bluuebunny/crossref_metadata_2025 huggingface dataset:
Five-year cancer survival rates in Monastir, Tunisia
Authors: Zemni I , Maatouk A , Bennasrallah C , Kacem M , Dhouib W , Abroug H , Ben Fredj M , Bouanene I , Sriha A
Published: October 2024

Background

Cancer is a major public health problem worldwide. To the best of our knowledge, there is no Tunisian population-based registry studies investigating cancer survival in Tunisia. The objectives of our study were to estimate the five-year cancer survival rates in the province of Monastir, Tunisia.

Methods

We performed a retrospective cohort study including patients originating from Monastir diagnosed with cancer between 2002 and 2014. Data were collected from the cancer register of the center. Patients were followed until December 2022.

Results

In total, 9318 cancer cases were identified of whom 5741 were included for the survival analysis. The 5-year cancer survival rate, all sites combined, was 46% (95% CI: 45-47.3). Among the 10 most frequent cancer sites in Monastir, cancers having the lowest 5-year survival rates were lung cancer in men (18.2% (95% CI: 15.6-20.7)) and stomach cancer in both sexes (32.1% (95% CI: 23.4-40.7) and 25.3% (95% CI: 16-34.5) in men and women respectively). The cancers with the highest 5-year survival rates among men were skin cancer (other than malignant melanoma) (64% (95% CI: 54.5-73.4)), prostate cancer (59.1% (95% CI:54.7-63.4)) and colon cancer (55.1% (95% CI: 47.7-62.4). In women, cervical cancer (70% (95% CI: 61.8-78.1), skin cancer (other than malignant melanoma) (66.2% (95% CI: 55.1-77.2) and breast cancer (63.8% (95% CI:58.8-67.7)) were those with the highest 5-year survival rates. Patients ≥ 65 years had the lowest 5-year survival rates for almost all cancer sites in both genders.

Conclusions

Our study has shown that cancer survival rates in Tunisia remain low compared to developed countries. The widespread implementation of cancer control programs including healthy lifestyle, education, screening and early detection are urgently needed.

Key messages

• The 5-year cancer survival rate, all sites combined, in Monastir was 46% (95% CI: 45-47.3).

• Cancers with the lowest 5-year survival rates in Monastir were lung cancer in men and stomach cancer in both sexes.
Exploring Sense of Coherence and Death Anxiety among patients with Chronic Illness in Greece
Authors: Papadakaki M , Alexias G , Maniou M , Togas C , Braila E E , Lioliou S , Kounali V , Vagionaki K , Pedioti N , Markakis G
Published: October 2024

Introduction

Chronic illness often brings about existential concerns, including fear of death, which can significantly impact individuals’ well-being. The concept of sense of coherence provides a framework for understanding how individuals perceive and cope with stressors, including those associated with chronic illness.

Purpose

This study investigated the correlation between Sense of Coherence, death anxiety, and chronic illness among Greek patients, aiming to understand how these factors interplay.

Methods

An electronic survey was distributed to chronic illness patients in Greece. Sense of Coherence was measured using the Sense of Coherence scale, while death anxiety was assessed using the Collett-Leste Fear of Death scale. Various chronic conditions were considered, and demographic data were collected.

Results

The final sample consisted of 118 participants (female 79.7%; death anxiety score=mean109.2, Sd = 19.2; sense of coherence score=mean55.12, Sd = 13.61). Women and the age group of 58-65 years presented higher death anxiety score followed by the group of 34-41 years. No differences were found between genders in terms of sense of coherence. The highest coherence was manifested in the age group of 50-57 years and the lowest in the age group of 42-49 years. A significant negative correlation was observed between sense of coherence and fear of death (rs(118)= -.299, p < .01). Further correlation tests were performed between axes of coherence, which indicated a stronger negative correlation in two of the three axes of the sense of coherence (Manageability and Meaningfulness) and among all the axes of fear of death, beyond the first, which concerns the loss of one’s own life.

Conclusions

The study suggests that individuals with a stronger sense of coherence experience lower death anxiety. Understanding these dynamics is crucial for tailored patient interventions and support strategies.

Key messages

• Gender and age-specific variations exist in how people approach and experience disease and mortality.

• Understanding patients’ coping mechanisms and perceptions of illness is important in disease management.
Climate change and its health effects - an optional subject for medical students
Authors: Abram Z
Published: October 2024

The Standing Committee of European Doctors urged to include training on the impact of climate change on health for health professionals. Currently, in the curriculum of most medical schools, the health-related impacts of climate change represent a peripheral part. The teaching of health effects of climate change should be made part of the training of health professionals and should be introduced in the curriculum of medical schools. ClimateMed is an Erasmus project that improves the curriculum and expands knowledge about the health effects of climate change at medical universities. The World Café method, based on round table discussions, was applied to assess the needs, summarize the proposals, and develop the necessary strategy. At the same time, a questionnaire was applied to those medical students from UMFST Targu Mureș who chose this subject as an optional subject. Students related the importance of understanding the diseases caused directly or indirectly by climate change, and reported what kind of topics should be included in a new course, in which semester/module and in what format it would be appropriate to teach it. The most frequently reported topics were: excessive heat and heat-related illnesses, extreme weather, vector-borne diseases, food safety, air pollution, and mental health. According to the goals of the project and students’ opinions, since 2023 medical students can choose Climate Change and Health Effects as an elective course. Based on the demand for medical universities to include in their curriculum knowledge related to the health effects of climate change, ClimateMed project can facilitate this integration and can promote the increase of teacher motivation and the development of methodological guidelines for university teachers. The project contributes to the preparation of some educational materials and the introduction of an optional subject in the training curriculum of the students of the Faculty of Medicine, UMFST Targu Mureș.

Key messages

• There must be made efforts to include training on the impact of climate change on health for health professionals, to introduce this subject in the curriculum of medical schools.

• ClimateMed project can facilitate the integration of knowledge about the health effects of climate change into curriculum and can promote the practical use.
Heatwaves, Hospitals, and Health System Resilience in England: A Qualitative Assessment (Summer 2019)
Authors: Brooks K , Landeg O , Kovats S , Sewell M , Oconnell E
Published: October 2024

Background

Frequent heatwaves challenge healthcare delivery in England, affecting patient safety and staff welfare. This study addresses the observational gap in how healthcare settings adapt to extreme weather.

Methods

We utilised a qualitative approach, conducting semi-structured interviews with fourteen NHS staff across England to explore experiences during the 2019 summer heatwave. Participants included clinical and non-clinical personnel, providing broad insights into operational challenges and adaptive strategies.

Results

The 2019 heatwave significantly disrupted service delivery, with variable staff awareness of the Heatwave Plan for England affecting responses. Key issues included managing infection control versus electric fan usage, impacting patient and staff comfort and safety. These conditions also led to an increase in hospital admissions.

Conclusions

The findings highlight the need for improved workforce training and strategic planning to enhance resilience to heat-related risks. Further research is essential to develop a comprehensive evidence base on the impacts and costs of heatwaves and to assess the effectiveness of adaptation strategies. This will support national health adaptation planning and emergency response.

Key messages

• Enhanced planning and training are crucial for health system resilience to heatwaves.

• More research is needed to understand heatwave impacts and effective responses.
Flooding and Mental Health interventions for vulnerable groups
Authors: Munro A , Armstrong L , Tran A , Landeg O , Petrokofsky C , O’Connell E , Kar-Purkayastha I , Rajamani A , Coleman P , Sousa A
Published: October 2024

Issue/Problem

The UK is increasingly vulnerable to flooding due to climate change, which significantly affects mental health. Vulnerable populations are disproportionately impacted, experiencing stress, anxiety, and other severe mental health issues, requiring effective intervention strategies.

Description of the problem

The UK’s third Climate Change Risk Assessment (CCRA) highlights flooding as a key challenge, with mental health impacts representing a major health burden. Effective interventions are crucial for these communities.

Results

UKHSA’s flooding and mental health guidance is incorporated into flooding and health advice documents for the public and frontline responders. It includes assessment and support strategies for health and social care staff, emergency responders, and local authorities. It focuses on those most at risk and promotes a phased approach to care-from immediate safety and shelter to long-term psychological support. This strategy accommodates the prolonged nature of mental health recovery, requiring adaptable and sustained interventions.

Lessons

Addressing the mental health impacts of flooding demands a comprehensive, multi-phase strategy that adapts to the evolving needs of affected populations. Early intervention and long-term support are vital to mitigate the extensive psychosocial damage.

Key messages

• Flooding severely affects mental health, necessitating structured, long-term interventions.

• Flexible support strategies that evolve over time are crucial for effective recovery, ensuring that interventions meet the changing needs of those impacted by flooding.
Clean-up actions as catalysts for sustainability and physical activity promotion
Authors: Rosa G B , Ourique M
Published: October 2024

Issue

The convergence of global sustainability and health promotion implies integrated policies and actions. Initiatives like the European Green Deal and the UN’s Sustainable Development Goals emphasize the urgent need to address climate change while promoting health through behaviours such as physical activity (PA).

Description

We explore the relationship between PA, sustainability, and health outcomes, highlighting the European Green Deal’s impact on PA promotion and the 2030 Agenda for Sustainable Development’s alignment with health behaviours. In addition, we further discuss the concept of “green exercise” and provide insights about how eco-friendly initiatives (e.g., plogging) may have dual benefits in both individual and environmental domains.

Results

Emerging eco-friendly activities, including plogging, plalking and pliking, directly benefit the environment, while holding the potential to contribute to PA accumulation. Walking while picking up litter (i.e., plalking) can represent up to 4-5 metabolic equivalents (METs), which corresponds to performing a moderate-intensity PA. If other activities - running or cycling - are performed while picking up litter, the number of METs (i.e., >6 METs) involved may correspond to performing a vigorous-intensity PA.

Lessons

The physiological impact of eco-friendly activities, such as litter picking, reveals their potential as moderate to vigorous-intensity PA, favouring compliance with WHO PA recommendations (i.e., 150 min/week). Integrated policies and actions are needed to address global challenges effectively, emphasizing the interconnectedness of PA promotion, sustainability efforts, and health outcomes.

Key messages

• Engaging in green initiatives fosters PA and supports the United Nations’ goals for health and sustainability.

• Plogging and similar eco-activities offer dual benefits: cleaner environments and healthier lifestyles.
Urban Green Spaces on Maternal Sleep Quality One Year Postpartum Amid COVID-19 Alert Level Changes
Authors: Chen P A , Hsu H W , Zou M L , Wu C D , Chen Y H
Published: October 2024

Background

Benefits of green spaces (GS) on sleep quality were found, particularly for mothers, which, in turn, contributed to maternal health and offspring development. However, the COVID-19 pandemic imposed restrictions on environmental access, potentially altering the influence of urban GS on sleep quality. This study aims to explore the impact of urban GS on maternal sleep quality one year postpartum during the pandemic.

Methods

Participants were drawn from the Longitudinal Examination across Prenatal and Postpartum Health in Taiwan study, tracking individuals from early pregnancy across five hospitals in Taipei since 2011. We utilized data spanning from 2019 to 2024, with May 2021 (the initial soft lockdown due to community spread) serving as the cutoff point to delineate early and late pandemic stages. Self-reported sleep quality one year postpartum was assessed using the Pittsburgh Sleep Quality Index. Residential GS was evaluated using the Normalized Difference Vegetation Index (NDVI) within various radii (250m to 2000m). Multiple logistic regression was utilized.

Results

From the 311 participants, in the early stage of the pandemic, an increase of 0.1 units in NDVI within a 250m radius during both prenatal and postnatal periods (0-12 months) was associated with improved maternal sleep quality (OR = 1.57; 95% CI = 1.08, 2.32, and OR = 1.58; 95% CI = 1.07, 2.30) after adjustments. The impact diminished as the radius increased. Additionally, no significant association was found during the late stage of the pandemic across any of the studied radii.

Conclusions

The findings suggest a positive correlation between proximity to urban GS and maternal sleep quality during the early stages of the pandemic, with more significant benefits observed at shorter distances, likely due to restricted movement and access. These results underscore the importance of proximity in urban planning and environmental improvement initiatives aimed at enhancing maternal and child health.

Key messages

• Urban green spaces significantly enhance maternal sleep quality one year postpartum in the early stages of the pandemic, highlighting the importance of proximity for health benefits.

• As the radius of green spaces decreased, their positive impact on maternal sleep quality during the early pandemic intensified, underscoring the need for adaptive urban planning strategies.
Investigation of Global Climate Change Awareness Levels Among Faculty of Medicine Students
Authors: Gündoğdu S , Sülü M , Boz G , Baran A , Özer A
Published: October 2024

Background

According to the WHO, climate change is the biggest threat to global health in the 21st century. Thus, it is important to understand medicine faculty students’-who are future doctors-awareness of climate change and its effects on human health. The aim of this study is to determine the level of awareness of Inonu University Faculty of Medicine students about global climate change.

Methods

This descriptive cross-sectional study was conducted between February and March 2024. The target population consisted of 1692 students studying in a medical university. The sample size was calculated as 260 students based on a percentage of awareness of global climate change of 32.3%, and 283 respondents were included in the study. A questionnaire was used that included questions about the respondents’ sociodemographic characteristics and global climate change awareness. In addition, they answered the items of the Awareness Scale of University Students About Global Climate Change (GCCAS). The dependent variable was total GCCAS scores, and the independent variables included age, concern about climate change, and knowledge status. A Student’s t-test was used in the statistical analysis.

Results

Of the students, 50.2% were female, 51.6% were older than 22 years of age, 82% were worried about the negative effects of climate change, 79.5% said they received no education about climate change during their medical education. The mean total GCCAS score in the study group was 71.74 +/-13.81. Women, students who were concerned about climate change, and those who had knowledge about climate change had significantly higher mean GCCAS scores (p < 0.05).

Conclusions

More than 75% of study group said that they had received no education about climate change. However, the percentage of students who were aware of and concerned about climate change and who had information about climate change was even higher.

Key messages

• Due to the potential for medical students to encounter the health effects of climate change, these issues should be included in education programs to increase their awareness of this important issue.

• Medical students need to take conscious and informative steps regarding climate change to help protect the health of future generations.
Guidance on health promoting and climate-friendly hospitals and health services
Authors: Metzler B , Ronge-Toloraya A , Eder J , Zillmann N
Published: October 2024

The negative impacts of climate change on health and the healthcare system are becoming increasingly evident. The healthcare sector, which accounts for nearly seven percent of Austria’s CO2 emissions, contributes to the exacerbation of climate change on one hand, but is also affected by its consequences on the other. To meet these challenges, it is necessary for healthcare facilities to both adopt climate-protective measures and adapt to the changed conditions. A project launched in 2023, supported by the Austrian Health Promotion Agenda and in cooperation with the Austrian Network of Health Promoting Hospitals and Health Services, has shown that there is a need for support in implementing climate protection measures in healthcare facilities. In response, the WHO Collaborating Centre for Health Promotion in Hospitals and Healthcare, located at the Competence Centre for Health Promotion and Healthcare at the Austrian National Public Health Institute, will work on the development of standards based on international models to support healthcare facilities in the introduction of climate-friendly practices until 2026. The methodology of the project includes the analysis of existing quality criteria and instruments, as well as a modified Delphi process with two rounds of online questionnaires directed at an international panel of experts. After each round, exchange meetings with a smaller group from the panel take place to achieve consensus. Based on the research findings and the Delphi consultations, a draft of standards and an implementation manual will be created. These drafts will be piloted in various healthcare facilities in Austria and other countries to assess their practicability and effectiveness. Following the pilot tests, the standards and the manual will be revised to integrate the practical insights gained. At the time of the conference, the initial results of the Delphi process will be presented, providing insights for the further development of the standards.

Key messages

• Integrating climate-friendly practices into all aspects of healthcare can reduce its environmental impact, improve health outcomes, and contribute to the broader sustainable development goals.

• Climate-friendly approaches yield significant health, economic, and social co-benefits.
Climate change among health students in France: a multicenter, cross-sectional study
Authors: Guihenneuc J , Cambien G , Talineau M , Migeot V , Ayraud-Thevenot S
Published: October 2024

Introduction

Climate change (CC) has been identified as the greatest global health threat of our time. To foster the resilience of our health system and promote sustainable health, it is essential to rely on aware and trained actors. We evaluated the level of awareness, perception, and commitment of health students in France about CC and sustainable development (SD) issues. We also assessed their expectations in terms of initial training on these subjects.

Methods

We conducted an observational, cross-sectional, multicentre study targeting students enrolled in Medicine, Pharmacy, Odontology, Maieutics, Nursing, Physiotherapy, and Medical Electroradiology in the southwest region of France. The questionnaire used was designed to identify the Knowledge, Behaviors, Practices, and expectations on SD and CC during their studies. It was distributed in a format to be completed online in April 2022.

Results

A total of 529/7000 (7.5%) health students participated in our survey. Our results show that students have little perception of the impact of the health system on CC. However, they are already committed to reducing energy (97%) and water consumption (94.5%) and sorting their waste (87.8%) in their daily lives. Among students, 73.6% envision themselves as future actors in sustainable healthcare. Although they expect a strong commitment from their training institution, 92% of them think that students are the most active on these issues. Regarding their training, 83% of them think that it should integrate CC and SD issues, while 58.7% say that they have never dealt with this topic at this stage of their studies.

Conclusions

In France, the initial training of future health professionals must be rapidly adapted and must enable them to acquire the knowledge and skills necessary to understand the health impacts of CC on the one hand and to reduce the impact of the health sector on the climate on the other to build climate resilient and environmentally sustainable health systems.

Key messages

• French health students appear to be committed to the fight against climate change.

• Initial training of future health professionals needs to be adapted to give them the knowledge and skills to understand the challenges of climate change with health and the health system.
Autochthonous dengue outbreak in Lombardy, Italy: enhanced surveillance and vector control measures
Authors: Scardina G , Faccini M , Rossetti E , Bonini M , Barozzi M , Valenti M , Cereda D , Rovida F , Baldanti F , Senatore S
Published: October 2024

Description of the problem

On 18 August 2023, the first autochthonous case of dengue was registered in Lombardy, in a person living in a village in Lodi province. The case, a man with no history of travels prior to symptoms onset, developed flu-like symptoms on 3 August. After initial suspicion of WNV infection, he was confirmed to have a DENV-1 infection. Following the notification, measures to control the spread of the disease were activated, including alert of healthcare professionals, vector control activities, entomological monitoring and active case finding among household contacts and people living close to the case. Moreover, a serological screening was proposed to population of the entire municipality, along with a survey collecting data about travels abroad and symptoms.

Results

Forty-one confirmed and six probable autochthonous cases were identified. The last case developed symptoms on 20 October. Among confirmed cases, 24 were identified after admission to Emergency Department, 16 through community screening and one at the time of blood donation. 38/41 confirmed cases were symptomatic, with fever, rash and retro-orbital pain being the most common symptoms. Mean age was 55,5 years (3-88), while male: female ratio was 2:1. Hospitalisation was required for 7/41 cases. Community screening was offered from 25 August to 8 October and 416 individuals participated. Among them 10 tested positive for DENV IgG and 27 for DENV IgM (16 were subsequently confirmed as DENV cases, 6 remained probable and 5 were ruled out as non-cases). The primary case of the outbreak was not identified. Vector control activities and entomological monitoring were conducted on 21 August within 200-m radius area around the residence and places visited by index case. Subsequent interventions were conducted in all public areas and sensitive sites of the municipality.

Lessons

Enhancement of surveillance through community screening allowed identification of several additional autochthonous cases.

Key messages

• Strengthening of surveillance, vector control activities and entomological monitoring is crucial to prevent and control future outbreaks in non-endemic areas with stable presence of Aedes mosquitoes.

• To minimize the risk of introduction and spread of dengue virus in non-endemic areas, it is essential to raise awareness among travellers and general population about preventive and control measures.
Association of Built Environment with Well-Being: An Experience Sampling Method
Authors: Chen Y , Nakagomi A , Hanazato M , Abe N , Ide K , Kondo K
Published: October 2024

Background

Well-being (WB) is important because it extends beyond physical health, as defined by the World Health Organization (WHO). From a temporal perspective, WB encompasses two aspects: long-term WB (LWB), such as overall life satisfaction, and momentary WB (MWB), such as immediate mood. While research has demonstrated a positive association between built environments such as urban land, grassland areas, and LWB, there is limited research exploring the association between the characteristics of built environments and MWB.

Methods

We applied the Experience Sampling Method (ESM) to collect data on the location, detailed environmental characteristics, and the MWB and LWB of adult participants living in Kashiwa City, Japan. Structural equation modeling was used to calculate the correlation coefficients between different built environments and both MWB and LWB.

Results

Nine hundred reports from 273 valid participants were obtained. In terms of types of locations, it was shown that cafes/restaurants/bars (coefficients = 0.85), culture/sport/education facilities (0.45), and public spaces (0.62) have a positive association with MWB. Additionally, environments perceived as natural (0.43), relaxing, and clean (2.31) have a positive association with MWB. Conversely, being on the move (-0.88) and vibrant environments (-0.58) have a negative association with MWB. Moreover, higher LWB levels were associated with higher MWB (0.64).

Conclusions

This study used the ESM to measure MWB and confirmed an association with various built environments. These findings provide guidance for city planning and policies that focus on enhancing urban well-being. This study highlights the benefits of places such as parks and cafes that promote happiness and the need for well-designed transportation and roads. These elements are important for developing urban areas that not only meet residents’ physical requirements but also support their emotional and psychological well-being.

Key messages

• Our findings show that public spaces, cafes, and cultural facilities are significantly associated with MWB, highlighting their role in urban planning as places that promote happiness.

• ‘Being on the move’ is associated with lower MWB, indicating the need for well-designed transportation and road environments.
Exploring knowledge, attitudes and practices towards sustainable food aid programmes across Europe
Authors: Belogianni K , Oliveira M A , Rodrigues A , Truszkowska N , Żebrowska D , Jasińska A , Striglio F , Knöbl C F , Patsea M
Published: October 2024

Background

Food insecurity has increased following the COVID-19 pandemic and the Ukraine conflict. In some EU high-income countries, more than 70% of food aid users experience food insecurity, highlighting the need for food aid programmes to provide good quality and sustainable services and maximise the social inclusion of food aid users. The aim of this study was to identify areas that can promote sustainability in food aid programmes.

Methods

Knowledge, attitudes and practices towards sustainable food aid were assessed via a quantitative questionnaire. Socio-demographic data were also collected. The survey was translated and disseminated online across 5 EU countries (Austria, Cyprus, Greece, Poland, Portugal), targeting staff and volunteers involved in food aid programmes (20 per country, total N = 100). Descriptive statistics were used for data analysis.

Results

Most participants were female (68%), 18-49 years old (87%) and occupied in a NGO (89%) as employee (55%). The mean total knowledge score was 11.8 out of 19 (SD 3.2) with low knowledge (% of correct answers) on household food waste (18%) and environmental impact of cooking appliances (29%). In all countries (except Austria) more than 70% of participants agreed that they can apply sustainability through their work; however, more than 50% agreed that sustainability is not always feasible in food aid programmes. Food loss/waste, access to local food and the economic crisis were the main parameters reported to impact sustainability in food aid (≥70% of N). The most frequently applied practices were storing food according to expiration date, monitoring quantities in food distribution, considering beneficiaries’ needs and reading food labels. The least frequently applied practices were composting food leftovers and using energy-efficient methods to distribute food.

Conclusions

Sustainability is considered important; however, more effort is needed to promote and embed sustainability parameters in food aid programmes.

Key messages

• Sustainability is considered important in food aid programmes; however, more effort is needed to promote and embed sustainability parameters in practice.

• Identifying sustainability areas in food aid programmes can lead to successful educational and training initiatives.
3.E. Scientific session: Environmental Health Tracking Systems: a tool for planetary health
Authors:   Organised by: EUPHA-HIA, -ENV, -PHMR, International Network on Public Health and Environment Tracking,   Chair persons: Piedad Martin-Olmedo (EUPHA-HIA), Peter Van Den Hazel (EUPHA-ENV)
Published: October 2024

Planetary health offers a good framework for better understanding the interconnection between human health and environmental changes, promoting effective cross-sector actions and partnerships, and ensuring policy coherence. Effective implementation of this conceptual framework requires monitoring and reporting on indicators relevant to planetary health that capture the scope, spatial and temporal scales of changes in natural systems that affect human health and well-being. An approach in that sense are the environmental public health tracking systems (EPHT), which imply the ongoing collection, integration, analysis, and interpretation of data at the same spatiotemporal scale about environmental hazards, and related human exposure and health effects, maintaining appropriate data protection measures. It aims to provide public-health decision makers with timely, accurate and systematic data for quantifying health impacts related to environmental factors. EPHT system are proposed as an essential tool for designing and monitoring policies and actions that prevent and reduce environmental health burdens (EHB) efficiently and cost-effectively, and as an alerting system against present and future climatic and health crisis. Pursuing such goals requires the use of health information systems that enable the monitoring and assessing of environmental health in multiple dimensions, considering specificities across different geographical and cultural settings. EPHT system requires defining a rationale on how to select the dimensions and indicators to be included. Common challenges for defining those indicators are related to the availability of data recording, data standardization, and the linkage, integration and sharing of databases. In parallel, it is also important to define a decision aiding tools in which evidence and data are understandable and inform about the extent to which specific policy goals are attained, tailoring such tools to the specific settings. Present session attends to answers to those challenges by sharing experiences from different contexts and countries

Key messages

• EPHT systems represent an effective tool for progressing in achieving planetary health goals and as a surveillance alerting system for future health crisis.

• Adjusting EH data quality recording and analysis in EPHT systems is essential for improving resources assignment, and the effectiveness of healthy policies in reducing EHB.
Attitude of Romanian students and their families concerning waste management
Authors: Prejbeanu I , Dina M E , Prejbeanu D F
Published: October 2024

Waste recovery, recycling included, is an important step in waste management, preceding final disposal. In 2018, according to Eurostat, the recycling rate of municipal waste was 47% in the European Union and only 11.1% in Romania. Thus governmental institutions have implemented new measures in order to reduce environmental pollution by ineffective waste management. In 2022, 535 students aged 22-24.5 years, males and females, studying in Craiova (one of the six largest academic cities of Romania), were asked to answer an 18-item questionnaire regarding their and their families’ attitude towards waste recycling. Most of the students (60.7%) were residents in the university city, while the others - in smaller cities or in villages of the region. Only 38.3% of the subjects (N = 205) declare their families recycle waste; the most common excuse for no-recycling (37.8%) is the lack of recycle bins in the house proximity. Only 20 families (3.7%), all of them living in Craiova, take the fried oil to collecting points in supermarkets; most of the others eliminate it in the sewerage system, especially those from outside the city (p < 0.01). Seventy-five students (14%) are not able to mention any recent measure taken by the government in order to reduce plastics environmental pollution; the others discuss about the increased number of recycle bins around the city (53.2%), recycling of single-use plastics (34.5%) or use of biodegradable bags (25.2%). No-recycling (42%), using daily his/her own car (18.7%, p < 0.01 males vs. females), using too much plastics (11.2%) are the most frequent self-reported students’ disregards for the environment. Most of the subjects consider environmental health of essential importance (88.7%) and would like to participate in environment protection actions (92.5%). Romanian students seem to have a positive attitude and like to be involved in the environment protection, without a significant influence regarding the gender and the residence place.

Key messages

• Education and information are essential tools to make people ecologically aware.

• Recycling is one of the best ways to have a positive impact on both natural and community environment.
Long-term ozone exposure and asthma: a systematic review and meta-analysis
Authors: Hassen H Y , Charalampous P , Luyten A , Martins C , Breitner-Busch S , Devleesschauwer B , Haagsma J A , Buekers J
Published: October 2024

Background

Ambient air pollution, particularly surface ozone, is a significant global health concern, with 9 out of 10 people exposed to levels exceeding WHO guidelines. This exposure is linked to approximately 7 million premature deaths annually, a number expected to double by 2050. While the effects of short-term exposure to ozone on exacerbation of asthma symptoms and mortality are well-documented, the impact of long-term exposure remains unclear.

Aim

This systematic literature review aims to quantify the association between long-term exposure to ozone and asthma incidence and prevalence and derive an exposure-response relationship.

Methods

International electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, were searched, supplemented by grey literature sources such as Google Scholar and WHO - Global Index Medicus from conception to July 31, 2023. Observational epidemiological cohort, case-control, or cross-sectional studies reporting quantitative associations between exposure and outcome were included. Meta-analysis will synthesize effect size estimates using a Meta-Regression - Bayesian, Ensemble, Regularized, Trimmed (MR-BRT) model.

Results

A total of 5,947 titles were initially identified from databases, and following the removal of duplicates, 3,235 titles and abstracts were screened, resulting in 84 articles deemed eligible for full-text review. The full-text screening identified 29 studies comprising 38 articles. A comprehensive overview of the included studies will be provided. We will describe the study settings, design, and measurement methods used by the identified studies. Furthermore, results of the MR-BRT model will be summarized, and exposure-response functions will be discussed. Funding: This work is part of the BEST-COST project which is funded by the European Union’s Horizon Europe programme under Grant Agreement No.101095408.

Key messages

• This research fills the gap in understanding the association between long-term exposure to ambient ozone and asthma incidence and prevalence.

• Developing exposure-response functions would enable estimation of the disease burden associated with long-term ozone exposure.
Fluoride exposure and risk of fractures: a systematic review and dose-response meta-analysis
Authors: Iamandii I , Mazzoli R , De Pasquale L , Vinceti M , Filippini T
Published: October 2024

Introduction

Fluoride (F) is a widespread natural element, whose exposure occurs mostly through drinking water, fluoridated foods and use of toothpastes. At high levels, it may adversely affect human health by altering thyroid and cognitive function in children, and inducing dental and skeletal fluorosis. Since bone health significantly impacts quality of life, we performed a systematic review and meta-analysis to evaluate the effect of F exposure on risk of bone fractures.

Methods

We conducted a literature search in online databases and selected studies that were carried out in humans and reported risk estimates with 95% confidence intervals for bone fractures according to F exposure. We eventually performed a meta-analysis using a random effects model, comparing the highest versus the lowest exposure, and one-stage dose-response model, to explore the shape of the association.

Results

Of the 1052 potentially eligible articles, 28 were included in the quantitative analyses. Most studies were conducted in adults (n = 26) and in Western countries (North America=16, Europe=11) and assessed fluoride exposure in drinking water, urine, serum, toenail or diet. The preliminary dose-response curve showed a positive non-linear relation between F exposure through drinking water and bone fracture risk, regardless of site, starting at 1.5 mg/L. Sex-stratified analyses, based on a lower number of studies, showed similar trends, with an indication of higher susceptibility in males compared with females.

Conclusions

Overall, risk of bone fractures appears to non-linearly increase along with exposure to fluoride in drinking water, regardless of bone site and sex, at levels of exposure above the WHO standard and similar to those that have associated to altered thyroid and cognitive function. Under a public health perspective, fluoride in drinking water should be kept below 1.5 mg/L to prevent bone fractures.

Key messages

• Our analysis revealed a positive non-linear association between fluoride in drinking water and bone fracture risk.

• Public Health actions should be oriented in keeping fluoride in drinking water below 1.5 mg/L to prevent bone fractures.
Spatially varying associations between community-level predictors and COVID-19 outcomes in NYC
Authors: Thompson R L , Johnson G D , Gordon R , Nakaya T
Published: October 2024

Background

The cumulative impacts of COVID-19 on hospitalization and mortality were not uniformly distributed across New York City (NYC). To better understand potential drivers of this observed geospatial disparity, we explored the associations between community-level sociodemographic characteristics and cumulative COVID-19 hospitalizations and mortality using geographically weighted Poisson regression (GWPR).

Methods

Cumulative COVID-19 hospitalization and mortality rates in 177 NYC modified ZIP code tabulation areas as of Dec 2022 were taken from the NYC Department of Health and Mental Hygiene, and sociodemographic predictors were taken from the 2018 American Community Survey. GWPR was applied using both non-multiscale (single bandwidth) and multiscale (flexible bandwidth) models to assess which predictors were significant and which associations varied spatially (allowing them to potentially act as both risk and protective factors, depending on the location).

Results

Multiscale GWPR models outperformed non-multiscale models in rendering residual spatial autocorrelation insignificant. Although multiscale GWPR allowed flexible bandwidths for each predictor, most yielded global bandwidths, suggesting geographically consistent effects. For mortality, the percent of residents without health insurance acted solely as a risk factor. Similarly, for hospitalizations, the percent of residents with a disability acted solely as a risk factor. The percent of residents with a bachelors degree or higher acted solely as a protective factor against both outcomes.

Conclusions

Even when associations were allowed to vary spatially in GWPR models, we still found geographically consistent associations between many sociodemographic predictors and cumulative COVID-19 outcomes in NYC. Consistent risk factors, such as prevalence of disability, or protective factors, such as prevalence of higher education, highlight potential areas for city-wide policies to reduce the burden of future epidemics.

Key messages

• For cumulative COVID-19 outcomes across NYC communities, geographically consistent risk factors include disability prevalence for hospitalization and lack of health insurance for mortality.

• Increasing prevalence of higher education acted as a geographically consistent protective factor against both hospitalization and mortality due to COVID-19.
Deprivation and stroke incidence, treatment and mortality in Germany
Authors: Belau M , Becher H , Riefflin M , Bartig D , Schwettmann L , Schwarzbach C J , Grau A
Published: October 2024

Background

Previous research suggests that regional deprivation significantly influences the risk of stroke. However, little is known about regional differences in stroke incidence and mortality within Germany.

Methods

We utilized data from the Diagnosis Related Groups statistics (2016-2019) and the German Federal Register of Physicians (2019). We used negative binomial regression analysis to investigate the relationship between the German Index of Multiple Deprivation 2015, covering 401 districts and district-free cities in Germany, and stroke incidence, treatment, and mortality.

Results

The adjusted rate ratios of stroke incidence and mortality with the highest deprivation level compared with the least deprived area were 1.16 (95% CI [1.14, 1.17]) and 1.19 (95% CI [1.14, 1.23]), respectively. Furthermore, this study showed that the density of physicians was higher in district-free cities than in districts.

Conclusions

The findings document a relationship between regional deprivation and stroke incidence and mortality, and call for a more targeted approach to stroke prevention in deprived regions.

Key messages

• Regional deprivation in Germany linked to increased stroke incidence and mortality rates.

• Policy action needed for effective prevention measures.
EHT and environmental justice at EPA Victoria: Aspirations and regulatory realities
Authors: Chaston T , Mavoa S , Dennekamp M , Hadgraft N
Published: October 2024

EPA Victoria (Australia) is a statutory authority that regulates polluting activities and advises other Victorian government departments on relevant policy settings. In 2016, a public health function was installed at EPA Vic to provide emergency health messaging during pollution events, review research evidence of environmental-health relationships and assess industry-contracted health risk assessments of polluting entities. An Environmental Health Tracking Network (EHTN) is under development to support these activities. The EHTN is an agile data and analytical infrastructure for translating expertise across an expanding multidisciplinary network of public health researchers, EPA operational staff and public sector policy makers. Its current interactive dashboards calculate health impacts and associated costs of air pollution scenarios, model land-use influences on land and water contamination and identify coincidences of sociodemographic-, urban environment- and pollution exposure-disadvantage in a high spatial resolution environmental justice (EJ) framework. Regulatory leverage of EHTN intelligence, however, requires legislated EJ thresholds and/or legally tractable costing of industry-externalised human health impacts. Thus, to establish triggers for more stringent conditions on polluting activities and promote equity of interventions and regulations, novel regionally and EJ specific health risk functions are required. Considering these ambitions and challenges, the EHTN at EPA Vic is focussed on 1) identifying and characterising vulnerable populations at high spatial resolution, 2) estimating associated exposure-health effect size modifications using primary epidemiological methods and 3) applying these to health impact and cost assessments of pollution and waste. We seek defensible grounds on which to impose more stringent standards for polluters and redress entrenched social, health and economic disadvantage.

Speakers/Panelists

Hanna Tolonen

THL, Helsinki, Finland
Past-year mental health issues: discrepant survey & administrative data
Authors: Vinko M , Zaletel Kragelj L , Kukec A
Published: October 2024

Introduction

Accurately measuring mental health disorder prevalence is crucial for public health planning. Administrative and survey data are common methods, but often yield differing results. This study compares case identification of mental health issues across these data sources in Slovenia.

Methods

We linked the 2019 European Health Interview Survey (EHIS) with three Slovenian health administrative databases: the National Hospital Health Care Statistics Database, Outpatient Prescription Drugs Database, and Absence From Work Database. Case identification utilized self-report of any mental health issue in the past 12 months and healthcare utilization records in 12 months preceding participation in EHIS. Multinomial logistic regression was used to examine the association between socio-demographic factors and case identification across data sources.

Results

Significant differences were found in 12 month prevalence of any mental health issue estimates between data sources. Only 45.9% of self-reported cases were identified in administrative data, and 36.6% of administrative cases self-reported mental health issues (Kappa = 0.302). Socio-demographics, including age, gender, education, and employment status, were significantly associated with the likelihood of identification in specific data sources.

Discussion

Our findings underscore the importance of data source and assessment tool selection on mental health prevalence estimates. Variations in identification across population subgroups could reflect differences in healthcare access and self-disclosure biases. Linking data sources and considering their inherent limitations is crucial for accurate burden estimation.

Key messages

• Data source and assessment methods significantly impact how we identify individuals with mental health issues in the past year.

• Combining data sources and understanding their limitations is essential for improving mental health burden estimation.