bluuebunny/crossref_metadata_2025 huggingface dataset:
Air pollution costs in Western Balkans’ cities
Authors: Belis C , Matkovic V , Ballocci M , Jevtic M , Millo G , Mata E , Van Dingenen R
Published: October 2023

Poor air quality is responsible for increased risk of mortality which global cost in in 2019 was associated with 4.1 million premature deaths globally. The Western Balkans were selected for this study because the levels of particulate matter and ozone are frequently above the EU Air Quality Directive guidelines. Air pollution health impact (mortality and morbidity) assessment was carried out using the attributable fraction approach based on different relative risk attribution methodologies: concentration response functions (CRF) and integrated exposure responses (IER). Air pollution costs were estimated using the value of statistical life (VSL) and the value of life year (VOLY) attributable to air pollution obtained with the benefit transfer method (BT) from a global database of non-market welfare-based unit costs. The health impact and related external costs attributable to air pollution in 2019 were assessed in 30 urban areas of the Western Balkans region, one of Europe's air pollution hot spots. The evaluation was based on PM2.5, O3 and NO2 concentrations in 2019. The average cost of mortality attributable to PM2.5 in 26 urban areas was above 200 million Euro per city while the ones of O3 and NO2 were 4 times lower than PM2.5. The study results suggest that the economic burden of air pollution per capita and compared to the GDP in the Western Balkans is higher than the one observed in EU27 in the same time window.
Depressive/Anxiety Disorders in People with Early Onset Dementia in South Korea
Authors: Kwon K J , Jo J Y , Cho J H , Choi E H , Yuk H S , Yeob K E , Kim S Y , Park J H
Published: October 2023

Background

Early-onset dementia (EOD) relatively occurs at a young age. We know that the burden of family care and difficulties in economic activities greatly affect not only EOD but also the family. However, the healthcare policy for EOD is still less than that for late-onset dementia (LOD). In addition, there are few studies on mental disorders of EOD using national data in South Korea. We aimed to analyze the current status of depressive/anxiety disorders in EOD using national data and provide basic data for establishing EOD mental healthcare services and policies.

Methods

A total of 3,882,915 EOD and LOD with depressive/anxiety disorders were compared for gender, residential area, health insurance premium, and type of insurance using NHIS DB (National Health Insurance Service Database) from 2016 to 2021.

Results

There were differences according to socio-economic demographic factors for both depressive/anxiety disorders. During the observation period, the diagnosis rate of depressive/anxiety disorders in EOD was higher than LOD. After adjusting for gender, residential area, health insurance premium, and type of insurance, the risk of depressive disorder was 1.87 times higher (i.e., EOD higher, adjusted odds ratio [aOR]: 1.87, 95% confidence interval [CI]: 1.78-1.95) among EOD compared to LOD. The risk of anxiety disorder was 1.24 times higher (aOR: 1.24, 95% CI: 1.16-1.32) among EOD compared to LOD.

Conclusions

During the observation period, the diagnosis rate and risk of depressive/anxiety disorders in EOD were much higher than LOD. Therefore, this study suggests that mental healthcare services for EOD should be provided, treatment burden and economic difficulties should be reduced, and additional research on preventing and treating mental disorders should be conducted.

Key messages

• The diagnosis rate and risk of depressive/anxiety disorders in EOD were much higher than LOD.

• The healthcare policy for EOD is still less than that for LOD.
The effectiveness of school based interventions to prevent psychotic experiences over a year period
Authors: Staines L
Published: October 2023

Prevention is a key step to improving public mental health. Psychotic experiences, transient hallucinations/delusions which occur outside of a psychotic disorder, are relatively prevalent in the general population, particularly in childhood (∼15%) and adolescence (7-8%). They are associated with high psychopathology, increased risk of mental disorders, and suicidal behaviours. Therefore, psychotic experiences are well-placed to be used as a “marker” for prevention interventions. Current knowledge on prevention of psychotic experiences is extremely limited, with one previous study. With such limited information, but such potential benefits, we opted to conduct a secondary data analysis to test three school based interventions for their potential efficacy at preventing psychotic experiences. This study used the Saving and Empowering Lives in Europe study, Irish site (n = 1096). The interventions were a teacher training intervention, an educational tool, and a universal mental health screener and selective referral system (ProfScreen). A minimal intervention arm was used as a control. Schools were randomly assigned to one of the arms, and the students were followed over a year period. ProfScreen showed a 12-month reduction in point prevalence in psychotic experiences. This intervention was also associated with prevention of incident psychotic experiences, and a reduction in depression and anxiety scores in those with psychotic experiences. Ours is the first study to look at school based interventions for psychotic experiences, offering promising evidence for universal screening and selective referral strategies. Notably, the intervention showed improvements for all students in that sample, not just those who attended the clinical referral. This suggests that universal screening may itself support better mental health, and may be an important integrative component to improving mental health at a population level.

Key messages

• Psychotic experiences are a valid marker of vulnerable youth, and prevention of psychotic experiences in schools is possible using a universal screening and selective referral intervention.

• Regardless of if the child was referred/attended services, overall mental health rates improved in this arm, suggesting a universal mental health screening tool in schools itself may be valuable.
Health anxiety and COVID-19: examining changes before and during the pandemic
Authors: Davis Norbye A , Hoftun Farbu E , Terjesen C L , Fleten N , Höper A C
Published: October 2023

Background

Health anxiety has been expected to increase as a consequence of the COVID-19 pandemic. However, few longitudinal studies have examined health anxiety in the general population during this period. The aim of this study was to longitudinally examine health anxiety before and during the COVID-19 pandemic in an adult, working population in Norway.

Methods

We included 353 participants aged 18-70 years with two or more measurements of health anxiety (743 measurements) from the pre-pandemic period (2015 to 11.03, 2020) and/or during the COVID-19 pandemic (12.03, 2020 - 31.03, 2022). We measured health anxiety with the revised version of the Whiteley Index-6 scale (WI-6-R), and the effect of the COVID-19 pandemic on health anxiety scores was estimated with a general estimation equation analysis. Age, sex, education, and friendship were included in subgroup analyses.

Results

We found no significant change in health anxiety during the COVID-19 pandemic compared to the pre-pandemic period in our adult, working population, with a non-significant change of 0.06 points on WI-6-R (95 % CI -0.34 - 0.46). No significant effect of the COVID-19 pandemic on health anxiety scores was found in any subgroup analysis.

Conclusions

Health anxiety remained stable, with no significant change observed between the pre-pandemic period and the first 2 years of the COVID-19 pandemic in an adult, working population in Norway. This corresponds to other longitudinal studies examining mental health in general during the pandemic. The implications from our study can add to public health decision-making and prioritising of healthcare support in times of pandemics, where other consequences of COVID-19, such as social and economic burdens, may require targeted intervention over anxiety about health.

Key messages

• Health anxiety in an adult, working population remained stable during COVID-19.

• Other consequences of the pandemic may require targeted intervention over anxiety about health.
Health of people with selected citizenships in Germany: results from the interview survey GEDA Fokus
Authors: Bartig S , Bug M , Koschollek C , Kajikhina K , Blume M , Hövener C
Published: October 2023

Background

Health chances and risks of people with a history of migration vary according to a wide range of social, migration-related as well as structural factors. Aim of this contribution is to describe the health of people with selected citizenships living in Germany on the basis of various health indicators from the field of non-communicable diseases and to identify relevant determinants of the respective outcomes.

Methods

Analyses are based on data from the multilingual and multimodal interview survey GEDA Fokus, which was conducted from 11/21 until 05/22 among 18- to 79-year-old people with Croatian, Italian, Polish, Syrian or Turkish citizenship living in Germany. Poisson regressions were used to calculate prevalence ratios and 95% confidence intervals to examine the association between the individual indicators (chronic diseases or long-term health problems, coronary heart disease, diabetes mellitus and depression) and various social as well as migration-related characteristics.

Results

In particular, older age, low income, a longer duration of stay, a low sense of belonging to society in Germany and self-reported experiences of discrimination in everyday life are associated with higher prevalence of all the health outcomes.

Conclusions

Given the importance of subjective sense of belonging to the society in Germany and self-reported experiences of discrimination for the health outcomes studied, the results point to health inequalities among people of selected citizenships that are partly caused by mechanisms of social exclusion.

Key messages

• Low income, self-reported experiences of discrimination in everyday life and a lower sense of belonging to society in Germany are associated with increased prevalence of non-communicable diseases.

• Social and structural exclusion mechanisms must be sustainably dismantled in order to ensure health equity.
Self-reported general health/psychological status of Ukrainian female refugees in the Czech Republic
Authors: Mazhak I
Published: October 2023

533 490 refugees from Ukraine received ‘temporary protection’ from the Czech government. The data for the cross-sectional study (919 females) were obtained via an online survey which recorded self-reported physical health and psychological status, specific aspects of mental health, coping strategies and demographic characteristics. The average age of participants was about 38 years old and more than 70% had children. Most respondents have a university education (71%), came from cities and towns (88.7 %), and had employment in Ukraine (73.8 %). As regards, self-reported health, 43% of females reported their general health as good, 46.8% as fair, and 10.2% as bad and very bad. In addition, 27.9% reported that their health has worsened during the last month and 4.5% that their health had worsened or that they had sustained injury due to the war. Also, 52.7% self-reported their psychological status as fair, 26% as bad, and 7.7% as having very bad status. Preliminary results showed that refugees more often used problem-focused and emotion-focused strategies and less avoidant coping strategies. Ineffective coping strategies of self-blame and behavioural disengagement were associated with poorly reported physical health/psychological status. Effective coping strategies were positively associated with better-reported psychological status. The majority of Ukrainian female refugees (75.2%) have a moderate level of perceived stress, and 20.3% have a high level. Total stress score was moderately positively correlated with the avoidant coping strategy (r = .48), so the higher the perceived stress the higher the possibility for respondents to employ avoidant coping strategy. Moreover, there were strong positive correlations between perceived stress and self-reported emotional and psychological status (r = .61) and positive correlations with self-reported physical health (r = .29). The higher level of perceived stress related to the worst self-reported physical and mental health.

Key messages

• The research outcomes could be used in the social policy of the Czech government to help Ukrainian female refugees to better adapt to the country and avoid worsening physical and mental health status.

• Social policies can reduce the negative physical and mental health outcomes associated with refugees’ resettlement.
Social prescribing as a community health-promoting tool: lessons from a country exchange visit
Authors: Costa L , Costa A , Papartyte L
Published: October 2023

Issue

Social Prescribing (SP) describes evidence-based interventions designed to improve health and wellbeing by referring individuals with non-medical, health-related social needs to health-promoting community-based support and services. Differences in national health systems, sociopolitical infrastructures and terminology, has however created a heterogeneity on SP practice and limited its implementation.

Description of the problem

On may 2022 the Portuguese National Institute of Health Dr Ricardo Jorge in partnership with EurohealthNet, organised a Country Exchange Visit to Lisbon. The purpose was to discuss SP and other health promoting primary care strategies in practice at European level and explore the political, financial and practical enablers that connect community and primary health care and social services, in order to build up knowledge-base to foster further SP policy and practice.

Results

Participants from ten European health authorities visit on site several community-based initiatives and shared information about relevant activities in their countries. In particular, brainstorming sessions between participants and the twelve key SP partners from the voluntary and community sector, were continuously facilitated by organizers. A summary report was published, providing an overview of the knowledge exchange.

Lessons

Overall, the importance to strengthen the collaboration between health and social sectors was recorrently highlighted. Co-funding between the governmental bodies and development of intersectorial partnership projets were pointed out as key innovative approaches to launch and scale up sustainable SP implementation. It was noted that despite the evidence showing the health benefits of a SP model, quality of individual interventions should be ensured and supported by common evaluation frameworks. The development of new training and competence modules adapted to contextual needs was considered particularly relevant to foster SP implementation.

Key messages

• Social prescribing represents an innovative tool that enables health systems to meet in a better way the new societal challenges by a complete paradigm shift to a biopsychosocial model of care.

• Implementation of social prescribing and its integration into national health systems is crucial to develop new models of care and health to face 21st century health problems.
Harnessing lived experience in a community-based intervention to address gambling-related harms
Authors: Jenkins C , Mills T , Reavey P , Moss A , Sykes S , Wills J , Grimes J
Published: October 2023

Background

Lived experience of people directly or indirectly affected by public health issues can provide unique insights into how to improve interventions. Increasing availability of gambling necessitates involving communities in efforts to reduce gambling-related harms. This presentation reports qualitative exploratory research into the value of lived experience across a city-region gambling harm reduction initiative in the UK.

Methods

Focus groups and interviews were used to explore the practical application of lived experience with participants: advisory panel members, external stakeholders, community project staff, and public health professionals. Collaborative data analysis combined the framework method with theme development inductively (from participants’ accounts) and deductively (from academic and grey literature).

Results

Four themes were identified: (1) lived experience spans formal and informal settings with different activities and personal impacts; (2) organic and structured pathways to lived experience involvement coexist; (3) the emotional work of people affected by gambling-related harms ranges from frustration at policy inertia to deeper understanding of their own recovery journey; and (4) lived experience encompasses diverse experiential knowledges.

Conclusions

Involving lived experience in this intervention increased participants’ awareness of the harmful role of the gambling industry and critical reflection on the representativeness of lived experience. Harnessing lived experience at a regional level requires multi-setting support free from stigma and industry influence to ensure the sustained vitality of a diverse lived experience community specialised in gambling-related harms and equipped to navigate conflicting emotions and a challenging policy environment.

Key messages

• Increasing availability of gambling necessitates involving communities in efforts to reduce gambling-related harms.

• The use of lived experience in gambling-related harms prevention efforts and research can inform intervention development.
A scoping review of retail environment interventions and their impacts on health and wellbeing
Authors: Rinaldi C , McGill E , Petticrew M , Knai C , Egan M
Published: October 2023

Background

‘High streets’ and town centres are influential in shaping health. In recent years many countries implemented policies to revitalise and financially support retail environments. The aim of this scoping review is to systematically map evidence on retail environment interventions, to gain an understanding of their possible health and wellbeing impacts. This review identifies types of interventions, the health outcomes they address and the associated theories of change.

Methods

Peer-reviewed studies in English were identified through five academic databases using search terms for relevant initiatives and health and wellbeing outcomes. Grey literature was identified online and through citation scanning. Studies were eligible if they evaluated interventions with a significant focus on supporting the retail environment, reporting on at least one health and wellbeing outcome. Extracted data were presented descriptively. Theories of change were analysed using an interpretive approach.

Results

Of 6,752 identified evaluations, 53 peer-reviewed studies and 10 grey literature reports were included. Interventions types were area-based initiatives, business improvement districts, business incentives, and demand-side incentives. The most common outcomes were social and environmental determinants of health, although impacts on physical health, mental health, and food consumption and purchasing were also studied. Most interventions involved partnerships with the private sector or were ‘whole-of-society’ initiatives. Evidence for the effectiveness of interventions was mixed, depending on the type of intervention. Theories of change were found to be reductionist and often did not account for context-specific factors.

Conclusions

To our knowledge, this is the first review of literature evaluating the health impacts of interventions aimed at revitalising retail environments. Future interventions should more comprehensively address economic, health and social outcomes.

Key messages

• High street environments are influential in shaping health, and initiatives aimed at supporting local businesses should consider health and social objectives.

• Most literature to date evaluates social and environmental outcomes of retail environment interventions rather than more direct health and wellbeing outcomes.
Implementation gaps of the Portuguese Nacional Health Plan 2012-2021: evidence mapping analysis
Authors: Costa A , Costa L , Rosa A , Mexia R , Matias Dias C
Published: October 2023

Background

The National Institute of Health Doutor Ricardo Jorge (INSA) is responsible for carrying out the evaluation of the Portuguese National Health Plan (PNS) 2012-2016, extended to 2020 (and later to 2021). As part of PNS evaluation, this study aims to identify gaps in the implementation of the PNS 2012-2021, and to identify the degree of alignment and coherence between the strategic axis, goals, and monitoring framework issued by the PNS at different levels of implementation (national, regional, local and municipal).

Methods

A mix study, employing both qualitative and quantitative approaches was performed based upon a modified scoping review. Portuguese healthcare institutional websites and municipality websites were identified as the main data sources and secondary data were gathered. Evidence (plans, programs, or strategies) with publication date between 2015 and 2020 were included. A data collection matrix was validated by a group of experts from major stakeholders from academia and public health services. The matrix included 3 main categories following the PNS intervention logic (5 strategic axis, 4 goals and 37 monitoring indicators).

Results

A total of 204 documents met the inclusion criteria. Evidence from national level (55%) and local level (35%) represented about 90% of the sample. Overall, three implementation gaps were identified: 1) absence of two Regional Health Plans (in a total of 5 mainland health regions); 2) lack of about 1/3 of the expected Local Health Plans (16 out of 53) and, 3) low transposition (or approximation) of the PNS monitoring framework into the hospital and primary care contract-programs, one of the main management tools for planning.

Conclusions

The identification and analysis of implementation gaps contribute to the final evaluation of the PNS. Moreover, the results can guide the next planning cycle pointing out sensitive areas of implementation which need more attention from various stakeholders.

Key messages

• Implementation gaps can compromise the impact of PNS as the strategic tool to set the necessary health interventions and their alignment at national, regional and local level of implementation.

• The next planning cycle should tackle the identified implementation gaps with the purpose of strengthen PNS as a strategic planning platform and with the aim of maximize population health gains.
Establishing a Platform for Public Health Advocacy in the midst of a Pandemic
Authors: Buckley C M , Hamilton D , McDarby G , Migone C , Cianci F , Beatty K , Kelly C , Ceannt R , Smyth B
Published: October 2023

Issue/problem

Prior to the COVID-19 pandemic, Doctors working in Public Health Medicine in Ireland lacked a platform to present a collective voice to advocate on issues of public health concern. The aim of this abstract is to describe the establishment of a platform for advocacy through the formation of the Irish Society of Specialists in Public Health Medicine (ISSPHM).

Description of the problem

An independent society for Public Health Doctors in Ireland was lacking. Models used by other medical specialties in Ireland and international practice was reviewed. The ISSPHM was developed to build capacity and capability for advocacy amongst Public Health Doctors in Ireland by providing indemnity for members and a forum to interact with the media.

Results

A constitution, mission statement and website for the society were developed. The formal launch of the ISSPHM took place in December 2021. Outputs to date include co-hosting of webinar entitled ‘Public Health and the Law'; contributing to the Irish Public Health Reform Expert Advisory Group; a position paper on pandemic preparedness; a statement on migrant health (published on the ISSPHM website and widely quoted in the media); letters published in Irish media; interviews on national radio and the formation of a Climate Change Working Group.

Lessons

The ISSPHM successfully creates an environment where Public Health Doctors can advocate on major issues. The establishment of an independent society requires diverse expertise and resources. Future plans for the ISSPHM are to further collaborate and build on existing partnerships and expand eligibility for membership to include other colleagues working in Public Health e.g. nurses, surveillance scientists, data analysts.

Key messages

• An independent national society for Public Health Doctors is an extremely useful vehicle for advocacy.

• The establishment and development of an independent society is a significant undertaking requiring diverse expertise.
Quasi-experimental evaluations of health-related policies in Europe: a scoping review
Authors: Sell K , Rabbani S , Burns J
Published: October 2023

Background

Quasi-experimental methods (QEM) are study designs increasingly used in public health to evaluate the impact of health-focused policies. We sought to examine the scope, methodological characteristics as well as health equity considerations of policy evaluations using QEM that assess health and social outcomes in Europe.

Methods

We conducted a scoping review as outlined in our pre-registered protocol (https://osf.io/n5rvg). We searched Medline, EMBASE, and EconLit databases in December 2022 and included studies labelled as interrupted time series, difference-in-difference (DID), controlled before and after, regression discontinuity, and synthetic control studies; that focused on policies implemented at regional, national, and supranational level in the WHO European region. Among all identified records, we drew a random sample of 350 records for title and abstract screening and subsequent full-text screening, data extraction and analysis.

Results

Database searches rendered 2102 records. Of the random sample of 350 records, we identified 59 records as eligible for inclusion. Most studies evaluated health and social policies implemented on a national level in EU member states and the UK. Common policy topics were related to tobacco control, healthcare co-payments, and employment. DID was the most common study design label. Few studies were based on pre-registered protocols. There was substantial variability in the number and types of additional analyses conducted to assess the appropriateness of assumptions and the robustness of results. With respect to health equity (HE), 16 included studies had a strong HE focus by examining disadvantaged populations, and in 23 and 18 studies, respectively, HE was discussed and HE-related recommendations were made.

Discussion

QEM were frequently used to undertake policy evaluations and studies showed great diversity in scope and methodology. Health equity was considered in a surprisingly low number of studies.

Key messages

• We identified a large number of policy evaluations employing quasi-experimental methods.

• Studies were heterogeneous in scope and methodological rigour and few considered health equity.
Trickle-down policies: Utilizing strategic plans to facilitate local public health work
Authors: Maass R , Hope S , Lillefjell M
Published: October 2023

Background

The main weight of health promotion strategies are outlined internationally, but carried out locally. More knowledge is needed about how municipalities and communities can be supported in building capacity for carrying out systematic, local Public Health Work. This study explores how strategic recommendations from national/international levels can contribute to the facilitation of systematic, local health promotion work through conscious utilization of juridical and strategic municipal documents.

Methods

An in-depth hierarchical document analysis was carried out in selected municipalities. A contextual content analysis of central terms was conducted the aim to understand how these were addressed across document-type and municipality.

Findings

Central aims and strategies from health promotion have “trickled-down” into national and municipal documents. Variations in how intentions are anchored and implemented in the municipal context occur: if and how they were addressed, linked to higher-level aims and operationalized in ways that enabled collaborative action (including the allocation of resources). Obligatory activities (e.g. establishing a local knowledge-base) were more likely to be implemented locally; however, variations occured regarding how these were followed-up subsequently.

Discussion

Global health promotion aims and strategies can contribute to facilitate for local public health work. Differences in how the planning literature was utilized might facilitate for different outcomes. To enable coherent approaches across sectors and actors, top-down approaches have to be combined with local competence-building and enable collaborative action. Framing spatial tasks in ways that highlight their contribution to achieve overarching goals can built competence across stakeholders, and enable systematic approaches over time.

Key messages

• Utilizing local strategic documents can facilitate for the realization of global and national health promotion intentions.

• To enable coherent approaches across sectors and actors, top-down approaches have to be combined with local competence-building and enable collaborative action.
Development of a Physical Activity Environment Policy Index (PA-EPI) composite implementation score
Authors: Volf K , Woods C B
Published: October 2023

Background

To promote physical activity (PA), it is necessary to look beyond specific interventions to upstream policies formulated across multiple sectors. The Physical Activity Environment Policy Index (PA-EPI) tool consists of 45 indicators for assessing the extent of policy implementation by national government. Combining measures from different indicators into a single composite measure of policy implementation is complex, but can facilitate cross country policy comparison and communication of policy implementation status to stakeholders. This study describes how a composite measure can be constructed.

Methods

To create a composite measure two methods were necessary. Firstly, international experts (N = 73, 20 countries) with knowledge of PA policy independently rated the importance of the 45 indicators for increasing population levels of PA on a 10-point Likert scale. A formula was utilised to convert these ratings into weightings for each indicator. Secondly, these weightings were combined with real PA-EPI implementation data. Data from the first study to use the PA-EPI tool, in the Republic of Ireland, was used to demonstrate how a composite implementation score can be calculated. This composite score was expressed as a percentage of a perfect implementation score

Results

Indicator weightings ranged from 2.7 (highest importance) to 0.8 (lowest importance). Implementation data on indicators ranged from 0.75 to 0.25. The formula used to calculate weightings for each indicator was ωi = (x¯i-∑x¯n)+2. The formula used to derive a composite implementation score was C=∑(ωi×fi) + (ωj×fj)...(ωn×fn). A composite rating implementation score of 59% was calculated for the Republic of Ireland.

Conclusions

This study demonstrates how data from 45 indicators can be combined. Transnational comparisons are important as they reveal countries at the forefront of PA policy implementation in domains known to be effective for increasing population levels of PA.

Key messages

• Researchers can use the methods described as part of a process for assessing the extent of implementation of the physical activity policy using the PA-EPI.

• By calculating a composite physical activity policy implementation score, researchers can facilitate transnational PA policy comparisons.
Evidence and gap map of infodemic management interventions in emergencies: a case of COVID-19
Authors: Purnat T , Pundir P , Machiri S , Ishizumi A , Rajwar E , Murthy S , John O , Briand S , Nguyen T
Published: October 2023

Background

Because infodemic management (IM) is an evolving field that is bridging science into practice, it is often conducted in the field in an ad-hoc manner, focusing on implementation to address immediate challenges, and is less evaluated or reported in the scientific literature. This project used the Evidence and Gap Map (EGM) as a tool to provide an overview of investments in research and evidence for IM interventions.

Methods

A WHO working group advised development of protocol and of taxonomy of IM interventions and outcome measures based on literature review and expert discussion. Search was conducted on electronic databases and grey literature. Screening/coding of the studies was carried out independently by reviewers in two stages: the title and abstract and the full-text screening stage. Data extraction/critical appraisal was carried out for the included studies.

Results

983 studies were included from 29,117 search records. Among impact studies that measured and reported outcomes, the reported interventions were on ‘science & health communication’ (n = 30), ‘education & training’ (n = 30), and ‘engagement’ (n = 10). ‘Individual knowledge, attitude and behaviors’ was the most frequently measured outcome. In descriptive studies not measuring outcomes, majority reported an intervention of ‘monitoring/detection of narratives, questions, concerns, and misinformation in the information ecosystem’ (580 studies), by ‘science + health communication’ (n = 258), ‘education + training’ (n = 86), ‘engagement’ (n = 86) and ‘laws, regulation + ethics’ (n = 60).

Conclusions

The EGM reviewed the evidence base on IM interventions. The analysis shows scarcity of impact evaluation studies in this area. Moreover, the map reflects concentrations of research in social media analytics studies, model studies for misinformation detection, individual level interventions. Major gaps exist in systems level interventions that address the information environment, and in broader impact measures.

Key messages

• Research funders should prioritize impact evaluation studies for systemic interventions to address infodemic to support solutions in design and implementation of such complex studies.

• More research on infodemic management interventions is needed in LMICs and at health system level.
Cluster analysis of sub-national differences in life expectancy at birth in the European Union
Authors: Pinheiro V , Santos J V , Feldens T , Devleesschauwer B
Published: October 2023

Background

Life Expectancy (LE) at birth, the average number of years a person is expected to live from birth, supposing constant age-specific mortality, is an essential indicator of a country or region's well-being, reflecting policy options at the regional level and highlighting progress and gaps in societal health, including at the sub-national level. In this study, our goal was to explore patterns on groups of European Union (EU) member states according to sub-national gaps in LE at birth, between 2000 and 2020.

Methods

A longitudinal retrospective analysis on differences in LE at birth among NUTS2 regions in 20 EU countries (due to data availability issues) was performed, taking the largest absolute difference between NUTS2 regions, in 2000-2020, as the country value. A hierarchical agglomerative cluster analysis was then performed. All data was retrieved from Eurostat and analysis performed in R version 4.0.0.

Results

3 clusters were identified: (1) Belgium, France, Czechia, Hungary, Portugal and Spain (cluster mean: 3.78); (2) Austria, Slovenia, Croatia, Romania, Bulgaria, Poland, Finland, Germany, Italy and Greece (cluster mean: 2.44); (3) Denmark, Netherlands, Sweden and Lithuania (cluster mean: 1.17).

Conclusions

3 clusters of EU member states based on sub-national gaps in LE at birth were identified. Further studies are necessary to assess possible associated factors, such as health expenditure and health system efficiency, in order to better inform public policy and close the gap on existing inequalities.

Key messages

• Important sub-national differences in LE at birth exist in the EU, with considerable variability across groups of countries.

• These results may have an important impact on policy-making and inequalities.
Vaccination and risk compensation during the COVID-19 pandemic in France
Authors: McColl K , Raud J , Martin-Lapoirie D Dylan
Published: October 2023

Vaccination has played a key role in reducing the health burden of COVID-19 (World Health Organisation (WHO), 2022), however, concern has been raised worldwide that risk compensation, a process whereby feelings of security arising from being vaccinated may lead people to reduce their engagement in other protective behaviours (Hedlund, 2000), could detract from the overall health benefit of the COVID-19 vaccination campaign (WHO, 2020). We explored whether COVID-19 vaccination elicited risk compensation and whether this changed over time by conducting a repeated cross-sectional study at seven intervals over the initial months of the vaccine rollout in France (February–September, 2021). Participants (N = 14,003) completed an online survey measuring vaccination status, vaccination intention and engagement in four preventive behaviours: mask wearing, avoidance of physical contact, hand hygiene, and avoiding social gatherings. Risk compensation was measured indirectly by comparing levels of engagement in protective behaviours according to vaccination status, with those unvaccinated but intending to vaccinate serving as a baseline. Risk compensation did not occur systematically and was mostly observed towards the end of the vaccine rollout for two of the four protective behaviours: avoiding social gatherings and wearing a mask. Fully-vaccinated participants reported avoiding social gatherings less often than those intending to vaccinate in July (Adjusted Odds Ratio (AOR) = .72, p = .045), and in September (AOR = .54, p = .022). A similar trend was observed in September among participants vaccinated with one dose who reported wearing a mask less often than their unvaccinated-but-intending-to-vaccinate counterparts (AOR = .48, p = .029). Our findings suggest that whilst unlikely to impede the overall effectiveness of public health campaigns, risk compensation, particularly among certain groups, nonetheless merits attention when designing informed, targeted public health messages and policy.

Key messages

• Limited evidence of risk compensation was observed towards the end of the vaccination campaign in France.

• Risk compensation may not negate overall health benefit of a vaccination campaign, however from a public health perspective, nonetheless merits attention.
Precarious employment at a young age and alcohol-related health problems
Authors: Thern E , Elling D L , Badarin K , Hernando-Rodriguez J C , Bodin T
Published: October 2023

Background

Precarious employment, a known determinant of poor health, is increasing in prevalence, particularly among young adults, where the long-term health consequences are not fully understood. The aim is to examine the effects of precarious employment at a young age on later alcohol-related health problems.

Methods

We used register-based data from the Swedish Work, Illness, and Labor-market Participation (SWIP) cohort to follow a cohort of 367 655 young adults aged 27 years between 2000-2003. Register data on labour market establishment (precarious employment, sub-standard employment, unemployment, and standard employment) was collected three years after graduation from school. The Swedish index of alcohol-related diagnoses was used to define the outcome, which was collected during a 26-year follow-up. Alcohol-related morbidity and mortality was combined into the outcome of alcohol-related health problems and collected from the National Patient Registers and Cause of Death Register. Cox Regression models were used to obtain hazard ratios (HR) with 95% confidence intervals (CI).

Results

The preliminary results suggest, after adjusting for important covariates (e.g. sex, parents highest level of socioeconomic status and prior mental and alcohol-related health problems), that young adults who were precariously employed three years after graduation from school were at an increased risk of alcohol-related health problems compared to young adults with standard employment (HR 1.49, 95% CI: 1.37, 1.61). Young adults in long-term unemployment had an even higher risk (HR 2.05, 95%CI: 1.89, 2.22).

Conclusions

In Sweden, a nationwide register-based study with a long-term follow-up suggests that young adults with lower labour market attachment when entering the labour market are at an increased risk of later alcohol-related health problems.

Key messages

• Exposure to precarious employment at labour market establishment can have long-term determinantal consequences on later well-being.

• Policies targeting the transition from school to the workforce are needed to ensure decent employment conditions for the vulnerable group of young adults.
Poliomyelitis alert on Tunisian borders: response and challenges
Authors: Ben Mrad I , Bouguerra H , Yahyaoui M , Driss N , Ben Khalil M , Ammari L , Haddad-Boubaker S , Triki H , Gzara A
Published: October 2023

Introduction

Poliomyelitis, which disappeared in Tunisia 30 years ago, should be the second disease to be eradicated after smallpox. However, a few endemic foci persist and its recent detection in some regions is causing great concern. On January 11, 2023, Tunisia received an alert with the notification of 2 polio cases in Algeria, the second of which was detected in November 2022 at about 400 KM from Tunisia. The objective of this study is to describe the results of the investigations following this alert as well as the prevention and response measures triggered.

Methods

We conducted an active search for acute flaccid paralysis (AFP) cases in all governorates and a retrospective search for possible unreported AFP cases hospitalized from November 1, 2022. Vaccination coverage was verified for catch-up if incomplete vaccination. Surveillance of poliovirus shedding in patients with primary immunodeficiencies (PIDs) was also conducted as well as other public health measures.

Results

As of April 20, 2023, 38 AFP cases have been reported through active search. Retrospective hospital-based surveillance has revealed 31 cases. In addition, 3142 children with deficient vaccination were identified, distributed differently by region. All of them were caught up with Inactivated polio vaccine (IPV). A total of 90 PIDs were followed up. The replacement of the Oral polio vaccine (OPV) dose at 6 months by IPV in the national immunization schedule as well as a request for verification of the possibility of using the new OPV2 in Tunisia and of the required requirements were made.

Conclusions

The risk of poliomyelitis resurgence in our country is not negligible. Sustained vigilance is necessary, particularly through ensuring high vaccination coverage and effective surveillance to rapidly detect any imported case. This is essential in view of the global context and the existence of outbreaks especially in certain African countries with which several exchanges and migratory flows remain.

Key messages

• The Poliomyelitis alert on Tunisian borders in January 2023 is a real threat, that should also be taken into consideration by neighboring countries.

• Sustained vigilance is necessary, particularly through effective surveillance and appropriate vaccination strategy.
Predictive performance of polygenic scores for coronary artery disease in multiple genetic ancestries
Authors: Regazzi L , Bolli A , Cadeddu C , Boccia S , Busby G
Published: October 2023

Background

Polygenic scores (PGS) for coronary artery disease (CAD) measure a person's genetic liability for CAD. PGSs for CAD are generally considered sufficiently predictive in individuals of European ancestry, but their performance is attenuated in non-European ancestry groups (AGs). We collated publicly available CAD PGS and benchmarked their performance across several AGs to evaluate their utility for personalized prevention.

Methods

We queried the “PGS Catalog” to extract standardized odds/hazard ratios (OR/HR) for published CAD PGSs across multiple AGs (European-EUR, African-AFR, Hispanic-HIS, South-Asian-SAS, East-Asian-EAS). We restricted our analysis to PGSs specifically developed for prevalent and/or incident CAD and identified the five best-performing PGSs in each AG. We then computed these PGSs in a sample of 504,096 individuals of EUR (94.5%), AFR (2.6%), SAS (1.9%), EAS (0.7%) and HIS (0.3%) AG and evaluated their performance through logistic regression (covariates: age, sex, family history of CAD, principal components of AG).

Results

PGS000018 performed best in SAS (1.69[1.56-1.83]), EUR (1.62[1.60-1.64]) and EAS (1.45[1.11-1.89]). PGS001780 was the best performing PGS in AFR (1.18[1.04-1.33], on par with PGS000749) and ranked second in EUR (1.59[1.57-1.61]) and SAS (1.64[1.53-1.76]). Finally, PGS002262 was best in HIS (1.39[1.07-1.81], almost on par with PGS000337) and second in EASs (1.41[1.13-1.75]). Overall, the highest standardized ORs were found for the SAS and the EUR AGs, while the AFR AG had the worst performances. PGSs performed differently than previously reported both in an absolute and relative way, corroborating the need of a standardized comparison.

Conclusions

There is currently no gold-standard trans-ancestry CAD PGS, but the employment of different AG-specific CAD PGSs can achieve the best possible predictive performance in every individual, an essential prerequisite towards implementing PGSs in CAD personalized prevention protocols.

Key messages

• No gold standard PGS for CAD exists that can be applied with equal predictive performance across all AGs, which can be partially counterbalance by using the best performing PGS in each AG.

• In our analysis, the absolute performance of all PGSs was worse than expected and the best performing PGS for each AG was different from the one reported in the “PGS Catalog” across all AGs.