bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoting a sustainable diet among office workers in Sweden: A pilot Study
Authors: Halling Ullberg O , Toivanen S , Tillander A , Bälter K
Published: October 2024

Background

Society is facing multiple challenges, including lifestyle-related diseases, alongside global climate change. Actions are needed to promote sustainable lifestyles advocating for healthy and environmentally friendly diets. This study aimed to assess how a sustainable lifestyle, compared to conventional healthy lifestyle education at work, affects participants’ energy intake, nutrient consumption, and diet-related CO2e.

Methods

An 8 week two-armed randomized trial was conducted, comprising a sustainable lifestyle arm (n = 21) and a healthy lifestyle arm (n = 16) based on the theoretical framework of the Behavioral Change Wheel, in total (n = 33) completed the trial. The office workers participated in 6 workshops during working hours. Linear mixed-effects models and analysis of variance tests were used for data analysis. Changes over time are presented as arms combined, along with their respective mean differences.

Results

A significant decrease in mean diet-related CO2e was observed (p < 0.001), with a decrease on average of 0.74 and 0.71 kg CO2e/day. The mean change in daily kilocalorie intake had a significant decrease over time (p = 0.008), on average of 192 and 386 Kcal. Moreover, a significant decrease in mean protein intake was observed (p < 0.001), with a decrease on average of 16 and 18 grams, possibly explaining the decrease in CO2e. No significant differences were observed between the arms at any timepoint.

Conclusions

Promoting sustainable lifestyle habits has a similar impact to advocating for a conventional healthy lifestyle regarding diet. This supports the new Nordic Nutrition Recommendations 2023. Despite the small sample size, insights into facilitating sustainable behaviors can influence public health policies across Europe and the workplace as an arena for health promotion.

Key messages

• The promotion of sustainable and healthy lifestyle habits at work can promote both individual and planetary health by decreasing diet-related CO2e emissions.

• Here we demonstrate that the workplace has the potential to act as an arena to combat climate change.
Hip fracture in elderly: malnutrition and health outcomes. A systematic review and meta-analysis
Authors: Ricciotti G M , Genga A , Chiavarini M , Faggi M I , Rinaldi A , Toscano O D , D’Errico M M , Barbadoro P
Published: October 2024

Background

Hip fracture is a common condition among elderly and one of the leading causes of disability. Malnutrition is widely present in older patients and has been identified in several studies as an important and modifiable prognostic factor for several medical conditions, including hip fracture. The aim of the present study is to evaluate the association between malnutrition, assessed by validated tools, and selected health outcomes for different follow-up intervals from hip fracture, in particular: mortality, changes in mobility/living arrangements and postoperative delirium.

Methods

A literature search on PubMed, Web of Science and Scopus databases up to September 2023, was conducted to identify all studies involving older subjects that reported an association between MNA/GNRI/PNI/CONUT score and health outcome after hip fracture. Meta-analysis was performed by a random-effects model using risk values (RR/OR/HR) extracted from 14 eligible selected studies.

Results

Malnutrition significantly increased the risk of any adverse outcome by 70% at 1 month, and up to 250% at 1 year, showing an increasing trend with longer follow-up periods. One month after hip fracture, malnutrition significantly increased the risk of postoperative delirium by 275% (OR = 2.75; 95% CI 1.80-4.18; p ≤ 0.05), mortality by 342% (OR = 3.42; 95% CI 2.14-5.48; p ≤ 0.05) and mortality hazard risk by 351% (HR = 3.51; 95% CI 1.63-7.55; p ≤ 0.05). One year after hip fracture, malnutrition significantly increased the risk of transfer to more supported living arrangements by 218% (OR = 2.18; 95% CI 1.58-3.01; p ≤ 0.05), declined mobility by 41% (OR = 1.41; 95% CI 1.14-1.75; p ≤ 0.05), mortality by 368% (OR = 3.68; 95% CI 3.00-4.52; p ≤ 0.05) and mortality hazard risk by 234% (HR = 2.34; 95% CI 1.91-2.87; p ≤ 0.05).

Conclusions

These findings underscore that malnutrition worsens outcomes after hip fracture in elderly, emphasizing the importance of nutritional assessment to mitigate potential adverse consequences.

Key messages

• The results of the present study underscore that malnutrition increases the risk of death and worsens mobility and independence after hip fracture in older adults.

• Routine nutritional status evaluation could prove beneficial in the management of hip fracture older patients in order to prevent potential adverse outcomes.
Adherence to Mediterranean diet and cardiometabolic risk among mountain communities in European Alps
Authors: Squillacioti G , Aguilar Palacio I , Bédard A , El Sherbiny S , Ghelli F , Panizzolo M , Bellisario V , Bono R
Published: October 2024

Background

The Mediterranean diet has emerged as a model promoting a better health status, particularly for cardiovascular diseases prevention. Adherence to the Mediterranean diet (AMD) may vary depending on geographical location and sociocultural factors. Mountains and rural communities may experience lower adherence, also depending on food provision-related services availability. Our cross-sectional study aims to investigate the association between AMD and cardiometabolic risk in a cohort of mountain dwellers. As a secondary aim, we will test if services availability may influence health status via AMD.

Methods

In spring/summer 2023, healthy volunteers from 5 small villages in Italian Alps were enrolled. Dietary habits were investigated by Medi-Lite standardized questionnaire. The waist-to-height ratio (WHtR) was calculated by dividing the waist circumference by height, then used as an anthropometric index for central adiposity and related cardiometabolic risk. Services availability was assessed by network analysis implemented in QGIS. A multilevel logistic regression model, with center as random intercept and adjusted for age, sex, BMI, education and physical activity was used to test the association between AMD and cardiometabolic risk. Ethical approval was provided by University of Turin.

Results

To date, 142 subjects (59.2% females, 49.9±14.0 y.o.) have been enrolled. Preliminary analyses showed that, as compared to the least adherent group, subjects reporting the highest AMD level (3rd tertile of Medi-Lite scoring) were strongly protected from cardiometabolic risk (OR: 0.07, 95% C.I.: 0.01, 0.67; p = 0.021). A similar trend was observed for the 2nd tertile.

Conclusions

Our preliminary findings suggest the beneficial role of the Mediterranean diet also in remotely located populations. We plan to investigate how service availability may impact AMD and, indirectly, cardiometabolic health to reinforce the importance of equity in services distribution for Public Health

Key messages

• Independently of age, sex, BMI, education and physical activity, adherence to the Mediterranean diet can promote cardiometabolic health among rural and mountain communities.

• Mediterranean eating pattern can positively influence central adiposity and should be promoted to ensure more effective prevention strategies in mountain dwellers.
Health disparities continue to report in DEIS schools: Irish COSI Round 6 study
Authors: Ravichandran N , Kilduff O , Slattery J , Lee C , Hunt E , Douglas A , O’Brien S , Murrin C , Kelleher C
Published: October 2024

Background

Previous reports have identified clear differences in the prevalence of overweight and obesity among children living with disadvantaged compared to those living in advantaged circumstances. Childhood obesity is influenced by factors in the home environment, including lifestyle behaviours and socio-economic status. The Childhood Obesity Surveillance Initiative (COSI) family survey provides insights into these factors, particularly in children that attend disadvantaged (DEIS) and non-disadvantaged (non-DEIS) schools.

Aim

This study aims to compare various demographic and socioeconomic factors within the home environment of primary school children across DEIS and non-DEIS schools in Ireland, elucidating the differences in their performance with implications for health policy.

Methods

Parents of 1st and 2nd class children (mean age 7) from 121 sentinel schools invited to participate in the family survey, returned it by post or online using Lime Survey. Ethical approval was secured for COSI R6, with consent from families. Data on demographics, diet, transportation, activities, and clinical characteristics of children in Ireland were collected, anonymised and analysed in SPSS, comparing children from DEIS (n = 147) and non-DEIS (n = 1014) schools.

Results

Around 88% of respondents of returned surveys included in the study (n = 1161) were mothers. Significant disparity in families with diabetes diagnosis or treatment observed between DEIS and non-DEIS schools (10.6% vs. 5.4%, p = 0.016). Breastfeeding rates were higher in non-DEIS schools (57.0% vs. 46.9%, p = 0.015). Children consuming at least 3 portions of fruits and vegetables daily were also higher in non-DEIS schools (58.9% vs. 46.0%, p < 0.001). More children in non-DEIS schools engaged in physical activities outside of school hours (93.7% vs. 74.5%, p < 0.001).

Conclusions

The findings underscore the significant socioeconomic disparities between families whose children attend DEIS and non-DEIS schools in Ireland.

Key messages

• Irish COSI R6 reveals disparities in health-related factors between disadvantaged and advantaged schools.

• Targeted interventions and policies are necessary to address factors influencing child health.
Disparities in Breastfeeding Patterns Persist Despite Improved Rates: Findings from Irish COSI R6
Authors: Ravichandran N , Kilduff O , Slattery J , Lee C , Hunt E , Douglas A , O’Brien S , Murrin C , Kelleher C
Published: October 2024

Background

Breastfeeding is crucial for reducing childhood obesity, recommended exclusively for 6 months by World Health Organisation (WHO). Previous reports have highlighted disparities in breastfeeding patterns between Irish and non-Irish mothers. The Irish Childhood Obesity Surveillance Initiative (COSI) family survey offers insights into breastfeeding rates and patterns in Ireland and their differences between Irish and non-Irish mothers.

Aims

This study aims to compare the breastfeeding rates in Ireland between COSI Round 6 (R6) and COSI R5, elucidating the differences between Irish and non-Irish mothers. Additionally, it aims to establish the association between breastfeeding pattern and socio-economic factors involved in the Irish households.

Methods

Parents of 1st and 2nd class children (mean age 7) from 121 sentinel schools invited to participate in the family survey, returned it by post or online using Lime Survey. Ethical approval was secured for COSI R6, with consent from families. Data on breastfeeding rates and pattern were collected, anonymised, and analysed using SPSS version 29.

Results

Around 88% of respondents were mothers. The number of children breastfed for at least a month increased in R6 (55.7%) compared to R5 (45.6%). The mean duration of exclusive breastfeeding increased to 5.86 months in R6 from 4.91 months in R5, in line with WHO recommendations. Significant disparities were found in breastfeeding patterns, with higher rates among non-Irish mothers (67.8%) compared to Irish mothers (52.6%) (p < 0.001). Linear regression showed a significant association between breastfeeding duration and maternal birth country. Irish mothers exhibited a negative coefficient (b1=-2.442; 95% CI -4.1 to -0.8; p = 0.004), suggesting shorter breastfeeding durations compared to non-Irish mothers.

Conclusions

Breastfeeding rates improved in COSI R6 compared to R5. There are significant disparities in breastfeeding pattern between Irish and non-Irish mothers.

Key messages

• Improved breastfeeding rates indicate good feeding practices in Ireland.

• Targeted interventions and policies are necessary to address the disparities between Irish and non-Irish mothers in breastfeeding patterns.
Strengthening ecosystems
Authors: Geyer G , Teperi J
Published: October 2024

The mission of THCS activities with respect to strengthening ecosystems is based on the understanding that the actual transformation of health and care systems is dependent on the ability of numerous actors to align their goals and actions so that they are complementary. At the same time, it is also true that the transformation takes place at national, regional and local levels, making activities and support at these levels essential for the success of THCS. Therefore, the focus lies on connecting and supporting the broad community and other stakeholders in developing ecosystem-wide approaches and creating awareness and urgency among ecosystem layers and components, thus serving as a platform for transformation. One strand of activities for strengthening ecosystems aims at identifying, analysing, describing and disseminating key learnings from successful transformative ecosystems (TE’s). TE’s are broad constellations of interacting organisations and people who are committed, and through aligned actions, able to reach joint, explicitly defined goals in long-term. Making not only the most successful TE’s but also the dynamics explaining their achievements visible, value is being added through three main routes. Firstly, the experiences are distributed widely on European arenas and platforms as well as through national, regional and local channels to inspire ecosystem building processes in earlier stages of maturity. Secondly, collaboration between identified forerunner ecosystems is supported to enable mutual peer-learning. Thirdly, the examples are used to give guidance and inspiration to consortia that are applying for or receiving THCS project funding. As strategic partners of the ecosystem strengthening activities, other work packages of the THCS programme as well as the THCS National Mirror Groups are of great importance.
Healthy lifestyle promotion project among healthcare workers
Authors: Zilli E , Tikvina S , Bonaldo D , Varotto M , Bevilacqua S , Calzavara A , Madia A , Ruffatto A
Published: October 2024

Background

The psychosocial risks generated from difficult work conditions are damaging not only for the workers’ health and safety, but also have a huge impact on the organization and management efficiency.

Description

Some of the primary challenges that health workers face are demanding schedules and stressful shift patterns which lead to higher levels of worker burnout. Ensuring the well-being of healthcare staff is crucial not only for the individual workers, but it also brings important lessons to the community creating an environment built on a culture of health.

Results

In the past year, the Hospital of Cittadella (Province of Padua) has launched a set of programmes structured to help the staff make better lifestyle choices that affect not only their personal life but also create a more sustainable work environment. One of the projects involved various meetings with a Physical Medicine-Rehabilitation physician, a physical therapist, an Occupational Medicine physician and a medical yoga teacher. The encounters, attended by nearly 10% of the hospital staff, were aimed to help healthcare workers create a more balanced lifestyle and to implement physical activity and posture exercises in their daily routine. Four nutrition classes were also organized with the help of a nutritional biologist. The aim of this course was to show the basics of healthy diets supported by scientific data and guide the participants towards realistic and healthy meal plans.

Lessons

In conclusion, increasing the general wellbeing within the healthcare context is not an easy task, especially when organizational circumstances like staff reduction are being faced. These projects represent a small step towards facing these difficulties. It is important to note that the motivation, collaboration, inclusivity, flexibility and reliance are all elements that contribute to better mental and physical health of the healthcare staff which is crucial on an individual, organizational and societal level.

Key messages

• Increasing personal well being amongst healthcare workers can help create a more sustainable work environment.

• A healthy work environment is crucial for a better functioning organization.
Focus on food instead of nutrients improves consumers’ understanding of meals’ nutrition quality
Authors: Viegas C , Lamy E , Prada M , Rocha A
Published: October 2024

Background

Nowadays, most of the information directed to consumers focuses on nutrients, ignoring the impact of the interactions between different foods, origin or degree of processing. The methodologies currently applied have led consumers to confuse foods with nutrients, meat and fish are often referred to as “proteins”, grains and potatoes are referred to as “carbohydrates, forgetting that these foods are source of other nutrients, such as fat, proteins or fibre. Furthermore, its efficacy is compromised by the difficulties of reading labels among consumers.

Objectives

This study aimed to evaluate the understanding about food and nutritional information presented in menus to consumers, comparing the nutrient-focused approach (Nutrition Declaration) and the new food-focused approach (infographic - based on the Portuguese food Guide, from previous research).

Methods

4 different meals were created, 2 balanced and complete in terms of food and nutrient content and 2 unbalanced and uncomplete. A questionnaire was applied, evaluating the understanding of the balance and healthiness of the meals, using the two approaches (nutrient-focused and food-focused). The order of presentation of the approaches and the meals was randomized for all participants. The questionnaire was distributed online through snowball sampling.

Results

221 individuals participated, mostly female (67%), aged 25 to 54 years old. Evaluation of meals (“how balanced” and “how complete” the meal is) using the Nutrition Declaration did not allow to distinguish the quality of meals (Mb = 3,8;Mc=4,0), in opposite the Infographic returned significant differences between M1/M2 (Mb = 4,3;Mc=4,4) and M3/M4 (Mb = 2,5;Mc=2,6) (p < 0.01) allowing consumers to perceive differences between meals. The percentage of consumers that respond “I don’t know” to these questions decreased using the food-focused tool (13% vs 2%).

Conclusions

The food-focused approach allows for better understanding of meals’ nutritional balance.

Key messages

• The infographic provides more information about the daily food portions and how different meals and types of food contribute for complying food and nutritional recommendations.

• The use of the infographic in menus, recipes, cookbooks and clinical advice may improve better food choices and a healthier lifestyle.
When toxicity is not just from gluten: a systematic review on financial toxicity and celiac disease
Authors: Di Simone E , Panattoni N , Celiboni G , Renzi E , Di Muzio M , Villari P , Massimi A
Published: October 2024

Background

With an incidence of up to ∼2% globally, Celiac Disease (CD) is probably one of the most life-long common chronic conditions. Although ‘Financial toxicity’ (FT) has been mainly linked to oncology, significant financial burdens have been described across all healthcare domains, even in CD and to the unexpected economic effort resulting from illness and the need for treatments. This study aimed to investigate the potential relationship between CD and FT.

Methods

A systematic literature review was performed according to the PRISMA Statement 2020 guidelines. The search query queried the following databases: PubMed, Scopus, CINAHL and APA PsycInfo. No time and study design limits were included.

Results

105 articles were found, and 25 were included in the review. The main results revealed that CD impacts physical health and imposes a significant financial burden on patients and their families. FT in CD is primarily due to the high costs of diagnosis, lifestyle changes, and expenses for gluten-free foods. Several studies highlighted the scarce adherence to the therapeutic diet due to the cost of food and poor acceptance of CD. Furthermore, since 2007, there has been increased attention to the difficulty of finding gluten-free products and their expensive fees. All these aspects, even for low-income countries, were faced differently globally, as documented by the heterogeneity of government subsidy policies highlighting the health inequity.

Conclusions

Considering the prevalence, a comprehensive health assessment with a global health approach should consider clinical, social, and economic aspects. This regard could improve the quality of life for CD patients and ensure fair and personalised access to care, regardless of their geographical location or financial situation. This review has highlighted the fragmentation of resources available internationally, underlining the relevance from a public health point of view.

Key messages

• Celiac Disease is one of the most common life-long disorders, and financial toxicity is an aspect that should be taken into account also from a public health point of view to ensure health equity.

• The gluten-free diet represents an important therapeutic choice in CD; the related expensive fees could increase scarce adherence and worse health outcomes.
Characterising users of community-based interventions designed to improve the food practices
Authors: Petre O , Allan J , Craig L , Douglas F , Kyle J , Stephen A , Thies F
Published: October 2024

Promoting affordable ways to help low-income families improve dietary behaviours and achieve a healthy weight represents a priority for UK public health policy. For such interventions to be appropriately tailored and targeted, it is important to better understand the intended recipients. The present study aimed to assess the dietary practices and psychosocial characteristics of users of Aberdeen City community-based interventions (e.g., food banks, pantries, social cafés) designed to support low-income communities in accessing food and engaging in healthier food practices. From January to June 2023, a cross-sectional survey was conducted employing convenience sampling among users of community-based interventions (N = 105; 73 females). The questionnaire assessed diet quality (SFFQ), household food insecurity (HFIAS), mental health (PHQ-4), well-being (Cantril Ladder), intention and self-efficacy toward healthy eating, and sociodemographic variables. Data were analysed using descriptive statistics, group comparisons, correlations, and regression analyses. Results indicated that community-based food provision users are highly vulnerable to food insecurity. Among participants, 53.3% reported severe food insecurity, and 18.1% reported moderate levels. Service users’ diets were high in discretionary foods and drinks (26% consume daily >1 portion of fizzy juice, 18.2% sweets, 16.7% crisps vs. 11.5% fruits and 10.6% vegetables). The mean dietary quality score was 9.48 (SD = 1.90) from a possible 15. Higher food insecurity and lower diet quality were significantly associated with greater mental distress (r=.41, p<.001; r=-.287, p=.005;) and poorer well-being (r=-.460, p<.001; r=.19, p=.049;). This study is part of a larger project aiming to optimise community-based dietary interventions for low-income populations. The results provide a clearer picture of the intended beneficiaries of such interventions and highlight user needs that can be prioritised in optimisation efforts.

Key messages

• Community-based food provision users are highly vulnerable to food insecurity and related negative health experiences.

• The burden of poor diet and its associated health consequences disproportionately affect those living in the most deprived communities.
Health Impact Assessment (HIA): a tool to drive health in all policies?
Authors: Green L
Published: October 2024

Health Impact Assessment (HIA) is often promoted as a tool to implement ‘health in all policies’ and sustainable development approaches to improve health and equity outcomes. However, is this truly the case? Currently global HIA practice is variable. This paper shares learning from the development and implementation of HIA in Wales to date to understand how HIA has been, and can be, used to inform policies and decisions and reduce health inequalities. The research investigated if, and how, HIA can be used as a tool to mobilise HiAP in reality. It followed a mixed methodological approach and investigated the contribution of HIA to practically advancing HiAP viewed through the lens of Wales and internationally. Primary and secondary evidence and statistics were collected and analysed. A literature review, stakeholder interviews, online statistical questionnaires and case studies were conducted. Thematic and content analysis techniques used. Findings include the importance of conceptual considerations i.e. the perspective on health - social determinant an equity or environmental determinant driven - taken by those carrying out or commissioning a HIA; the importance of centres of expertise to learn from; and practical considerations such as the political and regulatory environment, workforce and organisational knowledge and capacity. Wales has a dedicated expert HIA Unit, an enabling political environment and has led to HIA influencing policies and plans over 20 years. It has transferrable learning for other nations and the research including the online survey has been replicated by others, led to collaborations with nations such as Portugal and contributed to the reviewed literature by providing case studies on a topics like climate change which have influenced decision makers. Tangible ways forward for policy makers, researchers and academics include the need to develop more cross collaboration and fill gaps in the evidence i.e. on institutionalisation of HIA.

Key messages

• HIA is a excellent process to drive Health in all policies approaches.

• HIA needs an enabling environment and workforce support such as that in Wales to thrive.
What are the challenges in the Health Technology Assessment of genetic and genomic applications?
Authors: Baccolini V , Isonne C , Siena L M , Sciurti A , Migliara G , Leone I , Marzuillo C , La Torre G , Villari P
Published: October 2024

Introduction

Evaluating genetic/genomic applications (GGAs) is crucial for their implementation in clinical practice but hindered by several issues, such as rapid development processes and unclear benefits. Since these challenges lack comprehensive discussion, this study aims to identify and analyze all barriers emerged in the Health Technology Assessment (HTA) of genetic/genomic tests, filling a gap in the current literature.

Methods

PubMed, Scopus and Web of Science were searched to identify studies that specifically discussed any challenge or barrier in the HTA evaluation of GGAs. No restriction was applied on evaluation aspect or study type. Challenges/barriers were then grouped into the domains outlined in the EUnetHTA Core Model. A narrative synthesis of the main findings was performed. This study was supported by the EC and MUR- PNRR-M4C2-I1.3 Project PE_00000019 ‘HEAL ITALIA’.

Results

19 articles were included: one third involved experts from different countries, and about 50% were author perspectives. Articles either focused on one aspect only (37%) or were more general (47%). The most challenging domain was economic aspects (69%), followed by clinical effectiveness (47%) and social impact (42%), but issues were found in all domains. The lack of a standardized HTA approach, the paucity of evidence on clinical outcomes, the challenges in capturing all health benefits, and the difficulties in identifying the healthcare pathways triggered by the test were consistently mentioned across the HTA domains.

Conclusions

Our study systematically summarized challenges in the HTA evaluation of GGAS, providing a thorough analysis and categorization of these issues. Various challenges surfaced, notably related to the identification of costs, as well as clinical and non-clinical benefits. There is a need for exhaustive discussion on potential solutions to facilitate the assessment process of these technologies to ultimately foster their implementation in clinical practice.

Key messages

• There are multiple challenges in the HTA evaluation of genetic and genomic tests in clinical practice that impact every HTA domain.

• There is a need for concrete efforts in generating further evidence in relation to the definition of costs and benefits of the healthcare pathways triggered by genetic/genomic applications.
The efficacy of vaccination against respiratory syncytial virus across priority population subgroups
Authors: Domnich A , Bertola C , Lupi C , Vece M , Lorenzini E , de Waure C
Published: October 2024

Background

Respiratory syncytial virus (RSV) has recently become a vaccine-preventable disease as two vaccines have been approved for use and a third one is likely to become available by the end of the year. National Immunization Technical Advisory Groups as well as scientific societies across the world have issued recommendations on RSV vaccination that differ in respect to the identification of the target group. The latter has been identified in respect to age or underlying medical conditions mostly according to epidemiological data. In order to strengthen the evidence basis for future decisions, we performed a stratified meta-analysis of efficacy data considering all the three RSV vaccines currently or soon available.

Methods

We searched Randomized Controlled Trials (RCTs) assessing the efficacy of RSV vaccines in terms of reduction of RSV-related Lower Respiratory Tract Infection (LRTI). The research was conducted on PubMed and clinicaltrial.gov. The extraction of relevant data was stratified by pre-defined age groups (60-69, 70-79, 80+) and presence of underlying conditions increasing the risk for RSV.

Results

Three RCTs, one for each of the three vaccines, were considered for the quantitative analysis. Considering the overall 60+ population, the efficacy of RSV vaccines was 78% (95%CI 76-86%) in preventing LRTI. Considering the different age groups (60-69, 70-79, 80+), efficacy was respectively 72% (95%CI 53-84%), 90% (95%CI 66-97%) and 57% (95%CI 0-93%). The efficacy in healthy people and those with at least one underlying condition was similar, namely 77% (95%CI 60-87%) and 78% (95%CI 50-90%).

Conclusions

The available evidence shows the efficacy of RSV vaccines in reducing LRTI with no differences across different priority groups. Further studies may contribute to better understanding if the efficacy may change according to individual characteristics, that could be highly relevant in the decision-making process.

Key messages

• The available evidence from RCTs shows the efficacy of RSV vaccines in reducing LRTI with no differences across different priority groups.

• National recommendations on RSV vaccination can be further informed for future studies investigating RSV vaccines efficacy across different subgroups.
Assessment of controlled assistance from e-bikes as a mitigation strategy for individual PM exposure
Authors: Bonardi A , Borgese L , Negro F
Published: October 2024

Background

While promoting active mobility and outdoor activities can benefit health (HLT), it also increases Exposure (EXP) to air pollutants, such as particulate matter (PM), due to the increased ventilation rate (VR) under physical activity. Traditional assessments of individual (IND) PM EXP involve costly equipment inaccessible to the public, but real-time low-cost sensors (LCS) are now emerging. This study presents a proof of concept to demonstrate the use of LCS for examining the real-time IND respiratory dose deposited (RDD) to PM cycling across the Brescia province.

Methods

An e-bike was ridden 33 times between 2022 and 2023 wearing a LCS for PM concentration [PM] linked to a GPS. Respiratory dose deposited(RDD) was calculated for six different locations within each route based on experimental PM and various VR.

Results

The LCS allows for the study of the spatial and temporal variability of [PM], revealing a significant difference (p < 0.01) according to the heating system operation and no significant difference (p > 0.05) depending on the location. RDD increases with [PM] and VR. Real-time and integrated RDD is calculated for routes with high (> 50 µg/m3), medium (25 µg/m3), and low (<10 µg/m3) [PM2.5]. The e-bike assistance is activated when the WHO interim target 4 of [PM] is reached to reduce VR, which corresponds to a shift to a lower physical activity intensity. The RDD calculated using the e-bike assistance over the path reduces RDD by about 23% and 11% over the high and medium [PM], while it never activates for the low [PM].

Conclusions

This study demonstrates that the use of LCS allows the estimation of IND RDD, and the implementation of mitigation strategies based on controlled assistance from e-bikes would enable the reduction of PM individual EXP.

Key messages

• The integration of HLT data from wearable and air quality LCS enables the promotion of active mobility and outdoor activities controlling the EXP to air pollutants.

• Establishing generalized guidelines based on this mitigation strategies for individual exposure reduction may also inform policy recommendations for promoting active and green mobility.
BEST-COST project: a scoping review on the use of multiple deprivation indices in Europe
Authors: Mogin G , Gorasso V , Baravelli C M , Idavain J , Lepnurm M , Delaunay-Havard S , Luyten A , Corda M
Published: October 2024

Background

A Multiple Deprivation Index (MDI) is a composite measure designed to comprehensively evaluate the socio-economic status of individuals within a population. While various countries have employed their own versions of MDI to assess deprivation, none have been developed at the European level thus far. The BEST-COST project (www.best-cost.eu) aims to integrate the dimension of social inequalities in the assessment of the burden of environmental stressors, using a new MDI. Therefore, the objective of this study is to conduct a scoping review to identify and assess current MDIs while extracting details on the methodologies employed in their development.

Methods

We conducted a scoping review on deprivation indices in European countries, encompassing three databases (Medline, Embase and Web of Science). Following screening of all the articles based on inclusion criteria, we specifically examined the methodological choices made across the development of the MDIs, such as the choice of the underlying indicators, geographical scales, data source used, and if and/or how indicator weighting was applied in creating a composite score.

Results

In total, 22 MDIs were identified from 195 articles. 42% of these indices were developed from census data at the municipality level or finer. About half of them (55%) employed weighting of indicators, thereby reflecting their relative importance within the index’s score. From these 22 MDIs, a total of 156 individual indicators were extracted. These indicators encompass several domains such as basic amenities, crime, education, employment, family structure or income. The extensive variety of indicators can be attributed to cultural differences within the EU, data availability and the specific time period during which each index was developed.

Conclusions

Several European countries have separately developed their own MDI, showcasing significant variability in both the included individual indicators and the methodologies applied.

Key messages

• This review highlights the variability of existing indices and which methodologies could be used for the development of a Europe-wide multiple deprivation index.

• It further emphasizes the importance of considering cultural differences and data availability across countries in this process.
A Conceptual Model for Health Impact Assessment of Personalized Prevention Policies
Authors: Costa C , Lopes F , Costa A , Cardoso M L , Gris A V , Kannan P , Garvão F , Perola M , Boccia S , Vicente A M
Published: October 2024

Background

Personalized prevention and pharmacogenomics are emerging fields in global health, promoting tailored approaches to disease prevention and individualized drug therapy, based on the individuals’ genetic profile. However, adoption of these technologies in public health is challenged by the possibility of health disparities. Health Impact Assessment (HIA) is a useful tool to address this issue, by examining how policies differentially impact population groups, guiding stakeholders to more equitable and inclusive outcomes. Solid frameworks for assessing health impacts are needed to avoid heterogeneity when accounting for equity outcomes in HIA. This study tested a conceptual model for HIA in personalized medicine, using a case study in pharmacogenetics to map potential impacts and outcomes, with a focus on health equity.

Methods

A conceptual model for a HIA was developed to map expected impacts and outcomes of a health policy, aimed at enforcing DPYD genotype-guided dosing to prevent fluoropyrimidine toxicity in colorectal cancer patients. The conceptual model was developed based on literature reviews and consultation with stakeholders. Identification of relevant impacts guided selection of indicators and quantitative impact assessment using a Markov chain model.

Results

Impact pathways were identified using a three-tiered reference framework encompassing individual and population perspectives, organizational factors, and overarching health system considerations. The final diagram outlined key outcomes in four categories: health, organizational, economic and equity. HIA projections using this model were obtained for the DPYD testing policy.

Conclusions

In the rise of personalized medicine and pharmacogenomics, health inequalities challenges need to be addressed before implementation in healthcare. This study provided a novel HIA conceptual model for personalized prevention policies based on genomic information, with an emphasis on equity.

Key messages

• HIA is an adequate tool to evaluate potential health inequalities resulting from personalized medicine policies in healthcare.

• This study provides a validated framework for HIA of personalized prevention policies grounded in genomic data.
Rapid health technology assessment to inform policy: a case study with respiratory syncytial virus
Authors: Byrne D , Power V , Bergin A , Panaro A , Cardwell K , Teljeur C , Walsh K A , Harrington P , Ryan M
Published: October 2024

Background

Respiratory syncytial virus (RSV) can cause severe acute respiratory tract infection in infants and older adults. However, until recently, no immunisation interventions were available to reduce the burden of RSV disease in the general population. New health technologies have now been authorised in Europe for infants (a long-acting monoclonal antibody (nirsevimab) and a maternal vaccine (RSVpreF)), and two vaccines for adults aged ≥60 years (RSVPreF3 and RSVpreF). A rapid health technology assessment (HTA) was requested by the Irish Department of Health to support an interim decision on RSV immunisation.

Methods

The rapid HTA commenced in January 2024, and comprised description of technology, a summary of international practice, national and international epidemiology and burden of disease, and a costing analysis. The summary of international practice (including underpinning evidence) was undertaken rather than a systematic review of effectiveness and safety due to the rapidly changing evidence base and short timeline within which information was required.

Results

While new recommendations regarding immunisation against RSV are emerging internationally in response to recently authorised technologies, implementation and funding strategies are not currently widespread. Compared with a full HTA, a rapid HTA enabled an efficient and flexible approach to producing a high quality evidence synthesis to inform a temporary policy decision, taking approximately 6 months to complete rather than 12 months or longer. A full HTA is planned to inform long-term decision-making on this topic, but would not have been feasible to inform an interim decision.

Conclusions

This rapid HTA will inform a temporary decision on immunisation policy for a single RSV season in Ireland. Conducting a rapid HTA prior to a full HTA has enabled timely decision-making, with implications for Ireland’s national healthcare system and people at risk of severe RSV-related disease.

Key messages

• Innovations in immunisation against RSV are leading to changes in policy across Europe.

• Rapid HTA can support timely, evidence-based public health decision-making in a fast-evolving field.
Enhancing preparedness by developing robust implementation
Authors: Kaag F , Koeck J F
Published: October 2024

In EUVABECO, a goal is defined as a public health objective that motivates a vaccination practice. A vaccination practice encompasses specific methods or approaches used in vaccination efforts, while a tool refers to a tangible resource or software developed to support the implementation of these practices. EUVABECO is undertaking a series of structured activities from January 2024 until mid-2026. These include mapping innovative practices, deriving requirements for tools and validation plans, developing implementation plans, and facilitating their adoption by European MS. The project will also evaluate, validate, and verify these plans to ensure their efficacy and sustainability. EUVABECO’s methodology is informed by the Systems Development Lifecycle (SDLC) framework, utilizing the V-model to ensure a strong linkage between the development and testing phases, thereby guaranteeing a cohesive workflow. Each implementation plan developed will feature comprehensive policy recommendations and a workplan that covers the necessary organizational, technical, legal, and ethical aspects required for the tool’s deployment. Additionally, these plans will include tailored strategies to enhance the tool’s functionality during outbreaks, criteria for verifying implementation effectiveness, and financial considerations critical for supporting adoption. The implementation plans will undergo a rigorous validation process to assess their suitability, transferability, and sustainability across MS. The ultimate goal is to disseminate validated plans whilst ensuring a parallel multistakeholder engagement approach to ensure MS are actively involved in key project phases, thus, facilitating rapid uptake of said plans across EU MS and a transformation of the vaccination ecosystem across Europe.
Early exposure to (hetero)sexism in medical settings: young patients’ experiences with gynaecology
Authors: Miani C , Ouma M , Alaze A
Published: October 2024

Background

Gynaecology is a highly gendered specialty where gender norms are particularly susceptible to shape patient-provider interactions. Consultations about contraceptive practices, reproductive choices, and sexual activity are fertile settings for the potential confrontation of different sets of gender-related expectations, and the expression of gender-based discrimination, i.e. sexism and heterosexism. We therefore investigated young patients’ first experiences with gynaecological care in Germany with a focus on their experiences of (hetero)sexism.

Methods

We conducted 15 qualitative interviews with a gender-inclusive sample of patients aged 16-25 who narrated their first consultations and experiences of gynaecological care. We analysed the data thematically.

Results

Cis-gender heterosexual women composed the majority of the sample; a trans man and two persons who reported being at some point in same-sex relationships were also included. The main reasons for a first consultation were painful periods and contraception. Participants narrated examples of gender-based discrimination, with providers making what was perceived as gender-insensitive, demeaning, or plainly homophobic remarks. Those were particularly present in relation to conversations about the contraceptive pill, with either providers refusing to prescribe it on the account that the patient didn’t have sex or “real sex” (i.e. heterosexual intercourse) or with providers pushing for use of the pill “just in case”, even when patients didn’t need nor want it. Additionally, sexist, unrequited arguments about how the pill could enhance a patient’s breast or skin occurred in several conversations.

Conclusions

Our study shows clear occurrences of (hetero)sexism on the part of gynaecologists, from demeaning comments to more subtle reminders of sexist gender norms. It highlights the need to implement more patient-centred, gender-sensitive gynaecological practise to support the promotion of respectful care.

Key messages

• Young patients are exposed to various forms of gender-based discrimination in gynaecological care in Germany, highlighting how entrenched traditional, (hetero)sexist gender norms are among providers.

• Promoting more gender-sensitive, respectful care could start with a reflection on consultations around the contraceptive pill, as they often crystallise the manifestation of damaging gender norms.
Characteristics of applicants with a first-time recognition of need for long-term care
Authors: Schnitzer S , Haeger C , Baldenius T , Jürchott K , Kuhlmey A , Schwinger A , Blueher S
Published: October 2024

Background

The increasing number of care-dependent individuals requires approaches to prevent care dependency or reduce loss of independence. Long-term care assessments can provide valuable insights into this. In Germany, the Medical Service is responsible for the long-term care assessment (care level) that focuses on limitations in independent living.

Objectives

The aim of this contribution is to describe initial applicants with identified need for long-term care.

Materials and methods

The nationwide database consists of long-term care assessments conducted by the German Medical Service of health insured people aged 60 and above who received a care level (1=smallest till 5= largest limitations) for the first time in 2021. Long-term care-relevant information is analyzed descriptively.

Results

339,486 individuals with an average age of 79.6 years (SD: 8.4) were analyzed. The age distribution shows that the 80-89 age group comprises half of the sample (49.9%), whereas those aged 90+ encompass the smallest proportion of the sample (9.3%). More women than men received a care level (59.0% women vs. 41.0% men), with women predominant in care level 1-2 and men in the higher care level 3-5. Overall, approximately half of the sample received care level 2, 32.4 % received care level 1. Care levels 3-5 were assessed less frequently (16.2 % vs. 4.8 % vs. 1.7 %). The most frequent care-relevant diagnoses were senility (R54), polyarthrosis (M15), and dementia (F03).

Conclusions

Over three quarters of initial applicants are classified into the lowest care levels (1 and 2). Accordingly, tertiary prevention measures are recommended, as these may delay the further progression into a higher care level.

Key messages

• Over three quarters of initial applicants for long-term care are classified into the lowest care levels. Accordingly, tertiary prevention measures may recommended to delay further care progression.

• The most frequent care-relevant diagnoses were senility (R54), polyarthrosis (M15), and dementia (F03).