bluuebunny/crossref_metadata_2025 huggingface dataset:
“Economic migrants will anyway be deported soon”. Negotiating access and deservingness of refugees
Authors: Ziegler S , Bozorgmehr K
Published: October 2023

Background

Conflicting rationales permeate the European discourse on refugee migration: inclusiveness and human rights clash with xenophobia and aims to protect territory and wealth. Against this backdrop, health care access for newly arrived refugees in many European countries is restricted. The legal frame in Germany allows for extended restrictions as well as inclusive health care. While vague legal formulations create uncertainties regarding entitlements, they allow for discretionary decisions by a plethora of health care and government actors.

Methods

An ethnographic field study in two German refugee outpatient clinics including participant observation and interviews with 29 members of health care, administrative, social work and interpreting staff was conducted. By means of a qualitative content analysis we explored prioritisation criteria and negotiations about service provision to refugees by street-level decision-makers.

Results

Medical decision makers adopted government criteria to increase the chances of success of requests for reimbursement. We could identify various non-medical criteria, like asylum status and logistics impacting on access to care. Political and societal discourses seeped into discussions on granting or denying medical services: Medical and government decision-makers reflected on prospects of staying associated with the countries of origin of asylum seekers and illegitimate motives for flight, such as poverty, while negotiating what services should be provided to whom.

Conclusions

The vagueness of legal concepts allows for the implementation of restrictions based on non-medical grounds in practice, that would contradict international conventions if included in the legal norm unambiguously. In the face of contradictory imperatives, the state has chosen to leave policymaking to practitioners. They are in danger of being instrumentalized as agents of migration control, exclusion and deterrence, which raises practical and ethical questions.

Key messages

• Legal uncertainty leads to inconsistent medical care practices, that can exacerbate health inequities.

• Health professionals have to be made aware of their responsibility as gate keepers to the medical system for refugees, so they cannot be politically instrumentalized as agents of migration control.
Drug use among non-binary people in Europe: findings from European Web Survey on Drugs
Authors: Vale Pires Cristiana , Montanary Linda , Matias João
Published: October 2023

Traditionally, the survey-based methods used in drug research and drug monitoring at national and European levels tend to be blind to the specific experiences of non-binary people who use drugs. The invisibility of gender-diverse people is related to the use of standard one-step methods in the sex/gender demographic question, specifically the use of binary and mutually exclusive categories (male/ female or M/F). This presentation is based on the quantitative analysis of a sample of 817 non-binary people (non-probabilistic sample) who responded to the European Web Survey on Drugs 2021 (EWSD 2021), promoted by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). In specific, this presentation describes the sociodemographic profile, living conditions, drug use patterns (lifetime prevalence, last year's prevalence, last month's prevalence), and the context of drug use of non-binary people who responded to EWSD. The relationship between the non-binary gender identity and other categorical variables was analysed by using descriptive statistics and the Chi-square test for independence on the software IBM SPSS Statistics. This analysis allowed a preliminary identification of the specific drug use trends and health and social needs of non-binary people who use drugs, which will also be briefly included in this presentation. Moreover, this was the first time EMCDDA used a two-step approach method to collect data regarding sex (M/F) and gender (Man, Woman, Non-binary). In this sense, relevant methodological considerations regarding gender inclusiveness in survey data collection will also be presented, highlighting the relevance of systematically collecting gender-inclusive data to monitor gender-specific drug use patterns and trends and to inform the design of gender-responsive policies and social and health responses to drug problems.

Key messages

• Non-binary people who use drugs present gender-based specificities in drug use patterns.

• It is relevant to systematically collect gender inclusive data to monitor gender-specific drug use patterns and trends.
An international and interdisciplinary Delphi study to measure digital public health system maturity
Authors: Maass L , Zeeb H , Rothgang H
Published: October 2023

Background

The Covid-19 pandemic showed how crucial digital public health (DiPH) interventions are for continuous treatment and system sustainability. Several studies highlighted how the digital system transformation might improve access to and quality of healthcare services. However, there is no consensus on how to best assess the national readiness for the digitalization of such systems. Therefore, this Delphi study aimed to collect indicators to measure the maturity of DiPH systems nationally.

Methods

The three-stage international and interdisciplinary Delphi study included 82 experts. During the first round, participants proposed indicators to measure maturity among the technological and legal requirements of DiPH tools, the willingness of the general public to use them, and the degree of application of DiPH tools to the national healthcare system. The suggestions were qualitatively assessed and presented for ranking on a 4-point Likert scale during the second round. Experts were also able to rephrase or add indicators. In the third round, experts could only rank indicators.

Results

Finally, 96 indicators to measure the maturity of DiPH systems were finally. Of these, 31 fall under the legal and 24 under the technological requirements. 26 assess the social level and 15 the degree of application. All dimensions can be clustered into 3-4 sub-groups each. The qualitative analysis highlighted the importance of data protection regulations, affordable smartphone and internet access, interoperability between interventions, financial incentives, user motivation and literacy, and whether interventions were implemented as local pilots or national services.

Conclusions

The study identified indicators for interdisciplinary assessing DiPH system maturity. While this Delphi can’t answer how best to integrate these indicators into national health system evaluation procedures, this approach is an essential first step towards an index to measure the maturity of DiPH systems.

Key messages

• When assessing the digital public health system's maturity, one needs to include legal, technological, and social influencing aspects and not only evaluate the health services implementation degree.

• International and interdisciplinary Delphi study panels are vital for finding consensus on indicators to create tools of international importance and usability to measure health system maturity.
Contested and Evolving Pandemic – A Follow-up Study on National Policymakers’ Interpretations
Authors: Paananen H , Janhonen K , Kihlström L , Satokangas M , Tynkkynen L-K
Published: October 2023

Background

The prolongation of the COVID-19 pandemic has shown that perceptions of the crisis change over time. In this follow-up study we explore how national level policymakers interpret COVID-19 pandemic as a past, present, and future event and crisis. By doing so the contested nature of pandemic governance reveals, i.e. that the interpretations of the on-going crisis shape the policy choices and health system response. National policymakers have been demanded to make sense of emergent and ambiguous events and to form public health actions accordingly. Different interpretations on pandemic have been in core of pandemic governance and have influenced public policy and pandemic responses.

Methods

We applied a qualitative follow-up research design. Study informants were identified by purposive sampling by their position as central government pandemic policymakers in Finland. The semi-structured interviews were collected in 2021 (n = 21) after the first two pandemic waves, and in winter 2022-2023 (n = 16) after full vaccinations of the population.

Results

Three interpretations of COVID-19 were identified: Underlining the hard work needed to overcome the crisis, pandemic as a past event was framed through undeniable success. As an ongoing crisis, pandemic was discussed as having become mundane and less important on the public health agenda. As future crisis the pandemic was merged into a continuum of other (non-public health related) crises instead of being reflected solely from health perspectives.

Conclusions

The way of interpreting a crisis has significant influence on public policy. Prolonged pandemic showed contested nature of public health crisis in general public policy agenda; and its’ ending was not represented as clear cut, as it dissolved and was entwined into other crises and agendas. Crisis interpretations effect on future, since they profoundly affect how crises responses, future pandemic preparedness, policies or evaluation of effects are framed and formed.

Key messages

• Conceptions on COVID-19 crisis evolve in time and they effect policies to be formed.

• Contested nature of pandemic draws attention from solely public health policies into continuum of crises on public policy agenda.
Shifting towards a Well-being Economy in Wales for a fairer, sustainable and healthier society
Authors: Stielke A , Ashton K , Dyakova M
Published: October 2023

Wales, and other nations globally, face long-standing challenges such as climate change and on-going impacts of the pandemic. This has increased persisting health inequities, widening the health gap and putting health and social systems and other public services under even more pressure. Economic models that prioritise growth and profit over well-being of societies and the planet underpin these developments, this is unsustainable and threatens human, economic and planetary well-being. New political imperatives are emerging across Wales that foster new collaborations and innovative, sustainable and inclusive solutions that shift towards a Well-being Economy, creating shared and co-created well-being for current and future generations. Health is key component to create a Well-being Economy in Wales and is a driver and beneficiary. Public Health Wales’ work has been focused around the social determinants of health taking a holistic approach enabling cross-sector responsibility for health to shift to a Well-being Economy. Wales has created an enabling legislative environment with the (i) Well-being of Future Generations (Wales) underpinning all public body decisions, (ii) created a strong Foundational Economy and (iii) established a Future Generations Commissioner that encourages public bodies to take greater account of the long-term impact of their decisions. Metrics were implemented that go being Gross Domestic Produce (GDP) and monitor well-being outcomes in all sectors decisions. Welsh culture and language has been vital to create a sense of belonging and community cohesion building trust and healing social fractures. Shifting towards a Well-being Economy in Wales takes a whole of systems approach, working across sectors at all levels. A variety of mechanisms such as legislations, metrics, accountability measures and participation takes the approach forward. Public health appears to be a driver, co-creator and beneficiary in the approach.

Key messages

• Re-envisioning the economy in Wales towards a Well-being Economy is crucial to improve health and well-being and tackle inequalities.

• Wales’ Well-being Economy approach has created a national cultural change at all levels that focuses on co-created well-being for all.
Comparison of the Choices criteria with national logo criteria in Sweden and Singapore
Authors: Tognon G , Lee C , Chan W K , Ingman A , Wasserman M , Hunsberger M , Lissner L , Middelham J , Roodenburg AJC , Smorenburg H
Published: October 2023

Background

Food-based dietary guidelines often do not consider processed food products and typically do not address the rising popularity of plant-based meat and dairy alternatives or non-nutritive sweeteners. Multi-level nutrient profiling systems, such as the Choices 5-level criteria, can surmount these limitations and support nutrition policies, including the development and enhancement of national front-of-pack labeling systems. Nevertheless, new criteria for plant-based meat and dairy alternatives, as well as for foods containing non-nutritive sweeteners, must be established.

Methods

This study investigates the comparison of the Choices criteria with the Keyhole logo used in Sweden and the Healthier Choice Symbol employed in Singapore and proposes adaptations to align with food-based dietary guidelines. Additionally, scoping literature reviews on the health effects of non-nutritive sweeteners and international policies guiding their use were conducted. Alignment was evaluated by determining whether foods categorized as healthy by Choices (i.e., classified as level 1 or 2) were also eligible for a national logo in Sweden and Singapore.

Results

The results demonstrated that Choices can serve as a foundation for national endorsement of logo criteria. Qualifying criteria for plant-based meat and dairy alternatives, as well as for non-nutritive sweeteners, were also developed.

Conclusions

The Choices 5-level criteria can support stimulating and restrictive nutrition policies and facilitate a desirable transition to a healthier, more plant-based diet.

Key messages

• Food-based dietary guidelines often do not consider processed food products and typically do not address the rising popularity of plant-based meat and dairy alternatives or non-nutritive sweeteners.

• The Choices 5-level criteria can support stimulating and restrictive nutrition policies and facilitate a desirable transition to a healthier, more plant-based diet.
An equity lens on COVID-19 transmission policies in Catalonia, Spain: a PROGRESS-PLUS analysis
Authors: Gutiérrez-Zamora Navarro M
Published: October 2023

COVID-19 pandemic has affected all individuals, but especially vulnerable populations. In Spain, Catalonia has been the most affected region by the infection, with higher incidence rates among foreigners, certain occupations, and neighborhoods. Interventions addressing differential vulnerability to infection are crucial in addressing the impact of social factors on pandemics. I aimed to describe the presence of social factors in the formulation of policies to address COVID-19 transmission in Catalonia, Spain. For this, a descriptive policy analysis on the frequency of the presence of social factors was carried out using the PROGRESS-PLUS framework, from the Campbell and Cochrane Equity Methods Group. It represents 8 dimensions of inequalities: Place of residence, Race, Occupation, Gender/sex, Religion, Education and Socioeconomic status. ‘Plus’ refers to other dimensions that may imply inequality. For the production of results, 29 policies were analyzed. Only policies formulated between the two states of alarm and the de-escalation phase were included (March 14, 2020-May 9, 2021). Of these, 72.4% (n = 21) mention at least one component of the framework. ‘Age’ was the most mentioned component 37.9% (n = 11); followed by ‘Occupation’ (27.6%, n = 8); ‘Place of residence’ (10.3%, n = 3). ‘Gender’ and ‘Income’ were mentioned once (3.4%). ‘Educational level’ and ‘Race’ were not mentioned in any policy. For ‘Plus’ component, 18 policies (62.1%) mention some dimension of vulnerability, such as disability, mental disorders, immigration, deficient housing conditions or ‘vulnerable groups’ but without specifying who these groups are. To conclude, it is necessary to increase the relevance of health equity when formulating policies to face future pandemics. It is needed to establish protocols that consider inequality in pandemics, in conjunction with investing in public health and healthcare. Further research on this issue is also relevant to draw lessons learned for future pandemics.

Key messages

• Despite the mention of axes of inequality in most of the policies studied, it is necessary to increase the priority of health equity in its formulation, especially for future pandemics.

• Since inequality is a structural issue, protocols should be implemented before health emergencies occur in order to increase their effectiveness in terms of equity and health outcomes.
A mapping review of study designs and statistical methods used in early COVID-19 impact research
Authors: Feteira-Santos R , Jorge Nogueira P
Published: October 2023

Background

The COVID-19 Pandemic has prompted a significant amount of research investigating the direct and indirect impacts of the disease on the population's health and well-being. However, the plethora of published literature on the topic requires its analysis to identify commonalities and potential areas for improvement. This study aims to describe the use of study designs and statistical methods in COVID-19 research to inform evidence-based decision-making.

Methods

PubMed was searched using “covid-19” and “data” terms to retrieve records until November 2020. Articles reporting direct or indirect impacts of COVID-19 were included based on predefined criteria, and their methods sections were analysed using the R software. The full text was considered if the methods section could not be found parsed. Text-mining-related R packages were used to identify terms reporting study designs and statistical methods.

Results

Of the 19837 records retrieved, 5473 were included after the screening stage, and 4463, for which the full text or methods section could be fetched, were analysed. Direct impacts of COVID-19 were reported in 2771 articles (62.1%) and indirect in 1692 (37.9%). Surveys, cohorts, trials, and cross-sectional designs were the most used in early COVID-19 research, with their frequencies differing between studies assessing direct and indirect impacts. Descriptive statistics were the most mentioned statistical method (88% of studies, n = 3937), followed by student's t-test (25.5%, n = 1138), logistic regression (23.3%, n = 1038) and chi-square test (22.3%, n = 997).

Conclusions

This comprehensive overview of methodologies of early COVID-19 research highlights potential implications for the level of evidence produced by studies investigating the direct and indirect impact of the disease. The findings can guide policymakers and stakeholders on which evidence can support recommendations and which research gaps need to be addressed for better preparedness in future pandemics.

Key messages

• Early COVID-19 research employed different study designs and statistical methods in studies assessing its direct or indirect impacts, with potential implications in the evidence produced.

• A comprehensive overview of methodologies used in early COVID-19 research can help evidence-based decision-making, address research gaps, and better prepare for future pandemics.
Heat health action plans: a European perspective
Authors: Lampl C , Schmidt A E , Brugger K , Kendrovski V
Published: October 2023

Background

With average temperatures on the rise, collaboration of European countries regarding climate change adaptation and climate resilience of their health systems is becoming an important lever for protecting older people, while recognising the diversity of older people's living environments, socio-economic conditions, as well as intersectionalities with gender and race within different subgroups of older people. Heat-health action plans (HHAPs) are one example where a common European framework (e.g. within the WHO-European region) may guide general measures, yet without being able to account for context-specific, geographic and population-specific conditions in each country, or at the subnational level.

Objective

Along WHO-Europe's framework for HHAP, this presentation aims to provide an overview of the core elements in place at the European level that public health officials can utilise to protect older people from heat and/or prevent heat impacts on older people, and will highlight the barriers and enablers for action. The presentation will also examine current levers and assets that exist at European, sub-national and local/municipal level to strengthen responses.

Results

Using examples from across European countries, the presentation summarises the current strategic and policy context framing responses to heat health for older people and will highlight what has worked well and where further work needs to be done. The presentation will also inspire dialogue among attendees, sharing knowledge from their countries and contexts.

Conclusions

A more targeted approach leveraging existing strategies and assets is needed to support policy-makers in implementing interventions to protect older people within the context of current HHAPs at different governance levels.
How to evaluate small-scale interventions in deprived neighborhoods?
Authors: Vendrig-de Punder YMR , Koops-van Hoffen H E , Borlee F , Droomers M , Seeleman M C , Kamphuis CBM , van Lenthe F J , Vermeulen RCH , Jambroes M
Published: October 2023

Background

In deprived neighborhoods there is not only an accumulation of public health problems, but also an accumulation of small-scale interventions to address these problems. For evidence based public health policy it is important to know which interventions are most effective. However, many small-scale interventions are not well evaluated because standard research methods are not sufficient to provide information about the vulnerable target group. Therefore in the IGLO Utrecht study we developed an evaluation method for small scale interventions in the living environment of deprived neighborhoods.

Methods

Principles from the quadruple helix approach were combined with core components of a methodology for reaching a hard to reach population. This was applied in three studies in a deprived neighborhood in Utrecht: health evaluation of the renovation of a social housing flat, a study about redevelopment in the neighborhood and a study about health-related reasons to visit nature. The intervention and the geographical area of the expected effect on residents health were discussed with professionals. Details about the personal approach, choice of words in the announcement letter and questionnaire were developed in collaboration with an advisory group of residents.

Results

Linking the study to the intervention in the neighorhood was helpful in making contact with residents. The response rate of the questionnaire was 49% (86/174) with reach out by telephone, 34% (140/414) with a combination of telephone and door-to-door and 31% (64/209) with a reach out door-to-door. Participants were representative for the neighborhood regarding migration background and education level. Field notes about the informal contact provided additional information to the questionnaires.

Conclusions

Close collaboration with professionals and residents contributes to a high response in the health evaluation of small-scale interventions. The personal approach is very time-consuming.

Key messages

• Close collaboration with professionals and residents contributes to a targeted approach and higher response in the health evaluation of small scale interventions in deprived neighborhoods.

• A thorough evaluation of small-scale interventions in deprived neighborhoods is possible, when enough time, budget and capacity can be made available.
Disparities in HIV Testing among Adults with Adverse Childhood Experiences
Authors: Gupta S
Published: October 2023

Background

It is estimated that more than 13% of persons 13 years and older living with HIV are unaware of their status. 80 percent of new HIV infections are transmitted by people who are not aware they have HIV or not receiving any HIV care in the US, presenting a major public health concern and stressing the importance of enhanced HIV screening. Adverse Childhood Experiences (ACEs) have been shown to be risk factors for HIV transmission and studying the relationship of ACEs and the likelihood of HIV screening is thus important to explore.

Methods

Using combined data (2019-2021) from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) dataset, adjusted analyses models were constructed to determine the likelihood of adults receiving HIV testing and their past history of ACEs.

Results

Overall, compared to individuals reporting no ACES, individuals reporting 1 to 3 ACEs were significantly more likely to be tested for HIV. However, despite higher prevalence of ACEs, significantly higher prevalence of men who have sex with men (MSM) remained unaware of their HIV status. Significant disparities in HIV testing were also observed by socio demographic characteristics.

Conclusions

Healthy People 2030 aims to increase the proportion of persons who know their HIV status to at least 95% by 2025. Our findings highlight the urgent need for targeted interventions that target high risk groups, promote testing benefits, and encourage increased testing among individuals with a history of ACEs. Given the importance of testing to HIV prevention outcomes, more research is needed to unpack the relationship between HIV risk and HIV testing for individuals with a history of childhood adversity.

Key messages

• New trauma-informed training programs for health care providers are needed to facilitate targeted HIV testing.

• Ongoing research is critical to unpack the relationship between HIV risk and HIV testing for individuals with a history of childhood adversity.
Community Interpreting in Germany - Interpreters’ working conditions and qualification
Authors: Hanft-Robert S , Kreienbrink A , Mösko M
Published: October 2023

Background

Community Interpreters (CI) play a crucial role in multilingual communication in health care and community services. Since CIs in Germany are mainly organized on a regional basis, there are no nationwide data available. The aim of this explorative cross-sectional study is to gain a better understanding of the work of CIs in Germany.

Methods

In cooperation with the Federal Chamber of Psychotherapists and the Federal Association of Non-statutory Welfare, a nationwide online survey was conducted between June and August 2022. Interpreters’ working conditions and qualification were assessed. Interpreters were recruited primarily through interpreter pools and training institutions in Germany.

Results

Across all 16 federal states, n = 1199 people clicked on the survey, of which n = 873 responses were usable for analysis. Most of the participants are female (74%) and born abroad (77%). The average work experience as interpreters is MED = 6 years (IQR = 3-10). 44% reported interpreting every now and then in their leisure time. The median hours of interpreting per month is 10 hours (IQR = 5-30). Most often they interpret in person (MED = 90%, IQR = 80-100%). They work in MED = 4 different areas (e.g. health care, education, social services, authority, court or police). 27% stated interpreting in six or more different settings. 69% have attended interpreting training (MED = 20 hours, IQR = 10-70), 29% of them passed a final exam. Of those who have never attended any training, 69% consider themselves as rather/very competent in interpreting.

Conclusions

This study provides a first national data basis for the group of CIs in Germany. People who work as CIs work in various fields. A large percentage do not interpret on a full-time basis. Most interpreters lack formal training for interpreting.

Key messages

• Community Interpreters in Germany lack formal training and qualification for interpreting.

• Interpreting in health and community services is primarily a job that is done on the side.
Early life factors and grip strength at older ages in two distinct populations in China and England
Authors: Chisala M , Leah L
Published: October 2023

Background

Early life factors are associated with poor physical and mental outcomes in late life. However how these are associated with grip strength, an objective measure of physical capacity and therefore morbidity and mortality in late life unclear. This analysis therefor explores the long-term effects of adverse childhood socioeconomic experiences and health on grip strength in late life, and how these are mediated by adult factors.

Methods

Data on early life events, health and socioeconomic factors and grip strength were collected from the China Health and Retirement Longitudinal Study (CHARLS) and English Longitudinal Study of Ageing (ELSA). Participants’ first entry into the survey from waves 1-3 in CHARLS and waves 1-9 in ELSA were included in the analysis. Sex stratified linear regression models were used to explore how early life factors affect grip strength. Childhood events included parental socioeconomic position and childhood health.

Results

17,205 participants from CHARLS and 6,692 participants from ELSA were included in this analysis. Unlike ELSA, participants from CHARLS were younger, had lower education, low-income occupation and obese. Low parental education and poor child health perception were negatively associated with grip strength even after controlling for childhood and adult factors (adult socioeconomic position, adult body size, adult health and lifestyle) in men from both studies. While parental occupation was associated with grip strength for both males and females in both studies. Association of SEP and health in childhood with grip strengths at older ages were however explained by body size and adult health factors, and not adult SEP.

Key messages

• Early life socioeconomic position has a persistent effect of late physical health, even after considering adult health, socioeconomic position and lifestyle.

• Early intervention in socioeconomic inequalities might improve health outcomes across the life course.
Effective promotion of sustainable wellbeing among older people: the social quality approach
Authors: Mäki-Opas T
Published: October 2023

Background

Social quality approach examines the elements of social and health policies that should constitute a decent society that quarantines sustainable wellbeing for all. We co-developed and evaluated the effectiveness of a comprehensive intervention for promotion social quality among older people to answer their multiple wellbeing needs.

Methods

Participatory workshops were held for older people aged 70+ years (N = 76) and for public-private-NGOs (n = 35) working with them in Finland. The co-develop model was piloted and evaluated using quasi-experimental design with 4 months follow-up measurements. Qualitative interview data were collected from older people and managers. Thematic analyses was applied using the elements of social quality: socioeconomic security, social empowerment, social inclusion, and cohesion.

Results

Older people reported having poor socioeconomic security (unequal access of multidisciplinary services), poor empowerment (insufficient skills to use the digital services), and low cohesion (lack of trust to local service providers). The developed intervention effectively supported older people's perceived social quality: socioeconomic security, empowerment and cohesion.

Conclusions

Sustainable wellbeing promotion among older people should constitute from the socioeconomic security but also empower and build trust to public stakeholders. The co-developed intervention group model could be one solution for this and to support older people to live a healthy and meaningful life at home.

Key messages

• The inclusive approach to wellbeing promotion could help to health and social service provided to answer the multiple health and wellbeing need of the older people.

• The wide stakeholder collaboration between public, private and non-governmental organizations is essential in developing, producing and evaluating the multidisciplinary services for older people.
Semmelweis Caring University Model Program: A Holistic Approach to Promoting Healthy Ageing through a Longitudinal Cohort Study, Preventive Services and Workplace Health Promotion
Authors: Ungvári Z , Adany R , Tabak A , Purebl G , Kaposvari C , Fazekas-Pongor V , Östlin P , Yon Y , Voko Z , Merkely B
Published: October 2023

Hungary is facing an alarming public health situation due to the unhealthy ageing of its population, calling for innovative and effective approaches to promote healthy ageing. This presentation showcases the Semmelweis Caring University Model Program, a unique and holistic program developed by the leading health sciences university in Hungary to address this societal challenge. The program serves as a model for the ongoing primary care reform, which incorporates preventive services, the first study to address determinants of unhealthy ageing in Hungary, and includes a workplace-based health promotion program that could be implemented nationally. The Semmelweis Caring University Model Program aims to promote the health and wellbeing of its 8500 employees and provides potential answers to the unfavorable public health situation in Hungary. The Semmelweis Study, a longitudinal occupational cohort of university employees, investigates the complex relationships between lifestyle, environmental, and occupational risk factors and the development and progression of chronic age-associated diseases. Data is collected through computer-assisted questionnaires, physical health examination, physiological measurements, biomarker assessment and data linkage to national registers. The results of the Semmelweis Study inform the development of the Centre of Preventive Services (CPS), which provides health risk assessment, screening, and counseling services to employees, with medical specialists in preventive medicine and primary care, public health professionals, dieticians, physiotherapists, and psychologists. The CPS units also serve as practical training sites for medical and health sciences students. The Semmelweis Workplace Health Promotion Program is a personalized public health model program that utilizes infrastructure and human resources of Semmelweis University to encourage healthy behaviors and environments in the workplace, with a potential for nationwide implementation.
School toilets use: the perspective of French school doctors
Authors: Godeau E
Published: October 2023

Background

Access to school toilets, seems no more an issue in France. However, presence does not mean use. We will illustrate the underuse of school toilets by pupils from the perspective of school doctors (SD). In France, prior being in post, SD are trained for a year, during which they have to work on a relevant school health topic, here school toilets.

Results

Almost 40 years ago, visiting over 500 rural primary schools, a SD found 14% of toilets in an << intolerable state >>. Children complaints were in accordance. Twenty years later, in a questionnaire (126 girls; urban secondary school), another SD found that 31% do not use school toilets, 45% do not feel secure, 91% find them dirty and smelly, 9,5% experience bladder weakness. Daily observations of toilets revealed a conflict between disciplinary rules and students’ fundamental needs. In 2018, 2119 questionnaires of parents about their children's behaviours and perceptions about school toilets found an overall use of 87% while 69% of pupils had an appropriate use for urine. The main obstacles reported to use were lack of hygiene and comfort (51%), lack of security or privacy (33%) and limited accessibility (28%). Last, in 2022, 24 SD conducted a collaborative project on school toilets. In a health promotion perspective, they collected data from 164 adults and 225 pupils. They agreed on one global aim: “School toilets, a place of challenges and a reflection of the well-being of each and every one”; one health priority: “Ensuring appropriate and respectful access for pupils’ needs”, and one general objective: “Mobilize all actors to ensure access to toilets and uses that respect the basic needs of pupils”. Currently two SD are developing a questionnaire assessing the state of schools toilets.

Conclusions

still and even in France, pupils underuse school toilets, causing medical problems, lowering school well-being with the risk to endanger learning availability, confirming that this is a true public health issue.
Active commuting and low-grade inflammation: a population-based cross-sectional study
Authors: Allaouat S , Halonen J I , Jussila J J , Tiittanen P , Ervasti J , Ngandu T , Mikkonen S , Jousilahti P , Lanki T
Published: October 2023

Background

Active commuting (i.e., walking and cycling to work) could have public health benefits while simultaneously fostering climate change mitigation. Current evidence suggests that regular physical activity decreases circulating C-reactive protein (CRP) levels. Yet, it is unclear whether active commuting is associated with lower CRP levels. Study aims: To explore the association between active commuting and CRP levels in working Finnish residents. Our hypothesis is that CRP levels are lower in active commuters than passive commuters.

Methods

A total of 6208 working Finnish residents were drawn from the FINRISK population surveys of years 1997, 2002, 2007 and 2012. We cross-sectionally analysed the association between active commuting, defined as the time spent walking or cycling to work daily, and high sensitivity (hs-) CRP serum levels in this sample. For the analyses, we used linear and additive models, and we adjusted for potential confounders.

Results

Participants who engaged in a minimum of 45 minutes of daily active commuting had 16.8% (95% confidence interval, CI: -25.6%, -7.0%) lower hs-CRP than passive commuters. The direction of the association in the main model was the same when active commuting lasted 15-29 minutes daily (% mean difference: -7.4; 95% CI: -14.1, -0.2), but the estimates lacked precision after adjusting for leisure-time physical activity and diet. In subgroup analyses, we observed associations for women.

Conclusions

High level of active commuting, at least 45 minutes a day, was associated with reduced low-grade inflammation; the association was driven by women.

Key messages

• Promoting active commuting could help reduce many chronic diseases.

• Active modes of transport, such as walking and cycling, may not only be an alternative to motorized vehicles to decrease emissions, but they may also have public health benefits.
Impact of air pollution on mortality: geo-epidemiological study in French-speaking Africa
Authors: Capitanio L , Josseran L , Ratte S , Gautier S
Published: October 2023

According to the WHO, air pollution is responsible for 90% of deaths in Africa. However, few data on exposure to air pollution is available, and studies are rare, particularly in French-speaking Africa. This study aims to investigate the impact of air pollution on mortality in 13 French-speaking African countries (Algeria, Benin, Burkina Faso, Burundi, Cameroon, Ivory Coast, Guinea, Madagascar, Mali, Morocco, Democratic Republic of Congo, Senegal, Tunisia). Using data from the IHME, annual concentrations of the PM2.5 pollutant from different cities were integrated into a spatial interpolation model (IDW) at the scale of each country. The interpolation was validated using cross-validation models. For each of the considered cardiorespiratory diseases (LRI, stroke, COPD, IHD), the attributable mortality fraction was estimated using literature data and population exposure calculated using demographic data from each country. Large variations in concentration between the 13 countries are observed, with concentrations ranging from 1.76µg/m3 in Morocco to 67.03µg/m3 in Benin. Concentrations are higher in West Africa than in Central or North Africa. In 2019, 291,417 deaths attributable to air pollution were recorded in the 13 countries: 19.7% for ischemic heart disease, 6.5% for lower respiratory infections, 3.6% for chronic obstructive pulmonary disease, and 18.8% for stroke. Our model allowed us to obtain a spatial distribution and the number of deaths related to air pollution. However, the health impact of pollution could be improved by more systematic and comprehensive data collection through a system for monitoring concentrations of atmospheric pollutants.

Key messages

• This study estimates the number of deaths attributable to air pollution in 13 French-speaking African countries using a spatial interpolation model.

• This study highlights the need for more data on air pollution exposure in French-speaking Africa.
Foresight for policy making to be better prepared for the future
Authors: Moye-Holz D , Mutubuki E N , de Vries M , Hilderink H
Published: October 2023

Background

The COVID-19 pandemic showed that we were not prepared for unexpected and uncertain events. Foresight provides a process that explores the future to anticipate such events and be better prepared. However, in public health, foresight is underdeveloped and underused. It is necessary that policy makers and stakeholders realize the potential and benefits of including foresight into the policy cycle and advocate towards its implementation.

Methods

Foresight provides a systematic, participatory, and vision-building process that explores the future to anticipate trends and support present-day actions. It provides a participatory platform to discuss such trends and explore different scenarios to get insights into possible challenges and how to address them.

Results

Foresight studies can allow policy makers to discuss trends, build scenarios, and anticipate future challenges while also exploring desirable futures. We propose several recommendations to professionals and policy makers to include foresight into the policy cycle to promote sustainable and resilient health systems.

Conclusions

Foresight does not predict the future, it rather explores it through plausible scenarios that consider uncertainty. It provides an overview into possible future challenges to allow present-day policies that anticipate and address these challenges. Implementing foresight into the policy cycle can be a strategic tool towards addressing uncertain challenges and building desirable futures.
Socioeconomic inequalities in noncommunicable diseases in Portugal: an analysis of three decades
Authors: Martins Teixeira M , Varela A , Santos J V , Perelman J , Leão T
Published: October 2023

Background

Least favored people experience poorer health than those with higher socioeconomic (SE) status. These inequalities are mainly due to disparities in noncommunicable diseases (NCD). Over the last decades, Portugal experienced important SE challenges, including the recession, making it fundamental to assess how health inequalities have been affected. Hence, this study aimed to examine the evolution of SE inequalities in the prevalence of NCD in Portugal in the last 32 years.

Methods

We used data from all the six National Health Interview Surveys (1987, 1995, 1999, 2005, 2014, and 2019). Considering the main causes of morbimortality and data availability, we selected seven self-reported NCD: diabetes, hypertension, stroke, acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), asthma, and depression. We estimated the relative (RII) and absolute (SII) indexes of inequalities using education and income as proxies for SE status, adjusted for sex and age, for each NCD and survey.

Results

Regarding education, RII decreased until 2005 but increased since 2005 for diabetes (RII87=4.4; RII05=2.0; RII19=2.6) and hypertension (RII87=1.8; RII05=1.3; RII19=1.8). For asthma, RII oscillated until 2005 but increased since then (RII05=0.9; RII19=1.9). Although data for the remaining diseases are only available since 2005, an upward trend in educational RII is noticeable in stroke (RII05= 2.1; RII19=4.3), AMI (RII05=0.9; RII19=3.4), COPD (RII05=1.4; RII19=2.2), and depression (RII05=0.9; RII19=2.1). The results for SII and using income as SE indicator followed similar trends.

Conclusions

This study found persisting inequalities in NCD, with an increasing trend after 2005. These findings are of concern since they emphasize the persistence of health inequalities and the vulnerability of the most deprived groups to economic crisis. Health and social policies are crucial to attenuate these inequalities, especially considering the announced financial crisis.

Key messages

• In Portugal, socioeconomic inequalities in noncommunicable diseases have been increasing since 2005.

• It is crucial to tackle inequalities in health, especially considering the predicted economic crisis and the vulnerability of the most deprived groups to such events.
Contribution of meat-free days, meat-free meals, and portion sizes to UK meat consumption declines
Authors: Bellows A , Jaacks L , Alexander P , Stewart C
Published: October 2023

Background

In the UK, reduced meat consumption is needed to protect planetary health and reduce noncommunicable disease. An analysis of the UK's National Diet and Nutrition Survey (NDNS) found from 2008-2019, daily meat consumption per capita decreased from 103.7g to 86.3g (∼1.7% per annum). This trend is not fast enough to meet reduction targets, such as the National Food Strategy's goal of a 30% reduction by 2030.

Objectives

This study aimed to examine behaviours driving the reduction in meat consumption. Specifically, we investigated two key strategies: reduced consumption frequency and smaller portion sizes.

Design: Using NDNS rolling programme (2008/09-2018/19) data, we evaluated changes in: 1) the number of meat-eating days, 2) the number of meat-containing meal occasions, and 3) the portion size of meat per meat-containing meal occasion using Poisson and linear regression models. Meat consumption was based on disaggregated data from 4-day food diaries. Using decomposition analysis, we estimated the proportion of responsibility for each consumption behaviour relative to the overall decrease in consumption.

Results

The mean number of meat-eating days decreased from 3.3 to 3.0 days (P < 0.001), the mean number of daily meat-containing meal occasions decreased from 1.2 to 1.1 occasions (P = 0.01), and the mean portion size of meat decreased from 85.8g to 76.1g (P < 0.001). Portion size contributed most to the reductions in meat consumption (57%), followed by meat-eating days (37%), and meat-containing meal occasions (6%).

Conclusions

Our findings suggest the decrease in UK meat consumption can be largely attributed to smaller portion sizes of meat. Understanding the nuances of meat consumption behaviours (i.e., “meat-free days” vs. “meat-free meals” vs. “low-meat meals”) could help tailor behaviour change interventions by showing the need for a focus on promoting low-meat meals to accelerate reductions in meat consumption toward population and environmental health goals.

Key messages

• The decrease in UK meat consumption is largely being driven by reductions in portion size of meat at meal occasions.

• Understanding nuances of meat consumption behaviours can help tailor behaviour change interventions by showing the need for a focus on promoting low-meat meals to accelerate reduced meat consumption.