bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the Relationship between School Age Children's Refractive Errors and Outdoor Activity
Authors: Arslan Torba T , Oznur Muz F N , Bal M , Sert S , Muz O E , Metintas S , Onsuz M F
Published: October 2023

Background

Uncorrected refractive errors, one of the most common health problems of the pediatric age group. It is known that outdoor activities are effective in the prevention of refractive errors in childhood. The aim of the study was to evaluate the frequency of refractive errors in primary school children and their relationship with outdoor activity.

Methods

This croos-sectional study conducted with 4th grade primary school students in Eskisehir in 2023. Schools in the city center were divided into clusters according to their socio-economic status. Then, 1009 students from seven schools selected according to their randomization weights were included in the study. A questionnaire including sociodemographic characteristics, The Physical Activity Questionnaire for Older Children (PAQ-C) and questions about outdoor activities was administered to the students. They were examined for visual impairments. Outdoor activities were taken on weekdays and weekends and the daily average value was calculated.

Results

The mean age of the students was 9.8±0.5 years and 52.3% of them were female. Of 16.4% students had refractive errors, 5.85% had strabismus and 1.20% had depth perception deficits. Students with refractive error had lower scores on the PAQ-C scale and lower mean daily outdoor activity duration (p < 0.001 for each). In multivariate analysis, the risk of refractive error was found to be higher 4.61 times in those with good income (OR; 95%CI; 1.975; 10.75), 4.55 times in students who have visual impairment other than refractive error (OR; 95%CI; 3.01; 6.83), and 2.63 times (OR; 95%CI; 1.75; 3.95) in those who did outdoor activities for two hours or less a day.

Conclusions

Physical activity and outdoor activity duration were shorter in students with refractive errors. The risk of refractive error was found to be higher in those with good income, who have visual impairment other than refractive error, and those who did outdoor activities for two hours or less a day.

Key messages

• It is important to include regular screening programs on visual impairments and physical activity within school health studies.

• In order to prevent the development or progression of refractive errors, children should be encouraged to engage in outdoor activities during the day.
Investigating the Transition to Parenting within a Digital Health Context
Authors: Donelle L , Hall J , Hiebert B , Jackson K , Stoyanovich E , LaChance J
Published: October 2023

Background

The ubiquity of digital technology use created the need to understand parents’ digital technology use in pre-conception, pregnancy and the postpartum period (the transition to parenting). This research investigated the role of digital technology in the lives of individuals in the transition to parenting.

Methods

A qualitative descriptive study used purposive sampling. Participants were eligible if they were new parents, up to 2 years postpartum, were 16-35 years old, and English speaking. Focus groups were recorded and transcribed; thematic data analysis was used.

Results

26 participants identified as heterosexual females reported prolific use of digital technologies to direct fertility (e.g., ovulation timing), for information seeking regarding foetal growth and development, to prepare for labour and delivery, and in searching for a sense of community during postpartum. Smartphone technologies, social media, and prenatal apps were predominantly used. Participants expressed concerns related to their personal patterns of use, and the potential negative impacts. Themes included: “Is this normal; is this happening to you?!”, “Am I having a heart attack; what is this?”, “Anyone can put anything on Wikipedia”: Managing the Negative Impacts of Digital Information.

Conclusions

Digitally informed parenting practices include enhanced access to information regarding normal infant growth and development. Immediacy of information access was valued over integrity. Important implications of this work relate to the need for effective digital health literacy skills. Future research on the gendered use of digital technologies among parents is needed.

Key messages

• Digital technology use creates important health implications for pre and post-natal care among parents.

• Digital technology use is requisite for prenatal public health education.
How common are sleep issues and burnout in Irish farmers?
Authors: Firnhaber J , O'Connor S , Malone S , O'Shaughnessy B , McNamara J
Published: October 2023

Background

Farming is often a stressful, isolating and unpredictable career with notable occupational and health hazards. Therefore, farmers may be more vulnerable to experiencing sleep issues and burnout than other workers. However, pressures and stressors may differ between countries. There is little research on sleep issues and burnout in Irish farmers.

Methods

A cross- sectional survey was distributed to Irish adult farmers (N = 351) both online and in-person at farming events. The Pittsburgh Sleep Quality Index, a subscale of the Maslach Burnout Inventory and the Short Form Health Survey-12 examined their sleep and burnout, along with how sleep and burnout were associated with farmers’ mental and physical health and examined individual differences such as income, age, and gender. Prevalence assessments, descriptive analyses and non-parametric tests were used.

Results

Burnout (23.6%) and sleep issues (50.1%) are widespread in Irish farmers. Burnt-out farmers reported poorer sleep (p<.001, r=.42) and worse mental (p<.001, φ=.31) and physical health (p=.003, φ=.17). Farmers with poor sleep also reported worse mental (p<.001, r= .31) and physical health (p=.003, r=.16). Low-income was a risk-factor for sleep issues such as sleep disturbances (r=-.13, p=.032) and daytime dysfunction (r=-.15, p=.008) while age (p=.036, r=.11) and parenthood (p=.022, φ=.13) were risk-factors for burnout. There were no gender differences apart from females taking longer to fall asleep (p=.022, r=.12).

Conclusions

The high prevalence of sleep issues and burnout has serious health implications as both burnt-out farmers and farmers with poor sleep reported greater physical and mental health issues. Our cross-sectional analysis identified three at-risk groups that interventions can target to maximise impact: sleep issues are highest in lower-income farmers and burnout is highest in older farmers and farmers with children.

Key messages

• Sleep issues and burnout endanger the health and safety of farmers, their families and the Irish agricultural industry.

• Farmers require urgent intervention targeting sleep issues and burnout.
Associations between lifestyle change during the COVID-19 pandemic and mental health in adolescents
Authors: Manneville F , Omorou A Y , Bitar S , Lalloué B , Epstein J , O'Loughlin J , Agrinier N , Minary L
Published: October 2023

Background

It is unclear whether changes in physical activity or sugar consumption during the COronaVIrus Disease (COVID)-19 pandemic relate to later mental health among adolescents. This study identified profiles of change in physical activity and sugar consumption during the COVID-19 pandemic, and estimated associations between these profiles and later anxiety, depression and wellbeing among adolescents.

Methods

Data were from the EXIST cross-sectional pilot study conducted in schools in northeastern France, one year after the end of the first lockdown (May-June 2021). Adolescents provided data on lifestyle behavior changes during lockdown and mental health using self-report questionnaires. We used latent class analysis to identify profiles of change in physical activity and sugar consumption, and conducted multinomial logistic regression to estimate associations between these profiles, and mental health.

Results

Among 380 adolescents (52.5% male; 13.5±0.6 years), we identified four change profiles: 1) “increased physical activity and decreased sugar consumption” (21.8%), 2) “physical activity and sugar consumption stable over time” (36.1%), 3) “decreased physical activity and increased sugar consumption” (28.4%), and 4) “consistently low physical activity and stable sugar consumption over time” (13.7%). Compared to adolescents in profile 1, odds of depression one year after the end of the first lockdown were higher among adolescents in profile 3 (OR [95%CI]= 2.42[1.17; 4.99]) and profile 4 (OR = 3.16; [1.39; 7.19]). Associations were similar for wellbeing, but profiles were unrelated to anxiety.

Conclusions

Unhealthy changes in physical activity and sugar consumption during the COVID-19 pandemic may have contributed to deteriorating later mental health of adolescents. Future studies should assess long-term effects of the pandemic on physical activity and sugar consumption, and whether any long-term changes are associated with adolescent mental health.

Key messages

• A total of 42% of adolescents experienced unhealthy changes in physical activity and sugar consumption during the COVID-19 pandemic.

• Unhealthy changes in physical activity and sugar consumption during the COVID-19 pandemic may have contributed to deteriorating later mental health of adolescents.
Seeking professional help for mental health issues in Slovenia: Prevalence and associated factors
Authors: Ropret N , Roškar S , Mikolič P , Vinko M
Published: October 2023

Background

The aim of the study was to examine the prevalence of seeking professional help for mental health issues and explore its association with sociodemographic factors, various aspects of mental health literacy, and symptom severity.

Methods

A cross-sectional survey was conducted from November 2021 to January 2022 using a probability sample of Slovenians aged 18-64 (prepared by The Statistical Office of the Republic of Slovenia). Of the 9000 participants invited, 2677 (52.2% males) completed the survey (30% response rate) either online (78.9%) or in paper format (21.1%). The prevalence of mental health issues and professional help-seeking was assessed using self-developed questions. Logistic regression was used to test the probability of seeking professional help, with predictor variables including sociodemographic, Depression literacy questionnaire (D-lit), Anxiety literacy questionnaire (A-lit), Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS), General Help-Seeking Questionnaire (GHSQ), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Assessment (GAD-7), General mental health (self-developed question).

Results

Among those who reported having mental health issues currently or in the past (44% of the sample), 46.6 % had never sought professional help. The logistic regression model was statistically significant (p < 0.001, χ2 (df)= 214,637(16)), revealing that women, older participants, those with higher score on A-lit, GHSQ, and those participants which reported worse general mental health were more likely to seek professional help. The variable D-lit, as well as PHQ-8, GAD-7, and subjective social status, were not significant predictors. For education and the variable IASMHS, only some of the predictors were statistically significant.

Conclusions

The study highlights the need for systematic approaches and targeted interventions at the national level to promote and enhance seeking professional help for mental health issues.

Key messages

• The study found a large help-seeking gap for mental health issues, with only specific aspects of mental health literacy (eg anxiety literacy) being significant predictors of seeking professional help.
Beyond medication: Exploring social prescribing for mental ill health in Portugal
Authors: Hoffmeister L , Henriques J , Figueiredo C , Gama A , Dias S
Published: October 2023

Mental ill health represents a priority challenge in public health due to its considerable burden on people's health and well-being, as well as economic consequences. Individuals with mental health problems have been presented with limited alternatives for improving their mental well-being, with medication being the most widely adopted solution. It is imperative that the focus shifts to prevention and the promotion of positive mental health. This can be achieved through non-medical alternatives, such as social prescribing (SP), a person-centered and intersectoral intervention. Some studies reveal that mental ill health is one of the most common reasons for referral to a SP service, with encouraging results about SP's benefits in mental health. SP has been implemented in Portugal since 2018, a country that had one of the highest prevalence of mental health disorders in the European Union. The aim of this study was to establish the prevalence of mental health-related referrals in Portugal and to describe the type of community services patients were referred to. Sociodemographic, health, and referral-related data was collected for 714 patients at primary healthcare units in Lisbon between 2018-2021. Results show that 53.6% of participants were aged between 26-65 and 66.9% were female. Approximately 20% were referred for mental health reasons and 65.5% had been diagnosed with a mental health disorder. Patients were referred to a range of third-sector organizations (associations, ONGs, municipalities) and activities (swimming, music classes, volunteering, pregnancy club), but no specific mental health services were identified among them. This could suggest that there is a lack of available mental health responses in the community or that they are not yet accessible to SP team. Further efforts are needed to map out these resources and reinforce the intersectoral work to create and promote mental well-being responses, to ensure access to mental health support for all.

Key messages

• There is a need to shift the focus towards prevention and promoting positive mental health through non-medical alternatives, such as social prescribing.

• In SP in Portugal, there is a lack of available mental health resources in the community, suggesting the need for further efforts to create and promote mental well-being responses for all individuals.
Gender based violence among LGBTQ+ health students
Authors: Tavolacci M , Karmaly A , Ladner J
Published: October 2023

Background

Although there has been increased attention to campus gender based violence,(GBV) much of that attention should be focused on victimization of LGBTQ+. The aim was to evaluate the risk of LGBTQ+ ob being exposed to GBV.

Methods

An anonymous online survey among health students was performed in a French university. Self-questionnaire included socio-economic characteristics: age, gender and LGBTQ+ status (e.g., lesbian, gay, bisexual, transgender, nonbinary, queer and other). The CES-D 8 score was used to measure depression levels. Five GBV were collected 1-Damage to the image with a sexual connotation on social networks; 2-Sexist remarks and behavior; 3-Comments with sexual connotations; 4-Sexual assaults; 5-Rape or attempted rape

Results

Overall 1152 students filled the questionnaire The mean age was 20.8 years (SD = 2.26), 82.6% of students were women (non binary 0.4%) and 14.7% were LGBTQ + (16.4% in men et 14.0% in women). Since the beginning of their study, respectively the non-LGBTQ+ and LGBTQ+ students were exposed to GBV1: 3.1% and 7.6 % (p = 0.005), GBV2 35.8% and 45.9% (p = 0.01); GBV3 37.0% and 32.9% (p = 0.10); GBV4 6.0% and 13.5% (p < 0.001) and GBV5 1.2% and 5.3% (p < 0.001). The CEDS-8 score was 15.3 for non-LGBTQ+ students and 17.1 for LGBTQ + (p < 0.001). After logistic regression, LGBTQ+ health students have a higher risk of being exposed to GBV than non LGBTQ+ students AOR=2.01 CI95% [1.41-2.87].

Conclusions

LGBTQ+ health students have twice as likely to be exposed to GBV than non LGBTQ+ students. Four on the five GBV are more frequent among LGBTQ+ students. These negative outcomes may be exacerbated by minority stress due to discrimination and oppression in institutions and communities. Policy changes could help more affirming environments for LGBTQ+ students to reduce the disproportionate prevalence and impact of GBV on them. It could be include LGBTQ+ student examples in campus sexual misconduct policies.

Key messages

• LGBTQ+ health students have twice as likely to be exposed to GBV than non LGBTQ+ students.

• Sexist remarks and behavior is the more frequent GBV among health students.
The podcast as strategy to professional development and knowledge transfer in Health Care Planning
Authors: Paiva Neto F T , Shimocomaqui G , Souza I S , Souza E L , Gadelha A K , Sousa AAF , Eshriqui I
Published: October 2023

Background

Is a notorious concern to seek new ways to use technologies in strategies for the development of health professionals with a focus on changes in the work process of health teams and in management practices. The PlanificaSUS Project implements the Health Care Planning (HCP) methodology in Brazil, with a goal to organizing and integrating Primary Health Care (PHC) and Specialized Outpatient Care (SOC) services. Some materials present podcasts as one of the pedagogical resources for reflection and discussion of heath themes. In this sense, each episode of the podcast has a specific theme. Objective: Report the experience of using podcast as a strategy to professional development and knowledge transfer in Health Care Planning.

Results

So far, nine podcast episodes, lasting ten minutes each, have been made available in the HCP materials and total more than 15,000 views. This strategy reached 4,000 health professionals, who work in 1,635 health units, distributed in 19 federative units in Brazil. All podcasts episodes are prepared using language that dialogues with the health professional and stimulates discussions of changes through cycles of continuous improvement. In specific HCP evaluation moments, participants demonstrated that, in their practice scenarios, the use of the podcast together with repetitive listening, helped to significantly improve their understanding.

Conclusions

The podcast presents flexibility in its aspects of production and distribution, supporting pedagogical possibilities. As one of the great challenges the training of teacher specialists to produce podcasts, this requires not only technological fluency, but also pedagogical fluency. The use and study of this tool in the educational context of health in Brazil is still incipient, but possible in the different realities of the country. Main messages: The podcast strategy has promising attributes for developing knowledge transfer strategies among healthcare professionals.

Key messages

• The podcast support possibility of making educational material available in the form of lectures or audio interviews, being accessible at any time without limitation of location.

• It is important to provide information access strategies for professionals who have difficulty obtaining protected time to read and study.
Effect of a modified Nutri-Score on the understanding of nutrient profile and ultra-processing
Authors: Srour B , Hercberg S , Galan P , Monteiro C A , Deschasaux-Tanguy M , Julia C , Touvier M
Published: October 2023

Introduction

When considering health-related impacts of foods, nutrient profile and processing are 2 complementary dimensions. Nutri-Score informs on the nutrient profile. Recently, mounting evidence linked ultra-processed food (UPF) consumption to various adverse health outcomes, independently of their nutrient profile. To inform consumers about each of these health-related dimensions of food, we tested, in a randomised controlled trial, if a graphically modified version “Nutri-Score 2.0”, including a black “ultra-processed” banner, would improve the capacity of consumers to rank products according to their nutrient profile, and to detect UPF, compared to a no-label situation.

Methods

21,159 participants included in the NutriNet-Santé web-cohort were randomly assigned to a control arm (no front-of-pack label) or an experimental arm (Nutri-Score 2.0), and were presented an online questionnaire with 3 sets of food products (cookies, breakfast cereals, and ready-to-eat meals) to rank according to nutrient profile, and to identify UPF. The primary outcome was objective understanding of nutrient profile and ultra-processing, represented by a score of correct answers. Secondary outcomes were purchasing intentions and the healthiest-perceived product. Multinomial logistic regressions were performed.

Results

Nutri-Score 2.0 improved objective understanding of both nutrient profile of food products from 0.9% to 24.2% (OR = 29.0 (23.4-35.9), p < 0.001), and the ultra-processing dimension from 4.4% to 77.7% (OR = 174.3 (151.4-200.5), p < 0.001). Trends were similar for cookies, breakfast cereals, and ready-to-eat meals. The Nutri-Score 2.0 had a positive impact on purchasing intentions and on the products perceived as the healthiest.

Conclusions

This randomised controlled trial demonstrates the interest of a front-of-pack label combining Nutri-Score (informing on nutrient profile) with an additional graphic mention indicating when the food is UPF, compared to a no-label situation.

Key messages

• This study suggests relevance for providing information on both nutrient profile and ultra-processing on front-of-pack labels.

• Our results show that participants were able to independently identify and understand these two complementary dimensions of foods.
Climate, extreme weather and the health of older people: An umbrella review and framework for action
Authors: Mavrodaris A
Published: October 2023

Background

Older people are affected more severely and unequally by disturbances in climate and ecosystems. Directly, from extreme weather events such as heat waves, flooding, and severe storms; and indirectly, through droughts and compromised water safety catalysing food insecurity, displacement and poverty. Limited understanding of the impacts and interfaces of climate and extreme weather on older people and subgroups at potential increased risk hinders our ability to plan and respond effectively to protecting older populations as climatic instability continues.

Objectives

To progress this agenda, our work aims to i) systematically assess the health impacts of extreme weather on older people ii) synthesise the evidence to examine interfaces and subgroups at increased risk iii) develop a framework to inform responses.

Methods

An umbrella review is being conducted to systematically examine and synthesise the links between extreme weather events and health impacts on older people. The review will include original or primary research published between 2013 and 2023. Electronic searches will be conducted in Medline via Ovid, Embase via Ovid, Web of Science, CINAHL via EbscoHost, Cochrane Library, ASSIA via Proquest and PsycINFO via EbscoHost. Reference lists of retrieved articles will be checked for further relevant studies and experts in the field will be consulted to identify any further potentially relevant papers. Quality will be assessed using STROBE checklists and a narrative synthesis of the results conducted.

Findings

The results of this review will provide a comprehensive and up-to-date understanding of the impacts of climate instability and extreme weather events on the health and wellbeing of older people. It will be used to develop a framework demonstrating the interfaces between climate, extreme weather and the health of older people which will inform guidance on which subgroups are at increased risk and which actions and responses are needed.
Capturing youth voices to improve food policy: applying CO-CREATE’s Dialogue Forum Tool in Ireland
Authors: Murrin C M , Lee C , Slattery J , Vladu C , Bouillon C , Lien N
Published: October 2023

Background

The percentage of children eating fruit and vegetables and consuming milk in Europe is low The EU School Fruit, Vegetable, and Milk Scheme (SFVMS) is funded by the European Commission to promote the daily consumption of fruit, vegetables and milk. In 2023, the Commission plan to revise the scheme and are interested in hearing the views of young people. The aim of this research is to capture the voices of European Youth on the SFVMS from a collaboration of 4 countries. The present study provides initial findings from 11 and 12 year olds living in Ireland using the novel CO-CREATE Dialogue Forum Tool (DFT).

Methods

Two primary schools were recruited from a list of schools participating in the EU school, fruit, vegetables and milk scheme. The schools were from a high and a low socioeconomic status area. In each school, 6 pupils were invited to participate in the forum with consent from their parents. The DFT was applied to capture youth voices. The tool involved a moderated structured discussion about a prewritten SFVMS policy idea. The moderator guided the participants through the discussion with a series of activities on a physical canvas.

Results

The participants felt the policy idea was important to improve health. They discussed the obstacles and opportunities to the policy idea, including the quality of the school food products and their preferences. They proposed actions for improvement, including raising awareness of the quality and creating an advertising campaign. The participants enjoyed taking part in the dialogue forum and felt it was important to have their voices heard.

Conclusions

The CO-CREATE DFT was useful to discuss a policy idea for the EU SFVMS. The implementation of the tool by other countries will provide a wider European perspective of the policy idea.

Key messages

• Participants engaged well with The CO-CREATE dialogue forum tool.

• Youth voices can be readily captured to co-create food related policies.
A research platform for measuring information exposure, trust, and behaviour – burden of infodemics
Authors: Purnat T , Dunn A G , Ishizumi A , Nguyen T , Machiri S , Briand S
Published: October 2023

Background

During a health emergency, accurate and useful information can be drowned out by legitimate questions, concerns, information voids, conflicting information, and misinformation. Very few studies connect information exposure and trust to health behaviours and health outcomes, which limits available evidence to inform when and where to act to mitigate infodemics, especially in low resource settings. We have developed a toolkit that can support studies linking information exposure to health behaviours at the individual level and therefore can help estimate burden of infodemics at population level.

Methods

We developed and validated a research toolkit to measure topic-specific information exposure and health behaviors. We evaluated it in realistic scenarios to understand the usability of the toolkit.

Results

We address researcher requirements via a web-based study platform that includes an app that participants use to record topic-specific information exposure, a browser plugin for tracking access to relevant webpages, questionnaires that can be delivered at any time during a study, and app-based incentives for participation such as visual analytics to compare trust levels with other participants. Platform features include tailoring studies to local contexts, ease of use for participants, and frictionless sharing of de-identified data for aggregating individual participant data in international meta-analyses. The toolkit was improved for usability to researchers and study participants.

Conclusions

When applied in research studies, as per proposed protocol and with Institutional Review Board ethics clearance, this toolkit can capture detailed data about information exposure and health behaviour data, standardise study design while supporting localisation, and make it easy to synthesise individual participant data across studies. This will facilitate estimations of population-level estimated of impact of information diets on health behaviors and health outcomes.

Key messages

• The toolkit will make it easy to synthesise results in a global meta-analysis, also by researchers in resource poor settings.

• Next steps include establishing a coordinating site to support training in regional centres to turn meta-analyses into ongoing monitoring of the global burden of infodemics.
Does a digitalized single-mode survey lead to similar participation as a mixed-mode survey?
Authors: Grønkjær M , Eliasen M H , Bekker-Jeppesen M , Gøtzsche N , Jacobsen M H , Elsborg P , Toxværd C G , Andreasen A H , Lau C J
Published: October 2023

Background

Choice of survey administration mode in surveys mapping public health may influence the participation rates and hence the generalizability of the results. The aim of the study was, in a randomized design, to examine whether three digital invitation letters (i.e., single-mode administration) lead to a similar participation as two digital letters and three physical letters (mixed-mode administration) mailed with a shorter time interval between reminders.

Methods

The study utilizes data on 10,000 individuals (≥20 years) who participated in The Danish Capital Region Health Survey in 2017 and were re-invited in 2021. Citizens who were registered to receive digital mail from public authorities were randomized into two groups; the intervention group that received three digital letters (day 0, 21, 46; N = 4,745), and the control group that received two digital letters (day 0 and 7) and three physical letters (day 23, 44, 68; N = 4,744). Participation rate in the intervention and control group was compared after the entire period. Furthermore, the two groups were compared in terms of increase in participation rate between first reminder and 14 days later, as well as after second reminder and 19 days later.

Results

The overall response rate was 69%, divided into 61% in the intervention group and 78% in the control group. After the first reminder, the response rate increased from 39% to 53% in the intervention group and from 34% to 53% in the control group, while the response rate after the second reminder increased from 54% to 60% in the intervention group and from 53% to 68% in the control group.

Conclusions

A digitalized single-mode survey with three digital letters led to a significantly lower participation rate compared with a mixed-mode survey with two digital and three physical letters. The results can create a better basis for choice of survey administration mode in future surveys.

Key messages

• Mixed-mode survey administration with multiple reminders leads to significantly higher response rates compared with single-mode surveys with fewer reminders.

• Although it is more expensive and time-consuming, mixed-mode survey administration with multiple reminders should be considered in surveys to increase generalizability of data.
The impact of HIV pre-exposure prophylaxis on sexually transmitted infections incidence in Bulgaria
Authors: Pakov I , Birindzhieva E , Milanov A , Terzieva K , Gancheva G
Published: October 2023

Background

The global introduction of effective Pre-Exposure Prophylaxis (PrEP) alongside with available antiretroviral medications against HIV strongly limited the spread of infection among the high-risk population. This remarkable success predisposes to riskier sexual behaviour and has emerged as leading cause of the increased incidence of sexually transmitted infections (STIs) in sizes of new threatening pandemic.

Methods

Checkpoint - Sofia is a medical centre located in Sofia, Bulgaria for consultations, prevention, diagnosis and treatment of STIs and HIV. Retrospective clinical study was performed on 507 consulted HIV-negative males with monitored normal renal function (October 2020 to March 2023).

Results

The mean age was 32±7.8 years (18-58 years) with prevalent ages <30 and 30-40 years (41% and 47%, respectively). As “men having sex with men” (MSM) identified themselves 96% of the studied individuals and 131 (26%) reported past STI history. Drug substances usage monthly reported 25% and weekly 11%; vaccinated for HBV <55%. On demand regimen (2 + 1+1 tablets) of PrEP was preferred at 91% and 15% switched to every-day receiving before increased risk. Voluntary were tested 58% of the subjects at least once during the first year of PrEP intake. No one was positive for HIV, HBV and HCV. We observed notable increase of STIs such as syphilis, chlamydia and gonorrhoea among the PrEP users - 9% (3/4 of them in the initial phase of the disease), 6% and 4%, respectively. Mixed infection (gonorrhoea and chlamydia) was confirmed at three.

Conclusions

The drastic increase of unprotected sex practices in people regularly taking PrEP gradually leads to Ð° significant raise of other STIs and potential antibiotic resistance. This trend confirms the extreme importance of sexual health centres in the application of parallel approach towards HIV/STIs including periodic screening among risk groups, confirmation of asymptomatic cases and conduction of proper prevention or therapy.

Key messages

• The dramatic increase of unprotected sex practices in people regularly taking PrEP as HIV prevention, gradually leads to a drastic raise of other STIs and potential antibiotic resistance.

• Sexual health centres play a key role in the emergent screening among risk groups together with applying of preventive measures.
Associations of physical activity with risk of cardiovascular diseases using mediation analysis
Authors: Jasiukaitiene V , Luksiene D , Tamosiunas A , Radisauskas R , Bobak M
Published: October 2023

Background

The prevalence of cardiovascular disease (CVD) has been, and continues to be, one of the most pressing issues worldwide, and the most important risk factors for CVD are physical inactivity, tobacco consumption and metabolic syndrome (MS). The psychological well-being (PWB) of the population is also important, as optimism is associated with a lower risk of CVDs.

Aim

To evaluate the association of PA with risk of CVD.

Methods

In the baseline survey (2006-2008), 7100 men and women ages 45-72 were examined within the framework of the international study HAPIEE. 6770 participants were available for statistical analysis (after excluding 330 respondents due to missing information on study variables). PA was determined by the mean length of time spent per week during leisure time for walking, moderate and hard work like gardening and other PA. The respondents were categorized into three tertiles according to their PA in leisure time. MS is diagnosed according to the NCEP-ATP III criteria. PWB was assessed with the CASP-12 scale. When assessing the associations between direct variables, statistical significance is defined by the P-value. For indirect associations, significance is defined in terms of CI.

Results

The results for PA and incidence of CVDs show that PA is statistically significantly negatively associated with MS and smoking, and statistically significantly positively associated with PWB assessment (P < 0.001). There were also statistically significant positive associations found between MS and the incidence of CVDs, and statistically significant negative associations between PWB assessment and the incidence of CVDs (P < 0.001). A direct and indirect statistical relationship was found between PA and morbidity CVDs (P < 0.05).

Conclusions

PA is an important factor that directly and indirect predicts statistically significantly lower incidence of CVDs. PA has benefits in protecting against CVD, therefore it is important to encourage people to participate in PA.

Key messages

• PA directly predicts statistically significantly lower incidence of CVDs.

• Indirect associations between PA and the incidence of CVDs have been found.
The future of care in the Netherlands: application of foresight to explore challenges towards 2050
Authors: Dekker L H , Hilderink HBM
Published: October 2023

Background

Ageing populations have major impact on public health leading to more pressure on formal as well as informal health care. With rising health care expenditures, a sharp rise in geriatric diseases, multimorbidity, and a decrease in the available resources to manage complex health problems, it is of utmost importance to explore the impact of future public health challenges we are facing.

Methods

Foresight helps decision-makers anticipate future developments and inform current policies. It involves using the DESTEP methodology to analyze trends in formal and informal care and their impact on health. A participatory approach is used, including focus groups and interviews with stakeholders, to identify key drivers and challenges. Prioritized topics are then evaluated based on their potential impact on public health and healthcare, using both scientific and grey literature.

Results

Major future challenges such as the rising pressure on formal health care (shortage of personnel, limited financial resources) results in more people who will depended for the provision of informal care. At the same time many people have difficulties to be able to have sufficient control finding the right health care for of their own needs. Especially some vulnerable groups (lower educated, migrant background, elderly) will not be able to get proper care. At the same time digitalization is part of the solution (providing care more efficiently) and the problem (not all population groups are digitally literate, increased demand for care). Public health policy should target these challenges in order to achieve potential health gains in the future.

Conclusions

Long-term thinking could be stimulated by stronger involvement of policy-makers in the elaboration of options for action. Applying foresight aid understanding uncertainties and support policy makers focusing on challenges in the more distant future with the support of stakeholders.

Key messages

• The public health issues require an integrative approach with a focus on a more distant future and a comprehensive engagement of relevant stakeholders.

• Long-term thinking could be stimulated by stronger involvement of policy-makers in the elaboration of options for action.
Geographical inequality in health: results from a population-based health survey
Authors: Sørensen J B , Friis K , Jensen M M , Pedersen M H , Lasgaard M , Larsen F B
Published: October 2023

Background

The greatest public health concern is social inequality in health, which also includes a geographic dimension. Residents of less resourceful areas are often disproportionately exposed to health risks, and the negative health effects of both low social position and unhealthy surroundings can exacerbate each other. This study aims to explore the relationship between sociodemographic characteristics of local areas, health behavior and mental health.

Methods

The study used self-reported data from the ‘How are you? 2021’ health survey conducted in the Central Denmark Region (N = 33,925), and parish-level data from Statistics Denmark. Latent Profile Analysis was used to group parishes into five socio-geographic groups based on social composition, where deprived areas were characterized by low income, high unemployment, and low education. Health behavior and mental health were compared across socio-geographic groups using linear regression, contrasts and linear hypothesis tests.

Results

Citizens in less resourceful areas exhibit higher prevalence rates of daily smoking, physical inactivity, unhealthy diet, and obesity, alongside higher levels of perceived stress and depressive symptoms, as compared to citizens in more affluent areas. However, a higher proportion of individuals in affluent areas exceeded the Danish Health Authority's low-risk recommendations for alcohol consumption.

Conclusions

The health outcomes of citizens living in less resourceful areas are inferior to those of citizens in more affluent areas. Residents in less resourceful areas exhibit poorer health outcomes across health behaviors and mental health. Based on the study's findings, implementing health promotion initiatives at the local level and addressing the underlying social inequality through structural efforts are necessary. This could potentially help to reduce the disparities in health outcomes in citizens in less resourceful areas compared to those in more affluent areas.

Key messages

• Health outcomes of citizens in less resourceful areas are inferior to those living in affluent areas.

• Local health promotion initiatives and structural efforts addressing social inequality is needed.
A comparative study on the mandatory variation of COVID-19 vaccination policies
Authors: Batten N , Winter B , Grgic G , Wiley K
Published: October 2023

Background

Reflection on COVID-19 vaccine policies is critical to understand their effectiveness. Joint level vaccine mandates encouraged by the EU were not adopted by member states, leading to a multitude of vaccine policies that varied in their mandatory nature. We hypothesised that highly mandatory vaccine policies would result in high vaccine uptake & low mandatory polices would result in the opposite, & that differences between countries would impact policy implementation & effectiveness.

Methods

The mandatory vaccine framework was used to evaluate the mandatory nature of case study countries’ COVID-19 vaccine policies from 2020-23. France, Italy, Sweden, Poland, & Romania were chosen to represent a cross-section of economies, health systems, political histories, & COVID-19 experiences. Data was sourced from the ECDC's COVID-19 Data Tracker, government documents, media reports, & peer reviewed studies.

Results

Highly mandatory vaccine policies lead to higher overall vaccine uptake, as found in France 92.3% & Italy 89.8%. However, highly mandatory policies may cause social disruption & increase mistrust in vaccinations & governments, as seen in France. Moderate to low mandatory policies had mixed results. Romania & Poland had low vaccine uptake below the EU average. Additionally, low mandatory policies risk higher death & case rates & did not increase social acceptance of vaccination or avoid vaccine related social disruption, as seen in Poland. Sweden presents contrasting findings, reporting vaccine uptake of 86.2%, 13.1% above EU average despite their low mandatory policies, contradicting the hypothesis.

Conclusions

The research provides insights into vaccine policy decision making under the pressure of pandemic conditions, & the potential consequences of implementing various severity & enforcement levels within vaccine policies. The study demonstrates the need to develop pandemic vaccine framework to aid policymakers during disease crises.

Key messages

• The research highlights that it is essential that policy makers adopt cultural and health system appropriate vaccination policies for the populations they are targeting to vaccinate.

• The variation of vaccine uptake between member states also stresses the importance for the EU to take a more central role in health policy.
Organizational Vaccine Literacy (VL) can remove system barriers to Newly Arrived Migrants vaccination
Authors: Declich S
Published: October 2023

The strategic approach is to propose and support a pathway of organisational awareness that increases the capacity to recognise, value and resolve needs related to potential barriers to accessing information, adherence and use of the vaccination offer by dedicated services for Newly Arrived Migrants (NAMs). In this framework it will be presented the process and development of the VL tool (an exploratory survey, a Glossary of Essential Terms on Vaccination for non-health personnel) and of the training strategies for strengthening VL and cultural aware approach among “professional FOR health”.
Progress on drinking water, sanitation and hygiene in schools: global overview on the WASH programme
Authors: Baltag V
Published: October 2023

Context

Safe drinking-water, sanitation and hygiene are crucial to human health and well-being. Safe WASH is not only a prerequisite to health, but contributes to livelihoods, school attendance and dignity and helps to create resilient communities living in healthy environments. WHO and UNICEF, through the WHO/UNICEF Joint Monitoring Programme (JMP), produce internationally comparable estimates of progress on drinking water, sanitation and hygiene (WASH) and are responsible for monitoring the Sustainable Development Goal (SDG) targets related to WASH. Since the establishment of the SDGs, the JMP has published global baseline reports on WASH in households (2017), WASH in schools (2018) and WASH in health care facilities (2019), and a progress update on households (2019).

Objectives

To put the European findings in a global perspective regarding school toilets.

Results

Findings from the last report published under this JMP (2021) will be presented, updating national, regional and global estimates for WASH in schools up to the year 2019, with a special focus on the implications for ensuring the safety of students and school staff during and after the coronavirus disease 2019 (COVID-19) pandemic. Using service ladders to benchmark and compare progress across countries on WASH in schools by tracking progress towards a basic level of service, as the indicator used for global monitoring of SDG targets related to WASH in schools, we will see that situations are contrasted. Globally 63% of schools had a basic sanitation service in 2019, while it is the case of 99% of schools in Europe and Northern America. The differences are of the same level regarding basic drinking water service in schools (respectively 69% vs. 99%), as well as for basic hygiene (resp. 57% vs. 98%).

Conclusions

Those results illustrate the paradox that existence of a given facility, access and use are not equivalent and need to be explored further.
Social inclusion of people with mental illness: the widening gap in the adult population in Belgium
Authors: Smith P , Nicaise P , Lorant V
Published: October 2023

Background

Social inclusion is poor among people with mental illness (MI). In recent decades, many countries have developed policies to address this issue. It remains unclear, however, whether their social inclusion has improved over time. This study aimed to assess the evolution of the social inclusion of adults with moderate and severe MI compared to the general population without MI between 1997 and 2018 in Belgium.

Methods

Data on the general adult population were retrieved from the Belgian Health Interview Survey in six cross-sectional waves from 1997 to 2018. Three degrees of MI severity were compared using the 12-items General Health Questionnaire: no MI, moderate MI, and severe MI (score < 4, 4-7, and > 7). Social inclusion was measured using indicators relating to employment, income, social contacts, and partnership.

Results

Since 1997, the probability of being unemployed, having limited social contacts, and living on less than 60% of the median national income has been increasing among people with severe MI. Between 1997 and 2018, social inclusion increased among the general population without MI and among people with moderate MI, but decreased among people with severe MI.

Conclusions

The gap between the social inclusion of people with severe MI and people with moderate or no MI has widened over time, despite major reforms of mental health care and policies. Policymakers and clinical practitioners should pay more attention to supporting the social inclusion of people with more severe MI, particularly in relation to employability and social support.

Key messages

• In Belgium, the social inclusion of people with severe mental illness has decreased over the past two decades.

• The widespread social exclusion of people with severe mental illness is in conflict with international human rights conventions.