bluuebunny/crossref_metadata_2025 huggingface dataset:
Unravelling misinformation: investigating the associations between health literacy and resilience
Authors: Rosário R , Silva M J , Duarte A , Martins J , Martins S , Augusto C
Published: October 2024

Background

Resilience, the capacity to adapt to adversity, encompasses navigating challenges in health information. Despite the profound impact of health misinformation on behavior and trust in healthcare systems, effective tools to enhance resilience against misinformation remain scarce. Health literacy (HL) is pivotal for adeptly navigating information landscapes. While HL principles facilitate critical evaluation of health information, their link to resilience against misinformation has received inadequate attention. This study delves into the associations between HL and resilience to misinformation.

Methods

Within the BeE-school project, a randomized controlled trial in primary schools serving vulnerable populations, we developed a questionnaire to assess parental resilience to misinformation. Two dimensions were examined: self-regulation regarding misinformation and stress resistance to misinformation, stratified into low and high resilience categories. Parental HL was evaluated using the HLS-Q12 tool. General HL and three specific domains-health promotion, disease prevention, and healthcare management-were assessed. HL scores ranged from 0 to 100. Binary regression analyses examined the association between HL and resilience to misinformation.

Results

Parents with higher HL levels demonstrated significantly greater resilience to misinformation, with odds ratios ranging from 1.039 to 1.049 across different HL dimensions. These associations persisted after adjusting for potential confounders, including parental education and respondent sex.

Conclusions

This study highlights the potential role of health literacy in enhancing individuals’ resilience to misinformation. By promoting HL, individuals can develop critical thinking abilities necessary for navigating complex information landscapes effectively. Empowering communities to critically assess health information fosters resilience to misinformation and informed decision-making, thereby advancing public health.
The impact of misinformation on social media in the context of natural disasters
Authors: Hilberts S , Evers SMAA , Govers M , Petelos E
Published: October 2024

Background

Rapid dissemination of information during natural disasters plays a crucial role in managing public responses and ensuring safety. Social media can be a tool to disseminate lifesaving information but is also a ground for the propagation of misinformation. This study examines the impact of misinformation spread through social media in the context of natural disasters and explores related dynamics, effects, and countermeasures.

Methods

Cochrane and PRISMA recommendations were used for protocol development and sound reporting. Key terms related to misinformation, social media and natural disasters were used, with the search conducted in PubMed, and without time limitation for adequate capture. Only research papers in English were eligible for inclusion. Journal and article quality were considered. No restriction was imposed on country or age of target populations.

Results

Findings reveal significant influence of misinformation on public behaviour during disasters, often leading to panic and hindering effective disaster management. Specific characteristics of misinformation were identified, incl. its origins and spread mechanisms; proximity -both spatial and social- was found to be a critical factor in terms of spread and reach. Emerging evidence highlights the importance of trusted sources to effectively counter misinformation, yet response time remains a critical challenge. Technical detection of misinformation can help combat it but requires further enhancements for real-time application in diverse disaster scenarios.

Conclusions

Misinformation on social media poses complex challenges to disaster management, affecting both individual and societal resilience. Proactive communication strategies are critical, as is the development of advanced verification tools, and public education strategies to combat misinformation. Future research should focus on refining strategies to enhance disaster preparedness and response, ensuring a resilient and well-informed public.
Primary health care models for refugees and the involvement of nurses: A systematic review
Authors: Gold A W , Perplies C , Biddle L , Bozorgmehr K
Published: October 2024

Background

Primary health care is key to address the health and social needs of refugees. Nurses are often part of multidisciplinary teams in primary health care, but little is known about their roles and responsibilities in refugee health. Our systematic review aimed to synthesise the existing knowledge about models of care (MoC) for refugees in primary care settings and the involvement of nurses in these models.

Methods

We searched PubMed, CINAHL and Web of Science for literature published in English, Spanish, French and German. For grey literature, we additionally searched Google Search and Scholar, Microsoft Bing and DuckDuckGo. Eligible publications reported on MoC for refugees in a primary care setting and the involvement of nurses. We extracted and synthesised information about the structure of these models as well as the roles and responsibilities of nurses within these.

Results

112 publications met our inclusion criteria. Our narrative synthesis focuses on 61 publications with in-depth insights into existing MoC and nurse involvement. We identified 45 MoC, mainly originating from high-income-countries and with almost a third from Australia. The majority of MoC set up a parallel health care structure that refugees could access for a limited period of time. In most MoC, the role of the nurse is described with a relatively high degree of autonomy and with clear areas of responsibility. Clinical and administrative tasks are only part of the nurse’s role, while educational and coordinating activities are often equally important.

Conclusions

Despite the significant number of refugees in European countries we identified only few reports on MoC specifically addressing their needs. While parallel care structures may be an appropriate approach for a short period of time, integration of refugees into the regular health system is key. Specially trained nurses are well placed to support refugees through a range of measures, including health education and case management.

Key messages

• Models of Care for refugees could help to navigate within a new healthcare system and ensure that no one is left behind. However, development of and research on such structures are still scarce.

• Specially trained nurses are well placed to care for refugees and to support their integration into regular health systems through a range of measures, including health education and case management.
Educational achievement and health during adolescence in second generation immigrants in Sweden
Authors: Agnafors S , Bladh M , Sydsjö G , Svedin C G
Published: October 2024

Background

Over the last decades, immigration have increased markedly in Sweden. Educational achievement is essential for successful integration; however, second generation immigrants have been shown to lag behind. There is a complex intertwinement between educational attainment and health outcomes. Thus, schooling is crucial in terms of integration but also from a public health perspective. We aim to compare school performance and health in children of immigrant parents and children of parents born in Sweden.

Methods

In this population-based cohort study, 1723 children were followed from birth to age 20. Of these 246 (14.3%) had at least one parent born abroad. Logistic regression was performed controlling for gender, language spoken at home and sociodemographic data obtained at 3 months, 3-, 12- and 20 years. Outcome measures were school performance at age 12 (n = 984), grades from compulsory and upper secondary school (n = 1668) and register data on psychiatric diagnoses (n = 737). Self-response questionnaires on general health, long term health problems and psychiatric conditions were administered at age 20 (n = 731).

Results

There were no differences in reading (p = 0.676) or mathematics (p = 0.324) at age 12, eligibility to upper secondary school (p = 0.298) or university (p = 0.232) between second generation immigrants and children of native-born parents. No differences in frequency of psychiatric diagnoses (p = 0.112), presence of long-term health problems (p = 0.267) or self-reported health (p = 0.595) were shown.

Conclusions

The results indicate that young adults born in Sweden in the middle of the 1990’s with immigrant parents perform similarly in school compared to children of parents born in Sweden. They are not at increased risk for mental illness, long-term health conditions and report their general health equivalently to children of native-born. The comprehensive school system and child health programs used in Sweden are likely important factors to promote education and health.

Key messages

• In a birth-cohort of children followed into early adulthood, no difference in educational achievement or health was shown between second generation immigrants and children of parents born in Sweden.

• International comparative studies are needed to highlight the importance of underlying structural and socio-cultural factors.
4.P. Round table: Advancing genomic diagnostics for rare genetic diseases: a focus on non-clinical domains of HTA
Authors:   Organised by: EUPHA-HTA, -PHG, -ETH, -ECO, -HSR,   Chair persons: Chiara de Waure (EUPHA-HTA), Giovanna Elisa Calabrò (Italy)
Published: October 2024

Genetic rare diseases are a burning global public health issue requiring a thorough assessment of the related burden. Unfortunately, curative therapies are oftentimes unavailable for genetic rare diseases; nevertheless, a prompt diagnosis could allow clinicians to elaborate supportive care plans for patients and their caregivers, determine the best care setting, and potentially consider enrolling them in clinical trials, if suitable. Innovative, effective, and sustainable diagnostic techniques, such as Whole genome sequencing (WGS), are needed to address this growing health concern. At global level, there is a paucity of research that specifically investigates the implementation of WGS into clinical practice which is even more constrained at the European level. Furthermore, given the current challenges impacting pediatric patients suspected of having genetic diseases without a definitive diagnosis, there is an urgent need to improve the diagnostic workflow based on genomic techniques, such as WGS. Delving into this topic could contribute valuable insights that can inform policymakers, at macro-level, and health professionals, at micro-level, on how to develop suited genomic policies and clinical guidelines for the proper adoption of WGS within the daily clinical practice. From an international standpoint, it could be argued that these considerations resonate with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (i.e., “Good health and well-being”) and 10 (i.e., “Reduced inequalities”), as a priority for research and action. Notwithstanding, the broader implementation of WGS encounters hindrances owing to its complexity and the multifaceted social, economic, organizational, and ethical implications. In view of these challenges, Health Technology Assessment (HTA), as an integrated and multidisciplinary process, provides a comprehensive framework for the evaluation of these dimensions. This round table is intended to provide attendees with insights into nonclinical domains of HTA of WGS which, unlike clinical domains, demand a nuanced approach within the framework of the HTA. The intended objective is pursued through the initial presentation of a case study on the evaluation of WGS in paediatric genetic disorders from the Italian National Health Service perspectives followed by an open discussion with experts. The discussion will delve into issues related to economics, genomics, health services organization and ethics.

Key messages

• For pediatric patients suspected of having a genetic disease, WGS could shorten the so-called diagnostic odyssey.

• Context-depending aspects of implementing WGS should be properly taken into account through HTA.
Building Resilience: Strengthening European public health workforce through ECDC Fellowship Programs
Authors: Danis K , Stefanoff P
Published: October 2024

The European Centre for Disease Prevention and Control (ECDC) Fellowship programmes offer a two-year training in field epidemiology (EPIET) and in public health microbiology (EUPHEM) aiming to create and maintain a network of highly trained field epidemiologists and public health microbiologists and strengthen the public health epidemiology workforce in the European Union (EU) and beyond. The Mediterranean and Black Sea Programme for Intervention Epidemiology Training (MediPIET) also aims to strengthen the public health workforce in countries neighboring the EU. During the training, fellows who are based in different public health institutes in the EU and neighboring countries, set-up, implement and evaluate surveillance of communicable diseases, investigate outbreaks and conduct operational research directly linked to public health actions. The programmes facilitate knowledge exchange and collaboration across borders, building a foundation for participants and their institutions and promoting long-term collaboration through the alumni network. Participants from diverse disciplinary and cultural backgrounds enable interdisciplinary and multi-sectoral knowledge transfer, enhancing the effectiveness of public health responses. By facilitating collaboration and networking, exchanging experiences, disseminating best practices and assimilating lessons learned, these programmes contribute to addressing contemporary health challenges, including emerging vector-borne diseases and strengthening public health systems in Europe and neighboring regions. In the face of global challenges such as climate change and globalization, the fellowships exemplify how collaboration can strengthen Europe’s defenses against emerging health threats.
Comparing Aedes-borne disease surveillance systems in Southern Europe: France, Italy and Portugal
Authors: Fotakis E A , Grau-Pujol B , Kelly D , Charles T , Vasconcelos P , Vieira Martins J , Pezzotti P , Riccardo F , Ramalli L , Calba C
Published: October 2024

Introduction

Colonization by the Aedes albopictus vector, alongside rising autochthonous dengue cases in France and Italy and imported dengue cases in Portugal reflect the emergent risk of Aedes-borne diseases in Southern Europe. In view of improving surveillance, preparedness, and response against Aedes-borne diseases in Europe, we aimed to systematically describe and compare the respective surveillance systems and response measures in place across France, Italy, and Portugal.

Methods

We employed a benchmarking analysis using a comprehensive set of surveillance system descriptors based on the ECDC document “Data quality monitoring and surveillance system evaluation”. We collected data from key-informant interviews, national guidelines and literature, and ensured data collection harmonization through a consensus decision-making process.

Results

Each country has an integrated surveillance system for Aedes-borne diseases. The 3 countries share similarities in surveillance type (passive, compulsory, comprehensive, year-round operating systems), geographic coverage (national), case definitions (adapted EU case definitions), and notification processes. France also practices active surveillance and Italy and Portugal event-based surveillance to complement routine surveillance. Common response measures include visiting affected areas, active case-finding, and blood safety measures. France and Italy responses largely focus on vector control, while Italy and Portugal monitor pathogens in vectors.

Conclusions

Surveillance systems in France, Italy, and Portugal are similar, while their response measures vary, likely reflecting different epidemiological and entomological context. Implementation of harmonised, risk-based surveillance systems across southern Europe and enhanced cross-border collaboration may improve preparedness, control and response to Aedes-borne diseases.
5.D. Scientific session: Climate Change and Inequalities: Addressing Intersections and Impacts
Authors:   Organised by: EUPHA-ENV, -LAW,   Chair persons: Marija Jevtic (EUPHA-ENV), Brigit Toebes (Netherlands)
Published: October 2024

Climate change poses one of the greatest challenges of our time, with far-reaching implications for environmental sustainability, social equity, and economic development. In recent years, growing attention has been paid to the intersecting dynamics between climate change and inequalities, recognizing that vulnerable populations are disproportionately affected by climate-related risks and impacts. This workshop aims to explore the multifaceted relationship between climate change and inequalities and examine the root causes of disparities. In this workshop we will explore intersectionality by examining how climate change intersects with various forms of inequality, including socio-economic and health status, gender, age, indigenous status, and geography, shaping differential vulnerabilities and experiences of climate impacts. This workshop aims to facilitate dialogue, knowledge exchange, and collaboration among public health researchers and professionals. We offer a unique opportunity to deepen our understanding of the complex interplay between climate change and inequalities, shedding light on overlooked aspects [?]. By bringing together diverse perspectives and expertise, the workshop aims to generate actionable insights and solutions that promote social justice, sustainability, and human rights in the face of climate change. The presentations in this workshop are thematically interconnected, addressing key aspects of climate change and inequalities from multiple angles. Topics include: Gender and climate justice, Climate change adaptation equity, Legal perspectives on climate change and inequalities and Climate Change Impacts on Respiratory Health. In conclusion, this workshop serves as a critical platform for advancing understanding, dialogue, and action on the intersection of climate change and inequalities.

Key messages

• Climate change interacts with socio-economic, health, gender, age, indigenous status, and geography, influencing vulnerabilities and impacts.

• Vulnerable populations bear a disproportionate burden of climate change effects, including individuals with pre-existing lung conditions and children.
Legal perspectives on climate change and inequalities
Authors: Patterson D , Hesselman M , Tahzib F
Published: October 2024

In many areas of public health policy, litigation has delivered significant, long-lasting impacts. Examples include tobacco control, increasing access to treatments for HIV, and addressing air pollution and climate change. Litigation is an established part of public health’s advocacy toolbox in national courts, and increasingly in international courts and tribunals. In responding to climate change, in addition to potential policy and law reform, climate change litigation creates opportunities for public scrutiny and debate by raising awareness of inaction or harm caused by governments or private sector polluters, and sparking wider community mobilisation for climate action. Where climate change litigation is based on human rights claims, credible science-based evidence of the health and other human rights impacts of climate change is essential. Public health professionals are increasingly involved in assembling and presenting such evidence, often focusing on vulnerable populations. However, the multiple intersecting identities of vulnerable populations have not been sufficiently explored. For example, how does intersectional disadvantage influence the ways in which evidence of the impact of climate change is assembled and assessed? How are these issues addressed in the courts? Examples include older women (KlimaSeniorinnen v. Switzerland), young people, from both the global South and global North, in urban or remote areas, or with different pre-existing health conditions (Sacchi et al. v. Argentina et al), and Indigenous people, including women and children (Daniel Billy and others v. Australia; Teitiota and others v. New Zealand). Multiple identities can compound vulnerability. For example, young people may be more vulnerable both due to their physical immaturity and due to eco-anxiety and other mental health impacts. This presentation will explore these issues, and the critical role of public health professionals in legal action to address climate change.
Mediterranean Diet, ultra-processed food consumption and semen quality in healthy young men
Authors: Iacoviello L , Bonaccio M , Ceretti E , Donato F , Lorenzetti S , Marullo M , Ruggiero E , Viola GCV , Zani D , Montano L
Published: October 2024

Background

Diet quality can have beneficial effects on male reproductive health, although studies are still limited, and little is known on the potential impact of ultra-processed foods (UPFs) on semen quality parameters.

Methods

A cross-sectional analysis was run on 126 participants (mean age 20.0 ± 1.2 y) from the FAST randomized controlled trial in 2018-2019. Food intake was assessed through a FFQ. UPF was defined following the Nova classification and calculated as the ratio (weight ratio) between UPF (g/d) and total food (g/d). Adherence to the Mediterranean Diet (MD) was ascertained by the Mediterranean Diet Score (MDS). The semen analyses were performed using a microscope for optical evaluation with a Makler counting chamber and two automated semen analysers. The primary outcomes were sperm volume, concentration, motility and morphology. A hierarchical mixed model approach was utilized to accommodate the within-subject correlation arising from the triple temporal repetition of measurements.

Results

Highest UPF consumption (Q4), compared to lowest (Q1), was associated with lower sperm concentration (β=-54.1×106 spz./ml; 95%CI: -92.9 to -15.4; p-trend=0.002 across quarters), and progressive motility (β=-14.2%; 95%CI: -28.2 to -0.09; p-trend=0.036). The percentage of cells with normal morphology tended to be reduced in young men consuming more UPF compared to lowest intake (β=-2.93%; 95%CI: -6.22 to 0.37; p-trend=0.071). The MDS was not associated with any of the parameters under study.

Conclusions

A larger dietary share of UPF was inversely associated with sperm concentration and progressive motility in young men of reproductive age. MD adherence was not associated with semen quality parameters, and this is possibly due to the low variability of MD adherence in this sample. Dietary recommendations for improving sperm health should prioritize limiting UPF in the diet.

Key messages

• Ultra-processed food (UPF) intake was unfavourably associated with semen quality parameters amongst young men.

• Dietary recommendations for improving sperm health should recommend limiting UPF.
Unlocking adolescent dietary behaviours: the causal role of social contexts
Authors: Dierckens M , Van Cauwenberg J , Delaruelle K , De Clercq B , Clays E , Deforche B
Published: October 2024

Background

Using a causal inference framework, our study aimed to extend previous work in providing a comprehensive understanding of the role various social contexts across different levels can play in predicting adolescent dietary behaviours.

Methods

Data came from the 2017/18 Health Behaviour in School-aged Children (HBSC) survey in Flanders (Belgium). The sample included representative data from 8,702 adolescents in 165 schools. Social factors at individual-level (family meals, family, peer, student and teacher support) and at contextual-level (school culture of student and teacher support and school-level socioeconomic status [SES]) were considered. Multilevel logistic regression analyses were performed.

Results

At individual-level, family meals and family and student support were positively associated with fruit and vegetable consumption, family meals with sweet consumption too. Student and teacher support showed positive associations solely with fruit consumption. At contextual-level, adolescents attending schools with a lower school-SES demonstrated lower vegetable consumption. Culture of teacher support was negatively associated with sweets but also vegetable consumption. For culture of student support no associations were found.

Conclusions

The study mainly provide cues for strengthening family social ties as dietary health promotion initiatives, with some evidence supporting the role of beneficial peer and school social factors. Mixed results for contextual school-level social factors warrant further research to identify additional school-related influences on adolescent dietary behaviours to advance current understandings.

Key messages

• Family meals and support promote healthy eating in adolescents, emphasising the health promoting role of family social ties in dietary habits.

• Mixed findings on school-level social factors call for more research on school health policies.
The updated nutrient profile underlying the Nutri-Score label and adult weight gain: A cohort study
Authors: Sarda B , Manneville F , Kesse-Guyot E , Srour B , Déschasaux-Tanguy M , Fezeu L K , Galan P , Hercberg S , Touvier M , Julia C
Published: October 2024

Introduction

Nutrient profiling systems are key tools in the development of nutrition-related policies. Their prospective associations with health outcomes are a crucial step in assessing their validity as public health measures. In 2023, the nutrient profiling system underlying the Nutri-Score -a nutrition front-of-pack label used in the European Union- was updated. The present study aims to investigate the updated nutrient profile’s association with weight gain, overweight and obesity.

Methods

The dietary and anthropometric data of 75,775 participants of the Nutrinet-Santé cohort study was retrieved for this study. Standardized dietary indices derived from both nutrient profiling systems (the 2015 NS-NPM DI (initial profile) and 2023 NS-NPM DI (updated profile)) were computed based on at least 3 24-hour dietary records upon the first two years of inclusion in the cohort. The associations between these indices and the risk of developing overweight and obesity were assessed using Cox proportional hazard models and weight gain using mixed models.

Results

Participants with a higher 2023 NS-NPM DI (i.e. a poorer nutritional quality of diet) were more likely to gain BMI over time (T3 vs. T1: +0.23% points of BMI/year, p < 0.0001), had a higher risk of developing overweight (HR T3 vs. T1: 1.33 [95% CI: 1.24-1.43]) and obesity (HR T3 vs. T1: 1.29 [95% CI: 1.14-1.45]). Overall, the 2015 NS-NPM DI displayed similar associations and effect sizes with the outcomes and the predictive ability of the two indices on overweight and obesity risk was not significantly different (p = 0.32 for overweight risk, p = 0.09 for obesity risk).

Conclusions

These results constitute a step in the validation of the recently updated nutrient profiling system and help support its use in public policies for non-communicable diseases prevention.

Key messages

• The 2023 updated nutrient profiling system underlying the Nutri-Score was associated with weight gain and obesity, two important risk factors in the development of non-communicable diseases.

• The 2015 and 2023 NS-NPM DI showed similar prospective associations with overweight and obesity risk.
The state of primary health care systems in ten high-income countries
Authors: Gumas E , Lewis C , Horstman C , Gunja M
Published: October 2024

Primary care systems in high-income countries perform comparatively better than the U.S. system in large part due to decades of investment, an adequate workforce supply, and universal healthcare. This research identifies successes and areas of improvement of 10 high-performing primary care systems in four areas of care: 1) access, 2) continuity, 3) comprehensiveness, 4) and coordination. Cross-national comparisons using primary data from the 2022 CMWF International Health Policy Survey of Primary Care Physicians (N ranged from 321-2,092) and the 2023 CMWF International Health Policy Survey on the General Population (N ranged from 750-4,820). Countries included: Australia, Canada, France, Germany, Netherlands, New Zealand, Sweden, Switzerland, the U.K., and the U.S.

• More than 90% of adults in all surveyed countries reported having a regular primary care doctor except Sweden, the U.S., and Canada.

• Less than 5% of physicians reported high telehealth use in their patient encounters, except for in the U.K. and New Zealand where over 10% reported high use.

• Over a quarter of physicians in the U.S., Germany, and France report screening patients for social needs, compared to just 8% in the Netherlands.

• Care coordination with social services was a major challenge in all surveyed countries, with over 75% of physicians in the U.K., Australia, and France reporting major challenges.

Primary care systems in 10 other high-income countries outperform the U.S. system, particularly when it comes to access to care and care continuity. Policy options to consider for U.S. policymakers include narrowing the wage gap between generalist and specialist physicians and rewarding and holding providers accountable for continuity of care. On the other hand, countries like Sweden and the Netherlands can learn from the U.S. on how to adequately coordinate care between primary care physicians, specialists, and hospitals.

Key messages

• Investment in primary care yields better health outcomes, greater equity and lower costs.

• Many high-income countries in Europe have high performing primary care systems, something the U.S. system can learn from.
Co-designing health literacy actions: Connecting the dots to create meaningful impact
Authors: Behan S , Geoghegan B
Published: October 2024

In closing the workshop, this presentation will bring together the participatory research recommendations for promoting and developing healthy literacy in Ireland, which will be led by Slaintécare Healthy Communities in practice, dissemination and scale up. In particular, a worked example from a third Slaintécare Healthy Community (Westmeath) will be presented; a healthy literacy “Train the Trainer” professional development course for local health literacy champions. In this presentation, we will also challenge attendees to offer suggestions of how to support and facilitate other recommendations suggested by our participants, and invite them to consider how this participatory action approach to a health literacy needs analysis could be utilised in their own contexts.
Using Machine Learning to identify the social determinants of the mid-life decline in mental health
Authors: Henking C
Published: October 2024

Background

The mid-life decline in mental well-being, depicted as a U-shaped pattern, is debated across disciplines. This study seeks to identify the social determinants of this decline and the overall contribution of social determinants to changes in mid-life mental health.

Methods

We use data from the 1970 British Cohort Study, from the ages 26, 34, and 42 (N = 6992, 51.5% female). Mental distress was measured using the 9-score Malaise Inventory. Mental distress increased from age 34 (M = 1.67) to 42 (M = 1.86; p < 0.001), with 17.8% declining by at least 1 SD on the inventory. We contrasted this group of decliners with those exhibiting stable mental health. We included socioeconomic and family factors, as well as physical health and health behaviours as potential determinants of mental health decline (at ages 26, 34, or at birth). We combine Random Forest and logistic regressions.

Results

The Random Forest’s Variable Importance (VI; root Mean Squared Error (MSE)), revealed social class at birth (VI = 0.023), physical multimorbidity at age 26 (VI = 0.22), and income quintile at age 34 (VI = 0.022) as most important predictors. Regressions confirmed that low birth social class (OR = 1.51 [1.25-1.83]), high-income at age 34 (OR = 0.68 [0.53-0.88]), and physical multimorbidity at age 26 (OR = 1.25 [1.06-1.48]) predict mental health decline. For those with high income and social class, the predicted probability of mid-life mental health decline is 0.109 (CI = [0.08-0.139]), rising to 0.277 (CI = [0.227-0.324]) for high risk individuals. Social class does not predict changes in mental health between ages 26 - 34.

Interpretation

We show that various social determinants of health contribute to the observed decline in mental health during mid-life. Social class at birth, income, and physical health are the most relevant predictors; they reduce the risk of decline from up to 27% to 11%. The contribution of social class appears specific to mid-life, and it could help explain the U-shaped pattern.

Key messages

• Social Factors Matter: Social class, income, and health predict mid-life mental decline.

• Mid-life Class Impact: Social class uniquely affects mental health decline in mid-life.
Non-genetic risk factors for preeclampsia: an updated umbrella review
Authors: Giannakou K , Nikolaou A , Fakonti G , Vyrides A
Published: October 2024

Background

Preeclampsia (PE) is a common pregnancy disorder with complex mechanisms, and multiple risk factors may contribute to its development. Our objective is to update our literature search from our previous umbrella review, summarizing recent evidence on non-genetic risk factors associated with PE and assessing their credibility to identify those supported by robust epidemiological evidence.

Methods

We searched PubMed, EMBASE, Scopus, and ISI Web of Science up to June 2023. For each meta-analysis, we computed summary effect estimates, 95% confidence intervals, 95% prediction intervals, and assessed heterogeneity using I², while also examining small-study effects and excess significance bias. Quality assessment was conducted using the AMSTAR-2 tool.

Results

89 meta-analyses were identified, providing data on 219 associations. Of these, 151 (69%) showed statistically significant findings at P < 0.05, with 52 (24%) remaining significant at P < 10-6. Large or very large heterogeneity was observed in 121 (55%) associations. Evidence for small-study effects and excess significance bias was found in 27 (12%) and 29 (13%) associations, respectively. Only 16 (7%) presented convincing evidence: Polycystic Ovary Syndrome (PCOS), PCOS (adjusted), Obstructive Sleep Apnea (OSA), Obesity (adjusted), Chronic Kidney Disease (CKD), Pregnancy Intrahepatic Cholestasis, SARS-CoV-2 infection (adjusted), Oocyte donation (OD) vs. In vitro fertilization (IVF), Fresh embryo transfer vs. spontaneous conception (SC) (singleton), Frozen embryo transfer vs. SC, OD vs. SC (singleton), IVF-OD vs. IVF-AO, IVF-OD fresh ET vs. IVF-AO fresh ET, NC frozen embryo transfer vs. AC frozen embryo transfer, Fetal sex (term), and Smoking.

Conclusions

Maternal health conditions like PCOS, along with reproductive interventions such as OD and IVF, as well as lifestyle factors like obesity and smoking, showed convincing associations with PE.

Key messages

• Maternal health conditions, reproductive interventions, and lifestyle factors showed compelling evidence of association with preeclampsia.

• Our findings emphasize the multifactorial nature of preeclampsia and suggest potential avenues for further research and clinical intervention.
Risk of long COVID in migrants and the contribution of vaccinations, disease severity, social inequalities and preexisting health: A nationwide register study in Sweden
Authors: Cederstrom A , Rostila M
Published: October 2024

Background and aim

A number of studies have found higher COVID-19 infection rates, hospitalizations and deaths in migrants and ethnic minorities throughout the Corona Pandemic. Some recent evidence also suggests higher risk of long COVID in migrants although less is known about the risk factors for long COVID in this population. The objective of our study is to examine the risk of long COVID in migrants and to examine whether preexisting health conditions, disease severity, social inequalities and vaccinations contribute to the association.

Methods

We used linked Swedish administrative registers to estimate the risk of a long COVID diagnosis in the population that had a confirmed COVID-19 infection. Poisson regressions were used to calculate incidence rate ratios between the Swedish born and migrant groups. Adjustments for preexisting health conditions, disease severity, vaccinations and social inequalities were separately introduced.

Results

Higher risks of long COVID were found among migrants from Africa, Asia, Eastern Europe, Finland, Middle-East and South America. While the contribution of vaccinations and social inequalities were modest, we found that disease severity (i.e. whether the person was hospitalized or treated in an intensive care unit) primarily contributed to the higher risk of long COVID found in migrants.

Conclusions

The greater exposure and impact of the COVID-19 virus among migrants during the pandemic also affected the longer-term consequences of infection in this at-risk population.
Metabolic syndrome prevalence has increased in Finland from 2000 to 2023
Authors: Lehtoranta L , Jääskeläinen T , Palosaari T , Männistö S , Sääksjärvi K , Lahti J , Lundqvist A
Published: October 2024

Obesity presents a metabolic burden that leads to increased non-communicable disease (NCD) morbidity with metabolic syndrome (MS) as a pathway. The aim was to examine the trends in the obesity and MS prevalences. The study included health examination survey data collected in 2000 and 2023 (n = 7 258, 20-64 years). Examination measurements, blood samples, questionnaires, and register data were collected. MS criteria (ATPIII/AHA) included at least 3 of the following: increased waist circumference, elevated fasting glucose or medication, elevated triglyceride or medication, elevated blood pressure (BP) or medication, and decreased HDL-cholesterol or medication. Participants were divided according to BMI (normal weight 18.5-24.9 kg/m2, overweight 25.0-29.9 kg/m2, obesity 30.0-34.9 kg/m2, severe obesity = >35.0 kg/m2). Weighted prevalence and 95% confidence intervals (CIs) of MS and obesity were calculated considering sampling design and non-response. Prevalences of normal weight decreased from 2000 (men 32%, 95% CI 30-35; women 45%, 95% CI 43-47) to 2023 (men 26%, 95% CI 23-28; women 34%, 95% CI 32-37) and obesity increased from 2020 (men 17%, 95% CI 15-18; women 15%, 95% CI 14-17) to 2023 (men 20%, 95% CI 18-22; women 18%, 95% CI 16-20) as did severe obesity (in 2000: men 4%, 95% CI 3-5; 6%, 95% CI 5-7 - in 2023 men10%, 95% CI 8-12; women 13%; 95% CI 11-14). The prevalence of MS increased from 37% (95% CI 34-39) to 45% (95% CI 43-48) in men and 30% (95% CI 28-32) to 37% (95% CI 34-39) in women. The prevalence of MS with obesity varied from 2000 to 2023 from 73-77% in men and 69-61% in women and with severe obesity from 88-91% in men and 79-76% in women. From 2000 to 2023, no MS components remained stable with normal weight (men 29-25%, women 44%) and obesity (both sexes <1%). The prevalence of MS has increased in the last 20 years. Obesity is a major risk factor for MS that increases the future burden MS and, consequently, of NCD on societies.

Key messages

• Metabolic syndrome has increased in Finland from 2000 to 2023. At the same time, the prevalence of those with normal weight has decreased and severe obesity increased.

• The global obesity pandemic will further increase the burden of NCD’s in the future. This is already visible with increasing metabolic syndrome prevalence.
Healthcare professionals and students’ knowledge on termination of pregnancy: A systematic review
Authors: O’Shaughnessy E , San Lazaro Campillo I , O’Donoghue K , Leitao S
Published: October 2024

Background

Providing safe termination of pregnancy (TOP) according to each country’s legalisation is an important public health matter internationally. Healthcare professionals (HCPs) and healthcare students have key roles and need to be aware of legislation and clinical practice guidelines on TOP in their country to facilitate safe and effective care. The main aim of this systematic review was to investigate the level of knowledge on TOP legislation among HCPs and healthcare students. The second objective was to assess the knowledge of TOP methods, procedures and/or potential associated complications.

Methods

This is a systematic review of qualitative and quantitative peer-reviewed studies published in English or Portuguese until July 2020. Databases included in the search were EBSCO, PubMed, Embase and Scopus. The quality appraisal was done using the CASP Critical Appraisal tools.

Results

A total of 31 studies were included, published between 2002 and 2020 and from several regions around the globe. No studies were carried out in Europe or the United Kingdom. A total of 22 studies included healthcare professionals and nine studies included students. Overall, all the studies showed poor knowledge of TOP legislation and TOP methods, procedures and complications. Knowledge of special circumstances established in the law where TOP might be legal was also very limited. In studies focussing on medical (MA) and surgical (SA) TOP, knowledge of MA was lower than of SA. Studies reported that practitioners and students have limited training in TOP. Overall, education/training and experience with TOP seem to be the main factors associated with increased levels of knowledge. Similar results were found for student’s knowledge.

Conclusions

This study highlighted the importance of involving and promoting the participation of HCPs and students in the provision of TOP services. A clear need and desire for staff education and training on TOP was shown.

Key messages

• TOP training is limited and broadly excluded from medical and healthcare education globally. Students and staff have recognised this issue and the critical impact it has on TOP care provided.

• Adequate knowledge and training in TOP ensures service sustainability and preparation of current and future healthcare practitioners to provide high-quality, respectful and compassionate care.
Envisioning telemedicine in the EU health systems: Insights from policy experts and cancer patients
Authors: Schmitt T , Habimana K , Gottlob A , Habl C , Plomariti C , Farmaki A , Bogiatzidis P , Leclercq V , Delnord M , Van den Bulcke M
Published: October 2024

Background

Conducted as part of WP4 (Sustainability) of the eCAN Joint Action, the aim of this foresight exercise was to understand how telemedicine services in EU-Member States (MS) could be implemented in a patient-centric way to tackle cancer.

Methods

Based on a literature review, we identified factors that impact on the implementation of telemedicine in EU MS; these were integrated to an online survey. Health policy experts were invited to rank 34 factors using a 7-point Likert scale to better understand the barriers and facilitators of telemedicine services at the health system level, whilst patient associations ranked 28 other factors to capture end-users’ view. Next, survey respondents were invited to a foresight workshop to collect qualitative data and gain a forward-looking perspective.

Results

20 health policy experts working in digital health across 14 EU MS, predominantly from Ministries of Health, and 8 cancer patient associations from 5 EU MS responded to the surveys. For a sustainable integration of telemedicine services in the EU, policy experts recommend developing a clear legal framework, embracing a hybrid healthcare model, and enhancing digital literacy. They stress the importance of telemedicine as a complementary tool, advocating for solid IT infrastructure, privacy safeguards, and the integration of health equity. Similarly, cancer patients emphasise the importance of being able to choose between telemedicine and in-person visits, focusing on personal interaction. They advocate for the involvement of patients in the design and testing of telemedicine services, ensuring solutions meet their preferences.

Conclusions

Policy experts and patients are in favour of hybrid models for cancer care. Recommended public health actions include: i) develop legal frameworks to complement in-person care with telemedicine; ii) boost digital literacy and IT infrastructure, ensuring privacy and health equity; and iii) involve patients in design for tailored services.

Key messages

• Both the EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person healthcare services.

• Both the EU Member States and cancer patients champion telemedicine with a focus on equity, privacy, digital literacy and a hybrid model of care that respects patient preferences for cancer treatment.
A CDSS based Integrated Pathway for Influenza Vaccination Across Primary and Secondary Care
Authors: Specchia M L , Beccia F , Cacciuttolo M G , Tona D , Di Pumpo M , Porcelli M , Lontano A , Corona V F , Boccia S , Pastorino R
Published: October 2024

Background

In Italy, influenza vaccination coverage in people ≥ 65 years is unsatisfactory (56.7%), underlining the need to improve current vaccination strategies. The objectives of this study have been: to define a novel pathway to increase influenza vaccination adherence among ≥ 65 years population in the Lazio region; to provide a predictive estimate of the epidemiological and economic pathway’s potential impact.

Methods

A multidisciplinary working group (WG) featuring cross-sectoral expertise was created and WG periodic meetings were held to define the patient journey and its flow-chart representation. The pathway’s potential impact was assessed through epidemiological and economic indicators and scenario analyses.

Results

An integrated pathway across primary and secondary care was defined, based on the active patient in-Hospital recruitment and vaccination and enhanced by a Clinical Decision Support System relying on a digital algorithm to identify eligible patients. Assuming an increase of influenza vaccination coverage from the current rate of 60% (scenario 1) to 65% (scenario 2) in ≥ 65 years population in the Lazio region thanks to the pathway implementation, an increase of 8% in avoided influenza cases, influenza- or pneumonia-related hospitalizations and influenza-related outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatients visits of up 2,367,310 euros. Setting the vaccination coverage at 70% (scenario 3), an increase of 16% in avoided influenza cases, hospitalizations and outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatients’ visits of up to 4,833,259 euros.

Conclusions

Alongside offering a predictive estimate of the relevant pathway’s potential impact, both epidemiological and economic, this project, with its robust methodology, may serve as a scalable and transferable model for enhancing vaccination coverage at national and international level.

Key messages

• The proposed pathway, offering the option of receiving flu vaccination within the Hospital, supports the paradigm shift towards primary prevention pathways in secondary care settings.

• Another relevant aspect of the integrated pathway is the adoption of an Artificial Intelligence tool to identify suitable patients and improve their recruitment and adherence to vaccination.