bluuebunny/crossref_metadata_2025 huggingface dataset:
European Code against Cancer: Europe’s key cancer prevention tool in informing the general public how to reduce their cancer risk
Authors: Schüz J
Published: October 2021

The European Code against Cancer (ECAC), launched in 1987 and after several periodical updates now used in its 4th edition published in 2014-15 in all official European languages, is a key cancer prevention tool that translates scientific evidence into unambiguous public health recommendations for the general public of how to reduce their risk of getting or dying from cancer. The 4th edition is the most comprehensive one, providing context and background information for a better understanding of the twelve recommendations. It is further supported by a recently launched self-learning course for health promoters, hosted in the E-Learning Center of Europe's leading network of cancer prevention research institutions: Cancer Prevention Europe (CPE). With an abundance of rather confusing “cancer news” the public receives through media and the Internet almost everyday, there is indeed a need for a reliable, authoritative and evidence-based information source for cancer prevention. For that reason, the ECAC recommendations follow three key scientific principles: it only recommends scientifically established actions for reducing cancer risk, its messages are relevant for a broader general public, and it communicates them in a non-scientific language so they are easy to follow. In 2020, IARC/WHO, CPE, Association of European Cancer Leagues and other ECAC stakeholders, have developed a roadmap for the ECAC's sustainability within the innovative Partnership on Action Against Cancer (iPAAC). This plan being essential towards achieving the 80% awareness goal, its main elements include a scientific revision, an expansion to include scientifically established successful interventions in cancer prevention on both individual and population levels, an expansion on the target groups encompassing health professionals and policymakers, and an outreach for synergies with other non-communicable diseases prevention strategies.
Data collection during time of crisis – experiences from the COPERS study
Authors: Begotaraj E
Published: October 2021

Background

The pandemic situation has been present for more than a year all over the world. In almost all countries actions were taken following WHO recommendations of social distance, smart work, online lectures, using of masks, etc. These procedures reduced physical distance but increased social isolation, encouraging virtual connection among people and eventually, increasing psychological repercussions. In many countries, equivalent measures were taken, but the cultural vulnerability to the virus could be dissimilar, influencing on social disruption and economic inequalities among countries. COPERS study aims to examine the association between the exposure and depression, perceived stress, anxiety, suicidal ideation, social capital in different cultural contexts.

Methods

We carefully focused on measuring exposure. Exposure can be described and assessed by intensity and by duration. We assessed both intensity and duration of exposure to the pandemic itself and to the containment measures. IES-R was used to assess the impact of the pandemic Covid-19 among people, assessing among others, feelings, sleeping troubles, stressful life events and emotional reactions.

Results

The assessments included specific issues on exposure range to Covid-19 in different countries. Specifically, could be mentioned the mandatory isolation policy in specific hours, freely vaccination willingness and high suicidal occurrences as the Albanian case. Despite the high mortality and suicidal cases in Albania, many people acted as if virus was not around. However, it was possible to obtain data in a cultural environment which was reluctant to participate.

Conclusions

The measure to overcome skepticism to participate was mainly possible due to building trust to key persons. More measure how to conduct studies in populations which are reluctant to participate in research will be discussed. To obtain results in times of crises it is necessary to get data as well in difficult to reach populations.
Governing the COVID-19 response
Authors: Sagan A , Karanikolos M
Published: October 2021

The COVID-19 pandemic has demonstrated that effective leadership and strong governance are essential for resilience in the face of a shock to the health system. Even though adequate financing of health systems, and ensuring that they have an adequate workforce, physical infrastructure and material supplies can bolster health system resilience, resilience is not merely a function of hard resources but also of soft factors, including capacities of leaders, strengths of institutions, and societal values and culture. Indeed, countries that topped the Global Health Security Index (GHSI), an index that focuses on measuring technical preparedness for epidemics and pandemics, in 2019 were among those that performed the worst during the COVID-19 crisis, as measured in deaths or damage to the economy. A country's initial governance capacity, at the onset of the pandemic, shaped its ability to respond. For example, countries with effective leaders, strong institutions and higher levels of societal trust were often better positioned to respond adequately. But government capacity and trust could change over the course of the response. For example, deliberative decision making that is inclusive, transparent, and accountable, coupled with effective public engagement, can build legitimacy and support for difficult decisions. In the longer term, it can contribute to building trust and improving policy making. This presentation will provide an overview of the strategies that countries-mainly in Europe but also with examples from other regions-have implemented to achieve effective leadership and decision making, coordination, generation and use of information in COVID-19 response decisions. A brief overview of key metrics to assess resilience in the area of governance will also be provided.
Psychosocial Approaches and Discursive Gaps in Intersex Healthcare
Authors: Meoded Danon L , Schweizer K
Published: October 2021

Background

In the past several decades, conflicting discourses have coexisted in the field of intersex studies, including the pathologizing discourse of the biomedical disciplines and the affirmative, subjective psychosocial discourse of people born with intersex bodies and their advocates. Intersex activists call for a positive discourse and a humanistic healthcare approach that accepts and protects intersex bodily autonomy and change the continuing harmful, traumatic treatments aimed at normalizing variations of sex characteristics (VSC).

Methods

We created a collaborative German-Israeli action study, in with 30 health care professionals, intersex activists and scholars from Israel and Germany, were gathered to learn different perspectives on intersexuality, interact and work together on projects aim to improve the care for intersex people and families.

Results

The participants created different collaborative projects, including “intersex workshops” for caregivers and professionals in Israel and Germany; unique materials for raising an awareness, e.g., booklets on intersex bodies with a positive and affirmative approach and language and an article for health care within the ultraorthodox Jewish community; parents' groups and implementation of programs that aim to build bridges between biomedical professionals, caregivers, parents, and intersex people in Israel and Germany.

Conclusions

The participants increased their knowledge and awareness of and sensitivity to intersex issues, and implemented these in their daily work and practices. The participants acknowledged the differences between the countries, especially in relation to the heightened Israeli use of assisted reproductive technology, which effect on the treatment practices, early genetic diagnosis and the preventive medical attitude. In Germany, more activism for intersex human rights and significant laws which regulate the medical treatment practices.
Towards an Agency-based Model of Intersexuality, Variations of Sex Characteristics, and DSD Health
Authors: Crocetti D , Monro S , Vecchietti V , Yeadon-Lee T
Published: October 2021

Background

The health harms caused by sex-normalising and unnecessary irreversible medical interventions on intersex infants and children can include chronic pain, a need for repeat surgeries, damage to sexuality, serious mental health problems, and sterility. However, access to appropriate healthcare is needed - occasionally for lifesaving treatments in minors, but more often for reparative treatment or condition management in those able to give consent. A social model of intersex health, drawing on disability theory, is useful but insufficient to address intersex issues. Agency and bodily autonomy are key for this population, and this paper aims to develop an agency-based model.

Methods

Qualitative semi-structured interviews were conducted with 40 stakeholders in Italy, Switzerland and the UK, and participant observation and action research was carried out with the intersex activist organisation Zwischengeschlecht. The research was funded by the European Commission (grant number 703352).

Results

At present there are still serious healthcare deficits which are underpinned by social norms that include rigid ideas that there are only discrete categories of male and female, and entrenched medical practices that continue to violate intersex minor's bodily integrity, whilst overlooking healthcare needs that intersex people may have. Key impediments to intersex agency include body normativity and sex and gender binarism.

Conclusions

Agency-based approaches to the health of intersex people and those with differences of sex development (DSD) focus on bodily autonomy and the cessation of normalising medical interventions until an under-age person can exercise fully informed choice regarding treatment. These approaches can be useful in incorporating the social model's critique of the pathologisation of bodily diversities, whilst supporting the provision of effective healthcare where needed.
Perceived health and interaction with healthcare workers of a hard-to-reach group in a Roman suburb
Authors: Caminada S , Turatto F , Jaljaa A , Mazzalai E , Giannini D , Iorio S , Errigo M , Paglione L , Marceca M , Brandimarte A
Published: October 2021

Previous studies have showed that people living in Bastogi - a segregated and deprived peripheral area of Rome- have difficulties in accessing and relating to health services. Our aim was to analyze the health perception, health-related behaviors, and the interaction between healthcare professionals and the census population living in Bastogi, compared to the population living in the area of the same local health unit, ASL Roma 1 (hereafter ASL). The PASSI survey (from the Italian Surveillance System) was administered by phone and through door-to-door interviews to a sample of 210 residents of Bastogi. Data were analyzed and compared to the ones of the ASL collected in 2017-2018. Descriptive and univariate analysis were performed with STATA 13. P-values ≤ 0.05 were considered statistically significant. The socio-economic indicators, acknowledged determinants of health inequalities, showed a worse condition for the inhabitants of Bastogi. There was a significantly higher proportion of foreign and unemployed residents in Bastogi, with a lower educational level compared to the ASL. 58.1 % of the Bastogi group claimed their health to be good/very good (ASL: 71.6%; p = 0.000). 56.2% of the respondents from Bastogi were current smokers (ASL: 25.8%; p = 0.000). Risk factors for and prevalence of chronic diseases were significantly higher in Bastogi. The proportion of respondents who stated they had not had any recent contact with health professionals was significantly higher, and mammogram screening uptake was lower (75.3%; ASL: 90.4%; p = 0.001). Despite their lower help-seeking behavior, our study pointed out that the respondents from Bastogi who had had a contact with a health professional reported a higher perceived interest about their health than in the ASL. Further studies are needed to investigate whether this attention is attributable to the higher prevalence of chronic diseases or to the health professional's awareness of vulnerability of a hard-to-reach group.

Key messages

The population from Bastogi is marginalized and hard-to-reach: we found a worse overall self- reported health condition, a worse help-seeking behavior and a lack of reliance on health professionals. The PASSI survey administration has led to a greater involvement of the competent health institution, which resulted in the introduction of a community nurse and a Single Access Point.
Living and working in proximity to alcohol outlets and problem drinking: a longitudinal study
Authors: Raza A , Hanson LM , Westerlund H , Mäkelä P , Halonen JI
Published: October 2021

Background

Problem drinking causes burden for healthcare and society. No prior study has investigated the association between proximity of alcohol outlets to workplace and problem drinking. We assessed longitudinal associations of living and working in proximity to alcohol outlets with problem drinking.

Methods

Data comprised of employed respondents of the Swedish Longitudinal Occupational Survey of Health between 2012 and 2018. Road distances from home and from workplace addresses to the nearest liquor outlet, beer outlet, and bar were provided by Statistics Sweden. Self-reported problem drinking was assessed using modified Cut-Annoyed-Guilty-Eye questions. Within-individual analyses (N = 777) applied conditional logistic regression where each individual served as his/her case and control at two different time points. Between-individual analyses (N = 13306) applied binomial logistic regression with generalized estimating equation. Covariates were (age and sex for between-individual models), occupational position, civil status, chronic disease, work strain, and home/workplace neighborhood socioeconomic status.

Results

Within-individuals, the odds ratio for being a problem drinker was 3.42 (95 % CI, 1.41-8.27) and 2.99 (1.11-8.05) per each successive halving of the distance from work to beer outlets and bars, respectively. No within-individual associations were observed for proximity of outlets to home. Between-individuals, halving of distance from home to liquor outlet [1.06 (1.01-1.12)] and to bar [1.07 (1.00-1.16)] was associated with problem drinking. For distance from work, estimates were similar but did not reach statistical significance.

Conclusions

These findings suggest that alcohol outlet proximity to one's workplace could be a determinant of alcohol consumption behavior. Reducing the number of on- and off-premises alcohol outlets, even those that only sell beer, could reduce the level of harmful alcohol consumption.

Key messages

Alcohol outlet proximity to one’s workplace could be an additional determinant of alcohol consumption behavior. Reducing the number of on- and off-premises alcohol outlets, even those that only sell beer, could reduce the level of harmful alcohol consumption.
Evidence for differential care in Down syndrome screening based on maternal origin: a population based survey in France
Authors: Anselem O , Saurel-Cubizolles MJ , Khoshnood B , Sauvegrain P , Bertille N , Azria E
Published: October 2021

Background

Previous studies showed disparities in prenatal screening for Down syndrome according to socio-economic status and maternal place of birth. Thus, it remains uncertain that those disparities are related to access difficulties or lack of information offered to women. Our objective was to assess the opportunity for informed choice regarding Down syndrome screening according to maternal place of birth.

Methods

Data were based on French national perinatal surveys of 2010 and 2016. These surveys include several questions relative to Down syndrome screening, such as measurement of nuchal translucency and realization of maternal serum screening. We considered that women had the opportunity for choice in case of realization or refusal of prenatal screening, or realization of amniocentesis or chorionic villous sampling. We considered that women had no opportunity for choice in case of ignorance of the realization of the tests, or if the screening has not been performed because not proposed, late prenatal follow-up, or another reason or unknown reason. We used multinomial logistic regression models to assess the association between the use of the tests and women country of birth.

Results

The proportion of women undergoing measurement of nuchal translucency or maternal serum screening was higher in women born in France than women born in another country. After adjustment on the year of the survey, maternal age, parity, education level and type of maternity, and after exclusion of women without adequate prenatal follow-up, the opportunity for making an informed choice for Down syndrome screening was higher for women born in France than women born in another European country (ORa 2.36; 95%CI,1.8-3.0), in Maghreb (ORa 4.01; 95%CI,3.4-4.8) or in another African country (ORa 3.52(2.8-4.3).

Conclusions

Disparities in the use of Down syndrome screening according to women place of birth are almost partly related to differences in the opportunity of an informed choice.
Covid-19 vaccination – Malta’s attitude
Authors: Cuschieri S
Published: October 2021

Background

Covid-19 vaccines have been anticipated throughout the year 2020. These are envisaged by many as the way forward to beat the pandemic. However, vaccination hesitancy among the population is a public health concern. The aim was to explore the intend to take the Covid-19 vaccine among the adult residents of Malta. The vaccination roll-out in Malta started on 27th December 2020.

Methods

An anonymous survey was distributed through social media platforms during February 2021, targeting adults residing in Malta. Socio-economic data along with the intention to take the Covid-19 vaccine was gathered. Quantitative and qualitative analyses were performed.

Results

A total of 1,034 participants responded, with the majority showing intend to take the Covid-19 vaccine (75.44% CI95%:72.72-77.96). While 13.06% (CI95%:11.13-15.25) reported having already taken the vaccine. The majority of those not intending (n = 119) to take the vaccine were female (77.31% CI95%:68.95-83.96); between 30 to 39 years (42.02% CI95%:33.53-51.00), employed (76.47% CI95%:68.05-83.23) and with a post-graduate degree (36.97% CI95%:28.83-45.94). The commonest reasons for unintentional vaccine uptake were due to concern for its safety and long side effects as well as concerned if it is effective. Notably, 15.22% (CI95%:9.16-24.06) of the females reporting not intending to take the vaccine were concerned about the effect of the vaccine on their pregnancy or else were planning to become pregnant.

Conclusions

A high acceptance rate for the Covid-19 vaccine was observed among the Malta adults. However, an element of hesitancy was evident including among this study's high socioeconomic status group. The unknown future and long-term effects of the vaccine appear to be the main contributors to hesitancy.

Key messages

Covid-19 vaccine is well accepted in Malta, potentially reflecting the population’s desire to protect themselves and their families. Vaccine hesitancy is still evident even in the midst of the pandemic among high socio-economic group, reflecting the need for vaccine transparency.
The Arguments of the COVID-19 Vaccines Opponents on Facebook in Poland: Textual Analysis Study
Authors: Wawrzuta D , Jaworski M , Gotlib J , Panczyk M
Published: October 2021

Background

Social media allow users to quickly spread information and opinions. Unfortunately, it is often a place of anti-vaxxers activity, who create content that spreads easily. This situation leads to an increase in vaccine hesitancy and may result in outbreaks of infectious diseases. We wanted to find and characterize what negative arguments against the COVID-19 vaccines Facebook users create and how the popularity of the allegations against vaccines changes over time.

Methods

We followed the posts published on Facebook by the biggest Polish media. We have selected the highest commented events related to the registration and introduction of the COVID-19 vaccines. Then, we analyzed user comments related to those events and established the main themes of anti-vaccine comments. Using this list of topics, we categorized 3414 comments and checked the frequency of comments from given categories and their variability over time.

Results

The arguments of vaccine opponents about the COVID-19 vaccines can be divided into 12 categories. Seven of them also apply to other vaccines but five types are COVID-19' specific. Two new arguments say that vaccines were not properly tested or do not exist. The third topic mentions the history of the swine flu vaccine and the following narcolepsy cases. The fourth category suggests that vaccine against COVID-19 existed before the pandemic. The last argument says that no one takes responsibility for the side effects of the vaccine. The frequency of arguments from a given category varies over time. We also noticed that, while the comments were mostly negative, the reactions were positive.

Conclusions

Our codebook of anti-vaccine topics can help public health professionals better understand social media content. Real-time monitoring of social media is important because the popularity of certain arguments on Facebook changes rapidly over time but early recognition of social doubts allows for targeted interventions.

Key messages

Online anti-vaccine comments on the COVID-19 vaccines can be divided into 12 topic categories. The frequency of Facebook comments against COVID-19 vaccines from a given topic category varies over time.
Effects of plasma fatty acids and desaturase activity on metabolic syndrome in a general population
Authors: Zhu Y , Riphagen IJ , Minovic I , Heiner-Fokkema R , Vogelpohl F , Navis GJ , Bakker SJL
Published: October 2021

Background

Altered plasma fatty acid (FA) profile and desaturase activities have been associated with several metabolic disease, including MetS. However, their relations have rarely been studied among general population, and no study have included the FA profile in plasma phospholipids (PL) and triglycerides (TG) separately. We investigated the relationship of the FA profile and desaturase activities in plasma PL and TG with MetS, and investigated if there were new characteristics of altered FA profile that could be related to MetS status in a general population.

Methods

Baseline characteristic data from 850 participants (Male: 50.2%) aged 38-68 years who were recruited in the Lifelines Cohort study in the Netherlands were obtained. Individual FA profile was determined in fasting plasma PL and TG, and desaturase activities were estimated from product/precursor ratios. MetS was defined according to International Diabetes Federation in 2006. Logistic regression and odds ratios (OR) were used to examine these relations with the prevalence of MetS, and possible moderation effect of gender in these relation was also investigated.

Results

There was 102 people (12%) who had MetS. After adjustment for several confounders, higher tertiles of PL C18:3 n-6, C18:0, C20:3 n-6, Δ6 desaturase (D6D), and TG C14:0, C16:0, C20:0 were associated with an increasing prevalence of MetS, while higher tertiles of PL C18:1 n-7, C24:1 n-9, C20:0, C24:0, Δ5 desaturase (D5D), stearoyl-CoA desaturase (SCD-18), and TG C24:0, C18:2 n-6, C20:4 n-6, C24:1 n-9, C20:5 n-3, C22:5 n-3, C22:6 n-3, D5D were inversely associated with MetS. Meanwhile, men seemed to be more vulnerable to MetS when having an altered or unfavorable FA profile in both plasma PL and TG.

Conclusions

It is important to increase w-3 and w-6 essential fatty acids intake and decrease saturated fatty acids intake, and monitoring the D5D, D6D, and SCD-18 desaturases as additional fatty acids biomarkers is of equal importance.

Key messages

This study have added the evidence that an altered fatty acids profile was associated with metabolic syndrome (MetS) in a general population. The altered fatty acids profile that was associated with metabolic syndrome differed in plasma PL and TG, which requires further study.
Dietary trans fatty acid intakes and cancer risk: results from the NutriNet-Santé cohort
Authors: Wendeu-Foyet G , Chajes V , Huybrechts I , Debras C , Chazelas E , Srour B , Agaësse C , Druesne-Pecollo N , Deschasaux-Tanguy M , Touvier M
Published: October 2021

Dietary trans fatty acids (TFAs) are either natural (ruminant sources) or industrially generated by partial hydrogenation of vegetable oils. Increasing evidence demonstrated their role as cardiovascular risk factors. Their involvement in cancer etiology is suspected, but epidemiological evidence is limited so far. We aimed to investigate the associations between different types of TFAs (total, ruminant [rTFAs], industrial [iTFAs] and corresponding specific isomers) and the risk of cancer in the NutriNet-Santé prospective cohort (2009-2020). Overall, 104,909 participants were included. Usual TFA intake was estimated from validated repeated 24-h dietary records. Associations between sex-specific quartiles of dietary intake of TFA and cancer risk were assessed using multi-adjusted Cox proportional hazard models. A total of 3,374 incident cancer cases occured during follow-up (including 982 breast and 405 prostate cancers). Total TFAs was associated with higher prostate cancer risk (1.34[1.25;1.87] Ptrend=0.005). rTFAs were associated with increased overall cancer risk (HRfor quartile 4 versus 1: 1.21[1.06;1.39] Ptrend=0.03), in particular the conjugated linoleic acid isomer (CLA) (1.19[1.04;1.36] Ptrend=0.04). These associations were specifically observed for breast cancer, in particular before menopause (rTFAs: 1.78[1.11;2.87] Ptrend=0.006; CLA: 2.013[1.25;3.23] Ptrend=0.003). Several iTFAs were associated with overall (1.18[1.06;1.31] Ptrend=0.02 for transdocosenoic acid), breast (isomer 18:2t: 1.30[1.06;1.58] Ptrend=0.01; hexadecenoic acid: 1.28[1.05-1.56] Ptrend=0.02) and prostate (transdocosenoic acid: 1.52[1.09;2.12] Ptrend=0.07) cancer risks. In this large prospective study, several types of TFAs were associated with increased overall, breast and prostate cancer risks. Although further studies are needed to better understand underlying mechanisms, these results support the WHO's goal of achieving industrially produced TFAs elimination from food supplies.

Key messages

Higher intake of dietary trans fatty acids is associated with an increased risk of various cancers. Our findings support WHO’s global recommendation of eliminating industrially produced TFAs by 2023.
Planetary health diplomacy and transdisciplinary research
Authors: Paula N de
Published: October 2021

Given the urgent need for multilateral action for planetary health, the scope of planetary health research must be broadened. Key challenges are currently addressed through disconnected approaches and fragmented policy making. Planetary health is an integrative approach that can enhance synergies across multiple fragmented agendas, notably related to health, environment, human rights, and security. It is high time to boost an overlooked area: planetary health diplomacy. This involves measuring progress beyond gross domestic product, broadening the understanding of security to include planetary health, and reforming international organisations to ensure the protection of a rule-based international order. Efforts to address them lack a truly holistic narrative. The science of planetary health goes beyond the currently politicised climate change agenda. So far, planetary health studies have privileged natural science in order to become more impactful. However, the insights gained through this work deserve to be translated into actionable policies for decision makers. More social scientists are therefore needed in this process. Scholars of international relations are under-represented in the planetary health community. The absence of political scientists, lawyers, foreign policy experts, diplomats, and civil servants who are committed to translating planetary health knowledge into effective action comes at a high cost. Policy decisions are being reshaped in the context of evolving pandemic recovery planning, and strategies to advance planetary health that do not take account of unfolding shifts in global power relations are doomed to fail. With only a decade remaining to shift gears towards achieving the SDGs, there is no time to spare.

de Paula, N. (2021). Planetary health diplomacy: a call to action. The Lancet. Planetary Health, 5(1), e8-e9. doi:10.1016/S2542-5196(20)30300-4.
6.G. Workshop: Developing a consent model for health information – challenges in a rapidly changing digital world
Authors:   Organised by: Health Information and Quality Authority (Ireland),   Chair persons: Barbara Foley (Ireland), Sarah Jane Flaherty (Ireland)
Published: October 2021

Advances in eHealth and digital technologies have the potential to improve the quality of patient care and promote efficiency across a health service. The potential benefits have often not been realised, however, due to a sometimes greater focus on organisational needs rather than pursuing a person-centred approach. There are some concerns from the public in relation to the privacy and security of data, issues in relation to digital literacy and inadequate digital infrastructure, and the potential erosion of the patient-healthcare professional relationship. The introduction of new information systems requires clarity around consent to align with good information governance practices and support people's rights and involvement in relation to health information decisions. Internationally, the successful introduction of digital technologies in healthcare have been informed by effective public engagement and involvement from the outset. Public engagement helps to build trust and confidence in relation to health information use, and gives insight into important considerations for the development of a consent model. As part of this workshop, we will share the experiences of three different European countries who are at varying stages of development and implementation of eHealth solutions. Ireland is at the early stages of transition to a more digital healthcare service. In England, there are a number of eHealth systems in place although difficulties have been experienced at stages; understanding public expectations and involving the public in decision-making has been an important component of their progress. Estonia is recognised as a leader in eHealth and has much to offer in relation to the fundamental principles of successful implementation. The objectives of this workshop are to: 1) share experiences in relation to the process of public engagement across different contexts; 2) examine the eHealth landscape in relation to health information sharing; and 3) lead a discussion on the opportunities and challenges faced for the future of health information in a digital world. This workshop will be comprised of three presentations, from each of the above country perspectives, followed by a panel discussion with contributions invited from the audience.

Key messages

Building public trust, via public engagement, is essential for successful implementation of digital health technologies. Digital health can transform future health systems but success requires strong national leadership, information governance, robust standards, consent management, and access rights.
What data is currently collected on social prescribing outcomes?Case studies of two sites in England
Authors: Goldthorpe J , Khan K
Published: October 2021

Whilst a considerable amount of social prescribing activity is taking place across the North West of England, little is known about how different models are being implemented, how data is being collected to support evidence of impact and outcomes, and how these models could be positively or negatively influencing health inequalities. Our study aims to investigate the reach and impact of two social prescribing services by using a mixed-methods approach which will include analysing secondary data from social prescribing management databases held by participating organisations, workshops, focus groups and interviews. Participants will include professionals involved in commissioning, delivery and monitoring and evaluation roles related to social prescribing link workers and members of the public who have accessed social prescribing services. Observational data will also be collected during meetings and informal conversations with those involved in the project. The findings will be reviewed with participants to support the development of a larger research project to explore the effects of social prescribing on health inequalities in ways that are meaningful to stakeholders. In this presentation the findings will be presented and discussed loosely around the following questions: 1. What routinely collected outcome data is currently available to social prescribing researchers (locally, nationally and internationally)?; 2.What is missing from that data regarding meaningful outcomes in relation to health inequalities?; 3. How might social prescribing reduce or exacerbate health inequalities?
Psychological distress from the COVID-19 confinement is associated with unhealthy dietary changes
Authors: Bonaccio M , Costanzo S , Bracone F , Gialluisi A , Di Castelnuovo A , Persichillo M , Cerletti C , Donati MB , de Gaetano G , Iacoviello L
Published: October 2021

Background

The confinement due to COVID-19 pandemic had adverse effects on mental health, but the relation between psychological distress resulting from lockdown measures and dietary habits needs to be elucidated.

Methods

We analysed 2,741 subjects (mean age 58.1±15.3 y) pooled from 2 retrospective Italian cohorts recruited from May to September 2020: 1) The Moli-LOCK cohort consists of 1,401 adults, a portion of the larger Moli-sani Study (n = 24,325) who were administered a telephone-based questionnaire to assess lifestyles and psychological factors during confinement; 2) the ALT RISCOVID-19 is a web-based survey of 1,340 individuals distributed throughout Italy who self-responded to the same questionnaire by using Google® forms. Psychological distress was measured by assessments of depression (PHQ-9), anxiety (GAD-7), stress (PSS-4), and post-traumatic stress disorder (PTSD). Diet quality was assessed either as changes in consumption of ultra-processed foods (UPF) or adherence to Mediterranean diet (MD).

Results

In a multivariable regression analysis controlled for major sociodemographic factors, depression (β=-0.06, 95%CI -0.10, -0.01), anxiety (β=-0.05, -0.09, -0.004) and PTSD (β=-0.04, -0.08, -0.002) were inversely associated with MD and directly with UPF (β = 0.13, 0.09, 0.18; β = 0.12, 0.08, 0.16 and β = 0.10, 0.06, 0.13, respectively); stress was associated with UPF (β = 0.06, 0.02, 0.10) but not with MD (β=-0.03, -0.08, 0.01).

Conclusions

Psychological distress resulting from confinement due to the COVID-19 pandemic is directly associated with unhealthy dietary modifications in a sample of the Italian population. In view of possible future restrictive measures, particular attention should be paid to public health actions promoting psychological support to more vulnerable groups.

Key messages

Psychological distress resulting from confinement due to the COVID-19 pandemic is directly associated with unhealthy dietary modifications. Particular attention should be paid to public health actions promoting psychological support to more vulnerable groups also in view of future restrictive measures to contain the pandemic spread.
Ultra-processed food consumption modifies the association of Nutri-Score with all-cause mortality
Authors: Bonaccio M , Di Castelnuovo A , Ruggiero E , Costanzo S , Esposito S , Persichillo M , Cerletti C , Donati MB , de Gaetano G , Iacoviello L
Published: October 2021

Background

The Nutri-Score front-of-pack label rates foods according to their nutritional quality while the NOVA classification is focused on degree of processing; both systems separately predicted mortality in epidemiological contexts. We evaluated whether ultra-processed food (UPF) modifies the association of the Nutri-Score with mortality.

Methods

Longitudinal analysis on 22,549 Italian men and women (mean age 54±12 y) from the Moli-sani Study (2005-2010) followed for 11.2 y. Food intake was assessed by a food frequency questionnaire. The Food Standards Agency nutrient profiling system (FSAm-NPS) score, used to derive the Nutri-Score, was calculated for each food based on its amount of energy, saturated fat, sugar, sodium, fibre, protein, fruits, vegetables, legumes and nuts per 100 g of product. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed, and increased values indicate lower nutritional quality. UPF intake was the proportion (%) of UPF in the total weight of food consumed (g/d) and categorized as low/high (below/above the population median, respectively).

Results

In a multivariable analysis, 1-SD increase in the FSAm-NPS index led to increased risk of all-cause (HR = 1.07; 95%CI 1.02-1.13) and CVD mortality (HR = 1.08; 1.00-1.18). UPF intake was an effect modifier since the association of FSAm-NPS index with mortality was confined to individuals with high UPF intake (HR = 1.14; 1.05-1.25) but not in those with low UPF (HR = 1.00; 0.93-1.07; p for interaction=0.034). Similar findings were reported for CVD mortality (HR = 1.14;0.99-1.31 and HR = 1.01;0.90-1.13 for high and low UPF consumers, respectively; p for interaction=0.18).

Conclusions

Higher mortality risk associated with a NutriScore revealing nutrient-poor food intake is limited to individuals also reporting high UPF intake. Food labelling systems should account for food processing in addition to nutritional content.

Key messages

Ultra-processed food modifies the association between the 5-color Nutri-Score front-of-pack label with all-cause mortality in an Italian general population. Food labelling systems, that are conceived to help consumers make healthier food choices, should also account for food processing in addition to nutritional content.
Moral distress: Ethically appropriate actions
Authors: Maeckelberghe E
Published: October 2021

Andrew Jameton in 1984 coined the concept of moral distress as: “knowing what to do in an ethical situation, but not being allowed to do it” This original description presupposes that the right moral act can be identified and precludes situations of doubt and uncertainty. The 1984 definition emphasizes barriers that make it impossible for someone to do what they ought to do. Whereas Jameton in a revision in 2013 of his original concept emphasized reduction of the psychological dimensions, Peter& Liaschenko stress the element of moral agency. Moral distress then is a threat to the moral integrity of the professional. This requires three-step ananlysis: first, what is the moral question?; two, what are morally adeguate answers to this question?; three, what ethically appropriate actions are under pressure in the given situation? This will be illustrated with examples from the COVID-19 pandemic.
New evidence on the prevalence and risk of peripartum mental illness amongst migrant women: A global review of the literature
Authors: Fuhr D , Stevenson K
Published: October 2021

Migration is known to affect an individual's health and social status, and migrant women who are pregnant or postpartum are known to be at high risk of adverse health and social outcomes. They are at particularly high risk of mental disorders, especially perinatal depression (PND). Previous studies have demonstrated the prevalence of PND may be higher amongst migrant women when compared to the general population. The determinants of perinatal mental disorders amongst migrant women are complex and may include social isolation, discrimination, poor healthcare access, and low levels of emotional and practical support. The consequences of perinatal mental disorders include a high risk of suicidality and depression in the woman, as well as adverse outcomes for the child including a high risk of low birth weight, diarrhoeal disease, and poorer cognitive outcomes. We will present updated data on the prevalence and risk factors for perinatal mental illness (depression, anxiety, post-traumatic stress disorder, psychosis) amongst migrant women (refugee women, and internally displaced women) at a global level. We will synthesize the available evidence which is available to date, and create consensus on the prevalence and risk of perinatal mental illness amongst migrant women. We expect that migrant woman will be at significantly higher risk of perinatal mental illness when compared to the general population. We will discuss appropriate health system responses which may address the health care needs for migrant women in fragile or conflict-affected settings.
Experiences of Trans and Non-Binary Patients during Medical Transitioning and Associations with the Patient-Physician Relationship in Austria
Authors: Markovic L , Seiler-Ramadas R , Grabovac I
Published: October 2021

Background

Trans and non-binary (TNB) patients confront various issues in the healthcare system and with healthcare workers (HCWs) tasked with navigating complex systems to achieve optimal outcomes. The most time intensive and intimate contact TNB patients have is typically with physicians making the physician-patient relationship instrumental. This study aimed to explore the experiences of patient-physician relationship in TNB patients in Austria in order to identify caveats for future interventions.

Methods

We conducted an exploratory cross-sectional study using an online questionnaire consisting of 86 items including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9) distributed between June and October 2020 through various organizations working with TNB people. Austrian residents older than 18 who self-identified as TNB and were undergoing or finished medical transitioning were included. Descriptive statistics and linear regression models were applied.

Results

From a total of 91 participants, 58.3% identified as trans, 70.3% were assigned female at birth, and 87.7% were on hormone replacement therapy. Most (58.1%) perceived physicians as the most problematic HCWs, and 60.5% reported having never or rarely been taken seriously in healthcare settings. Linear regression model showed that PDRQ-9 score was associated with a diagnosis of a mental illness (beta=3.88, 95%CI 0.24 - 7.51), quality of life (beta=0.66, 95%CI 0.43 - 0.90), never being taken seriously (beta=11.69, 95%CI 2.91 - 20.47) and being misgendered (beta=-7.64, 95%CI -14.88 - -0.41) by HCWs.

Conclusions

TNB patients in Austria reported negative experiences in the healthcare system, mostly with physicians that often did not take their gender identity seriously or used inappropriate language. Future interventions should focus on increasing transgender care competencies across various components of medical education.
Health services use in people with chronic diseases during the pandemic: Results from the iCARE study
Authors: Stojanovic J , Deslauriers F , Lavoie KL , Bacon SL ,   iCARE study team
Published: October 2021

Background

COVID-19 containment measures, such as stay-at-home orders and transportation shutdowns, might have created barriers to healthcare access and impacted service utilization worldwide. This cross-sectional study aims to explore how COVID-19 impacted health service utilization in individuals with chronic health conditions across the globe.

Methods

We included a convenience sample of the global iCARE study (www.icarestudy.com) from March, 2020 to January, 2021. Logistic regressions were used to test association between difficulties getting non-COVID-19 related care and presence of physical health conditions, individuals' sex and age as well as countries' economy, with appropriate time adjustments. Stratified analysis was conducted for three continents (Europe, Asia and America).

Results

The study included 28,340 individuals from 33 countries (female (71%), mean age=43.4, low and middle-income country (LMIC) (31%)). Overall, 30% of people with chronic diseases had difficulties getting non-COVID related care, compared to 24% of individuals with no conditions. Individuals with chronic conditions were around 1.6 times more likely to have trouble in healthcare access in Europe, America, and Asia. Older age was associated with fewer difficulties in healthcare access (in Asia and America). Females, compared to males, had around 30% and 50% higher odds of difficulties in access (in America and Europe, respectively). Finally, individuals from LMICs reported higher difficulties in getting care (OR = 1.64; 95% CI = 1.50-1.79).

Conclusions

We observed decreased service utilization in people with chronic diseases during the pandemic, with certain disparities across continents and country income. Future research should assess indirect health effects of the pandemic (i.e., morbidity and mortality of specific diseases). Public health efforts should be directed towards improving the resilience of health systems, healthcare access and delivery in emergency situations.

Key messages

Globally, around 1 in 3 individuals with chronic health conditions reported decreased healthcare utilization during the pandemic. COVID-19 impacts on healthcare utilization were more pronounced in low and middle-income countries, compared to high-income countries.
National cancer planning instruments in Europe and their developments
Authors: Albreht Tit
Published: October 2021

National cancer plans (NCPs) saw a strong push with the recommendation of the European Commission from 2009, which called upon Member States to adopt NCPs or national cancer strategies. This process resulted in rapid adoption of NCPs. Joint Action EPAAC developed the European Guide for Quality National Cancer Control Programmes in support of their preparation. Europe's Beating Cancer Plan poses a new task and challenge in the need to transpose its recommendations into the national cancer documents.