bluuebunny/crossref_metadata_2025 huggingface dataset:
Noise at school: any implications for teachers’ health? Findings from the French CONSTANCES study
Authors: Temam S , Billaudeau N , Kab S , Zins M , Vercambre M-N
Published: October 2023

Background

While noise at school is a well-known issue concerning students’ well-being, data on its potential effect on teachers’ health are limited.

Methods

Among teachers (n = 13,843) and a sample of non-education employees (n = 34,338) participating in the French CONSTANCES cohort (enrollment phase 2012-2020), we evaluated self-reported noise exposure at inclusion with the question “do you work in an environment where you sometimes have to raise your voice to talk to people 2 or 3 meters away?”(yes/no). First, we compared proportions of teachers who reported noise exposure to different groups of non-education employees. Second, among teachers, we cross-sectionally assessed, using logistic regressions adjusted for potential confounders, how combined exposure to occupational noise and work-related stress (defined alternately as effort-reward imbalance or tension with the public) was associated with two health indicators: self-perceived health (poor vs. good) and depressive symptoms (Centre of Epidemiologic Studies Depression scale, sex-specific cut-points, high vs. low to moderate), respectively.

Results

Thirty-two percent of teachers declared working in a noisy environment compared to 14% among non-education employees included. Primary school teachers were particularly exposed (42.6%), in comparable proportions to manual workers (43.3%). Among teachers, noise alone was not significantly related to self-perceived health but slightly associated with higher odds of depressive symptoms. We further observed evidence of an interaction effect on depressive symptoms between noise and tension with the public.

Conclusions

This large study highlights that noise is a common occupational exposure among teachers in France. As it may interact with sense of physical insecurity to weight particularly on mental health, our results advocate for a better considering of such every day and long-term exposure on teachers’ health.

Key messages

• Noise is a common occupational exposure for French teachers.

• As it may interact with work-related stress to affect mental health, noise at school should not be overlooked as an occupational hazard.
Combating Weight Stigma in Healthcare: A Cross-Country Analysis and Intervention Initiative
Authors: Forray A , Johnson K , Cherecheș R M
Published: October 2023

Background

Rising global obesity rates coincide with increasing weight stigmatization, affecting various life aspects, including healthcare. Discrimination impacts patient well-being and care quality, leading to suboptimal treatment. This research compares weight stigma among healthcare professionals in Romania, UK, and Greece, addressing personal and second-hand weight bias.

Methods

The study used cross-sectional data from the Breaking Weight Bias survey, including 125 healthcare professionals from Romania, Greece, and the UK. Data collection occurred between June and August 2021 via an online survey. Measures included the Universal Measure of Bias-FAT (UMF-FAT) questionnaire, personal experience with weight bias, and experiences of weight bias in medical settings.

Results

More women participated in the study across all countries. The mean age was 37.12 years (SD = 10.92). Bachelor's degrees were most common (43.4%), with Greece having the highest percentage of Master's (41.7%). Romania had the highest Doctoral degrees (32.4%). Private healthcare settings were the most common (51.3%). UMB-FAT results showed varying bias between countries. Romania had the highest rates (M = 3.08, SD = 0.768). Statements indicating more bias included poor hygiene (M = 2.40, SD = 1.832) and lacking consideration for others (M = 1.74, SD = 1.459). Over half of the participants (53.3%) experienced personal weight-related teasing. Greece had the highest rate (62.9%). Regarding second-hand weight bias experiences in medical settings, a high level of agreement (30-50%) was observed.

Conclusions

This study confirms weight bias in healthcare professionals across multiple countries, revealing moderate bias levels. Despite limitations, the findings contribute to understanding weight bias across different regions and fields. There is a need for weight-bias education among healthcare professionals, as it can harm patient-provider relationships and care quality.

Key messages

• Research confirms moderate weight bias in healthcare professionals across Romania, UK, and Greece.

• Study highlights the need for weight-bias education in medical training to improve patient-provider relationships.
Adherence to the EAT-Lancet reference diet and risk of type 2 diabetes, mediation by body mass index
Authors: Berthy F , Allès B , Fezeu L K , Lairon D , Pointereau P , Touvier M , Hercberg S , Galan P , Baudry J , Kesse-Guyot E
Published: October 2023

Background

Prevalence of diabetes has more than tripled since 1980. Urbanization, more sedentary lifestyles, and modern diets high in fat, sugar and salt are among the main causes of this increased incidence. A diet rich in healthy plant-based products is a way to prevent T2D (4) but has also impact on the natural resources and environment. In 2019 the EAT-Lancet Commission proposed a planetary, healthy, and reference diet, designed to reduce the global health-environmental double burden of current dietary patterns. The objective of this study was to investigate the association between the EAT-Lancet reference diet and type 2 diabetes (T2D) risk.

Methods

The study was conducted using data from 88,964 adults participating to the French NutriNet-Santé cohort 2009-2022 (78.8 % female; mean (SD) baseline age of participants was 43.8 (14.5) y). The endpoint was incident T2D. The main exposure was the EAT-Lancet Diet Index (ELD-I) modelled as sex-specific quintiles (Qs). Hazard Ratios (HRs) and Confidence Intervals (CIs) were assessed by Cox proportional hazards models adjusted for potential confounders. A mediation analysis was also implemented. The role of body mass index (BMI) as a potential mediating factor in the relationship was investigated.

Findings

During follow-up (median = 6.79 y), 812 incident T2D cases occurred. The ELD-I ranged from −192 to 429 points with a mean (SD) score of 43.4 (25.7) points. Compared with the participants who had lower adherence to the EAT-Lancet reference diet, those with higher had a 29 % lower risk of T2D (HRQ5vs.Q1: 0.71; 95% CI: 0.56, 0.89; Ptrend = 0.0024). The association studied was mediated up to 58 % by BMI.

Interpretation

In this large cohort study, higher adherence to the EAT-Lancet reference diet was associated with a decreased risk of T2D beyond body weight change. These results support previous findings and highlights the interest of the EAT-Lancet reference diet as a healthy and sustainable diet.

Key messages

• Higher adherence level to the EAT-Lancet reference diet was associated with a decreased of type 2 diabetes risk.

• The association between the EAT-Lancet reference diet and the occurrence of type 2 diabetes is partially mediated by BMI.
The Influence of immigration on breastfeeding: Results from the FinChildren survey
Authors: Muhumed I , Meinilä J , Klemetti R , Adebayo F , Virtanen S , Erkkola M
Published: October 2023

Background

Breastfeeding (BF) is essential to health promotion, disease prevention, and diminishing health inequalities. Recent studies in the Nordic countries revealed suboptimal BF practices among immigrants. Our aim is, first time in Finland, to quantitatively examine breastfeeding practices and sociodemographic characteristics of immigrants in comparison with natives.

Methods

We use a nationwide FinChildren (2020) survey on parents with infants, focusing on Somali- (n = 29), Arabic- (n = 81) and Russian speaking (n = 181) parents and their infants. We compared them with native Finnish speakers (n = 7508) using logistic regression and adjusting for confounders.

Results

Somali/Arab mothers had lower educational level, had higher BMI, were younger in age, and had more often C-sections. Proportions of both exclusive and any breastfeeding at 4-5 months were lower among Somali/Arabic speaking mothers (14% and 97%, respectively) compared to native Finnish (39% and 99%, respectively) and to Russian speaking mothers (41% and 98%, respectively). The difference in proportions of any BF between groups was not statistically significant. In the regression models fitted, being a Somali/Arabic speaking mother alone increased the odds of non-exclusive BF at 4-5 months fourfold (aOR 0.23, 95% CI 0.07, 0.72). Over 30% of Somali/Arab mothers had planned to mix feed their infants during antenatal period. This was inversely associated with exclusive BF at 4-5 months (aOR 0.14, 95% CI 0.11, 0.18) in the adjusted model.

Conclusions

Both exclusive and any BF were more common amongst native Finnish and Russian speaking mothers compared with Somali/Arabic speaking mothers. This study suggests the need for culturally sensitive interventions to promote BF amongst immigrants from outside Europe and to minimise any health inequality resulted from it.

Key messages

• This study found suboptimal breastfeeding practices amongst immigrant groups from outside Europe. Hence, it emphasizes the need for future research to further examine this pattern.

• Results of the present study emphasize the need for culturally sensitive breastfeeding interventions to prevent health inequalities in early nutrition.
Local responses to migration crises: ASL Roma 2’s experience with the Afghani and Ukrainian crises
Authors: Rosso A , Rinaldi A , Coluzzi D , Perrelli F , Pavone R , Napoli P A , De Angelis G
Published: October 2023

Issue/problem

In August 2021 and March 2022, Roma 2 Local Health Authority (ASL) was confronted with the prompt arrival of migrants from Afghanistan and Ukraine, following the humanitarian crises occurring in the two countries. The Migrants and Vulnerable Populations’ Health Unit (MVPH) needed to promptly develop interventions to respond to the health needs of newly arrived migrants.

Description of the problem

A multidisciplinary team was established in both emergencies, coordinated by the MVPH Unit, composed of nurses, medical doctors, vaccination staff, administrative staff, cultural mediators, responsible for outreach activities in the hotels were migrants were hosted. A basic assessment of health needs, COVID-19 tests and vaccination, TB screening were offered on-site. People were also granted access to health services through release of an STP (temporarily present foreigner) code. For the Ukrainian population, a dedicated Hub was also set up to respond to the health needs of people not hosted in hotels, with the full-time presence of cultural mediators. Collaboration with Non-Governmental Organizations working in support to the humanitarian crisis was activated.

Results

From August 21 to September 2 2021, 469 people from Afghanistan arrived in three facilities located in ASL Roma 2 area who were all assessed for their needs, were offered COVID-19 vaccine and received STP codes. From 1 April to 30 June 2022, 626 people accessed the dedicated Ukraine Hub. Forty-five site visits were carried out in the six hotels hosting Ukrainan refugees, with 343 people receiving a clinical examination.

Lessons

The presence of a dedicated service has allowed a rapid reorganization of ASL Roma 2 services to deal with humanitarian emergencies and the prompt activation of already established collaborative networks. Preparedness, good governance mechanisms and networking are key elements to develop effective responses to humanitarian crises.

Key messages

• A dedicated service for the health needs of migrants and vulnerable populations allowed the prompt developemt of effective local responses to global migration crises.

• Preparedness, a clear governane mechanism and networking with partner organizations were key elements of the local response to migrant emergencies.
A latent transition analysis of a Danish smoking reduction intervention trial
Authors: Lund L
Published: October 2023

Background

Distinct use patterns of tobacco and nicotine products are evolving among young people, notably after the market expansion of today's products. This study aims to identify and characterize subgroups of distinct tobacco and nicotine use patterns and to determine how a smoking reduction intervention and sociodemographic factors affected the transition patterns.

Methods

Data were from a Danish smoking reduction intervention targeting vocational school students. A latent transition analysis (LTA) was applied to identify patterns in latent classes of tobacco and nicotine use (use of cigarettes, smokeless tobacco, e-cigarettes, and hookah) from baseline to follow-up and to evaluate intervention effects on these patterns.

Results

A total of 2,158 students completed baseline and/or follow-up (FU) surveys (mean age = 20.8 years, 49.5% female). Three classes were identified: non-users (baseline: 31.3%, FU:33.9%), cigarette users (baseline: 36.0%, FU: 38.2%), and poly-users (baseline:33.7%, FU:27.9%). Students at intervention schools had 36% lower odds of transitioning from cigarette use at baseline to poly-use at follow-up (OR = 0.64; 0.41-0.99, p = 0.047) than control school students. Male and younger students were more likely to transition from cigarette use to poly-use. In contrast, students with origins other than Danish were more likely to transition from poly-use to non-use.

Conclusions

Intervention efforts must address tobacco and nicotine use progression towards high-risk use patterns, targeting those at greater risk of these progressions, such as males and younger students. Future research could benefit from using the LTA approach when evaluating intervention effects.

Key messages

• Three distinct latent nicotine and tobacco use classes emerged among Danish young adults attending vocational schools: non-use, mainly smoking, and poly-use.

• Students at intervention schools had lower odds of transitioning from cigarette use at baseline to poly-use at follow-up than control school students.
School exposure to air pollution in the UK and Ireland: Indoor-Outdoor air quality assessment
Authors: Parra M , Knowlton T
Published: October 2023

Background

Globally, 93% of children under the age of 15 (1.8 billion) are exposed to fine particulate matter (PM2.5) levels that might cause respiratory/cardiovascular disorders, impaired neuro/cognitive development, and cancer. Air pollution causes 1/10 deaths in children under the age of 5.

Methods

The purpose of this observational study was to collect data on indoor and outdoor air quality in 24 schools over 10 school days and compare it with city-wide average air quality levels reported in rural/urban areas in the UK and Northern Ireland. Nitrogen dioxide, volatile organic compounds (VOCs) and PM10,2.5,1 were monitored inside the classrooms and school surroundings with personal pollution monitors. City-wide averages were taken from local reference air quality and ground-source monitoring stations. Data was expressed using the Plume Labs Air Quality Index (PAQI) thresholds [low (0-20), moderate (21-50), high (51-100), very high (101+) pollution level] aligned with WHO's exposure recommendations.

Results

Despite both AQIs being in the moderate threshold, the school's average indoor AQI was ∼44% higher than the city-wide average. Only 27% of schools’ indoor air quality indexes matched the city-wide average, 59% were higher and 14% were lower. Rural schools had a marginally higher average indoor AQI than urban schools. The primary classroom pollutants observed were VOCs, followed by PM10. The average walk-exposure AQI of 33% of total schools was higher than the city's average. The school reporting the highest average walk AQI was seven times higher than the lowest.

Conclusions

Poor indoor air quality and higher levels of pollutants were found inside the majority of the schools across the regions. There is a need for mitigation strategies to identify responsible factors for indoor air pollution. A regulatory framework for school ventilation and behavior interventions like nasal washes may reduce pollution exposure and its impact on children's health outcomes and mortality.

Key messages

• Poor indoor air quality (∼44% higher than the city-wide average) and higher levels of pollutants (volatile organic compounds and PM10) were found inside the majority of the schools across the regions.

• A regulatory framework for school ventilation and behavior interventions like nasal washes may reduce air pollution exposure and its impact on children’s health outcomes and mortality.
Sickness absence and/or disability pension and future work income after age 65 and 70 in Sweden
Authors: Martikainen A , Alexanderson K , Svedberg P , Farrants K
Published: October 2023

Background

As retirement ages are increasing in Europe, more knowledge is needed on factors that are associated with extended working life. Our aim was to explore if prior sickness absence (SA) and/or disability pension (DP) due to mental and/or somatic diagnoses were associated with income from work after age 65 and 70, respectively.

Methods

A 4-year prospective population-based cohort study using microdata from nationwide registers. We included all who in 2014 were aged 65-69 (cohort A; n = 201,263) and ≥70 (cohort B; n = 93,751), respectively, had income from work in 2014 (baseline), and lived in Sweden in 2010-2015. Cox proportional hazard regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for associations between prior SA (in spells >14 days) and/or DP due to mental and/or somatic diagnoses, overall and stratified by the number of net days (2010-2014), and future years with income from work (2015-2018), censored for death and emigration, adjusted for sociodemographic and work-related factors, and stratified by sex.

Results

The majority had no SA or DP during the exposure interval (cohort A 66.3% women, 75.8% men; cohort B 96.8% women, 97% men). Many had income from work at some point during follow-up (cohort A 77.8% women, 81.6% men, cohort B 81.9% women, 83.4% men). Prior somatic SA/DP was associated with a marginally but significantly higher HR for earlier exit from paid work in cohort A (women 1.08; 95% CI: 1.06-1.10; men 1.10; 1.08-1.12), lower HR for men in cohort B (0.93; 0.86-0.99), and non-significant HR for women in cohort B. The corresponding association for mental SA/DP was significant only for women in cohort A (1.09; 1.06-1.13).

Conclusions

The likelihood of earlier exit from paid work was slightly higher for those aged 65-69 at baseline with prior somatic SA/DP, but lower for men aged ≥70 at baseline with prior somatic SA/DP. Prior mental SA/DP was associated with earlier exit only for women aged 65-69 at baseline.

Key messages

• Prior SA/DP was in many cases marginally but significantly associated with future income from work. The direction of association differed depending on the diagnosis of the spell, cohort and sex.

• More knowledge is needed on how older workers with different types of morbidities and functional limitations can extend their working life in Sweden as well as in other European countries.
Effects of the COVID-19 pandemic on the wellbeing of LGBTQ+ individuals in Moldova
Authors: Holliday N , Mulear V
Published: October 2023

Background

Sexual and gender minority (LGBTQ+) individuals often face physical and mental health disparities. In Moldova, a lower-middle-income, former Soviet state, there are few legal protections or social rights for LGBTQ+ people. The COVID-19 pandemic exacerbated health disparities for many communities that have historically been marginalized, including LGBTQ+ people. The impact of the pandemic on LGBTQ+ people in Moldova was previously unstudied.

Methods

We conducted a mixed-methods analysis of the effects of the COVID-19 pandemic on the mental and physical wellbeing of LGBTQ+ individuals in Moldova. We recruited self-identified LGBTQ+ people in Moldova to participate in an online survey or in-depth interviews. We analyzed interviews with a grounded theory methodology and survey data with descriptive statistics and we interpreted the data sets concurrently to identify emergent themes.

Results

From June to July 2022, we collected 86 online surveys and 12 interviews. Regarding mental wellbeing, our findings suggest LGBTQ+ people experienced both negative and positive effects due to the COVID-19 pandemic. Participants described an inability to be their authentic selves, especially when sheltering with unaccepting family members, as well as feelings of depression, anxiety, and loneliness. At the same time, participants described social support from the LGBTQ+ community and time and circumstances in which to explore their identities. Relating to physical wellbeing, participants reported interruptions to transgender medical care and some concerns about housing affordability.

Conclusions

This research contributes to a limited set of health studies on the experiences of LGBTQ+ individuals in Moldova. Our results highlight some unique impacts of the pandemic on LGBTQ+ people and underscore the importance of further research in this area and on the necessity for response plans that can address the needs of LGTBQ+ people in future health crises.

Key messages

• Many LGBTQ+ people in Moldova cited the pandemic as an opportunity to explore their identities, especially away from the public eye.

• During the pandemic, many LGBTQ+ individuals in Moldova needed to conceal their authentic selves from household members, exacerbating feelings of depression and loneliness.
The association between Planetary Health Diet, body mass index and polygenic risk score for obesity
Authors: Suikki T , Maukonen M , Kaartinen N E , Marjonen H , Pajari A M , Männistö S
Published: October 2023

Background

The way we eat and produce food are threatening our health and environmental sustainability. The EAT-Lancet Planetary Health Diet (PHD) was launched to consider both aspects. The association between PHD and body mass index (BMI) has barely been studied, and especially the role of inheritance in this context is unclear. Therefore, we examined the association between PHD and BMI and further evaluated whether the association differs by the level of genetic susceptibility for obesity.

Methods

In total, 4377 participants (≥18 years, female 56%) from the Finnish FinHealth 2017 Study were included. A validated food frequency questionnaire was used to assess the habitual diet. We developed an energy-standardized dietary index based on the PHD adapted for the Finnish food culture (score range 0 − 13 points). Genetic susceptibility for obesity was evaluated with a polygenic risk score (PRS) based on one million obesity associated single nucleotide polymorphisms. Linear regression was used for the statistical analyses.

Results

The mean PHD score for all participants was 4,0 (SD 1,5). There was a borderline negative association between PHD and BMI (β -0.01 95% CI -0.02, 0.00). When the genetic background was considered, this negative association reached statistical significancy in two lowest quartiles of PRS (lower susceptibility for obesity) (p < 0.05). Whereas no association was observed among those with higher PRS for obesity.

Conclusions

Although, the adherence to PHD was relatively, our findings suggested that individuals with lower genetic susceptibility for obesity may benefit from the better adherence to a healthy and sustainable diet in terms of weight maintenance.

Key messages

• Genetic susceptibility for obesity may play a role in the association between diet and obesity.

• Healthy and environmentally friendly diet may be beneficial for weight maintenance even with the low adherence to the diet.
What's on the menu? An eco-nutrition analysis of foodservice options
Authors: O'Sullivan E , O’Brien K , Douglas F E , McCartney D , Kirwan L B
Published: October 2023

Foodservice plays a critical role in shaping consumer food choices, and can have significant implications on public health and environmental impact. Foodservice options in the UK are often high in calories, salt, and saturated fat, and contribute significantly to greenhouse gas emissions (GHGe). This study provides a quantitative analysis of foodservice options at a catering site in the UK from both an environmental and nutrition perspective. Analysis was conducted on 110 food offerings from October 2022 to March 2023. Nutrition was analysed using energy, protein and HFSS scores. Environmental impact was analysed using the Nutritics Foodprint system. Statistical analysis was conducted using IBM SPSS V28. 76% of food offerings were categorised as ‘healthy'. Main meals and breakfast meal categories contained the highest average calories and protein per serving. 69% (n = 76) of the food offerings were classified as sustainable (C02 eq., <1kg), the mean carbon foodprint of offerings was 0.48kg Co2 eq/kg, and the mean water foodprint of offerings was 84.3L/per 100g. Meal offerings categorised as ‘main meals’ were more likely to have an unsustainable E grade (82%, n = 9) than offerings in other categories (p<.001). As the carbon foodprint of a meal increased, so did protein (r = .560, p<.001), energy (r = .568 p <.001) and serving size (p <.001, r = .346). No relationship was observed between nutrient profiling method and environmental impact. Main meal category contained a higher number of unhealthy options compared to other categories. Meals with a higher environmental impact had higher energy and protein content and larger serving sizes, but the nutrient profiling method used was not significantly associated with environmental impact. The relationship between environmental impact and nutritional adequacy is therefore not straightforward. The results of this study provide an insight into the role of innovative technologies in menu design.

Key messages

• Main meals represented a higher number of unhealthy options, and were identified as a focus for reformulation for this site.

• Foodprint can enable an evidence based analysis of the nutrition and environmental impact of food offerings across foodservice sites.
Co-producing a new tool to inform policy development in the field of physical activity promotion
Authors: Messing S , Gelius P , Abu-Omar K , Beck F , Geidl W , Grüne E , Marzi I , Tcymbal A , Reimers A , Pfeifer K
Published: October 2023

Background

While there are several approaches to collect data on physical activity (PA) promotion policies, some governments require more in-depth overviews to inform policy development. Recently, the German Federal Ministry of Health expressed its interest in collecting detailed data on target group specific PA promotion, as relevant competences are distributed across a wide range of political levels and sectors.

Methods

Based on relevant national and international guidelines, the TARGET:PA tool was co-produced by researchers and ministry officials. It includes (1) PA recommendations, (2) national prevalence rates, (3) recommendations for PA promotion, and data on national (4) routine practices, (5) pilot projects and (6) policies. In a first study, data were collected for children and adolescents in Germany using desk research, semi-structured interviews and secondary data analysis.

Results

A policy brief was developed. Results showed that 46% of the 3-6-year-olds fulfil WHO recommendations but only 15% of the 11-17-year-olds, and that girls are less active than boys. Currently, no valid surveillance data are available for children under the age of three. An overview of routine practices for PA promotion was compiled, and experts critically assessed their effectiveness, reach and durability. Overall, 339 target group specific projects for PA promotion were found, with 22 classified as examples of good practice. Relevant national PA policies were identified across different sectors and settings.

Conclusions

The TARGET:PA tool supports the translation of research evidence into policy action as it is target group specific, has a unique focus on routine practices, and systematically identifies policy gaps. Starting in 2023, it will serve as a conceptual basis for the three additional PA policy briefs tendered by the German government. While developed to specifically suit the German context, it has the potential to be adapted to other countries and health behaviours.

Key messages

• The TARGET:PA tool was co-produced by researchers and government officials to inform policy development in the field of physical activity promotion.

• The tool is target group specific, has a unique focus on routine practices, systematically identifies policy gaps, and has the potential to be adapted to other countries and health behaviors.
Patient experience with primary health care during the COVID-19 pandemic in Bulgaria
Authors: Rohova M , Dimova A
Published: October 2023

Background

The COVID-19 pandemic has had a profound impact on the primary healthcare experience of patients. Restricted access, delays in routine services, postponed checkups owing to safety concerns led to disruptions in care, missed diagnoses, and delays in treatment. This study investigates primary care service obstacles faced by patients during the COVID-19 pandemic in Bulgaria.

Methods

A national cross-sectional survey was conducted between November and December 2021 by a poll agency using an online self-administered questionnaire with 800 respondents. Binomial logistic regression was used to examine the association between sociodemographic variables and issues related to the availability of primary care services.

Results

Around 32% (95% CI 28-35%; p < 0.001) of the respondents reported obstacles related to the primary care, and 25% (95% CI 22-38%; p < 0.001) postponed a visit to the general practitioner due to accessibility and availability issues or fear of infection. The most prevalent obstacle cited by patients was a refusal of a referral for specialized care (26%), followed by a refusal of an out-of-hours or weekend consultation in case of urgent need (25%). Home visits and routine examinations were also denied to patients, albeit less frequently. The multivariable analyses found associations between gender, health status, education, and impediments by obtaining primary care services. The odds of facing obstacles rose as self-rated health deteriorated (OR = 6.0, p < 0.001). The likelihood of experiencing availability issues increased with educational level (OR = 6.2, p < 0.001). Women were 1.6 times more likely (p = 0.009) to report difficulties with primary care.

Conclusions

The COVID-19 pandemic has created significant barriers for many patients to access primary healthcare services. In addition, it has highlighted the need for a primary healthcare system that is resilient and capable of maintaining its essential functions during public health emergencies.

Key messages

• Primary health care has a crucial role in supporting patients during public health emergencies.

• The health system needs resilient primary health care that can adapt to swiftly changing conditions.
COVID-19 impact on viral hepatitis in Italy: a time-series analysis
Authors: Russotto A , Cornio A R , Vicentini C , Zotti C M
Published: October 2023

Background

Worldwide there has been a sharp decrease in the number of notified cases of any type of viral hepatitis during the pandemic period. This study aims to investigate the impact of COVID-19 on viral hepatitis in Italy.

Methods

This was a retrospective study that analysed data extracted from the “Integrated Epidemiological System of Acute Viral Hepatitis” (SEIEVA) online platform from 1994 to 2022 in the Piedmont region of Northern Italy. Descriptive statistics were used to compare data from the pandemic period (2020-2022) to three years of pre-pandemic period (2017-2019). Second, a univariate ARIMA temporal forecast model based on the years 1994-2019 was built to predict how many cases should have been registered in the pandemic period. The Wilcoxon test was performed to detect if there was a statistically significant difference between the observed and predicted values.

Results

The time elapsed between the onset of symptoms and the serological test, potentially indicative of challenges related to hospital access, was delayed by a couple of days (median 7, 2-12 IQR) in the three-year period 2020-2022 compared to 2017-2019 (median 5, 3-9 IQR). The same occurred considering the time between the positive test and the epidemiological interview (median 6, 3-16 IQR vs median 4, 2-9 IQR). Although the ARIMA forecasting model confirmed a downward trend, the observed values of notified cases were lower than expected. A statistically significant difference was found between predicted and observed values (p = 0.004).

Conclusions

Although it is difficult to assess the impact of COVID-19 on the transmission of viral hepatitis, the results of this study suggest a lower accuracy of the surveillance. It will be important to restore the previous levels of attention and investigation, monitoring the trend in the coming years. The World Health Organization's goal is the eradication of viral hepatitis. COVID-19 may have slowed down the process.

Key messages

• It is important to keep up the level of attention towards viral hepatitis, which seems to have decreased following the COVID-19 pandemic.

• It will be important to pay attention to the trend of notified cases in the coming years to establish more precisely the level of impact of the pandemic.
Flu vaccination ‘influenced’ by Covid-19: Italy experience
Authors: Iannaccone R , Dragoni L , Messina G , Nante N
Published: October 2023

Background

During last decades, National Health System has guaranteed free flu vaccination to the ‘fragile’ population. However, the population's compliance with this prophylactic procedure has never been optimal, reaching only in a few years and only in some regions the percentage considered satisfactory of 70% of people at risk. The Covid-19 pandemic has greatly raised the public's awareness of diseases of an infectious nature, respiratory in particular, among which influenza occupies a prominent role. We aimed to assess whether that compliance is increased as a result of Covid-19.

Methods

From epicenter.iss.it, influenza vaccination coverage rates of the Italian population both as a whole and of individual regions from 1999 to 2022 were obtained. In particular, comparisons were made between data for the pre-Covid (2017-2019) and post-Covid (2020-2022) three-year periods.

Results

The comparison revealed an increase in influenza vaccine coverage nationwide over the last three-year period (2020-2022). An average of the values from 1999 to 2017 of 15.22% of the population, an average of the pre-Covid three-year period (2017-2019) of 16.3%, not deviating from the national average of previous years, and an average of the post-Covid three-year period (2020-2022) of 22.1% was developed. A 35.58% increase in influenza vaccine coverage in the general population in Italy between the two three-year periods could be ascertained, which was the subject of special attention.

Conclusions

The Covid-19 pandemic has raised awareness among the population toward the usefulness of vaccination and not only toward the anti-SARS-CoV2 one. Influenza vaccination adherence has increased over the past three years. We plan to investigate whether compliance particularly affects those at higher risk who should be the main recipients.

Key messages

• The population after the covid 19 pandemic has become more aware of the usefulness of vaccination, not just the SARS-CoV2 vaccination.
Assessment of breastfeeding-related healthcare and their association with breastfeeding motivation
Authors: Kaseliene S , Jonkiene G
Published: October 2023

Background

Breastfeeding (BF) is one of the best ways to ensure healthy growth and development for newborns. However, for successful BF, mothers often need knowledge, assistance, and support from the healthcare professionals. The aim of the study is to evaluate the attitudes of Lithuanian mothers towards BF related healthcare services and their associations with BF motivation.

Methods

Data was collected in June 2022 using a quantitative research method by anonymous questionnaire survey. 572 Lithuanian mothers who carried to a full-term and gave birth to a healthy baby were interviewed between the 2nd-6th month postpartum (response rate 38.9%). BF motivation was evaluated by 24 items scale, developed by Kestler-Peleg et al. BF related healthcare services were evaluated by the Ten steps to successful BF scale which consists of 22 items. The sum scores of the scales, means, and standard deviations (SD) were calculated. Relationships between evaluation of health care services and motivation were determined by Spearman's correlation coefficient.

Results

The respondents rated BF related healthcare services as average (65.3 (SD 20.1) out of 110 points). The services provided by healthcare professionals in the first hours after birth were rated the best (3.76 (SD 1.1) out of 5 points), BF services related to the help of health care professionals to successfully breastfeed the baby in the future the worst (2.40 (SD 1.0) out of 5 points). A weak positive but statistically significant correlations were found between the evaluation of the provided healthcare services related to BF and BF motivation: as the evaluation scores of BF related services increased, women's BF motivation also increased (P < 0.001).

Conclusions

The respondents rated the healthcare related to BF as average, especially services that can determine successful long-term BF. Improving the quality of health care services related to BF can lead to greater motivation and success among women in BF their babies.

Key messages

• Mothers of infants aged 2-6 months rated health care related to BF in Lithuania as average.

• A weak positive but statistically significant correlations were found between motivation to breastfeed and assessment of BF related healthcare services.
Mother's health prior to pregnancy and eligibility for earnings-related parental leave benefits
Authors: Heshmati A , Dunlavy A , Mussino E , Fritzell S , Juárez S P
Published: October 2023

Background

Parental leave generosity is protective for mothers’ mental health in the postpartum period and beyond. Strong work requirements exist for parents to receive more generous benefits which might penalise individuals who, due to poor health, have a weak labour market attachment. The aim of the study was to examine whether mothers with poor health prior to pregnancy are less likely to be eligible for more generous benefits in Sweden.

Methods

We used total population registers to study first-time mothers aged 25-45 years who were resident in Sweden and gave birth between 1 January 2009 and 30 September 2013 (n = 151,452). We performed logistic regressions to assess the association between health one and two consecutive years prior to pregnancy (to evaluate chronicity) and eligibility for earnings-related parental leave benefits.

Results

Mothers who were admitted to hospital or received specialist outpatient care for any health condition in the year prior to pregnancy were less likely to be eligible for earnings-related benefits (OR 0·79, 95%CI 0·76-0·83) compared to healthy mothers, with the likelihood reduced further among those with chronic health issues (OR 0·64, 95%CI 0·62-0·68). Findings were driven by mothers with mental health conditions (OR 0·22, 95%CI 0·20-0·23 for the year prior to pregnancy and OR 0·16, 95%CI 0.15-0·18 for chronic conditions).

Conclusions

Mothers with prior health conditions, and in particular mental disorders, are less likely to benefit from the protective health effect of parental leave as they may not meet the eligibility requirements for more generous remunerations.

Key messages

• Mothers with prior health conditions are less likely to benefit from the protective health effect of parental leave as they may not meet the eligibility requirements for more generous entitlements.

• The work requirement for parental leave benefits may invertedly increase health inequalities in society.
Targeted Hygiene reduces surface transmission and infection risk for respiratory viruses
Authors: Ackerley L , Jung Y , Cooper S , Upson S , Gent L , Buckley C , Spitzer M E , Sexton J D , Reynolds K A , Wilson A M
Published: October 2023

Background

In public spaces, the importance of surface contamination in the transmission of respiratory viruses has been debated. This study aimed to compare the spread of a surrogate virus in a hotel lobby before and after a Targeted Hygiene intervention, and to quantify the reduction in risk of infection from respiratory diseases.

Methods

In a working hotel lobby, 13 fomites were seeded with a bacteriophage (Phi-X174) tracer at 8 am; 4 hours later 25 surfaces were swabbed to determine baseline tracer distribution and contamination levels. This was then repeated with the addition of a pre-determined Targeted Hygiene intervention performed 2 hours after seeding. Four replicate baseline and intervention trials were conducted, and data were compared for statistically significant (p < 0.05) differences. Risk of infection was estimated via Quantitative Microbial Risk Assessment modelling.

Results

Following the Targeted Hygiene intervention there was a significant reduction in the spread of the tracer (contamination of 13% of sampled surfaces vs. 50% at baseline). Tracer concentrations (PFU/site) were significantly lower overall (9.1E+02 PFU vs. 5.8E+04 PFU, p < 0.0001), including surfaces that had not been disinfected. Our model estimates that the risk of infection from common respiratory viruses via surface transmission was reduced by 97%.

Conclusions

Extensive spread of surface contamination can occur in a hotel lobby in as little as 4 hours. This study demonstrates how a Targeted Hygiene intervention can significantly disrupt the journey of the germ, even on surfaces not cleaned and disinfected, resulting in a consequent reduction of infection risk via surface transmission of common respiratory infections. This demonstrates the value of carrying out effective hygiene interventions to those managing commercial spaces.

Key messages

• Targeted Hygiene can significantly reduce the spread of respiratory pathogens via surface transmission, providing a means for facilities managers to achieve high standards using a targeted approach.

• The Targeted Hygiene approach can significantly reduce the risk of infection from common respiratory viruses via surface transmission in public spaces.
Neutrophil-specific ORAI1 Calcium Channel Inhibition Reduces Pancreatitis-associated Acute Lung Injury
Authors: Niu Mengya , Zhang Xiuli , Wu Zengkai , Li Bin , Bao Jingpiao , Dai Juanjuan , Yang Zihan , Zeng Yue , Li Liang , Pandol Stephen , Sutton Robert , Wen Li
Published: October 2023

Acute pancreatitis is initiated within pancreatic exocrine cells and sustained by dysregulated systemic inflammatory responses mediated by neutrophils. Store-operated Ca2+ entry (SOCE) through ORAI1 channels in pancreatic acinar cells triggers acute pancreatitis, and ORAI1 inhibitors ameliorate experimental acute pancreatitis, but the role of ORAI1 in pancreatitis-associated acute lung injury has not been determined. Here, we showed mice with pancreas-specific deletion of Orai1 (Orai1ΔPdx1, ∼70% reduction in the expression of Orai1) are protected against pancreatic tissue damage and immune cell infiltration, but not pancreatitis-associated acute lung injury, suggesting the involvement of unknown cells that may cause such injury through SOCE via ORAI1. Genetic (Orai1ΔMRP8) or pharmacological inhibition of ORAI1 in murine and human neutrophils decreased Ca2+ influx and impaired chemotaxis, reactive oxygen species production, and neutrophil extracellular trap formation. Unlike pancreas-specific Orai1 deletion, mice with neutrophil-specific deletion of Orai1 (Orai1ΔMRP8) were protected against pancreatitis- and sepsis-associated lung cytokine release and injury, but not pancreatic injury in experimental acute pancreatitis. These results define critical differences between contributions from different cell types to either pancreatic or systemic organ injury in acute pancreatitis. Our findings suggest that any therapy for acute pancreatitis that targets multiple rather than single cell types is more likely to be effective.
COVID-19 Recovery: Consistent Absence of Cerebrospinal Fluid Biomarker Abnormalities in Patients With Neurocognitive Post-COVID Complications
Authors: Kanberg Nelly , Grahn Anna , Stentoft Erika , Bremell Daniel , Yilmaz Aylin , Studahl Marie , Nilsson Staffan , Schöll Michael , Gostner Johanna M , Blennow Kaj , Zetterberg Henrik , Padmanabhan Nikhil , Cohen Rachel , Misaghian Salvia , Romero Daniel , Campbell Christopher , Mathew Anu , Wang Mingyue , Sigal George , Stengelin Martin , Edén Arvid , Gisslén Magnus
Published: October 2023

Background

To investigate evidence of residual viral infection, intrathecal immune activation, central nervous system (CNS) injury, and humoral responses in cerebrospinal fluid (CSF) and plasma in patients recovering from coronavirus disease 2019 (COVID-19), with or without neurocognitive post-COVID condition (PCC).

Methods

Thirty-one participants (25 with neurocognitive PCC) underwent clinical examination, lumbar puncture, and venipuncture ≥3 months after COVID-19 symptom onset. Healthy volunteers were included. CSF and plasma severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid and spike antigen (N-Ag, S-Ag), and CSF biomarkers of immune activation and neuronal injury were analyzed.

Results

SARS-CoV-2 N-Ag or S-Ag were undetectable in all samples and no participant had pleocytosis. We detected no significant differences in CSF and plasma cytokine concentrations, albumin ratio, IgG index, neopterin, β2M, or in CSF biomarkers of neuronal injury and astrocytic damage. Furthermore, principal component analysis (PCA1) analysis did not indicate any significant differences between the study groups in the marker sets cytokines, neuronal markers, or anti-cytokine autoantibodies.

Conclusions

We found no evidence of ongoing viral replication, immune activation, or CNS injury in plasma or CSF in patients with neurocognitive PCC compared with COVID-19 controls or healthy volunteers, suggesting that neurocognitive PCC is a consequence of events suffered during acute COVID-19 rather than persistent viral CNS infection or residual CNS inflammation.
Build Forward Fairer: Covid-19, Lessons Learned
Authors: Kjaerum Morten
Published: October 2023

The article discusses the importance of adopting a human rights-based approach in addressing the lessons learned from the Covid-19 pandemic. The article highlights the case of a human rights-based hospital in Sweden that actively reached out to vulnerable individuals in the community during the pandemic, emphasizing how the human rights-based approach contributes to building trust and thereby realizing the right to life and health. Based on this example it explores the need for a human rights-based approach in crisis management including climate-induced disasters. The article emphasizes the interconnectedness of all human rights and the need for economic prioritizations that align with social justice commitments. It highlights the role of institutions, legal frameworks, and collaborative efforts at various levels to ensure the realization of human rights and the principle of ‘leave no one behind’. The article concludes by advocating for the integration of human rights principles into legislation, policies, and actions to build a fairer and more resilient society.