bluuebunny/crossref_metadata_2025 huggingface dataset:
BMI Trajectories and the Influence of Missing Data
Authors: Gray L A
Published: October 2024

Introduction

Body Mass Index (BMI) trajectories have been estimated in various ways. These estimates are important to understand how BMI develops over time and for use in cost-effectiveness analysis. However, missing data is often stated as a limitation in studies that analyse BMI over time and there is little research into how missing data can influence these BMI trajectories. The aim of this study is to determine how much influence missing data can have when estimating BMI trajectories and to explore the effects this has on subsequent analysis.

Methods

This study uses data from the English Longitudinal Study of Aging. First, a growth mixture model is used to estimate distinct BMI trajectories in adults over the age of 50. Next, methods that assume data is missing at random (MAR) are used: complete case analysis and multiple imputation. Finally, Diggle Kenward and Roy methods that assume data is missing not at random (MNAR) are implemented. Estimated trajectories from each method are then used to predict the risk of developing type 2 diabetes (T2DM) using discrete-time survival analysis.

Results

Four distinct trajectories are identified using each of the methods to account for missing data: stable overweight, elevated BMI, increasing BMI, and decreasing BMI. However, the likelihoods of individuals following the different trajectories differs between the different methods.

Results show that the influence of BMI trajectory on T2DM is reduced after accounting for missing data. More work is needed to understand which methods for missing data are most appropriate and give the most reliable results.

Conclusions

Missing data can significantly influence estimations of BMI trajectories. When using BMI trajectories to inform cost-effectiveness analysis or policymaking, missing data should be considered. More research is needed to examine the extent to which accounting for missing data might influence the cost-effectiveness of policies, e.g. weight management interventions.

Key messages

• Missing data is important when modelling BMI trajectories.

• More research is needed to examine the extent to which accounting for missing data might influence the cost-effectiveness of policies, e.g. weight management interventions.
Neighbourhood immigrant density and COVID-19 infection and hospitalization among healthcare workers
Authors: Nwaru C , Bonander C , Li H , Santosa A , Löve J , Nyberg F
Published: October 2024

Background

Studies have shown inequalities in COVID-19 infection among healthcare workers (HCWs), with occupational exposure failing to fully explain the inequalities. Little is known about the role of other social determinants of health, such as neighborhood immigrant density. We examined if living in immigrant-dominated neighborhoods was associated with increased risk of COVID-19 infection and hospitalization among HCWs in Sweden, and if so, whether such exposure amplified the risk of COVID-19 among immigrant HCWs. Addressing this question would contribute to a better understanding of factors driving COVID-19 disparities among HCWs.

Methods

Data were from HCWs aged 20 to 62 years (N = 86187) resident in one of 14 Swedish municipalities (three of which are Sweden’s largest metropolitan cities) on 1 January 2020. Residential neighborhoods were categorised into Swedish-dominated, mixed, and immigrant-dominated. The study outcomes were the first occurrence of COVID-19 infection and hospitalization registered until 30 September 2022. Multilevel mixed-effects survival regression was used for the association analyses, with control for confounders (age, sex, income, comorbidities etc).

Results

After adjusting for confounders, living in immigrant-dominated neighborhoods was only associated with an increased risk of COVID-19 infection in the first pandemic wave (HR 1.17, 95%CI 1.07 - 1.29), but living in these areas was associated with an elevated risk of COVID-19 hospitalization throughout the entire period. Immigrant HCWs, regardless of where they lived, had around 2-fold higher risk of being hospitalised for COVID-19 than non-immigrant HCWs living in Swedish-dominated neighborhoods.

Conclusions

Neighborhood immigrant density was associated with COVID-19 hospitalization among HCWs in Sweden. However, immigrant HCWs had a high risk of the outcome regardless of where they lived. More research is needed to identify the root causes of the excess risk among immigrant HCWs.

Key messages

• HCWs living in immigrant-dominated neighborhoods had an elevated risk of COVID-19 hospitalization.

• This study sheds additional light on the drivers of COVID-19 inequalities among Swedish HCWs.
Measured obesity and overweight in adults: the Italian Health Examination Survey 2023-CUORE Project
Authors: Marcozzi B , Lo Noce C , Vannucchi S , Di Lonardo A , Damiano C , Galeone D , Bellisario P , Palmieri L , Donfrancesco C
Published: October 2024

Background

The WHO recommends to halt the rise of obesity by 2025, considering 2010 as baseline. This analysis aims to assess if Italy can meet the WHO target in the general adult population using data measured in the periodic health examination surveys (HESs) conducted within the CUORE Project.

Methods

In the HES started in 2023, mean level of BMI and prevalence of obesity (BMI > =30 kg/m2) and overweight (25 < =BMI< 30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (727 men and 706 women), from 7 (of 20) Italian Regions, in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. Insufficient physical activity was defined as less than 150 minutes of moderate-intensity activity per week, or equivalent. The survey is funded by the Italian Ministry of Health-CCM.

Results

Prevalence of obesity was 23% (95% C.I. 16-29%) in men and 25% (19-31%) in women; prevalence of overweight was 47% (39-54%) in men and 30% (24-37%) in women. Mean level of BMI was 27.5 kg/m2 (27.2-27.8 kg/m2) in men and 26.9 kg/m2 (26.4-27.3 kg/m2) in women. Obesity resulted tendencially higher in persons with insufficient physical activity (27%, with 95% C.I. 17-36% in men; 28%, 19-37% in women) than among those without (19%, 11-27% in men; 21%, 12-30% in women), and in persons with primary or secondary school education (29%, 17-40% in men; 32%, 20-44% in women) than in those with higher educational level (20%, 12-27% in men; 21%, 14-28% in women).

Conclusions

Going in the direction of WHO target, preliminary data collected within 2023 showed a prevalence of obesity not statistically different in comparison to HES data of 15 and 5 years ago, both in men and women, however, 70% of men and 55% of women are in the overweight/obesity condition. Preventive actions at national and community level should be still massively implemented.

Key messages

• Prevalence of obesity and overweight resulted still at epidemic level in the Italian adult general population.

• In the Italian adult population stable obesity prevalence trend was observed in comparison to 15 and 5 years ago.
Long-term cardiovascular events in individuals hospitalised with COVID-19: a retrospective cohort
Authors: Soares P , Ruivinho C , Lobão M J , Paixão J , Simões I , Moça R , Costa A , Atanásio G , Brazão M L , Goes A R
Published: October 2024

Background

The post-COVID condition involves a range of persistent or new symptoms affecting various organs, including an increased risk of cardiovascular issues. As there are limited data on cardiovascular events in post-acute COVID-19 patients, we aimed to estimate their incidence and assess its association with patient and infection characteristics in Portugal.

Methods

We conducted a registry-based retrospective cohort study from seven hospitals across Portugal, including individuals hospitalised due to COVID-19 between March 2020 and March 2021. Our outcome of interest was cardiovascular events in the post-acute phase of COVID-19, occurring at least 30 days after the positive SARS-CoV-2 test. The variables of interest considered were the severity of the episode, existing cardiovascular risk and vaccination status before the SARS-CoV-2 test. Person-years and incidence rates were estimated. A Cox proportional hazard regression model was employed to assess risk factors.

Results

We included 1,803 patients in the analysis, of which 143 (7.9%) experienced at least one cardiovascular event following COVID-19 hospitalisation. The overall incidence rate of having at least one cardiovascular event was 34.65 per 1,000 person-years (95% confidence interval (CI): 29.20; 40.82). We found a higher risk of cardiovascular events for individuals with pre-existing cardiovascular risk (adjusted hazard ratio (aHR): 3.76, 95% CI: 1.53; 9.24) and lower risk for individuals with at least one vaccine dose before the SARS-CoV-2 test (partial - aHR: 0.44, 95%CI: 0.30; 0.64, complete - aHR: 0.46, 95%CI: 0.2; 0.80). We did not find a significant difference between the severity of the COVID-19 episode and the risk of having cardiovascular events post-COVID-19.

Conclusions

Our results indicate the presence of cardiovascular complications post-COVID-19, emphasising the need for healthcare systems to initiate screening and preventive strategies for individuals deemed at elevated risk.

Key messages

• COVID-19 vaccination decreases the risk of cardiovascular events post-COVID-19.

• Healthcare systems should start screening and preventive strategies for individuals with pre-existing risk of cardiovascular events.
Do poor psychosocial resources mediate health inequalities in type 2 diabetes? The Maastricht Study
Authors: Sezer B , Albers J , Meisters R , Schram M T , Koehler S , Stehouwer C , Koster A , Bosma H
Published: October 2024

Low socioeconomic position (SEP) has been identified as a risk factor for type 2 diabetes mellitus (T2DM). A potential pathway of this association is psychosocial resources. Disadvantageous environmental conditions result in low control beliefs through adverse resources and inferiority beliefs through social comparison for people with a low SEP. We examined two poor psychosocial resources, low control beliefs and inferiority beliefs, to explain socioeconomic inequalities in T2DM. We analysed mediating roles of low control beliefs and inferiority beliefs by using counterfactual mediation analysis. 8293 participants aged 40-75 living in Limburg, the Netherlands participated in The Maastricht Study starting from September 2010 to October 2020 and were followed up to 10 years with annual questionnaires with a median follow-up time of 7.18 years. SEP (education, income, occupation), control and inferiority beliefs, and (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum. 3.2%(N = 203) of the participants without T2DM at baseline reported incident T2DM. People with low SEP had more often prevalent and incident T2DM (e.g., low education:HR=2.13, 95%CI:1.53-2.97). Lower control beliefs and higher inferiority beliefs were more common among people with low SEP than people with high SEP. Moreover, lower control beliefs and higher inferiority beliefs were risk factors for T2DM (e.g., low control beliefs: HR = 1.50, 95%CI:1.08-2.09). The relationship between SEP and T2DM was partially mediated by control beliefs (7.98-13.56%) and inferiority beliefs (2.16-4.53%). Poor psychosocial resources are important in socioeconomic inequalities in diabetes. Researchers and practitioners should consider the psychosocial profile of people with lower SEP might differ from those with higher SEP and this might interfere with the development, treatment, and prevention of T2DM. We should aim to work with such beliefs, instead of against it.

Key messages

• Socioeconomic health inequalities in diabetes has many underlying mechanism including psychosocial pathways.

• Interventions and research should consider the different environment of low SEP and psychosocial profiles of people. We should aim to work with it, instead of against it.
Sexual harassment among higher education students: a worldwide review
Authors: Telfils R , Ladner J , Tavolacci M P
Published: October 2024

Introduction

Sexual harassment is an uprising problem in higher education systems worldwide with major impacts on students. The aim of this study was to describe and meta-analyze quantitative data on sexual harassment prevalence among higher education students.

Methods

We searched in seven databases and included studies published in English and French from 2000 until 2023 if they measured sexual harassment prevalence on students attending higher education, and they were quantitative cross-sectional studies. Prevalence estimates disaggregated by gender identity, and world region were meta-analyzed using a random-effects model and reported following PRISMA guidance.

Results

We identified 53 articles, from 6 different regions of the world, with highly variable sample sizes, ranging from 164 to 779,170. 45% of the samples were from the United States. 32% of studies used convenience or purposive sampling and 39% random sampling. The meta-analyzed prevalence of sexual harassment was globally 36.9% (95% CI [30.6, 43.6], 43.7% for women, 16.8% for men, 33.4% for non-binary. In additional, variations in prevalence were observed across the different world regions. In particular, the Eastern Mediterranean region presented the highest prevalence estimates for sexual harassment among women, reaching 67.5%, while the Americas region presented the highest prevalence estimates for sexual harassment among men, at 18.8%.

Discussions

Higher education institutions, especially in low- and middle-income countries, should commit to the conduct of surveys to monitor the prevalence of sexual harassment, and policymakers should allocate specific funds and resources to support the implementation of sexual harassment prevention and intervention initiatives in higher education, prioritizing the safety and well-being of students.

Key messages

• High prevalence of sexual harassment in higher education underscores urgent need for proactive measures to ensure student safety and well-being.

• Policymakers should allocate specific funds and resources to support the implementation of SH prevention and intervention initiatives in higher education.
Leishmaniasis in Tuscany: investigation of hidden human cases and comparison with canine incidence
Authors: Cosma C , Del Riccio M , Loretti E , Infantino M , Manfredi M , Veneziani F , Innocenti F , Casprini P , Voller F , Bonaccorsi G
Published: October 2024

The Mediterranean basin hosts endemic areas for leishmaniasis, mainly attributable to the presence of sand flies. Leishmaniasis has gained importance in Europe due to climate change, globalisation and migration. For at least the last 10 years in Tuscany, Italy, there has been an important discrepancy between official notifications of visceral and cutaneous leishmaniasis cases in humans and the number of hospital admissions, highlighting an important underestimation, despite mandatory notification. Moreover, official reports have increased alarmingly in the last three years. Human leishmaniasis does not always require hospitalisation: it often presents cutaneous manifestations, whereas in the immunocompetent individual it may not occur at all. For this reason, it is reasonable to assume that the number of cases is higher than the number of hospitalisations. The project aims to investigate the underreporting of human leishmaniasis cases from 2014 to 2023 by analysing laboratory diagnoses (considering any laboratory test that, according to the Italian Ministry of Health guidelines, is useful to identify a ‘confirmed case’, thus serological tests; parasitological tests; culture tests; PCR). To estimate the extent of underreporting, the capture-recapture method will be used, taking into account laboratory data, official reports and hospital data. Subsequently, a comparison will be made with the incidence, in the same territory, of veterinary cases, particularly in dogs, using data obtained from the Lazio-Tuscany Zooprophylactic Institute, to compare the trend of human and canine cases over time. Analyses are in progress and the results will be presented at the conference. Poor surveillance leads to ineffective prevention policies. The impact of the project is to strengthen the leishmaniasis surveillance system in Tuscany in order to reinforce prevention systems and face emergencies.

Key messages

• Due to climate change, globalization, and migration, there has been an increase in diagnoses of vector-borne diseases, including Leishmaniasis.

• Leishmaniasis surveillance need to be strengthened in order to enhance prevention systems and address emergencies.
Asbestos is still paid for dearly
Authors: Guerreschi E M , Dragoni L , Sisinni A G , Fabrizi S , Miceli G B , Nante N
Published: October 2024

Background

In Italy, asbestos is a current and important problem in terms of health effects due to the long latency of diseases related to its exposure. The aim of the study is to analyze the case history of malignant pleural mesothelioma (MPM) in the University Hospital of Siena in the period 2019-2023, comparing the type of exposure (occupational/non-occupational), the mean conventional latencies (MCL) of diagnosis, the histotype and the most exposed categories.

Methods

The study was conducted from January to April 2024, on 69 patients (79.7% male and 20.3% female) with a diagnosis of pleural mesothelioma between 2019 and 2023. 48 patients lived in Tuscany and 21 outside the region. The data were collected by consulting the medical surveillance records and radiological images through the VuePacs platform, then organized in a filtered database.

Results

Of 69 patients, exposure was occupational in 54 cases and non-occupational in the remaining 15. In patients with occupational exposure, the MCL was 55.9 years and the mean age at diagnosis was 73.66 years; in the other group, the MCL was 47.3 years and the mean age at diagnosis was 66.8. The study revealed the prevalence of epithelioid histotype in 76.81% of cases, biphasic in 15.94% of cases and sarcomatoid in 7.25%. The most at-risk categories were: metalworking (10 cases), construction (8), electricity/gas production (6) and shipyards (4). The study also identified two cases of atypical occupational exposure.

Conclusions

The shorter average latency in cases with non-occupational exposure is in accordance with the current scientific literature, as well as the prevalence of epithelioid histotype. Are hereby confirmed the primary role of health surveillance in the in-depth investigation of occupational anamnesis and of the environmental sites’ survey as prevention tool, especially in those cases of MPM whose evaluation, deviating from the exposure standards, could lead to the assignment of a misdiagnosed exposure.

Key messages

• The effects of asbestos exposure are a current and important problem in our country, even after its disposal, due to the long latency of disease onset.

• In-Department investigation of occupational anamnesis and survey of environmental sites as prevention tool play an essential role in MPM evaluation, especially in those cases of atypical exposure.
Risk Scores for Five Early Life Domains and Odds of Obesity and Hypertension Comorbidity
Authors: Stannard S , Berrington A , Ziauddeen N , Owen R K , Fraser SDS , Paranjothy S , Hoyle R B , Alwan N A
Published: October 2024

Background

For outcomes such as obesity and hypertension, determinants are likely to be complex and multidimensional. Therefore, to design realistic interventions, epidemiological research should incorporate information from multiple risk exposure domains to assess the effect on health. In this paper we explore risk scores for five early life domains and odds of obesity and hypertension comorbidity.

Methods

We used data from 17,196 participants in the 1970 British Cohort Study. The outcome was obesity (BMI of ≥ 30) and hypertension (blood pressure>140/90mm Hg or self-reported doctor’s diagnosis) comorbidity at age 46. Early life domains included: ‘prenatal, antenatal, neonatal and birth’, ‘developmental attributes and behaviour’, ‘child education and academic ability’, ‘socioeconomic factors’ and ‘parental and family environment’. Stepwise backward elimination selected variables for inclusion for each domain. Predicted risk scores of obesity and hypertension for each cohort member within each domain were calculated. Logistic regression investigated the association between domain-specific risk scores and odds of obesity-hypertension, controlling for demographic factors and other domains.

Results

In unadjusted models, higher domain-specific risk scores were associated with increased odds of obesity-hypertension comorbidity. In adjusted analyses, higher domain-specific risk scores remained associated with increased odds of obesity-hypertension comorbidity, with the strongest associations to the parental and family environment domain (OR1.11 95%CI 1.05-1.18) and the socioeconomic factors domain (OR1.11 95%CI 1.05-1.17).

Conclusions

Appropriate modelling choices of combined effects of early-life risk factors need to be explored and tested. Targeted prevention interventions aimed at population groups with shared early-life characteristics could have an impact on cardiovascular risk in adulthood.

Key messages

• Targeted prevention interventions aimed at population groups with shared early-life characteristics could have an impact on obesity-hypertension prevalence.

• Appropriate modelling choices of combined effects of early-life risk factors need to be explored and tested.
Are answers affected by data collection on paper or online? The case of Belgian adolescents
Authors: Castetbon K , Momo Damo A , Mertens C , Holmberg E , Assakali W , Eggen M
Published: October 2024

Background

In the early 2000s, the prevalence estimations were compared in relation with the mode of data collection, i.e. paper or online. Following the widely spread routine use of connected devices, especially in adolescents, such a monitoring is of interest. Within the 2022 “Health Behaviour in school-aged children” survey in French-speaking primary and secondary schools of Belgium, those participating could choose between paper and online collection. Our objective was to compare a large set of indicators between the two modes after adjusting for the students’ characteristics.

Methods

After a two-stage random selection of schools and classes, 11,751 10-to-20-year-old adolescents completed the questionnaire either on paper or online. Descriptive analysis and comparisons were conducted using chi2 and multiple logistic regressions adjusted for the students’ sociodemographic characteristics that may vary according to the questionnaire mode.

Results

Overall, 54.9% of the questionnaires were completed online. The choice of the collection mode provided to the schools’ headteachers was associated with the adolescents’ characteristics. Those who completed the questionnaire online were more likely to be in secondary schools, in Wallonia, and of a more favourable socioeconomic profile. After adjustments, no difference in the indicators regarding health, well-being, substance use, or sleep duration was observed. Conversely, a difference was observed for screen time (internet ≥2h/weekday: 70.4% on paper vs. 72.3% online; adjusted P-value: 0.02), some food groups (daily vegetables: 51.2% vs. 58.0%; P-value<0.001) and body weight status (overweight including obesity: 16.7% vs. 14.0%; P-value<0.001).

Conclusions

In some circumstances such as data collection in the school setting, mixed modes are still necessary due to operational issues. While most indicators did not show a difference between online and paper collection, potential implications for others need to be further understood.

Key messages

• Collecting data through online or paper questionnaires does not lead to major differences in prevalence estimates.

• With the rise of online surveys, further assessment is required to understand the potential declaration biases.
A novel developed DGS can be used to identify gene loci that may be associated with osteoporosis
Authors: Su S-L
Published: October 2024

Purpose

Previous meta-analyses only examined the association between single gene polymorphisms and osteoporosis; there is no compilation of all gene loci that correlate with osteoporosis in the literature. In this study, we develop a new literature-based approach, a decisive gene strategy (DGS), to examine the sufficiency of the cumulative sample size for each gene locus and to assess whether a definite conclusion of the association between the gene locus and osteoporosis can be drawn.

Methods

The DGS was used to search PubMed, Embase, and Cochrane databases for all meta-analyses that correlated gene polymorphisms with osteoporosis. Trial sequential analysis was employed to examine the sufficiency of the cumulative sample size. Finally, we assessed the importance of gene loci in osteoporosis based on whether there were enough sample sizes and the heterogeneity of the literature with the I2 value.

Results

After excluding 169 irrelevant publications, 39 meta-analysis papers were obtained. Among Caucasians, in 17 gene loci, there were eight gene loci (e.g., vitamin D Receptor ApaI rs7975232) with sufficient cumulative sample size to confirm that they were unrelated to the disease. Among Asians, in 15 gene loci, four gene loci that had sufficient sample sizes were risk factors: VDR FokI rs2228570 (odds ratio (OR) = 1.44, 95% confidence interval (CI) = 1.22-1.70), TGF β1 rs1800470 (OR = 1.35, 95% CI = 1.10-1.65), IGF1 rs2288377 (OR = 1.44, 95% CI = 1.28-1.62), and IGF1 rs35767 (OR = 1.20, 95% CI = 1.06-1.36), respectively, whereas one gene locus, ESR2 RsaI rs1256049 (OR = 0.69, 95% CI = 0.59-0.81), was a protective factor.

Conclusions

The DGS successfully identified five gene loci in osteoporosis that will apply to other diseases to find causal genes, which may apply disease-related genes in clinical practice, and to provide appropriate disease prevention policies.

Key messages

• The DGS that will apply to other diseases to find causal genes.

• The DGS, which may apply disease-related genes in clinical practice, and to provide appropriate disease prevention policies.
Socioeconomic deprivation and tuberculosis in Germany: a longitudinal spatial analysis (2001–2022)
Authors: Oppenberg J , Rohleder S , Sauzet O , Bozorgmehr K
Published: October 2024

Background

Socioeconomic conditions may affect tuberculosis (TB) dynamics. We analyzed the relation between area-level socioeconomic deprivation and TB incidence in Germany between 2001-2022.

Methods

Using nationally representative data at the level of 400 German districts, we fitted generalized linear mixed models to assess the effect of socioeconomic deprivation on TB incidence controlling for age, sex, share of non-nationals population, share of refugees, geographic effects, location and time. We estimated crude and adjusted risk ratios (RR) and corresponding 95% Confidence Intervals (95%-CI) for socioeconomic deprivation quintiles (Q1-Q5), ranging from least (Q1) to most deprived (Q5) districts.

Results

Preliminary findings show that crude TB incidence risk was 7% higher (RR = 1.07, 95%-CI=1.04-1.09) in least (Q1) compared to most deprived areas (Q5). Districts with medium-low (Q2), medium (Q3), and medium-high (Q4) socioeconomic deprivation showed 1% higher (1.01, 0.98-1.03), 4% lower (0.96, 0.94-0.99) and 3% lower (0.97 0.94-1.00) risk, respectively, compared to the most deprived districts (Q5). Fully adjusted incidence risk was 6% lower for Q1 compared to Q5 (0.94, 0.86-1.02), while districts classified in quintiles Q2-Q4 showed 8% (0.92, 0.86-0.99), 6% (0.94, 0.88-1.01) and 3% (0.97, 0.92-1.02) lower risk compared to Q5, respectively.

Conclusions

The adjusted effect of area-level socioeconomic deprivation on the risk of TB incidence has been low in Germany. Not considering the assumed confounders leads to over-estimation of the association between area-level SES and TB. Future studies should explore further area-level or individual factors in order to better understand the spatial variation of TB incidence in Germany.

Key messages

• Area-level socioeconomic deprivation has a low effect on the risk of TB incidence across German districts.

• Further research is needed in order to better understand the spatial variation of TB incidence in Germany.
Collaborative efforts of the Joint Action PreventNCD and the WHO Europe to protect children from harmful marketing
Authors: Gregorio M J , Gabrijelcic M
Published: October 2024

Control and counter the effects of advertisements and online marketing is one of the policy actions that will be explored within the JA Prevent NCD that has the overall aim to “reduce the burden of cancer and other NCDs and common risk factors, both at a personal and societal level, and support member states by taking a holistic approach for the prevention of cancer and other NCDs, through coordinated action”. The work that will be building on the JA Best-ReMaP sustainability framework recommendations to improve the effective implementation of policies to reduce harmful marketing of unhealthy food, would at the same time comprehensively address also tobacco and alcohol maketing. Thirteen different countries are involved in the work package on regulation and taxation that has the overall objective to “improve compliance, coherence, wider implementation and enforcement of fiscal and regulative measures targeting major NCD-risks factors.” This includes a broad range of tasks from mapping existing policies and frameworks, accumulating knowledge on health taxes and fiscal policies, promoting the use of joint nutrient profile models, assessing the impact of labelling on products to create healthier behaviors, supporting the implementation of policies to reduce the impact of harmful marketing, strengthening regulations towards hazardous substances and developing monitoring indicators for policies for prevention of NCD. An overview of the concrete collaborative actions to support the implementation of the marketing regulation will be given: (1) on JA work with the MSs and especially presidency countries, to allow for the discussions on the development of the EU regulation for reduction of the harmful marketing; (2) on the EU stakeholders positions regarding marketing regulation; (3) on the collaborative actions in scaling up the KidAd app. (5) the development of an algorithm to detect alcohol, tobacco and nicotine-containing products will be jointly developed and piloted.
Inequalities in local funding cuts to environmental and regulatory service expenditure in England
Authors: Murrell L , Fahy K , Clough H E , Gibb R , Zhang X , Chattaway M , Green M A , Buchan I , Barr B , Hungerford D
Published: October 2024

Background

The financial crisis in 2008 has led to governments across Europe introducing austerity measures. England has experienced significant financial cuts to local authority (LA) services. Environmental and regulatory (ER) services provide key functions in public protection such as, Food Safety (FS) and Animal and Public Health Infectious Disease Control (APH), services which are key infectious disease resilience. Here we investigate inequalities in local funding cuts to ER services by socioeconomic deprivation, LA type, and urbanicity, and impact on key ER service indicators.

Methods

This ecological study uses longitudinal modelling techniques to analyse trends in ER expenditure since the introduction of austerity and the inequalities present. We use Generalised Estimating Equations to estimate the annual percent change of ER service expenditure, and FS and APH expenditure between 2009/10 and 2020/21 in relation to deprivation, LA type and population density. Quasi-Poisson regression is used to assess impact of cuts on ER service indicators.

Results

Areas of higher deprivation had the largest reduction in expenditure, with ER and FS and APH cuts of 2% and of 23% respectively, compared to a 1% and 8% reduction in the least deprived areas. The share of ER expenditure spent on FS and APH decreased by 13% in the most deprived authorities compared to 6% in the least deprived areas. London boroughs had the greatest reductions in FS and APH expenditure, decreasing by 10%. Both ER and FS and APH expenditure decreased with increasing population density. Preliminary analysis shows inequalities in food business hygiene ratings in addition to other key ER service indicators since the introduction of these cuts.

Conclusions

The unequal distribution of cuts shows the need for increased and equitable investment into these services to enable resilience to infectious disease threats, and to prevent widening of health inequalities.

Key messages

• This work provides strong evidence of inequalities in local funding cuts to ER services and highlights where investment should be focused, in order to protect environmental and public health.

• This work introduces the impact of local funding cuts on a vital public health service and lays the foundation for future work into the unequal impact of cuts to these services on health outcomes.
Tobacco smoking during COVID-19 pandemic among social media users in Russia
Authors: Gil A U , Novikov A P , Demin A K , D’Souza L
Published: October 2024

Background

The COVID-19 pandemic has forced countries to take various restrictive measures, including “lockdowns”, which may have affected tobacco smoking. The study explored associations between an increase in smoking, sociodemographic, and related to pandemic factors during pandemic among social media users in Russia.

Methods

Between June-September 2020, 1518 users of the most popular in Russia social media networks participated in online survey investigating changes in alcohol, tobacco, and substance use during pandemic. Binary logistic regression was used to identify factors associated with an increase in tobacco smoking. The analysis was adjusted for sex, level of education, perception of the severity of public life restrictions, negative work/financial consequences of the pandemic, stress, changes in the frequency of drinking, heavy episodic drinking (6 or more standard drinks at a time), and the volume of alcohol consumed on a typical occasion.

Results

46.8% of the surveyed population were current smokers. 17.0% of them reduced, 37.9% increased, and 45.1% didn’t change their smoking during the pandemic. Relative to those whose smoking reduced or didn’t change, those who increased their smoking were more likely to be: 18-29 years old (OR = 1.906; 95% CI = 1.109-3.277), residents of medium to big cities (up to 1 mln inhabitants) (1.519; 1.017-2.270), had their income reduced (1.508; 1.024-2.222), faced severe restrictions in everyday life as a result of measures taken to contain SARS-CoV-2 (2.398; 1.440-3.758). After introducing alcohol consumption variables to the model, only two factors were associated with an increase in smoking: severe restrictions in everyday life (2.147; 1.227-3.993) and increased frequency of heavy episodic drinking during pandemic (2.338; 1.167-4.685).

Conclusions

Increase in tobacco smoking during pandemic was associated with severe restrictions in everyday life and increased frequency of heavy episodic drinking among social media users in Russia.

Key messages

• More than a third of social media users increased tobacco smoking during pandemic, which was associated with severe restrictions in everyday life and increased frequency of heavy episodic drinking.

• During pandemics and similar public health crises, it is advisable to expand remote counseling services for alcohol and tobacco cessation, which can be delivered through social media.
Mammography screening among women attending primary healthcare centers in Monastir, Tunisia
Authors: Ben Nasrallah C , Kacem M , Dhouib W , Maatouk A , Gara A , Zemni I , Abroug H , Ben Fredj M , Bouanène I , Belguith Sriha A
Published: October 2024

Background

Breast cancer is the leading cancer among women worldwide. Early detection through mammography screening improves prognosis and enhances survival rate for this disease. The aim of this study was to identify the factors associated with mammography screening utilization among women attending primary healthcare centers.

Methods

A cross-sectional study was conducted in four primary healthcare centers in Monastir governorate in October 2023 using a pre-tested questionnaire. Women aged over 45 years-old were included as they were the target group in the breast cancer screening strategy. Univariate then multivariate analyses were performed in order to identify the factors associated with mammography screening utilization. Data was analyzed by SPSS 21.0.

Results

A total of 192 women were included in the study with a mean age of 56.7±8.8 years-old. Among them, 79.7 % (n = 153) were married and 51.6% (n = 98) had three children and less. A total of 55.3 % (n = 94) had a primary education level. Regarding participants’ practices of breast cancer screening, 35% of our participants have had mammogram. Univariate analysis showed that the knowledge about breast cancer symptoms (p = 0.015), practicing Breast self-examination (BSE) (p = 0.002), being aware about mammography (p = 0.001) and the recommended age of the screening at 45 years-old (p = 0.001) were significantly associated with adherence to breast cancer screening. Multivariate analysis revealed that practicing BSE (ORa=2.60 [95%CI: 1.22-5.55] and knowing the recommended age of mammography screening (ORa=2.28 [95%CI: 1.17-4.45] were significant (P < 0.05) predictors of mammography screening utilization.

Conclusions

Mammography screening rate is low. This study had provided some informations about factors influencing mammography screening. Policymakers and public health practitioners should consider the identified factors when developing intervention programs to improve breast cancer screening.

Key messages

• There is a need to conduct education sessions in schools to raise awareness about breast cancer screening at an early age.

• Social media can be a tool for health education on mammography screening.
Prevalence and incidence of chronic wounds in Austria - a population-based real-world data analysis
Authors: Morasek K , Himmelsbach R , Schneider C , Ritschl V , Wieser S , Pötscher A , Stamm T
Published: October 2024

Background

Chronic wounds are associated with pain, odor, loss of mobility, an increased risk for infection and sepsis and a reduced quality of life. Treatment costs are rising due to the longevity of the population and increasing number of diabetes cases. For service planning in healthcare, it is thus necessary to describe patient characteristics and estimate the prevalence and incidence of chronic wounds. Currently, no data exists on this subject broken down by age group, gender, and province in Austria.

Methods

A retrospective analysis of real-world data was conducted using two merged datasets from an outpatient wound centre and the Austrian Health Insurance Fund. The study population consisted of people who resided in Austria and were covered by statutory health insurance from 2018 to 2022. We performed a descriptive, socio-demographic analysis of the data of patients, followed by a set of cluster analyses using the unsupervised K-means algorithm. From these clusters, we derived subgroup characteristics and patient trajectories and calculated prevalence and incidence rates for chronic wounds according to diagnoses, different age groups, gender, and different regions.

Results

Gender was almost evenly distributed in the wound centre’s data set (n = 4963; 49.6% female). The age distribution revealed the age group from 71-80 years being the largest group. In general, more women than men are affected by chronic wounds from the age of 81 onwards. 31% of chronic wound patients had diabetes as an underlying condition. More men were affected by peripheral arterial occlusive disease and diabetic foot syndrome and, conversely, more women by chronic venous insufficiency. These are preliminary results of the analyses.

Conclusions

Chronic wound patients were characterised by older age and multi-morbidity. Interestingly, gender differences appeared in the occurrence of comorbidities.

Key messages

• This study makes a crucial contribution in making routine data usable for the epidemiological study of chronic wounds, a cluster of diseases of complex aetiology.

• It thus contributes to filling a knowledge gap. The prevalence estimate serves as a basis of knowledge for health care planning and a basis for the health economic assessment of the problem.
Knowing the Antibody Status may influence compliance of health care workers to COVID-19 booster dose
Authors: Magid A , Hussein K , Dabaja-Younis H , Szwarcwort-Cohen M , Almog R , Hyams G , Gepstein V , Horowitz N A , Halberthal M , Shachor-Meyouhas Y
Published: October 2024

Background

Previous studies showed that the fourth SARS-CoV-2 vaccine dose has a protective effect against infection, as well as against severe disease and death. This study aimed to examine whether knowledge of a high level antibody after the 3rd dose may reduce compliance to the 4th booster dose among health care workers.

Methods

We conducted a prospective cohort study among health care workers vaccinated with the first three doses at Rambam Healthcare Campus, a tertiary hospital in northern Israel. Participants underwent a serological test before the 4th booster vaccine was offered to all of them, with results provided to participants. The population was divided into two groups: those with antibody below 955 AU/ml, and those with 955 AU/ml and higher, a cutoff found protective in a previous study. Multiple logistic regression was carried out to compare the compliance to the 4th booster between the two groups, adjusted for demographic and clinical variables.

Results

After adjusting for the confounding variables, the compliance was higher in those with antibody levels below 955 AU/ml (OR = 1.41, P = 0.05, 95% CI 1.10-1.96). In addition, male sex, and age of 60 years and above were also associated with higher vaccination rate (OR = 2.28, P < 0.001, 95% CI 1.64 - 3.17), (OR = 1.14, P = 0.043, 95% CI 1.06 - 1.75), respectively.

Conclusions

Knowledge of the antibody status may affect compliance with the booster dose. Considering waning immunity over time, reduced compliance may affect the protection of health care workers who declined the 4th dose.

Key messages

• Knowing the antibody status may affect compliance of health care workers with the booster dose.

• Reduced compliance of health care workers may affect their protection.
3.H. Scientific session: Advancing Health and Care System Transformation with the THCS Partnership
Authors:   Organised by: European Partnership on Transforming Health and Care Systems, EUPHA-HSR, -HTA,   Chair persons: Ilmo Keskimäki (Finland), Chiara de Waure (EUPHA-HTA)
Published: October 2024

Health and care systems across Europe are facing similar challenges. These include demographic and epidemiological changes, such as growing ageing population and increasing incidence and prevalence of chronic diseases, in addition to diminishing of budgets. These challenges can be met by innovative, evidence-based solutions, the research and development of which can be supported by several ways. The European Partnership on Transforming Health and Care Systems (THCS) is a co-fund action within the Horizon Europe Programme which supports coordinated national and regional research and innovation programs, alongside capacity building, networking, dissemination, and other activities crucial for health and care systems’ transformation. The core of THCS’s activities lies in funding research and innovation projects through transnational calls, engaging numerous research and innovation funding organisations. In addition to the funding activities, THCS develops several means for supporting the transformation towards sustainable, efficient, resilient, inclusive, innovative, and people-centred health and care systems accessible to all. This workshop aims at discussing on the trends and needs for research, development and innovation and capacity building in the European health and care systems, on leveraging research outcomes for evidence-based strategies and translating research into practice, on transferring and implementing innovative health and care practices, on fostering ecosystems, and on facilitating knowledge exchange and sharing. In the workshop the different means of the THCS partnership to support the transformation of health and care systems are presented and their further development discussed. The workshop consists of five presentations followed by a general discussion.

Key messages

• Participants will learn about the different means of the THCS partnership to support the transformation of health and care systems.

• Participants can contribute to the further development of the THCS activities by sharing their reflections, opinions, and viewpoints.
Happiness and all-cause mortality: the HAPIEE study
Authors: Pikhart H , Lin F , Tamosiunas A , Kozela M , Capkova N , Pikhartova J , Bobak M
Published: October 2024

Background

The evidence on the association between happiness and mortality is mixed. Similarly, the role of covariates in this association is not clear. Almost no evidence on the topic comes from the Central and Eastern Europe (CEE). This analysis aims to evaluate such association in longitudinal data from three CEE countries, and to investigate the role of other variables in this association.

Methods

The analysis is based on data from 18,362 men and women from the longitudinal Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study conducted in the Czech Republic, Lithuania and Poland who were 45-70 years old at the start of the study. Happiness was based on 4-points Likert scale answers ‘Very happy’, ‘Quite happy’, ‘Not very happy’, and ‘Not at all happy’ to the question ‘Taking all things together, would you say you are ...’. All-cause mortality was obtained from local or national mortality registers. Cox proportional hazards regression was used to estimate the hazard ratios (HRs).

Results

2,718 deaths have been observed during the 11 years of follow-up. The mortality rates were 13.0, 14.1 and 20.7/1000 person years in very happy, quite happy and unhappy groups. After adjustment for country and age the HR comparing very happy and unhappy was 0.53 (95%CI: 0.43-0.67) in men and 0.66 (0.48-0.91) in women. This association was reduced after adjusting for socioeconomic characteristics, health behaviours and conventional risk factors (HR 0.78 in men and 0.84 in women); and was further reduced after controlling for health conditions at baseline. No strong evidence for country interaction was identified although the association was slightly stronger in Polish men than in other two countries.

Conclusions

Happiness has been shown to predict all-cause mortality in these three countries from CEE although it may be (at least partly) explained by established risk factors and underlying health conditions. This work was supported by the NPO SYRI (LX22NPO5101). #NGEU

Key messages

• Happiness is shown to predict all-cause mortality in this CEE population.

• The association seems stronger in men than in women.