bluuebunny/crossref_metadata_2025 huggingface dataset:
Waiting for hip fracture surgery: Analysis of individual heterogeneity and discriminatory accuracy
Authors: Öberg J , Khalaf K , Perez R , Merlo J
Published: October 2024

Background

Evaluation of healthcare inequality could be improved by considering (i) the intersection of socioeconomic axes of inequality, (ii) the existence of individual heterogeneity and (iii) criteria to quantify group differences and how those differences translate into recommendations for universal or targeted interventions. In this study we illustrate how to achieve these improvements.

Methods

We applied analysis of individual heterogeneity and discriminatory accuracy (AIHDA) to analyze data from the Swedish patient registry for the quality indicator hip fracture (HF) surgery within the same day. We analyzed 57,340 patients residing in Sweden during 2011-2014 and belonging to 36 socioeconomic strata defined by age, sex, income, and country of birth and the 21 Swedish regions. We calculated prevalences and 95% confidence intervals as well as the absolute number of cases. The benchmark was set to 80%. To quantify group differences, we evaluated the discriminatory accuracy (DA) using the area under the ROC curve (AUC).

Results

68% (39,073/57,340) of the patients were operated in time. The prevalence across the 36 sociodemographic strata ranged from 51% (43-58%) to 81% (67-91%). However, the DA was low (AUC= 0.562) indicating very small group differences. About half of the operated HP (n = 20,287) occurs in 18/36 strata with the lowest prevalences of operations in time. The regions’ prevalences ranged from 37% (36-38%) to 88% (88-89%) with a rather high DA (AUC= 0.736) indicating larger differences. About half of the operated HP (n = 19,677) occurs in 12/21 regions with the lowest prevalence of operations in time.

Conclusions

The 80% benchmark was only achieved in one socioeconomic stratum and the group differences were very small. 6/21 regions achieved the benchmark and the group differences were large. Interventions aiming to reach the benchmark in the entire population should proportionately target regions and be universal and tailored to sociodemographic strata.

Key messages

• The AIHDA-framework improves evaluations of healthcare inequalities.

• Both differences between group averages and the groups’ DA need be considered when planning healthcare interventions.
Factors associated with drowning in Portugal, 2019-2023
Authors: Marques Mendes P , Alves T , Gaio V , Aniceto C , Horta Correia F , Matias Dias C
Published: October 2024

Worldwide, mortality from drowning amounted to 236.000 individuals in 2019, corresponding to 8% of the total global mortality, making drowning the third leading cause of death from unintentional injuries and a universal public health problem. Portugal has a coastal zone of 950 km long, with 658 bathing waters and, in 2023, 157 people died due to drowning. This work aims to determine the factors associated with drownings that occurred in Portugal, between 2019 and 2023. This epidemiological descriptive-analytical study used the National Maritime Authority database, regarding the users of the portuguese coastal zone who suffered maritime incidents between 2019 and 2023. SPSS was used for statistical analysis and the results of the Poisson regression models are presented as adjusted prevalence ratios (APR) with 95% confidence intervals, according to individual (sex, age group and nationality), temporal (period of the week and day) and environmental (maritime department and beach surveillance status) variables. The total sample was 406 drownings and 15 860 other maritime incidents. Overall, the frequency of drownings in Portugal was higher in men (APR=1.393, 95%CI=1.130-1.717, p=.002), in the >55y age group (APR=1.780, 95%CI=1.005-3.152, p=.048), in foreigners (APR= 1.293, 95%CI=1.037-1.612, p=.022), on weekends (APR=1.299, 95%CI=1.063-1.586, p=.010), in the afternoon (APR=1.584, 95%CI=1.127-2.226, p=.008) and on unsupervised beaches (APR=2.436, 95%CI=1.958-3.029, p<.001) in comparison with users who suffered other maritime incidents. Individual, temporal and environmental factors are associated with a higher frequency of drownings in Portugal. Despite the limitation of the study that only includes users suffering maritime incidents and not all users of the portuguese coastal zone, our results allow a preliminary characterization of the drowning profile in Portugal and can contribute to the design of preventive strategies and policies to address this public health problem.

Key messages

• This study shows that there are individual, temporal and environmental factors strongly associated with a higher frequency of drownings in Portugal.

• Portugal has a large coastal zone and the characterization of a drowning profile is the first step for the development of prevention strategies in order to oppose drowning morbidity and mortality.
Race/Ethnicity, Education, and All-Cause Mortality in US Adults: Mediation by Telomere Length
Authors: Kodali H , Jones H , Wyka K , Valeri L , Borrell L
Published: October 2024

Background

Racial/ethnic inequities in mortality risk are pervasive in the United States even after controlling for socioeconomic status indicators such as educational attainment. Although the mechanisms underlying these inequities remain unclear, telomere length (TL) has emerged as a potential mediator. We aimed to investigate the joint association of race/ethnicity and education with all-cause mortality risk, and the contribution of TL to this relationship.

Methods

We used data from the U.S. National Health and Nutrition Examination Survey, 1999 to 2002, and 2019 Linked Mortality File (n = 6,526 non-institutionalized adults aged 25 years or older, including 2,166 deaths), a retrospective cohort study with a follow-up period to December 31, 2019. Cox proportional hazards regression and causal mediation analysis were used to address these aims. We reported hazard ratios (HR) and 95 % confidence intervals (CI). Furthermore, for the mediation analysis, we reported the total, direct, and indirect effects measured as HR and 95 % CI.

Results

After adjusting for age and sex, among White individuals, those with less than a high school education had a 2.26 times higher (95% CI: 1.93, 2.65) rate of all-cause mortality compared to those with some college or higher education. When compared with White adults with at least a college degree, Black adults with at least a college degree had a 1.38 higher rate of dying (95% CI: 1.04, 1.84). There was no significant joint association of race/ethnicity and education on all-cause mortality in Mexican Americans. In the mediation analysis, TL did not significantly contribute to the joint association of race/ethnicity and education with all-cause mortality risk.

Discussion

These findings underscore the need for a better understanding of the joint relationship of race/ethnicity and education on mortality risk inequities and their potential mechanisms to improve population health ultimately.

Key messages

• Lower educational attainment was associated with higher mortality rates among White individuals, disparities persisted among the Black population, despite higher education levels.

• Our analysis did not find a significant mediation effect of telomere length on the joint effect of race/ethnicity and education-mortality relationship.
Risk factors for COVID-19 infection among the German older adult population
Authors: Ordonez Cruickshank A , Gaertner B , Neuhauser H , Zanuzdana A , Poethko-Muelller C , Nowossadeck E , Fuchs J
Published: October 2024

Background

There are scarce analyses on COVID-19 infection risk factors for the older adult population. This study aims to examine COVID-19 infection risk factors in the older adult general population.

Methods

The data for this analysis came from the population-representative Study on Health of Older People in Germany (Gesundheit65+) conducted by the Robert Koch Institute from 10/2021 to 08/2022. We considered information on COVID-19 infection status (self-reported infection confirmed by PRC test at least once vs. never), socio-demographic factors, health risk factors, and different face-to-face interactions. The analysis was restricted to 2,976 individuals aged 65+ years with complete infection status information. We assessed weighted prevalences and used univariable and multivariable logistic regressions to evaluate infection risk factors.

Results

The overall prevalence of infection was 7.2% (95% confidence interval, 6.0-8.7). Infection prevalences were significantly higher (compared to their respective reference group) among participants living in assisted living facilities (24.7% vs. 6.7%), individuals who got help to perform basic activities of daily living (10.8% vs. 6.8%), COVID-19 unvaccinated individuals (25.2% vs. 6.9%), individuals who did not meet family or friends in the last month (12.7% vs. 6.7%), and participants who did not smoke (7.8% vs. 2.6%). No other variable was significantly related to COVID-19 infection. In multivariable analysis, variables independently associated with higher odds ratio (OR) of COVID-19 infection were: living in an assisted living facility OR 3.6 (1.8-7.2), not being vaccinated against COVID-19 OR 4.6 (1.5-14.1), and not smoking OR 1.6 (1.1-2.6).

Conclusions

The preliminary results of this study align with the prevalence of COVID-19 infection found in concomitant studies. A noteworthy element of our study is the vaccine’s protective effect. The pandemic had a particularly detrimental effect on residents of assisted living facilities

Key messages

• Improvement in quality of care and infection preventive measures in nursing homes is necessary.

• Pandemic preparedness must consider the need for help in the daily life of the older population.
Neonatal screening for hearing loss and its associated factors: A pediatric hospital experience
Authors: Ceballos Vela M C , Ruiz Hernandez L D , Diaz Macedo R , Colonna Aguirre B , Martinez Breton P , Viñas Dozal J C , Castillo Ceballos C E , Villegas-Dominguez J E
Published: October 2024

Introduction

Hearing impairment affects 0.6% of children worldwide, with 60% of cases being preventable. Identifying risk factors for hearing impairment would facilitate early detection and better patient prognosis.

Objectives

To identify factors associated with abnormalities in auditory screening in a pediatric hospital.

Methods

A cross-sectional study was conducted on patients assessed in the early hearing detection program at the Pediatric Tower of the High Specialty Hospital of Veracruz, Mexico, between June 2022 and 2023. Screening was performed using otoacoustic emissions initially. Those with abnormalities underwent two retests, and those positive in all three evaluations underwent confirmatory testing. Newborn screening was conducted at discharge for healthy neonates and after reaching a weight of over 1.8 kg and more than 34 gestational weeks for preterm infants. For term and low-birth-weight babies, screening occurred when they reached 2 kg, considering positive results in any of the three tests indicative of altered screening and probable hearing impairment.

Results

A total of 2731 patients were fully evaluated, with 1416 (51.8%) being male, and a median Apgar score of 9 at 5 minutes. The incidence of hearing impairment was 0.7%, comprising 19 patients. Evaluation of sex, 5-minute Apgar score, weight, gestational age, congenital malformations, history of neonatal asphyxia, hyperbilirubinemia, sepsis, TORCH infections, family history of hearing impairment, maternal exposure to ototoxic drugs, substances, COVID-19, gestational diabetes, or maternal hypertension obtaining values of p > 0.05 in each of them.

Conclusions

The prevalence of hearing loss is similar to that reported in the literature. In our population, auditory screening abnormalities are not associated with classic perinatal factors, indicating the complexity of contributors to neonatal hearing impairment.

Key messages

• The neonatal screening program plays a fundamental role in identifying patients with hearing loss even without any clinical factor that arouses suspicion of hearing loss.

• Early diagnosis will favor timely care for patients with hearing loss, favoring their development with adequate care to improve their quality of life.
Epidemiology of ESKAPEE Complex at Veracruz Children’s Hospital during 2023
Authors: Ceballos Vela M C , Castillo Ceballos C E , Marín Vargas J A , Villegas-Dominguez J E , Carranza Promotor G J , Perez Villanueva M , Sosa Gonzalez Y R , Bravo Sarmiento E , Alba Aburto D E
Published: October 2024

Introduction

The ESKAPEE complex comprises bacterial species known for their propensity to develop multiple mechanisms of resistance against antibiotics. The elevated rates of mortality and morbidity associated with these microorganisms, along with the challenges posed by their treatment, have transformed them into a significant concern in global public health. However, in Mexico, the prevalence of the ESKAPEE complex in pediatric patients within tertiary care hospitals remains understudied compared to adults.

Materials and methods

A cross-sectional, retrospective, and descriptive study was conducted, encompassing 179 bacteria belonging to the ESKAPEE complex. These bacteria were isolated from pediatric patients between January and December 2023 at Veracruz Children’s Hospital. Laboratory samples were processed using the VITEK 2.0 system, and descriptive statistical analyses were performed using SPSS v22 software.

Results

A total of 179 antibiograms were analyzed, with 55.1% corresponding to male patients. The most prevalent age group among pediatric patients was school children (5 to 11 years old), comprising 20.2% of the sample. Blood culture was the most frequently sampled site, representing 35.4% of cases. Klebsiella pneumoniae emerged as the most common bacterium, accounting for 22.5% of isolates. The Pediatric Emergency Department was the primary area from which samples were obtained, constituting 18.5% of the total.

Conclusions

Klebsiella pneumoniae was the most frequently isolated bacteria inside de hospital in 2023, especially among school-aged patients, followed by E. coli, which coincides with reports in the literature from various countries around the world.

Key messages

• Establishing a national surveillance network within public health institutions is imperative, where ESKAPEE complex microorganisms are reported.

• Knowing the epidemiological profile of the ESKAPEE complex will favor the diagnosis and intentional search for infections with greater etiological certainty.
Double edged tech: navigating the public health and legal challenges of digital twin technology
Authors: Delerm F , Pilottin A
Published: October 2024

This research addresses the legal challenges posed by the implementation of digital twin technology in public health. Digital twins are advanced computational models which aim to replicate human organ functions and biological processes. Their goal is to enable the simulation of the entire human body and to personalize the outputs with individual patient’s health data. Digital twin technology promises to bridge gap between personalized medicine and precision public health. This research is based on a comprehensive review of the current European and Swiss legal frameworks for medical devices and data protection that apply to digital twin technology. Within these frameworks, digital twins are in a grey area, as they are only considered as medical device software when applied to individuals. They also incorporate artificial intelligence, machine learning, and data analytics, which are already a source of legal concern in a healthcare setting, but their effective use in public health raises additional issues. Preliminary findings suggest significant shortcomings in the legal frameworks regarding data privacy, and the potential for increased surveillance by health insurance systems, which could lead to human rights violations. The public health application of digital twins would require global data analysis of sensitive personal information, raising further questions about the secure storage, transmission, and processing of this data. The study concludes that current legal frameworks must be future proofed to manage the complexities introduced by digital twins in public health. In particular, it suggests that regulatory oversight of medical devices needs to be significantly improved in order to safely harness the potential of digital twin technologies for public health. Finally, the new European Union health data space and the forthcoming EU AI act will also play important roles in the implementation of digital twin technologies.

Key messages

• Applying digital twin technology in public health faces considerable challenges, particularly the issues around data privacy, potential discrimination, and increased surveillance.

• We need to adapt and strengthen existing legal frameworks to effectively manage the complexities introduced by digital twins, ensuring that these technologies can be safely used for public health.
Effect of unprocessed and minimally processed foods on blood pressure in children
Authors: Mastroeni S , Kasmirski G , Torres C , Mastroeni M
Published: October 2024

Background

The poor eating habits of children, including a decrease in the consumption of unprocessed foods and an increase in the consumption of processed foods, have been associated with excess body weight, which is a well-established risk factor for cardiovascular diseases (CVDs), especially high blood pressure (BP). We aimed to investigate whether the consumption of unprocessed and minimally processed foods is associated with high BP in children at nine years of age.

Methods

Cross-sectional study of 142 Brazilian children participating in a cohort study conducted at the participant’s home. The child’s food consumption markers were evaluated using the Brazilian Food and Nutrition Surveillance System (SISVAN) and were classified by NOVA. Using a standardized procedure for approaching the child, BP was measured by the auscultatory method. Biological, socioeconomical, demographic, and anthropometric data of the mother and child were also collected. Logistic regression analysis adjusting for important predictors was used to evaluate the association between food consumption and BP.

Results

The prevalence of high BP in children was 20.4%, and the mean systolic and diastolic BP were significantly (p < 0.05) higher in children classified as high BP (110.1 and 71.3 mmHg, respectively). An important proportion (44.8%) of children had excess body weight (>85th percentile) and high BP when compared to eutrophic children. Not consuming healthy foods was associated with high systolic BP, even after adjustment for other important covariates (OR = 3.97; p = 0.028).

Conclusions

Not consuming healthy foods was associated with increased odds of children having high BP at nine years of age. Interventions promoting a healthy diet and the consumption of fruits and vegetables in childhood may contribute to preventing diseases associated with CVD, a global public health problem.

Key messages

• Educating parents to avoid processed foods and monitoring children’s BP are essential actions to prevent associated chronic diseases throughout life.

• Public policies aimed at educating parents to encourage the consumption of healthy foods may significantly contribute to reducing adverse cardiovascular outcomes.
Total sugar intake significantly associated with systolic blood pressure in small sample population
Authors: Pessoa L , Viegas C , Rodrigues P O , Bandarra N M , Bispo P
Published: October 2024

Background

Hypertension contributes to 45% of all deaths from heart disease and up to 51% of deaths from strokes. Dietary factors, such as sodium (Na+) and potassium (K+) can play a role, but recent studies have also highlighted the importance of sugar intake on blood pressure. Very few studies have evaluated the impact of these factors and their ratio on cardiometabolic biomarkers. This study aims to assess the impact of dietary sugar intake, Na+, K+ and NA+/K+ ratio on hypertension and cardiometabolic biomarkers.

Methods

Fasting venous blood was collected to measure glucose, triacylglycerols (TAG), total cholesterol, HDL-c, ApoA1, ApoB, or hs-CRP, with enzymatic and turbidimetric techniques, and oxidized LDL by ELISA, and IL-6 and TNFa by Luminex system, the latter’s in a subset sample. Blood pressure (SBP, DBP, and HR) was measured at least twice with an automatic recorder. Dietary intake was obtained using semi-quantitative FFQ, comprising 82 items, and reported to the previous year. Data was analysed using R software through descriptive analysis and partial correlations adjusted to the participant’s BMI. A significant level of 0.05 was used.

Results

78 participants, aged from 19 to 80 years old (M = 48,5±13,5) were evaluated, with 47% taking hypertensive medication. BMI ranged from 19,7 to 41,1 Kg/m2 (M = 29,2±5,4). The average intake of Na+, K+ and NA+/K+ ratio were 3805±1397 mg, 3980±1300 mg and 1.65±0,38, respectively. Total mean sugar intake (% energy) represents 21,4%. No significant correlation was found between Na+ or K+ with SBP, HR, and the cardiometabolic biomarkers (p > 0.05). A positive correlation was found between % sugar intake and SBP (rs = 0,29, p < 0,05), which remains significant after adjusting for BMI, and a positive correlation, in the borderline of significance, with TAG (rs = 0,23, p = 0,0561).

Conclusions

N+, K+, and their ratio do not associate with SBP, HR and cardiometabolic biomarkers. However, % of sugar intake is positively associated with SBP.

Key messages

• Sodium and potassium may not always be associated with changes in blood pressure.

• Sugar intake might have an important role in the etiopathology of hypertension.
Overcoming barriers in implementing healthy school nutrition policies: insights from Ukraine
Authors: Yurochko T , Heiko L
Published: October 2024

The general mortality rate from NCDs in Ukraine exceeds that in European Union countries, (Yurochko et al., 2023) exacerbated by the ongoing war. Healthy nutrition plays a pivotal role in enhancing the overall quality of life and curbing the prevalence of non-communicable diseases (NCDs). Despite its significance, ensuring healthy eating habits, particularly during the early stages of life at the period of setting lifelong habits (Jackson et al., 2020; Riley et al., 2018), remains a challenge. Besides, school-based settings represent an ideal environment for effective intervention because they offer a shared common physical, academic, and social space (Tapia-Fonllem et al., 2020). Through a series of semi-structured interviews with key stakeholders, this study identifies barriers and facilitators to policy implementation, with a focus on educational institutions. Qualitative analysis reveals barriers such as inadequate human resources, funding constraints, resistance from the food industry, and ineffective communication strategies at the family level. Moreover, there exists a disjointed understanding of nutrition standards. However, collaborative efforts with civil society, empowerment of nursing roles, strategic utilization of grants and fundraising, engagement with the food industry, and the adoption of a family-oriented approach emerge as crucial enablers for successful policy implementation. These findings offer theoretical foundations for fostering healthier nutrition environments within schools. This research serves as a roadmap for policymakers and educators striving to create sustainable and effective strategies for promoting healthy eating among early school-age children in Ukraine and beyond. Study finds human resource shortages, funding constraints, and food industry resistance as major barriers to school nutrition policy. Recommendations include collaborative approaches, nurse involvement, and aligned standards for effective school nutrition policy.

Key messages

• Healthy nutrition plays a pivotal role in enhancing the overall quality of life and curbing the prevalence of non-communicable diseases.

• Through a series of semi-structured interviews with key stakeholders, this study identifies barriers and facilitators to policy implementation, with a focus on educational institutions.
Exploring the use of meal delivery services in Belgium
Authors: Oostenbach L , Thornton L
Published: October 2024

Background

Ready-to-eat meal delivery services have become commonplace in recent years and their growth accelerated during the COVID-19 pandemic. However, the potential ramifications on dietary habits and subsequent health outcomes remain largely unexplored. Given the well-established links between unhealthy dietary patterns and chronic diseases such as obesity, type II diabetes, and cardiovascular diseases, understanding the determinants and public health implications of ready-to-eat meal delivery services use is imperative. This study aims to investigate the determinants associated with the use of ready-to-eat meal delivery services and their implications for health behaviours and outcomes.

Methods

This cross-sectional study is conducted amongst adults residing in Flanders or Brussels, Belgium. A quantitative online survey commenced in April 2024 and is scheduled to conclude by June 2024. Structural equation models will be used to assess determinants and implications of ready-to-eat meal delivery services use. Latent class analysis will be used to identify user profiles and subsequent structural equation modelling will assess determinants of these profiles and their associated health (behaviour) outcomes.

Results

Preliminary results suggest meal delivery usage was higher in younger and middle-income users. Main reasons of use amongst users (n = 139) were more time for leisure activities (66%) and supermarket avoidance (64%). Main reasons for non-use amongst non-users (n = 69) were not wanting to spend money with meal delivery services (70%) and preference to cook own meals (81%). Data collection is currently ongoing. Further analysis is planned, and full results will be available by November 2024.

Conclusions

This study will provide a better understanding of drivers of meal delivery services use in Belgium and their potential impact on public health. It will also help inform public health strategies targeted at improving dietary habits.

Key messages

• Recognising that meal delivery services will become ever present in the future, insights into why people order meals for delivery and the potential health implications of such services are essential.

• The use of advanced statistical techniques highlights the potential of the study to offer novel insights into determinants and ramifications of meal delivery services usage.
Representativeness of disadvantaged pupils in a trial to improve beverage consumption in Belgium
Authors: Desbouys L , Assakali W , Thiébaut I , Castetbon K
Published: October 2024

Background

The cluster-randomized controlled trial DRINK was implemented in 2021 to evaluate the effect of interventions aimed at reducing sweetened beverages and increasing tap water consumption among children in French-speaking primary schools in Belgium. Multiple participation issues related to the implementation in the school setting were encountered. Our aim was to describe the individual characteristics of pupils at baseline and their participation in the data collection.

Methods

In 2021, out of a sample of 168 schools stratified by region and socioeconomic index (SEI), 46 were included. Children in grades 3 to 5 were asked to complete a 4-day diary to record all beverages consumed. Questionnaires were completed by children and parents, from which individual characteristics were summarised, such as the Family Affluence Scale (FAS; in three groups).

Results

School participation (overall: 29.0%) was higher in Wallonia (33.0%) than in Brussels (22.0%), and in schools with an intermediate SEI (33.0%). At baseline, a total of 3,631 children participated in the data collection, either through the 4-day diary, the child questionnaire, or the parent questionnaire; 2,013 completed all three instruments. Participating children were more likely to be girls, to have an intermediate FAS, to be born in Belgium, and to have two working parents. The proportion of children attending schools in the Brussels region was 27.9% of the total participating children and dropped to 11.5% for those who returned three valid questionnaires. The proportions of low FAS (14.4% to 11.8%), birth outside Belgium (11.8% to 8.7%), and low parents’ schooling (35.3% to 33.8%) were lower among children who completed the three instruments.

Conclusions

The low participation of Brussels schools, possibly exacerbated by the Covid-19 impact, may explain why disadvantaged children were less represented in the baseline sample. Such knowledge is valuable for interpreting the findings of such a trial.

Key messages

• Participation issues may have affected the representativeness of less advantaged children.

• Documenting such disparities is key to understanding the context in which interventions were implemented.
Barriers to adopting a plant-based diet in various Finnish sociodemographic groups
Authors: Sares-Jäske L , Paalanen L , Tapanainen H , Kaartinen N E , Kaljonen M , Konttinen H , Männistö S
Published: October 2024

Background

According to nutrition recommendations, plant-based diets are favorable for both climate and health. However, the adoption of such diets varies between sociodemographic groups. Aims of this study are to examine how large proportions of the population have shifted towards plant-based diets to combat climate change, and to identify perceived barriers to dietary changes by gender, age, urbanization level, education, and household income.

Methods

The study is based on the Healthy Finland Survey conducted in 2022-2023, including 5390 participants (56% women) aged 20-74 years. Questions related to plant-based diet had pre-defined response options.

Results

Women reported that they had changed their diets to be more plant-based more often than men (46% vs. 31%). Women and men living in urban areas, having high education, or belonging to the highest income quartile had made changes more often than those in other sociodemographic groups. Women and men reported barriers in shifting to more plant-based diets, such as uncertainty about nutritional value (20% and 24%) and lacking skills to prepare tasty vegetarian food (30% and 28%). Disliking vegetarian foods (23%) or not being interested in the topic (28%) were also frequent issues in men, while women commonly cited the preferences of their close ones as preventing them from making vegetarian food (17%). These perceived barriers also differed between sociodemographic groups. For example, while uncertainty about nutritiousness of plant-based diets was most common in the oldest age group (29%), lack of skills to prepare tasty vegetarian food was most common in the youngest age group (35%). One third of men living in remote rural areas or with basic education reported not being interested in the topic.

Conclusions

Understanding barriers that prevent people in different sociodemographic groups from changing their diets to more plant-based is critical in tailoring more targeted and effective health promotion and policy.

Key messages

• Moving towards more plant-based diets to combat climate change and perceived barriers to dietary changes vary by gender, age, urbanization level, education, and household income.

• Understanding barriers preventing people in different sociodemographic groups from changing their diets to more plant-based is critical in tailoring targeted and effective health promotion and policy.
The role of weight stigma and food literacy in eating behaviour
Authors: Timkova V , Katreniakova Z , Mikula P , Nagyova I
Published: October 2024

Background

Overweight/obesity is associated with negative health outcomes that may be caused by experience and internalization of weight stigma. Weight stigma seems to diminish weight control efforts and may be associated with unhealthy eating behaviours. Moreover, lack is known about the protective factors against stigmatization. We aimed to assess the role of weight stigma and food literacy in eating behaviour in people with overweight and obesity controlling for sociodemographic and clinical variables.

Methods

A total of 189 participants with overweight/obesity (52.9% female; mean age 48.8±14.5 years; body-mass index (BMI) 32.6±6.5 kg/m2; waist-to-height ratio (WHtR) 0.6±0.1) completed the Experienced Weight Stigma Questionnaire and the Weight Self-Stigma Questionnaire. To examine eating behaviours including cognitive restraint, uncontrolled eating, and emotional eating we used the Three Factor Eating Questionnaire. Multiple linear regression analyses were performed.

Results

Higher WHtR and BMI were associated with emotional eating and uncontrolled eating. Experienced weight stigma was associated with emotional eating but was no longer significant when self-stigmatization was added to the regression model. Self-stigmatization was associated with emotional eating and uncontrolled eating. This association attenuated when food literacy was added to the final models. Low food literacy was significantly associated with emotional and uncontrolled eating. No role of weight-related measures, stigma or food literacy in the cognitive restrain was found. The explained variance in the final regression models for emotional eating and uncontrolled eating was 41%, and 32.7%, respectively.

Conclusions

Emotional eating and uncontrolled eating may represent crucial components to address in health and weight management. Nutrition literacy may have a positive effect on diminishing associations between weight stigma and unhealthy eating patterns. [Funding: VEGA: 1/0748/22].

Key messages

• Eating disorder symptoms and their association with obesity should be considered when designing public health interventions.

• Interventions targeting weight stigmatization and food literacy may mitigate the negative impact of weight stigma on eating behaviours.
SustentAÇÃO: E-learning training on food sustainability for teachers in the Lisbon Metropolitan Area
Authors: Sousa J , Gouveia C , Coutinho I , Pinto A M , Pinto M L , Ferreira O , da Silva V D , Nogueira T , Vieira R , Mendes M
Published: October 2024

Background

It is essential to address food sustainability (FS) within the school community to enhance both public and environmental health. In Portugal, in the scope of AML Alimenta, teachers’ training on FS was identified as a priority. Therefore, local partners along with academia developed, implemented, monitored, and evaluated the SustentAÇÃO.

Objectives

SustentAÇÃO aimed to empower school teachers in the Lisbon Metropolitan Area to teach students between 6 and 14 years old on FS. The program consisted of 10 hours of asynchronous online learning (MoodleTM), structured in 4 modules, and 10 hours of autonomous learning (5 students’ educational sessions), offering autonomy and flexible time management. The contents were adapted for different age groups. The teacher’s performance was monitored and evaluated continuously. A process evaluation was conducted for both teachers and students.

Results

Of the 79 teachers enrolled, 47% completed the program. Teachers’ performance (0-20) on the 4 evaluation questionnaires was on average 17,9±3,13. Most teachers found the program benefited their work (94%) and considered it essential for enhancing student’s knowledge (98%). Considering overall satisfaction, 85% of teachers were satisfied or very satisfied with the training and 91% would recommend it to their colleagues. Additionally, 86% of students enjoyed the activities delivered, 76% considered that they were wasting less food, and 78% believed they had improved their ability to make healthier and more sustainable food choices.

Conclusions

Through a collaborative work between local partners and academia, an innovative e-learning training programme on FS was developed, implemented, monitored, and evaluated, responding to the local needs identified. SustentAÇÃO complies with national education guidelines and contributes to the sustainable development goals agenda.

Key messages

• SustentAÇÃO E-learning training highlights the importance of collaborative work, based on an initial assessment to target local needs.

• SustentAÇÃO E-learning training improve teachers’ knowledge on FS and benefit their students.
Exploring the multiple dimensions of perceived food access in the local food environment
Authors: D’Hooghe S , Inaç Y , Vandevijvere S , Deforche B , De Ridder K , Van Dyck D , Van de Weghe N , Dury S
Published: October 2024

Persons in socioeconomically disadvantaged situations (PSEDs) are more susceptible and disproportionally exposed to unhealthy food environments, resulting in poorer dietary outcomes. Food access plays an important role within the wider food environment. This qualitative paper explores the context-specific relationships between the dimensions of perceived food access within the local food environment among PSEDS. 23 participants were recruited through purposeful convenience sampling until data saturation was achieved in two municipalities in Flanders, Belgium. Utilizing the photovoice and photo-elicitation method, participants expressed their perceptions of food access within their local food environment and its role in their eating behaviour, both individually (n = 16) and in group (n = 7). Applying the access framework to our analysis, the dimensions of perceived food access among PSEDS were divided into the personal (acceptability and convenience), perceived external (accommodation and desirability) or both personal and perceived external (awareness, availability, accessibility and affordability) domain. Our results suggest that awareness (e.g. of local opportunities available) precedes the other dimensions and that affordability is related to all dimensions among PSEDs. This study underscores the importance of perceived food access in healthy eating among PSEDS. The identified food access dimensions can inform policy, urban planning and community-based interventions to promote equitable access to healthy food.

Key messages

• Understanding perceived food access is essential to identify ways in which inequalities in food access can be addressed.

• Perceived food access interacts between external and personal domains.
The health profile of Lithuanian beekeepers and use of bee products for health purposes
Authors: Sladkevicius P , Jakubauskiene M
Published: October 2024

Background

There is little research about the health profile and attitude of beekeepers themselves who are the main suppliers of apitherapy products to the general public. The study aims to describe the health profile of Lithuanian bee keepers and identify their attitudes towards use of bee products for health purposes. 

Methods

A cross-sectional survey was carried out from November 2023 to February 2024 among beekeepers in Lithuania. A representative sample of N = 369 (5% margin of error) has been enrolled in the study. A mixed-model approach was used for data collection. Research instrument consisted of a two-part questionnaire covering socio-demographic variables and questions on the use of bee products.

Results

369 respondents participated in the study: 73% (n = 270) males and 27% (n = 99) of females. The mean age was 57.8 years (SD = 14.4). Beekeepers assessed their health as good and only 2% assessed it as bad, while the Lithuanian rate is 12%. 95% of the respondents used bee products for health purposes, 5% did not use at all. Large beekeepers (>100 beehives) were more likely not to choose bee products (p < 0.001). No correlation was found between chronic diseases and consumption of bee products, except for diabetes mellitus (p = 0.001). The most common reasons for choosing apitherapy products included respiratory (62%), digestive (31%) diseases, immunity boosting (77%), dermatological conditions (53%). Propolis was pointed out in the survey as being used by 74%. Elder beekeepers (>65 years) were found to be more likely to use propolis (p < 0.001). They were also more likely to use it for prevention (p < 0.001) and in case of toothache (p = 0.001).

Conclusions

The majority of beekeepers use bee products for health purposes. The most common reasons for consuming honey and other bee products are immunity boosting and colds. It was found that beekeepers over 65 years of age are more likely to use propolis for prevention and toothache treatment.

Key messages

• Although the consumption of bee products is high among beekeepers, elder generation and owners of smaller apiaries are more likely to use bee products for health purposes.

• Chronic diseases are not associated with consumption of bee products, except for beekeepers with diabetes mellitus who do not consume it.
Company commitments on nutrition and sustainability: A three-country comparison
Authors: Steele M , Campos S , Nova R , Dastoum S , Vandevijvere S , Harrington J , Oliveira A , Rodrigues A , Vaz-Velho M
Published: October 2024

Background

The Business Impact Assessment (BIA) tools were developed by INFORMAS to document companies’ commitments on population nutrition (BIA-Obesity) and environmental sustainability (BIA-Sustainability). As part of the EU-funded Food Systems that Support Transitions to Healthy and Sustainable Diets (FEAST) project, we used the BIA-Obesity and BIA-Sustainability to map the public commitments of a range of national and international food companies active in Belgium, Ireland, and Portugal.

Methods

We selected companies (Belgium n = 37; Ireland n = 39; Portugal n = 36) across the packaged food, soft drinks, quick service restaurant, grocery retailers, infant formula, and catering industries. Selection was based primarily on the companies’ market shares in each country, but minor adaptations were made to enable comparison of findings between the countries. We searched each company’s website, annual reports, and other public sources, logging all commitments relevant to the domains of the BIAs. Domains and criteria were adapted to reflect the regulatory and legislative environment in each country.

Results

In all three countries, commitments on sustainability were significantly stronger than those on nutrition, though still falling short of best practice. Within sustainability, commitments found in Belgium and Portugal were significantly stronger than those found in Ireland. Nutrition-related commitments were more consistent across the three countries, with companies in Ireland and Portugal showing the highest-scoring commitments in relation to product formulation.

Conclusions

Companies across all industry sectors and countries fall short of best practices, with a stronger commitments to environmental sustainability than to tackling obesity and non-communicable diseases. These results underscore the critical necessity for more ambitious government regulations at both European and national levels.

Key messages

• Critical necessity for government regulations at both European and national levels to adress environmental and nutritional challenges.

• Industry need stronger commitments to tackling obesity and non-communicable diseases.
Combating antimicrobial resistance: A framework for educational tool innovation
Authors: Nowbuth A A , Parmar V S
Published: October 2024

Issue

The World Health Organization (WHO) stresses the need for educational and training initiatives to address antimicrobial resistance (AMR) across human, animal, and agricultural sectors. AMR, a growing public health threat, was responsible for approximately 4.95 million deaths in 2019. Traditional educational frameworks tackling AMR are often applied in isolated sectors, failing to incorporate a holistic or collaborative approach.

Description of the Policy

The Holistic Engagement and Adaptive Response Theoretical framework (HEARTf) proposes a comprehensive, innovative approach combining behavioral theories, and persuasive technology, including the Theory of Planned Behavior, Persuasive Technology, and Diffusion of Innovation. The framework is designed to integrate stakeholders in developing and accessing educational tools, specifically a game designed to teach students about AMR. HEARTf emphasizes a multidisciplinary methodology, beginning with Phase 1 (exploratory phase) to gather baseline information from potential prescribers in Norway and Zambia.

Results

Initial application of HEARTf is leading the development of an educational game on AMR. This game uniquely combines behavioral theories and digital design, focusing on high-impact areas of AMR. Preliminary feedback indicates enhanced stakeholder engagement and a heightened willingness to adopt AMR best practices across different sectors.

Lessons

The HEARTf approach demonstrates the potential for enhancing AMR education through innovative, theory-based game design and development. It advocates for the continued integration of comprehensive educational strategies into global health initiatives to combat AMR effectively. These actions, being tailored to diverse sectors, suggest that similar holistic, theory-driven approaches may be beneficial in other public health crises.

Key messages

• HEARTf fosters innovative, multidisciplinary AMR education, enhancing stakeholder engagement and adoption of best practices.

• Theory-based educational tools in AMR developed using HEARTf can significantly impact global health strategies and should be integrated into broader public health efforts.
A year of rapid reviews: evidence-based decision support for Austrian social insurances & hospitals
Authors: Jeindl R , Mayer-Ferbas J , Wild C
Published: October 2024

Background

The Austrian Institute for Health Technology Assessment (AIHTA) has supported the decisions of Austrian social insurance funds and hospital providers with rapid reviews since 2023. This summary of rapid reviews aims to provide insights on findings, as well as experiences and challenges of conducting the rapid reviews after one year.

Methods

We included all rapid reviews that were requested to the AIHTA team in 2023. For research questions that were withdrawn, the reasoning was documented. The completed rapid reviews were grouped into medical specialties, depending on the intervention analysed. The conclusions of the rapid reviews were presented in tabular form, with the strength of the available evidence classified as high, moderate, low or insufficient.

Results

The rapid reviews on interventions (n = 9) cover a variety of medical specialties (orthopaedics, gynaecology, neurology, physical medicine, ophthalmology, vascular surgery and dermatology). In three rapid reviews, the analysed evidence on the intervention was insufficient for benefit (compared to standard of care). In four rapid reviews, the evidence indicated a potential benefit with some limitations (e.g. indication-specific results, or minimal clinically important difference not clearly achieved). In two rapid reviews, the evidence indicated a potential benefit. For three topics, no rapid review was conducted (topic scope too broad for rapid review, change in prioritisation). Challenges include time constraints, as well as narrowing the research questions to be suitable for rapid reviews.

Conclusions

The overview of rapid reviews highlights evidence-based findings on medical interventions. Further steps include collecting feedback from inquirers, on the extent to which the evidence from rapid reviews was used to support the decision-making. Rapid reviews are a feasible tool but require continuous evaluation and further adaptation of methods.

Key messages

• The rapid reviews to inform decision-making processes for Austrian social insurance funds and hospitals spanned multiple specialties and revealed varying levels of evidence.

• To improve the implementation of rapid reviews, and to overcome challenges of time constraints and narrowing down research questions, feedback from stakeholders should be collected.