bluuebunny/crossref_metadata_2025 huggingface dataset:
Issues of social justice in the development of personalised therapy for paediatric SIRS patients
Authors: Yankulovska S , Thiemicke P , Stolte F , Orzechowski M , Steger F
Published: October 2024

Background

Systemic Inflammatory Response Syndrome (SIRS) is an often-emergent condition, which lacks specific diagnostic tools. Personalised therapy could fill this gap but as every new technology, it raises issues of social justice. Our report aims at identification and analysis of social justice implications within the bigger ERA PerMed funded project of development of tailored immunotherapy for paediatric SIRS patients (TIPS) coordinated by Prof. Catharina Schütz from Technic University Dresden.

Methods

Qualitative research methodology thought 10 semi-structured interviews. Systematic literature review grounded the interview questionnaire. Transcripts were subjected to thematic analysis by two independent researchers.

Results

Social justice was seen as equal chances of inclusion of different population groups in research. Socioeconomic differences were perceived as a challenge to ensure justice across various populations (N = 7). Two interviewees saw discrimination as inherent to precision medicine, which is focused on personalised treatment. Two experts viewed the exclusion of specific patients’ groups as an unsolvable problem, that only advocates for the inclusion of as many patients as possible. On the opinion of six experts individual and ethnocultural factors may influence outcomes in personalised treatment, especially considering the small sample size and the diverse populations. One medical expert, on the contrary, perceived no significant challenges associated with the heterogeneity of patients. Whether socioeconomic injustices should be addressed by guidelines and how these correspond to the rights of the patient were further discussed.

Conclusions

The issues of social justice accompany research in personalised medicine, including SIRS. In general, there is sensitivity to this issue, but current guidelines are too vague. As with other ethical problems, so with social justice we seem to have a rethinking of the concept, that needs further study.

Key messages

• In the context of SIRS personalised therapy research, there is a sensitivity to the issue of social justice, but no consensus how to ensure it.

• Issues of social justice are often boiled down to equal chances of inclusion in research and equal access to treatment. In the case of personalised therapy, there seems to be more to it.
The evolution of vaccine mandates: from historical perspectives to contemporary applications
Authors: Vigezzi G P , Vecchio R , Barbati C , Gentile L , Dallagiacoma G , Odone A
Published: October 2024

Luigi Sacco pioneered efforts in 19th-century Italian vaccination campaigns when mandatory vaccination practices began as a public health strategy. We bridge past and present through a systematic review of both historical and contemporary vaccine mandate policies. While Sacco’s early initiatives, characterised by compulsory vaccination and effective communication strategies, set foundational principles for vaccine mandates, the modern era, especially during the COVID-19 pandemic, has seen a significant shift in the nature and application of vaccine mandates. Recent legislative changes across various countries have introduced stricter mandates aimed at managing public health crises. For instance, Italy and France, deeply impacted by reduced vaccine uptake and subsequent measles outbreaks, responded by reinforcing vaccine mandates. These countries aimed to mitigate the dual challenges of achieving high vaccination coverage and combating growing vaccine hesitancy. Comparative analysis of recent legislative changes reveals a trend towards increasing coerciveness in vaccine mandates, reflecting a blend of functional and political pressures driving government decisions. This trend is evident in the legislative adjustments made in California, Australia, France, and Italy, where heightened penalties and reduced exemptions were introduced to counteract declining public compliance. The synthesis of these experiences highlights the critical role of robust, credible communication and the nuanced application of mandates that consider societal and cultural contexts. Contemporary strategies are characterised by targeted interventions aimed at specific populations, reflecting the complex interplay of social, political, and health dynamics in vaccine policy. The enduring relevance of vaccine mandates underscores the necessity of flexible, responsive public health strategies that effectively address both long-standing and emergent vaccine hesitancy and coverage challenges.

Speakers/Panelists

Carlo Signorelli

HSR, Milan, Italy

Maria Gańczak

Department of Infectious Diseases, University of Zielona Góra, Zielona Góra, Poland
Commuting violence: Social, mental and academic consequences. Is this concept necessary to adopt?
Authors: Hernández Rico M , Villegas Dominguez J E , Ramos Tenorio M P , Vicente Molina F Y , Viñas Dozal J C , Ruiz Garcia F
Published: October 2024

Introduction

Violence has emerged as a pressing public health issue due to its global impact, prompting the need to coin the term ‘commuting violence’ (CV). This term refers to any form of aggression experienced by students traveling from the University to other locations such as their homes or vice versa, considering that this situation could have health and academic consequences for students.

Objectives

To determine the consequences associated with CV in university students.

Methods

A cross-sectional and prospective study was conducted, including students from a Medical School in Veracruz, Mexico, from August to December 2023. Invitations to participate were extended to students of medicine, chiropractic, and radiology technology.

Results

A total of 279 participants with a mean age of 20 (±3.0) years were included. 89.6% of students perceive insecurity on their journey to the university, primarily due to the presence of suspicious individuals (93.9%); 70.6% of participants reported knowing a peer who has experienced CV, leading them to avoid certain streets (92.5%) to avoid it. Insecurity felt on the journey home from school showed a significant association (OR/CI95%) for anxiety due to JV of (7.2/3.2-16), stress due to CV of (11.1/4.74-25.9), and paranoia due to CV of (4.48/2.02-9.92). A total of 140 (50.2%) students reported experiencing CV, with the most frequent manifestations being sexual harassment (79.3%) and verbal harassment (57.8%), as well as two (1.4%) attempted rapes. Experiencing CV was positively associated with students avoiding class schedules before 8:00 a.m. (3.6/1.69-7.63) and after 6:00 p.m. (4.6/1.7-11.94), as well as absenteeism (7.37/2.51-21.67) and thoughts of dropping out (12.9/2.75-60.36) (p < 0.05).

Conclusions

PV is a relevant situation that exists within the well-being of students, impacting them both in anticipation and when faced with it. The concept of CV should be considered for use in future research.

Key messages

• We propose the concept of Commuting violence as an element to be taken into account since it has been demonstrated that this situation interferes with the academic activity of the students.

• Commuting violence occurs during academic activities, so universities should propose actions to make students feel safe on their daily journey to the university.
An action plan to improve organizational health literacy in hospitals in the Czech Republic
Authors: Šteflová A , Dudra J , Struk P , Homolacova H , Kopalova H , Ripa L , Kucera Z
Published: October 2024

Background

The National Institute for Health Literacy conducted in 2023 as part of the M-POHL network and in close collaboration with the team of the Klaudian Hospital a survey on the level of organizational health literacy using the OHL-Hos tool. The OHL-Hos tool was proven by the project implementation team as suitable for initiating and monitoring organizational change.

Methods

Based on the self-assessment and the results of the consensus workshop, the project implementation team identified development priorities that were submitted and approved by the hospital management. To keep the sustainability of the implementation, the hospital management decided to formulate an action plan, with the time horizon 2025.

Results

The proposed action plan, approved by hospital management, focuses on feasible measures within a given time horizon. For each development goal, responsible teams, time frames, and expected results were formulated. The implementation project team evaluated as the most innovative standard the standard dealing with internal communication with patients and their family after discharge and thus to ensure the continuity in supporting personal health literacy of patients and relatives. In addition, as further important standards, easy navigation and access to documents, materials, and services for patients and healthcare professionals were recognized. Interventions focusing on public education, especially for children and students of all school levels, have been proposed to enhance external communication and increase health knowledge in the region.

Conclusions

The process of regular OHL assessment of set up measures has been considered as a way how to ensure the long-term fulfilment of the newly adopted action plan by the hospital.
The Contrasting Risk Communication Strategies of European Leaders during the COVID-19 Crisis
Authors: Moriarty S
Published: October 2024

COVID-19 brought the role of leaders under intense scrutiny; their communication and framing of the crisis was crucial during the initial period of uncertainty. UK prime minister Boris Johnson and German chancellor Angela Merkel, managed and communicated the first wave of the crisis (March-June 2020) very differently. The clear contrast between pandemic response in two countries, with similar population sizes, wealth, and exposure to COVID-19, provides a lens through which to reflect on the different risk communication strategies utilized by both leaders. Following a grounded theory approach, the communication strategies of both leaders were examined. Transcripts from 31 press conferences from the initial announcement of COVID-19 to the end of the first wave were examined, and key themes identified. The analysis was framed using the CDC’s Crisis and Emergency Risk Communication lifecycle model, allowing for a structured comparison across different phases of the crisis. The findings were examined through the broader socio-political context of their communication. Similar themes were present in both leaders’ speeches, this included a focus on national identity; national strategy; health situation and social solidarity. However, they did so in markedly different ways. Merkel’s consistent, evidence-based communication strategy was more closely aligned with risk communication best practice compared to Johnson’s initial populist approach, which ultimately required a significant mid-crisis adjustment. Their different approaches also reflect their personas as political figures.

Key messages

• The consistent, science-based communication strategies exemplified by Merkel closely followed risk communication best practice and is likely enhanced public compliance and trust during the crisis.

• These finding demonstrate the importance of incorporating a political lens to understand leaders approaches to risk communication and in public health research more broadly.
From hesitancy to decision: shifts from intentions to uptake of Influenza and COVID-19 vaccines
Authors: Moura S , Guerreiro J , Romano S , Paulino E , Rodrigues A
Published: October 2024

Background

Vaccine hesitancy is context-related and risks coverage. In a context of growing hesitancy, this study aims to characterize and identify factors underlying shifts in Influenza and COVID-19 vaccines intention and uptake.

Methods

Questionnaires were administered to a random sample of the 60+ years old Portuguese population (n = 1400), before (Q1) and at the end of the campaign (Q2). Sociodemographic, clinical data and intention to Influenza/COVID-19 vaccine uptake, using a Likert-scale (0-2: refusal; 3-7: hesitancy; 8-10: acceptance), were assessed on Q1. On Q2, self-reported vaccination status and motives. A logistic regression was performed to identify underlying factors.

Results

COVID-19 vaccine: 26.2% of those reporting acceptance went for non-uptake (214/818), stating low susceptibility/severity and fear of side effects. Factors associated were not having chronic disease (OR 2.07, p<.05) and age 60-64 (OR 4.16, p<.05). 25.5% of those who refuse went for vaccine uptake (27/106), stating self-initiative. Age 65 + (OR 43.82, p<.05) was associated with the shift; 56.4% of the hesitant individuals went for non-uptake (154/273). Higher education associates with non-uptake (OR 0.53, p<.05). Influenza vaccine: 11.5% of reported acceptance went for non-uptake (100/873), stating low susceptibility/severity. Associated factors were age 60-64 (OR 5.85, p<.05), not having chronic diseases (OR 2.64, p<.05) and living alone (OR 2.34, p<.05). 23.4% of those refusing decided for vaccine uptake (29/124), stating self-initiative/risk awareness. Associated factor was age 60-64 (OR 6.41, p<.05). 69.5% of hesitancy went for uptake (139/200). Chronic disease associates with non-uptake (OR 0.26, p<.05).

Conclusions

Intention is a good predictor but not decisive for uptake. This research provides better understanding of shifts in intention versus vaccine uptake, as well as factors and motives for hesitancy, allowing more robust interventions ahead of a vaccination campaign.

Key messages

• For the Influenza vaccine, 13% of individuals reporting acceptance or refusal changed their mind. From the group reporting hesitancy, 70% decided for vaccine uptake.

• For the COVID-19 vaccine, 26% of individuals reporting acceptance or refusal changed their mind. From the group reporting hesitancy, 56% decided for non-vaccine uptake.
Home-based nursing care for clients carrying multidrug-resistant organisms: a focus group study
Authors: Langeveld TJC , Haverkate M , de Haan F , Eilers R , Timen A
Published: October 2024

Background

The growing population of vulnerable clients receiving home-based nursing care, combined with the worldwide increase in the prevalence of multidrug-resistant organisms (MDROs), poses a new burden on nursing staff. This study aimed to gain insight into the experiences, attitudes, perceptions, dilemmas in daily practice and needs of nursing staff providing home-based nursing care for clients carrying MDROs.

Methods

Seven focus group discussions with home-based nursing staff (N = 34) were performed in the Netherlands between April and July 2022, using a semi-structured, open-ended topic list based on the I-change model and seven domains synthesized by Flottorp et al. Data were analysed using thematic analysis.

Results

Home-based nursing staff often considered infection prevention and control recommendations inconsistent, unclear or inapplicable in daily practice. Although participants acknowledged the importance of these precaution measures, their proportionality was sometimes questioned. Participants indicated to be influenced by perceptions, knowledge and behaviour of their colleagues and clients. In addition, they frequently experienced untimely, incomplete or inconspicuous information transfers about clients carrying MDROs. Concerns were expressed that clients were often insufficiently informed, debating the roles and responsibilities of involved healthcare professionals in providing and exchanging information. Finally, participants elaborated on the effect of the covid-19 pandemic and expressed the need for organisational support in providing education and sufficient resources regarding MDROs.

Conclusions

Insights of this study have aided in aligning upcoming MDRO guidelines for home-based nursing care in the Netherlands. Organisational support in expanding knowledge and providing sufficient resources is essential and clarity about roles and responsibilities of involved healthcare professionals regarding information transfer and informing patients is needed.

Key messages

• Expanding knowledge, sufficient resources and adequate information transfer about MDRO carriage are essential to ultimately prevent transmission and spread of MDROs.

• The specific context of home-based nursing care for clients carrying MDROs should be acknowledged in MDRO guidelines.
A mixed method approach to evaluate a vaccine hesitancy assessment among parents in Dutch language
Authors: Bussink-Voorend D , Hautvast JLA , Wiersma T , Akkermans R , Hulscher MEJL
Published: October 2024

Vaccine hesitancy (VH), as a driver for falling vaccine uptake rates, is a significant public health challenge. It is important to monitor this phenomenon and compare results in a unambiguous manner. However, in Dutch and possibly other languages, there is no unequivocal translation for VH. Therefore, we aimed to develop and cross culturally validate a method to assess VH in a simple and self-reported manner, using five differently worded alternatives reflecting ‘doubt’, ‘reluctance’, ‘uncertainty’, ‘concerned’ and ‘indecision’. We designed a mixed method study with a quantitative and qualitative evaluation. In the quantitative evaluation, parents were asked to rate experienced vaccine hesitancy in their decision about vaccinations on a 10-item Likert scale, using the five differently worded alternatives. We analyzed internal consistency with Cronbach’s alpha and correlation with the short parental attitudes about childhood vaccination (PACV-5) scale. A total of 532 parents participated in the survey. We found that the five worded alternatives measured the same construct, indicated by a Cronbach’s alpha of 0.95. The wording resembling ‘doubt’ had the highest correlation with the PACV score (coefficient -0.525, p < 0.001). We subsequently conducted cognitive interviews with 12 parents with lower education levels to evaluate their interpretation of the five wording alternatives and the comprehensibility of the question itself. The wordings resembling ‘doubt’ and ‘uncertainty’ were viewed as most clear and reflecting VH, although some participants had a negative association with ‘uncertainty’. Overall, the question was well understood and minor suggestions were provided to improve comprehensibility. Based on the integrated results of both studies, we conclude that using the word resembling ‘doubt’ in Dutch language is the best instrument to assess VH. We encourage uniform translation of vaccine hesitancy in other languages to enable comparison of results across countries.

Key messages

• Uniform translation of the term vaccine hesitancy in other language is important to enable comparison of results across countries.

• In Dutch language, the word resembling ‘doubt’ is the best instrument to assess vaccine hesitancy.
Association between dietary supplements and frailty by sex: a cross-sectional study in South Korea
Authors: Kim H J , Suh H S , Lee E
Published: October 2024

Background

Evidence regarding the benefits of dietary supplements against frailty is lacking. Therefore, we aimed to examine the association between the use of dietary supplements and frailty. The analyses were stratified by sex to consider the sexual dimorphism in frailty.

Methods

This study used national, cross-sectional survey data from South Korea, namely the Korea National Health and Nutrition Examination Survey (KNHANES, 2018-2020). Adults aged 50 years were included. Data for up to four supplements were collected for each participant. A 46-item frailty index was constructed to assess frailty. All percentages (%) were weighted to represent the national population. The association between the use of dietary supplements and frailty was investigated using a linear regression analysis with socioeconomic/lifestyle factors and the amount of nutrient intake from diet included as covariates.

Results

Of the included 27,384 older adults, 57.28% were women. The proportion of supplement users was significantly higher in women (64.31% vs. 77.71%, p < 0.001). Any supplement use was negatively associated with frailty (B = -0.015, p < 0.001), and the association was more significant in women (Any supplement use * women: B = -0.012, p = 0.002). From the multivariable regression analysis stratified by sex, the use of red ginseng (men: B = -0.019, women: B = -0.015) and calcium (B = -0.027, women: B = -0.012) were negatively associated with frailty in both sexes while the statistical significance for vitamin C was found only in men (B = -0.020) (all p < 0.05).

Conclusions

Our findings demonstrated a significant negative association between the use of dietary supplements and frailty. The associations varied by type of supplements and by sex. The findings should be validated using prospective data.

Key messages

• Red ginseng and calcium supplements were negatively associated with frailty in both sexes.

• We assessed frailty using frailty index which highlights the potential role of dietary supplements beyond the context of physical or musculoskeletal function.
Designing infographics in health research with patients and the public: A scoping review
Authors: Sharma S , Dhaliwal G , Dore L , Goulao B , Jalali A , Salsberg J , Hannigan A
Published: October 2024

Patient and public involvement (PPI) in health research is increasing, in recognition for its potential to enhance the quality and relevance of research. To date, there has been no comprehensive review of the literature on the design of infographics with patients and the public in health research. This scoping review aims to explore the extent and nature of PPI in the design of infographics, a commonly used tool for communicating complex health information to diverse audiences. The review used Arksey and O’Malley’s methodological framework by Levac et al. Comprehensive searches were carried out in the following databases: Scopus, PubMed Central, Web of Science, EMBASE, CINAHL Complete, PsychINFO, and Cochrane Library. Identified citations were exported to Endnote and imported into Rayyan software for title and abstract screening. Preliminary results report a total of 738 citations imported, out of which 364 duplicates were removed and 374 citations underwent title and abstract screening. Of these, 80 citations were relevant for full-text review. Two independent reviewers evaluated full texts, resolving discrepancies through discussion or by a third reviewer. 62 studies were included in the review. Relevant data was extracted, and numeric and narrative analyses were performed to synthesize findings across included studies. The review found growing interest in PPI for health infographic design, using diverse approaches to engage patients and the public at various design stages. A wide variety of health topics were represented including disease specific topics, pain and weight gain. Common themes identified included the importance of accessibility, clarity, and cultural sensitivity in infographic development, as well as challenges related to generalisability, social desirability bias and ensuring meaningful involvement. This review offers insights and suggests further research and practice in leveraging PPI to optimize the design and impact of health infographics.

Key messages

• Growing Interest and Importance of Patient and Public Involvement (PPI) in Health Research Design.

• Challenges and Opportunities in Infographic Design for Health Communication.
Adolescent mental health literacy and help-seeking behaviours. Cross-Sectional survey in Barcelona
Authors: Boixadós Anglès M , Hernández Encuentra E , Casañas Sánchez R , Martín Fernández J , Lalueza Bosch F , Merino Rubio L
Published: October 2024

Background

Adolescents’ mental health information and help-seeking is critical for preventing the development of mental disorders. This study aims to examine the relationship between mental health literacy and information and help-seeking behaviours, as well as the effects of age and gender.

Methods

A cross-sectional online survey on a representative sample of 2,240 secondary school students in Barcelona from 11 randomly selected schools. Participants are evenly distributed by age (25% each course) and gender.

Results

Most adolescents show good recognition of mental disorders and knowledge of mental health (M = 6.39/10; SD = 1.97 and M = 7.75/10; SD = 1.21 respectively). They report having good literacy (M = 3.25/5; SD = 0.71) to search and manage online health information (eHealth literacy), and around half of them affirm having enough knowledge about mental health for them. Search engines (35.7%) and talking to family/friends (31.8%) are preferred for mental health information-seeking, but 19.8% chose not to engage in active information-seeking behaviour. When having mental health concerns, they prefer seeking help (“I would not ask for help” M = 2.4/7; SD = 1.93), and turning to family (M = 4.7/7; SD = 2.4) and friends (M = 4/7; SD = 2.1), instead of health professionals (M = 2.5/7; SD = 3.5). Chi-square test reveals that: lower recognition of mental disorders is associated with not help-seeking; lower mental health knowledge is associated with beliefs that information for mental health promotion, prevention, and care is unnecessary; and higher eHealth literacy is related to information searching in social media, but not to active searching. The ANOVA test reveals a significant gender-age interaction in certain variables, particularly in the recognition of mental disorders, which is higher in girls and increases with age.

Conclusions

Higher eHealth literacy is related to information-seeking on social media, but not to active search. Girls have a higher level of recognition of mental disorders.

Key messages

• Adolescents need a support network to seek mental health help, as they often avoid seeking professional help.

• Mental health promotion activities would benefit from further exploration of gender differences.
Evaluating mental health care initiatives after Ghana’s mental health act: a systematic analysis
Authors: Rizzieri M , Hannawa A
Published: October 2024

Mental health disorders affect 970 million people worldwide. Particularly in Africa, mental health is a growing concern, as it faces poverty and limited healthcare services. The Ghana Mental Health Act (GMHA 2012) marked a significant milestone in the development of a legislative framework supporting the provision of mental healthcare. However, evidence of progress since then is scarce. This systematic review examines the mental health initiatives that have been implemented since GMHA. Bronfenbrenner’s Socio-Ecological and Vygotsky’s Sociocultural Theory are used as frameworks to organize the interventions by ecological layers and cultural practices. All peer-reviewed articles published since the GMHA were retrieved from PubMed, Cochrane and Science Direct, using “mental health interventions,” “-collaborations,” “-health programs” and “Ghana” as keywords. The search yielded 3839 articles. Next, publications that were not conducted in Ghana or did not focus on mental health were excluded yielding a final sample of 69 articles for the review. Consistent with the GMHA’s guidelines interventions were conducted in communities (n = 56; 81%) rather than hospitals (n = 13; 19%). Most of them focused on institutional ecological levels (i.e., schools, health centers, traditional healing conventions; n = 29; 42%), followed by interpersonal (n = 14; 20%) and community-level (n = 14; 20%) approaches. Half (n = 33; 48%) entailed some form of cultural responsiveness, such as adapting educational tools to cultural contexts or accounting for spiritual beliefs. Only 23% (n = 16) of the interventions targeted children or adolescents. The findings of this review suggest three implications for future mental health research. First, stigma reduction and mental health literacy need to become a stronger focus. Second, research on children and adolescents needs to be increased. Third, interventions led by European partners must be tailored carefully to the Ghanaian beliefs system.

Key messages

• Assessing the community-based approach of mental health interventions following the Mental Health Act’s legalization in Ghana.

• European partners need to understand the context and the local culture before planning to research or implement intervention materials. Adaptation is key in the effectiveness of the intervention.
Rabies epidemiology in the central of Tunisia: A Call for a One-Health Approach
Authors: Ben Nasrallah C , Abroug H , Ghoul M , Grira S , Ben Fredj M , Kacem M , Dhouib W , Zemni I , Bouanene I , Belguith Sriha A
Published: October 2024

Background

Advocating for a One-Health approach is crucial for ensuring effective rabies surveillance in Africa, including Tunisia. Collecting information is essential to evaluate the prevalence of dog bites and rabies in Tunisia. To address this, we conducted an analysis of reported incidents in the central region of Tunisia from 2019 to 2022. This analysis aimed to generate valuable insights that can inform strategies for rabies elimination in Tunisia, highlighting the importance of the One-Health approach.

Methods

We carried out a descriptive study using surveillance data from Monastir governorate in Central Tunisia. All humans exposed to animals, residents in Monastir Governorate and declared to the regional directorate of primary health care from January 1, 2019 to December 31, 2022 were included in our study. Data were entered, cleaned, and analyzed using Excel.

Results

During the studied period, 7789 cases of human exposures to animals were reported with an annual average of 1969 ± 207 exposures per year. The annual incidence rate of exposure to animal bites was 324 per 100,000 population. The sex-ratio was 2.07 and almost one third of exposed humans were aged less than 15 years-old. The most listed offending animals were dogs (65.2%), followed by cats (24.4%). The number of exposures by unvaccinated dogs increased significantly during our study period. Post-exposure prophylaxis (PEP) was applied among 99% (n = 7772) of declared exposures. Among them, 2.5% (n = 202) did not complete the PEP recommended protocol. During our study period, rabies was confirmed in 39 animals. Two fatal human rabies cases were declared respectively in 2021 and 2022.

Conclusions

Rabies remains a worrying health problem in Tunisia with a high percentage reported among youth and males. Targeting children and adolescents by education and information campaigns about preventive measures and mass dog vaccination are the key to ending this scourge.

Key messages

• It is crucial to reinforce preventive strategies, such as mass dog vaccination programs.

• Public awareness about rabies prevention should be enforced in order to decrease Human rabies risks.
Beneficial clinical effects of honey from bees fed with specific plant extracts
Authors: Hajzer Z , Oláh C , Oláh B , Váradi C , Shaikh A , Daróczi L , Prokisch J
Published: October 2024

Background

Our team has demonstrated in a number of pre-clinical studies that special bees fed with syrups containing natural plant extracts contain a number of active substances that have beneficial effects on the human body. We have previously reported that bees fed with green walnut have beneficial effects on sugar metabolism, lowering serum glucose levels and reducing insulin resistance.

Methods

We conducted a prospective double-blind functional food study with 45 healthy volunteers using a strict inclusion and exclusion criteria with ethical approval. Participants ate 30 gramms of honey layered under 150 ml of yoghurt twice a day for 3 weeks. Fifteen participants consumed honey from bees fed with green walnut extract, while 15 participants consumed honey from bees fed with sea buckthorn extract, and 15 participants in the control group consumed acacia honey. Sleep quality was assessed with the SQS questionnaire, and quality of life with the SF-36, EORTC Q-C30 and EQ-5D tests on days 0 and 22 of the study.

Results

Consumption of both specific honey resulted improvements in the life quality parameters and in the sleep quality. ‘Buckthorn honey’ showed significant differences after the 3rd week: physical function improved (25.3±0.5 vs 27.4±2.8; p = 0.04), anxiety-depression decreased (1.4±3.6 vs 1±0.3; p = 0.03), complex physical status (84.1±9.7 vs 88.7±6.9; p = 0. 04), while ‘green walnut honey’ improved EQ-5D complex quality of life (84.1±9.7 vs 88.9±6.9; p = 0.01), overall quality of life functioning (90.6±14.9 vs 99.2±4.2; p = 0.03), EORTC Q-C30 total score (467.1±30.6 vs 487.4±21.4; p = 0.03).No such positive effects were confirmed in the control group.

Conclusions

Honey from bees fed with sea buckthorn extract has many beneficial physiological effects on the human body, improving physical well-being and reducing anxiety and depression. Honey from bees fed with green walnut extract improves the complex quality of life.

Key messages

• Improving the quality of life with nutrition is an increasingly important research field, playing a key role in our life.

• Our research has shown that honey from bees fed with green walnut and sea buckthorn extract improves several parameters in the quality of life.
Risk factors for bicycle-related overtaking, rear-end, and door crashes in the United Kingdom
Authors: Chao C C , Widodo A F , Pai C W
Published: October 2024

Background

Prior studies have offered valuable insights into risk factors associated with bicycle crashes at intersections. Nevertheless, limited research focuses on investigating three types of bicycle crashes that commonly occur on road segments: overtaking, rear-end, and door crashes.

Methods

In the present research, risk factors for these three types of crashes on road segments were examined by analyzing British STATS19 reports of crashes from 1991 to 2020. We calculated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for multiple risk factors using multivariate logistic regression models. The analysis included 127,637 bicycle crashes, categorized into 18,350 overtaking, 44,962 rear-end, 6,363 door, and 57,962 other crashes.

Results

Speed limits of ≥ 40 miles per hour (mph) (AOR = 2.238, 95% CI = 2.159-2.320), heavy goods vehicles (HGVs) as crash partners (AOR = 2.867, 95% CI 2.473-3.323), and elderly crash partners (AOR = 2.013, 95% CI = 1.937-2.092) were significant risk factors for overtaking crashes. Notable risk factors for rear-end crashes included midnight hours (AOR = 1.269, 95% CI = 1.190-1.354) and unlit darkness (AOR = 1.486, 95% CI = 1.404-1.573). Speed limits 20-30 mph (AOR = 16.185, 95% CI = 13.514-19.382), as well as taxis and private rental automobiles (AOR = 2.695, 95% CI = 2.310-3.145), were factors associated with door crashes. Further intriguing findings from our joint-effect analysis included higher probabilities for overtaking crashes in rural regions when older drivers and HGVs were crash partners (AOR = 2.93, 95% CI = 2.79-3.08 and AOR = 2.62, 95% CI = 2.46-2.78).

Conclusions

The mentioned risk factors have remained mostly consistent since our previous study was conducted in 2011. However, current research elucidated that certain factors have become more significant under specific circumstances. For instance, in rural areas, cyclists were more likely to be involved in overtaking crashes with heavy goods vehicles as crash partners.

Key messages

• Bicycle crash; Road segment; Door crash; Overtaking crash; Rear-end crash
Prediction of overweight/obesity risk in adolescence using static and dynamic multi-exposure models
Authors: Santos S , Oliveira MIT , Pereira R , Oliveira A , Barros H , Gaio R
Published: October 2024

Background

Studying the risk factors for obesity development and timely identification of individuals at increased risk are key for obesity prevention. We aimed to assess the associations of multiple prenatal, infancy and childhood exposures with overweight/obesity at 13 years (y) and develop static and dynamic multiple-exposure prediction models.

Methods

In 4232 mother-child pairs from the Generation XXI birth cohort, we assessed, during pregnancy/infancy and childhood, 55 sociodemographic factors, anthropometric measures, lifestyle behaviors, and clinical exposures related to the mother and the child and categorized body mass index z-scores as normal weight and overweight/obesity at 13y. Static models for pregnancy/infancy, 4, 7 and 10y, and a dynamic model were fitted using Elastic Net and logistic regression and were compared in terms of predictive performance.

Results

Mothers with lower educational level and household income, no partner, overweight/obesity before and after pregnancy, excessive gestational weight gain, pregnancy complications and who were smokers during pregnancy had children with a higher risk of overweight/obesity at 13y. Children with higher BMI during infancy, overweight/obesity during childhood, an early introduction of solid foods (before 4 months), a higher consumption of soft drinks at 4y and females had a higher risk of overweight/obesity at 13y. We observed the lowest predictive performance for the pregnancy/infancy model (prediction error of 36%) and the highest predictive performance for the 10y and dynamic models (prediction errors of 17%).

Conclusions

We identified the most important predictors of overweight/obesity in adolescence, most of them modifiable, and able to be targeted in prevention strategies. Predicting overweight/obesity risk in adolescence might be suboptimal if only considering pregnancy/infancy data and improves as closer to the age of the outcome, with no additional benefit in using a complex dynamic model.

Key messages

• Prevention of overweight/obesity should start during prenatal life.

• Children at higher risk of overweight/obesity may be identified years earlier using prediction models in clinical practice.
Health care and social benefits among long-term unemployed
Authors: Kärkkäinen S , Laaksonen J , Mesiäislehto M
Published: October 2024

Background

There is limited knowledge on the diverse pathways behind long-term unemployment. It is considered that impaired health may lead to exclusion from working life, and that unemployment together with financial difficulties may impair health. In this study, we identify different pathways behind long-term unemployment, and analyse differences in health care and social benefits use based on the diverse pathways. This study contributes to the early identification and supportive efforts for those in risk of labour market marginalisation.

Methods

Those who had been mainly unemployed in years 2020 and 2021 were identified among all working age (18 to 64 years) Finnish citizens. Register data from Statistics Finland, the Social Insurance Institution of Finland and THL were combined for the analysis. Sequence analysis was conducted for individuals with main activity information for each observation years from 2013 until 2021 (n = 72,485, age 26 to 64 in year 2021).

Results

Those unemployed for two years were on average 49 years of age (38% women). Five clusters were identified based on the main activity over the nine observation years: unemployed (54%), students (3%), employed (23%), inactive (10%) and those returned to unemployment (10%). Health care attendance was most frequent among those in cluster inactive. Mental health diagnoses were most common among those in clusters inactive and students. Share of those with musculoskeletal diagnoses doubled from 2013 until 2021 among the previously employed. Yearly percentage of those with sickness absence (>10 days) varied from 5 to 13% based on a cluster and a year. Share of recipients of basic social assistance was relatively stable throughout the years in all clusters being highest among inactive (50 to 60%) and lowest among students (6 to 18%).

Conclusions

Information on labour market background might be useful for preventive efforts and while developing services and social security for those in long-term unemployment.

Key messages

• There exists diverse backgrounds behind long-term unemployment.

• Labour market background should be considered while developing services for those in long-term unemployment.
Marketing or health promotion? A citizen science study of social media influencers’ health content
Authors: Gell S , Engel E , Heiss R , Karsay K , Schmidhofer J
Published: October 2024

Background

Social media influencers (SMI) became the dominant source of health information among adolescents, exerting influence through appealing content and para-social relationships. Personalized social media feeds of adolescents paired with latent platform algorithms result in myriads of individual information environments, which remain closed to researchers. Citizen science offers a solution to peek inside this black box and identify: What health content is disseminated by social media influencers and consumed by adolescents?

Methods

The citizen science study adopted a contributive approach, where adolescents collected and categorized SMI profiles and posts from their own feeds with a pre-tested survey tool which was available on Google Tabs. Data collection was conducted on Instagram, TikTok, and YouTube between April and May 2023 and subsequently analyzed by the research team.

Results

The study involved 19 school classes, containing 326 students, aged 12 to 19 years. They documented 255 SMI profiles and 2147 posts, primarily on Instagram and TikTok. Key topics included fitness, beauty ideals, and nutrition, while mental and sexual health received less attention. Although 41.5% of the posts contained advertising, the citizen scientists classified 63.5% as health-promoting. Topics relating to dietary supplements (84.1%), addictive substances (55.6%), nutrition (53.8%) and sport (47.2%) were particularly ad-heavy. Despite mental and sexual health having the lowest advertising rates at 35.4% and 37.7% respectively, this still accounts for over one third of the documented posts.

Conclusions

SMI present a distorted image of health that emphasizes nutrition, fitness and beauty ideals, while topics such as mental and sexual health are neglected. The positive reception of posts containing ads indicates a lack of critical reflection. Policies for advertising practices and balanced health education, including media literacy, are necessary to address these trends.

Key messages

• Social media influencers propagate a distorted health image, defined by nutrition, fitness, and beauty ideals.

• Adolescents lack the necessary skills to critically reflect on ad littered social media influencer health content.
Managing a 4000-participant cohort with a novel mobile app: data from the RisCoin study in Germany
Authors: Zhelyazkova A , Adorjan K , Koletzko L , Schrimf A , Koletzko S , Völk S , Fabry-Said A , Osterman A , Wichert S , Giang Le Thi T
Published: October 2024

Issue

RisCoin, a prospective monocentric longitudinal observational study, aimed to identify risk factors for COVID-19 vaccine failure. Secondary aim is to monitor symptoms, SARS-CoV-2 infection, vaccination status of 3816 enrolled healthcare workers (HCW) and 180 patients with inflammatory bowel disease (IBD). Since the LMU University Hospital Munich served both as study sponsor and employer of the HCW, a secured approach was required.

Description of the solution

Participants accessed the study app (CentraXX, KAIROS GmbH, Germany) via pseudonymized Contact-ID with irreversible anonymization after 6 months. Key app features were the serological results report, bidirectional messaging, and weekly survey for self-reported data on vaccinations, infections, and symptoms. Active app use was defined as submitting >1 weekly survey during the study period 10.2021-12.2022.

Results

Over 15 months, our study team maintained 1964 two-way communications with 958 participants via the app. Of 3979 participants with app access, 3622 (91%) were active users, 2606 (65%) submitted 1 to 11 surveys, 1016 (26%) made ≥12 submissions (P75, “frequent users”). Frequent users were more likely to be IBD patients (p = 0.001), female (p < 0.001), aged 60 or older (p < 0.001). Staff in administration and nurses were more likely to be frequent users compared to physicians (p < 0.001). Main problems included the initial operational system disparities resulting in app crashes and continuous need for app reactivation. Both led to loss of active participants and required substantial staff resources to onboard and support participants during the study.

Lessons

The study app enabled secure, flexible, bidirectional communication with all participants. Despite technical issues, the majority actively used the app and provided valuable longitudinal data through weekly survey submissions.

Key messages

• A study-specific app provides a flexible and secure bidirectional anonymous communication for the study team and participants.

• Adherence to app-based communication and data collection for pandemic monitoring was particularly high among patients, nurses and administrative staff.
Dual-tiered insights: cross-examining entities in free text electronic health records
Authors: ElHassan S , Sdralias A , Hamilton R , Shamsizadeh A
Published: October 2024

Background

Poor determination and processing of actions at the primary care level are found to be associated with unstructured and cluttered electronic health records (EHRs). Physicians recommend that EHRs must highlight entities, such as action items, findings, follow-ups, and reasons for medication changes. There’s consensus around the success of large language models (LLMs) in detecting clinical and non-clinical entities in EHRs. However, end-to-end systems make limited efforts to go beyond entity and relationship detection to support clinical decision-making.

Methods

We propose a two-tier system that generates case-based comparative reports for entities highlighted by physicians in EHRs. First, we fine-tuned a custom Bidirectional Encoder Representations from Transformers (BERT) model that detects the required entities within the EHRs. Second, a clustering-based service generates a report comparing the detected entities of a specific EHR with other EHRs sharing the same conditions determined by the healthcare professional.

Results

The system leverages the MIMIC IV deidentified free-text clinical notes dataset. The first-tier successfully classified entities with a macro-score average range of [0.87 - 0.94]. For the second tier, preliminary simulations on a set of test samples were made to cluster the entities. The simulations leverage a custom statistical tests engine offering a suite of entity-type specific tests. The results of these tests are used to generate the case-based detected entities comparative report.

Conclusions

Highlighting clinical and non-clinical entities bridges the communication gap between primary and secondary care. Clustering these entities extends the capability of LLMs in clinical support decision systems by providing healthcare professionals with the ability to run comparative analyses between EHRs. The comparative analysis reports provide a factual comparison between a selected number of detected entities and their thresholds.

Key messages

• Clustering clinical and non-clinical entities extends the capacity of named entity recognition in clinical decision-making systems.

• Ability to generate a comparative analysis report based on figures extracted from recognised entities in free-text electronic health records.