bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of daily troponin-I and D-dimer serum levels on mortality of moderate-to-severe COVID-19 pneumonia patients
Authors: Stavileci B , Ozdemir E
Published: October 2021

Introduction

Coronavirus Disease 2019 (COVID-19) caused by that infection resulted in a very high morbidity and mortality rates globally.

Purpose

The aim of this study is to analyses the daily Troponin-I and D-dimer levels and their impact on the need for intensive care and mortality of the COVID-19 infected patients.

Methods

206 patients who were hospitalized between 20.03.2020–05.05.2020 with a diagnosis of moderate-to-severe COVID-19 pneumonia were analyzed retrospectively. Serum Troponin-I and D-dimer levels were recorded at least 10 days.

Results

Average age was higher in mortality group compared to non-mortality group (respectively 67.79±14.9, 56.87±18.15, p:<0.001). Presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease were statistically significant affecting mortality (respectively p:0.003, p:0.004, p:0.045, p:0.02, p:0.003, p:0.007). First 10 days measurements of Troponin-I and D-dimer values was associated with mortality and intensive care requirement (p<0.001). Both Troponin-I and D-dimer were higher in mortality group compared to the patients requiring intensive care. Troponin-I value on the 7th day ≥16.05 pg/ml was related with need for intensive care (AUC: 0.896, sensitivity: %78.6, specificity: %78.3, p<0.001). Troponin-I value ≥30.25 pg/ml on the 9th day was related with mortality (AUC: 0.920, sensitivity: %89.5, specificity: %89.3, p<0.001). D-dimer value ≥878 hg/ml on the 2nd day was associated with intensive care need (AUC: 0.896, sensitivity: %78.6, specificity %78.3, p<0.001). D-dimer value ≥1106 hg/ml on the 10th day was associated with mortality (AUC: 0.817, sensitivity: %68.4, specificity: %65.2, p<0.001). It was observed that hospitalization periods ≥9.5 days were associated with mortality (AUC: 0.738, sensitivity %68.4, specificity: %65.9, p<0.001).

Conclusion

We observed that hospitalizations ≥9.5 days increased mortality. Troponin-I and D-dimer follow-ups in serum are more effective than other inflammatory markers to show the need for intensive care and mortality. A high Troponin-I value should alert the clinician in terms of clinical deterioration.

Funding Acknowledgement

Type of funding sources: None.
Beta-blocker/ACE inhibitor therapy differentially impacts the steady state signaling landscape of failing and non-failing hearts
Authors: Sorrentino A , Bagwan N , Linscheid N , Poulsen P , Kahnert K , Thomsen M , Delmar M , Lundby A
Published: October 2021

Background

The molecular underpinnings of heart failure with reduced ejection fraction (HFrEF) involves a complex remodeling of the contractile, metabolic and electrical functions. Current pharmacotherapy for patients presenting HFrEF includes combination of angiotensin-converting enzyme inhibitors (ACEi) and β-adrenergic receptor blockers (β-AR blockers). Yet, a knowledge gap exists regarding the molecular changes accompanying such treatment.

Purpose

The present study takes an omics approach to study protein and phosphorylation signaling derangement in HFrEF and to define the global changes resulting from treatment with β-AR blocker (metoprolol) and ACE inhibitor (enalapril) in control- and HFrEF hearts.

Methods and results

For induction of HFrEF, a tight and permanent ligature was applied to constrict the transverse aorta in male C57BL6 mice. Eight weeks post-surgery, an osmotic pump was implanted delivering either vehicle or treatment (enalapril, ACE inhibitor, and metoprolol, β-AR blocker) for a two week period. The proteome- and phosphoproteome of left ventricular tissue was resolved using high-resolution liquid chromatography-mass spectrometry. The resulting dataset covered 6,004 proteins and 14,967 phosphorylation events. HFrEF was characterized by profound downregulation of mitochondrial proteins coupled with derangement of β-adrenergic and pyruvate dehydrogenase signaling. Upon treatment, phosphorylation changes consequent to HFrEF were reversed, including a reversal of Pdhk4 activity. In controls, treatment mainly led to downregulation of canonical PKA signaling. Overall, the signaling response elicited by treatment was profoundly different for failing than for control hearts.

Conclusions

We used state-of-the-art proteomics and phosphoproteomics approaches to analyze changes in protein abundance and phosphorylation state of the left ventricle resulting from combination therapy with a β-AR blocker and an ACE inhibitor in failing and non-failing hearts. Our observation of divergent signaling outcomes depending on the disease state of the heart underscores the importance of evaluating drug effects within the context of the specific conditions present in the recipient heart.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Danish Council for independent ResearchLundbeck FoundationFondation Leducq Transatlantic Network of Excellence
Molecular background of impairments in skeletal muscle of heart failure patients
Authors: Ivanova O , Komarova M Y , Ignatieva E V , Lelyavina T A , Galenko V L , Sitnikova M Y U , Gusev O A , Shagimardanova E V , Kostareva A A , Dmitrieva R I
Published: October 2021

Background

Heart failure (HF) is characterised by systematic inflammation and chronic metabolic dysregulation. HF enhances the release of pro-inflammatory cytokines, induces activation of the complement system, production of autoantibodies, and over-expression of the major histocompatibility (MHC) complex class II molecules. It is known that skeletal muscles are exposed to the immunologic injury in disease; and muscle tissue appeared to be affected by HF leading to the muscle weakness and exercise intolerance development. However, molecular abnormalities occurring in HF patients' muscles and the mechanisms underlying its development are not clarified.

Purpose

To understand the molecular mechanisms underlying skeletal muscle immune and non-immune impairments in HF.

Methods

8 health donors and 5 HF patients with reduced ejection fraction (NYHA Class II and III) were enrolled in this study in accordance with the principles under the Declaration of Helsinki (1989). mRNA of skeletal muscle biopsies of gastrocnemius lateralis were sequenced on Illumina HiSeq. RNA-seq analysis was performed using STAR with reference genome GRCh38 and featureCounts program; differentially expressed genes (DEGs) were assessed using R package DESeq2 with FDR=0.01 and log2 fold change (l2fc) >1.5 filter; pathway analysis was performed using clusterProfiler in R (FDR=0.01).

Results

1404 differentially expressed genes distinguish muscles of HF patients and controls. Among upregulated genes there are different classical MHC molecules and specific one HLA-G (l2fc=2) that has been previously shown appeared in muscles under autoimmune myopathies, and potentially protect them. Unregulated DEGs were responsible for the activation of many molecular immunological pathways: type I interferon signaling pathway (16 DEGs out of total 89), regulation of T cell proliferation (14/153), neutrophil degranulation (31/485), granulocyte differentiation (7/32), negative regulation of viral process (11/53), that indicates about specific inflammatory response in HF muscles. Response to hypoxia (22/314) and gluconeogenesis pathways (12/87) were also activated. Downregulated genes include SLC5A1 (l2fc=−4) sodium glucose cotransporter; NRP3 (l2fc=−4) that plays a role in modulating intravascular volume and vascular tone; MMP1 (l2fc=−13) involved in the breakdown of extracellular matrix; the expression of many genes responsible for DNA-repair (44/534) and cilium assembly (34/366) was also suppressed.

Conclusion

Transcriptome analysis shows immunological and non-immunological alterations in HF skeletal muscles and provides the information about molecular mechanisms of its development.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation grant
Role of QRS amplitude, fractionation and duration in predicting clinical response to anti-inflammatory treatment in cardiac sarcoidosis
Authors: Arceluz M , Frankel D , Tschabrunn C , Santangeli P , Bravo P , Supple G , Muser D , Callans D , Schaller R , Hyman M , Kumareswaran R , Riley M , Lin D , Arkles J , Marchlinski F
Published: October 2021

Background

Low QRS amplitude (QRSa), QRS fractionation (QRSf) and longer QRS duration (QRSd) are markers of myocardial fibrosis and inflammation in non-ischemic cardiomyopathy (NICM).

Objective

To determine if reduction of inflammation with treatment of cardiac sarcoidosis (CS) may reverse these 12 lead ECG parameter changes.

Methods

21 patients (pts) with CS and VT ablation with a positive baseline positron emission tomographic (PET 1) scan were studied. All pts received prednisone ≥40 mg for 4 to 8 weeks followed by a taper and maintenance with methotrexate ± low-dose prednisone, <10 mg/day, until clinically stable and resolution of inflammation on PET 2 one year after initial. In addition, pts with low LV ejection fraction (13/21) received guideline directed medical therapy for heart failure. Pts at 1yr with positive PET2 (9) were compared to those with negative PET2 (12). Baseline and 1yr 12-lead ECGs were analyzed for QRSd, ≥2QRSf contiguous leads and QRSa in the limb leads.

Results

Pts in PET2(+) vs PET2(−) groups has similar gender (men 89% vs 100%, p=0.42), age (57±8 vs 56±10 years, p=0.8) and LV ejection fraction (41±11 vs 46±11, p=0.31). Baseline 12-lead ECGs showed similar QRSd, ≥2QRSf contiguous leads and QRSa for PET2(+) vs PET2(−); P all >0.15 (Table 1). At 1 yr there was a lower prevalence of ≥2QRSf contiguous leads and strong trend for shorter QRS duration and larger QRSa in lead DI if PET2(−) vs PET2(+). 4 pts demonstrated loss of QRSf 2 contiguous leads and/or increase in QRSa in DI by at least 0.15 mV from baseline if PET2(−) and none if PET2(+).

Conclusions

In pts with CS and VT, reversal of inflammation may result in a greater QRSa and reduction in QRSf. An increase in QRSa in lead 1 by >0.15mV and/or loss of QRSf identifies a clear positive response to treatment and negative PET at 1 year.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Richard T and Angela Clark Innovation Fund in Cardiovascular Medicine, the Mark S Marchlinski EP Research and Education Fund and the Winkelman Family Fund in Cardiovascular Innovation. Table 1
The effect of COVID-19 on schoolteachers’ emotional reactions and mental health
Authors: Nabe-Nielsen K , Christensen KB , Fuglsang NV , Larsen I , Nilsson CJ
Published: October 2021

Background

Schoolteachers play a major role in the society's response to the COVID-19 pandemic. When schools are open teachers are responsible for hindering spread of SARS-CoV-2, while carrying out their core task of teaching. This double role as well as the risk of infection may affect mental health in this occupational group. Therefore, we investigated schoolteachers' emotional reactions to COVID-19 and mental health during three phases of the COVID-19 pandemic in Denmark. We further analyzed if teachers, who belonged to a COVID-19 risk group, had more emotional reactions and poorer mental health than “non-risk” groups.

Methods

We collected questionnaire data in May, June, and November-December 2020 and used data from 2665 teachers employed at public schools (871 individuals participated in all three surveys). Participants reported their fear of infection, fear of transmission of infection to their home or pupils, perceived burnout and stress, and worries about their ability to manage the working conditions. We also had information about COVID-19 risk group status, sex, age, organization of teaching (physical presence or remote teaching), and the pupils' grade. We estimated prevalence ratios and took repeated measures into account.

Results

Fear of infection and transmission of infection as well as burnout, stress, and worries increased statistically significantly with 27-84% from May to November-December 2020 (p < 0.05). We also found that teachers, who were particularly vulnerable to the adverse consequences of COVID-19, had the highest prevalence of fear of infection and poor mental health.

Conclusions

The dual role of teaching and virus control along with concerns regarding the health consequences of an infection may contribute to the observed increase in emotional reactions to COVID-19 and poor mental health from the beginning of the pandemic to the beginning of the second wave.

Key messages

The results raise attention to the working conditions, exposure to infection and mental health of teachers being in the frontline when schools were open during the COVID-19 pandemic. School teachers play a major role in pandemic control along with teaching obligations, which warrants allocation of resources, clear guidelines, and possibilities for protection from infection.
Listening to community concerns in the COVID-19 infodemic: A WHO digital approach
Authors: Mahajan A , Czerniak C , Lamichhane J , Phuong L , Purnat T , Briand S , Nguyen T
Published: October 2021

Background

The Infodemic (too much information including false or misleading information in digital and physical environments) during the COVID-19 pandemic has led to confusion, risk-taking and behaviors that can amplify outbreaks, and reduce effectiveness of pandemic response efforts. To address this challenge, the WHO Information Network for Epidemics (EPI-WIN), in collaboration with research partners, developed a public health Infodemic intelligence analysis methodology for weekly analysis of digital media data to identify, categorize, and understand key concerns expressed in online conversations.

Methods

Thirty-five keyword-based searches (per language) using Meltwater Explore and Google Trends were created and grouped according to a set of pandemic public health taxonomy categories developed specifically for this analysis. The taxonomy has five thematic categories of conversation about COVID-19 and public health response: (1) the cause of the illness, (2) the illness, (3) the treatment, (4) the interventions and (5) Information.

Results

The two most recurring topics to attract increasing interest were Vaccines and Asymptomatic transmission followed by Immunity, Cause of the virus, Vulnerable communities and Reduction of movement, and Risk factors based on demographics and risk of misinformation.

Conclusions

The application of this taxonomy to online social listening week-on-week resulted in a better in-time understanding of the evolution and dynamics of high velocity conversations about COVID-19 globally during the pandemic and proposes a quantifiable approach to support planning of risk communication response.

Key messages

Describe widespread innovation in social listening methods for greater accountability to affected populations. Formulate insights into how digital media can be better utilized for more rapidly responding to the evolving needs of communities.
COVID-19, Public Transportation, and Public Health Communication
Authors: Hung C , Rojhani A , Cordoba Asprilla M , Kancharla R
Published: October 2021

Although necessary for controlling the COVID-19 pandemic, public health and social measures (PHSMs) that restricted public transportation in cities diverted people to private motorized vehicle use, a trend that persisted despite evidence that public transit represented a low-risk COVID transmission environment. Mass transit and active modes of transportation in cities are key for preventing noncommunicable diseases (NCDs) and injuries and for reducing traffic-related emissions. Under the Partnership for Healthy Cities, Buenos Aires, Bangkok, Cali, Ho Chi Minh City, Istanbul, and Kyiv implemented communication campaigns to encourage and inform citizens how to safely resume use of public transportation and alternative safe, active transportation. Between July 2020 and March 2021, campaigns reinforced adherence to the 3Ws (wash hands, watch distance, wear a mask), and promoted walking and cycling as commuting alternatives. In total, the cities conducted social media campaigns, displayed posters (605), billboards (50), and videos (15) at bus, train, and bike stations, cycling lanes, and hospitals. Posters at bus stops in Buenos Aires were visible to 286,000 passengers/day, 16% of the city's passengers. Cali's social media campaign reached 1.7 million people. 70 km of new cycle lane added 1,527 cycling trips, preventing an estimated 266,920 tons of CO2 emissions. Bangkok's social media campaign reached 511,660 people and videos on television reached 1.75 million people. Ho Chi Minh City reached 48,000 passengers/day on public transport and totaled 4 million impressions on social media. Istanbul's social media campaign reached 20,000 people, promoted messaging on 50 billboards across the city's cycling network, and 4 Turkish cities replicated the campaign. Kyiv reached 800,000 transit passengers with 2,200 posters in metro stations. Simple and clear messaging is key for crisis communication and is essential to address overlapping public health and mobility priorities.

Key messages

Cities are at the forefront to use communication campaigns to promote PHSMs and transport alternatives when adapting COVID-19 responses to address negative impact on urban transport and mobility. Simple and clear messaging is key for crisis communication and is essential to address overlapping public health and mobility priorities.
Maternal and paternal dietary quality, dietary inflammation status, and offspring DNA methylation
Authors: Lecorguillé M , Navarro P , Shivappa N , Hébert JR , Mehegan J , Kelleher CC , Suderman M , Phillips CM
Published: October 2021

Background

Altered nutritional conditions at early life stages may increase the risk of future disease in offspring. Recent evidence suggests that developmental programming may involve epigenetic mechanisms. However, few studies have evaluated the effect of parental dietary quality on offspring DNA methylation. We investigated the relationships between dietary quality and inflammatory potential of future parents and DNA methylation of their children at nine years.

Methods

We used data from the Lifeways Cross-Generation cohort, established between 2001 and 2003 in the Republic of Ireland. Maternal dietary intake during the first trimester and paternal diet of the 12 previous months were assessed with a food-frequency questionnaire. Dietary quality and inflammation were determined by the healthy eating index (HEI) 2015 score and the energy-adjusted dietary inflammation index (E-DII), respectively. The Illumina Infinium HumanMethylationEPIC (EPIC array) assessed methylation levels in saliva samples from 264 children. Dietary associations with DNA methylation at individual CpG sites were examined.

Results

After adjusting for multiple tests, maternal HEI-2015 scores were inversely associated with DNA methylation at 1 CpG site (cg21840035, p-value=5.5 × 10-8) located near the PLEKHM1 gene, whose functions involve regulation of bone development. An increase in paternal HEI score was related to lower methylation at one CpG site (cg22431767, p-value=4.1× 10-8) located near cell signaling gene LUZP1. No significant associations between maternal or paternal E-DII and DNA methylation at individual CpG sites were observed.

Conclusions

Parental dietary quality in the prenatal period may influence offspring childhood DNA methylation. A better understanding of the nutritional programming effects on epigenetic markers is essential to design public health strategies that could help women to achieve a healthier diet and optimize the health capital of children and future generations.

Key messages

Our findings suggest that both maternal and paternal dietary quality may have a long-term influence on the offspring epigenome, expand the current understanding of parental nutritional programming. Replication in other populations with contrasted dietary intake is warranted, with a view to informing public health recommendations to benefit the health of future generations.
Mechanisms for addressing the influence of corporations on public health
Authors: Mialon M , Vandevijvere S , Carriedo A , Bero L , Gomes F , Petticrew M , McKee M , Stuckler D , Sacks G
Published: October 2021

Introduction

Manufacturers, such as producers of cigarettes, drugs or ultra-processed foods, influence health policy, research and practice. This influence is one of the main barriers against the implementation of public health policies around the world. Our goal was to identify existing mechanisms to limit this influence.

Methods

We conducted a scoping review in 2019. We searched five scientific databases: Web of Science Core Collection; BIOSIS; MEDLINE; Base; Scopus. Twenty-eight institutions and networks related to our research objective were also contacted to identify additional mechanisms and examples. In addition, we identified mechanisms and examples drawn from our collective experience. We have classified the mechanisms into two groups: those of international organizations and governments; those for universities, the media and civil society.

Results

Thirty-one publications were included in our review, including eight scientific articles. Nine mechanisms focused on several industries; while the other documents targeted specific industries. We identified 49 mechanisms that could help limit corporate influence in health policy, science and practice. For 41 of these mechanisms, we found examples, around the world, where they have been implemented. The main objectives of the mechanisms identified were to manage conflicts of interest and ethical issues, while increasing the transparency of public-private interactions. Mechanisms for governments (n = 17) and universities (n = 13) were most frequently identified, with fewer examples existing to protect the media and civil society.

Discussion

The development, implementation and monitoring of these mechanisms are essential to protect public health from industrial influence.

Key messages

We found 49 mechanisms that could help limit corporate influence in health policy, science and practice. There are fewer mechanisms to protect the media and civil society, than to protect governments and universities.
Daily composition of movement behaviors with cardiovascular disease incidence in elderly
Authors: Yerramalla MS , McGregor DE , Hees VTV , Fayosse A , Dugravot A , Tabak AG , Chen M , Chastin SFM , Sabia S
Published: October 2021

Background

Moderate-to-vigorous physical activity (MVPA) is proposed as key for cardiovascular diseases (CVD) prevention. At older ages, the role of sedentary behavior (SB) and light intensity physical activity (LIPA) remains unclear. Evidence so far is based on studies examining movement behaviors as independent entities ignoring their co-dependency. This study aims to examine the association between daily composition of objectively-assessed movement behaviors (MVPA, LIPA, SB) and incident CVD in older adults.

Methods

Whitehall II accelerometer sub-study participants free of CVD at baseline (N = 3319, 26.7% women, mean age=68.9 years in 2012-2013) wore a wrist-accelerometer from which times in SB, LIPA, and MVPA were extracted. Compositional Cox regression was used to estimate the hazard ratio (HR) for incident CVD for daily compositions of movement behaviors characterized by 10 (20 or 30) minutes greater duration in one movement behavior accompanied by decrease in another behavior, while keeping the third behavior constant, compared to reference composition.

Results

Of the 3319 participants, 299 had an incident CVD over a mean (SD) follow-up of 6.2 (1.3) years. Compared to individuals with daily movement behavior composition composed with MVPA at recommended 21 minutes per day (150 minutes/week), composition with additional 10 minutes of MVPA and 10 minutes less SB were associated with smaller risk reduction -8% (HR, 0.92; 95% CI, 0.87-0.99) - than the 14% increase in risk associated with a composition of similarly reduced time in MVPA and more time in SB (HR, 1.14; 95% CI, 1.02-1.27). For a given MVPA duration, the CVD risk did not differ as a function of LIPA and SB durations.

Conclusions

An increase in MVPA duration at the expense of time in either SB or LIPA was associated with lower risk of incident CVD. This study lends support to public health guidelines encouraging increase in MVPA or at least maintain MVPA at their current duration.

Key messages

Older adults should be encouraged to increase their moderate-to-vigorous physical activity or at least maintain at their current levels to lower risk of incident cardiovascular disease. Highly sedentary older adults should increase their moderate-to-vigorous physical activity by decreasing sedentary time rather than light-intensity activity to prevent cardiovascular disease.
2.F. Workshop: Informing COVID-19 responses with longitudinal studies: demonstrating harmonised data infrastructure
Authors:   Organised by: EUPHA-EPI,   Chair persons: Srinivasa Katikireddi (UK), Tea Lallukka (Finland)
Published: October 2021

Longitudinal studies which have collected information from participants repeatedly over time have the potential to provide timely intelligence to respond to the COVID-19 pandemic. The UK has a rich resource of population-based longitudinal studies, which have now collected information during the COVID-19 pandemic. These include multiple national birth cohort studies going back to 1946, the Understanding Society household panel study, ageing cohorts such as the English Longitudinal Study of Ageing and regional cohorts such as ALSPAC, Born in Bradford and Generation Scotland. The UK is therefore well placed to combine COVID-19 surveys with rich pre-pandemic information and provide timely insight into how the pandemic is affecting people with different backgrounds and circumstances. Similar longitudinal studies exist in many other European countries. In this workshop, we will illustrate the potential for collaborative approaches to analysing longitudinal datasets - an approach which could be applied elsewhere in Europe and indeed, across European countries. Four papers present important evidence on health inequalities during the COVID-19 pandemic, each addressing a single topic in up to a dozen longitudinal surveys. Results are meta-analysed showing findings overall and stratified by socio-demographic characteristics. This represents a collaborative effort under the Longitudinal Health and Wellbeing strand of the National Core Studies initiative in the UK: an important advance methodologically, in addition to the substantive value of the questions addressed. Co-ordinated analyses across multiple studies can act as replication for each other and/or differences in study designs and assumptions can be informative, e.g., by comparing findings in cohorts of respondents at different life-stages. While improving understanding of inequalities in the public health impacts of the pandemic, this effort is also building a strong foundation for future multi-study comparative research. This workshop will provide an example of some of the opportunities and practical challenges to conducting such research. Professors Tea Lallukka and Vittal Katikireddi will act as discussants and the potential for collaboration across European cohorts will be explored.

Key messages

Co-ordinated analysis of multiple UK longitudinal datasets to inform the COVID-19 response has been achieved and this approach could be extended across Europe. Existing health inequalities may be exacerbated during the pandemic as disadvantaged groups experience greater disruption.
A conceptual framework for supporting the mental health of the health workforce and key determinants
Authors: Lionis Christos
Published: October 2021

EXPH members and Opinion collaborators

A conceptual framework was developed to guide the Opinion. The visual representation shows how determinants of mental health interact and displays the evolution of various mental health profiles of an individual over time under different stressful scenarios. Mental health is a continuum of two dimensions - mental wellbeing and mental health-illness. Mental health is influenced by a complex interplay of determinants. At work, these include both non-occupational and occupation-specific factors that interact. Following a particularly stressful event, an individual may face a possible deterioration in their mental health. There are various trajectories. The individual can respond or cope effectively and maintain his/her current level of mental health. If the stressor is intense, severe, and/or prolonged, deterioration in mental health may result. The level of deterioration depends on prior mental health and the interaction of non-occupational and occupation-specific factors. A recovery in mental health from the stressor may occur spontaneously or some form of intervention may be needed. Intervention could help to mitigate the appearance of a stressor (primary prevention), to mitigate impact of the stressor on mental health and/or ensure a rapid recovery from the stressor (secondary prevention), and/or decrease the rate of deteriorating mental health (tertiary prevention).

Work-related risk factors related to mental health in the health workforce include issues related to role, relationships, control, demand, job-related factors, organizational environment, career-related factors, and interaction with non-work factors. Exposure-related concerns, burnout, and moral injury have received considerable attention during the COVID-19 pandemic.
Health related quality of life measured by in Tunisian female patients with breast cancer
Authors: Bannour I , Kacem I , Azem A , Bannour R , maalel O , Mrizek N
Published: October 2021

Background

Breast cancer is a worldwide public health issue. In Tunisia It is the leading cause of cancer mortality and morbidity and accounts for 20-25% of malignant tumors in women in all age groups. There is limited information about the long-term quality of life (QOL) in disease-free breast cancer survivors

Aim

To assess the quality of life of women with breast cancer in remission.

Methods

A cross-sectional study was conducted among women with breast cancer, treated at the maternity ward of the University Hospital Farhat Hached in Sousse during the period from January 1, 2013 to December 31; 2017. The patients were surveyed 24 to 60 months after their cancer diagnosis. The quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer supplementary measure (QLQ-BR23).

Results

100 breast cancer patients were recruited with a mean age of 52 ± 8 years. The mean Global Health Status was 77.5 (SD = 25.5). From the QLQ-C30, the mean score in the functioning scale was highest for ‘social functioning' (93; SD = 16.3), while the mean score in the symptom scale was highest for ‘Pain' (39, SD = 20.5). From the QLQ-BR23, the mean score for functioning scale was highest for ‘Sexual Pleasure' (88.33; SD = 21.9) while the mean score in the symptom scale was highest for ‘upset by hair loss' (56; SD = 15.2). The global health Status was significantly associated with professional category; health condition; age and type of treatment.

Conclusions

The results of the present study demonstrated the importance of a global therapeutic management that specifically targets the physical and psychological needs of breast cancer survivors. Improving doctor-patient communication has a central role during clinical approach to ensure the success of diagnostic and treatment strategies.

Key messages

Importance of a global therapeutic management tha target the quality of Life of cancer patients. Improving doctor-patient communication has a central role during clinical approach to ensure the success of diagnostic and treatment strategies.
The Evolving HTAi Statement on COVID-19 Vaccines
Authors: Postma M , Boersma C , Hagens A , van der Schans J
Published: October 2021

Developments in COVID-19 have gone unprecedently fast, and HTAs have tried to keep pace, for example, in HTA-committees like the Joint Committee of Vaccination & Immunization. Necessarily, HTAs of COVID-19 related issues have been numerous and of a dynamic character to adequately cope with the rapidly changing landscape. HTAi drafted a statement on COVID-19 vaccines in the 2nd half of 2020 and an update in the 1st half of 2021. Here, we will address the role of real-world data (RWD) on effectiveness, safety and benefit/risk coming from the close monitoring programs around implementation in selected countries. Notably, an abundance of data came from Israel and the United Kingdom. Where the initial vaccination programs were designed based on clinical trials, HTA-committees continuously monitored observational data and dynamically re-designed the programs based on these. RWD have sometimes enhanced an increasing generic view on the vaccines, for example, concerning the use in older adults, as well as prioritizing specific ones for specific groups. RWD clearly show the effects of the vaccination programs on hospitalizations and deaths, in particular in those countries with an early kick-start of vaccination. Typically, cost-effectiveness analysis has so far not played any role in HTAs within crisis situations. We will address this in our presentation, illustrating potential value-for-money of the current vaccines in various country-specific settings looking at dynamic modelling and extensive data needs underlying economic assessments. Correspondingly, these models were initially populated with clinical trial data and are currently undergoing continuous updates as RWD come. Increasing interest in cost-effectiveness, dynamic pricing, tiered pricing in different parts of the world and enhanced competition will further shift attention to the economic aspects, further illustrating the dynamic character of HTAs in this field and HTAi's statement as an overall concept.
COVID-19 vaccination: what are the costs we should include?
Authors: Santos J
Published: October 2021

As for previous communicable diseases, the vaccine against SARS-CoV-2 can be a truly “game-changing” factor to tackle the COVID-19 pandemic. A lot has been discussed about what is the less expensive vaccine and how health expenditures might be overrun with pandemic containment measures. There are interesting questions on cost estimation of this technology that should be discussed. The focus has been mainly on vaccine costs rather than on immunization delivery costs, which might also represent an important constraint. This includes human resources, equipment or maintenance which cannot be ignored. Such programs are highly dependent on labor supply, as well as on opportunity costs of reallocating an important share of health care workers for COVID-19 vaccination. On the other hand, costs regarding prevented health care use on COVID-19, from testing to intensive care unit, cannot be neglected, with associated opportunity costs as well. However, prevention of potentially needed measures such as lockdowns with effects in all spheres of society, such as economy and education, are of utmost relevance and are not commonly accounted for in health technology assessments. Furthermore, vaccines have important effects that are not commonly present in prescription drugs such as herd effect, protection against comorbidities or others to be explored in such a recent disease. Only a few efforts for COVID-19 vaccines' economic evaluations exist. However, at the same time, vaccines (and the rollout of vaccination programs) continue to be developed and improved. Therefore, such assessments will be important for studying boosters or revaccinations later on, but also for future pandemic preparedness. Moreover, such efforts on estimating vaccination cost-effectiveness, considering a wide range of costs, might be essential for sub-population prioritization.
Selection of equalization scale and its effect on income-health gradient in the EU countries
Authors: Karvonen S , Moisio P
Published: October 2021

Background

It has become customary to adjust income across different household types by using an equalization scale. When assessing inequalities in personal health using the equalized income entails, however, a number of assumptions that are rarely discussed in the socioeconomic health inequality studies. Earlier studies show, e.g. that rather small changes in equalization scale can produce different poverty and income inequality estimates. The aim of this study is to analyse the effect of selection of the scale on socioeconomic health inequalities.

Methods

For this we utilize the 2018 data of the Statistics on Income and Living Conditions (EU-SILC) for 32 European countries. Health is measured with a five choice question on self-perceived health to the household reference person. Household income is measured with the total disposable household (previous year) annual income. Two widely used equalization scales (OECD and OCED modified) are used to for calculating incomes per consumption unit, and then ranked into five income quintiles. A multidimensional frequency table is analyzed with nonparametric tests and log-linear modelling.

Results

Preliminary analyses from a smaller group of the countries indicate that the OECD modified scale produces more “flat” income-health gradient than the OECD scale. Also a smaller proportion of those reporting poor health are classified as having low income. The finding accounts probably for the fact that those living in a single household tend to report poorer health and lower personal income compared to respondents living in a bigger household.

Conclusions

Adjusting for income for the household size appears to affect more on larger households - who also report higher perceived health. Due to this effect, selecting an equivalence scale that imposes a bigger weight on additional household members, such as the OECD modified scale, produces less steep income-health gradient.

Key messages

Adjusting income for household size using standard scales affects the steepness of income-health gradient. Even relatively small changes in the modification scale may have large effects on the health gradient.
Preliminary data on physical well-being of children and adolescents during the SARS-CoV-2 pandemic
Authors: Salussolia A , Montalti M , Marini S , Rallo F , Masini A , Paternò M , Agosta M , Guaraldi F , Dallolio L , Gori D
Published: October 2021

Background

The COVID-19 outbreak has forcibly overshadowed the physical well-being of children and adolescents, of which we will see the consequences in near future. The programs to contain the spread of Sars-CoV-2 resulted in prolonged lockdown periods, discontinuity of educational services and a possible decrease in physical activities (PA) among the youngest. In the local reality of the Metropolitan City of Bologna children and adolescents underwent a radical change in habits and lifestyle, overall predisposing sedentariness and unhealthy behaviors. Our project, “Come te la passi?”, aims to acknowledge lifestyle variations (concerning diet, PA, sleep behavior/quality) to design, in second-phase interventions, individualized school-based educational programs.

Methods

This ongoing study is being conducted using an on-line anonymous questionnaire targeting parents/guardian of children and adolescents aged 6-17 recruited from 26th to 28th of April in Bologna, a city in Northern Italy.

Results

Preliminary data suggested that among adolescents (n = 124) 91.2% used to do PA 2 or more times a week before lockdown, while during lockdown this percentage decreased, reaching 41.1%. In children (n = 38) we observed an even more pronounced difference, with PA decreasing from 89.5% to 26.3%. In children 29% of the participants also reported a weight gain, while 65.8% did not report any variation and only 5.2% reported a weight loss. For the majority of both children's and adolescents' parents (n = 162), the strategies to address the reduction in PA were predominantly having school time dedicated only to PA (53.1%) and being more educated about simple physical exercises (14.5%).

Conclusions

Our preliminary findings suggest that the current pandemic had a strong impact on the well-being of children and adolescents; “Come te la passi?” second-phase interventions could be crucial in addressing the youngest' needs, to educate and promote healthier lifestyles through school-based programs.

Key messages

Children’s and adolescents’ lifestyle behaviors were strongly affected by the current pandemic, with physical activity frequency more than halved. “Come te la passi?” objectives are to frame the major critical issues detected and to shape educational school programs based on identified needs.
Change in the perception of cancer risk factors in the general population during a 10-year follow-up of more than 10,000 people: results and perspectives for the European Code against Cancer (ECAC)
Authors: Foucaud J
Published: October 2021

The seven main cancer risk factors are at the heart of the ECAC. This raises the question of the perceptions of these factors in the general population and their changes over time, which are revealed by the Cancer Barometer Survey. Socio-demographic variables and items on health and these risk factors were submitted to representative samples of the French population aged 16 to 75 years, in telephone surveys administered during four periods between 2005 and 2020. Chi-square tests were performed to compare differences in proportions regarding perceptions of risk factors, and odds ratios were calculated to measure the effect of socio-demographic and behavioural variables. In total, just over 10,000 people responded to the survey [2005, n = 3,736; 2010, n = 3,392, 2015 n = 3,817]. The responses show that almost the entire sample considers that tobacco smoking and unprotected exposure to the sun can cause cancer. A greater recognition of alcohol, diet and excess weight as risk factors for cancer (p < 0.001) is observed. Environmental factors show the largest increase, with some increasing by almost 25 points between 2005 and 2015 (p < 0.001), although others remain poorly understood. The perception of these factors appears to be more pronounced in certain sub-samples. Finally, there is a lack of relativity between the risk factors. This survey enables the identification of the risk factors for which efforts need to be made to raise the population's awareness, and the sub-samples to be targeted because their responses differ most from these perceptions. It is a tool for developing a differentiated communication strategy and interventional research in this field.
The EU-funded Joint Action ImpleMENTAL: an overview
Authors: Konte V , Papageorgiou Ch C , Peppou L E , Stamou M , Papachristou S
Published: October 2021

The Joint Action (JA) on Implementation of Best Practices in the Area of Mental Health -JA ImpleMENTAL prioritizes cooperation across EU and other European countries in order to improve citizens' mental health, especially amid the COVID-19 pandemic. Specifically, it aims to:

Support participating countries to improve mental health via innovative and sustainable (mental) health system change and the establishment of networks for knowledge sharing and peer learning; Reinforce capacity to address system transformation to support citizen-centered and integrated approaches; Improve the mental health of children, adolescents and adults, by facilitating their access to care, as well as promoting and improving the continuity, quality and coherence of preventive, promotive, curative and rehabilitative mental health services adapted to their individual needs and provided in their local and social environment; Work across disciplines and increase integration of mental health in primary care thus contributing towards developing health-care services providing more person-centred, coordinated care to people with (often comorbid) mental and physical health conditions; Through transfer of best practices with the highest priority ranking, which also require a strong involvement of governmental actors to enable such practices to be embedded in health systems.

 

Work Package 1 provides technical, scientific, financial and administrative coordination and management in order to ensure the overall effective implementation of the JA. The wide coverage of the Action brings to the fore the challenging task of addressing the diversity across member states.

In the presentation, the context, objectives, the strengths and challenges, the methods used to facilitate the implementation process and ensure the effective monitoring as well as the anticipated impact, will be delineated.
Survival of colorectal cancer: the role of contextual, individual and tumour-specific characteristics
Authors: Voigtländer S , Hakimhashemi A , Grundmann N , Maier W , Gerken M , Meyer M , Müller-Nordhorn J
Published: October 2021

Background

Colorectal cancer (CRC) is the second most common cancer in women and the third most common cancer in men in Germany. One in two people suffering from CRC dies within five years after diagnosis. The aim of our ongoing research project is to investigate the interaction of contextual, individual and tumour-specific characteristics and their effect on CRC survival in Bavaria.

Methods

A total of 124,958 incident cases of CRC (ICD-10 C18-C20) from the Bavarian Cancer Registry are linked with data on area deprivation based on the Bavarian Index of Multiple Deprivation (BIMD). We include all years with a CRC-specific case completeness of 90% or more, i.e. 2004 to 2018. We calculate Kaplan-Meier curves as well as mixed proportional hazards models including non-linear effects. Our modelling strategy starts from a baseline model with random effects at district, municipality, and individual level, which we continuously extend to include regional (deprivation), individual (age at diagnosis, sex) as well as tumour-specific variables (tumour site, grading, cancer stage, histological subtype, diagnosis of multiple primary tumours).

Results

Preliminary results show significant random effects at district and municipality level as well as a negative impact of deprivation on CRC survival for all sites. Individual as well as tumour-specific characteristics, such as age, grading, and cancer stage, demonstrate the strongest effects on CRC survival and partly explain survival differences according to area level (districts, municipalities), and level of deprivation. The effects of individual as well as tumour-specific characteristics vary between districts and municipalities in Bavaria depending on their level of area deprivation.

Conclusions

Contextual, individual and tumour-specific characteristics have an impact on CRC survival. Future studies may also include health services characteristics in CRC survival analysis.

Key messages

CRC survival is inversely associated with area deprivation in Bavaria. The effects of individual and tumour-specific characteristics, e.g. age and cancer stage, increase with the level of deprivation.