food safety and security. Pressures from factors such as population growth, changing consumption patterns and intensified production systems, particularly animal-based protein production, contribute to environmental pressures. In addition, environmental changes, including climate change, further threaten food safety and access to healthy food.

Methods

Through the InsectERA agenda, funded as part of the Recovery and Resilience Plan, stakeholders collaborated across sectors to explore the potential of insects as bioindustrial tools to address food system challenges. A structured, integrated approach combining health and sustainability considerations was matured and applied to pilot food products developed through this initiative. Recognising the potential health and sustainability impacts of these products, a comprehensive assessment was carried out.

Results

This study defined a structured, integrated approach to assessing the health and sustainability impacts of foods developed under the InsectERA agenda. Key steps included i) identifying critical issues and questions, ii) prioritising considerations, iii) defining methodologies, iv) collecting and analysing data, and v) integrating results for communication.

Conclusions

The study highlights the importance of integrated approaches in addressing food system transitions. Integrated approaches, guided by the One Health framework, play a critical role in informing policy decisions by providing policy makers with robust evidence. There is an urgent need for food system transformation based on decisions that holistically consider health and sustainability impacts, to ensure the protection of Public Health.

Key messages

• Integrating health and sustainability into the transition of food systems, within the One Health framework, is crucial for identifying options that safeguard Public Health.

• A structured, integrated approach within a multi-stakeholder environment offers robust insights for policy decisions, advancing sustainable food systems.
Organisation of school environment on reopening schools amidst COVID-19: Barriers and facilitators
Authors: Iaochite R T , Matos M M , Costa Filho R A , Carvalho G S , Anastácio Z , Azevedo M , Alves R F , Oliveira L
Published: October 2024

Background

The reopening of schools during the COVID-19 pandemic has had a profound global impact, affecting millions of students, educators, and families worldwide. This organisation study, conducted in collaboration with professionals from Brazil, Mozambique, and Portugal, focuses on the organisation of school environments to ensure education safety and continuity, underscoring the global relevance of our findings.

Methods

A consortium of 12 countries developed a script for the semi-structured online interviews used in this study, which took place between March and December 2021. Focusing on the reorganisation of schools during lockdowns in the classroom, we interviewed 12 native Portuguese speakers involved in this process. We applied thematic analysis using NVivo v.22.0 to transcript interviews.

Results

Results revealed complexities in school reopening during the public health crisis. Key barriers were disparities between public and private schools and inadequate infrastructure. Facilitators included thorough preparation of staff, community engagement, and strong collaboration between the educational and health sectors, along with classroom and school space adaptations.

Conclusions

This study highlighted significant barriers and facilitating factors affecting school reopening during the pandemic. Challenges such as educational inequalities and infrastructure gaps were evident, while effective facilitation involved comprehensive planning and stakeholder engagement. These findings offer valuable insights for strategic planning and professional practice in ensuring safe and continuous education during pandemics.

Key messages

• Global collaboration in this study spotlights the complex challenges and necessary strategies for safely reopening schools amid a pandemic.

• Research underscores the critical role of thorough preparation and community engagement in overcoming educational disparities during crises.
A canine onchocercosis report from the portuguese west region in 2024: implications for Public Health
Authors: Neves D , Ourique M , Magalhães T , Rodrigues N
Published: October 2024

Issue/problem

Onchocerca lupi parasitosis, known as onchocercosis, affects dogs, sporadically cats and humans, posing a public health concern due to possible vectors in the environment. This neglected tropical disease(NTD), has no known human cases outside endemic areas. However, recent reports in non-endemic areas raise concerns about future implications. Climate change has increased the potential risk of disease vectors establishing themselves in previously unaffected areas.

Description of the problem

A case of canine onchocercosis in the West Region of Portugal, made the pet owner look for medical counselling. Primary health care providers contacted the Public Health Unit(PHU) for guidance and actions. There had been no previous reports in this region. In this case report, we explore the potential public health implications, through a one-health approach.

Results

History of the disease was collected, and travel history of the dog revealed that he had lived in the Algarve during 11 years with only a one-and-a-half-month travel to Italy in this period. Literature review revealed reports of previous cases of oncochercosis in the Iberian Peninsula. Collaboration between the PHU, research institutes, and veterinary authorities led to the assumption of probable transmission in the Algarve.

Lessons

Increased vector surveillance is needed, especially in areas associated with animal onchocercosis. Proactive measures reduce transmission risks, protecting both humans and animals. Tracking animal cases is vital for understanding regional environmental factors. PHU’s must conduct thorough risk evaluations and maintain assertive risk communication strategies to address public and pet owner concerns effectively. Adopting a One Health approach improves the understanding of the disease dynamics and enables targeted interventions.

Key messages

• NTD’s transmitted by vectors pose a potential future challenge. This report underscores the need for a One Health approach, with collaborative multidisciplinary efforts to address these challenges.

• Furthermore, systematic interaction and reporting between human, animal, and environmental health authorities are crucial to ensure comprehensive surveillance and mitigation strategies.
Working on new applications: Use of economic evaluation in burden of disease estimates
Authors: Cecchini M , Lerouge A
Published: October 2024

Burden of disease (BoD) analyses provide policy-makers with useful evidence to prioritise policy responses to major public health threats. Increasingly, however, epidemiological data alone is not considered as sufficient to inform decisions, particularly when funding is allocated within a single government approach and different sectors compete for a larger share of the overall budget. Similarly, other funders, such as charities and foundations, may want to prioritise budget allocation between health and non-health objectives. In all these cases, traditional BoD analyses need to be complemented by economic evaluations. In its simplest form, the economic component may mean adding an assessment of the healthcare costs caused by the diseases in the study. A more comprehensive, though still with limitations, approach is to use monetary values to measure the extent to which individuals are willing to exchange their income - which can be spent on other things - for the health outcomes they experience. Finally, in its most advanced and comprehensive form, analyses can include assessments of a number of relevant dimensions, such as those in the OECD’s Better Life Index. The latter approach is also consistent with, and its results support the implementation of, a health in all policies approach. This presentation will look at traditional and innovative approaches that can be used to add an economic dimension to BoD analyses. After introducing the rationale and key methodological issues of each approach, the presentation will discuss the advantages and disadvantages of each methodology and will identify areas where their use can be beneficial in guiding the decision-making process. Examples of the use of these methodologies in real-world analyses will also be presented to support the theoretical part of the discussion.
Barriers to Personalised Prevention: Perspectives from a Multi-Stakeholder Consultation
Authors: Costa A , Cardoso M L , Carvalho A , Osti T , Farina S , Flodkvist E , Gyllenberg A , Boccia S , Vicente A M
Published: October 2024

Background

The high and increasing burden of Non-Communicable Diseases (NCDs) demands a healthcare shift towards prevention. Personalised preventive interventions (PPIs) that consider biological, sociocultural, environmental, and behavioural characteristics of individuals, are not as widely adopted as other personalised medicine approaches. To identify the main barriers and gaps that are hindering the adoption of PPIs in healthcare systems, we consulted a wide range of European stakeholders, including health professionals, policy makers, citizens and patients, and researchers.

Methods

The consultation process included experts’ interviews and an online survey, taking place over 10 months in 2023/2024. Interviews were analysed using qualitative Thematic Analysis. The online survey development was based on the barriers identified by the interviewed experts, complemented with findings from the literature. Respondents scored their level of agreement/disagreement using a 6-point Likert scale. Descriptive statistical analysis was performed.

Results

A total of 26 semi-structured interviews and 270 complete surveys were obtained. Overall, the main barriers highlighted were: 1) Health systems strategies are geared towards curative care and not prevention. 2) Awareness and understanding of the concept of PPIs is low. 3) There is a lack of basic and life-long training for health professionals on PPIs; 4) There is insufficient evidence for PPIs to raise the necessary policymakers’ interest. 5) Health literacy of citizens and patients is low. 6) There is insufficient prevention research, evidence of cost-efficiency and regulation procedures for translation into health practice.

Conclusions

Identified barriers are interconnected and the challenges extend beyond prevention to personalized medicine interventions. Collaborative efforts are needed to elevate visibility and engage stakeholders, facilitating integration of PPIs into healthcare systems for widespread adoption.

Key messages

• This consultation offers valuable insights on challenges that need to be addressed to enable the integration of PPIs into healthcare and reduce the burden of NCDs.

• Investments in disease prevention and PPIs should stand as a global key priority.
Public perceptions of the health impacts of climate change: a survey study in Greece
Authors: Lamnisos D , Michalopoulos G , Andrianaki M
Published: October 2024

Background

Climate change is the biggest global health threat of the 21st century. Despite the tremendous challenges, many people remain unaware of the human health implications of climate change. People perceptions about the health harms of climate change can increase public support for the action needed to reduce climate change. The aim of this study was to examine the public perception of climate change as a human health issue in Greece.

Methods

A population survey study was conducted from October to December 2023 in the municipalities of Messini and Alexandroupoli, Greece, following proportional quota sampling. A questionnaire was developed and included measures about the socio-demographic background of participants, their understanding of key facts about climate change and their views about climate change thread to human health.

Results

406 individuals with a mean age 37.7 (sd = 14.8) participated in the study. Participants understood that climate change is happening (93.6%) and 54% of them think climate change is mostly or entirely caused by human activities, whereas 38% think it is caused equally by human activities and natural causes, and about 8% think climate change is mostly or entirely caused by natural causes. A majority of participants reported that climate change has adversely affected the health of people in various way, either a moderate amount or a great deal, including physical or mental harm from forest fires (90%), physical or mental harm from storms and floods (87%), heat-related illnesses (82%), illness due to reduced outdoor air quality (70%) and loss of housing for residents displaced by extreme weather events (70%).

Conclusions

Participants viewed climate change as an important cause of health harm, however they partially understood that climate change is caused by humans. Public health authorities should educate the public and policymakers about the climate change and advocate for policies to address the human health challenges of climate change.

Key messages

• Public health authorities should educate the public and policymakers about the climate change problem and its impact to human health.

• Providing people with information about the health harms of climate change can increase public support for the actions needed to reduce emissions.
A questionnaire to assess ecoanxiety and its sociodemographic determinants among Italian adolescents
Authors: Nachira L , Innocenti M , Di Russo M , Congedo G , Campo E , Zjalic D , Lombardi G , Perilli A , Bruno S , Fioravanti G
Published: October 2024

Background

Climate change poses serious challenges to Public Health, including mental health impacts. In Italy, few studies investigated the rise of eco-anxiety, especially among adolescents, who are the main group affected by this feeling. Specific measurement tools for this population are needed to fill this gap. The aim is to adapt the Italian version of the Climate Change Anxiety Scale (CCAS) to adolescents, and pair it with a socioeconomic and demographic questionnaire (SDQ) to assess determinants.

Methods

The Italian CCAS was modified for adolescents through a process involving a literature review, expert discussions, and a pretest. This adapted version (a-CCAS) was tested with individuals aged 14-18 years old, maintaining an ideal ratio of 10 respondents per item. Extant psychometric scales were utilized to assess its validity. The SDQ was developed from results of a systematic review of known associations between socioeconomic and demographic factors and eco-anxiety in youth, and expert discussions, and validated by piloting the SDQ with another sample of adolescents. Internal consistency of the a-CCAS and SDQ was assessed by Cronbach’s alpha (Cα).

Results

The a-CCAS kept most of its original content, comprising 13 items and 2 subscales: cognitive and functional impairment. Pilot respondents were 162; Cα coefficient was >0.7 for both subscales. Convergent and concurrent validity showed positive correlations with the extant scales. The SDQ comprised 12 items in 3 domains: family, social and political-environmental determinants. Respondents were 47 and Cα coefficient was >0.7.

Conclusions

The a-CCAS and SDQ are valid tools for assessing baseline eco-anxiety and its determinants in Italian adolescents and can contribute to Public Health efforts to reduce the climate-related mental health burden, by measuring the impact of specific educational interventions about climate change targeted at the young. This questionnaire was created as part of the PRIN P2022JJ3LB project.

Key messages

• These results contribute to filling an evidence gap on eco-anxiety and its socioeconomic and demographic determinants among Italian adolescents by providing researchers with a valid measurement tool.

• This tool holds promise for assessing the impact of psychologically-informed educational interventions about climate change and adaptive coping strategies on adolescents’ eco-anxiety levels.
From Pandemic to Heatwave: Digital Strategies for Health Resilience
Authors: Loureiro M , Vasconcelos H , Neves A L
Published: October 2024

Heatwaves threaten public health in the EU, as evidenced by the high heat-related mortality in the summer of 2022. Despite their frequency, European heat-health action plans (HHAPs) largely exclude digital solutions. The COVID-19 pandemic shifted perceptions and use of digital health tools, demonstrating their effectiveness in responding to health crises and providing insights for heatwave management. This work explores the potential of further including digital health interventions into European HHAPs. The objective is to identify adaptable digital strategies to mitigate heatwave health impacts. We started by analyzing WHO’s guidance on the creation of HHAPs, as well as the European Observatory on Health Systems and Policies’ assessment of the four main areas supported by digital health tools during the pandemic. Later, we proposed four main areas where digital health solutions could be efficiently integrated. Each area underwent a rapid literature review to identify digital solutions used during COVID-19, followed by a critical analysis for applicability in heat-health action planning. We identified four areas where the implementation of digital tools should be explored: Communication and Information Dissemination (focusing on raising awareness among vulnerable groups, caregivers, and organizations); Modeling and Forecasting (developing precise forecasts for proactive planning); Health services coordination (among services delivering immediate care during heatwaves); Monitoring and Population Surveillance (implementing strategies to identify and mitigate heat-related risks e.g. among vulnerable populations). Results indicate that digital health solutions from COVID-19 can enhance national HHAPs. Tools for pandemic prevention and response are applicable to extreme weather events. The pandemic’s increased digital usage resulted from policy changes and infrastructure investment - leveraging these advancements could prepare Europe for extreme heat threats.

Key messages

• Results indicate that digital health solutions from COVID-19 can enhance national HHAPs. Tools for pandemic prevention and response are applicable to extreme weather events.

• The pandemic’s increased digital usage resulted from policy changes and infrastructure investment - leveraging these advancements could prepare Europe for extreme heat threats.
The role of class stigma in socioeconomic inequalities in type 2 diabetes: The Maastricht Study
Authors: Sezer B , Albers J , Meisters R , Schram M T , Galan B E , Kallen CJH , Greevenbroek MMJ , Dagnelie P C , Koster A , Bosma H
Published: October 2024

Background

Low socioeconomic position (SEP) is a risk factor for type 2 diabetes mellitus (T2DM). An underlying mechanism behind socioeconomic health inequalities can be stigma, particularly classism. Studying the influence of class stigma in the context of (pre)diabetes and socioeconomic inequalities may shed light on the societal factors influencing diabetes.

Methods

Data from 1947 participants aged 49-88 who participated in the second phase of The Maastricht Study starting between November 2020 and April 2023 were used. SEP (education, income, occupation) and 6-item classism scale were measured through self-reported questionnaires. (Pre)diabetes was measured through an oral glucose tolerance test. We conducted multinomial logistic regression analyses to investigate the associations between SEP, classism, and diabetes status.

Results

20.9% (N = 406) of the study sample had T2DM (Mage=69.8(±6.8) years; 31.3% women). People with low SEP had more often T2DM (e.g., income OR = 2.13, 95%CI:1.54-2.82) and reported perceived classism (e.g., education OR = 2.07, 95%CI:1.33-3.21) than people with high SEP. Classism was not statistically significantly associated with T2DM (OR = 0.78, 95%CI:0.48-1.29).

Conclusions

Social health inequalities are apparent in T2DM; however, our results suggest that class stigma might not be a major factor in underlying processes. Further research can investigate the role of chronic stress and intersection of multiple stigmas.

Key messages

• The underlying factors behind socioeconomic health disparities are complex. Social and psychological environment in low SEP should be investigated carefully.

• Although low SEP is strongly associated with T2DM and perceived classism, class stigma might not be a major target in explaining socioeconomic pathways in diabetes.
Benefits of hypothetical air pollution reduction interventions on NCDs in Belgium
Authors: Pelgrims I , Devleesschauwer B , Van der Heyden J , De Clercq E
Published: October 2024

Background

The adverse health impact of air pollution on non-communicable diseases (NCDs) is well documented, yet methodological tools for assessing the potential health benefits of interventions are lacking. This study uses a parametric g-computation approach to evaluate the impact of hypothetical interventions targeting long-term air pollution exposure on reducing NCDs prevalence in Belgium, using data from three national Health Interview Surveys (BHIS 2008-2013-2018).

Methods

BHIS data (n = 27,536) were linked to environmental data at participants’ residential addresses. A g-computation approach was used to calculate the potential impact fractions of air quality interventions on several NCDs. Regression models were adjusted for socio-economic, environmental and lifestyle factors. The scenarios involved reducing individual long-term air pollution exposure to WHO air quality guideline levels, followed by investigating dose-response functions through various percentage reductions in air pollution exposure.

Results

Significant associations were found between air pollution and asthma, stroke, and multimorbidity. Adhering to WHO air quality guidelines would substantially reduce stroke risk in Belgium by 0.87% (95% CI:0.38; 1.35) for PM2.5 and 0.32% (95% CI:-0.05; 0.70) for NO2, preventing 63% and 22% of cases, respectively. For asthma, risk reduction was 1.43% (95% CI:-0.53; 3.4) for PM2.5 and 0.83% (95% CI: 0.01; 1.63) for NO2, preventing 27% and 16% of cases, respectively. For multimorbidity, risk reduction was 3.20 % (95% CI: -1.75; 8.16) for PM2.5 and 0.43% (95% CI:-2.03; 2.90) for NO2, preventing 7% and 0.4% of cases, respectively. Results revealed a clear dose-response association between air pollution reduction and the prevalence of stroke, asthma, and multimorbidity in Belgium.

Conclusions

This study demonstrates that air pollution reduction interventions could effectively decrease the prevalence of asthma, stroke, and multimorbidity in Belgium.

Key messages

• Air pollution reduction interventions could effectively decrease the prevalence of asthma, stroke, and multimorbidity in Belgium.

• The g-computation approach to assess PIF of interventions represents a straightforward approach for drawing causal inferences from observational data.
Thermal indices for evaluating the impact of thermal conditions on human health: a systematic review
Authors: Pantavou K , Fillon A , Li L , Maniadis Z , Nikolopoulos G
Published: October 2024

Background

Thermal indices assess individuals’ perception of their ambient thermal surroundings (thermal comfort and heat/cold stress) considering several meteorological factors, such as temperature, humidity, wind, and radiation. As climate change progresses, there is an increased demand for accurately monitoring the association between thermal environment and human health. This study summarizes the available evidence on the association between thermal indices and health outcomes.

Methods

We conducted a systematic search in PubMed, Scopus, and Web of Science until December 31st, 2023, to identify all relevant studies examining the association between thermal indices and health outcomes in outdoor environments.

Results

A total of 5,034 electronic records were screened. Of these, 310 were considered eligible, examining 1,143 associations. Seventeen indices were identified, with 32 (10.3%) articles using more than one index. The most commonly employed index was Apparent Temperature (articles: n = 141, 38.2%; associations: n = 634, 55.5%). The specific-cause health outcomes examined spanned 18 categories of the International Classification of Diseases. Most associations (n = 304, 26.6%) pertained to mortality/morbidity related to diseases of the circulatory system, followed by all-cause morbidity/mortality (n = 288, 25.2%). The 48.6% (n = 556) of the associations suggested an increased risk of adverse health outcomes when indices increased while 32.5% (n = 372) of the associations were non-significant. The 14.2% (n = 162) of the associations suggested an increased risk of adverse outcomes when indices decreased while 16% (n = 183) of the associations were non-significant.

Conclusions

The relevant literature revealed associations between thermal indices and health outcomes. Therefore, thermal indices, considering several meteorological variables, could be a useful tool for public health planning. However, there is diversity in their methodologies and reporting.

Key messages

• Summarizing the published evidence regarding thermal indices is expected to attract the interest of public health professionals and policy makers, and enhance their use.

• Implementing integrated methods to monitor the association between thermal conditions and health, including using thermal indices, could be valuable for developing and evaluating policies.
Picking a bone with fluoride – dose-response meta-analysis on exposure to fluoride and bone density
Authors: Mazzoli R , Iamandii I , De Pasquale L , Filippini T , Vinceti M
Published: October 2024

There are still uncertainties around the effects, beneficial and adverse, of water fluoride exposure on bone density and strength. We selected bone mineral density (BMD) for investigation as it is recognized as the major non-invasive indicator of bone strength, representing its clinical assessment standard. The aim of this systematic review and meta-analysis was to characterize for the first time the relation between fluoride exposure and BMD through a dose-response approach, using a one-stage dose-response meta-analysis based on a cubic spline random-effects model. Out of 1201 potentially relevant literature records retrieved, after removing duplicates, title/abstract screening, and full-text evaluation, 16 studies were eligible for this review, 12 of which were also suitable for the dose-response meta-analysis. We observed an almost linear association between fluoride and BMD, yielding a mean difference of 2.60 (95% CI 0.17 to 0.40) at 4 mg/L of fluoride exposure. This pattern was also confirmed for hip BMD (MD = 2.83; 95% CI 0.11 to 0.40 at 4 mg/L). However, sex-specific analyses showed different patterns of association. In males, the relation between fluoride exposure and BMD was almost linear until 0.75 mg/L (MD = 0.24; 95% CI -0.22to 0.37), after which it plateaued. Females showed a slight increased BMD at 1 mg/L (MD = 0.05; 95% CI -0.02 to 0.16) but decreasing values above 2.5 mg/L (MD=-0.22; 95% CI -2.72 to 2.38 at 4 mg/L), with an indication of an inverted U-shaped association. This pattern was clearer when we restricted our analysis to hip BMD (MD=-0.56; 95% CI -2.98 to 1.85 at 4 mg/L). Sensitivity analyses examining both bone-specific BMD and conducting risk of bias assessments are currently underway. Moreover, imprecision of the estimates, especially in stratified analyses, and potential for residual confounding, underscore the need for further prospective studies, to more adequately assess the relation between fluoride exposure and bone density and strength.

Key messages

• At fluoride exposure below 1 mg/L, we observed a linear correlation between fluoride exposure and increase bone density in the overall pooled dose-response analysis of eligible studies.

• Sex-specific patterns: males show positive response until certain exposure threshold; while females demonstrate an increase only at low doses of exposure and a downward trend at higher exposures.
The effect of outdoor air pollution on Alzheimer’s disease: a systematic review
Authors: Wilson S , Dhillon G , Hassan N , McArdle R , Su L , Slight S
Published: October 2024

Air pollution is one of the largest global environmental risks to public health. Over recent years, neuroimaging techniques have started to uncover the detrimental impact air pollution has had on brain health, including the development of Alzheimer’s Diseases (AD). We systematically reviewed the literature to evaluate the effects of long-term exposure (months to years) to outdoor air pollutants on the development of AD-like neurology. This review was registered on PROSPERO (CRD42023482979) and followed PRISMA guidelines. Four large databases (MEDLINE, Embase, Scopus, and CINAHL) were searched in November 2023 using terms associated with air pollution, neuroimaging, and AD. Only peer-reviewed primary research articles using neuroimaging data to examine AD-like pathology after long-term exposure to air pollutants (Particulate Matter (PM2.5, PM10), SO2, NO2, O3, and/or CO) were included. Titles, abstracts and full-texts were screened, and included articles were quality assessed using the Newcastle Ottawa Scale. A narrative synthesis was conducted to analyse the studies. Our search yielded 397 results, of which eight articles met our inclusion criteria. Articles focused on changes to white matter (n = 5), cortical thickness (n = 6), and grey matter (n = 2). Exposure to PM2.5 was commonly associated with white matter reductions, and PM10 and NO2 exposure was associated with reduced cortical thickness. The effect of exposure to different outdoor pollution on grey matter was inconclusive, with both increases and decreases in grey matter volume observed. This review highlighted how PM2.5, PM10 and NO2 exposure was associated with neurological changes commonly seen in AD. These findings can be used by policymakers and researchers to identify specific pollutants that need greater restrictions and regulations to improve population health.

Key messages

• PM2.5, PM10 and NO2 exposure are associated with neurological changes commonly seen in AD.

• Greater restrictions and regulations are needed on specific pollutants to improve population health.
Self-reported health effects from wildfire smoke: A cross-sectional study in New York State
Authors: Noel C A , Barrera E , Hayden A , Meredith G
Published: October 2024

Background

Wildfires and exposure to wildfire smoke (WFS) are forecasted to increase, in part driven by climate change. As witnessed in 2023, regions in Europe and North America are facing more sustained periods of poor air quality due to WFS. Growing evidence suggests average daily WFS correlates with morbidity and mortality, but the impact of prolonged WFS exposure remains understudied, especially in areas where WFS is a newer occurrence. We examine associations between consecutive days of WFS experienced and self-reported health symptoms in the northeastern United States.

Methods

This retrospective cross-sectional study explored New York State (NYS) residents’ experience with WFS in summer 2023 via an online survey. Participants reported the longest period of consecutive WFS days and symptoms experienced. Log-binomial regression models estimated prevalence ratios (PR) and 95% confidence intervals (CI).

Results

553 NYS residents were included, representing a healthy, primarily female and White population, ranging from 18 to 86 years. 549 (99.3%) reported experiencing WFS, with the longest period of consecutive WFS days varying (≤3 days: n = 152; 4 to 6 days: n = 255; ≥7 days: n = 146). 490 (88.6%) reported ≥1 health symptom, with itchy/watery eyes, sore throat, and headache as the most frequent. Compared to ≤ 3 consecutive WFS days, symptom prevalence was 9.1% higher for those reporting 4 to 6 days (PR [95% CI]:1.09 [1.00, 1.19]) and 16.7% higher for ≥7 days (1.17 [1.07, 1.27]). The trend of increased symptom prevalence with longer WFS periods persisted and was pronounced for specific symptoms. Control for potential confounders did not appreciably change estimates.

Conclusions

Our findings suggest longer sustained WFS exposure associates with higher symptom prevalence, which may be precursors to more serious health conditions. As global populations face more WFS with climate change, public health professionals should prioritize strategies to mitigate prolonged exposure.

Key messages

• In a convenience sample of 553 primarily healthy New York State residents, 99.3% reported experiencing wildfire smoke and 88.6% reported at least 1 symptom of poor health during summer 2023.

• Associations between consecutive days of wildfire smoke experienced and prevalence of any and specific symptoms tended to vary in a dose-response manner.
The INPHET- a global approach to Environmental Public Health Tracking
Authors: Yip F , Lauriola P , Zeka A , Crabbe H , Leonardi G
Published: October 2024

Environment and health monitoring and information systems are fundamental infrastructure for evidence provision for policy making. The International Network for Public Health and Environment Tracking (INPHET) was formed by a community of environmental public health practitioners to address common interests and activities that advance environmental public health surveillance (EPHS) and data systems, and their uses to inform public health actions. Its main goal is to address the vast inequalities across countries and communities in their ability to monitor, assess, inform and mitigate environmental and health issues. INPHET supports the relevant role of environmental epidemiology as the pillar science providing evidence for decision making and interventions aiming at reducing and preventing environmental related diseases and contributes to an overall vision for public health. As a “Community of Practice”, INPHET focuses on sharing experiences and expertise; addressing common challenges for implementing and enhancing the science of EPHS/tracking; improving understanding of the link between the environment and health; and providing the appropriate evidence that informs public policy. The network, initiated in conference meetings in 2012-13 and formally launched in Modena, Italy in 2014, has carried out several activities which aim at sharing expertise and learning from different models of environmental and health data integration and surveillance systems that directly inform policy. These include Twinning cooperation with Euro-Asian and Balkan countries and sharing of expertise with African Public Health Agencies. Some experiences are presented in this workshop and highlight the EPHS/EPHT model adopted by several national public health agencies. It promotes that such integration and uses of environmental and health data is key for EPHS, including their accessibility and usability for communities of public health researchers, practitioners and policy makers.
2008 economic crisis impact on perinatal and infant mortality in Southern European countries
Authors: Doetsch J N , Almendra R , Severo M , Leao T , Pilot E , Krafft T , Barros H
Published: October 2024

Introduction

The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession’s impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems’ response to protecting the health of the most vulnerable groups.

Objectives

To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain.

Methods

Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models.

Results

IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018.

Conclusions

Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population’s health from the earliest days.

Key messages

• Mortality patterns refer to the internal variability of the crisis’ effect and to persistent spatial regional inequalities appealing to the need for attention in policymaking.

• The relevance of considering the political economy of global health finance and macroeconomic volatility as a major influence on the association of mortality rates with socioeconomic indicators.
Gender Differences in Years of Life Lost resulting from the 2015 Gorkha Earthquake in Nepal
Authors: Tonnelier M , Bhandari M , Delforge D , Moitinho de Almeida M , van Loenhout J , Devleesschauwer B , Haagsma J , Speybroeck N , Charalampous P
Published: October 2024

Background

Nepal has a history of regular natural hazards, including significant earthquakes and floods. Previous studies have shown that females, particularly younger females, are more likely to die due to disasters compared to males. This study aimed to explore gender differences in mortality - measured in Years of Life Lost (YLL) - caused by the 2015 Gorkha earthquake across 41 districts of Nepal.

Methods

Mortality counts were derived from the Nepal Police Report. YLL was estimated by multiplying mortality counts (stratified by age, gender, and district) by age-conditional life expectancy from the 2019 Global Burden of Disease reference life table. Both absolute numbers and rates of YLL per 100,000 population were calculated. YLL per deaths, stratified by age-gender-and-location, were estimated and compared. Male-to-female YLL rate ratios were estimated as well, and compared across districts.

Results

The 2015 Gorkha earthquake resulted in 8,950 deaths (females: 56.1% versus males: 43.9%), accounting for 526,617 YLL. Males had a slightly higher number of YLL per death (59.2) compared to females (58.5); this is mainly due to the different number of deaths between males and females. YLL per deaths ranged from 65.4 (Rautahat district) to 0 (in several districts) among males and, from 65.3 (Rautahat district) to 0 (in several districts) among females. The YLL rate per 100,000 population was higher for females (3,158 per 100,000) than for males (2,575 per 100,000). Approximately 40% of the districts had male-to-female YLL rate ratios of less than one, which can be partly explained by the gender distribution of the population at rik of dying due to earthquake.

Conclusions

The study found relatively higher YLL per death for males and higher YLL rates for females. This underscores the necessity to further investigate the factors that contribute to fatalities from earthquakes, especially in lower middle income countries such as Nepal.

Key messages

• Gender disparities in mortality following the 2015 Gorkha earthquake in Nepal were addressed using Years of Life Lost (YLLs); males had higher YLL per death, while females had higher YLL rates.

• Exploring the factors that contribute to earthquake-related fatalities should be a priority for disaster mitigation strategies.
Lifestyle factors before and after colorectal cancer treatment and their association with fatigue
Authors: Vlaski T , Caspari R , Fischer H , Rosenlechner S , Bilsing B , Fernandes-Almeida C M , Hoffmeister M , Slavic M , Brenner H , Schöttker B
Published: October 2024

Background

As colorectal cancer (CRC) survivorship increases, so does the challenge of managing cancer-related fatigue, a prevalent condition that severely impacts survivors’ ability to work and overall quality of life. This study delves into the relationship between lifestyle behaviors, assessed using the HEALTHY lifestyle score, and its influence on fatigue among CRC patients.

Methods

Data was derived from MIRANDA, a multicenter cohort study that enrolls adult CRC patients during a 3-week in-patient rehab within a year after primary CRC treatment. Up to date, n = 438 participants provided information on lifestyle factors at the rehabilitation start (baseline) and then every three months for the first year. The predictors were the HEALTHY lifestyle score and its components (diet, alcohol consumption, physical activity, BMI, and smoking status) calculated at three time points: before surgery, after surgery, and 12 months following rehabilitation. The outcome was fatigue, assessed using the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F-FS) scale.

Results

Participants with a higher HEALTHY lifestyle score after CRC surgery had statistically significantly lower fatigue levels. The components that contributed most to this finding were smoking and physical activity. Participants who engaged in exercise post-surgery or did not smoke before their cancer diagnosis experienced lower fatigue levels during rehabilitation.

Conclusions

Lifestyle modifications, such as increasing physical activity and smoking cessation, are crucial in preventing or reducing fatigue among CRC patients. Tailored public health initiatives that advocate for these lifestyle adjustments and their incorporation into CRC rehabilitation protocols could significantly advance survivor care, ultimately leading to better health outcomes.

Key messages

• The HEALTHY score is associated with fatigue of CRC patients during rehabilitation, highlighting the crucial role of lifestyle changes after CRC treatment.

• Smoking cessation and physical activity programs may be the most effective measures for decreasing the fatigue burden of these patients.