bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral health literacy strategies focused on community-based learning
Authors: Veiga N , Moura A C , Correia P , Couto P , Pereira R , Lopes P , Correia M J
Published: October 2023

Background

Oral health literacy relates to the capacity of individuals to acquire, understand and to act upon oral health information to make appropriate health decisions. The objective of this work is to present the strategies under development in the community, focusing interventions of oral health literacy by the application of community-based learning models in the central region of Portugal.

Methods

At the Faculty of Dental Medicine of the Universidade Católica Portuguesa (Viseu, Portugal), various community oral health projects have been developed focusing on oral health literacy promotion among the most vulnerable population, with the goal of achieving acceptable levels of empowerment towards adequate oral health behaviors. One of the main strategies consists in the application of the Service-Learning methodology that has allowed the identification of community needs and the active participation of dental medicine students in community interventions and scientific research in oral health.

Results

Innovative oral health community strategies should be performed to improve oral health literacy within the most vulnerable risk groups of society, specifically oriented to a community-based learning model. Service-Learning is an educational approach where the student learns specific soft skills, collaborating directly with a social institution and society “outdoors” and engages in reflection activities to deepen their understanding of what is being taught.

Conclusions

One of the main strategies to incorporate the health professional in social responsibility and direct contact in community is by experiencing Service-Learning programs during their training phase. It is important to highlight that health-related degreeś curriculum should favor community-based learning as a successful and engaging learning model that addresses both professionalism and humanism.

Key messages

• Community-based learning projects can be developed in order to work with and for the community contributing, simultaneously, for the development of soft-skills among future oral health professionals.

• Public health strategies should be performed to improve oral health literacy within the most vulnerable risk groups of society, specifically oriented to a community-based learning model.
Which journal indicator to consider when submitting a paper on Public Health area?
Authors: Taneri P E , Civaner M M , Devane D
Published: October 2023

Background

Each journal metric has a one-of-a-kind algorithm with unique strengths and limitations. This study aims to explore the correlations among the journal metrics of the Public Health, Environmental, and Occupational Health (PHEOH) journals to help inform researchers’ decisions on their publications.

Methods

We included the first 300 journals listed in the PHEOH area by SCImago. Journal Impact Factor (JIF), SCImago journal rank indicator (SJR), CiteScore (CS), h-index, and Source Normalized Impact per Paper (SNIP) indexes were obtained for every journal, between 01 August-30 September 2022. We performed bivariate Spearman ranking correlations, with SPSS 26.0. The statistical significance level was p < 0.05.

Results

There were very strong correlations between JIF&CiteScore (r = 0.831, p < 0.05), SJR & JIF (r = 0.817, p < 0.05), and SJR & SNIP (r = 0.829, p < 0.05). There were strong correlations between JIF & SNIP, CiteScore & SNIP, and SJR & CiteScore (r = 0.760, p < 0.05; r = 0.772, p < 0.05; r = 0.792, p < 0.05 respectively). There was a moderate correlation between the h-index and CiteScore (r = 0.414, p < 0.05); weak correlations between the h-index&JIF (r = 0.263, p < 0.05), and the h-index&SNIP (r = 0.310, p < 0.05). Among the top 50 journals, the correlations between JIF& CiteScore (r = 0.795, p < 0.05), SJR & JIF (r = 0.631, p < 0.05), and SJR&SNIP (r = 0.601, p < 0.05) were strong. Moderate correlations were found between JIF&SNIP (r = 0.593, p < 0.05), CiteScore&SNIP (r = 0.550, p < 0.05), and SJR&CiteScore (r = 0.505, p < 0.05). There were no correlations between h-index&JIF (r = 0.140, p = 0.354), h-index&CiteScore (0.194, p = 0.176), h-index&SNIP (0.055, p = 0.704), and h-index&SJR (r = 0.275, p = 0.053).

Conclusions

Our study highlights that there is instability in the correlations among mentioned metrics. Journal metrics, especially the h-index, should be carefully evaluated by the researchers before submitting any manuscript to a journal in the PHEOH category.

Key messages

• Journal metrics are not highly correlated in the public health area.

• Researchers should carefully consider all metrics before publication, especially h-index.
Professional Public Health Practice in Spain - Insights from the Spanish Public Health White Paper
Authors: Llimós M , Segura-Benedicto A , Urbanos R , Satue E , Barbaglia G , García-Benavides F
Published: October 2023

Issue/Problem

The public health professionals has gained attention during the COVID-19 pandemic. However, the weakness of Spain's public health structures has been exposed during the crisis, which is partly due to the delay in modernising institutions and the low percentage of GDP dedicated specifically to theses public health institutions. In addition, there is a lack of specific training for public health practitioners to acquire the necessary multidisciplinary competences for high quality public health practice.

Description of the problem

The Spanish Society of Public Health and Health Administration (SESPAS) has developed a white paper of the public health profession. The main objective is to contribute to strengthening the professional practice of public health by identifying some of its problems and agreeing on possible solutions. The specific objectives were to frame public health as a profession, to describe the socio-demographic characteristics of the people affiliated to the associations federated in SESPAS, to carry out a qualitative analysis of the discourse of public health professionals on its meaning, and developing conclusions and recommendations to address public health challenges.

Results

The demographic and employment data of the 3,467 people belonging to seven SESPAS societies show that, overall, about 60% are women and 40% were under 50 years of age. Undergraduate degrees were Medicine (35.9 %), Nursing (17.4 %) and Pharmacy and Veterinary Medicine (10.4 %), other life science degrees (4.3 %). Key aspects of the meaning of public health, training, employability and career and institutionalisation of public health were collected through 19 interviews and 6 focus groups.

Lessons

In order to agree on the conclusions and recommendations, a meeting was organised with the participation of 29 members of SESPAS. A total of 25 conclusions and 24 recommendations were drawn.

Key messages

• White paper is a step forward in the strengthening of public health in Spain.

• Public health should develop leadership and advocacy skills for people's health from a multidisciplinary and cross-sectoral practice.
Behavioural risk factors and psychophysical well-being among University students in Pavia Colleges
Authors: Vigezzi G P , Blandi L , Cacitti S , Bertuccio P , Mosconi G , Casali L , Cena H , Politi P , Rigano F , Odone A
Published: October 2023

Pavia, Italy, is one of the oldest university city campuses in Europe and the venue for 16 Colleges, hosting around 2,500 Italian and international students (10% of the whole student population). Colleges represent a distinctive identity of the city and quite a unicum in the Italian academic system. Since leaving their parents’ homes and starting University has an impact on young adults’ health behaviours, potentially impairing their future life pathways, we investigated students’ health status and well-being through a rigorous assessment of lifestyles and behavioural risk factors. A cross-sectional online survey was designed and administered to students living in Pavia's Colleges. The questionnaire was structured into five sections, aimed at collecting information on university careers, lifestyles and behavioural risk factors, psychological well-being, and experience in residences during the COVID-19 pandemic. Where available, validated structured scales were used to gather specific study's endpoints (i.e., IPAQ, Audit-C, Medi-Lite, GHQ-12, BHS and 3-item loneliness scale). Of the 1199 students enrolled between March and August 2022, 814 subjects participated in the study. Regarding the most common behavioural risk factors, smokers were 25.2% of our sample, while at-risk alcohol consumption and regular cannabis use stood at 42.9% and 4.0%, respectively. Around 17% of the students gambled 1-2 times/week, and 4.5% did not take measures to prevent sexually transmitted infections. In terms of psycho-physical well-being, the level of physical activity was inadequate in 11.7% of the subjects, and the results of the mental health tests showed a risk for loneliness (3-item loneliness score≥6) in 36.9% and for hopelessness (BHS≥6) in 17.7%. Our findings may provide useful information to tailor the most appropriate health promotion and health education interventions so as to design a culture for well-being across the whole lifespan.

Key messages

• Our study offers a comprehensive overview of the student population residing in colleges, providing representative data.

• Promoting healthy behavioral risk factors early in life, with a life course perspective, is crucial to enhancing individuals’ chances for a healthy life.
Impact of a digital therapeutic on adult asthma
Authors: Bijlani A , Mauger D , Goodheart C , dOrsay G , Suman J
Published: October 2023

Background

Asthma impacts 334 million people globally. Medication adherence is estimated at 50% worldwide. Digital therapeutics (DTx) may improve medication adherence and health outcomes.

Methods

Prospective, single cohort observational study of 104 adults with asthma managed on inhaled corticosteroids. Subjects had 90-day access to Aptar Digital Health respiratory platform: HeroTracker to monitor adherence, spirometer for lung function, and BreatheSmart mobile app with real-time alerts. Primary outcomes: asthma control, rescue medication use. Secondary outcomes: controller medication adherence, patient feedback.

Results

Subjects completed Asthma Control Test (ACT) at baseline (T0); 96% (N = 100) completed ACT at 90 days (T1). Between T0 and T1, ACT scores increased significantly (baseline: 16.5 ± 4.7; ΔT0 to T1: + 2.8, 95% CI (2.0, 3.6), p-value <0.001); rescue medication use decreased 44% ((95% CI: 14.1, 63.5), p-value = 0.008); adherence to controller medication decreased 10.7% ((95% CI: 6.4, 15.1), p-value <0.001). 82.5% of subjects reported platform very/somewhat easy to use, 97.5% rated spirometer very/somewhat easy to use, 92.5% reported alerts very/somewhat helpful. Platform rating mean score = 7.825/10 (1-10; 10=high).

Conclusions

DTx may improve asthma control and decrease rescue medication use. T1 medication adherence was 17% higher than global medication adherence. Patient feedback was positive.

References

1. Enilari, O., Sinha, S. (2019). The global impact of asthma in adult populations. Ann Glob Health, 85(1), 2, 1-7.

2. Kim, J., et al. (2018). Medication adherence: the elephant in the room. US Pharm, 43, 1, 30-34.

Key messages

• DTx promoted improvement in ACT scores and decreased rescue medication use.

• DTx platform feedback was positive.
Adverse childhood experiences and pain in early adolescence: A study in the Generation XXI cohort
Authors: Abrahamyan A , Lucas R , Talih M , Soares S , Severo M , Fraga S
Published: October 2023

Background

The cross-sectional association between Adverse Childhood Experiences (ACEs) reports and adult pain conditions is well-established. Studies in children are scarce, yet evidence indicates that ACEs may trigger a health-damaging cascade, especially in stress-sensitive developmental stages of higher brain plasticity. We aimed to examine the associations between ACEs and pain experiences in childhood and adolescence.

Methods

Participant data from the third (2016-17) and fourth waves (2018-20) of the Generation XXI birth cohort study (2005-06) was used. ACEs were reported by children aged 10 and 13 using a 15-item questionnaire. Recent pain experiences (i.e., presence of pain episodes, number of pain sites, and pain intensity) were measured using structured questionnaires. Pain episodes were reported a week prior to the interview at age 10 and in the previous three months at age 13. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were obtained from binary and multinomial logistic regression analyses.

Results

ACEs reported until the age of 10 were associated with pain experiences (i.e., presence of pain episodes, number of pain sites, and pain intensity), with higher number of events conferring a greater risk of experiencing pain at age 10 (aOR 3.18 for ≥6 ACEs; 95% CI [2.19, 4.74]). ACEs until age 10 were associated with pain reports at 13 years. Further, each point increase in ACEs at age 10 increased 9% the odds of reporting pain at age 13 (OR 1.09; 95% CI [1.07, 1.12]). No interaction was observed between ACEs score at ages 10 and 13 was (OR 0.99; CI [0.98-1.00]), showing that the effect of ACEs at age 10 on recent pain at age 13 was not moderated by the ACEs at age 13.

Conclusions

Adverse experiences occurring during the first years of life may predict pain conditions later in life.

Key messages

• A dose-response association was observed between the cumulative number of ACEs and reports of pain in 10-year-old children.

• Embodiment of ACEs starts as early as childhood, and pain related to ACEs begins earlier than previously reported.
Digital psychosocial assessment of youth in Australian hospitals: From aspiration to implementation
Authors: Waller D , Ho J , Fong C K , Iskander A , Towns S , Bailey S , Zolfaghari E , Feuerlicht D , Ross K , Steinbeck K
Published: October 2023

Background

Some of the leading causes of morbidity and mortality for Australian youth arise from modifiable psychosocial concerns. Psychosocial assessment can help identify young people at risk and support actions that protect wellbeing. The gold standard assessment for youth is the HEEADSSS interview. Australian governments recommend the HEEADSSS interview for young people in health settings, but adoption is still in its early stages. Recently, a digital self-assessment version of the HEEADSSS (the e-HEEADSSS) was piloted at the Sydney Children's Hospital Network. A program of research has been established to evaluate outcomes and consider broader implementation.

Methods

Study 1 involved a retrospective analysis to compare the HEEADSSS interview and the e-HEEADSSS. Documentation from 146 matched records collected at the Sydney Children's Hospital Network were analysed to compare approaches. Study 2 utilised a qualitative design to evaluate patient and staff barriers and facilitators to implementation and scale-up of the e-HEEADSSS. Patients (n = 8) and staff (n = 8) participated in online semi-structured interviews.

Results

Study 1 found the e-HEEADSSS improves assessment uptake and sensitivity compared to face-to-face interviews and takes less time. Disclosure rates were higher for all psychosocial categories especially in sensitive areas of emotions, drug use, sex, and safety. Study 2 found strong support for the e-HEEADSSS from patients and staff. Key benefits included design, functionality, reduced time, convenience, improved disclosure, perceived privacy, improved fidelity, and reduced stigma. Key challenges were available resources, continuity of staff training, clinical pathways, and risks of off-site completions.

Conclusions

The e-HEEADSSS shows promise as a psychosocial screening tool to support intervention for young people. More work is required to appropriately scale and sustain implementation of the e-HEEADSSS within the Australian health system.

Key messages

• Digital psychosocial assessments show promise for supporting the mental and physical health of adolescents and young adults.

• Implementation of digital psychosocial assessments within the Australian health system requires considered support.
Parental imprinting
Authors: Capitani E , Marin O , Alaimo L , Montomoli E , Nante N
Published: October 2023

Background

Parental identity formation is rooted in childhood experiences and internalised relationships with one's family. The present study aims to investigate the possible correlations between the outcomes of experienced motherhood and the woman's internalised parenting style.

Methods

A retrospective observational study was conducted on an Italian sample of mothers enrolled through an online questionnaire administered from July to September 2022. The Parental Bonding Instrument was used, consisting of 25 items, 12 of which refer to caring (max score 36) and 13 to overprotectiveness (max score 39). From the combination of the scores calculated for the two dimensions, four possible patterns of maternal parenting style can be obtained (affectionate bonding, optimal parenting, controlling without affection, negligent parenting).

Results

The sample consisted of 1828 mothers (average age 38). Our sample shows that 15.54% of the women have a mother with an affectionate bond, 32% an optimal mother, 36.54% a controlling mother without affection and 15.92% a neglectful mother. Those who have an affectionate mother have a lower likelihood of developing depression (OR:0.6;C.I.:0.4-0.9).Those who have an optimal mother have a higher likelihood of breastfeeding (OR:1.3;C.I. 1.1-1.7).Those with a controlling mother without affection have a higher probability of suffering from anxiety (OR:1.4;C.I.:1.2-1.7).Those with a controlling mother without affection have a higher probability of suffering from depression (OR:1. 7;C.I.:1.3-2.1).Those with a neglectful mother have a higher probability of suffering from anxiety (OR:1.3;C.I.:1.1-1.7).Those with a neglectful mother have a higher probability of developing depression (OR:1.7;C.I.:1.3-2.3).

Conclusions

Our data shows the existence of a statistically strong correlation between the variables related to the psycho-emotional sphere and the four attachment patterns.

Key messages

• The parental imprint received has repercussions on various aspects related to one's motherhood and influences its events and outcomes.

• Mental health is also influenced by the parental imprint.
Evaluation of the Ministry of Health's pilot program - A personal pregnancy follow-up service
Authors: Satran C , Bord S , Cohen A , Tzadik H , David R , Nattiv O , Madjar B
Published: October 2023

Background

The Israeli Ministry of Health has developed a unique pregnancy follow-up (PF) service in the Haifa District Infant-Parent Centers, including a fixed nurse attending the necessary examinations and services, supporting and guiding the woman throughout her pregnancy.

Aim

To examine the differences between the participants who received PF within the pilot program (research group) and those who received standard PF (control group) regarding health behaviors, receiving information and attitudes regarding health behaviors, professional support, and satisfaction with the service.

Methods

Questionnaires were filled in by 293 mothers to infants- 38% of which belonged to the research group and 62% to the control group. There were no significant differences between the two groups’ characteristics.

Findings

Significant differences were found between the groups regarding receiving information and support, and some of the attitudes and behaviors, as well as a difference in satisfaction, in favor of the research group; e.g., 95% of the participants in the research group were vaccinated against Pertussis, as compared to 85% of the control group (z = 2.47, p<.001). Process model for parallel mediation revealed that receiving PF in the research group was associated with (1) More positive attitudes (Effect=0.06, SE = 0.04 CI=0.01,0.15) and receiving information (Effect=0.18, SE = 0.08 CI=0.02,0.33), which in turn were associated with more reported health behaviors (Total indirect effect=0.30, SE = 0.09 CI=0.14,0.49); (2) Receiving more support (Effect=0.16, SE = 0.04 CI=0.09,0.26), as well as more information (Effect=0.10, SE = 0.05 CI=0.01, 0.19), which in turn were associated with higher satisfaction with the PF (Total indirect effect=0.25, SE = 0.05 CI=0.16,0.36).

Conclusions

The findings indicate the pilot program's success in promoting pregnant women's health, among other things, due to the guidance and support provided by a fixed dedicated nurse.

Key messages

• Personal pregnancy follow-up is efficient for supporting and guiding women during a sensitive period for their fetus’ and their own health, and encourages compliance with health behaviors.

• It is recommended to implement the program in additional districts, and to examine the findings among a wider and more diverse sample.
Women’s health report for Belgium: addressing the information gap
Authors: Scohy A , Mogin G , Guariguata L , Nayani S , Schmidt M , Van den Borre L , De Pauw R , Gorasso V
Published: October 2023

Issue

In the last years, Belgian policy makers have become increasingly concerned about health problems affecting only women (e.g. endometriosis) or affecting women in different ways than men (e.g. cardiovascular diseases). The current monitoring tools on the health status in Belgium routinely present information disaggregated by sex. Nevertheless, there is a need to go further than a mere comparison of men and women and strive for gender-sensitive health reporting.

Description of the problem

To address the information gap pertaining to the health of girls and women, a women's health report for Belgium was developed. The goal of this report is to identify and highlight health issues specific to women or affecting them differently and possible knowledge and data gaps.

Results

The report highlighted several data gaps, e.g. prevalence of endometriosis and polycystic ovary syndrome, and several opportunities to fill them. The process also uncovered available but underused data on women-specific issues, including fertility treatments, abortions, and contraception. Among the main results, an analysis on girls (11-18 years old) showed an alarming difference in health status compared to boys, starting from a young age and increasing throughout adolescence. For example, girls reported experiencing more psychosomatic symptoms more often than boys with the difference increasing with age. Girls reported more often a negative perception of their health (22%) compared to boys (15%) and more often depressive symptoms (47%) than boys (31%). Conversely, boys were twice as likely to meet WHO recommendations on physical activity.

Lessons

This first report on women's health in Belgium highlighted the need to collect better information on women-specific issues and the need to promote the use of existing data. Results showed that gender differences in health emerge and increase during adolescence. We strived to put results into context to produce knowledge and recommendations for policymakers.

Key messages

• Developing a women’s health report allowed to highlight data gaps and underuse of existing data.

• Specific interventions should target teenage girls.
Health-Related Quality of Life and Sleep Habits of Children with Overweight or Obesity
Authors: Kleppang A L , Abildsnes E , Haraldstad K , Stea T H
Published: October 2023

Background

Obesity is a major public health challenge affecting children of all ages worldwide. Being overweight or obese can have severe negative psychological impacts and a significant reduction in health-related functioning. To improve health-related quality of life (HRQoL) and sleep habits for children with overweight/obesity, it is important to design and implement effective interventions. Few studies have included parents as behavioral agents to improve sleep habits and quality of life in children and adolescents with overweight/obesity.

Methods

This 6-month, non-randomized, cluster-controlled trial included 166 Norwegian children aged 5-13 years with overweight/obesity and their parents. The intervention group received individual family counselling and participated in physical activity groups and nutrition courses. A frequency questionnaire was filled out by parents, and the sleep habits questionnaire (CSHQ) and Kidsscreen-10 index (proxy version) were used to assess HRQoL.

Results

The results indicate that, overall, the children had good HRQoL. The mean average scores for HRQoL were 50.0 (standard deviation (SD): 8.1) for the intervention group and 49.0 (SD: 10.1) for the control group, which are broadly in line with normative data. For sleep habits, the mean average score was 43.8 (SD: 11.6) for the intervention group and 45.1 (SD: 11.7) for the control group. No significant changes in HRQoL and sleep habits were reported as a result of the intervention.

Conclusions

The children with overweight/obesity reported overall good HRQol at baseline and somewhat worse for sleep habits than the general population. No increase in quality of life or sleep quality was found in the intervention group compared to the control group in children with overweight/obesity.

Key messages

• The HRQoL among the children with overweight/obesity was good, but there were clinically relevant challenges related to sleep.

• No increase in HRQoL and sleep habits were found after the intervention.
ChatGPT & clinical decision-making: a cross-sectional study on Italian Medical Residency Test
Authors: Conrado F , Scaioli G , Lo Moro G , Rosset L , Bert F , Siliquini R
Published: October 2023

Background

The increasing application of artificial intelligence (AI) in healthcare offers significant opportunities for improving clinical decision-making and medical education. This study assesses the performance of ChatGPT, a large language model (LLM), on the Italian State Exam for Medical Residency (SSM) test, to evaluate its potential as a tool for medical education and clinical decision-making support. Given the high stakes of medical decision-making, understanding the capabilities of AI tools like ChatGPT in this context is crucial.

Methods

A cross-sectional study design was employed, analyzing 136 questions from the official SSM test. ChatGPT's responses were compared to the performance of medical doctors who took the test in 2022. Questions were classified into clinical cases (CC) and notional questions (NQ). The study assessed ChatGPT's overall accuracy, performance on CC and NQ, and compared its results with participating medical doctors.

Results

ChatGPT achieved an overall accuracy of 90.44%, with higher performance on clinical cases (92.45%) compared to notional questions (89.15%). ChatGPT's performance was higher than 99.6% of the medical doctor participants.

Conclusions

Based on the data, ChatGPT shows promise as a useful tool in clinical decision-making, particularly in clinical reasoning. This study recommends further research to explore the potential applications and implementation of LLMs in medical education and medical practice, as well as the initiation of procedures and policies for their safe and effective integration into healthcare systems.

Key messages

• ChatGPT outperforms 99.6% of medical doctors in the Italian State Exam for Medical Residency, demonstrating potential as a clinical decision-making tool.

• Further research is needed to explore LLM implementation in medical education and practice, and to develop policies for safe AI integration.
The impact of digital health literacy on anxiety and preventive behaviors during the pandemic
Authors: Duplaga M , Wojcieszko M
Published: October 2023

Background

From the pandemic's beginning, many authors suggested that digital health literacy (DHL) may be an important factor in protecting against araising misinformation and enhancing compliance with preventive behaviors. In this study, we analyzed the effect of DHL on future anxiety and generalized anxiety, as well as on adherence to preventive measures and COVID-19 vaccination uptake after adjusting for sociodemographic factors.

Methods

Data used in the analysis originated from the web-based survey carried out in a representative sample of 2189 Polish Internet users in the later phase of the COVID-19 pandemic. The effect of DHL on FA, GA, and APM after adjusting for SD factors was analyzed with multivariable linear regression and on C19VU with multivariable logistic regression. DHL was measured with an eHealth Literacy Scale (eHEALS) consisting of 8 items. The effects of predictors in MLiR models were expressed as B coefficients and 95% confidence intervals (B; 95%CI) and in MLoR model as odds ratio and 95%CI (OR; 95%CI).

Results

Mean age (standard deviation, SD) of respondents was 44.1 (15.25) years, mean DHL measured with eHEALS was 28.91 (5.17). The analysis demonstrated that higher DHL was significantly associated with a higher level of FA (B; 95%CI: 0.07; 0.02-0.12) but with lower GA (B; 95%CI: -0.01; -0.016 - 0.03). Interestingly, higher DHL favored greater compliance with general PM (wearing the mask, washing hands, and keeping a social distance) (B; 95%CI: 0.04; 0.02 - 0.05). However, no effect was observed concerning C19VU (OR, 95%CI: 0.99; 0.97 - 1.01).

Conclusions

The effect of DHL on the outcomes related to the pandemic is not consistent. Higher DHL seems to predict the perception of long-term consequences of the pandemic reflected by higher levels of FA. However, the level of GA shows the status of current anxiety is lower with persons with higher DHL.

Key messages

• The effects of digital health literacy are not fully consistent with predictions from the beginning of the COVID-19 pandemic.

• Digital health literacy is significantly associated with adherence to general pandemic preventive measures but not with readiness to get vaccinated against COVID-19.
Health Catch-UP!: process evaluation of a migrant multi-disease screening and vaccination tool
Authors: Carter J , Knights F , Goldsmith L P , Deal A , Crawshaw A F , Hayward S E , Zenner D , El Kheir N , Requena-Mendez A , Hargreaves S
Published: October 2023

Background

European migrants face a disproportionate burden of infection (tuberculosis, HIV, hepatitis B/C and parasites), are at-risk of underdiagnosis of non-communicable diseases and are an under-immunised group. Reducing these health inequities is a key public health priority, with the ECDC calling for innovative strategies to deliver multi-disease screening to at-risk migrants. Current strategies in the UK to screen migrants report low uptake despite clear health and cost benefits. Health Catch-UP! is a collaboratively produced innovative digital tool applying UK guidance to identify screening and vaccination requirements of migrants based on country-of-origin. (https://emishealth.vids.io/videos/a49ad1bb1a18e4c72c/health-catch-up-with-requested-editsmp4

Methods

We did a mixed methods process evaluation of the Health Catch UP! tool in two GP practices, using the Medical Research Council framework for complex interventions. We recorded data on demographics, patients screened, disease detection and catch-up vaccination rates. We conducted qualitative interviews with staff and migrants to explore barriers and facilitators.

Results

Outcomes data were extracted for 99 migrants, predominantly from Asia (31.3%), and Sub-Saharan Africa (26.1%). 61.6% of participants were recommended screening, uptake of screening was high with 86.9% were screened for at least one health problem. New diagnoses included: one case of hepatitis C, 6 hypercholesteremia, 4 pre-diabetes and one diabetes. Catch-up vaccination uptake was poor (2.0%). Qualitative data strongly supported the acceptability and feasibility of the tool but recommended clear laboratory and management pathways, financial incentives, and a staff and patient information and training implementation package.

Conclusions

Innovative primary care digital tools like Health Catch-UP! have potential to significantly improve disease detection and effective implementation of screening guidance but require robust testing and resourcing.

Key messages

• Migrants face disproportionate burden of infectious diseases, screening and vaccination innovations are required to reduce health inequity.

• Digital clinical support tools in primary care have potential to improve disease detection and implementation of migrant screening guidance.
Educational inequality in cause-specific mortality among immigrants and their descendants in Sweden
Authors: Miething A
Published: October 2023

Introduction

Although immigrants in Western countries often face disadvantages and vulnerabilities such as lower socioeconomic status, they tend to exhibit weaker educational gradients in mortality compared to the native majority populations. However, it is unclear how these gradients vary across specific causes of death and whether they persist among second-generation immigrants. Therefore, this study aims to investigate educational inequalities in cause-specific mortality among first- and second-generation immigrants compared to the native ancestral population in Sweden.

Data & Methods

Individual-level analysis was conducted on Swedish register data from 2004 to 2016, including men and women aged 25 to 64. Poisson regression was used to examine the association between the highest educational degree attained and mortality due to circulatory diseases, neoplasms, external causes, self-harm, drug and alcohol use.

Results

The findings indicated that first-generation immigrants exhibited significantly lower educational inequality in all causes of death compared to native ancestral Swedes. In contrast, second-generation immigrants showed similar degrees of educational inequality in all-cause mortality and mortality due to neoplasms when compared to ancestral Swedes. However, they displayed more pronounced educational inequalities in mortality from external causes, self-harm, and drug use.

Conclusions

The results highlight that while first-generation immigrants experience lower educational inequality in the considered causes of death, second-generation immigrants show pronounced educational inequalities in avoidable causes of death. This study emphasizes the importance of considering heterogeneity in educational disparities in immigrant mortality and calls for policy interventions to address educational inequalities in second-generation immigrants.

Key messages

• When compared to the native majority population, first-generation immigrants in Sweden demonstrate lower educational inequality in mortality, regardless of the underlying cause.

• Conversely, second-generation immigrants display larger educational inequalities, particularly for mortality caused by preventable factors.
An HIV prevention intervention helps immigrants open up about transactional sex. The Makasi study
Authors: Coulibaly K , Gosselin A , Desgrées du Loû A ,   for The Makasi study group
Published: October 2023

Background

Transactional sex is known to be an exposure factor for HIV acquisition among immigrants in France. We analysed the factors associated with the increase in the proportion of transactional sex among African immigrant men and women living in precarious situations in the greater Paris area.

Methods

Data were collected in the Makasi research project. Participants were recruited in public places based on their precarious situations, they were randomised into two groups (intervention and control) followed during six months between 2019 and 2021. We described the levels of transactional sex at each follow-up time (0, 3, 6 months) and used random-effects logistic regression models to analyse factors associated with the evolution of transactional sex participants.

Results

The majority of participants were men (76.5% (470/614)) and almost half of them arrived in France in two years prior to inclusion (49.8%). Transactional sex increased in both study groups: at inclusion, 1% of men in the control group and 0% in the intervention group reported having had transactional sex. At the six-month follow-up, 15% and 8% of men in the control and intervention groups respectively reported transactional sex. Among women, 7% in the control group and 8% in the intervention group reported transactional sex at baseline. They were 27% and 24% respectively to report transactional sex at the six-month follow-up in each group. We find that exposure to the intervention liberate the speech about transactional sex, especially among men.

Conclusions

Our results suggest that the proportion of transactional sex seems to be important among immigrants in precarious situations, especially among men, and that the empowerment intervention facilitated participants’ openness about their sexual activities. These results suggest that the social hardships and structural barriers faced by immigrants in precarious situations limit the effect of HIV prevention interventions in this population.

Key messages

• Social hardships experienced by immigrants must be addressed to reduce their exposure to HIV.

• An empowerment-based outreach intervention facilitated participants’ openness about transactional sex.
Nutritional quality of food intakes according to the Nutri-Score and blood biomarker concentrations
Authors: Deschasaux-Tanguy M , Huybrechts I , Julia C , Hercberg S , Riboli E , Touvier M ,   EPIC collaborators
Published: October 2023

Background

Diet has a direct impact on our health and as such is an important leverage in public health prevention strategies. Nutri-Score is a scientifically validated 5-color front-of-pack nutrition label based on a nutrient profile called FSAm-NPS that was proposed as a tool to help people choose healthier foods. It has been adopted by several European countries, but remains optional under current EU labeling regulation (under revision). This study aimed to provide insights into the relevance of the FSAm-NPS to characterize healthier foods by studying associations with a range of biomarkers reflecting pathways underlying nutrition-health associations.

Methods

This analysis included healthy participants from the EPIC cohort study (inclusion in 1992-2000, 8 European countries) for which blood biomarkers were measured from baseline samples in several case-control studies. Food intakes were assessed using country-specific dietary questionnaires. The FSAm-NPS was calculated for each food based on its 100g content in energy, sugar, saturated fatty acid, sodium, fibre, protein, and fruit and vegetables. Multi-adjusted linear models were computed.

Results

Consuming foods with higher FSAm-NPS scores (lower nutritional quality) was positively associated with the concentration of C-peptide (n = 788, β = 0.02, P = 0.04) and C-reactive protein (n = 899, β = 0.04, P = 0.04) and with a multi-marker profile characterized by apolipoprotein B, total and LDL cholesterol concentrations derived from principal component analysis (n = 498, lsmeans = -0.35 in quintile 1 and -0.03 in quintile 5, P = 0.02).

Conclusions

In this European context, higher concentrations of blood biomarkers reflecting hyperinsulinism, inflammation and dyslipidemia were observed in participants consuming foods and beverages with higher FSAm-NPS scores (lower nutritional quality/less favourable Nutri-Score). This adds to the evidence on the relevance of Nutri-Score as a public health tool to help people eat healthier food products.

Key messages

• The consumption of foods with a lower nutritional quality as graded by the Nutri-Score was associated with concentrations of blood biomarkers reflecting hyperinsulinism, inflammation and dyslipidemia.

• This adds to the evidence supporting the relevance of the Nutri-Score as a complementary tool to dietary guidelines to help people choose healthier foods and beverages.
Systems dynamics for healthy and sustainable local food environments
Authors: Poelman M P , Wopereis T , Wierda J , Rongen F , Dijkstra S C
Published: October 2023

Background

Current food environments steer unhealthy food choices, increasing the risk for diet-related non-communicable diseases. Changing food environments is complex and underlying system dynamics of local food environments are relatively unclear. This study aimed to identify factors and leverage points that shape local food environments and to develop systemic actions with local stakeholders to improve food environments.

Methods

Two workshops (in 2022) were held in a Dutch municipality using a community-based system dynamics approach in which a variety of stakeholders (n = 13) participated (e.g., policy maker, retailers, health coach, citizens). Group model building exercises were used to identify factors shaping the local food environment and to develop a causal loop diagram. Subsequently, leverage points and actions to improve food environments were identified by the stakeholders.

Results

Based on the first workshop, a total of 46 factors influencing the local food environment were identified and categorized into four subsystems including commercial-, political-, global- and societal factors. The leverage points included the anti-lobby from food industry, food industry's willingness to change, Government/consumer priority on healthy food, food policy, e-commerce and platform economy, demand for healthy food, time to prepare/consume meals. In correspondence, 20 actions to improve the local food environment were identified during the second workshop. Moreover, the exercises initiated dialogues and collaborations between the participating stakeholders to adapt their local food environment.

Conclusions

This research yielded one of the first causal loop diagrams showing the multiple and varied factors influencing the local food environment. It underlines the importance of using a systems approach to adapt and improve food environments. More work is needed to implement the developed actions and to translate the system dynamics approach for use by non-academics.

Key messages

• Food environments are complex adaptive systems, which require a systems dynamic approach to generate change.

• Food environments need to be adapted at multiple levels requiring multiple pathways and stakeholders to succeed, and thus move away from single component interventions.
Effects of social protection programs on suicide mortality: a study in 81 LMICs between 2000-2019
Authors: Landín Basterra E , Silva N J , Alves FJO , de Sampaio Morais G A , Brachowicz N , Rasella D
Published: October 2023

By 2019, LMICs bore more than 77% of the global suicide burden worldwide. In addition, the consequences of the COVID-19 pandemic exacerbated the existing inequalities and social protection gap between high- and low- and middle-income countries (LMICs). The United Nations’ Sustainable Development Goals 2021 Agenda targeted, both, the promotion of social protection for all (target 1.3) and the reduction of suicide mortality by one-third (target 3.4) by 2030. These targets will not be met if current trends maintain. There is a lack of studies investigating the link between social protection and suicide in LMICs. This study aimed to help fill this knowledge gap by assessing the effects of social protection (SP) programs on the suicide mortality rates in 81 low- and middle-income countries (LMICs), over the period 2000-2019. Multivariable regression analyses using Poisson models were performed adjusting for relevant socioeconomic and healthcare factors. Robust standard errors and fixed-effects specifications were included to estimate the relationship between SP coverage and suicide rates. Our results showed that a 1% increase in the population covered by SP programs could reduce by 0.19% (IRR:0.83;95%CI:0.74-0.94) the suicide rates of the 81 LMICs over the 20 years studied. By disaggregating, the strongest suicide reductions were found among the youngest population of 10-24 years (a 0.21% suicide reduction when increasing SP coverage by 1%: IRR:0.81;95%CI:0.69-0.95). To our knowledge, this study shows for the first time in a large sample of LMICs, that social protection programs could reduce the suicide mortality in LMICs, especially among the youngest populations. Understanding the potential benefits that SP programs could have on reducing health inequalities in LMICs could guide policymakers to target more efficient interventions to prevent suicide and associated factors, quantify its public health cost, and create strategies to tackle stigma-related behaviors.

Key messages

• Promoting the expansion of social protection interventions could be an effective strategy to reduce the suicide burden over the next years in LMICs, especially among the youngest populations.

• Advocating for the de-stigmatization and promotion of standardized methods to classify suicide should be a public health priority.
Achieving a healthy, sustainable and climate-friendly diet: what do municipalities and counties need?
Authors: Lyshol H , Totland T H , Helleve A , Budin Ljøsne I S , Torheim L E
Published: October 2023

Background

In 2022 the Norwegian Institute for Public Health was asked to ascertain how local authorities help their citizens maintain a healthy, sustainable and climate-friendly diet. The research should identify the barriers and promoting factors involved, and pinpoint national policies and tools that would support the local authorities, using quantitative and qualitative methods.

Methods

356 municipalities and 10 counties were asked to fill in an online questionnaire. 6 municipalities and 6 counties took part in qualitative interviews. Interview transcripts and text from the 180 received questionnaires were subjected to content analysis and combined with questionnaire data in a mixed methods analysis.

Results

The municipalities did not consider sustainability and climate in their nutrition work, apart from projects on food waste. The counties were involved on their own behalf and also tried to support the municipalities. Main barriers for the municipalities were lack of personnel (67%), economic resources (65%), and competence (48%). Several municipalities indicated that lack of policy foundations and support from local authorities along with lack of knowledge about local challenges hindered this work. The opportunities indicated by the municipalities were making nutrition a part of local policies and budgets (55%) and making the prioritization of nutrition visible within the municipality (66%). Local cooperation and having access to personnel with nutritional competence and responsibility for nutrition were also considered important. The counties saw their roles as facilitators and distributors of project funds to the municipalities, but many of them required more resources to fulfil their duties.

Conclusions

The municipalities’ work to promote a healthy and sustainable diet is inadequately anchored in Norwegian municipalities’ policies and governance. The municipalities need interventions and tools to increase the public health sector's competence in the field.

Key messages

• Municipalities should include nutrition and sustainability in local planning, policy, and governance.

• Counties should be provided with tools that help them to support local level work.