bluuebunny/crossref_metadata_2025 huggingface dataset:
Climate change and health topics in pre-university education in Kosovo: A Content Analysis
Authors: Ramadani L , Boeckmann M , Sioen G
Published: October 2024

Background

Climate health literacy (CHL), recommended and recognized as vital for the global response to climate change and impacts on health, lacks comprehensive studies on its integration into primary and secondary school curricula. In Kosovo, where numerous environmental issues already exist and are expected to worsen due to climate change, the resulting health outcomes pose significant challenges. Moreover, the low environmental knowledge among youth further adds to the complexity of addressing these issues. This study addresses this gap by focusing on understanding and enhancing the inclusion of climate change and health topics in pre-university education.

Methods

A content analysis was conducted on: (1) core curricula, (2) subject curricula, and (3) textbooks for pre-university education (grades 0-12) in Kosovo. The outcomes of the content analysis were then juxtaposed with the CHL framework to identify alignment and gaps.

Results

We found that curricula in Grades 0-5, contained one topic on climate change and health topic out of 638 (0.16%) topics documented; however, textbooks did not elucidate this focus. Grades 6-9 had 2 out of 701 (0.28%) and the relevant textbook revealed that various environmental and health topics are covered, but that they lack exploration of the interrelatedness between environmental pollution, climate change, and health. Grades 9-12 had the highest integration with 4 out of 745 (0.54%). Textbook analysis of these grades revealed a more in-depth coverage of climate change and health linkages. In total, seven topics out of a pool of over 2000 topics encompassed learning outcomes related to climate and health in Kosovo’s pre-university education.

Conclusions

The current efforts to integrate climate change and health into Kosovo’s curriculum fails to meet the recommendations for achieving CHL levels. Localized and context relevant additions are needed to fulfil CHL among students in Kosovo and other countries interested in improving CHL.

Key messages

• This case serves as a testing ground for a framework assessing climate health literacy within curricula. The results identify gaps and areas of improvement, which inform the implications to attain CHL.

• Results reveal shortcomings in the incorporation of climate change and health topics in schools, underscoring the necessity for tailored strategies to foster CHL among students.
National early warning systems for emerging AMR in high-income countries: a systematic review
Authors: Iera J , Isonne C , Seghieri C , Tavoschi L , Ceparano M , Sciurti A , Migliara G , Villari P , D’Ancona F , Baccolini V
Published: October 2024

Background

An urgent need of implementing national surveillance systems for timely detection and reporting of emerging antimicrobial resistance (AMR) was recently advocated by the World Health Organization (WHO). However, public information on existing national early warning systems (EWSs) is often incomplete. Furthermore, when findings are available, understanding these systems is challenging due to different approaches used for data collection, reporting and definitions, with a comprehensive overview on this topic currently lacking. The aim of this study was to map existing EWSs for emerging AMR, focusing on high-income countries, and describe their main characteristics.

Methods

A systematic review was performed on bibliographic databases, and a targeted search was conducted on national websites. Any article, report or webpage describing national EWSs in high-income countries was eligible for inclusion. EWSs were identified considering the emerging AMR reporting WHO framework.

Results

We identified seven national EWSs in 72 high-income countries: two (Australia, Japan) in the East Asia and Pacific Region, three (France, Sweden, United Kingdom) in Europe and Central Asia, and two (United States, Canada) in North America. The systems were established quite recently; in most cases they covered both community and hospital settings, but their main characteristics varied widely across countries in terms of organization and microorganisms under surveillance, with also different definitions of emerging AMR and alert functioning. A formal system assessment was available only in Australia.

Conclusions

A broader implementation and investment of national surveillance systems that allow early detection of emerging AMR is still needed to establish EWSs in countries and regions lacking such capabilities. A more standardized data collection and reporting is also advisable to improve cooperation on a global scale.

Key messages

• This study provides a synthesis of publicly available information on national EWSs for emerging AMR in high-income countries, highlighting the urgent need for a broader implementation of such systems.

• Main characteristics of EWSs have been outlined, varying widely across countries. Findings could help stakeholders in strengthening current standard national AMR surveillance systems.
Advancing urban health in Portugal: exploring liveability and its association with mental morbidity
Authors: Baptista A C , Morgado P , Matias Dias C , Ribeiro A I , Sousa Uva M
Published: October 2024

Background

As cities face challenges posed by urbanisation, it becomes essential to understand how city planning can contribute to protecting public health. In this study, we aimed to assess the liveability of different areas in Lisbon, Portugal, by developing a liveability index at the parish level. Secondly, we aimed to explore its association with hospitalisation due to mental disorders.

Methods

The liveability index was built based on the World Health Organisation’s Urban Health Index methodology. We obtained data on liveability related to housing, socio-economic conditions and access to services (e.g. healthcare) from the 2011 census and other open data sources for Lisbon’s parishes (n = 22). Data on hospital admissions due to mental disorders was sourced at the parish level from the national database for hospital morbidity for the period 2013-2016 and sex-age-standardised. Binomial negative regression was employed to estimate the association between the liveability index tertiles and observed hospital admissions. We used the expected number of hospitalisations as the offset variable and tested for spatial autocorrelation among the regression residuals.

Results

Our analysis showed that living in the most liveable parishes is associated with a significant decrease in the standardised admission ratio due to mental disorders, compared to living in the least liveable areas (Incidence Relative Ratio=0.643; 95% CI: 0.427, 0.967). We did not observe any geographical pattern in the regression residuals (Moran’s I= -0.035, p = 0.427).

Conclusions

Our findings show disparities in liveability among Lisbon’s parishes and identify a protective association between living in higher liveability areas and hospital admissions due to mental disorders. This work should prompt further studies concerning this subject to inform urban planning policies to improve liveability and equally reduce the risk of mental health-related harm within cities.

Key messages

• A spatial index to assess liveability in urban areas was developed. The association between the liveability of Lisbon’s parishes and hospital admissions due to mental disorders was explored.

• We found a significant protective association between higher liveability and hospital admissions due to mental disorders. This work is relevant to inform the implementation of urban planning policies.
Climate Change, Air Pollution, African Dust Impacts on Public Health and Sustainability in Europe
Authors: Adamopoulos I , Syrou N
Published: October 2024

Climate change poses a significant threat to environmental sustainability and public health, leading to extreme weather events, rising sea levels, and biodiversity loss. Research on air pollution from African dust adversely associated with climate change highlights its significant role in trapping heat in the atmosphere and causing heat-related illnesses, cardiovascular disorders, and respiratory ailments. Smog, dust, acid rain, and ozone depletion also negatively impact ecosystems. The methods of the study also include the dynamics of climate change-induced air pollution. The implications for public health and environmental sustainability through GWR modeling and MODIS-NDVI analysis of controlling air pollution are crucial for reducing the climate crisis, safeguarding public health, and maintaining ecosystem sustainability. Results from particulate matter (PM 2.5-10), which consists of tiny particles with varying diameters, can enter the respiratory system through inhalation. This can lead to a diameter of less than 10 μm (PM 2.5-10). According to the relevant legislation, the limit value refers to the daily average value and must not exceed 50 μg/m3. While ozone in the stratosphere serves a protective function against ultraviolet radiation, excessive levels at ground level can be harmful and have been recorded in atmospheric samples ranging from 146.6 μg/m3 up to 702.3 μg/m3. impacting the respiratory and cardiovascular systems. Policy leaders, businesses, and individuals need to be proactive in reducing air pollution, adopting clean energy technology, and implementing stricter pollution rules. Stricter pollution rules, environmentally friendly transportation choices, and the adoption of clean energy technology. The sustainability of the ecosystem and public health are significantly impacted by climate change linked to air pollution. To solve these global problems and move toward a healthier, cleaner future for future generations, we must act now on climate justice.

Key messages

• Examine the impact of African dust air pollution on public health and its significant impacts from climate change, provide solutions to mitigate its effects on environmental sustainability in Europe.

• Public health workers, Policymakers and stakeholders must prioritize reducing emissions and enforcing strict air quality laws to mitigate the negative impact of African dust on European populations.
Building bridges in Climate Pact activities and Climate Action - example from Serbia
Authors: Jevtic M , Cattoir C , Matkovic V
Published: October 2024

The European Climate Pact is a movement of citizens united around a common cause, each taking steps in their own worlds to build a more sustainable Europe. Launched by the European Commission, the Pact is part of the European Green Deal and is helping the EU to meet its goal to become climate-neutral by 2050. This work presents examples of activities of the EU Climate pact ambassador in different directions (international and national/local level), with an unique goal, to increase awareness of importance of action, change of mindset, and exchange positive experiences. Climate Action is presented:

• through educational activities in EUGLOH project (European Global Health Universities Alliance) - by organizing Course Climate Action for Health and presenting to students at international level different Climate actions activities.

• engagement of citizens through Rotary Climate Action in RD 2483 and wither in Rotary international community - as citizens activities - Rotary Climate Action with the aim to increase awareness of climate change and health consequences.

• as mentorship activities with PhD students in the field (climate change and air pollution impact on respiratory diseases) - as a research activities.

• as an example of cooperation with media in Serbia - increasing of awareness among journalists.

There are a lot of possibilities to work in the long-term in the community, using glocal principles and trying to find a way to change the behaviour of citizens towards acceptance of climate neutrality as an important goal.

Key messages

• Climate Action is citizens action.

• Climate action is a way to change the behaviour of citizens towards acceptance of climate neutrality as an important goal.
Determinants in disaster preparedness of nurses in the Azores
Authors: Costa A , Gatinho E , Nogueira P , Mexia R , Arriaga M , Henriques A
Published: October 2024

Background

Disasters are situations of complexity and unpredictability, increasingly frequent and more destructive. They require rapid and effective action from different teams from different contexts, with preparation and qualifications for an adequate response to victims, recovering the environment, and restoring living conditions, and nurses play a significant role in these events. Understanding the level of preparedness of nurses for disasters is fundamental for defining the competency framework in the disaster management cycle.

Objectives

To analyze the preparation of nurses in the Azores for a catastrophe.

Methods

A cross-sectional study was performed with 160 nurses from the Azores. The questionnaire validated for the Portuguese population “Disaster Preparedness Evaluation Tool (DPET ®): Preparation of nurses in the face of a catastrophe” was applied. It was approved by the Ethics Committee.

Results

More than half of respondents (n = 137, 71%) indicated that they were not fully prepared to respond to disasters, while 29% (n = 46) acknowledged that they felt adequately prepared. Of the 160 respondents, only 20% (n = 30) participated in the development of emergency plans and only 14% (n = 22) participated in the creation of emergency plans that contribute to improvements at the local level. Training through simulation training was cited as important in disaster preparedness (n = 129, 78%).

Discussion

The present study identified little involvement of RAA nurses in preparing emergency plans and less than half feel poorly prepared in responding to a catastrophe. This finding is consistent with studies by Baker, Alamri, & Aboshaiqah (2019) and Emaliyawati et al. (2021).

Conclusions

This study was conducted in a region prone to natural disasters. It is vital to invest in the training of these professionals throughout the disaster cycle so that they can contribute to reducing the impact that the catastrophe will have on the individual/family and community.

Key messages

• Strengthening capabilities through regular disaster training based on effective information.

• Low participation in the development of emergency plans that contribute to improvements at the local level.
The burden of lung cancer attributable to ambient PM2.5 exposure: a systematic literature review
Authors: Corda M , Clemente M , Oliveira J , Morgado J , Redondo H , Charalampous P , Haagsma J A , Pires S , Martins C , Assunção R
Published: October 2024

Background

Lung cancer is recognized as one of the most common causes of cancer morbidity and mortality worldwide and is the second cause of death with highest years of life lost in highly developed regions. Ambient exposure to particulate matter (PM2.5) is the leading global environmental risk factor. Long-term exposure to PM2.5 is associated with several health outcomes, including lung cancer, ischemic heart disease, and chronic obstructive pulmonary disease.

Aim

To review and estimate the impact attributable to PM2.5 exposure due to lung cancer.

Methods

A systematic review and a meta-analysis were conducted to determine whether long-term exposure to PM2.5 increases the risk of lung cancer and to derive exposure-response relationships between PM2.5 and lung cancer. The literature search was performed in databases (i.e., Pubmed/Scopus) and studies published from January 1, 2010 onwards were considered. Studies describing the association between long-term exposure to the pollutant under research and the incidence, prevalence, and mortality of lung cancer, considering a relative measure of association were included, with no restriction in geographical area.

Results

In the literature review, 2215 articles were considered for the first step of data synthesis, all articles were screened, considering the screening of titles (first step), abstracts (second step) and full-text (third step) considering the inclusion criteria. In a second step the data was extracted from the included articles (n = 129) and considering the variables related to the characteristics of the study and the study population, exposure, and outcome measurement, and details of risk of bias assessment.

Conclusions

These findings provide data to synthesize effect size estimates using a Meta-Regression - Bayesian, Ensemble, Regularized, Trimmed (MR-BRT) model, important to provide evidence data on the impact of air pollution on human health, which is crucial for decision-making.

Key messages

• Long-term exposure to PM2.5 increases lung cancer risk so the estimating of the impact of the exposure is an urgent need to provide evidence-based data for air quality improvement.

• Meta-analysis aims to establish a relation between PM2.5 exposure and the burden of lung cancer.
Health burden and economic costs of vector-borne diseases in Italy: the AUSL Romagna case
Authors: Monti M , Golfera M , Angelini P , Soracase M , Angelini R
Published: October 2024

Introduction

Vector-borne diseases (VBDs) are a serious threat for global health, representing around 17% of communicable diseases and more than 700.000 deaths every year. In Europe, and especially in Italy, this is a subject of growing concern, due to the increase of VBDs outbreaks that need vector control plans.

Objectives

Evaluate the 2013-2022 trend of VBD outbreaks within the AUSL Romagna area (provinces of Ravenna, Rimini, and Forlì-Cesena, in Emilia-Romagna Region, Italy) and the economic impact caused by hospitalizations and local prevention/disinfestation treatments.

Methods

We used aggregated and anonymized data from 3 informative systems: communicable disease system (SMI) for VBD prevalence; hospital discharge records (SDO) for hospitalizations, with a contribution of the VBD-related Diagnosis Related Groups (DRG); municipality records regarding the cost of dedicated interventions for vector prevention and disinfestation, communicated to the Emilia-Romagna Region.

Results

For the area of interest, 479 cases of VBDs were notified from 2013 to 2022, with a slight increasing trend over the years. Through hospital SDOs, 252 cases were identified with a diagnosis of VBD, plus 283 with a VBD-related DRG, with a total expenditure of €9.587.777. The distribution was not uniform between the provinces, Ravenna having the highest expense. The municipality records highlighted expenses for €95.443 for prevention and control interventions against mosquitoes, with a very variable trend over the period considered. Forlì had the highest expense.

Conclusions

VBDs show a highly variable trend and distribution during time, also in relatively small, sub-regional areas. The Emilia-Romagna regional plan against arboviruses, annually updated, can contribute to reduce this specific health and economic burden, lowering transmission among the population and resulting hospital pressure, thanks to prevention and timely interventions.

Key messages

• The use of information systems enables monitoring of the impact of arboviruses, as well as the related cost for hospital care and local treatments.

• Putting in place an effective and updated plan against arboviruses, like the Emilia-Romagna Region one, helps managing VBDs and mitigating economic costs.
Microbial source tracking to address of bacterial contamination in recreational waters
Authors: Esenther S , Pascucilla M
Published: October 2024

Background

Beach closures in the USA are determined by fecal indicator bacteria thresholds, which are insufficient to identify causes of contamination. We use microbial source tracking (MST) to identify the species source of bacteria entering chronically impaired waters. We find canine bacteria is the primary source of high E.coli levels and demonstrate the power of MST for direction of remediation efforts.

Methods

This environmental sampling study was performed in Short Beach, Branford, Connecticut, USA. Water samples were collected from outfalls under wet and dry precipitation conditions by 10 Citizen Scientist volunteers. The highest E.coli samples were analyzed for avian, human, and canine markers using MST.

Results

E.coli from 103 samples was tested from April-October 2023. Pearson’s r between average site E.coli and same day precipitation was 0.71 (p-value = 0.006). Among the high E.coli samples, 19 (76%) were low/non detectable, 5 (20%) were moderate, and 1 (4%) were high for human tracers; 10 (50%) were low/non detectable and 10 (50%) were moderate for avian tracers, and 3 (15%) were low/non detectable, 11 (55%) were moderate, and 6 (30%) were high for canine tracers.

Conclusions

Precipitation is a driver of elevated bacteria levels. Canine bacteria is likely the primary source of elevated bacterial levels in beach waters, while avian contributors are of moderate concern and human contributors are of low concern. As a result, an education campaign and watertight waste receptacles, rather than costly sewer line replacements, are being deployed to improve beach quality.

Key messages

• Use of microbial source tracking found canine bacteria is the likely driver of elevated E.coli levels in local beaches, initiating a community education campaign rather than costly sewer replacements.

• Microbial source tracking technology offers a powerful public health tool for identifying causes of bacterial contamination in chronically impaired recreational waters.
Reducing the climate impact of food choices with comparable nutritional quality: a randomised trial
Authors: Aguirre-Sánchez L , Maione S , Maeder S , Infanger E , Suggs L S
Published: October 2024

Background

Diets largely contribute to the global disease burden, and a third of global warming emissions. We assessed the climate footprint reduction effect of framing the climate impact of diets as a collective action problem (social dilemma), compared or in combination with a reflective intervention (information) and a choice architecture intervention (nudge). Interactions with lifestyle factors were examined.

Methods

A randomised 2X2X2 between-subjects online experiment was conducted among university students ≥18 years, enrolled at a Swiss university, and not following a medically prescribed diet. The outcome was the mean climate footprint of food choices (in kg CO2-eq), based on a Life Cycle Assessment. Meals varied in climate footprints while adhering to the Swiss dietary guidelines.

Results

This analysis focused on the subset of meat eaters (n = 1691). Median age was 24 years, and 59.85% (n = 1012) were female. Seven intervention groups resulted in significantly lower climate footprints compared to the control. The social dilemma plus a nudge menu was the most effective behavioural intervention leading to 20.20% footprint reduction (b = -1.20 kg CO2-eq) compared to the control group (Mcontrol=5.94, SDcontrol=2.76; Mdilemma+nudge=4.74, SDdilemma+nudge=2.09 t(436) = -5.10, p < 0.001). Lifestyle factors linked to a higher climate footprint of food choices included adhering to a low-calorie diet (b = 1.21 kg CO2-eq, p < 0.05), or a muscle gain diet (b = 2.12 kg CO2-eq p < 0.05) and practising physical activities (PA) while adhering to a muscle-gain diet (Aerobic/Cardio: 3.82 kg CO2-eq, p < 0.05; Muscle-strengthening: 2.24 kg CO2-eq, p < 0.05).

Conclusions

The combination of reflective collective action communication and menu nudges is an effective strategy to mitigate the climate footprint of food choices in education institutions. Adherence to a muscle-gain diet was identified as a critical but manageable lifestyle factor linked to a higher climate footprint.

Key messages

• The dilemma plus a nudge was the most effective to reduce the climate footprint of food choices.

• This combined intervention can manage the high climate footprints linked to lifestyle factors.
Metabolically healthy obesity and cardiovascular outcomes
Authors: Tabara Y
Published: October 2024

Obesity increases cardiovascular risk through a deterioration of the metabolic profile. However, obesity is not always accompanied by a worsening metabolic profile. This longitudinal study aimed to determine whether obesity with a normal metabolic profile, i.e. metabolically healthy obesity, increases the risk of cardiovascular disease. We analyzed a health insurance data of Shizuoka prefecture resident. This data includes data from annual health check-ups performed for insured persons. This study analyzed data from 168,699 individuals aged <65 years. Obesity was defined as ≥ 25 kg/m2 body mass index. Metabolically healthy was defined as ≤ 1 metabolic risk factors (high blood pressure, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, or high hemoglobin A1c). Incidence rate of cardiovascular diseases (stroke and myocardial infarction), and all-cause mortality identified from the insurance data were compared between clinical profile-matched metabolically healthy obesity and non-obesity groups (n = 8,644 each). Clinical parameters, namely systolic blood pressure (standard mean difference = 0.03), HDL cholesterol (0.01), LDL cholesterol (0.01), and hemoglobin A1c (0.01) did not differ among the metabolically healthy obesity and non-obesity groups. The incident rate of stroke (obesity: 9.2 per 10,000 person-years; non-obesity: 10.5; log-rank test P = 0.595), myocardial infarction (obesity: 3.7; non-obesity: 3.1; P = 0.613), and all-cause mortality (obesity: 26.6; nonobesity: 23.2; P = 0.304) also did not differ significantly among the groups even when abdominal obesity was considered in the analysis, though the population with metabolically healthy obesity reported negligibly worse metabolic profiles than the population with nonobese at the 5.6-year follow-up. Obesity, when accompanied by a healthy metabolic profile, did not increase the risk of cardiovascular outcomes and all-cause mortality.

Key messages

• Metabolically healthy obesity did not increase cardiovascular disease risks.

• Metabolically healthy obesity was associated with worse metabolic profiles after a few years later.
Investigation of a Norovirus GII.4Sydney[P16] outbreak in a care facility in Portugal, 2022
Authors: Ourique M , Minetti C , Manageiro V , Vicente A , Roque C , Coelho A , Oleastro M , Martins Correia D , de Sousa R , Rodrigues N
Published: October 2024

Background

On the 29th of April 2022 the local Public Health unit was notified of 12 cases of acute gastroenteritis in residents of a long-term care facility (LTCF). A joint epidemiological investigation team was established and initiated an outbreak investigation to characterize the outbreak and implement infection control measures.

Methods

Epidemiological questionnaires were administered to staff (n = 44) and residents (n = 60). Case definition was LTCF residents or staff members with at least one of the following symptoms: diarrhoea, vomiting, nausea, between April 25th and May 14th, 2022. Stool or vomit samples were collected for 11 individuals. To assess environmental contamination fifteen food samples from previous meals and six surface samples from toilet faucets, wash tubs, and cutting boards were collected. Spatial distribution of cases within the LTCF was performed to guide infection control implementation.

Results

A total of 43 people met the case definition. Attack rates in residents and staff were 37% (23/63) and 42% (20/48), respectively. Of the total tested specimens, six (6/8) from residents and two (2/3) from staff were positive for the Norovirus (NoV) GII.4 Sydney [P16] variant by genotyping. Two (2/6) samples from surface swabs from the toilet faucet in the resident’s living room were also positive for NoV GII. Food samples were negative for major bacterial agents implicated in gastrointestinal outbreaks. Cases were distributed throughout the LTCF wards with no clear clustering. Four residents required hospital admission.

Conclusions

Results suggest person-to-person as well as environmental transmission of NoV. Identification of behavioural and spatial patterns of residents and staff and subsequent enactment of infection control strategies mitigated the outbreak. These findings reinforce the need for public health to maintain continuous technical support to LTCF on the implementation of infection control best practices.

Key messages

• Outbreak investigation in LTCF confirms Norovirus transmission, emphasizing the importance of infection control measures in long-term care facilities.

• Study reveals Norovirus outbreak in LTCF, underscores the role of person-to-person and environmental transmission, highlighting the need for robust infection control protocols.
Musculoskeletal disorders and risk factors in the modern era: results from the Specchio cohort
Authors: Bouhet A , Baysson H , Uppal A , Lamour J , Zaballa M-E , Stringhini S , Nehme M , Guessous I
Published: October 2024

Background

Musculoskeletal disorders (MSDs) represent a major challenge for occupational and public health, but data are scarce in Switzerland or concentrated on a few sectors of activities. The aim of this study is to provide results on the prevalence and risk and protective factors of MSDs in the general working-age population of the Geneva canton, Switzerland.

Methods

A cross-sectional analysis was conducted as part of Specchio population-based cohort study. Prevalence and associations between MSDs and sociodemographic variables, individual behaviour (smoking, physical activity, sleep), health conditions (BMI, chronic diseases), physical and psychological risks at work were examined using regression models. The impact of teleworking was also evaluated.

Results

2’733 participants took part in the survey, of which 38% were men, and mean age was 50. Overall prevalence of MSDs was 74% among men and 84% among women. 80% of the individuals experience back pain and 56% shoulder pain. Among individuals who experienced MSDs, 55.2% consulted a healthcare professional. The risk factors for MSDs were female sex (OR = 1.95; 95% IC = 1.55-2.28), body mass index (obese) (2.2; 1.51-3.32), lower education (1.77; 0.84-4.37), smoking (1.65; 1.19-2.35), exposure to physical risks (3.54; 2.78-4.51), stress at work (effort-reward imbalance) (3.23; 2.45-4.29) and a poor work-life balance (2.36; 1.88-2.97). The prevalence of MSDs remained high among workers who telework (78% versus 84% in working population).

Conclusions

This study, carried out in a large population-based cohort, confirmed several risk factors for MSDs. These results will contribute to the implementation of prevention strategies, especially as teleworking has gained in importance in recent years, which may have aggravated workers’ isolation and stress, sedentariness, and poor body posture. Main message: These data confirm the weight of musculoskeletal disorders and will help implementation of prevention health strategies.

Key messages

• The relationship between psychosocial risks at work and the occurrence of Musculoskeletal Disorders (MSDs) persists even following adjustment for exposure to physical risks and individual risk factors.

• The prevalence of musculoskeletal (MSDs) disorders remained high among workers who telework.
Innovative tools from WHO Europe to protect children from digital marketing of unhealthy products
Authors: Zhiteneva O , Hetz K
Published: October 2024

Children in the WHO European Region are extensively exposed to marketing of unhealthy products, including tobacco, alcohol, HFSS foods, and gambling, which negatively influences their dietary choices, behaviors, and perceptions of a norm, threatening their health rights. Recognizing the urgency to protect children’s developmental potential and rights, WHO has actively addressed this issue both within Europe and globally. In 2010, WHO issued recommendations for Member States on marketing foods and beverages to children. Building on these efforts, the CLICK framework for monitoring digital marketing to children was introduced in 2018. In 2023, WHO released guidelines urging countries to adopt comprehensive, mandatory policies to protect children from HFSS food marketing. Despite political commitments and policies, children and adolescents continue to be exposed to unhealthy product marketing, increasing their risk of NCDs as online activity rises. At the same time, while efforts have focused on restricting specific products, rapid changes in digital marketing strategies necessitate broader measures. Emerging trends include promoting brand loyalty among young children through brand characters and logos. Tools and support are urgently needed to monitor and implement WHO recommendations in online settings, including brand marketing. Despite WHO recommendations, few countries have implemented mandatory policies. Reliable monitoring mechanisms are essential. To address this gap, the WHO Regional Office for Europe developed the KidAd platform to monitor children’s exposure to digital advertising.
Evaluating perinatal health in Europe: a comparison of routine population birth data sources
Authors: Philibert M , Gissler M , Zurriaga O , Donati S , Drausnik Z , Heller G , Velebil P , Mohangoo A , Sakkeus L , Zeitlin J
Published: October 2024

Background

International comparisons provide essential benchmarks for evaluating perinatal health policies, but these rely on the availability of routine national birth data. This study aimed to describe population birth data sources in Europe by their ability to provide core perinatal health indicators.

Methods

The Euro-Peristat Network collected routine national data on a recommended set of core indicators from 2015 to 2021 using a federated protocol based on a common data model with 17 data items. Data providers filled in an on-line questionnaire to describe the sources used in each country. We classified countries by the number of data items they provided (all 16, 15-14, <14).

Results

28 out of the 31 countries that provided data responded to the survey. Routine data sources included birth certificates (14 countries), electronic medical records (EMR) from delivery hospitalizations (14 countries), direct entry by health providers (9 countries), EMR from other care providers (6 countries) and Hospital Discharge Summaries (7 countries). Completeness of population coverage was at least 98%, with 15 countries reporting 100%. These databases most often included mothers giving birth on the national territory, regardless of nationality or place of residence (19 countries). In 20 countries, routine sources were linked, including linkage between birth and death certificates (15 countries). Countries providing all 16 items (N = 8) were more likely to use EMRs from delivery hospitalizations, 88%, compared to 50% and 13% in countries with 15-14 items (N = 13) and <14 items (N = 8). Linkage was also more common in these countries, 100%, versus 75% and 50% respectively. Other data source characteristics did not differ by the ability to provide data for the common data model.

Conclusions

There is high diversity in the data sources used to construct perinatal health indicators in Europe. Countries using EMR with linkage to other sources had the best data availability.

Key messages

• There is high diversity in the data sources used to construct perinatal health indicators in Europe.

• Countries using Electronic Medical Records with linkage to other sources had the best data availability.
Linking health-related behaviours to quality of life in older adults: A latent class analysis
Authors: Felsinger R , Simon J , Haidinger G , Weber M , Mayer S
Published: October 2024

Background

Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population.

Methods

Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions.

Results

In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics.

Conclusions

To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class.

Key messages

• This study explores the relationship between health behaviour and QoL in older Austrians.

• Findings support the development of differentiated interventions targeting different types of behaviour.
Incidence of type 2 diabetes by occupation – 10-year follow-up of the Gutenberg Health Study
Authors: Bauer J , Hegewald J , Rossnagel K , Prigge M , Jankowiak S , Chalabi J , Riechmann-Wolf M , Nübling M , Wild P , Seidler A
Published: October 2024

Background

In order to implement targeted type 2 diabetes (T2D) prevention measures for the workplace, it is important to identify high-risk occupations. Most previous studies examine the association between T2D and occupation cross-sectionally, but longitudinal studies are missing. This study aims to investigate the 10-year incidence of T2D in the working population of a German cohort and identify occupations with an increased risk.

Methods

Data from the population-based Gutenberg Health Study (GHS) were used to examine occupation at baseline (2007-2012) and T2D incidence at the 10-year follow-up. Occupational phases were coded into categories according to the KldB 2010. T2D was defined as either a physician-diagnosed T2D, HbA1c-level ≥6.5% or use of antidiabetic drugs. Age- and sex-standardised incidence and 95% confidence intervals (CI) were calculated for occupational groups based on the age- and sex-distribution of the German population. Standardised incidence ratios (SIR) and 95% CI were calculated using the incidence in the total GHS working population as the reference.

Results

Of 8130 workers at baseline, 45.2% were female, the mean age was 48.4 years and 4.5% had prevalent T2D. 388 cases occurred between baseline and the 10-year follow-up within the subgroup of persons without prevalent T2D at baseline and with follow-up data (n = 5954). The standardised incidence was 6.9%. “Food production and processing” (20.7%), “cleaners” (16.5%) and “drivers and mobile plant operators” (14.8%) had the highest standardised incidences. Compared to the total working population, we observed a threefold increased SIR for employees in “food production and processing” (3.0, 95% CI 1.8-4.7) and a two times higher SIR for “cleaners” (2.2, 95% CI 1.0-4.7) and “drivers and mobile plant operators” (2.2, 95% CI 1.3-3.3).

Conclusions

We identified occupations with an increased risk of T2D. Preventive measures and etiological research on work-related risks should focus on these occupations.

Key messages

• The highest standardised incidence was observed in the occupational groups “food production and processing”, “cleaners” and “drivers and mobile plant operators”.

• Targeted prevention measures for type 2 diabetes in the workplace should focus on these occupational groups with increased incidence.
Measles cluster in Northern Portugal: enhancing surveillance strengths
Authors: Mendes A , Vieira M , Vidal-Castro J , Duarte L , Areias R , Cruz-Alves G
Published: October 2024

Although measles was declared eliminated in Portugal in 2015, outbreaks persist, despite high vaccination coverage. The last outbreak in the northern region was in 2017. Portugal has a Surveillance System implemented for mandatory communicable diseases (SINAVE) integrating clinical, epidemiological and laboratory data. In 2021, WHO expressed concern about the low sensitivity of measles surveillance and urged Portugal to strengthen its surveillance practices. Our study aims to describe a measles cluster in northern Portugal during the first trimester of 2024. Data from measles cases from the first trimester of 2024 were collected from SINAVE. Contact tracing and Public Health (PH) intervention data was sent by Local Public Health Authorities through a survey designed for that purpose. A total of 70 suspected cases were reported and investigated: 6 cases were laboratory confirmed and 64 were discarded. The confirmed cases had a mean age of 28 years (all adults), with 50% female. The mean notification time was 0,3 days. The index case was imported (Mauritania) and unvaccinated, leading to 2 secondary cases. Five cases had 2 doses of a measles vaccine, with 1 case being a health professional. Additionally, 1 case was imported from France. For 2 cases the source of infection could not be unequivocally identified and no travel history during incubation period. A total of 851 contacts of confirmed cases were identified. Although sustainable transmission is not evident in our region, measles is being introduced through migration and tourism. Despite clinical awareness, strengthening early case detection is essential to enforce effective control measures. PH teams have been working tirelessly to trace clusters origins, gathering large number of contacts and adapting strategies for sustained control. In a globalized world, ensuring surveillance sensitivity is paramount. Integrating other data sources in surveillance routine is crucial for upholding Measles-Free Status compliance.

Key messages

• Measles must take centre stage on our agenda.

• Reinforcing surveillance, integrating additional data sources, is crucial for heightened sensitivity and prompt response.
The process of developing a framework for code of ethics
Authors: Athanasopoulos P , Tahzib F
Published: October 2024

Issue/Problem

The World Health Organisation (WHO) and Association of Schools of Public Health in the European Region (ASPHER) roadmap for the professionalisation of the public health workforce has noted ethics as a pillar for professionalisation. It also highlights the need for code of ethics and professional conduct for all public health professionals and institutions. The Global Network for Academic Public Health (GNAPH), in collaboration with EUPHA, ASPHER, and the UK Faculty of Public Health has been working together for a code of ethics.

Description of the problem

The WHO/ASPHER group asked for a framework to be developed by the expert group as part of the rollout of the professionalisation agenda. The objective of this work was to develop a guide that is applicable to different countries within Europe to develop their own of code of ethics and conduct. A modified Delphi approach to building consensus amongst professionals in ethics included law, academia, and public health professionals. The questions sought to be answered were what and how to develop a framework and what should be included in the guide for creating a public health code of ethics.

Results

Throughout this method we developed five values, and twelve principles that are essential for the development of a code of ethics through a consensus building exercise. This framework was the first of its kind as part of the professionalisation agenda for different regions. There will be ongoing work piloting this framework in practice with various professional groups and institutions.

Lessons

Throughout this process, the need and demand across the public health community for ethical education and development of code of ethics was made evident. Collaboration between academics, ethicist, lawyers, and public health professionals and policy makers were key in developing a public health code of ethics. Identifying the challenges with monitoring and evaluating of its implementation a public health code of ethics.

Key messages

• Ethics, and a code of ethics are an essential component of the professionalisation agenda of the public health workforce.

• There is need for continued collaboration and partnership with public health professionals and institutions in enacting its implementation and evaluation.
Effect of plastic-free diet, education and Bisphenol A exposure feedback on urine BPA in adolescent
Authors: Ulusoy F , Gozum S , Parlak M
Published: October 2024

Background

BPA is an endocrine disrupting chemical and is mostly taken orally. Adolescence is the critical sensitivity to these chemicals is maximum. This study was conducted to compare the effects of a plastic-free diet program, plastic-free diet education program and BPA exposure feedback on urine BPA levels in adolescents with high use of packaged products.

Methods

The first phase of the two-phase study is descriptive, the second phase is a single-centre, single-blind, three-arm non-randomized experimental design. The study was conducted at Antalya/Türkiye in the 2022-2023 academic year, and in the first stage, adolescents with high use of plastic packaged products and low attitudes towards healthy nutrition were identified. In the second stage, participants were assigned to the group-1 (n = 36), group-2 (n = 36) and group-3 (n = 36) by simple random sampling method. An eight-week plastic-free diet program was applied to the group 1, plastic-free diet education program and BPA exposure feedback was given to the group-2, and only BPA exposure feedback was given to the group-3. Plastic Packaged Product Usage Survey, Attitude Scale towards Healthy Nutrition, and spot urine samples were used to collect data.

Results

It was found that 2% of adolescents used low plastic packaging, 34% medium, 57% high, and 7% very high. Pre-posttest urine BPA levels ng/ml (µg/g creatinine) were 1.98 (2.54), 1.43 (1.51) in the intervention1 group, respectively; 1.91 (2.35), 1.43 (1.47) in the intervention2 group; It was found to be 1.97 (2.49) and 1.49 (1.66) in the intervention3 group. The effect sizes of pre-posttest BPA/creatinine values were calculated as 1.38, 1.13 and 1.09 in intervention1-2-3 groups, respectively.

Conclusions

All three interventions (plastic-free diet program, plastic-free diet education program and BPA exposure feedback) were effective in reducing urinary BPA levels, reducing plastic-packaged product use levels, and increasing attitudes towards healthy eating.

Key messages

• Since all three interventions are effective in reducing adolescents’ urinary BPA levels, it may be recommended to use the intervention appropriate to the field conditions.

• In the post-tests, the use of plastic packaged products by adolescents in all three groups decreased and their attitudes towards healthy nutrition increased.