bluuebunny/crossref_metadata_2025 huggingface dataset:
Using indoor temperature in heat health warning systems: Deployment in community housing in Canada
Authors: Oetomo A , Kaur J , Wang K , Berry P , Butt Z , Morita P
Published: October 2023

Background

Heat waves are a major global public health concern and present a significant challenge to society, especially to underserved populations and those aged 50+, due to their increasing frequency and intensity. They also add significant burdens to the healthcare system's resources, and it has been shown that most deaths occur indoors. Still, our warning systems are based on outdoor temperature measurements. We developed a real-time indoor temperature alert ecosystem to capture indoor temperatures that may aid in assessing and responding during a heat wave.

Methods

We placed ecobee thermostats into homes with community housing partners and local health authorities (N = 70), recorded indoor temperature data in near real-time, and administered three surveys during the study period. We investigated: (i) indoor temperatures trends during the heatwave season of 2022 in Vancouver and Ottawa, Canada; (ii) behaviours of participants during the study; (iii) housing characteristics; (iv) delivery of time-sensitive temperature alerts to enable check-ins, and (v) perceptions to heat risk and methods of communication.

Results

Initial results show different observations that include: a) unsafe indoor temperatures were reached and persisted (>26 °C and 31 °C) despite a milder heat wave season (in British Columbia); b) gaps in understanding of best practices to stay safe exist; c) home characteristics increase risk of overheating; d) coordinating check-in can protect individual health; and e) ensure individuals are protected during extreme heat events. Results suggest that indoor temperature provides vital information to inform heat health response plans.

Conclusions

The smart thermostat technology can be retrofitted into homes in Canada as it is commercially available. This study presents a scalable solution for monitoring indoor temperatures; it demonstrates they can be used to monitor indoor temperature exposure conditions to prevent deaths during extreme heat events.

Key messages

• This study presents a scalable solution for monitoring indoor temperatures, demonstrating how smart thermostats can monitor indoor temperature conditions to prevent deaths during extreme heat events.

• Indoor temperatures pose significant risks to health; this study seeks to understand indoor temperature exposures to guide public health resource allocation during extreme heat events.
The silent support marathon: men’s role and experience in pregnancy after prior pregnancy loss
Authors: Koert E , Schmidt L , Nielsen H S
Published: October 2023

Introduction

Pregnancy loss (PL) occurs in ∼25% of pregnancies. The negative psychosocial impact of PL on women is well documented and there is growing evidence that men are negatively impacted as well. After a PL, most couples try to become pregnant again. In a subsequent pregnancy, both partners report feeling anxious about the safety of the new pregnancy and worried about miscarrying again. After PL, partners are the main source of support for women but we know less about their role in a subsequent pregnancy. The research question that guided this abstract was: What is men's role and experience in a new pregnancy after prior PL?

Methods

Dyadic (joint) interviews were conducted with 15 couples over four time points in a new pregnancy after PL (once after pregnancy test, once in each trimester). The participants were recruited from a national cohort study of couples with PL in Denmark. Interviews were conducted in person or online. For this abstract, data specific to men's role and experience was extracted and analyzed using thematic analysis.

Results and analysis

An overall theme: “the silent support marathon” reflected the men's role as supporters of their pregnant partners. Men described a feeling of exhaustion and needing endless stamina to support their partners through the ups and downs of the conception and pregnancy process. They described internal pressure and perceived pressure from their partners to be the “strong” one. Being strong was both a coping strategy and a burden. Men coped by trying to remain optimistic about the pregnancy but also not getting their hopes up. Men also felt they were “silent” and their needs were invisible and unacknowledged by health care providers in the new pregnancy. They wished for tools and advice on supporting their partner and coping with their own worries and anxieties about the pregnancy. They wanted health care providers to acknowledge their role in the process and to take a “couple focused” approach.

Key messages

• Men play an important role in supporting their partner with the worry and anxiety in a new pregnancy after PL. However they are impacted by pregnancy worries as well.

• A couple focused approach is needed to promote overall family health and well-being.
Establishment of a social listening mechanism on refugee crisis
Authors: Timotin A , Mita V , Paladi A , Chihai V , Lozan O
Published: October 2023

Background

The Russian invasion of Ukraine in February 2022 captured the public attention. For the Republic of Moldova, a border country that sheltered the highest number of refugees reported to its local population, managing the refugee crisis became a challenge, including countering mis- and disinformation with major impact on public health. The paper aims to identify the social listening mechanism that allows to track rumors regarding the refugees crisis and propose recommendations for adapting public messages.

Methods

The Social Listening soft Talkwalker was used to monitor and identify conversations on the refugee crisis in the Republic of Moldova between September 2022-March 2023, by developing a search syntax (with a health focus on services, vaccination, Covid-19, etc.). A second step was a qualitative analysis of the messages and comments, with recommendations.

Results

A total of 131,5K of results were detected with a 1.1 million Engagement. The performance remained constant, with sporadic peaks (3 most evident) and decreases on weekend days. The net sentiment is negative (-25,8 %), being dominated by anger, followed by fear and sadness. In general, prevail messages of support for the Ukrainian people, but there are also harsh criticisms of the authorities. One of the propagated ideas is that too little is being done for the local population and more support is being shown for refugees. Netizens tend to comment or share material for expressing their political views. Posts about the refugee crisis (creating better conditions in maternity hospitals or employing refugees), are less popular than those about the military conflict as a whole. Potential stigma issues have to be analyzed regarding displaced persons from Ukraine.

Conclusions

Undermining trust in the authorities is a good opportunity for disinformation, that's why the subject should be fact-checked. Enhancing communication of public authorities is essential.

Key messages

• Refugee crisis have a major impact on public health and social listening help managing it effectively. The mechanism developed (including the search syntax) can be adapted for other countries.

• The research shows how monitoring conversations on social media regarding refugees can help authorities counter mis and disinformation and adapt their public messages.
A mixed methods evaluation of a digital antenatal quality improvement intervention in Nepal
Authors: Das S , Karmacharya B , Karki S , Shakya R , Shrestha A , Shrestha A , Penn-Kekana L , Radovich E , McCarthy O , Campbell O
Published: October 2023

Background

Quality antenatal care plays an important role in reducing maternal and perinatal mortality. Electronic decision support systems (EDSS) aim to promote adherence to evidence-based practices. The evaluation aimed to assess the effectiveness of the intervention on improving quality of antenatal care (ANC) and understanding of implementation process and intervention effects.

Methods

The study was conducted in primary health care settings in Nepal. Theory of change framework was used for mixed-method evaluation. Quantitative and qualitative data were collected at multiple time points. Data were integrated using concurrent triangulation to develop explanations about the implementation process and the observed effects.

Results

Guided by our theory of change, we identified eleven themes that help to understand how the EDSS was used in the real context, and why the EDSS was not much effective in bringing the desired changes that was required to improve quality of ANC. EDSS appear to slightly influence ANC staff behavior, however, training ANC staff in using the EDSS did not necessarily lead to confidence in using it and ANC staff used the EDSS as recordkeeping system. We found mixed evidence on ANC staff believe that the EDSS offers benefits to their work. Inflexibility of EDSS during ANC consultation caused difficulties adapting to women's need and challenging to integrate the EDSS in ANC staffs’ workflow and daily activities. Inadequate linkage of the EDSS with existing health systems impaired the EDSS guided clinical performance.

Conclusions

There is some indication that the EDSS have the potential to increase the quality of care. However, the EDDS alone are not enough to bring the adequate change in ANC staff delivery of quality care. Active participation of government and grassroot level understanding of health system would be essential considering conducting further research taking in account the resources, and other factors that hinders the EDSS utilization.

Key messages

• Concurrent triangulation helps to understand that digital health intervention is not enough to bring intended changes in the quality-of-service delivery at health facility.

• Understanding of context and ground reality is essential to improve the quality of care and enhance the performance of healthcare providers.
Justificatory explanations: a step beyond explainability in machine learning
Authors: Guersenzvaig A , Casacuberta D
Published: October 2023

AI systems may have many potential negative effects, so understanding how they generate results is important. AI explainability is a crucial but highly technical field that might be inaccessible to many experts in (public) health. We present a non-technical approach to the issue and is focused on the conceptual foundations for decisions made by developers and stakeholders during the system's lifecycle. To illustrate, imagine an app that tracks snoring to offer health recommendations. A classical explainability approach would be to evaluate the quality of the training dataset and the model itself. We argue that if we want to understand the system, we also need to look at the notion of “health” as it is its basic conceptual underpinning. We believe that these conceptual foundations as well as rich descriptions of goals and purposes that are pursued can be integrated into what we call ‘justificatory explanations'. These would illustrate how key concepts influence design and development decisions offering thus valuable insights into the workings and outcomes of the explained system. ‘Justificatory explanations’ are declarative statements written in plain language that provide a high-level account of the team's understanding of the relevant key concepts related to the project's main domain and how these understandings drive decision-making during the lifecycle stages. We propose that ‘justificatory explanations’ should be incorporated into the technical documentation that usually accompanies the release or deployment of a system. In short, ‘justificatory explanations’ complement other efforts around explainability by highlighting the reasons the person or persons designing, developing, selling and deploying the system consider to have plausible justificatory power for the decisions that were made during the project. This increased conceptual awareness may be beneficial to all, even to those without a background in mathematics, and data and computer science.

Key messages

• Explainability in AI should go beyond the data and the model to integrate design decisions.

• Justificatory reasons about the system should be provided in plain language.
Five years after the Earthquake and nuclear accident: Loss and its psychological effect
Authors: Tsuchiya Y , Tsujiuchi T
Published: October 2023

Background

On March 11, 2011, the Great East Japan Earthquake hit Tohoku. The Fukushima nuclear power plant accident forced many people to relocate, leaving their hometowns. This study focused on the sense of loss and its psychological effect on the people of Fukushima five years after the earthquake and nuclear accident.

Methods

Quantitative and qualitative analysis from a questionnaire survey including the IES-R scale and open-ended questions.

Results

1021 people participated in this study. At the time of the survey, 490 people relocated within Fukushima prefecture and 531 people left. During the nuclear accident, 632 participants were close to the nuclear power plant; 407 participants reported actual nuclear accident experiences such as exposure to blast ashes, seeing the explosion, hearing explosive sounds and escaping. People lost family members (n = 112) and homes (n = 338) due to the tsunami and earthquake; 439 lost jobs after the earthquake and 410 had economic difficulties; 736 reported their sadness over losing hometowns; 391 people showed IES-R scores over 25, suggesting potential PTSD (Post Traumatic Syndrome). From a multivariate analysis, psychological distress was significantly affected by nuclear accident experience (OR = 1.43, p = 0.04), lost jobs (n = 1.57, p = 0.01), economic difficulty (OR = 1.68, p < 0.01), hometown loss (OR = 1.58, p < 0.05), feeling difficulty living (OR = 3.84, p < 0.01) and social isolation (OR = 1.74, p < 0.01). For hometown loss, significant factors were lost houses (n = 596, p < 0.01), friends (n = 590, p < 0.05), life (n = 421, p < 0.01), family relationships (n = 377, p < 0.01), community (n = 403, p < 0.01) and futures (n = 310, p < 0.01). From qualitative analysis,”I relocated with the children, leaving behind my husband which I regret (a mother with children)” and others.

Discussion and conclusions

After natural disasters, nuclear accidents and wars, people suddenly lose their special monitoring and support are necessary for affected people.

Key messages

• Many people still suffer from PTSD after the Nuclear Power Plant accident after 5 years.

• Many people suffer from a variety of loss such as loss of hometown, friends, family and others due to migration from Fukushima.
Offspring hospitalization for substance use and changes in parental mental health in Finland
Authors: Bishop L , Almquist Y B , Pitkänen J , Martikainen P
Published: October 2023

Background

Prior research indicates that parental psychiatric disorders increase their offspring's risk of substance use problems. Though the association is likely bidirectional, the effects of an adult child's substance use on parental mental health remain understudied. We examined parents’ psychotropic medication use trajectories by parental sex and educational attainment following a child's alcohol- or narcotics-attributable hospitalization.

Methods

We identified Finnish residents, born 1979-1988, with a first hospitalization for substance use during emerging adulthood (ages 18-29, n = 12,851). Their biological mothers (n = 12,283) and/or fathers (n = 10,765) were followed for the two years before and after the hospitalization. Psychotropic medication use was measured in three-month periods centered around the time of child's hospitalization, and the probability of psychotropic medication use at each time point was assessed using generalized estimating equations logit models.

Results

Among mothers, the predicted prevalence of psychotropic medication use increased during the year before, peaked during the 0-3 months after hospitalization, and remained at a similarly elevated level until the end of follow-up. The prevalence among fathers increased gradually and linearly across follow-up, with minimal changes evident either directly before or after the hospitalization. Parents’ educational attainment did not modify these trajectories.

Conclusions

Our results highlight the importance of considering linked lives when quantifying substance use-attributable harms and underscore the need for future research examining the intergenerational spillover effects of substance use in both directions, particularly in mother-child dyads.

Key messages

• Adult children’s substance use has a detrimental impact on maternal mental health, irrespective of the mother’s socioeconomic position.

• The study highlights the importance of considering the intergenerational spillover effects when quantifying the burden of substance use-attributable harms.
How might a Universal Basic Income influence UK mental health? A microsimulation modelling study
Authors: Thomson R M , Kopasker D , Bronka P , Richiardi M , Khodygo V , Baxter A J , Igelström E , Pearce A , Leyland A H , Katikireddi S V
Published: October 2023

Background

Universal Basic Income (UBI) may improve mental health (MH), but no studies have trialled or modelled UBI in whole populations. We simulated the MH effects of UBI on UK working-age adults.

Methods

Adults aged 25-64 were simulated from 2022-26 with the SimPaths microsimulation model, using data from the UK Household Longitudinal Study. SimPaths models short-term MH effects of UK tax/benefit policies via income, poverty and employment transitions. Three counterfactual UBI scenarios were modelled from 2023: ‘Partial’ (value equivalent to existing benefits), ‘Full’ (equivalent to the UK Minimum Income Standard) and ‘Full+’ (retained some means-tested benefits). Likely common mental disorder (CMD) was measured using the General Health Questionnaire (GHQ-12, score ≥4) and stratified by gender, education, and household structure. Simulations were run 1,000 times to generate 95% uncertainty intervals. Sensitivity analyses relaxed SimPaths assumptions about reduced employment resulting from Full/Full+ UBI.

Results

Partial UBI had little impact on poverty, employment or MH. Full UBI scenarios practically eradicated poverty, but decreased employment. Full+ UBI increased CMD prevalence by 0.38% points (0.13-0.69), equivalent to 157,951 additional CMD cases (54,036-286,805); effects were largest for men (0.63% [0.31-1.01]) and those with children (0.64% [0.18-1.14]). In our sensitivity analysis assuming minimal UBI-related employment impacts, CMD prevalence instead fell by 0.27% (-0.49, -0.05), a reduction of 112,228 cases (20,783-203,673); effects were largest for women (-0.32% [-0.65, 0.00]), those without children (-0.40 [-0.68, -0.15]) and those with least education (-0.42% [-0.97, 0.15]). MH effects waned by 2026 in all modelled scenarios.

Conclusions

UBI has potential to improve short-term population MH by reducing poverty, but impacts may be highly contingent on whether individuals choose to remain in employment following its introduction.

Key messages

• A UBI meeting living costs may slightly improve population mental health if people continue working after receiving the benefit, especially for women, the least educated, and those without children.

• In a ‘worst-case scenario’, where the increased income led to maximal reductions in employment, UBI might instead worsen short-term mental health, especially for men and those with children.
Individual-level exposures and risk of COVID-19: an umbrella review
Authors: Savoia C , Pezzullo A M , Farina S , Di Pumpo M , Tona D M , Porcelli M , Boccia S
Published: October 2023

As of April 2023, over 650 million people have been confirmed to have contracted COVID-19. The risk of transmission of COVID-19 might be influenced by various factors, including immunity from vaccination or previous infection, the use of personal protective equipment (PPE), indoors vs. outdoors environments, the degree of ventilation in indoor environments, and distance from the source of the infection. This review aims to assess the credibility of research conducted on individual risk factor epidemiology and prevention of COVID-19. A search was conducted on PubMed to identify systematic reviews and meta-analyses of studies examining the association between individual-level exposures and COVID-19. The study estimated the summary effect size and its 95% CI using both fixed-effect and random-effects models, and the 95% prediction interval was used to evaluate uncertainty. The study also examined heterogeneity among the studies and the presence of biases. We identified 141 meta-analyses examining 84 types of exposures or treatments. These were categorized into eight macro-groups: demographic factors, behavioural factors, dietary nutrient intake, comorbidities, drugs, PPE, contact types, and vaccination. Interventional studies comprised 5.7% of the total, contact tracing studies were 9.8%, and the remaining studies (84.5%) were other types of observational comparative studies. In these preliminary findings, the heterogeneity index (I2) ranged from large to very large, and there was evidence of small study effect and excess significance bias in many meta-analyses. Preliminary findings suggest that, apart from vaccines, for which abundant randomized evidence exists, the evidence base for COVID-19 prevention consists largely of studies of low or uncertain epidemiological credibility.

Key messages

• Overall epidemiological credibility of COVID-19 association studies might be low.

• Rigorous methodological practices are recommended when conducting epidemiological studies.
Assessing adverse childhood experiences in young refugees – development of the BRACE questionnaire
Authors: Abdelhamid S , Fischer J , Steinisch M
Published: October 2023

Background

With the persistence of ongoing crises and subsequent displacement of individuals, including children, knowledge about adversities experienced in this context is crucial, given the harmful effects of adverse childhood experiences (ACE) on mental and physical health. With the tools currently available, a comprehensive assessment of adversity exposure faced by refugee children is not possible. The BRACE (beyond refugee ACE) project set out to develop a core set of screening items that are refugee children specific and measure exposure and severity at all stages of migration. Here, the development of the Arabic (one of the majority languages of asylum seekers in Europe) parent report version is described.

Methods

The BRACE questionnaire was developed based on results of 1) a qualitative study involving semi-structured interviews with 47 refugee parents and 11 children (Germany, 2018-2020), and 2) a systematic review of relevant measures. Categories and associated adverse/protective experiences derived in 1) built the foundation of the BRACE. Whenever possible, items of validated ACE tools identified in 2) were used to assess exposure. The item set was finalized after translation into Arabic and cognitive pre-testing with 12 participants from the target population.

Results

The developed BRACE consisted of 52 items for 48 categories covering 8 adverse (e.g. disruption, violence) and 2 protective themes (e.g., connections). 19 items were developed by the study team (e.g., police brutality), 33 items were adopted from existing ACE tools (e.g. family member arrest). A binary response format expanding into a 4-point Likert scale was employed. Minor difficulties regarding respondent interpretation and answering ability could be resolved resulting in a final 50 item set.

Conclusions

This item set provides a starting point for field trials of a measure needed to facilitate the identification of at-risk individuals for targeted interventions.

Key messages

• Adverse childhood experiences (ACE) can harm mental/physical health. Adequate tools assessing ACE exposure in flight contexts are needed in order to develop mitigation strategies for those at risk.

• The BRACE project has developed a core set of screening items specific to refugee children's experiences to measure adversity exposure and severity at all stages of migration.
Socioeconomic characteristics and COVID-19 infection in Belgium: the mediating role of vaccination
Authors: Ghattas J , Cavillot L , Van den Borre L , de Pauw R , Hubin P , van Loenhout J , Devleesschauwer B
Published: October 2023

Background

Evidence suggests that people from lower socioeconomic status are at higher risk of infectious disease impact, owed to virus exposure, susceptibility and incomplete or delayed vaccination. However, It is unknown whether COVID-19 incidence disparities is due to social inequalities or social vaccination inequalities. The aim of this research is to determine whether socioeconomic characteristics are associated with COVID-19 infections in Belgium by measuring its direct effect, and to quantify the indirect role of socioeconomic determinants on COVID-19 infections by examining the role of vaccination as a mediator in this association.

Methods

In this retrospective cohort, all patients tested for COVID-19, at least once, in Belgium between 1 September 2021 and 1 September 2022 will be included in our analysis. A survival analysis will be conducted to compare time to the endpoint defined as COVID-19 infection according to socioeconomic characteristics. Mediation analysis for vaccination status will be conducted to assess the role of vaccination in the association between socioeconomic factors and COVID-19 infection.

Results

Expected results would give us an understanding of the impact of socioeconomic characteristics on COVID-19 infections in Belgium using on a population-based approach and considering the mediating effect of vaccination.

Conclusions

Mediation analysis is a novel approach for better understanding virus exposure and susceptibility in a context marked by socioeconomic inequalities. Understanding these patterns will allow better health-system preparedness for future pandemics.

Key messages

• Understanding social inequalities is essential for better health-system preparedness and response.

• Mediation analysis allows to understand the direct effect of socioeconomic inequalities on COVID-19 infections and the indirect effect mediated through vaccination.
Inequalities in health outcomes of SARS-CoV-2 infection by migration status in Barcelona, Spain
Authors: Pérez-Muto V , Barón L , Bertran M J , Vilella A , Torà I
Published: October 2023

Background

Migrants are a vulnerable population at risk of worse health outcomes due to legal status, language barriers, and socioeconomic and cultural factors. Considering the conflicting literature on the subject, it is important to further explore the extent and nature of these inequalities.

Aim

To compare health outcomes associated with SARS-CoV-2 infection between migrant population and Spanish natives living in Barcelona.

Methods

Observational retrospective cohort study including all adult cases of SARS-CoV-2 infection who visited a tertiary hospital in Barcelona between the 1st March 2020 and the 31st March 2022. We established five health outcomes: the presence of symptomatology, hospitalisation, intensive care unit (ICU) admission, use of mechanical ventilation (MV), and in-hospital 30-day mortality (IHM). Using Spanish natives as a reference, Odds Ratios (OR) with 95% CI were calculated for migrants by multivariate logistic regression and adjusted by sociodemographic and clinical factors.

Results

Of 11,589 patients (46.8% females), 3,914 were born outside of Spain, although 34.8% of them had legal citizenship. Most migrants were born in the Americas Region (20.3%), followed by other countries in Europe (17.2%). Migrants were younger than natives (median 43 [IQR 33-55] years vs 65 [49-78] years) and had a higher socioeconomic privation index, less comorbidities, and fewer vaccine doses. Adjusted models showed migrants were more likely to report SARS-CoV-2 symptomatology with an adjusted OR of 1.36 (95%CI 1.20-1.54), and more likely to be hospitalised (OR 1.11 [IC95% 1.00-1.23], p = 0.043), but less likely to experience IHM (OR 0.67 [IC95% 0.47-0.93], p = 0.02).

Conclusions

Native population had higher odds of IHM, but migrants were more likely to be hospitalised. Although migrants tend to be younger and healthier, more of them presented to the hospital symptomatic. These results could suggest disparities in healthcare access for migrant population.

Key messages

• Characteristics of immigrant and native population differ greatly, which could be translated into different needs and health priorities.

• More research on health disparities beyond COVID-19 in migrant populations is necessary to identify gaps in healthcare access and health literacy.
Complementary and alternative therapies for PTSD in refugees and asylum seekers: a systematic review
Authors: Paudyal P , Less E , Cooper M
Published: October 2023

Background

Over 100 million people worldwide are displaced every year, including 26.3 million refugees and 4.5 million asylum seekers. Previous research has identified that up to 46% of asylum seekers and refugees (ASRs) use complementary and alternative therapies (CAT) in their lifetime. This study aimed to systematically review and summarise the findings from existing studies evaluating the effectiveness of practitioner-based complementary therapies in PTSD in ASR populations.

Methods

The study protocol was registered in PROSPERO [ID: CRD42022311069]. Electronic searches were conducted in MEDLINE, Embase, Google Scholar, PubMed, Cochrane Library, and Web of Science. Studies published in English that considered practitioner-based CAT in PTSD in adult ASRs were eligible. Results from quantitative studies were summarised using effect size and, for qualitative/mixed methods studies, narrative synthesis was conducted using thematic analysis. Quality assessment of the studies were conducted using the Mixed Methods Appraisal Tool (MMAT).

Results

Of the total 605 studies identified in the search, 15 were included: quantitative (n = 11), qualitative (n = 2), and mixed methods (n = 3). Music therapy was identified as the most widely used intervention (five studies), followed by art therapy, body awareness therapy, meditation, yoga and spiritual therapy. Meditation, yoga and spiritual therapy were significantly associated with reduction in PTSD symptoms whereas the findings varied across the studies in relation to other therapies. Qualitative findings suggested that CAT interventions are acceptable to ASR populations.

Conclusions

This study suggests that spiritual therapy, yoga, and meditation have a beneficial role in PTSD in ASR populations. However, the findings should be interpreted cautiously as the studies were small with considerable inter-study heterogeneity.

Key messages

• Practitioner based complementary and alternative therapies are acceptable to asylum seekers and refugees.

• Spiritual therapy, yoga and meditation may have beneficial role in PTSD.
Attitudes towards the childhood immunisation programme among Polish immigrants in Norway
Authors: Gleditsch R N , Hynek K , Ofitserova T S , Hansen B T , Skogheim T S
Published: October 2023

Background

Norwegian-born children by Polish-born parents have lower coverage of some childhood vaccines than the general population in the nationwide Childhood Immunisation Programme. However, we know little about why this group have lower coverage. This study explored attitudes towards the Childhood Immunisation Programme among Polish immigrants in Norway. This knowledge can enhance vaccine information and further improve the prevention of infectious diseases in Norway.

Methods

We conducted semi-structured interviews with 15 Polish immigrants in Norway in the fall of 2022. The project explored vaccination in general, while the focus herein is on child vaccination. To better understand how the experiences and knowledge shape the participants’ attitudes towards vaccines and vaccination, the data was inductively analysed using a reflexive thematic analysis. The analysis is ongoing, and results are thus preliminary.

Results

Most of the participants had lived more than 10 years in Norway, while three had lived here for less than five years. All the participants had children. Based on the thematic analysis, we focused on three sub themes: 1) view of the child immunisation programme; 2) vaccine hesitancy; and 3) differences in childhood vaccination between Poland and Norway. Most of the participants’ children followed the immunisation programme. Some reported hesitancy towards the pneumococcal vaccine and the human papilloma virus vaccine. The majority of the participants expressed feeling less vaccine pressure in Norway than Poland and emphasized a high level of trust in the Norwegian health authorities.

Conclusions

The knowledge related to vaccine attitudes and differences between the Polish and the Norwegian programmes identified in the study, can help adapt better vaccine information and further improve the prevention of infectious diseases in Norway in general and for under-vaccinated groups in particular.

Key messages

• This knowledge can be used to adapt better vaccine information.

• This knowledge can help to improve the prevention of infectious diseases in Norway and for under-vaccinated groups in particular.
Improving the governance of a regional research network: from needs’ assessment to policy making
Authors: Maltoni S , Negro A , Alberghini L , Lavezzini E , Camerlingo M D , Moro M L , Tedesco D , Rolli M
Published: October 2023

Clinical research is a pivotal element for the Emilia-Romagna (Italy) healthcare system. Since 2009, several regional legislative acts established that clinical research was one of healthcare workers’ institutional activity as well as healthcare assistance and recommended each public Hospitals and Local Health Trusts (LHTs) to set up a research infrastructure (RI) to support clinical researchers. The goal of this intervention was both to assess the regional RI organization and to design a policy fostering the development of a RIs’ regional network. Our work, that took place in one year, consists of three-steps conducting: (I) a survey on all 15 RIs to assess their organizational model; (II) an interview to the key informants of each RIs to assess their strengths and weaknesses; (III) a three-round Delphi survey to evaluate the stratification of the activities in terms of complexity. The survey showed a high level of heterogeneity among RIs in terms of organizational structure, activities, human and instrumental resources and strengths and weaknesses. For example technological, economic, and human resources were considered opportunities, although difficulty at hiring data managers emerged as a potential threat. The Delphi panel assigned 3 levels of complexity (low, medium, high) to each activity carried out by RIs: 14 (47%) were considered low (mandatory for all RIs); 11 (37%) were considered medium (needed in RIs with medium volume/complexity of research activities) and, lastly, only 1 (3%) was considered high (needed in RIs with high complexity of research activities); for 4 (13%) activities no consensus was reached. The survey showed high level of heterogeneity and fragmentation among regional RIs in terms of organization, activities, resources and support offered to researchers. It also identified which level of complexity each RI should have and proposed possible solutions fostering a regional network of RIs to improve research activities in our Region.

Key messages

• Research is a key element of any innovative healthcare system. Public research needs a strong coordination.

• This work enabled policymakers to draft a policy based on evidence coming from stakeholders.
Irish consumers attitudes and behaviors to transitioning to more sustainable dietary
Authors: Harrington J M , Kenny T , O'Mahony L , McCarthy S , McCarthy M , Woodside J V
Published: October 2023

Background

The evidence on the environmental, socio-cultural and economic impacts of current diets highlights the need for countries to develop food based dietary guidelines incorporating sustainability. This study assessed consumers current beliefs, attitudes, and behaviours to transitioning to more sustainable dietary practices.

Methods

An online quantitative survey was developed. An all-Island sample in Ireland, representative of national age and gender distribution was recruited by Qualtrics XM market research company. Ethical approval for the study was granted by the Social Research Ethics Committee of UCC and reaffirmed by Queens University Belfast. Data were analysed using STATA SE Version 17.0.

Results

Affordability, accessibility, nutrition, and health were the most important characteristics of sustainable diets reported by participants that influence food purchases. Almost half of respondents were not interested in eating less animal-based food (45%) and more plant-based foods (51%). However, 22% reported to have started reducing red and processed meat consumption ‘some of the time'. The most popular sustainable dietary behaviours that people were already engaged with are: eating more home-cooked meals (59%), reducing food waste through prevention (41%), and eating less discretionary foods (55%).

Conclusions

Facilitating dietary change is a critical component of the transition towards more sustainable diets. A multi-pronged strategy is needed to transition to food environments that empower people to choose healthier and more sustainable options. This includes downstream actions at the individual level, including awareness and education campaigns, but more importantly upstream where strong leadership through public policies taking a whole of population approach is imperative.

Key messages

• Much work has to be done to reconnect human and ecological health, building awareness and knowledge of sustainable diets, and to make the more sustainable choice the easier, and acceptable choice.

• Affordability, accessibility and nutrition and health are important characteristics of sustainable diets influencing food purchases. These need to be considered in the development of key messages.
An interdisciplinary approach evidenced the influence of human activities on honey in Northern Italy
Authors: Consonni M , Moroni G , Tovagliari B , Gianelle V , Tesauro M
Published: October 2023

Background

Bees are important environmental indicators, revealing pollution through mortality or residues in honey and other hive products. We compared honey quality in a rural (Western Milan) and an industrial area (Northern Milan-Rho) in Lombardy (Italy).

Methods

In collaboration with the local Health and Environmental Protection Agencies, we collect and evaluate data regarding organic and inorganic residues in the honey samples from 2011 to 2022. Furthermore, we investigate the possible sources of air emissions through INEMAR database (INventario EMissioni ARia).

Results

Tetracyclines were detected in one case in the rural area, while Pb concentration was found above legal limits in several samples in the industrial area. INEMAR evidenced combustion in industry and road transport as the main sources of Pb emission in that area. It was also noticed Hg emissions in the rural area, clearly higher than in other territories.

Conclusions

The fraudulent use of antibiotics to eliminate pathogens, such as Paenibacillus larvae, responsible for American foulbrood, can be at the origin of their presence in the honey. Continuous monitoring of these compounds is critical since their environmental persistence can be very long lasting and a risk for human health. Heavy metals are harmful for human health and can have natural and mostly anthropic origins. The main sources are motor traffic, exhaust gases and fumes, as well as pesticides and synthetic fertilizers. Pb contamination can derive from the location of the apiaries near roads with high vehicular traffic, but in some cases, from the paints used to waterproof hives. The unexpected high Hg emissions better address next monitoring on honey in the rural area where no in-depth Hg analysis has been carried out until now. This interdisciplinarity is a new approach and an essential tool to better understand the influence of anthropic activities and of air pollution on honey quality.

Key messages

• Comparison of chemical quality (organic and inorganic residues) in honey produced in rural and industrial areas in Lombardy (Northern Italy).

• An interdisciplinary approach in honey quality assessment, considering estimated emission loads from anthropic activities in both areas.
The role of hybrid immunity after the administration of the first booster dose
Authors: Pascucci D , Nurchis M C , Lontano A , Marziali E , Grossi A , Capelli G , Vetrugno G , Damiani G , Laurenti P
Published: October 2023

COVID-19 vaccines have been shown to be safe, effective and life-saving. However, the advent of the Omicron variant has greatly impacted the effectiveness of vaccination and the transmissibility of the virus requiring the analysis of the different factors leading to breakthrough infections. The aim of this study is to investigate, in a cohort of healthcare workers (HCWs), the role of hybrid immunity on the incidence of breakthrough infection after the administration of the first booster dose. This retrospective study was conducted in an Italian hospital from September 2021 to September 2022. Only HCWs who had received BNT162b2 vaccine and the first booster dose were included. Participants were assigned in the cohort of hybrid immunity if were infected prior to the administration of the first dose and completing the primary course, with a single inoculation, while in the other cohort individuals had received three doses of the vaccine. The risk of infection was estimated by means of the Nelson-Aalen cumulative risk function. Cox regression was applied to detect potentially interacting covariates. Out of 5.650 HCWs observed, 402 got infected before primary schedule (hybrid immunity). Comparing the two cohorts, individuals with a hybrid immunisation had a lower risk of becoming infected after the booster dose. At 30 weeks the cumulative risk was 50% in those with three vaccine doses against 30% in those with hybrid immunity, showing an increasing trend over time. The difference between the two curves in the log-rank test appears to be statistically significant (p < 0.001). Cox regression analysis confirmed the results (HR = 0.40; 95% CI, 0.35-0.57). These findings contribute robustly to the scientific debate on the comparison of protection conferred by the full vaccine cycle or by COVID-19 vaccines plus infection. The pandemic has highlighted the importance of rapidly generating clinical evidence that can allow regulatory agencies and HCWs to make informed decisions.

Key messages

• Hybrid immunity from previous infection and recent booster vaccination conferred the strongest protection against infection.

• The data collected confirm the need for continuous monitoring of vaccine-induced immunogenicity and for establishing the exact timing of vaccination with more effective vaccination schedules.
Years Lived with Disability due to COVID-19 in the capital of Serbia in 2020 and 2021
Authors: Šantrić Milićević M , Rosić N , Pavlović N , Stevanović A , Jovanović V , Vujetić M , Devleesschauwer B , Anton A , Von der Lippe E , Rommel A
Published: October 2023

Background

Valid estimates of the national disease burden often lack during crises. They need to be improved to help assess the effectiveness and efficiency of the national public health system. To determine the magnitude of acute COVID-19 in Belgrade in 2020 and 2021, we estimated the total, age and sex-disaggregated Years Lived with Disability (YLD).

Methods

YLD and YLD/100,000 population due to acute COVID-19 were calculated for Belgrade (Serbia) in 2020 (March 6 - December 31) and 2021 (January 1 - December 31) within the EU COST Action 18218 and the BoCO-19 study. The City Institute of Public Health Belgrade provided surveillance numbers of cases of ICD-X: U07.1 and U07.2 (unknown age cases were proportionally redistributed) and population estimates. Severity weights and length of the disease were taken from the German National Burden of Disease study.

Results

In 2020, 33,842 acute COVID-19 cases (50.04% were men) had 73.0 YLD (men: 40.6 YLD or 5.1 YLD /100,000; women: 32.4 YLD or 3.6 YLD/100,000). In 2021, 65,020 COVID-19 cases (54.5% were women) had 130.3 YLD (men: 65.1 YLD or 8.2 YLD /100,000; women: 65.2 YLD or 7.3 YLD/100,000). Mild cases were more often among men 10-19 years and women 35-44 years. Moderate cases were more often among persons 35-44 years. Critical cases were more often among the men. More YLD were estimated for severe cases among women in 2021 than in 2020.

Conclusions

In Belgrade, the YLD burden of acute COVID-19 in 2021 was almost double that of 2020. Women had more often severe forms of acute COVID-19 and more YLD in 2021 than in 2020. Men often had moderate and critical cases of acute COVID-19 and higher YLD rates than women. The COVID-19 pandemic demonstrates the importance of having disease burden metrics to help contextually assess the health system's response to crises. Belgrade-level estimates can also be used for national estimates because of the same case definitions, treatment protocols, and data collection methods.

Key messages

• The YLD burden of the COVID-19 pandemic in 2021 was almost double that of 2020 for population of Belgrade.

• In 2020, higher YLD had men due to critical cases, in 2020, women due to severe cases in 2021 indicating greater exposure of men and greater vulnerability of women.
The impact of rotavirus vaccination in Italy: an eleven-year (2009-2019) nationwide analysis
Authors: Isonne C , Petrone D , Del Manso M , Iera J , Baccolini V , Costantino C , Pezzotti P , D'Ancona F
Published: October 2023

Although the positive effects of the introduction of rotavirus (RV) vaccination in Italy, a national updated analysis of its effect in still lacking to date. This study aims to analyze the implementation of rotavirus vaccination in Italy, evaluating its impact on discharges for acute pediatric gastroenteritis. A retrospective analysis including hospital discharge records and data on vaccination coverage for children aged 0-71 months from 2009 to 2019 was conducted. We examined trend in hospital discharge standardized incidence before and after vaccine introduction using a negative binomial mixture model with fixed effects to evaluate the impact of universal vaccination. The percentage of vaccination coverage increased over the years, from < 5% between 2009 and 2013 to 26% in 2017. After the inclusion to the National Im-munization Plan, in 2019 over 70% of children received the vaccine. In the first phase (2009-2013), the standardized incidence of discharges was 16.6/100,000 inhabitants; it decreased in the second phase (2014-2017) reaching 14.1/100,000 inhabitants. During the third phase (2018-2019) it significantly decreased to 9.9/100,000 inhabitants. In this phase, about 15% of the estimated hospital discharges were avoided compared with those estimated using the first phase data. The implementation of rotavirus vaccination reduced acute pediatric gastroenteritis incidence discharges in children aged 0-71 months. Further efforts are needed to continue monitoring the vaccination effect over time and to increase vaccination coverage.

Key messages

• The implementation of Rotavirus vaccination in Italy resulted in a reduction of acute pediatric gastroenteritis.

• Further efforts are needed to maintain high vaccination coverages, thus reducing the negative impact of rotavirus disease.