bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral health related cardiovascular disease risk factors: a cross-sectional study
Authors: Németh N O , Móré M M , Nagy A N
Published: October 2024

Background

Hypertension, cardiovascular disorders, and hypercholesterolemia represent significant public health concerns. This research presentation examines the impact of various oral health indicators, such as bleeding gums, untreated dental decay, loose teeth, and missing teeth, on these conditions within Hungary.

Materials and methods

This study utilized data from 5,603 individuals participating in the 2019 Hungarian European Health Interview Survey. Predictor variables were chosen using elastic net regularization and k-fold cross-validation to enhance the performance of weighted logistic regression models. Sensitivity analysis underpinned the robustness of the results.

Results

Significant associations emerged between deteriorating oral health and the prevalence of various cardiovascular conditions. An increased likelihood of hypertension was observed in individuals with multiple tooth removals, showing an odds ratio (OR) of 1.67 with a 95% confidence interval (CI) of [1.01-2.77]. The use of dental prosthetics presented an OR of 1.45 [1.20-1.75]. Additionally, presence of gum bleeding corresponded to elevated odds for both cardiovascular disease (OR = 1.69 [1.30-2.21]) and hypercholesterolemia (OR = 1.40 [1.09-1.81]).

Conclusions

enhancing oral health could potentially mitigate chronic cardiac conditions, highlighting the importance of integrating dental care in comprehensive disease management strategies.

Key messages

• Poor oral health is linked to higher hypertension and heart disease odds.

• Dental care is crucial in cardiac disease prevention and management.
Toothbrushing habits are associated with self perceived stress
Authors: Vinder N
Published: October 2024

Background

Personal self-care is one of the most important factors in maintaining and improving oral health. Public health guidelines are recommending tooth brushing at least twice daily, once before bed time and at least on one occasion. On the other hand, our regular routines and caring for our own health is influenced by different factors including stress. We wanted to research how much does daily stress influencing tooth brushing habits.

Methods

We analyzed data from 2020 CINDI nationwide cross-sectional survey in Slovenia. Tooth brushing once a day or less was assessed as inadequate. Stress was assessed with question >>How often in the last 14 days have you felt tense, stressed or under a lot of pressure? << Participants who chose often or always as an answer were assessed as persons under stress. Method of binary logistic regression was used for statistical analysis of association between tooth brushing frequency and self-perceived stress, modified for some socioeconomic factors.

Results

Prevalence of inadequate frequency of tooth brushing was present in 31,6 % of sample, 31,5% in participants who were not feeling tense and 31,8% in participants who often felt tense or stressed. At first it seemed stress is not associated with tooth brushing habits. We adjusted this association for gender, education level and age and this association became clearer. Participants who felt stress and/or under pressure had higher odds for poor tooth brushing habits, their odds ratio was 1,283 (p < 0,001; 95% CI 1,124; 1,464) when adjusted for aforementioned factors.

Conclusions

Oral health is integral part of general health. Association between oral and mental health is often overlooked even though psycho-social aspects are part of modern oral health definition. As personal self-care is cornerstone of maintaining and improving oral health, implementation of mental health aspects should be incorporated in public health advises and programmes for promoting oral health.

Key messages

• Self-perceived stress is associated with toothbrushing habits.

• People who are under stress less regularly brush their teeth.
Living with a chronic disease: tertiary prevention tools in asbestos-exposed patients
Authors: Guerreschi E M , Dragoni L , Sisinni A G , Fabrizi S , Miceli G B , Nante N
Published: October 2024

Background

The main asbestos-related pathology is asbestosis, frequently associated with pleural plaques. The spirometric pattern is mainly restrictive, with reduction in all lung volumes (FEV1, FVC, TLC). Also a reduction in alveolus-capillary diffusion of carbon monoxide (DLCO) may be added, related to the fibrotic process. The aim of the study is to analyze the health surveillance data, correlating the spirometric finding and its variation over time with the clinical and radiological picture.

Methods

The study is conducted on 372 patients with asbestosis from occupational exposure diagnosed in the period 2017-2023, as part of the Tuscany Region’s program for former asbestos exposures (DGR 396/2016). The investigation is at the second level of surveillance, which includes chest CT and Respiratory Functionality Testing (RFT). Data are obtained from patients’ medical records and processed through a database.

Results

Out of 372 patients with asbestosis, 213 had pleural plaques (57.25%). Out of those, there is a progressive worsening of RFTs in a restrictive direction (TLC <80%, FEV1/FVC >70%) in 71 patients (33.3%), with a mean TLC loss of 8.7 ± 5.9 mL over subsequent follow-ups on a yearly basis. The FEV1/FVC ratio also declines, with a mean reduction of 5 ± 2.4%. Out of those 71 patients, 14 (19.7%) also show a mean reduction in DLCO of 6.7 ± 5 mL/min/mmHg. The negative trend in RFTs correlates with the worsening clinical and radiological picture attributable to the occurrence of plaques on a fibrotic framework.

Conclusions

The health surveillance protocol that we adopted has as objective the ascertainment of pulmonary pleura-parenchymal alterations correlated with occupational exposure, investigating their evolution over time through the analysis of spirometric data, and to optimize the management of the functional disability, with a view to the tertiary prevention of patients with asbestos-related disease.

Key messages

• The negative trend in asbestosis PFRs correlates with the worsening of the clinical and radiological picture attributable to the appearance of pleural plaques on an interstitial fibrosis.

• Health surveillance is essential in order to optimize the management of functional disability, with a view to tertiary prevention of patients with asbestos-related disease.
Expanding access to non-communicable disease screening in war-affected communities in Ukraine
Authors: Darahan H , Rodyna R , Karpiuk K , Bogdanov A , Shcherbak-Verlan B , Zaika N , Gamazina K , Dravniece G
Published: October 2024

Background

Non-communicable diseases (NCDs) account for 91% of premature deaths in Ukraine. However, NCD screening lags among young people and across the entire population. The ongoing war has exacerbated barriers to NCD screening due to damaged infrastructure, understaffed medical facilities, and health system deterioration.

Intervention/response

To improve screening, diagnosis, and care, in March 2023 the PATH-led, USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project established community level health access points (HAPs) in five conflict-affected communities. STBCEU procured screening tools (tannometers, glucometers, portable ECGs) for common NCDs, printed informational materials, trained 143 specialists, designed a reporting system, and facilitated monitoring visits to 77 HAPs.

Results

By the end of 2023, the project equipped 113 HAPs in the five communities, and 102 of them initiated NCD screening. From January-March 2024, 1,694 people under 40 years old were screened for NCDs. Among 1,488 blood pressure measurements, 143 cases had high readings (9.6 ±1.5%), 90 (62.9%) of which were first-time diagnoses, and 53 (37.1%) treatment monitoring. Glucose levels were measured 809 times, with elevated levels in 44 cases (5.4 ±1.5%), 30 (68.2%) of which were first-time diagnoses, and 14 (31.8%) treatment monitoring. Additionally, 1,144 mental health consultations were provided.

Conclusions

This initiative represented a first in Ukraine: per national requirements, young people have not historically been screened for NCDs. Expanding NCD screening in war-affected communities has demonstrated substantial early success, with significant detection of high blood pressure and elevated glucose levels among people under 40. This proactive, cost-effective intervention underscores the need for accessible, community-level health interventions in crisis settings and showcases a scalable model for integrating NCD screening into emergency health response frameworks.

Key messages

• The implementation of community-level NCD screening has shown early success in detecting high blood pressure and elevated glucose levels among people under 40.

• Cost-effective NCD screening underscores the need for accessible, community health interventions, providing a scalable model for integrating NCD screening into emergency health response.
A long journey from telemedicine to digital (public) health: the vision of different stakeholders
Authors: Duplaga M
Published: October 2024

The healthcare system willingly adopts new innovative means of communication and solutions offered by computer science. Telemedicine was one of the first terms used in this context. It was initially associated with providing medical services but quickly extended to other areas of health-related activities, including public health. The growth of the global web yielded new prospects for the provision of health services, also resulting in new terms to name the use of information and telecommunication technologies in healthcare. E-health, stemming from the end of 90ies in the 20th century, was initially defined as a new domain strongly associated with public health, especially in the context of access to health information. Quickly, its understanding was extended to all health-related interventions based on innovative digital technologies. Today, digital health and digital public health have emerged as the key terms, signifying the next phase of emerging applications that leverage the advancements made on the technical front. The medical community is probably more inclined to use the former term, while public health professionals are dedicated to the latter. But do these terms carry distinct meanings? Or is it merely a matter of the professional group’s background? Is the focus on individual or population health a differentiating factor? In the meantime, business and technical communities have developed the concept of Health 4.0. This concept emphasizes using technologies like the Internet of Things, cloud computing, big data, and artificial intelligence. However, digital (public) health benefits hugely from these solutions. One can ask whether every professional community needs other concepts and new terms for naming fields, resulting from the multidisciplinary effort. And where are the plain people in this landscape? Do they have sufficient digital and health literacies to accept new modes of health service delivery?
Mortality due to ischemic stroke in Serbia after redistribution of the inaccurately coded deaths
Authors: Todorovic J , Santric-Milicevic M , Stamenkovic Z , Rosic N , Tamburkovski G , Brankovic B , Miltenovic S , Jankovic Mladenovic S
Published: October 2024

Background

Ischemic stroke is a major common cause of death not only in Serbia but worldwide. Mortality statistics commonly include ill-defined, impossible and insufficiently specified causes of death among the underlying causes of death (CoDs). In the activities of the Laboratory for Strengthening the Capacity and Performance of the Health System and Workforce for Health Equity, we examined mortality due to ischemic stroke either as well-defined underlying CoDs or garbage codes (GCs - including the ill-defined, unspecified or impossible CoDs) in Belgrade in 2015 and 2020.

Methods

Anonymous mortality data of the City Institute of Public Health Belgrade were analyzed, and the GCs were redistributed to ischemic stroke as underlying CoDs (ICD-10 codes I63-I63.9), based on the principles of the Global Burden of Disease study, using the three-step approach: 1) exploration and analysis of GCs; 2) modelling of the underlying, antecedent and immediate causes of death; 3) proportionate redistribution.

Results

17% of the total of all deaths in Belgrade in 2015 and 20.9% in 2020 were GCs. Before the redistribution, the share of ischemic stroke as the well-coded CoDs of total mortality was 7.3% (1443/19641) in 2015 and 4.6% (1022/21957) in 2020. A total of GCs - 309 deaths in 2015 and 322 in 2020 were identified for redistribution to ischemic stroke. Based on the type of GCs, in 2015, a total of 139 cases were redistributed in type 1 GCs, 83 in type 2 GCs and 87 in type 3 GCs. In 2020, 141 cases were redistributed due to type 1 GCs, 62 type 2 GCs and 119 type 3 GCs.

Conclusions

This study underscores the significant proportion of all ischemic deaths in Belgrade that were coded with the GCs. After the redistribution, almost one-fifth of the ischemic strokes, previously known as GCs, were added, emphasizing the crucial role of accurate coding in understanding mortality patterns. Improving the coding of deaths is necessary to have reliable information for health policymaking.

Key messages

• One-fifth of the ischemic strokes in Belgrade were previously GCs.

• Accurate coding is essential for understanding mortality patterns and developing valid health policies.
Adult Individuals Applicable to the Family Health Center Knowledge and Awareness About Osteoporosis
Authors: Özkoç H , Erol S , Ergün A
Published: October 2024

Background

The aim of this study is to determine the knowledge and awareness of adult individuals applying to the Family Health Center (FHC) about osteoporosis.

Methods

A descriptive design study was conducted at a FHC in Turkey/Istanbul between January and May 2022. The sample of the research consisted of 320 adults selected by purposeful sampling method. Ethical approval and necessary permissions were obtained from the the conduct of the study. Data were collected through a socio-demographic characteristics form, a 20-item single-subscale Osteoporosis Knowledge Assessment Questionnaire (OKAQ), and a 27-item Osteoporosis Awareness Scale (OAS). Descriptive statistics, normality tests, analysis of variance, Kruskal-Wallis analysis of variance, t-test, and Mann-Whitney U test were used for data analysis. Statistical significance was accepted at p < 0.05.

Results

T The average age of adults is 60.47±13.17 and 55.9% are female and 44.1% are male. 34.7% had completed middle school. Participants’ highest correct response rate in the osteoporosis knowledge assessment questionnaire was for the item ‘Osteoporosis increases the risk of bone fracture’ (81.6%), while the lowest correct response rate was for the item ‘Osteoporosis generally causes symptoms (such as pain) before fractures occur’ (26.3%). According to the Osteoporosis Awareness Scale, adults’ awareness levels were above average. They scored the highest in the preventive behaviors subscale and the lowest in the risk factors subscale. Adults with university-level education scored significantly higher in all subscales of the OAS compared to other education levels (p < 0.05). Individuals with knowledge about osteoporosis and those who consumed milk regularly scored significantly higher in all subscales of the OAS (p < 0.05).

Conclusions

Although adults’ awareness of osteoporosis is above average, their correct knowledge about osteoporosis is inadequate.

Key messages

• An individual’s education level affects osteoporosis knowledge and awareness.

• It is recommended to plan educational initiatives to increase osteoporosis knowledge and awareness.
Burden of inflammatory bowel disease in Belgium, 2020
Authors: Claerman R , Devleesschauwer B , Nayani S , De Pauw R
Published: October 2024

Inflammatory bowel disease (IBD) comprises digestive disorders resulting from non-infectious inflammation of the colon and gastrointestinal tract. With its global prevalence on the rise, IBD poses significant challenges to healthcare systems. There is a need for more accurate disease burden estimates to guide decision-making processes within the health sector. As a part of the Belgian national burden of disease study (BeBOD), this study aims to estimate the burden of IBD in Belgium based on locally available data. We estimated the Belgian IBD burden in 2020 in terms of mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life years (DALYs). As there is no single comprehensive data source on prevalence of IBD in Belgium, a critical appraisal of existing local and national data sources was conducted. Prevalence data were combined with disability weights to yield YLDs. YLLs were calculated using the most recent Global Burden of Disease (GBD) 2019 reference life table and the number of deaths caused by non-infective IBD (ICD-10 K50-52). Cause of death data were extracted from Statbel, the Belgian statistical office. The best available data source to estimate the IBD prevalence in Belgium was a widespread network of general practitioners. The prevalence of IBD was 1.5% in 2020. The prevalence-based YLD for IBD was 220 YLDs per 100 000, while the YLL rate was 11.5 per 100 000. We estimated 26 276 DALYs caused by IBD in 2020. Of the total DALYs caused by IBD, 5% were due to YLLs and 95% were due to YLDs. Our burden estimates for IBD in Belgium were however higher than those of the GBD study. IBD imposes a low fatal burden, whereas the burden of morbidity is more prominent. Our findings could be useful for policy makers to justify and prioritize resource allocation. Integrating the current research in BeBOD will allow monitoring the burden of IBD over time.

Key messages

• Inflammatory bowel disease is characterized by a substantial non-fatal burden due to chronic relapsing and persistent symptoms.

• National inflammatory bowel disease burden estimates are useful to guide decision-making within the health sector.
Spatial disparities in cancer incidence and mortality, indicating gaps in prevention and/or care
Authors: Ádány R , Juhász A , Nagy C , Pikó P , Oroszi B
Published: October 2024

Background

There is a rich literature on the distribution of cancer incidence and mortality in socioeconomically different regions of the world, but none of the studies has compared the spatial distribution of mortality and morbidity to see if they are consistent with each other.

Methods

All malignant neoplasms and separately by cervical, colorectal, breast, pancreatic, lung and oral cancers were studied in the Hungarian population aged 25-64 years for the period 2007-2018 at the municipality level by sex. In each case, the spatial distribution of morbidity and mortality and their clusters were compared with each other and with the level of deprivation using disease mapping, spatial regression, risk analysis and spatial scan statistics.

Results

All-cause cancer morbidity and mortality showed a significant association with deprivation. However, the slope of the increase in mortality with increasing deprivation was much steeper than for morbidity in both sexes. The association between deprivation and morbidity was not consistent across all cancers. No significant association was found for male colorectal cancer (RR: 1.003; 95%CI 0.986-1.019), pancreatic cancer (1.014; 95%CI 0.983-1.045) and female colorectal cancer morbidity (RR: 0.977; 95%CI 0.991-1.029), whereas a negative association was found for breast cancer morbidity (RR: 0.977; 95%CI 0.963-0.991). In contrast, a positive association between deprivation and mortality was found for each type of cancer, although with different RRs. However, disease mapping analyses showed only partial overlap between high-risk morbidity and mortality areas, often independent of deprivation.

Conclusions

Our results highlight not only the diverse relationship between the epidemiological situation and deprivation, but also the disproportionate relationship between cancer morbidity and mortality, thus identifying geographical regions and sub-regions with populations that require special public health attention.

Key messages

• Comparative spatial analysis of cancer morbidity and mortality at the municipality level is strongly recommended to identify populations in need of targeted cancer prevention and/or care.

• The usefulness of comparative spatial analysis of cancer morbidity and mortality is demonstrated in Hungary, one of the countries with the most unfavourable cancer burden in international comparison.
A review of the risk factors for Autism
Authors: McGrevey S , Farr W , Male I , Memon A
Published: October 2024

Background

Autism Spectrum Disorder (or Autism) is a neurodevelopmental and neurological condition, with prevalence of 1 in 100 children globally. This review examines the most common factors associated with Autism.

Methods

We conducted a scoping review of factors associated with an increased risk of developing Autism. These included genetic predisposition, parental age, gender, birth complications and morbidities due to other medical conditions.

Results

Evidence from twin studies shows a 90% genetic predisposition towards Autism - with 102 genes strongly associated with Autism, including SCN1A and SLC6A1. There are also genetic syndromes and chromosomal disorders associated with Autism, including Fragile X syndrome and Tuberous Sclerosis complex (TSC). Several studies have demonstrated an increased risk with advanced parental age (>35 years) (e.g., fathers >50 years are 2.2 times more likely to have a child with Autism than those <30 years). Other factors include infections during pregnancy (e.g. immune dysfunction) and gestational diabetes. Prematurity, such as low birth weight (<1500g) and low gestational age (<32 weeks) are also associated with an increased risk of Autism. With regard to gender, boys are more likely to be diagnosed with Autism - gender ratio of 3:1 and 4:1 has been reported in different populations. Abnormalities in brain development during early prenatal or postnatal periods may increase the risk of Autism. These abnormalities can lead to social, communication, and behavioural challenges characteristic of Autism.

Conclusions

Autism is a complex and heterogeneous condition that likely arises from a combination of factors such as genetic susceptibility and pre- and postnatal factors. An understanding of these factors is important for early detection, intervention, and support for children to improve their quality of life and reduce morbidity.

Key messages

• Risk factors associated with an increased risk of developing Autism include genetic predisposition, parental age, gender, birth complications and other comorbidities.

• There is need to increase awareness of the risk factors of Autism to improve quality of life.
Understanding Knowledge and Perception of Hypertension in Rural Zambia: A Population-Based Study
Authors: Tateyama Y , Honda Y , Zulu R
Published: October 2024

Introduction

Hypertension poses a significant challenge in sub-Saharan Africa, with Zambia reporting a 32% prevalence in 2019. However, there is a presumed lack of knowledge among residents due to inadequate preventive education. This study aims to describe the knowledge and perception of hypertension among rural residents in Zambia.

Methods

This cross-sectional study employed rigorous probability sampling. We recruited 690 residents aged 25-64 from the Mumbwa district using a multistage, clustered, household sampling method for surveys and measurements conducted from May to July 2016. Data analysis considered the complex sampling design.

Results

Males accounted for 48.6%, with a mean age of 41.9 (SE 0.6). The prevalence of hypertension was 36.5%, with only 37.1% of those aware of their condition. 98.0% perceived hypertension as common, 71.8% expressed concern, and 62.9% deemed it a more serious health risk than HIV. Stress (85.3%) and dietary habits (excessive oil 51.8%, salt 47.5%, sugar 42.4%, poor diet 31.5%) were recognized as the risks. Perception of smoking and physical inactivity as risk factors was low, at 14.9% and 22.7%, respectively. Regarding hypertension prevention, 73.9% believed it to be preventable, mainly through dietary improvements (69.0%), medication (51.1%), and exercise (36.0%). Perception of smoking cessation and alcohol abstinence was 18.0% and 1.4%, respectively. Only 20.4% had prior hypertension education.

Conclusions

This study reveals residents’ concerns about hypertension and their perception of dietary improvements as preventive measures. However, there was a notable gap in perceiving stress as a preventable risk factor, along with limited awareness of smoking and alcohol as risk factors. Comprehensive health education programs in rural Zambia are necessary to address these gaps, emphasizing lifestyle changes such as stress reduction, smoking cessation, and reducing alcohol consumption to enhance hypertension awareness and prevention.

Key messages

• Participants show a strong awareness of hypertension, perceiving it as a serious health risk and recognizing common factors such as stress and poor dietary habits.

• There is a lack of awareness concerning smoking and physical inactivity as risk factors, emphasizing the necessity for comprehensive education to promote preventive measures.
Long COVID in the UAE: symptomatology, gender gaps, and health implications among COVID-19 survivors
Authors: Saddik B , Zeidan R , Shukla A , Awad M , AlZubaidi H , Al-Bluwi N , Agha R , AlHano Z , Mohammed G , ElBarazi I
Published: October 2024

Background

A growing number of COVID-19 survivors are experiencing symptoms post-SARS-CoV-2 infection, known as long COVID. It is a new multisystem condition and understanding its associated factors and its impact on individuals is crucial. This study aims to characterize long COVID in previously hospitalized patients in the UAE, identifying associated factors and assessing its impact on patients’ daily lives.

Methods

A multicenter retrospective cohort study was conducted in hospitals in Dubai and Sharjah from January 29, 2020 to October 14, 2021, involving RT-PCR confirmed cases. Clinical, epidemiologic, and long COVID data were collected via hospital records and phone interviews.

Results

Long COVID affected 48.7% of 533 patients, with 46.6% prevalence persisting over a year. A total of 43 symptoms across 11 organ systems were reported. Females had 1.83 times higher odds of long COVID (95% CI [1.22, 2.74], p = 0.003). Each additional initial symptom (AOR = 1.22, 95% CI [1.05, 1.40], p = 0.008), ICU admission (AOR = 1.77, 95% CI [1.06, 2.98], p = 0.030), and ≥ 2 comorbidities (AOR = 2.19, 95% CI [1.09, 4.40], p = 0.027) increased the odds of long COVID. Long COVID significantly impacted daily life, with poorer health ratings (AOR = 5.576, 95% CI [3.029, 10.265], p < .001), worse health status (AOR = 7.842, 95% CI [4.954, 12.415], p < .001), and work limitations due to physical (AOR = 4.808, 95% CI [3.229, 7.158], p < .001) and emotional issues (AOR = 3.149, 95% CI [2.01, 4.933], p < .001). This impact persisted beyond 12 months post-infection.

Conclusions

Long COVID presents prolonged multisystem involvement and substantial disability among survivors, necessitating further research to understand its lasting effects and intervention development to mitigate its impact

Key messages

• Long COVID poses a substantial challenge to public health in the UAE, affecting almost half of hospitalized survivors and extending its impact beyond 12 months post-infection.

• Risk factors like gender initial symptoms, ICU stay, and comorbidities increase the risk of long COVID, warranting the need for tailored interventions and support strategies for vulnerable populations.
Diagnostic pathways and outcomes by comorbidity in cancer patients: a study in Northern Italy
Authors: Pennisi F , Russo A , Andreano A , Braga M , Renzi C
Published: October 2024

Background

Pre-existing chronic conditions can influence cancer diagnosis and outcomes. The study aimed to examine variations in diagnostic pathways and outcomes in colorectal cancer (CRC) patients by comorbidity status and socio-demographic characteristics in the provinces of Milan and Lodi, Northern Italy.

Methods

A population-based cohort study using linked administrative health data from the Agency for Health Protection (ATS) of Milan was conducted on individuals aged ≥18 years diagnosed with CRC in 2014-2017. We examined pathways to cancer diagnosis, stage at diagnosis and short-term mortality by specific comorbidities and sociodemographic factors.

Results

Among the 5,272 colon cancer and 2,120 rectal cancer patients, 43.9% and 61.5%, respectively, had at least one pre-existing comorbidity, most frequently hypertension (52.7% and 49.9%) and cardiovascular disease (CVD, 23.2% and 18.5%). Cancer diagnostic pathways included screening (4.1% colon and 4.4% rectal cancer patients), EP (22.8% and 12.6%) and inpatient/outpatient admission (73.1% and 82.9%). At multivariable logistic regression, patients with pre-existing cerebrovascular or neurological diseases had significantly higher odds of EP for CRC. In the multinomial logistic regression analysis, the odds of EP were significantly higher for patients aged <50 or ≥ 80 (vs 60-69), belonging to the highest deprivation group and being widowed (vs married). The odds of screen-detected CRC were lower for patients with multimorbidity (2 vs 0 comorbidities: adjusted OR = 0.32, 95% CI 0.14-0.75). 30-day and one-year mortality were higher in colon cancer patients with EP vs inpatient/outpatient (aOR=2.46, 95%CI 1.95-3.09; aOR=2.02, 95%CI 1.74-2.35 respectively). As the number of chronic conditions increased, mortality increased especially at one year. One-year mortality was also higher for rectal cancer patients with 3+ comorbidities (vs no comorbidities).

Key messages

• Patients with pre-existing chronic conditions had a lower likelihood of screening, higher odds of emergency CRC diagnosis and higher mortality. EPs occur in one in five CRC patients.

• Tailored interventions might be needed to facilitate CRC screening, reducing emergency diagnoses and improving health outcomes for the large number of patients with chronic conditions.
COPD empowerment scale: a scale development and validatıon study
Authors: Aksoy Z , Erol S , Oruç Ö
Published: October 2024

Background

The fact that COPD symptoms seriously affect daily life makes it different from other chronic diseases. The purpose of this study was to develop the COPD Empowerment Scale and test its psychometric properties.

Methods

This study, carried out with a methodological design, was carried out in a Chest Diseases Hospital in Istanbul, Turkey, between June 2023 and March 2024. A scale item pool was created by literature review and semi-structured interviews with COPD patients, and opinions were obtained from 16 experts. The draft scale, consisting of 55 items, was applied to 30 COPD patients as a pilot study. The draft scale was applied to 275 COPD patients and its psychometric properties were tested. The validity of the scale was evaluated by Content Validity Index (CGI) and exploratory and confirmatory factor analysis. Its reliability was evaluated by internal consistency analysis (Cronbach Alpha coefficient), item-total score correlations and test-retest analyses. Statistical significance level was accepted as p < 0.05.

Results

The KGI of the scale was found to be 0.97. The draft scale was transformed into a scale with five sub-dimensions and 31 items as a result of exploratory factor analysis. Cronbach’s Alpha value of the total scale is 0.896, and its sub-dimensions Cronbach’s Alpha values are; knowledge and understanding was found to be 0.731, access to health services was 0.816, self-efficacy was 0.719, symptom management was 0.842, and psycho-social coping was 0.728. Factor loadings of all items were 0.40 and above. As a result of confirmatory factor analysis, χ2 /df (2.59), RMSEA (0.076), NFI (0.92), NNFI (0.95), SRMR (0.03) and CFI (0.95) measurements are within the desired fit values. In the test-retest reliability study of the scale, the Pearson moment correlation coefficient was found to be ráµªáµª=.996 (p<.01).

Conclusions

The COPD empowerment scale was found to be psychometrically valid and reliable.

Key messages

• The developed scale is a valid and reliable tool to determine the reinforcement needs of COPD patients.

• The scale can be used to evaluate the effectiveness of empowerment initiatives.
Risks of high temperature exposure on infectious diseases in Portuguese hospitals
Authors: Oliveira M , Alho A M , Oliveira A P , Nogueira P
Published: October 2024

Background

The convergence of climate change and infectious diseases presents a growing public health challenge. As global temperatures continue to climb, the geographical spread of climate-sensitive diseases is shifting, underscoring the necessity for comprehensive early warning systems grounded in a One Health framework.

Methods

This retrospective observational study analyzed daily maximum temperature from May to September, between 2000 and 2018, in mainland Portugal, at a county level, obtained from a European-level gridded observations dataset. Hospital admissions with a primary diagnosis of infectious and parasitic diseases were sourced from the Hospital Morbidity Database. A distributed lag non-linear model was developed to estimate the immediate and lagged relative risks (RR) of temperature exposure on admissions, focused on a lag of 10 days.

Results

Our research reveals a 16% (95% CI: 9% - 23%) rise in the RR of hospital admissions due to infectious and parasitic diseases after exposure to extremely high temperatures (39 °C). This elevated risk persists for up to 2 days following exposure, with the second day exhibiting the largest increase at 53% (31% - 80%). Furthermore, our findings indicate a subsequent resurgence in RR, reaching 6% (2% - 11%) 9 days after exposure.

Conclusions

Our results highlight a short-term effect of extreme temperature exposure on infectious and parasitic disease admissions. This data provides valuable insights to guide policymakers in identifying critical periods of vulnerability and implementing this knowledge into heat early warning systems, contributing to developing effective public health strategies against climate change.

Acknowledgments

The authors thank Fundação para a Ciência e a Tecnologia (FCT, Portugal) for research grant UIDP/04923/2020 and NOVA National School of Public Health for access to the Hospital Morbidity Database made available for research purposes by Administração Central do Sistema de Saúde, IP (ACSS).

Key messages

• Exposure to extremely high temperatures increases the risk of admission due to infectious and parasitic diseases by 16%, with a peak occurring two days after exposure.

• This data is essential for policymakers to identify and integrate vulnerable periods into early heat warning systems, enhancing effective public health strategies against climate change.
Integrated Care in Parkinson’s disease: e-training for multidisciplinary team members
Authors: Fornes-Romero G , Fernández Salido N , Marín Valero M , Grande Gordon M , López Ortiz M , Mattarucco M , Zanutto O , Garcés Ferrer J
Published: October 2024

Background

Parkinson’s is a high prevalence disease worldwide and training in Integrated Care (IC) for professionals in this field is an obvious need. The SUPER training course is focused on integrated care applied to Parkinson’s disease (PD) and aimed at social and health professionals. Both the content and the training methodology have been co-designed with people living with PD, relatives/caregivers and professionals from Spain and Italy. The course comprises3 training modules (10 units), alongside self-assessment questions, as well as case studies. Accessible open access via an e-learning platform. It is available in English, Spanish, Italian and French enhancing its applicability and transferability.

Objectives

The SUPER e-training course aims to equip members of multidisciplinary teams with knowledge, skills and competencies in IC applied to PD.

Results

The course was validated with 89 socio-health professionals in Spain and Italy (M age = 37.28; 75.28% women), who completed a questionnaire assessing the usefulness and quality of the training modules and the platform, as well as an overall evaluation of the training in terms of quality and impact. According to the them: the training could improve the quality of care offered to people living with PD; it is expected to heighten interest in IC, while also introducing novel and invaluable elements.

Conclusions

This course is useful to train professionals of different profiles (and European contexts) on IC in PC, increasing their knowledge and skills and improving the provision of care to people living with PD. The SUPER multilingual course is an innovative tool because it has been designed from a bottom-up approach and makes available to any professional a free training that can be taken online at any time.

Key messages

• SUPER training course equips professionals from a holistic, multidisciplinary and person-centred approach to PD.

• This multilingual tool aids diverse professionals in social & health care.
State of oral health in the Portuguese population and associated psychological and social aspects
Authors: Krippahl H , Neto M , Namorado S
Published: October 2024

Background

Oral diseases are a global public health challenge and remain among the most prevalent non-communicable diseases. This study aims to characterize the self-assessment of oral health state, degree of edentulism, oral rehabilitation and the quality of life, namely chewing capacity, and the associated psychological and social aspects in the Portuguese Population.

Methods

Data were collected by telefone survey, on the 2nd half of 2018 and 1st half of 2019, using the Portuguese population representative, ECOS panel. Descriptive statistics, as well as prevalence estimates, were obtained with weighting for age, sex, region and sample design, for 95% confidence intervals. The modified F-statistic, a variant of the 2nd order Rao-Scott chi-square adjustment, was used to test the bivariate analyses.

Results

For 53% of the population, the health status of the mouth was perceived as Good or Very Good, for 37% Fair and, in 11% of cases as Bad or Very Bad. It is estimated that around 76% of the population has good oral hygiene habits, approximately 26% have all of their teeth and 8% the total absence of teeth. It is estimated that only around half (49%) underwent rehabilitation using, in the vast majority of cases (78,5%), removable prostheses. It is estimated that 32% of its users have difficulty chewing hard foods and, of these, around 20% have great difficulty or are unable to chew at all. Psychological discomfort due to oral health was higher in the Portuguese population when compared to the European population (17% vs 7 %), psychological limitations due to the appearance of teeth or dentures were equally higher (7% vs 4%), as were social limitations (8,8% vs 4%).

Conclusions

The oral health panorama in Portugal remains bleak, so strengthening the application and deepening of the national oral health promotion program should constitute a priority aspect in the development of public policies in the country

Key messages

• Integrating oral health into general health promotion strategies and assessing oral health needs to include psychological and social aspects in the Portuguese Population.

• Strengthening the strategies that have been developed in the context of health promotion, prevention and early treatment of oral diseases in Portugal.
Sociodemographic Disparities and Prevalence of Type 2 Diabetes Multimorbidities in Serbia
Authors: Jankovic J , Djikanovic B , Ayis S , Todorovic J , Parmar D , Marovic B , Santric-Milicevic M , Curcin V , Harding S
Published: October 2024

Introduction

In many countries, including low- and middle-income nations, the prevalence of diabetes is on the rise. Type 2 Diabetes Mellitus (T2DM) is frequently accompanied by the presence of one or more long-term conditions (LTCs), however, their link to patients’ socioeconomic traits remains unclear in many LMICs, particularly in the Western Balkans. Thus, our objective was to investigate the risk for the development of T2DM and one or more LTCs in Serbia among different sociodemographic population groups.

Methods

We conducted a secondary analysis of data from the National Health Surveys of 2013 and 2019, focusing on individuals aged 45 and above. Utilizing multinomial logistic regression models, we explored the relative risk ratios (RRRs), along with 95% confidence intervals (CI) and predicted probabilities, to examine the sociodemographic characteristics of participants across various disease groups, distinguishing between those with and without T2DM and one or more LTCs.

Results

The prevalence rates for comorbidities and multimorbidities of T2DM were 8.8% and 29.5%, respectively. In 2019, compared to 2013, there was a rise in the prevalence of T2DM and 1 LTC for 9.4%, and decrease in the prevalence of T2DM and 2 or more LTCs for 6,9%. Most commonly, T2DM was associated with stroke, myocardial infarction, and liver cirrhosis. The highest risk for T2DM and 1 LTC was observed for females in the most disadvantaged fifth quintile of the wealth index (RRR 1.83, 95% CI 1.09-3.07, p = 0.022) compared to those in the most advantaged first quintile.

Conclusions

Socio-economic inequalities contribute to the risk of developing LTCs in Serbia, which must be considered in the early detection and management of diseases and addressed by innovative service models. Similar studies should be conducted in the wider region to explore the feasibility of larger joint research initiatives.

Key messages

• There are socio-economic disparities in the co-occurrence of Type 2 Diabetes Mellitus and long-term conditions in Serbia, where deprived women of older age are most at risk.

• Innovative approaches in the early identification of populations at risk for multimorbidities can help in disease management and timely prevention of complications.
Integrating SDGs, One Health and transdisciplinarity into AMR Education Strategies
Authors: Nowbuth A A , Parmar V S
Published: October 2024

Introduction

The increasing prevalence of Antimicrobial Resistance (AMR) threatens modern medicine, undermines food security, and impedes environmental sustainability. The complexity of AMR requires various stakeholders to contribute to mitigate this challenge. We discuss the critical need for integrating the One Health framework, transdisciplinarity, and Sustainable Development Goals (SDGs) within AMR education; and demonstrate how these integrations enhance the effectiveness of educational strategies against AMR.

Methods

Through a review of existing literature and analysis of multiple interventions, we synthesize findings from instances where One Health strategies have been applied. We assess their effectiveness in fostering cross-sector collaboration and enhancing health outcomes, thereby providing a grounded framework for developing integrated educational strategies.

Results

Our analysis reveals that AMR education programs incorporating the SDGs and One Health principles are more likely to foster interprofessional collaboration and a deeper understanding of AMR. Case studies demonstrate that such educational approaches significantly improve the preparedness of health professionals in managing AMR through innovative and cooperative approaches. Despite the significant potential of One Health education in impacting global health positively, current interventions lack specific SDG indicators directly related to AMR, suggesting a gap in policy and global health prioritization.

Conclusions

By aligning AMR education with SDGs and One Health, there is an opportunity to enhance global health security. We call for a paradigm shift in educational strategies to effectively combat AMR, advocating for policy reforms and curriculum adjustments to incorporate these integrated approaches. The findings are crucial for educators, policymakers, and healthcare professionals aiming to redesign AMR education to be more comprehensive and globally oriented.

Key messages

• AMR education integrated with SDGs and One Health enhances interprofessional collaboration and understanding, improving health professionals’ preparedness to manage AMR effectively.

• Current AMR educational strategies lack specific SDG indicators; aligning education with SDGs and One Health can significantly boost global health security.
Exploring Climate Health Risks and Adaptations among Vulnerable Populations in Israel’s Negev Desert
Authors: Shapira S , Negev M , Natour S , Singer M , Porat I , Rosenthal A
Published: October 2024

Background

Climate change represents the paramount challenge to global health, disproportionately impacting particular vulnerable individuals and communities. By identifying and elucidating disparities in health-related climate risks among these groups, we can facilitate the development of appropriate and equitable climate adaptation strategies. This research identified climate-related risks, health perceptions and needs, and behaviors among Jewish and Bedouin populations in the Negev Desert, a region highly susceptible to climate change, located at the intersection of geographical and social marginality.

Methods

Ten focus groups (n = 69) among vulnerable Jewish and Bedouin residents were conducted and systematically analyzed to identify disparities in health-related climate risks and behaviors. Vulnerabilities were defined based on income, age, health status, living environment, and outdoor activities.

Results

The findings highlight both shared and distinct difficulties and barriers vulnerable Jewish and Bedouin Negev residents face in the context of climate-related health risks. Key themes that emerged address: a) the direct and indirect impacts of climate-related events on health and well-being; b) the exacerbation of climate-related health risks by existing vulnerabilities and systemic barriers; c) the pivotal role of community resources in coping strategies; and d) lack of trust in the state and its institutions which underpin climate-related experiences.

Conclusions

The complexity of coping with climate change encompasses individual, community, and national/institutional levels. Vulnerable populations’ experiences with climate change are impacted by factors such as poverty, social marginality, violence, and barriers to accessing healthcare and other services, and is not a standalone phenomenon. Therefore, climate change adaptation and mitigation cannot be distinguished from other challenges impacting the health and well-being of populations.

Key messages

• Climate adaptation efforts must integrate with broader social and health strategies to effectively support vulnerable groups.

• Community resources and trust in institutions are crucial for vulnerable populations facing climate change impacts.