bluuebunny/crossref_metadata_2025 huggingface dataset:
SIRT1 protects the heart against doxorubicin-induced cardiotoxicity by mediating the DNA damage response via deacetylation of histone H2AX
Authors: Kuno A , Hosoda R , Horio Y
Published: October 2021

Background

Doxorubicin induces DNA damage not only in tumor cells but also in the cardiomyocyte, and accumulation of damaged DNA has been implicated in doxorubicin-induced cardiotoxicity. We previously found that cardiomyocyte-specific deletion of SIRT1, a NAD+-dependent histone/protein deacetylase, worsens doxorubicin-induced cardiotoxicity in mice. However, its molecular mechanism remains unclear. Phosphorylation of histone H2AX at Ser139 catalyzed by ATM (mutated in ataxia-telangiectasia) at the sites of DNA damage is a critical mediator for DNA repair.

Purpose

Here, we tested the hypothesis that deacetylation of H2AX by SIRT1 mediates DNA damage response to counteract doxorubicin-induced cardiotoxicity.

Methods and results

Wild-type (WT) mice and tamoxifen-inducible cardiomyocyte-specific SIRT1 knockout (SIRT1-cKO) mice at 3 month of age received doxorubicin (4 IP injections of 5 mg/kg/week) or a vehicle. Immunoblotting of myocardial lysates from mice 1 week after final doxorubicin showed that doxorubicin increased phospho-Ser139-H2AX level by 1.6-fold in WT, but such a response was blunted in SIRT1-cKO. Ser1981-phosphorylations of ATM induced by doxorubicin were similar in WT and SIRT1-cKO. DNA fragmentation evaluated by TUNEL staining revealed that the increase in TUNEL-positive nuclei by doxorubicin was more in SIRT1-cKO (0.13% to 0.38%) than those in WT (0.07% to 0.19%), suggesting higher DNA damage in SIRT1-cKO.

In H9c2 cardiomyocytes, knockdown of SIRT1 also abolished the doxorubicin-induced Ser139-phosphorylation of H2AX without changing phospho-ATM levels. Increases in DNA damage evaluated by comet assay and cleavage of caspase-3 by doxorubicin were also enhanced in SIRT1-knockdown cells. Immunostaining for acetyl-Lys5-H2AX in the heart sections revealed that acetyl-Lys5-H2AX levels were increased in SIRT1-cKO by 58% compared with those in WT. In H9c2 cells, acetyl-Lys5-H2AX level was also increased by SIRT1 knockdown and reduced by expression of wild-type SIRT1. To test the role of the increased acetyl-Lys5-H2AX level under SIRT1 inhibition, we generated a mutant in which Lys5 was substituted to glutamine (K5Q H2AX) as a mimic of acetylated Lys5. In COS7 cells expressing WT or K5Q H2AX, Ser139-phosphorylation induced by doxorubicin was suppressed in K5Q mutant. In addition, doxorubicin-induced cleavage of caspase-3 was enhanced in H9c2 cells expressing K5Q H2AX as well as S139A H2AX, that cannot be phosphorylated at Ser139, compared with cells expressing WT H2AX.

Conclusions

These findings suggest that the increased Lys5 acetylation of H2AX via SIRT1 inhibition interferes Ser139 phosphorylation, leading to accumulation of damaged DNA and promotion of the apoptotic response. Such regulation of the DNA damage response contributes to protection by SIRT1 against doxorubicin-induced cardiotoxicity.

Funding Acknowledgement

Type of funding sources: None.
Activated myofibroblasts promote cardiac hypertrophy and systolic dysfunction independently of cardiac fibrosis in experimental autoimmune myocarditis
Authors: Tkacz K , Jazwa-Kusior A , Rolski F , Dzialo E , Weglarczyk K , Czepiel M , Siedlar M , Kania G , Blyszczuk P
Published: October 2021

Background/Introduction

Heart-specific inflammation – myocarditis is a common cause dilated cardiomyopathy which is characterized by pathological tissue remodeling, ventricular stiffening, cardiomyopathy and heart failure. In experimental autoimmune myocarditis (EAM) susceptible mice immunized with alpha myosin heavy chain (αMyHC) and complete Freund's adjuvant (CFA) develop acute myocarditis driven by autoreactive CD4+ T cells that is followed by progressive fibrosis, cardiomyopathy and systolic dysfunction.

Purpose

The aim of the study was to investigate the role of cardiac fibroblasts and myofibroblasts in myocarditis and post-inflammatory dilated cardiomyopathy in mouse model of EAM.

Methods

EAM was induced in BALB/c mice by immunization with αMyHC/CFA. We used reporter mice expressing EGFP under collagen type I promoter (Coll-EGFP) and RFP under a control of α-smooth muscle actin (αSMA) promoter (αSMA-RFP) and transgenic αSMA-TK mice with ganciclovir-inducible ablation of proliferating myofibroblasts. Cardiac cells were quantified using flow cytometry. Cardiac fibroblasts (CD45-CD31-EGFP+) were sorted from healthy and myocarditis-positive (day 21) mice using BD FACSAria™ II Cell Sorter and analyzed for the whole genome transcriptomics by RNA sequencing. Echocardiography was performed on Vevo 2100 Imaging System. Cardiac fibrosis was assessed by Trichrome Massons's staining and hydroxyproline assay, whereas cardiac hypertrophy by analysing cross-sectional cardiomyocyte area. Profibrotic gene expression was assessed by qRT-PCR.

Results

The total number of cardiac fibroblasts (CD45-CD31-EGFP+) and the subset of myofibroblasts (CD45-CD31-EGFP+RFP+) remained unchanged at inflammatory (d21) and fibrotic stages (d40). Analysis of differentially expressed genes (min. 2x fold change, p value <0.05) pointed out activation of immune processes (mainly chemokine production), response to stress, cytoskeletal and extracellular matrix re-organization in cardiac fibroblasts in response to myocarditis. αSMA-TK mice treated with ganciclovir (from day 21) showed comparable percent of fibrotic area, but significantly reduced heart weight, decreased cardiomyocyte hypertrophy and improved ejection fraction and cardiac output at day 40 comparing to PBS-treated mice. Ganciclovir-treated mice showed also attenuated cardiac Acta2 and Srf but markedly enhanced Mmp2 expression.

Conclusions

In EAM model cardiac fibroblasts actively participate in proinflammatory and profibrotic responses, while activated myofibroblasts contribute to dilated cardiomyopathy development independently of cardiac fibrosis.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Centre (Poland)
1.A. Workshop: Public health, climate change and strategic litigation
Authors:   Organised by: EUPHA-LAW, EUPHA-ENV, Global Health Law Groningen (Netherlands), PETRA,   Chair persons: David Patterson (Netherlands), Vlatka Matkovic Puljic (Belgium)
Published: October 2021

There is ample and growing evidence of the damage to human and planetary health from environmental pollution and climate change. National and international legal frameworks provide opportunities for strategic legal challenges to government inaction (whether as the primary polluter or for a failure to regulate a third-party polluter) and to industry polluters. Public health professionals need to understand how litigation can be used as a public health tool to advance policies to address environmental and health challenges. [Parmet, W.E. and Daynard, R.A., 2000. The new public health litigation. Annual Review of Public Health, 21(1), pp.437-454; Laaser U. and Beluli F. A Global Public Health Curriculum. South Eastern European Journal of Public Health. 2nd Edition (2016); Foldspang, A. ed., 2018. ASPHER's European List of Core Competences for the Public Health Professional. Sage Publications.]

A positive court decision can require governments to take immediate and long-term action or require polluters to cease, clean up and compensate. Successful national court decisions also provide precedents for legal action in other countries. If action in national courts fails or is not possible, legal action may be taken in European and international courts and tribunals. When legal action fails, or there is no decision, strategic litigation can still focus national and international media coverage and draw public attention to real or potential harms caused by government or industry action or inaction. Public health, environmental and human rights advocates can make better use of strategic litigation to address environmental harms and advance climate change mitigation and adaptation. Most European countries have already seen some strategic litigation on climate change. Litigation based on international and European human rights frameworks is also gaining ground. The workshop will examine the elements of strategic litigation and current cases in European courts. The workshop will follow a planned pre-conference webinar on public health, climate change and strategic litigation sponsored by EUPHA in October 2021.

Key messages

Strategic litigation supported by effective interdisciplinary collaboration can strengthen government resolve and stimulate action to address environmental and climate goals. Strategic litigation can advance public health objectives even without a favourable court decision. Its value includes the publicity and awareness generated and engagement of multiple stakeholders.
COVID-19 as a syndemic: from inequalities to biological embodiment
Authors: Vineis Paolo
Published: October 2021

Different determinants play a role in the health and wellbeing of people, population groups, communities, and the society as a whole. During the COVID-19 epidemic (and beyond) the direct and indirect impact of such determinants has become yet more evident. Individual proximal factors such as age, ethnicity, socioeconomic position, underlying comorbidities have concurred to increase individual risk of acquiring the infection as well as of developing severe disease complications, including death. The concept of COVID-19 as a syndemic has been proposed on this ground, whereby socioeconomic determinants of disease have catalyzed health worse outcomes.
Did the COVID-19 pandemic impact population’s mental health?
Authors: Forgeot C , Pontais I , Khirredine I , Gillaizeau I , Du Roscoat E , Fouillet A , Bauchet E , Caserio-Schonemann C
Published: October 2021

Background

Sanitary, societal and economic effects due to the COVID-19 pandemic could lead to an impact on population's mental health. Santé publique France (SpF), the French public health agency set up a specific monitoring based on emergency department (ED) and GP's associations (GPs) SOS Médecins (SOSMed) data to early assess the impact of COVID-19 pandemic on mental health.

Methods

Since 2004, SpF daily collects data from ED participating to the OSCOUR® network (93% of French emergency attendances) and from SOSMed network. For both data sources, visits for several mental health disorders were analyzed for different age groups in 2020 and 2021 (until Week 16) and compared to years 2018 and 2019 (mean) with a focus on the two lockdown periods (resp W11 to W19-2020 and W45 to W51-2020)

Results

During the first lockdown period, while a major decrease of all-cause activity was observed in both networks, the number of SOSMed visits for anxiety increased in adults with a peak of + 115% in W13-2020 compared to 2018-19 and remained higher than the 2 previous years until W12-2021. An increase in ED visits for mood disorders (including depression) for children (especially 11-17yo) were also observed from W36 (back to school) and reinforced at the beginning of the 2nd lockdown period to reach +111% in W12-2021 compared to 2018-19. 11-17yo children were also concerned by an increase in ED visits for suicide ideation since W36 (peak of + 170% in W12-2021) and suicide attempt from W04-2021 to W12-2021 (peaks of + 45% and +41% in W05 and W10-2021).

Discussion

ED and SOSMed visits are the most reactive data sources to assess the impact of COVID-19 pandemic on the mental health of French population. These results confirm that the impact concerns all age groups. For children, the condition seems to worsen in 2021 and highlight the need of a close follow-up of the situation and the reinforcement of preventive measures in order to prevent long-term impacts.

Key messages

Results confirm an impact of COVID-19 pandemic on populations mental health. Impact of COVID-19 on mental health: a long-term issue for children?
COVID-19 fake news, conspiracy beliefs and the role of eHealth literacy: an Italian nationwide survey
Authors: Lo Moro G , Bert F , Minutiello E , Zacchero AL , Sinigaglia T , Colli G , Tatti R , Scaioli G , Siliquini R
Published: October 2021

Background

The pandemic has been accompanied by an infodemic, which includes false information that can lead to harmful consequences. Additionally, conspiracy theories have been linked to lower preventive behaviors. This work mainly aims to explore the skill in identifying COVID-19 fake news and the conspiracies beliefs.

Methods

A cross-sectional study has been conducted amongst a convenience sample throughout Italy, using a Computer-Assisted Web Interview method (from 12 April 2021-ongoing). The survey included the Single-Item Literacy Screener (SILS), the eHealth Literacy Scale (eHEALS), a Fake News Score (FNS: percentage of misclassified news), a Conspiracy Score (CS: score from 1 to 5). Multivariable linear regressions were run (p < 0.05 as significant).

Results

Up to date, participants were 1252. The median FNS and CS were: 25% (IQR=19-44) and 2.8 (IQR=2.2-3.4). For instance, 54% thought ibuprofen worsens COVID-19 symptoms and 50% agreed with “politicians usually do not tell us the motives for their decisions”. The 17% had low health literacy (SILS) and 41% low eHealth literacy (eHEALS). COVID-19 vaccine hesitant people were 13%. The multivariable models identified many significant relationships. Low economic status and vaccine hesitancy were positively associated with FNS and CS. Higher education had a negative association with FNS and CS. Age was positively associated with FNS. Low health and eHealth literacy were positively associated with FNS. Low eHealth literacy had a negative association with CS. FNS was positively associated with CS.

Conclusions

Associations between news misclassification, conspiracy beliefs and vaccine hesitancy might suggest shared determinants. EHealth literacy had a conflicting role. Attention should be paid to the mass media COVID-19 coverage as key information source for the general population. Public health campaigns should be planned to fight beliefs that hinder the reduction of transmission and might cause additional damages.

Key messages

The median percentage of misclassified news was 25% (IQR=19-44) and the median Conspiracy Score was 2.8 (IQR=2.2-3.4). COVID-19 vaccine hesitant people were 13% and 41% had a low eHealth literacy. News misclassification, conspiracy beliefs and vaccine hesitancy were associated. EHealth literacy had conflicting associations with fake news and conspiracy beliefs.
Syrian refugees perspectives on substance use
Authors: Lindert J , Schäfer Ingo
Published: October 2021

Background

Little is known about Syrian refugees ‘perspectives on substance use. Syrians have been the largest groups of refugees in Germany since 2014. To investigate Syrian refugees’ perspectives on substance use we applied a qualitative study design.

Methods

Five semi-structured focus group discussions with a total of 19 refugees were conducted in 2019 among the difficult to reach population of Syrian refugees. Audio recordings were translated and transcribed, and inductive thematic was analysis conducted.

Results

The following common themes were identified: (a) perception that substances are widely accepted and available in Germany; (b) availability of substances is linked to rules and norms in Germany which are different in Syria, (c) and to the intention to escape not only the past (d) but the present and finally that (e) mental health professional treatment for substance use is associated with shame.

Conclusions

Findings support Syrian refugees ‘perspectives of substance use as a way of escaping past and present in a socio-ecological understanding which includes past and present exposures. Understanding the explanatory model of Syrian refugees can inform future interventions to prevent substance abuse and design tailored interventions. Further studies with Syrian refugees in more countries are needed to better understand resettled refugees’ perspectives on substance use.

Messages

The intention to escape past and present elucidates links between the context of using substances and context of feeling rejected. Context specific knowledge of substance use is necessary which includes past and present factors.
The health workforce: central to an effective response to the COVID-19 pandemic in Europe
Authors: Zapata T , Buchan J , Azzopardi-Muscat N
Published: October 2021

Background

COVID-19 has reinforced the centrality of health workers at the core of a well performing and resilient health system. It has concomitantly exposed the risks of staffing and skills shortages and the importance of protecting the health workforce. This paper focuses on highlighting some of the lessons learnt, challenges and future needs of the health workforce in Europe in the context of COVID-19.

Methods

We use secondary sources and expert information.

Results

During the pandemic innovative and flexible approaches were implemented to meet increasing demand for health workers and new skills and responsibilities were adopted over a short period of time. We have seen the rapid adaptation and use of new technologies to deliver care. The pandemic has underlined the importance of valuing, protecting and caring for our health workforce and the need to invest appropriately and adequately in the health workforce to have sufficient, capable and well-motivated health workers. Some of the main challenges that lie ahead of us include the imperative for better investment, to need to improve recruitment and retraining whilst better retaining health workers, a focus on domestic sustainability, redeploying and developing new skills and competences among health workers, enabling more effective multi-professional collaboration and team work, improving the quality of education and training, increasing the public health focus and promoting ethical and sustainable international recruitment of health workers.

Conclusions

The WHO European Region through its European Programme of Work 2020-2025 is fully committed to support countries in their efforts to continue to respond to COVID-19 and whilst addressing upcoming health workforce challenges.
Health system resilience and health workforce capacities: health system responses during COVID-19
Authors: Burau V , Kuhlmann E , Falkenbach M , Neri S , Peckham S , Wallenburg I
Published: October 2021

Background

The present crisis offers a unique opportunity to better understanding the specific contribution of the health workforce to health system resilience, and more specifically to the adaptive, absorptive and transformative capacities that influence how health systems respond to the COVID-19 pandemic.

Methods

The study examined different capacities in the context of the health system as the central prerequisite of health system resilience. We compared health policies and services responses in Austria, Denmark, Germany, Italy, the Netherlands and the UK. The selection is based on differences in types of health care systems and pandemic burdens in the first wave. Country experts complied descriptive case studies using written secondary and primary sources.

Results

During the first wave of the pandemic, the contribution of the health workforce rested on a broad range of capacities. The absorptive capacity concerned the freeing up capacities for newly established Covid-19 wards in hospitals. The adaptive capacity focused on increasing health workers. The transformative capacity concerned new service offerings. The influence of health systems was most visible in relation to the substantive areas of health care delivery at play, and less so in relation to the specific range of capacities of the health workforce. The lack of distinct patterns was striking, considering the inclusion of health systems, which differ on many counts.

Conclusions

The study calls for a reconceptualization of the institutional perquisites of health system resilience to grasp more fully the manifold and unique health workforce contribution. Governance is the key to effective health system responses to the COVID-19 crisis, and health professions are part and parcel of governance as frontline workers and collective actors. This requires improving health workforce capacities and strengthening the integration of health professions in health governance.
An Evaluation of the Keeping Well at Home Booklet
Authors: Money A , McDermott J , Littlewood A , Todd C
Published: October 2021

Background

In the first wave of COVID-19, the UK Government relied heavily on digital channels to provide information to the public. This disproportionately excluded older people - one of the groups with least access to (or experience of) using the internet. Approximately 11.5 million people in the UK lack digital skills and 4.8 million people never go online, with around half (51%) of these being aged over 65. The Greater Manchester (GM) response was to work collaboratively with a number of key Ageing groups to develop Keeping Well at Home, a booklet providing evidence based health and wellbeing information and advice for older people during COVID-19 restrictions.

Methods

An evaluation of the booklet was undertaken during summer 2020 by the Healthy Ageing team at the Applied Research Collaboration GM. As national restrictions on movement remained in place at the time, a postal questionnaire was distributed to a sample of older adults in GM.

Results

Nearly 500 questionnaires were returned. The response was overwhelmingly positive; 92% found the information helpful; 90% agreed the booklet would help older people stay healthy during lockdown; 74% had used the home exercises section; 78% found the tips for keeping their mind well helpful. Around 50% of respondents did not have internet access. Paper based resources was the preferred choice for 92% of respondents with only 6% opting for digital versions.

Conclusions

The evidence from the evaluation challenges the growing trend towards communicating just through digital channels, and emphasises the need for tailored paper-based materials for older adults. The Keeping Well at Home booklet also shows the value of working with older adults to ensure the content and design are inviting to readers. Information, support and services must be made available in an offline equivalent and proactively disseminated to reach those who otherwise would not have access to it.

Key messages

Print-based communications are preferred over digital for some groups; ensuring inclusivity is critical as the ‘digital by default’ approach excludes large numbers of our population. Including target group representatives as co-editors to advise on content and stylistic design is key to ensure content is relevant and useful.
The effects of the COVID-19 pandemic on population mental health policy: A Swiss case study
Authors: Wieber F
Published: October 2021

This presentation will explore the mental health response to the COVID-19 pandemic in Switzerland with a focus on prevention and early intervention. To describe the pandemic context, the continuous literature screening on the secondary health impact of the pandemic measures on the mental health of children, adolescents and young adults in Switzerland will be used that Julia Dratva and the author lead on behalf of the Swiss School of Public Health and the Federal Office of Public Health. These findings will be complemented with selected results from the longitudinal Swiss Corona Stress Study that focuses on stress, anxiety and depression, the longitudinal COVID-19 Social Monitor that contains indicators on well-being and mental health, and the longitudinal <> study that assesses student depression and anxiety during the pandemic. As a major finding, all three studies observed significant increases in psychological stress during the second Covid-19 wave. In the Swiss Corona Stress Study, for instance, 18% of participants reported severe depression symptoms in November 2020 relative to 12% in May, 9% in April during the lock-down, and 3% prior to the pandemic. The presentation will then describe the specific mental health responses. For instance, psychiatrists and psychotherapists were allowed to bill treatment by telephone and the recommendations and billing options have been regularly adapted in response to the developments. However, these changes have not yet affected medium-term mental health policies. Similarly, the continuous screening of the scientific literature is established as a short-term measure. It is reviewed periodically and extended only as needed. The presentation will discuss policy changes in relation to the long-term strategies and their present implementation state. Finally, it will draw initial comparisons with other European countries discuss implications for the future mental system in Switzerland.
Implementing an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care: lessons from Spain
Authors: Requena Ana
Published: October 2021

Dr Requena will share new data from a pilot randomised controlled trial of a novel integrated multi-infection screening digital decision support tool, to promote screening for multiple infections in primary care in Spain among presenting migrants.
The Health and wellbeing impacts of Home and agile working in Wales: A HIA Approach
Authors: Green L , Ashton K , Evans L , Morgan L , Lewis R , Azam S , Bellis MA
Published: October 2021

The SARS-COV-02 pandemic has globally resulted in a number of policies and interventions to address and reduce the transmission of the disease throughout the population. Mitigation measures have ranged from ‘Staying at Home' or ‘Lockdowns' to social distancing policies and requirements to work from home when you can. Whilst there are a number of papers which discuss the effects of home or remote working on employees and their families the large scale shift, accelerated pace and wider impacts of such a shift has not been well explored in the literature or has been focussed on specific topics, for example, productivity. HIA is promoted as a beneficial tool to identify the wider impacts of a policy, plan or intervention across a population and as such is well placed to examine and articulate who in a population may be affected and how, and the inequalities that may be created by an intervention such as home working. Using the lens of social determinants and equity focussed-HIA, this work examines the wider impact of home working in Wales during the COVID-19 pandemic. It provides a coherent overview of the major impacts on health and the particular populations affected. It articulates the process followed, the key evidence based findings, discusses the gaps in the evidence base that require further exploration and the impact and influence it has had to date. Finally, it shares the transferable learning, which will be of use to researchers, policy and decision makers, organisations and public health agencies.
The relationship between health literacy, health status and health outcomes among German 4th-graders
Authors: Bollweg T , Okan O , Freţian A , Janner C , Schulenkorf T , Kirchhoff S , Pinheiro P , Bauer U
Published: October 2021

Background

The WHO describes Health literacy (HL) as a critical determinant of health, and a number of studies among adults link low HL to adverse health outcomes. However, little research has been conducted on HL and health outcomes in younger populations. Thus, this study describes the relationship between HL, health behaviors, and health status among children in primary schools.

Methods

A cross-sectional pen-and-paper survey was conducted in a convenience sample of 4th-graders in the federal state of North Rhine-Westphalia, Germany. Self-report measures were used for subjective HL, health behaviors (freq. of brushing teeth, eating fruit, exercising, screen time), and health status (subj. health, chronic condition, freq. of doctor visits, feeling ill). Correlations and binary logistic regression for the outcome “at least one adverse health behavior” (e.g. brushing teeth <2x a day; not eating fruit every day) are reported. Sex, age, family affluence, background of migration, numeracy, literacy, and health knowledge are included in the regression model.

Results

In our sample of n = 899 children (mean age 9,56 years), HL is significantly correlated with subj. health (ρ=.262**) doctor visits (ρ=.086*), feeling ill (ρ=-.078*), brushing teeth (ρ=.116**), eating fruit (ρ=.191**) exercising (ρ=.124**) and screen time (ρ=-.096**). Logistic regression (X2=29.237; p=.001, n = 648) shows that the relative risk for ≥1 adverse health behaviour is higher for boys (OR: 1.4; 95%-CI [1.016-1.927]) and children with lowest family affluence (1.7 [1.097-2.694]). Also, for one unit increase in HL (range 1-4), risk decreases by about 50% (0.472 [.298-.748]).

Conclusions

Already at a young age (9-10 years), HL is linked to a number of health outcomes. Further, HL has been found to be a potential predictor of adverse health behaviors after controlling for confounders.Thus, the promotion of HL might play an important role in mitigating adverse health behaviors early in the life course.
Female genital mutilation remains high in Senegal: an analysis of DHS 2018
Authors: Sougou NM , Seck I
Published: October 2021

Background

Female genital mutilation (FGM), also known as female genital cutting or female circumcision, threatens the health and well-being of millions of girls, women and their children across the globe. In Senegal, despite numerous health interventions, female genital mutilation is still a harmful practice. The objective of this study is to conduct a descriptive and analytical analysis of female genital mutilation practices in Senegal in 2018.

Methods

This study is a secondary analysis of the 2018 Senegal DHS. The analyses for this study were done on the Individual Records file. The DHS data covered 9414 women aged 15 to 49 years. A multivariate analysis was performed to consider confounding factors. The dependent variable was the existence of female genital mutilation in women. Data were analyzed with STATA 17 software.

Results

The prevalence of FGM was 17.18%. Women who had flesh removed from genital area represented 60.96% (1338), 29.39% (252) had genital area just nicked without removing any flesh, 6.88% (151) had genital area sown closed. Women who thought that FGM was justified by religion represented 11.52%. However, 80.59% of the women thought that it was a practice that should be stopped. The protective factors for the occurrence of FGM were women's empowerment factors (high level of education of the woman (primary ajOR=0.64 [0.50-0.83] and secondary ajOR=0.43 [0.32, 0.57]) and the fact that the head of the household is a woman ajOR (0.75 [0.59-0.97]); belonging to the central region of Senegal and the Christian religion (ajOr=0.05 [ 0.02-0.13]). The risk factors for female genital mutilation in Senegal were ethnicity and belonging to certain regions in the northeast and southeast of Senegal.

Conclusions

The prevalence of FGM in Senegal is still high. Ethnicity remains an important risk factor. Women's empowerment would allow the reduction of FGM. In the fight against FGM, politics should include women's autonomy strengthening like girls schooling.

Key messages

This study highlights the still significant extent of FGM. Women's empowerment factors would prevent these harmful traditional practices.
The caring perspective during a COVID pandemic
Authors: Mamo Julian
Published: October 2021

Work as a private primary health care practitioner with a special interest in older persons has been a rollercoaster ride over the course of the pandemic with the need to improvise, provide a wider form of care and an inordinate amount of role changing. The initial recommendation was to stay away from any possible cases which may have remotely resembled COVID with a view to keeping physicians and their practice safe. This message was unheard after the start of the second wave as the health services struggled to cope, testing became ever more accessible and patients who did develop COVID-19 needed someone to care for them when state services were overstretched. Meanwhile, the availability of all forms of specialist care grew ever scarcer in the community and increasingly caregivers such as myself realised that boundaries were now blurred under such circumstances. As hospital wards became taken up with exclusively COVID-19 patients, other hospital care delivery became on an urgent only basis and this had an effect on care in the community for patients living with chronic diseases. Physicians such as myself became ever more involved in caring for persons with mental illness and with the plethora of anxiety prevalent in a community burdened with a pandemic, an overabundance of morbid media coverage and social media feeding on fear and doubt.
Using foresight methodologies to tackle SARS-COV-2 related health impacts
Authors: Tijhuis M , Delnord M , Moye Holz D , de Vries MA , Lapão LV , Peyroteo M , Hilderink H
Published: October 2021

Background

A better understanding of possible future developments is essential for policy makers to anticipate and influence these trends. Public health foresight studies (PHFS) are tools to support this. The current health crisis makes clear that PHFS are necessary more than ever to target possible future impacts resulting from SARS-COV-2 induced changes in e.g. regular health care services, lifestyle and socio-economic developments. To support European countries in doing their own foresight studies, PHIRI aims to strengthen foresight capacity.

Methods

PHIRI follows a 4-step approach: 1. Making an inventory of current PHFS capacities and capacity needs across European countries using desk research and an online survey; 2. Providing PHFS capacity building via a training course and workshops; 3. Supporting the development of public health scenarios for the short term (0-5 years) and longer-term (5-20 years); 4. Supporting the identification of promising policy strategies, using policy dialogues.

Results

The online survey was completed by participants of 21 countries and shed light on existing national PHFS and needs for capacity building. It also provided a basis for the development of a professional network on PHFS within the project. Literature research revealed a range of studies using stakeholder involvement and scenario analysis to explore alternative futures. A PHFS capacity building course was developed consisting of three parts: a general, introductory module; three advanced modules deepening on several PHFS elements; and a final module evaluating and preparing countries for developing scenarios together.

Conclusions

There is a lot of interest in using foresight in public health, especially in these times of crisis. PHIRI provides more insight in the wider public health impacts of the SARS-COV-2 pandemic and in translating this into policy options.
Assessment of the COVID-19 related knowledge and its association with perceived worries of COVID-19 infection and severe illness among higher education students in 26 countries: A cross-sectional study
Authors: Berhe N , Van De Velde S , Van Hal G
Published: October 2021

Background

During COVID-19, various public health measures such as physical distancing and distance learning are being implemented. As a consequence, higher education (HE) students face social as well as mental trauma at a crucial developmental stage in their lives. Having inadequate COVID-19 related knowledge can lead to an exaggerated worrying as well as to negative COVID-19 outcomes. Our study aims to assess COVID-19 related knowledge and its association with perceived worries among HE students.

Methods

Between April 27 & July 7, 2020, a cross sectional survey, called COVID-19 International Students Well-being Study (C19 ISWS) was conducted in HE institutions in 26 countries. A stratified convenience sampling technique was used to select HE institutions. An online questionnaire was distributed to HE students to investigate behaviour and mental well-being. Descriptive, bivariate and mixed effect logistic regression analysis were conducted using R software. Perceived worries of COVID-19 infection as well as of severe COVID-19 illness (outcome measures) were studied.

Results

Over 127,000 students from more than 100 HE institutions in 26 countries filled out the questionnaire. 97,495 (76.5%) respondents have never acquired COVID-19 (our study population). 70,365 (72.1%) of these respondents were female. The most frequent correct response to COVID-19 related knowledge questions among respondents was observed about having the virus without having symptoms (94.3%). The odds of being worried of contracting severe COVID-19 illness among respondents with poor knowledge is 1.15 (95%CI:1.11,1.18).

Conclusions

COVID related knowledge was independently associated with perceived worries of contracting severe COVID-19 illness. We recommend scaling up of awareness creation campaigns to increase the comprehensive and timely COVID-19 related knowledge in order to tackle exaggerated perceived worries of severe COVID-19 illness among HE students.
Sustainable dietetic models in Europe: the Mediterranean diet as case study
Authors: Scazzina F
Published: October 2021

More than five years since the global commitment to the 2030 Agenda for Sustainable Development, 690 million people lack sufficient food and economic projections suggest that the COVID-19 pandemic may add an additional 83 to 132 million people to the ranks of the undernourished. Meanwhile, 1.3 billion tons of food are wasted globally each year, utilizing 38% of total energy consumption in the global food system. Child and adult overweight and obesity are increasing in almost all countries, and on a global level the cost of a healthy diet is 60% higher than the cost of a nutrient adequate diet, and almost 5 times the cost of an energy sufficient diet. The Mediterranean Diet is one of the recognized models of healthy and sustainable diets. This model has proven to promote longevity and well-being, not only by considering specific food items and dietary patterns, but also taking into account the culture and the history of populations living in that region, as well as social aspects such as tradition and conviviality. Moreover, it is strongly tied to a gastronomic background that links health with enjoyment. This may be extremely important for the implementation of feasible programs for the prevention of chronic non communicable diseases. In fact, long lasting lifestyle changes are difficult to achieve and, although health motivations may lead to satisfactory dietary compliance in the short term, pleasure remains an important determinant of any dietary change that is intended to last. While keeping traditional dietary habits at European level, the main principles of the Mediterranean diet could be taken into account to identify key features that ensure both health benefits and sustainable impact on environment. Assessing the sustainability of these products can be an effective operational approach for preserving and promoting a Mediterranean-type dietary pattern in the European region.
Preparing the public health workforce for digital health futures: the case for digital Health training & capacity building
Authors: Wong B , Buttigieg S , Vital Brito D
Published: October 2021

Digital technologies are rapidly being integrated into a wide range of health fields, public health in particular. While ‘digital health' has the potential to significantly improve population health and well-being outcomes, its effective implementation and responsible use are contingent on building a public health workforce with a sufficient level of knowledge and skills to effectively navigate the digital transformations in health. In particular, the next generation of public health professionals-namely youth-must be adequately prepared to maximise the potential of these digital transformations. This presentation will highlight three key priority areas which should be prioritised in digital health education in public health to fully harness the potential benefits of digital health: capacity building, opportunities for youth, and an ethics-driven approach. It will also present applications of digital health (technologies) and best practices for public health education.
Exploring gendered practices by social position in epidemiology: the gender score applied to Germany
Authors: Wandschneider L , Sauzet O , Razum O , Miani C
Published: October 2021

Background

Gender as a relational concept is rarely taken into account in epidemiology, yet an in-depth reflection on gender conceptualisation and operationalisation can advance gender analysis in quantitative health research, allowing for more valid evidence to support public health interventions. We constructed a context-specific gender score to assess how its discriminatory power differed in sub-groups defined by social positions investigated in intersectional analyses, i.e. sex/gender, race, class, age and sexual orientation.

Methods

We created a gender score based on gendered social practices on a masculinity-femininity continuum (ranging from 0-1) using data of the German Socioeconomic Panel. With density plots, we exploratively compared distributions of gendered social practices and their variation across social groups.

Results

We included 13 gender-related variables to define a gender score in our sample (n = 20,767). Variables on family and household structures presented with the highest weight for the gender score. Calculating tertiles, the score ranged between 0.01 and 0.68, 0.69 and 0.93 and 0.94 to 1 in women and 0 and 0.18, 0.19 and 0.40 and 0.41 to 1 in men, showing that the distribution for women is more skewed than for men. Comparing social groups, we saw that young individuals, those without children, not living with a partner or currently living in a same-sex/gender partnership, showed more overlap between feminine/masculine social practices among men and women.

Conclusions

Our explorative findings showed that the distribution of gendered social practices differed among social groups, which empirically backed up the theoretical notion of gender being a context-specific construct. Economic participation and household structures remain essential drivers of heterogeneity in practices among women and men in most social positions. Concerted efforts must continue to overcome these gender (in)equalities - which are important determinants of health inequalities.

Key messages

Family and household structures are crucial to constructing the gender score, indicating that interpersonal relationships are key determinants of gendered social practices. Including gendered practices in representative health monitoring data could allow for differentiation of biological sex and socially constructed gendered practices that drive health inequalities.
Intersectional inequalities in physical and mental health by sex, gender and immigration in Germany
Authors: Wandschneider L , Miani C , Razum O
Published: October 2021

Background

The mapping of migration-related health inequalities remains challenging, since immigrant populations constitute a heterogenous socially constructed group whose health experiences differ by social determinants of health. In spite of the increasing awareness that population mobility and its effects on health are highly gendered, an explicit gender perspective in epidemiology is often lacking or limited.

Methods

To map health inequalities in Germany at the intersection of sex, gender and immigration status, we used data from the German Socioeconomic Panel (SOEP) and applied an intercategorical intersectional approach conducting multilevel linear regression models. We differentiated between sex (male/female) as reported in the survey and gendered social practices, quantified through a gender score (femininity-masculinity continuum).

Results

We included 20,897 participants in our analyses. We saw an intersectional gradient for physical and mental health. Compared to the reference group, i.e. non-immigrant men with masculine gendered practices, physical and mental health steadily decreased in the intersectional groups that did not embody one or more of these social positions. The highest decreases in health were observed in the intersectional group of immigrant women with feminine gendered practices for physical health (-1.54 CI -2.41;-0.79) and among non-immigrant women with feminine practices for mental health (-2.71 CI -3.19;-2.14).

Conclusions

We saw differentiated patterns of physical and mental health along the intersectional axes of sex, gender and immigration status, both for physical and mental health. These findings highlight the relevance of these intersections in describing population health statuses and emphasise the need to take them into account when designing public health policies aiming at effectively reducing health inequalities.

Key messages

Being a man and having masculine gendered practices were associated with higher mental and physical health scores, for both immigrants and non-immigrants. Adopting an intersectional perspective, which takes into account social positions (e.g. gender, immigration status) and their impact on health inequalities, can help to target public health policies.
Socioeconomic inequalities in COVID-19 DALYs in Scotland, 2020
Authors: Wyper GMA , Fletcher E , Grant I , McCartney G , Harding O , de Haro Moro MT , Stockton DL
Published: October 2021

Aim

Our aim was to estimate the overall, and inequalities in the, population health impact of COVID-19 in Scotland, measured by disability-adjusted life years (DALYs) in 2020.

Methods

National deaths and daily case data were input into the consensus model outlined by the European Burden of Disease Network, to estimate DALYs. Total Years of Life Lost (YLL) were estimated, and for each deprivation quintile of the Scottish population. Years Lived with Disability (2% of all DALYs) were proportionately distributed to deprivation quintiles, based on YLL estimates. Socioeconomic inequalities were measured by the Relative Index of Inequality (RII), Slope Index of Inequality (SII), and attributable DALYs were estimated by using the least deprived quintile as a reference. Results were presented as a range, using a sensitivity based on YLL estimates using: cause-specific; and COVID-19 related deaths.

Results

COVID-19 DALYs ranged from 96,500 to 108,200 in 2020, representing the second leading cause of disease/injury in Scotland, in 2020. Marked socioeconomic inequalities were observed across several measures. The difference between the most and least deprived areas, measured by SII, was 2,048 to 2,289 DALYs per 100,000. The RII was 1.16, meaning that the rate in the most deprived areas was around 58% higher than the mean rate of the population. DALYs attributable to differences in socioeconomic status accounted for 40% of total COVID-19 DALYs.

Conclusions

The direct population health impact of COVID-19 in 2020 was substantial. Despite unprecedented mitigation efforts, in Scotland, a single case in early 2020 developed to having an impact second only to ischaemic heart disease. This impact was not shared equally, and socioeconomically deprived areas were hit hardest, a result confirmed across all measures of inequality. DALY estimation on both the ongoing direct, and indirect, pandemic harms will evidence the extent of impact on overall, and inequalities in, population health.

Key messages

The population impact of COVID-19 has been highly damaging. When measured by DALYs, the population health impact of COVID-19 in Scotland, during 2020, was second only to ischaemic heart disease. The population health impact of COVID-19 has not been shared equally, a result confirmed across all measures of socioeconomic inequality.