bluuebunny/crossref_metadata_2025 huggingface dataset:
SARS-CoV-2 incidence and effect on absences at a university hospital in Germany
Authors: Zhelyazkova A , Bonigut M , Weber M , Geiser-Metz S , Geis M , Heindl B , Mayr T , Prueckner S
Published: October 2023

Background

The COVID-19 pandemic highlighted the challenges and risks of in-hospital exposures among the health workforce. Health facilities were compelled to conduct their operation while both securing patient care and employees’ health in the context of changing regulatory requirements.

Methods

We performed Time Series Models and a T-Test for Polymerase Chain Reaction (PCR) SARS-CoV-2 in-hospital test results reported via the digital COVID-19 platform of the LMU University Hospital, Germany. The cohort consists of all persons employed at the hospital during the platform's utilisation (N = 14,419; 11.2021-12.2022).

Results

Overall, 179,135 in-hospital PCR tests were executed (monthly range: 5,528-24,560; R2=.993) of which 6,538 were positive (monthly range: 92-1,095; R2=.991). In a symptomless or evanescent course of infection, employees were able to get a control test and resume their duties prior to the designated end of isolation if their viral load were below the benchmark of, initially, 100,000 or, as adapted later, 1,000,000 copies/ml (as per Robert Koch Institute's recommendation): 8,100 PCR control results below the respective benchmark were reported (monthly range: 92-1,429; R2=.995). In total, 6,841 persons were able to resume duties prior to their isolation expiration date (monthly range: 10-1,478; R2=.996). No significant differences between the monthly number of PCR tests indicating a new infection and control tests were observed (t=−1.246, p=.235). Incidence trends were tracked closely via the hospital's platform.

Conclusions

The number of executed and positively reported tests fluctuated considerably. The benchmark for PCR tests in positive symptomless or evanescent cases allowed for a large number of staff to resume their duties prior to the expiration of their mandated isolation, yet without presenting a risk to other employees or patients. This measure prevented major staff shortages and ensured the uninterrupted provision of patient care at the hospital.

Key messages

• The establishment of a control test process facilitates the risk-reduced resumption of duty following a positive PCR test and reduces the isolation period with a decisive effect on staff capacity.

• In-hospital test surveillance requires evidence-informed and agile adaptations, thus highlighting the need for centralised strategic management, including segmented visualisation and analysis.
Success story of food reformulation monitoring, building capacities from French good practice to implementation in 19 EU member states
Authors: Vin K , Gabrijelčič Blenkuš M
Published: October 2023

Obesogenic environments stimulate the consumption of excess calories through HFSS foods. Therefore, activities aimed at reformulating foods into healthier alternatives are the first crucial step in improving the food supply for children. Harmonised EU monitoring of the reformulation actions was addressed as one of the key approaches in creating healthier options for children and their caregivers. Supported by the EU AP on childhood obesity 2014-2020, access to an improved and healthier food offer in supermarkets should be made easier. Currently, only a few European countries are monitoring processed food supply at the brand level, and this deprives European and national policy makers of an objective description of the situation to define and assess nutrition policies. JA Best-ReMaP, building on the JANPA and EUREMO outcomes, aimed to fill in the reformulation monitoring gap and to add to the improved access to high quality foods for the European citizens, especially for children. To do so, in 19 European countries, JA Best-ReMaP implemented a standardised European monitoring system for processed food reformulation. Such a tool, at a country level, enables to monitor food offerings and nutritional content of individual monitored processed foods, as well as to identify best formulation and room for reformulation of the food produced, sold, and consumed. Complex steps were taken in the project implementation, including the identification of the priority processed food groups for a European monitoring of the food supply, exploration of the new technologies and new sources of data capacities for nutrition data collection, development of the knowledge to conduct and analyse own data collection in the participating EU MSs, explorative development of an open European branded foods database, and first attempt of the European analysis of the trends of the nutritional quality of processed food and their impacts.
Barriers in the implementation of burden of disease estimates in Belgium and potential solutions
Authors: De Pauw R
Published: October 2023

Injuries are a leading cause of morbidity and mortality in Europe, and not only place a huge burden on individuals and health care services but on society as a whole. However, estimates on the burden of disease expressed as disability adjusted life years (DALY) are only available in some countries. Other countries don’t have the required data or resources available to calculate DALYs attributable to injuries. The recent report on the European Injury Data Base (IDB) shows that there are important between-country differences in morbidity and mortality related to injuries, emphasizing the important of country-specific estimates. In the current presentation the process of DALY calculations will be briefly discussed, after which a more in-depth scope will be given on the barriers that exist in Belgium to calculate these valuables DALYs. These barriers include, for example, a lack of data availability and specific barriers in linking data registries. Afterwards, the potential solutions to yield estimates based on incomplete information will be discussed.
The dark side of light at night: assessing breast cancer risk with a dose-response meta-analysis
Authors: Urbano T , Vinceti M , Wise L A , Filippini T
Published: October 2023

Light at night (LAN) is a ubiquitous environmental issue resulting from exposure to artificial light during the night-time hours. The adverse effects of LAN include circadian disruption, melatonin suppression and altered clock gene expression. Very recent evidence suggests that LAN may increase risk of several diseases, including cancer. Breast cancer is the most common diagnosed cancer globally and the second leading cause of cancer-related mortality. Several environmental and life-style related risk factors have been linked to breast cancer onset. In this updated meta-analysis, we investigated how exposure to LAN may affect breast cancer risk. Using systematic online database searches (PubMed, Scopus, and Web of Science), we included 19 eligible studies (10 cohort and 9 case-control) investigating the association between LAN, either outdoor or indoor, and breast cancer risk. We first performed a meta-analysis comparing the highest versus lowest levels of exposure. Then, we performed a dose-response meta-analysis to investigate the shape of such relation. Overall, we found a positive association between LAN and breast cancer (risk ratio [RR] 1.08, 95% confidence interval-CI 1.03-1.13). In stratified analyses, the risk was more pronounced in premenopausal (RR 1.15, 95% CI 1.05-1.26) and normal-weighted (RR 1.17, 95% CI 1.00-1.36) women, while stratifying for outdoor/indoor exposure and for estrogen receptor status did not gave substantial differences in the risk estimates. The dose-response relation showed a linear risk increase up to 60 nW/cm2/sr after which the curve reached a plateau, especially among premenopausal women. These results strengthen the hypothesis that LAN is associated with breast cancer risk. Public health measures are warranted to minimize LAN exposure and reduce its related adverse effects on human health.

Key messages

• Light at night is positively associated with breast cancer risk.

• The dose–response relation between light at night and breast cancer supports a positive association particularly in premenopausal women.
Mitigation potential of local traffic interventions on paediatric asthma incidence in EU cities
Authors: Vandeninden B , Bouland C , Declercq E , Devleesschauwer B , Faes C
Published: October 2023

Issue/Problem

Motorised road traffic is a major contributor to Nitrogen Dioxide (NO2) emissions, contributing to the development and worsening of asthma. With a substantial and escalating prevalence of asthma in urban areas worldwide, this is an issue of public health significance.

Description of the problem

Deploying methods such as Random Forests and Boosted Regression Trees, this study aims to determine the potential reduction in paediatric asthma incidence in European cities that could be achieved through policy interventions targeting local traffic reductions, such as car-free days.

Results

In trafficked areas in European cities such as Brussels and Paris, up to 40% of asthma incidence can be attributed to NO2 exposure. Preliminary results show a potential reduction of 29% [95% CI: 20-34%], 21% [95% CI: 13-25%], and 12% [95% CI: 7-15 %] in paediatric asthma incidence in trafficked areas, central urban areas, and residential areas in Brussels, respectively. In Trafficked and Urban Background Areas in Paris, we found a potential reduction of 17% [95% CI: 11 -19%] and 13% [95% CI: 8-16%] in paediatric asthma incidence respectively. Trends and findings are consistent with several methodologies applied.

Lessons

Using real-world interventions such as car-free days is an innovative way to assess the mitigation potential of diseases associated with traffic. Our study highlights the public health significance of local traffic reduction policies in addressing asthma incidence in urban areas. The recommended public health actions include implementing policy interventions to reduce traffic levels and emissions in urban areas. These findings can be useful for other countries/settings facing similar issues with traffic-related air pollution and asthma incidence. The policy intervention can also positively impact other traffic-related health effects such as physical activity, noise, and availability of green spaces.

Key messages

• Local traffic reduction policies can significantly reduce (paediatric) asthma incidence in urban areas in large European Cities.

• Reducing traffic levels reduces traffic-related air pollution and improves public health via pathways such as promoting physical activity, reducing noise, and increasing green space availability.
9.N. Workshop: How to solve shortages and uneven distribution of health workers in Europe?
Authors:   Organised by: Nivel (Nethrlands),   Chair persons: Ronald Batenburg (EUPHA-HWR)
Published: October 2023

Background

Europe's health workforce is under extreme pressure. The increasing challenge of an uneven distribution of health workers within countries is amplified by a structural problem of shortages, inappropriate skill mix, inadequate working conditions and ageing of health workers. In this workshop the results from five research projects, ROUTE-HWF, OASES, AHEAD, TASHI and METEOR (joined in the EU Health Workforce project cluster) will be presented. The ROUTE-HWF, OASES and AHEAD projects focus on the uneven distribution of health workers resulting in ‘medical deserts’, while the TASHI project focusses on task shifting and METEOR on the retention of health workers. In this workshop it will become clear which lessons can be learned from the five projects and how they complement each other. How should retention and task shifting policies be implemented locally, and can they mitigate the uneven distributions of health workers? And vice versa, how should retention and task shifting policies by customized in different types of medical deserts? By combining the five projects into one workshop their links and added values will be made clear. While all projects are based on cross-national comparisons and aim to improve health workforce policy by in-depth research, they also differ and complement approaches to overcome the pressing struggles of the current health workforce.

Aims and Objectives

The aim of this workshop is to present the key findings of the different projects, focusing on the need for different solutions for countries to mitigate structural problems of health workers.

Workshop format

This will be a regular workshop. During the workshop, all five projects will shortly present their key results and after each there will be room for discussion. At the end of the workshop there will be room to discuss the complementarity of the five projects, and how they jointly provide an overview of policy options to mitigate structural problems related to medical deserts, task shifting and retention of health workers.

Key messages

• The workshop will give insight into the specific problems of medical deserts and the possible approaches with regard to retention and task shifting policies.

• The workshop will give insight into the need for customizing policy solutions to attach the complex problem of health care worker shortages and regional disparities.
Exploring subjective risk-benefit perception as an integral component in risk communication
Authors: Lohmann M
Published: October 2023

Consumer health protection involves assessing and communicating risks. One-way risk communication may cover information on food safety regulations, food handling practices, and contaminants in food, as well as concerns related to food recalls, outbreaks, or other safety issues. This approach is legitimate if the aim is simply to share information. However, adequate risk communication needs to reach people with the information they need, in a form they can use, and overcome discrepancies between scientific risk assessment and risk perception of laypersons. Often risks that are low from a scientific point of view are overestimated by the public (e.g., pesticide residues, genetically modified food), or the opposite (e.g., foodborne pathogens). Furthermore, foods also have health benefits, and the balance between adverse and beneficial effects is difficult to perceive. Communication related to food should consider all aspects of food choices, including health beliefs, cultural practices, and personal preferences that influence choices and perception of risk and benefits. In this presentation, we will explain how an institute for risk assessment with a mandate for risk communication can apply quantitative and qualitative methods to identify patterns of perception and behaviour. Quantitative methods are used to measure risk perception and communication, qualitative methods to investigate psychological aspects and motivations, and media analyses to reveal topics that are prioritized in the media, which can influence risk perception. We will show how social science methods can be used to understand how consumers respond to risk-benefit information and discuss how common metrics for assessing both risks and benefits are expected to facilitate communication of results of RBA. The challenges that these metrics pose for risk-benefit communication and whether it is to be expected that consumers will be able to accurately weigh between risks and benefits will also be discussed.
COMMA: A microsimulation model investigating the impact of COVID-19 lockdowns on depression
Authors: Thompson K , Qi J , Pham A , Viviani E
Published: October 2023

Background

The COVID-19 pandemic has highlighted the importance of tailored preparedness plans to cope with potential disease outbreaks. During the pandemic, a major challenge for policymakers was finding the balance between containing the disease and supporting mental health and well-being. Although COVID-19 lockdowns and accompanying restrictions mitigated the spread of the virus, many countries witnessed significant increasing rate of depression during these periods. It is not clear the extent to which different lockdown scenarios impacted depression rates, and whether these effects might be felt in the future.

Methods

In this study, a microsimulation model, COMMA (COvid Mental-health Model with Agents), was developed to simulate behaviors of individuals under different lockdown scenarios, both actual and hypothetical, and of varying duration, sequence and severity. COMMA helps to understand how the prevalence of depression changed in each scenario. The characteristics of simulated population were synthesized based on health cohort data from Lifelines. The data included participants living in the Dutch city of Groningen during the pandemic.

Results

Preliminary results show that hard lockdowns resulted in increased rates of depression. Light lockdowns had smaller effects on depression rates. In all simulations with lockdowns, depression rates had almost rebounded to pre-COVID levels, although they remained slightly higher than in simulations with no lockdowns at all.

Conclusions

COMMA is the first microsimulation model to examine COVID-19 lockdowns’ impact on mental health, and offers important insights into the actual, hypothetical and potential effects of lockdowns on mental health.

Key messages

• Simulations showed that lockdown severity mattered, with hard lockdowns resulting in elevated rates of depression.

• This study highlights that lockdowns are not without secondary health consequences, which may be important for policymakers to consider during future pandemics.
Healthy Finland survey as the latest uptake for 50 years of population health monitoring in Finland
Authors: Lundqvist A , Tolonen H
Published: October 2023

In Finland, population-based health examination surveys (HESs) have been conducted in regularly since early 1960's to obtain information on population health and health determinants. These surveys have covered adult population living in the mainland Finland. Surveys have always been conducted by specially trained personnel using international standardized protocols such as WHO MONICA protocol or EHES protocol. The latest HES, Healthy Finland, is ongoing and will run until June 2023. The Finnish Institute for Health and Welfare (THL) had the responsibility of the coordination of the preparation phase as well as conducting the survey. Survey planning was started already in early 2021 with a multidisciplinary group including representatives from different stakeholders. Survey sample includes 66.000 randomly selected adults aged 18+ years living in Finland. In the 1st phase, they receive a questionnaire to be filled in. Questionnaire covers topics such as quality of life, health, use of health care services, lifestyles, background information, work ability and functional capacity, wellbeing, accidents, and sexual and reproductive health. In the 2nd phase, 10.000 of those selected to the survey were invited to health examination including for example anthropometric measurements, blood pressure, spirometry test, collection of biological samples and sub-studies. This from these national HESs has been widely used for policy making, planning and evaluation of the prevention programmes, as epidemiological background for clinical treatment guidelines of several diseases, and for research. Information obtained from the Healthy Finland survey will be used for the evaluation of wellbeing service counties which are responsible for the organization of social and health care services in Finland. Survey will generate new information about health inequalities by providing information not only by age and sex but also by education and other socio-economic indicators.
A hidden epidemic during COVID-19: Sleep disturbance and alcohol use among healthcare workers
Authors: Lee B , Ling M , Boyd L , Sheen J
Published: October 2023

Background

The COVID-19 pandemic has led to significant mental health issues among healthcare workers (HCW), including depression, anxiety, and post traumatic stress disorder. Emerging studies are now showing that HCWs are facing additional mental health challenges such as insomnia and alcohol use disorder that also require urgent attention. The current study thus aimed to evaluate the prevalence and factors related to sleep disturbance and alcohol use in Australian HCWs.

Methods

In January 2023, 211 Australian hospital HCWs completed an online cross-sectional survey that included a modified version of the Coronavirus Health and Impact Survey, a single item measure of sleep disturbance, a single item measure of alcohol use, and a demographic measure. Missing data were imputed and analysed using adjusted multivariate regressions and relative weight analysis to determine key predictors of outcomes.

Results

Results show that 172 (81.5%) participants experienced sleep disturbance affecting their personal or occupational life, with 49 (23.2%) at very or extremely high levels. With alcohol use, 73 (34.6%) reported monthly intake, 58 (27.5%) reported weekly intake and 8 (3.8%) reported daily intake. Sleep disturbance was significantly associated with poor pre-covid mental health (p < 0.001, R2=17.66%), time spent outdoors (p < 0.01, R2=4.2%), poor physical health (p < 0.05, R2=4.9%), COVID infection worries (p < 0.05, R2=3.9%), and providing direct care to COVID patients (p < 0.05, R2=3.1%). Alcohol use was higher in physicians compared to nurses (p < 0.01, R2=3.1%) and associated with direct care of COVID patients (p < 0.05, R2=2.4%) and relationship stress (p < 0.05, R2=1.9%).

Conclusions

These findings are the first to investigate sleep disturbance and alcohol use in Australian HCWs and shows that these challenges pose a significant risk for this cohort. Findings highlight at risk groups and potential treatment targets to address these outcomes.

Key messages

• Sleep disturbance and alcohol use are increasingly becoming a growing concern for HCWs, indicating an urgent need for interventions and supports to prevent long term consequences.

• Findings highlight 4 risk and 1 protective factor for sleep disturbance and 3 risk factors for alcohol use that can be targeted in interventions and supports for HCWs.
Patients’ factors of choice in dental care and impact of the Covid-19 pandemic – a systematic review
Authors: Felgner S , Handrock J F , Schroll C C , Schütte F , Henschke C
Published: October 2023

Background

Patients often face individual challenges at their dentist, e.g., high co-payments. Why patients decide for or against dental treatment can be determined by many factors: own financial resources, preferences, and external circumstances. The study's aim is to identify these factors with an international perspective.

Methods

We systematically searched for literature in three biomedical databases. Factors of choice etc. were extracted from relevant publications. We used a qualitative approach for analysis, and the MMAT (Mixed Methods Appraisal Tool) for quality assessment.

Results

After multistage screening of n = 4,226 publications by two reviewers, n = 233 relevant articles of different study types [qualitative (n = 42), quantitative (n = 177), and mixed-methods (n = 14)] were included in the analysis. Data collection was realized across different settings [e.g., practice (n = 18)] and approaches (e.g., interviews) in n = 49 countries. Included studies focused on specific treatments (e.g., caries treatment) or treatments in general (e.g., dental tourism). Across countries, various factors of choice (n = 101) were identified, divided into three categories: (I) ‘dentist & dental institution’ (e.g., communication), (II) ‘patient’ (e.g., fear), and (III) ‘treatment’ (e.g., durability). Cost and dental fear were mentioned most frequently (n = 148, n = 73). In countries with most articles [UK (n = 28), Saudi Arabia (n = 23), USA (n = 22), India (n = 19), and Brazil (n = 14)], the cost factor was identified most often [e.g., USA (n = 16, 73%)]. One publication addressed the Covid-19 pandemic reporting that treatment appointments were cancelled by patients due to their fear of infection with SARS-CoV2. Study quality is highly variable.

Conclusions

A variety of factors influence patients’ choice regarding dental treatment. There is little research on impact of the Covid-19 pandemic. Regulatory measures and information efforts should be adapted to reduce patients’ access barriers to dental care.

Key messages

• A variety of factors influence patients’ choice regarding dental treatment.

• Fear of SARS-CoV2 infection is a new factor of choice in dental care from patients’ perspective.
Cancer risk behavior and healthcare utilization among people experiencing homelessness in Europe
Authors: Grabovac I , Doñate-Martínez A , Alhambra-Borras T , Blanes V , Gomez Trenado R , Barrio Cortes J , Gawronska J , Belogianni K , Tabaki I , Jeleff M
Published: October 2023

Background

People experiencing homelessness (PEH) are a vulnerable population, having higher cancer morbidity and mortality compared to the housed population. Reasons for this may be due to higher prevalence of risky health behaviors but also owning to barrier to access and utilize healthcare services. This study aimed to show the prevalence of risky health behavior and utilization of healthcare services in PEH in Austria, Greece, Spain and the UK.

Methods

Data from 262 PEH participating in an ongoing longitudinal study on cancer prevention and early detection were included in a preliminary analysis (03/2023). Participants were adults, with no history of cancer recruited during their visits to social and healthcare services. Demographic data, high-risk health behaviors and visits to healthcare services were collected via questionnaires.

Results

Mean age of participants was 47.6 years (SD = 12.9) with 56.2% identifying themselves as male. The majority (50.4%) were homeless for up to 3 years and 61.6% had no history of homelessness. On average, 13.6 (SD = 10.2) cigarettes per day were reported by 62% of active smokers, 51% reported regular alcohol intake and 20.6% reported use of illicit drugs. Multimorbidity (co-occurrence of two or more chronic illnesses) was prevalent in 20.2% of participants. Half of participants reported having health insurance and 55% reported utilizing health care services in the past 12 months. The average number of visits to general practitioners and medical specialists was 3.9 (SD = 5.5) and 2.1 (SD = 5.1), respectively with an average of 2.2 (SD = 7.3) nights spent in hospital.

Conclusions

The proportion of PHE engaging in high-risk health behaviors is higher and utilization of health services is lower compared to the housed population. PEH may benefit from improved access to preventive and community health services, which is currently assessed by implementing the Health Navigator Model as part of the Horizon 2020 CANCERLESS project (GA965351).

Key messages

• High prevalence of risky health behaviors and multimorbidity in PEH was observed.

• The reported low health care utilization among PEH may be due to structural barriers.
Smoking status of medical students and changes during the COVID-19 pandemic
Authors: Babjakova J , Wimmerova S , Argalasova L
Published: October 2023

Background

Smoking is a major public health threat that contributes to many diseases and deaths. This study aimed to investigate cigarette and alternative tobacco products (ATP) use and knowledge among students. Additionally, changes in smoking prevalence and contributing factors during the COVID-19 pandemic were examined.

Methods

The cross-sectional, anonymous online survey was conducted among students from the Faculty of Medicine, Comenius University in Bratislava, by sending e-mails with links, during November-December 2022. Our study population consisted of 783 students with a mean age of 22.7±2.7 years; 68.1 % of students studied in Slovak; 67.0 % of respondents were female; 21.8% did not have COVID-19, and 6.6% were not vaccinated. The data were analyzed by SPSS 25.

Results

Out of these, 89 were current smokers (11.4%), 216 ex-smokers (27.6%), and 478 non-smokers (61.0%) in the study sample, significantly higher number of smokers were men (16.2% vs 9.1%; p = 0.004), more foreigners (9.4% vs 15.6%; p = 0.021). A total of 170 medical students (21.8%) reported using any kind of alternative tobacco product, with a significant intersexual difference (27.4% males vs. 18.9% females; p < 0.001), more Slovaks (22.9% vs. 19.4%; p = 0.503). The pandemic did not affect a significant change in classic nicotine product intake for 11.4%; 11.8% of students decrease intake; while 8.0% increased their intake. 17.5% of users of ATP did not change their habits during the pandemic; 7.0% of students decrease intake; 12.6% increased. Respondents who were smokers and ex-smokers reported an increase in alcohol consumption during the pandemic more frequently than non-smokers (23.6% and 21.5% vs. 10.7%, respectively).

Conclusions

The results show the high consumption of different tobacco products, and the lack of knowledge and awareness among medical students, future healthcare providers, who should serve as a model for their patients and the public. Supported by KEGA 015UK-4/2022

Key messages

• As future healthcare providers, medical students will play key role in health promotion and disease prevention, and they should serve as a model for their patients and the general public as well.

• Our study emphasizes increasing awareness and education regarding tobacco use and the need for intervention in the field of disease prevention at medical faculties.
Mediterranean diet in five Mediterranean countries: the DELICIOUS project
Authors: Godos J , Laudani S , Guerrera I , Mata A , Pardo M A , Busó P , Grosso G
Published: October 2023

An abandonment of traditional dietary patterns is growingly observed in Mediterranean countries, especially among younger generations. This study aimed to explore determinants of Mediterranean diet (MD) adherence in 5 Mediterranean countries (Italy, Spain, Portugal, Egypt, and Lebanon) within the context of the EU funded project DELICIOUS (UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and LIfestyle in Children and adolescents through behavIOUral change actionS). The sample consisted of 2011 parents of children and adolescents aged 6-17 years old. The main background characteristics, including age, sex, education, family situation, weight status, physical activity levels, sleep and screen time duration, were collected. The level of adherence to the MD was assessed using the KIDMED index. Eating habits (i.e., breakfast, place of eating, etc.) were also investigated. Logistic regression analyses were performed to test for likelihood of higher adherence to the MD. The mean KIDMED score in the study sample was 6.1 [standard deviation (SD) 2.0] with significant differences across countries [Lebanon 5.7 (SD 2.0), Italy 5.8 (SD 2.1), Spain 6.3 (SD 2.1), Egypt 6.5 (SD 1.9), and Portugal 6.5 (SD 2.0)]. A total of 865 participants were deemed as highly adherent to the MD [highest tertile, mean KIDMED score = 8.0 (SD 0.9)]. Major determinants of higher adherence to the MD were the following: among background characteristics, younger age group, higher physical activity level and adequate sleep duration; regarding dietary habits, having breakfast, out-of-home eating, eating with family members and at school, and home-cooked meals were associated with higher MD adherence. Parents’ younger age and higher education were also determinants of higher adherence. In conclusion, a cluster of healthy lifestyle behaviors can be observed among Mediterranean children and adolescents as determinant of higher adherence to the MD.

Key messages

• Lifestyle habits tend to cluster into healthy behaviors.

• Differences in Mediterranean diet adherence may occur across countries.
The link between smart device use and ADHD—how can reading and physical activity make a difference?
Authors: Chen C C , Lin W Y , Zou M L , Hsu H W , Lin W C , Chen Y H
Published: October 2023

Background

Attention deficit and hyperkinetic disorders (ADHD) lead to poor academic performance and relationship problems in schoolchildren. While improper use of smart devices was found to have a negative impact on children's attention and behavior, few studies used a computerized self-administered scale for children to assess suspected ADHD more accurately. Therefore, this study aimed to investigate impact of weekend smart device usage on ADHD and child behavior, as well as the moderating effect of children's reading habits and activity levels.

Methods

A total of 137 students aged 6-8 in Taiwan participated in this study between Dec 2022 and Mar 2023. Data was collected through the self-reported instruments of Child Behavior Checklist for Ages 6-18 to assess behavior and an online questionnaire to gauge smart device usage by parents. The Computerized Attention Diagnostic Assessment (CADA) was conducted by children to evaluate their attention performance. Multiple linear regression was used for analysis.

Results

After adjusting for potential confounders in a stratified analysis, we found that among children with less physical activities, higher smart device usage was associated with more anxious/depressed (β = 8.40, p < 0.01), social problems (β = 6.48, p = 0.01), and thought problems (β = 6.43, p = 0.02), while among those with higher activities, higher device usage was associated with better picture attention scores (β = 5.67, p = 0.0237). Meanwhile, children who don't read habitually, higher smart device usage was associated with more somatic complaints (β = 3.31, p = 0.0235).

Conclusions

We highlighted the modifying effects of reading and physical activities on the link between smart device usage and attention and behavioral problems. In this digital age, it is imperative to provide parents with guidance on how to encourage reading and physical activities to help children mitigate the negative impact of smart device usage, including attention deficit and emotional problems.

Key messages

• High device usage in inactive or non-reading children is linked to behavioral problems like anxiety, social issues, and somatic complaints.

• Promoting physical activities and reading can mitigate negative effects of device usage, highlighting the need for parental guidance in the digital age.
Changes in ambient particulate matter exposure and evaluation of its health relevance in Germany
Authors: Kienzler S , Plass D , Tobollik M , Wintermeyer D
Published: October 2023

Introduction

To evaluate the health relevance of fine particulate matter (PM2.5), it is necessary to assess the PM2.5 exposure of the populations. For this purpose, time series (2010-2021) for two PM2.5 indicators for Germany were developed: (1) the mean population-weighted PM2.5 exposure per year and (2) the proportion of the population exceeding the recent WHO air quality guideline value for PM2.5 of 5 µg/m3 (annual mean).

Methods

To calculate the two indicators for the period 2010-2021, nationwide modelled annual means of PM2.5 background concentrations were used. They were joined with spatial information on population density from the 2011 census. The population data were additionally scaled for each year according to the official population update. On this basis, the population could be assigned to different PM2.5 exposure classes per year.

Results

Over the years considered, the mean population-weighted PM2.5 exposure in Germany decreased by approximately 41 %: in 2021, the indicator value of 9.3 µg/m3 was significantly lower than in 2010 with 15.9 µg/m3. However, throughout the time series, almost 100 % of the German population was exposed to PM2.5 annual mean concentrations above the current WHO air quality guideline value.

Conclusions

Generally, the decreasing PM2.5 exposure of the German population is very positive. Measures taken in recent years to reduce emissions from stationary sources and the transport sector have contributed significantly to this development. On the other hand, the large proportion of the population above the WHO guideline value shows that the current annual average PM2.5 reduction is still far from being sufficient to protect human health. In fact, far-reaching measures are required to significantly reduce particulate matter concentrations in Germany.

Key messages

• The mean population-weighted particulate matter exposure in Germany has decreased significantly in recent years.

• The exposure reduction in Germany is still not sufficient. To protect human health, further and far-reaching measures are required to significantly reduce particulate matter concentrations in Germany.
Early-life droughts and cognitive performance among children in rural India
Authors: Pradella F , Gabrysch S , Van Ewijk R
Published: October 2023

Introduction

Organisms adapt to prenatal conditions in a way that prepares for similar postnatal circumstances. Fetal programming research has identified associations between various prenatal shocks and numerous health outcomes, yet the role of the postnatal environment for effect manifestation remains understudied. This is the first study to investigate the interplay of pre- and postnatal environmental conditions for cognitive health among school-aged children. We focus on nutrition, a cognitive health risk factor in both pre- and postnatal life.

Methods

Data from the 2007-2018 Annual Status of Education Report (ASER) on 5-16-year-olds from rural India (N = 4,589,590) were linked to University of Delaware rainfall data. As rural India heavily depends on rainfed agriculture, we exploit droughts - i.e. rainfall below the 20th percentile of the district-specific mean - as a quasi-experiment for nutritional shocks. Drought exposure is assigned based on birth year. We first test if prenatal drought exposure is associated with test scores, and then interact prenatal exposure with exposure in the first years of life, while controlling for household, district, birth year, and interview year.

Results

Our results show that prenatal drought exposure is associated with lower scores in math and reading, and a lower probability of being on track in school, particularly among 11-16 year-olds. Droughts in the first few years after birth, too, are associated with poorer scores. However, this effect is alleviated among adolescents who had previously experienced a drought prenatally.

Conclusions

Prenatal exposure to suboptimal conditions might mitigate the effects of similar shocks in early postnatal life for cognitive health. Future research on interactions between such pre- and postnatal factors is needed, e.g. to gain insights for resilience-building in face of the climate crisis.

Key messages

• The occurrence of droughts during the prenatal phase, as well as during the first few years after birth, lead Indian adolescents to perform worse in school.

• Prenatal circumstances prepare for postnatal ones. This explains our finding that the effects of droughts after birth are alleviated among those who had already been prenatally drought-exposed.
Social disconnectedness co-exists with health literacy and treatment burden in individuals with CVD
Authors: Christiansen J , Lasgaard M , Pedersen S S , Pedersen M H , Friis K
Published: October 2023

Background

Social disconnectedness (e.g., loneliness and social isolation) is associated with increased risk of morbidity and mortality, including cardiovascular disease (CVD). However, loneliness and social isolation do not merely increase the risk of incident CVD; rather, they seem to also aggravate the course of disease. Low health literacy and patient-perceived treatment burden are common among individuals with CVD, and may further impact health outcomes. Understanding the potential mechanisms linking social disconnectedness with CVD and disease prognosis is crucial for clinical practice. However, research investigating the associations between social disconnectedness, health literacy, and treatment burden in individuals with chronic disease remains sparse despite its apparent relevance.

Methods

This study used cross-sectional self-reported data from the 2017 Danish National Health Survey entitled ‘How are you?', investigating the associations of loneliness and social isolation with low health literacy and high treatment burden in individuals with CVD (n = 2,521; mean age = 65.7 years).

Results

Logistic regression analysis showed that loneliness and social isolation were associated with increased odds of low health literacy in terms of difficulties with ‘understanding health information’ and ‘engaging with healthcare providers'. Likewise, loneliness and social isolation were associated with high treatment burden.

Conclusions

Our findings showed that loneliness and social isolation coexist with low health literacy and high treatment burden in individuals with CVD. This is of concern as socially disconnected individuals already experience more health issues, and these factors could worsen their condition. Our findings underscore the importance of interventions in clinical care that counter social disconnectedness while considering the individual's health literacy and treatment burden.

Key messages

• Social disconnectedness coexists with low health literacy and high treatment burden in individuals with CVD. This reflects a potential accumulation of risk factors.

• The coexistence of social disconnectedness with low health literacy and high treatment burden highlight the need for efforts addressing social connections in the context of patient care.
Interventions to ameliorate negative psychosocial effects of the COVID-19 pandemic on the young
Authors: Wendel F , Rehfuess E , Jung-Sievers C
Published: October 2023

The psychosocial health of the young has been particularly affected by the pandemic. Containment measures have restricted social development, education and recreational activities, and may have increased sleep disturbances, symptoms of anxiety and depression. The objective of this study is to assess the effectiveness of interventions that seek to build resilience and to ameliorate negative psychosocial effects of the COVID-19 pandemic on children and adolescents. We conducted a systematic review and meta-analyses based on PRISMA guidelines and Cochrane recommendations. Literature searches were conducted in the databases MEDLINE, EMBASE, PsycINFO, CENTRAL, and COVID-19 specific databases of WHO and Cochrane. The searches retrieved 9957 records of which we included 13 RCTs for evidence synthesis. Included studies predominantly implemented online group sessions with either a psychological component, a physical activity component, or a combination of both. A meta-analysis of studies on anxiety (n = 7) and depressive symptoms (n = 5) provided evidence for a positive effect of interventions by reducing anxiety (SMD (95 % CI): -0.33 (-0.59; -0.06)) and depressive symptoms (-0.26 (-0.36; -0.16)) compared to control interventions. Studies also showed improvements in positive mental health outcomes, such as resilience (n = 2) and mental/psychological wellbeing (n = 2). Exploratory subgroup analyses suggested a greater effectiveness of interventions that are of higher frequency and duration, enable real-time personal interaction, and include a physical activity component. Psychosocial interventions are promising to prevent and mitigate anxiety and depressive symptoms and to enhance resilience and wellbeing among children and adolescents during the COVID-19 pandemic. Interventions in the school setting as well as interventions including a component of physical activity may be favorable particularly in individuals at risk.

Key messages

• Interventions can mitigate the negative psychosocial effects of the pandemic and build resilience among the young.

• Online group sessions, physical activity or psychological counseling seem to be effective strategies.
A longitudinal study on symptom profiles and risk factors in patients with post COVID-19 condition
Authors: Van Zon SKR , Ballering A V , Brouwer S , Rosmalen JGM
Published: October 2023

Background

To improve research and care for patients with post COVID-19 condition more insight into different subtypes of post COVID-19 condition and their risk factors is urgently needed. We aimed to identify risk factors of post COVID-19 condition in general and for specific symptom profiles.

Methods

This study is based on data collected within the Lifelines COVID-19 cohort (N = 76,503). Mean pre- and post-SARS-CoV-2 infection symptom scores were compared to classify post COVID-19 condition. Latent Profile Analysis was used to identify symptom profiles. Logistic and multinomial regression analyses were used to examine the association between demographic, lifestyle and health-related risk factors and post COVID-19 condition and symptom profiles, respectively.

Results

Of 3,465 participants having had COVID-19, 18.5% (n = 642) classified for post COVID-19 condition. Four symptom profiles were identified: muscle pain (55.6%), fatigue (14.3%), cardiorespiratory symptoms (5.6%), and ageusia/anosmia (24.5%). Female sex was a risk factor for the muscle pain (OR: 1.63; 95% CI: 1.26, 2.10) and fatigue (OR: 2.09; 95% CI: 1.24, 3.51) profiles. Being overweight or obese increased the risk for all profiles, except the fatigue profile. Having a chronic disease increased the risk for all profiles except the ageusia/anosmia profile, with the cardiorespiratory profile being only significant in case of multimorbidity. Being unvaccinated increased the risk of the ageusia/anosmia profile (OR: 2.45; 95% CI: 1.65, 3.79).

Conclusions

Findings from this study suggest that SARS-CoV-2 may trigger different pathophysiological mechanisms that may result in different subtypes of post COVID-19 condition. These subtypes have shared and unique risk factors. Further characterization of symptom profiles and quantification of the individual and societal impact of specific symptom profiles are pressing challenges for future research.

Key messages

• Our unique approach identified four symptom profiles characterised by 1) muscle pain, 2) fatigue, 3) cardiorespiratory symptoms, and 4) ageusia/anosmia.

• Shared and unique demographic, lifestyle and health-related risk factors were identified for the four symptom profiles.
Turning words into action: pro-environmental interest and personal commitment of different groups
Authors: Weitensfelder L , Lemmerer K , Poteser M , Wallner P , Hutter H-P
Published: October 2023

Background

Numerous models point to notable discrepancies between internal attitudes and environmental protection behaviour. Especially in regards to the high social value of climate protection, the question arises to what extent the commitment to environmental protection is not just a socially desirable “lip service”. A snap survey was conducted among participants of climate demonstrations in Vienna to find out whether they differ from other groups not only in their interest in environmental issues, but in particular in their personal commitment.

Methods

A total of 331 participants (below 16y) were surveyed (177 Fridays4Future participants, 41 visitors of non-climate-related mass events, 113 medical students). The survey regarding interest in climate and personal commitment to environmental protection was conducted using an 11-point Likert scale.

Results

Participants of the climate demonstrations described higher values regarding their interest in climate protection, their interest in environmental protection as well as their personal commitment to environmental protection. All differences between the pairwise mean-group comparisons were significant in the expected direction (lowest values: visitors of non-climate-related events; p < 0.017). Results concerning flight renunciations already made showed large differences between the groups (Pearson Chi-Square: 71.913; df = 4; p < 0.001): Around 5 times more participants of climate demonstrations than visitors to other mass events reported that they had already refrained from flying in the past year. In contrast, there were no differences with regard to the statement that they had not yet renounced flights, but intended to do so in the future.

Discussions

Differences with regard to renunciations already made indicate that values expressed by the groups are also mirrored in actual behaviour. Considering the magnitude of differences and control response our results are unlikely to be explained by socially desired response behaviour.

Key messages

• First short survey on to quantify group differences regarding refrainment of air travels.

• Climate activists showed considerably higher commitment regarding personal sacrifices.