bluuebunny/crossref_metadata_2025 huggingface dataset:
An enhanced version of the PHIRI infrastructure: improving the technological solutions
Authors: Derycke P
Published: October 2022

The proof of concept tested by PHIRI consisted of the development of several research questions in multiple data hubs using a federated approach. It was possible to embed the use cases’ analytical pipelines in a portable standalone (i.e. docker image) and distribute it in different health data hubs and technological environments sources for execution. The tested solution has the advantage of not moving sensitive data out of the silos and thus protecting privacy - the code meets data and not the opposite. Some precious lessons provide guidance on how to further develop the PHIRI infrastructure. 1) A deep knowledge on what data is available in the different data hubs of a federation is key since the basis for the development of a research query is the construction of a data model that is common to all the nodes in the federation. In an eventual enhanced PHIRI infrastructure, a solution will be implementing a semantic information system that allows the exchange of metadata using federated and interoperable metadata catalogues based on Semantic RDF graph databases, compliant with the W3C DCAT metadata standard and exposing the end-points of the SPARQL querying language of the Web of linked-data. 2) Making available training samples mimicking real-world data within the docker image has been of high added-value for the development of the use cases’ analytical pipelines. In an eventual enhanced PHIRI infrastructure, a generalisation could consist of setting up a “knowledge hub” where synthetic data, twinning the population, data would allow any expert users to search and find data through federated queries and prepare and train their analytical pipelines; the “knowledge hub” would provide a computational environment (e.g. Jupyter as a service playground), the necessary tools (i.e. cookbooks and capacity building services) and training samples to answer research questions, with the advantage of using data that is anonymous by nature and open access.
Barriers and Facilitators to Healthcare Service Access among Persons with Spinal Cord Injury (SCI)
Authors: Bychkovska O , Egen C , Strøm V , Juocevicius A , Tederko P , Arora M , Rizzo Battistella L , Engkasan JP , Gemperli A
Published: October 2022

Background

Despite having a high healthcare need, persons with complex conditions are less likely to receive comprehensive care. Individuals with SCI experience difficulties accessing services 2-4 times more than the general population. There is little agreement concerning the factors that influence these access restrictions. Few studies focus on health system impact on characteristics on access.

Objective

To outline barriers and facilitators to service access among persons with SCI across 22 countries in terms of health system characteristics

Methods

InSCI(2017): 1st community survey on experience of persons with SCI, 12591 participants, 22 countries (Australia, Brazil, China, France, Germany, Greece, Indonesia, Italy, Japan, Lithuania, Malaysia, Morocco, the Netherlands, Norway, Poland, Romania, South Africa, South Korea, Spain, Switzerland, Thailand, USA).

Data analysis

1. Hierarchical cluster analysis based on Gower distance (to group systems by access restrictions: Acceptability, Approachability, Availability, Affordability, Appropriateness).

2. Generalized linear mixed-effects decision tree (to explore the association of system characteristics and access, including WHO and OECD system indicators (e.g. UHC index, expenditure, human resources). Missing values were imputed with missforest.

Results

12% of persons with SCI reported having an access restriction, most of them (7%) with Availability. By country, the highest unmet needs were reported in Poland (25%), Germany, Lithuania, and Romania (13).

1. Cluster analysis: 7 health systems clusters (groups) were identified.

2. By June 2022, we will have the results of the second analysis: the association of system characteristics with access and how it is modified by socio-demographic and medical factors.

Expected conclusions

The study identifies factors a country could modify in order to improve access and strengthen the system for persons with SCI/disability, that might be relevant to general population as well.

Key messages

• Persons with SCI often experience similar access restrictions across countries, incl. those with high-performing health systems. System strengthening in this area is further required in all countries.

• Health systems are fragmented, e.g. healthcare quality and access inside a country differs by region, urban/rural setting etc., hence, the systems are challenging to classify.
The integrated GOR-COVID-19 health monitor: quarterly reporting (“short-cycle monitoring”)
Authors: Derks M , Baliatsas C , Dückers M , Bosmans M , Marra E
Published: October 2022

Introduction/objective

Given the capricious nature of COVID-19, infections and accompanying restrictive measures to reduce spread of the virus are known to strongly vary over time. The impact of the corona crisis on the mental and physical health of the general population may fluctuate accordingly. The quarterly monitoring research line is aimed to monitor the health impact of the corona crisis over time on a high frequency basis.

Methods

This is achieved through a multi-method approach, combining: a) survey data on perceived impact of corona measures and several health outcomes from two representative panels (∼ 5.000 adolescents/young adults aged 12 and 25 years; ∼ 5.000 adults aged 26+ years), and b) surveillance data of acute health problems from the Nivel Primary Care Database (∼1,6 million patients from 380 general practitioners). Data collection started in September 2021 and continues during the five-year monitoring program. Panel data is collected every quarter; Nivel surveillance data is collected weekly. Our contribution to the EUPHA conference will include data up and until September 2022 (i.e. five rounds of survey and surveillance data).

Results

Preliminary results from September 2021 through March 2022 indicate that adolescents/young adults reported worse mental and physical health outcomes compared to adults. Moreover, they experienced a more negative impact of corona measures. Accordingly, their mental health related problems, including suicide ideation, spiked between December 2021 and February 2022, a period characterized by highly restrictive COVID-19-measures.

Discussion

The quarterly monitoring research line showcase the relevance and feasibility of integrating multiple data sources in understanding the short- and long-term effect of the corona crisis. The results increase our understanding in the potential adverse effects of corona-related restrictive measures on population health, potentially aiding policy making and health promotion.
The integrated GOR-COVID-19 health monitor: annual reporting (“long-cycle monitoring”)
Authors: Baliatsas C , Meerdink A , Tak N , Dückers M , Geuijen P , Marra E , Bosmans M
Published: October 2022

Introduction

Because of foreseeable COVID-19- related mental and physical health risks for the general population, a longitudinal health monitor was launched in the Netherlands. The monitoring program includes multiple methods. The current contribution places an emphasis on the so-called “long-cycle” monitoring activities at the national and regional level. The aim is to produce (bi-)annual reports on developments in health status of the general population and several potentially vulnerable subgroups (e.g. psychological and somatic comorbidities, lower socio-economic status).

Methods

Primary care registrations and questionnaire data were used. Both depend on existing methods of data collection, cover a broad spectrum of health aspects and offer the possibility of pre-COVID-19-comparison. Primary care data were obtained from electronic health records of general practices in the Nivel Primary Care Database. Large-scale survey research with questionnaires was conducted in all the 25 health regions of the Netherlands among 2nd and 4th graders in high schools, adults, elderly and young adults (16-25 years old). Where possible, data were combined with data on socio-economic status and additional health aspects from Statistics Netherlands (CBS).

Results

The first results from both data sources show that the COVID-19 pandemic undeniably had an effect on the mental health of youth. Compared to 2019, there was a general decrease in overall health and happiness in 2020 and a perceivable increase in social problems as well as health symptoms such as lack of smell and taste. Furthermore, a smaller groups of people experienced more psychological symptoms, serious problems like suicidal thoughts and PTSD symptomatology.

Discussion

Adverse effects of the pandemic on youth are already visible in the first year after the outbreak. It is crucial to closely monitor the course of this health impact in the years to come, based on the combination of large, representative databases.
European Regional and Local Health Authorities (EUREGHA)
Authors: Calabro M
Published: October 2022

EUREGHA's vision is to ensure that the local and regional perspective is represented in EU health policy because local and regional authorities are the natural interface between citizens and European institutions, being the bridging bodies between policies and practices and the closest organizations to the concept of communities. We are the only European network prioritizing the representation of local and regional health authorities at EU level, as they fulfil a key role in improving efficiency, quality, and accessibility of healthcare systems and services. EUREGHA understands their specific needs and works tirelessly to represent regional and local health authorities in EU health policy, to amplify their voices as a means to improve European public health and healthcare. Through advocacy, policy monitoring, profile promotion, partnerships, and project development, EUREGHA facilitates and promotes collaboration between its members, EU institutions, pan-European health networks and other healthcare stakeholders. Network activities and projects are implemented upon a strategic background of “ways to make things happen” such as value based healthcare, smart specialization strategies and skills for innovation and digital transformation - on one side - and along thematic and field objectives such as cross-border healthcare, cancer, obesity, mental health and ageing - on the other side. Lower Austria is a long-standing member and Vice-Chair of EUREGHA.
Nitrites and nitrates dietary exposure from natural sources and additives and type-2 diabetes risk
Authors: Srour B , Chazelas E , Debras C , Druesne-Pecollo N , Agaesse C , Szabo de Edelenyi F , Sellem L , Kesse-Guyot E , Deschasaux-Tanguy M , Touvier M
Published: October 2022

Nitrates and nitrites occur naturally in water and soil and are commonly ingested from drinking water and dietary sources. They are also used as food additives. The epidemiological evidence linking exposure to nitrites/nitrates with type-2 diabetes (T2D) risk is scarce. We aimed to study these associations in a large population based prospective cohort study. Overall, 104,168 adults from the French NutriNet-Santé cohort study (median follow-up time 6.7 years) were included. Associations between intakes of nitrites and nitrates (evaluated using repeated 24h dietary records, linked to a comprehensive food composition database and accounting for details of commercial names/brands of industrial products) and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). During follow-up, 969 incident T2D cases were ascertained. Total nitrites and nitrites from natural sources were both positively associated with higher T2D risk (HRtertile 3 vs.1=1.29 (95% CI 1.06-1.56), Ptrend=0.004, and 1.27 (95% CI 1.05-1.54), Ptrend=0.01, respectively). Participants with higher exposure to nitrites from food additives (i.e. above the sex-specific median), and specifically those having higher exposure to sodium nitrite (e250) had a higher T2D risk compared with those who were not exposed to food additive nitrites (HRtertile 3 vs.1=1.58 (95% CI 1.28-1.94), Ptrend<0.001, and 1.59 (95% CI 1.30-1.96), Ptrend<0.001), respectively). There was no evidence for an association between nitrates of any source and T2D risk (all Ptrend>0.4). In this large prospective cohort, a higher dietary exposure to nitrites (from both natural sources and food additives) was associated with higher T2D risk. These results provide additional evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.

Key messages

• A high exposure to dietary nitrites (from both natural and food additive sources) is associated with an increased risk of type-2 diabetes.

• These findings support further regulations concerning the use of nitrites as food additives in processed meats.
Circadian nutritional behaviours and risk of type 2 diabetes in NutriNet-Santé
Authors: Srour B , Palomar-Cros A , Andreeva VA , Fezeu LK , Julia C , Bellicha A , Kesse-Guyot E , Romaguera D , Kogevinas M , Touvier M
Published: October 2022

Skipping breakfast and late-night-eating have been associated with risk factors for type 2 diabetes (T2D). However, less is known about the link between daily timing and frequency of food intake and risk of developing T2D. The objective of the present study is to investigate the associations between circadian nutritional behaviours, defined by meal timings and frequency, and risk of T2D. 103,312 adults (79% females, mean age at baseline=42.7) from the French NutriNet-Santé cohort were included. Participants’ circadian nutritional behaviours were assessed using repeated 24 h dietary records. Associations of time of first and last meal of the day, meal frequency and of nighttime fasting duration with risk of T2D were assessed by multivariable Cox proportional hazard models adjusted for known risk factors. During a median follow-up of 7.3 years, 963 new cases of T2D were ascertained. Compared with subjects reporting on average a first meal before 8AM, those having a first meal after 9AM had a higher risk of developing T2D, HR = 1.59 (1.30 to 1.94). A late time of last meal (after 9PM) was associated with a higher risk of T2D, HR = 1.28 (1.06 to 1.54), but this association was no longer significant after adjusting for time of first meal. Each additional eating episode was associated with a reduction of the risk of T2D, HR = 0.95 (0.90 to 0.99), p-value=0.01. Overall, nighttime fasting duration was not associated with risk of T2D, except in participants having breakfast before 8AM after a nighttime fasting duration of more than 13 hours (HR = 0.47, 0.27 to 0.82). In this large prospective study, circadian nutritional behaviours were associated with risk of T2D. Daytime nutritional behaviours and specifically an early first meal was associated with a lower risk of type 2 diabetes. If confirmed in other largescale studies, an early breakfast should be considered in preventive strategies for type 2 diabetes.

Key messages

• If confirmed in other largescale studies, an early breakfast could be considered in preventive strategies for type 2 diabetes.

• Beyond nutritional quality of meals, meal timing could also be a risk factor for type-2 diabetes.
Group discussion: Challenges and key elements to be addressed when transferring GP
Authors: Txarramendieta J , Roca J , Zahorka M , Strand Kudajewski K , Papa R , Dolecek Z
Published: October 2022

In this group discussion, all speakers will participate in a group discussion. The moderator will launch questions to speakers, and attendees will be encouraged to make contributions to the group discussion.
Access to health literacy best practices and the role of health libraries (BiblioSUS Network BVS) in Brazil
Authors: Saboga-Nunes L , Santini LA , da Silveira F , Moro E , Estabel L
Published: October 2022

Introduction

Health Literacy (HL) has received recognition of its role and is proposed as a key element of incrementing wellbeing in public health. In the south, this discussion is engaged but a dialogue north-south needs to be incremented to allow further comprehension and implementation of HL best practices. The BiblioSUS Network in Brazil engaged in this discussion while it aims to expand and democratize access to health promotion & HL best practices, disseminated through the virtual health libraries (BVS). As a distribution model of content production by the Ministry of Health in Brazil it reaches a large audience in the country.

Methods

The target of this research includes BiblioSUS workers, representing the most diverse areas of knowledge and the community served by the Network. Data collection included an online survey on HL using the HLS-EU-BR instrument.

Results

The study involved 717 members of the Network and community users of cooperating libraries. Inadequate (12%) and problematic (36%) HL levels revealed that 48% had low levels of HL. The analysis of the 12 variables to assess community's health information needs, showed that 83% of participants do not use the network for health promotion needs, 70.4% do not use for quality of life purposes, but that 41.4% use it for related diseases issues.

Discussion

This research is the first of its kind and emphasize the need to promote health promotion and HL by several means (e.g. like BiblioSUS Network libraries). Communities need to be reached out to help them make decisions favorable to health in everyday life and settings (e.g. home, community, work). While health promotion and disease prevention are targeted, the Brazilian population need to have easier access to reliable health promotion information, in order to contribute to citizens’ empowerment in health.
The effect of active breaks on cognitive performance and classroom behaviour: the I-move study
Authors: Masini A , Ricci M , Marini S , Ceciliani A , Barone G , Gori D , Bragonzoni L , Sansavini A , Tessari A , Dallolio L
Published: October 2022

Background

Active Breaks (ABs) intervention involves short bouts of moderate to vigorous physical activity (MVPA) conducted during or between curricular lessons by the appropriately trained teachers. The aim of the Imola Active Breaks Study (I-MOVE study) was to evaluate the effect of an ABs intervention on cognitive function and classroom behaviour in primary school children.

Methods

The study was quasi-experimental, and it involved two groups attending a primary school in Imola (Bologna, Italy). The Active Breaks group (ABsG) performed the I-MOVE protocol consisting in 10 minutes of ABs divided in warm up, tone-up with high intensity interval training and cool-down. This is repeated three times a day for one year and half. The control group (CG) continued with regular lessons. The baseline assessment was conducted in October 2019 and the follow-up in May 2021. Cognitive performance was assessed using working memory test and classroom behaviour was monitored using an “ad hoc questionnaire”.

Results

Working memory performance increased significantly more in the ABsG (change: 1.30±1.17) than in CG (0.96±1.20), p < 0.05. Almost the entire sample of the children wanted to continue with this intervention in the next following year. Children reported improvements in their school-life quality, including feeling better in class (75.40%) and in school (82.50%) when using ABs. Improvements were also reported in children time-on-task behaviours: 52.90% said they work easily in class, 52.90% that they could listen more clearly, 58.80% reported they can stay seated easily, and 59.60% that they learned better and were more focused after ABs.

Conclusions

In conclusion the program has proven to be very effective on the children's cognitive improvement and classroom behaviour. Since the ABs intervention demonstrates these positive effects, its implementation in schools can have a beneficial, sustainable and long-term impact on childhood health.

Key messages

• ABs intervention represents a cost-effective strategy to be implemented in the school settings regardless of the age and sex differences, to make the school a more dynamic environment.

• Despite the pandemic difficulties, the ABs intervention proved to be sustainable, and to have a positive effect on classroom behaviour by improving children’s concentration and attention in class.
Trust and emotional difficulties in adolescence: findings from a Swedish cohort study
Authors: Brolin Låftman S , Östberg V , Raninen J
Published: October 2022

Background

Trust is a key component of a socially sustainable society, and is typically divided into general trust (referring to trust in other people) and institutional trust (referring to trust in the public institutions of society). Trust tends to be developed and formed early in life. While a plethora of research has reported positive links between trust and health in adults, the aim of this study was to examine the associations between general and institutional trust and emotional difficulties in mid and late adolescence.

Methods

Data were derived from the Swedish cohort study Futura01, using information collected amongst 3622 grade 9 students (∼15-16 years, t1) who were followed-up two years later (∼17-18 years, t2). General and institutional trust was measured by indices based on five items each at both t1 and at t2 (range 1-4). Emotional difficulties were measured by the Strengths and Difficulties Questionnaire (SDQ) subscale at both t1 and at t2 (range 0-10). Control variables included family type and cash margin at t1 and upper secondary school program (academic vs. vocational) at t2. Linear regressions were performed using the first difference (FD) approach, analysing the change in emotional difficulties (t2-t1) regressed on the change in general and in institutional trust (t2-t1), respectively.

Results

Analyses simultaneously adjusting for change in both dimensions of trust showed inverse associations between the change in general trust and the change in emotional difficulties (b=-0.21, 95% CI -0.39, -0.04) and between the change in institutional trust and the change in emotional difficulties (b=-0.22, 95% CI -0.35, -0.09).

Conclusions

Increases in general and in institutional trust between ages 15-16 and 17-18 years were associated with a corresponding decrease in emotional difficulties. The findings suggest that trust is a social determinant of emotional difficulties in adolescents. Endeavours to enhance trust in this age group are relevant.

Key messages

• Changes in trust were inversely associated with changes in emotional difficulties in adolescents.

• The findings indicate that efforts to reinforce trust in adolescents are relevant.
Indoor metals pollution and metabolic outcomes among Italian children
Authors: Renzetti S , Schito M , Borgese L , Cirelli P , Cagna G , Patrono A , Peli M , Ranzi R , Lucchini RG , Placidi D
Published: October 2022

Background

Through this study, we aimed to test the association between the exposure to metals measured in indoor dust and metabolic outcomes among children living in areas with environmental exposure to metals.

Methods

The project “Health impacts of environmental exposure to airborne pollutants in the sites of Brescia and Taranto, Italy: increase knowledge to address preventive intervention of local and global relevance” (ISEIA) enrolled 130 children aged 6 to 13 years (51.5% females) resident from pregnancy in highly industrialized areas of the Brescia province, Northern Italy. Metabolic outcomes including BMI, fasting blood glucose and blood creatinine were measured. The concentration of a mixture of 10 metals in indoor dust was determined through an X-ray fluorescence portable analyzer (p-XRF). Linear regressions and Weighted Quantile Sum (WQS) regression were applied to test for the association between metal exposure and metabolic outcomes. All models were adjusted for age, gender, socio-economic status and area of residence.

Results

A significant association was observed between Cd and blood creatinine (β = 0.01; 95%CI=0.001, 0.02; p-value=0.028) when considering each individual metal separately in the model. WQS regression showed a positive significant association between the mixture of metals and fasting glucose (β = 0.87; 95%CI 0.14, 1.61; p-value=0.023) identifying Mn, Cr and Cu as the elements with the higher weights, while a marginally significant association was found between the metal mixture and blood creatinine (β = 0.01; 95%CI=-0.001, 0.02; p-value=0.075) where Cd and Ti showed the highest weight.

Conclusions

We assessed the potential association between exposure to metals in indoor household dust and blood glucose and creatinine. Our results contribute to clarifying the role of metal exposure in the burden of non-communicable diseases although further studies are needed to better understand the relationship between metal exposure and metabolism.

Key messages

• The metal mixture in indoor household dust is associated with an increase in fasting glucose.

• Cd concentration in indoor household dust is associated with an increase in blood creatinine.
Suicide Patterns in Malta: pathways for prevention
Authors: Cachia J
Published: October 2022

Background

Suicidal behaviour is the result of several risk factors, such as acute stress, severe depression, violence, sexual abuse, etc. A mental public health approach to suicide prevention needs to look beyond the demographic characteristics of deaths by suicide and to take into account specific country determinants. Available clinical information can help identify and quantify risk, analyse patterns of behaviour, explore links between risk and behaviour and generate possible suicide prevention pathways.

Methods

162 deaths by suicide for the period January 2015 - June 2021 in Malta are analysed against available clinical information. Major sources of detailed clinical information include obligatory notifications to the Commissioner for Mental Health of all cases of persons involuntarily admitted to acute psychiatric services and other medical records held within the Maltese public mental health system.

Results

81% of 162 deaths by suicide for the period under study were males, two-thirds of them between 25 and 54 years. The preliminary findings have confirmed that less than 50% of these deaths had previous contact with the public health system. The two main diagnostic criteria among deaths with recent psychiatric admission/s were acute stress reaction to personal life events and very severe mood disturbances, particularly depression. There seems to be increased risk among migrants and foreign workers residing and working in Malta. The frequency of prior admissions, age-related issues, the time-event relationships, and relevance of elicited clinical findings are still being evaluated and will be presented in more detail in the workshop.

Conclusions

Exploring risk factors within the history of cases of suicide through available clinical information can contribute to the development of suicide prevention pathways, relevant to the specific context of local communities.
Supporting decision making on public health and social measures in response to COVID-19- The PHSM calibration tool
Authors: Cocciolone D , King K , Latta A , Lindmark S , Owen L , Perehinets I , Roman C , Sane J , Schmidt T , Wippel C
Published: October 2022

Public health and social measures (PHSM) are preventative measures taken by individuals, communities and government institutions at national and local levels to prevent and reduce transmission of an infectious disease - in this instance SARS-CoV-2. The decision to introduce, adapt or lift PHSM should be based primarily on a situational assessment of the intensity of transmission of SARS-CoV-2 and the capacity of the health system to respond to subsequent increases in hospital admissions, but must also consider the effects these measures may have on the general welfare of society and individuals. The WHO Regional Office for Europe developed an online public health and social measures (PHSM) calibration tool to assist Member States in decision-making relating to PHSM implementation during the COVID-19 pandemic. The tool, designed to be used primarily by policy-makers in national and local government authorities, provides guidance based on a situational-level assessment framework that is determined by the level of community transmission and the overall capacity of health systems and public health services within a country or region to respond. By using a combination of country-reported and user-input data, the tool automatically generates a situational assessment and corresponding PHSM guidance for users, summarized in a downloadable report.

Reference

https://phsm.euro.who.int/calibrationTool
Covid-19 Vaccination and the issue of insurance status
Authors: Schröpfer D , Fortunato R , Devaud N , Koppensteiner R
Published: October 2022

Issue

It is estimated, that 11000 - 14000 people that live in Zurich do not have health insurance. For the vaccination against Covid-19 in Switzerland one had to register oneself on a website (Vacme) with your address and a Swiss health insurance number was required. This systematically excluded any people without insurance or Sans Papiers.

Description

To address this issue the city physician service Zurich organized a vaccination program for the uninsured from 14.06.2021 onward. To achieve this a code which could be used instead of the regular insurance number was organized and the staff recorded personal information of patients on site to remove language and technological barriers. Furthermore, the Police department was informed and agreed not to circulate the area of the vaccination service on vaccination days to minimize access-barriers for patients without legal residency.

Results

Between 14.06.2021 and 19.02.2022, 880 people came for vaccination of which 603 were clearly identifiable as individuals from vulnerable populations with no insurance. After initial organization, other vaccination centers in Switzerland were able to use the substitute number to vaccinate people without health insurance as well..

Lessons

There is a sizeable amount of people living without registration or/and health insurance. It is therefore critical not to forget these people when organizing public health measures, especially when addressing a pandemic or other infectious diseases (HIV, Hep C). Non-insurance is a known issue for universal access to care.

Acknowledgements: We would like to thank the hold crew of the ambulatorium kanonengasse at SAD

Key messages

• When fighting a pandemic it is of utmost importance to reach as many people as possible.

• Acess must be possible also for vulnernable people.
Ultra-processed food intake is associated with worse mental health in Southern Italian individuals
Authors: Grosso G , Godos J , Micek A
Published: October 2022

Background

A growing body of literature suggests that inclusion of ultra-processed foods (UPFs) in the diet may be associated with various non-communicable diseases, including obesity, cardiometabolic diseases, and increased mortality. However, one of the most underrated research topics is represented by the potential role of diet for mental disorders. The aim of this study was to explore whether there was an association between UPF consumption and mental health outcomes in a cohort of southern Italian individuals.

Methods

Demographic and dietary data from 1572 adults living in southern Italy was collected. Food items were categorized by the level of processing according to the NOVA classification. Multivariate logistic regressions were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between UPF intake and mental health outcomes, including sleep quality and depressive symptoms.

Results

Individuals in the highest quintile of UPF intake were more likely to have low sleep quality compared to those with the least intake (OR = 1.54, 95% CI: 1.02-2.34). Among the main component of sleep quality, high UPF intake was associated with sleep latency and efficacy individually. No apparent associations were found between UPF intake and depressive symptoms. However, when considering different age groups, younger individuals (age <40 y) consuming more UPF were more likely to have depressive symptoms than low consumers (OR = 3.50, 95% CI: 1.53-7.99).

Conclusions

These findings show a potential association between UPF consumption and mental health outcomes. Further studies are needed to understand whether the retrieved relation depends on alteration of the physiological feeding patterns leading to food-anticipatory and binge-type behaviors or on nutritional (i.e., high sugars and unhealthy fats) and non-nutritional factors (i.e., additives) triggering pro-inflammatory pathways.

Key messages

• Ultra-processed food consumption is associated with worse sleep quality and depressive symptoms in Italian adults.

• The detrimental associations between ultra-processed food consumption and depressive symptoms seem stronger among younger individuals.
Rapid systematic review of smoking cessation interventions for people who smoke and have cancer
Authors: Frazer K , Bhardwaj N , Fox P , Niranjan V , Quinn S , Kelleher C , Fitzpatrick P
Published: October 2022

Background

Higher rates of cancer are reported in smokers compared to non-smokers, and continued smoking following a cancer diagnosis is associated with reduced health outcomes and survival. Despite international evidence of increased risks, a substantial percentage of people with a cancer diagnosis continue to smoke. Patients may be unaware of the additional risks associated with continued smoking, and health care professionals may not engage with quit supports. As part of a larger feasibility study to develop a smoking cessation pathway in cancer services in Ireland, a rapid review of the evidence was completed.

Methods

Systematic searches of PubMed, Embase, and CINAHL 2015 to December 2020 were conducted; with studies restricted to adults with a cancer diagnosis [lung, breast, cervical, head and neck] and published in English. No restriction was placed on study designs. 6404 studies were identified and uploaded into COVIDENCE platform, Cochrane's systematic review methods were adopted throughout, PRISMA reporting guidelines were used, and narrative data synthesis was completed (CRD 42020214204).

Results

The twenty-three-studies report evidence from USA, Canada, England, Lebanon, and Australia. The setting for all interventions was hospitals and cancer clinics. Evidence identifies high dropout rates, inconsistencies in approaches and duration of smoking cessation interventions with varied outcomes. A wide-ranging number of critical components emerged associated with optimal quit support- including the timing of and frequency of quit conversations, use of electronic records, in-person support meetings, provision of nicotine replacement therapy and extended use of Varenicline, smoking cessation services embedded in oncology depts, and engaging with families wanting to quit at the same time.

Conclusions

Developing tailored smoking cessation interventions are needed for smokers diagnosed with cancer to enable engagement.

Key messages

• Continued smoking following a cancer diagnosis is associated with reduced health outcomes.

• Smoking cessation programmes for cancer patient should be tailored to meet needs.
Association of birthweight with lung function and respiratory diseases: results from the GEIRD study
Authors: Tocco Tussardi I , Tfaily A , Antonicelli L , Bono R , Corsico AG , Murgia N , Pirina P , Tardivo S , Jarvis DL , Verlato G
Published: October 2022

Background

Early life conditions are associated with lung function and the development of respiratory and non-respiratory illnesses. The relationship with birthweight (BW) is however conflicting. We examined associations of BW with lung function and respiratory diseases within the GEIRD (Gene-Environment Interaction in Respiratory Diseases) study.

Methods

GEIRD is an Italian multi-centre, multi-case control study of people aged 20-84 from the general population conducted from 2008 to 2014. The study included cases of COPD, asthma, allergic rhinitis and controls. Multinomial logistic regression was performed with case/control status (control/COPD/asthma/allergic rhinitis) as response variable, and BW as main determinant adjusting for sex, age and smoking status.

Results

Of 2,287 reporting BW, 6.4 % (n = 147) had low BW (<2500 gr), and this proportion was greater in women than men (7.8% vs. 5.1%; p = 0.006). Lung volumes were significantly lower in individuals with low than normal BW. Median FEV1 was 3.01 L (p25-p75=2.60-3.45 L) versus 3.16 L (2.65-3.86 L) (p = 0.019) and median FVC was 3.68 L (3.19-4.34 L) versus 3.91 (3.34-4.81 L) (p = 0.003). However, FEV1 and FVC were not affected by BW when expressed as percent predicted. Of note, both men and women with low BW were shorter than those with normal BW (mean±SD: 160.2±5.5 vs. 162.6±6.5 cm in women, p = 0.009; 172.4±6.1 vs. 174.8±7.2 cm in men, p < 0.001). FEV1/FVC expressed as absolute ratio or as percent predicted, was not affected by BW. In multinomial analysis, BW was not associated with respiratory diseases in adulthood. However, those with low BW had a higher risk of self-reported hospitalisation for lung disease before age 2 (10.3% vs. 4.1%) and severe respiratory infection before age 5 (16.9% vs. 8.8%) (p = 0.003).

Conclusions

BW was not associated with lung function in adulthood, when controlling for sex and height. Low BW was a risk factor for respiratory diseases in childhood, not in adulthood.

Key messages

• Low birthweight was associated with respiratory diseases in childhood but not in adulthood.

• Although spirometrically-assessed lung volumes were lower in adults with low birthweight, this is likely explained by associations of low birthweight with sex and height.
Perceived quality and willingness to continue using telemedicine services in patients with diabetes
Authors: Sanmarchi F , Maietti E , Palestini L , Golinelli D , Esposito F , Boccaforno N , Fantini MP , Di Bartolo P
Published: October 2022

Background

Plenty of literature reported the applicability and usefulness of telemedicine and teleassistance (TMTA) services in the management of diabetes and other chronic conditions. Specifically, TMTA proved to be effective for conditions that require radical lifestyle modifications, tailored pharmacological interventions, and periodic monitoring of clinical health status. The purpose of this study is to investigate the individual and contextual determinants of the perceived quality (PQ) of the telemedicine and teleassistance (TMTA) services and the willingness to continue (WC) with them among patients with diabetes using TMTA during the COVID-19 pandemic in one large region of Italy (Emilia-Romagna).

Methods

A structured survey was administered to patients with type 1 and 2 diabetes who used TMTA services during the first wave of the COVID-19 pandemic. The questionnaire was comprised of questions on TMTA service experience and participants’ socio-demographic characteristics. Multiple regression models investigated the independent factors associated with PQ (score 1-100) and WC (yes/no).

Results

The final analysis included 569 patients with diabetes (54.7% female), with an average age of 58.1 years. TMTA services’ PQ and WC were high. A higher education (OR = 1.83; 95%CI 1.04, 3.31) and being unemployed (OR = 2.57; 95%CI 1.17, 6.02) were factors associated with an increased WC. Older age was negatively related to PQ (b = −3.6; 95%CI −6.8, −0.29). Perceived support from TMTA service was positively associated with PQ (b = 10.1; 95%CI 5.1, 15) and WC (OR = 2.03; 95%CI 1.07, 3.85). Perceived increase in disease self-management was positively associated with PQ (b = 5.3; 95%CI 0.24, 10) and WC (OR = 7.11; 95%CI 4.04, 12.8).

Conclusions

Our study identified several determinants of PQ and WC. These socio-demographic and patient-perception related factors should be considered in the implementation of care pathways integrating in-person visits with TMTA services.

Key messages

• Socio-demographic factors play a crucial role in TMTA acceptance and should be taken into due consideration when implementing health pathways integrating in-person visits with TMTA services.

• Health workers should always try to improve patients’ self-management skills and should always make patients feel supported. This is also true in the digital health era.
Content related with preschool children's health on Facebook: a study of parental informational needs
Authors: Liepinaite I , Austys D
Published: October 2022

Background

Little is known how Lithuanian mothers use social networks to seek information about preschool children's health. This study aimed to identify health topics of the posts, characteristics of the most engaging posts, and practices shared in the comments.

Methods

This study included all accessible posts published in 2021 on one Facebook group with more than 21 000 Lithuanian mothers. In total, 1674 posts and 3192 comments on the most engaged group of posts (gastrointestinal disorders) were analysed. Number and type of reactions to posts, categories of health topics, aim, form, tone, and structure of the posts, also practice type on comment were registered.

Results

Among all posts, 72.9% were related to children's health. The most common health topics included injuries (17.1%), healthcare (15.1%), gastrointestinal disorders (9.7%), allergies and skin diseases (9.7%), nutrition, physical activity and health promotion (9.3%), nurture (8.9%). The most common form was text only (48.7%), repetitive aim was to ask about personal experience (47.5%), and recommendations (35.5%). Larger numbers of reactions achieved posts with sensitive tone, including appeal, child's health description, gratitude in advance, and written in Lithuanian (p < 0.05). Comments with healthy lifestyle recommendations, recommendations for medication, also recommendations to treat children by themselves, to visit physicians accounted for 73.6%, 26.4%, 36.0% and 10.8% respectively.

Conclusions

Main topics of children's health on Facebook for Lithuanian mothers are injuries, healthcare, gastrointestinal disorders, allergies, skin diseases, nutrition, physical activity, health promotion, nurture. Posts with sensitive tone, appeal, situation description, gratitude, written in Lithuanian achieve the largest number of reactions. Comments most frequently include advices to treat children at home, also healthy lifestyle recommendations.

Key messages

• Lithuanian mothers most frequently seek advices regarding preschool children’s injuries, healthcare, gastrointestinal issues, allergies and skin diseases, and nurture.

• Publication of posts including text only, sensitive tone, greetings, situation description, and gratitude might help to promote health more effectively.
Youth health promotion in countries affected by forced migration: The role of mHealth technologies
Authors: Karadag O , Karabey S , Yazbik-Dumit N , Almakhamreh S , Al-Mousa A , Orhon EN , Ceyhan DI , Sumbuloglu I , Dasgupta A , Ben Amor Y
Published: October 2022

Issue/problem

Young refugees often face barriers in accessing youth-friendly health information and care. Differing cultural norms, languages, laws, financial difficulties, gender disparities, and stigma pose additional challenges for youth in forced migration settings.

Description of the practice

REACH is a regional initiative of Columbia University, which aims to bridge the gap in health literacy and health care access among refugee and disadvantaged youth in Turkey, Lebanon, and Jordan, which are heavily affected by the Syrian conflict. Supported by TaiwanICDF, Blue Chip Foundation, and Columbia University, the REACH Project uses a community-based participatory action research approach and aims to assess the impact of mHealth technologies on improving health literacy and health care access among youth in host countries. With a strong adult-youth partnership, the project includes stakeholder meetings, mixed-methods studies with youth, health service providers and policy makers, in addition to health advocacy, communication and dissemination activities such as photo exhibitions, panels, and production of policy briefs and scientific publications. REACH has been working with youth, software developers, health professionals, academia, and I/NGOs to develop the multilingual and freely available REACH4Health app to promote youth health.

Results

Findings from three countries show that mHealth technologies have the potential to provide innovative, youth-friendly and widely used solutions to address the health education, health communication, and health care needs of disadvantaged and marginalized youth.

Lessons

Youth-adult partnerships, working with mixed groups of refugee and local youth, using community-based participatory research, peer-to-peer methodologies, and co-design approaches, as well as using social media tools contribute to the overall success of mHealth and health promotion interventions for disadvantaged youth in countries affected by forced migration.

Key messages

• mHealth technologies have a strong potential to improve health literacy and health care access of refugee and disadvantaged youth in countries affected by forced migration.

• Youth-adult partnerships, working with mixed groups of refugee and local youth, using participatory approaches and peer-to-peer methodologies significantly contribute to youth health interventions.
Real-time classification of causes death using Artificial Intelligence – sensitivity analysis
Authors: Pita Ferreira P , Godinho Simões D , Pinto de Carvalho C , Duarte F , Fernandes E , Casaca P , Loff J , Soares AP , Pinto Leite P , Peralta-Santos A
Published: October 2022

Background

Last year Europe registered >365 000 excess deaths, most from preventable causes. In order to timely track deaths, the Portuguese Directorate-General of Health developed a deep neural network that codifies ICD-10 causes of death (AUTOCOD) by analyzing free text in a death certificate (DC). While the performance of AUTOCOD has been demonstrated, it was not clear if it was sustained during excess mortality periods, when text quality could be lower due to the increased pressure on health services.

Methods

We performed a sensitivity analysis comparing the ICD-10 classifications of 330 098 Portuguese DC by AUTOCOD and by human-coders, from 2016 to 2019. Excess mortality was defined using the EuroMOMO methodology and a sub-analysis in periods of extreme excess (+4 and +6 SD). We compared the periods without excess mortality with the periods of excess and extreme mortality by chapter. The same analysis was performed for ICD-10 blocks, for the three most common chapters (neoplasms; diseases circulatory and respiratory system). The confusion matrixes allowed us to calculate AUTOCOD's performance metrics, like sensitivity.

Results

AUTOCOD showed high sensitivity (≥0.75) in 10 chapters, with values above 0.90 for the three most common ones. The weighted-average of sensitivity showed no difference between periods without excess mortality and periods of excess mortality, a difference of 0.01 for periods of extreme mortality (+4 SD) and a difference of 0.04 for periods of extreme mortality (+6 SD). For the block classification, performance was similar.

Conclusions

Even in periods of excess and extreme mortality, AUTOCOD accurately predicts the classification of the cause of death. Meaning that it is not affected by a potential loss in text-quality due to pressure in health services. This allows for the use of AUTOCOD for real time mortality surveillance and it highlights the importance of Artificial Intelligence as an advisory tool for Public Health policies in emergencies.

Key messages

• Artificial Intelligence algorithms like AUTOCOD can predict the ICD-10 cause of death with very high sensitivity, during periods with and without excess mortality.

• Artificial Intelligence algorithms like AUTOCOD can be used for real-time cause specific mortality surveillance, providing valuable information for policy making during periods of excess mortality.