bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of life among people with different chronic diseases – A Finnish population-based study
Authors: Jääskeläinen T , Pietilä A , Härkänen T , Koskinen S , Koponen P
Published: October 2023

Background

In Finland, the associations between different chronic diseases and quality of life have not been comprehensively studied since the early 2000s. Updated information is needed. The aim of this study was to assess how much different common chronic diseases impair quality of life in the adult population.

Methods

This cross-sectional study was based on the FinHealth 2017 Study (sample n = 10 000) representing the Finnish adult population. The study population comprised 5208 individuals (PR 52%; aged 25+) whose quality of life (QOL) was measured using the EUROHIS-QOL 8-item index (EUROHIS-8). The overall EUROHIS-8 score was calculated by summing the scores on the eight items, with higher scores indicating better QOL. The mean value (ranging 1 to 5) of EUROHIS-8 was used. A total of 14 common chronic diseases including both psychiatric and somatic diseases were determined from the national health registers. Weighted mean values based on predictive margins were analyzed using linear regression models adjusted for age, sex, education, marital status, and other chronic diseases, taking into account the sampling design and non-response.

Results

Most of the chronic diseases studied impaired the quality of life. The lowest EUROHIS-8 mean scores were observed in individuals with depression (3.35; 95% CI 3.24, 3.46) compared to those without (4.01; 95% CI 3.99, 4.03) followed by Parkinson's disease (3.64; 3.45, 3.82 vs. 3.98; 3.96, 4.00), severe psychological disorders (3.75; 3.60, 3.89 vs. 3.98; 3.96, 4.00), rheumatoid arthritis (3.79; 3.69, 3.89 vs. 3.98; 3.96, 4.00), stroke (3.82; 3.66, 3.97 vs. 3.98; 3.96, 4.00), heart failure (3.84; 3.74, 3.94 vs. 3.98; 3.96, 4.00) and diabetes (3.84; 3.78, 3.91 vs. 3.99; 3.97, 4.01).

Conclusions

In the Finnish adult population, quality of life is impaired especially in those with mental disorders and in those having chronic diseases which limit physical functioning. Promoting the prevention of common chronic diseases is essential.

Key messages

• In social and health care, it is important to identify those people who are at the greatest risk to impaired quality of life and support their mental and physical functioning.

• Health promotion actions to improve the prevention of chronic diseases are essential to promote quality of life and reduce human suffering at the population level.
A cost-utility analysis on a multicomponent intervention for fibromyalgia syndrome in Spain
Authors: Arfuch V , Aguilar Martín C , Berenguera A , Caballol Angelats R , Queiroga Gonçalves A , Carrasco-Querol N , Friberg E , Pettersson E , Casajuana M
Published: October 2023

Background

Fibromyalgia is a chronic musculoskeletal condition associated with widespread pain, fatigue, and other somatic symptoms that reduce functionality and quality of life. Its significant economic burden for society urges improving the usual clinical practice.

Methods

This study presents a trial-based cost-utility analysis on a multicomponent intervention programme (MCI) for patients with fibromyalgia compared to the usual clinical care in Catalonia's primary care centres. This economic evaluation was conducted from a societal perspective, a human capital approach, and a one-year time horizon. The study outcomes included direct medical costs, productivity losses, and quality of life. Quality-adjusted life years (QALYs) were calculated using the SF-6Dv2 metric algorithm. Subsequently, crude and adjusted incremental cost-utility ratios (ICUR) were estimated to compare the treatment strategies and one- and two-way deterministic sensitivity analyses were performed.

Results

The complete case analysis comprised 297 individuals (161 in the intervention group / 136 controls). The obtained crude ICUR of €1,780.75 per QALY gained, and the adjusted ICUR of €851.67 suggested that the increase in participants’ quality of life outweighed the cost increase as they fell below the cost-effectiveness threshold. Furthermore, the sensitivity analyses supported the robustness of the results when variating large cost components and increasing therapeutic adherence, which endorsed the implementation scheme.

Conclusions

Given its cost-utility for society, the study's results support including the proposed MCI as part of the standard regional practice for patients with fibromyalgia. These findings provide decision-makers with evidence to enhance the healthcare approach to fibromyalgia syndrome, reduce its social burden and improve patients’ quality of life in a context of medical uncertainty.

Key messages

• The usual clinical practice for fibromyalgia syndrome urges improving its therapeutic approach in a scenario of medical uncertainty.

• Patients with fibromyalgia syndrome can benefit from multicomponent intervention programmes that cover physical, psychological and health education needs reducing the economic burden for society.
Involving Older People in Co-creation of Social Health Promoting Activities in a Senior Village
Authors: Terkelsen A , Jespersen J , Gulis G , Andersen P T
Published: October 2023

Background

Since 2018 the municipality of Esbjerg has been engaged in the WHO global network for age-friendly cities in which they are obligated to have age-friendly visons and strategies. With an establishment of a senior village with shared facilities, the municipality offers its older citizens an environment with opportunities to co-create social activities. Experiences of co-creation initiatives with older people are sparse and it is thus important to explore the benefits and drawbacks of this initiative.

Objectives

To co-create social activities with older people in senior village with shared facilities to develop a sustainable solution to the welfare challenge of a rising number of older people and a lack of staff to keep up the level of service for securing health and well-being in old age.

Methods

The co-creation initiative consisted of an initial information meeting inviting older people interested to participate in social activities followed by a series of workshops framing activity groups with concrete ideas for activities. Employees from the municipality facilitated the workshops and attended all activity groups during implementation.

Results

150 older people attended the information meeting and the following workshops generating 12 activity groups, each managed by one or two older people. However, interviews with older people involved in the co-creation process suggested barriers for co-creation at both individual and organizational level: Personal resources for organizing and managing social activities among older people were less than expected due to high average age of participants, while the level of information from the municipality on the intention, aim and anticipations on active involvement of citizens was scanty.

Conclusions

Informing older people about the intentions and aim of a co-creation process and aligning expectations between stakeholder is essential early in the process to guide the optimal utilization of personal and organizational resources.
Promoting students’ digital health literacy: does learning in school make a difference?
Authors: Renninger D , Stauch L , Fischer L , Hartmann A , Ranow P , Dadacznyski K , Okan O
Published: October 2023

Background

Given the increasing use of digital media among schoolchildren and the resulting opportunities concerning health information seeking and use, it appears important to equip them with the necessary skills to access, understand, appraise, and apply online-based information. The school setting is key to strengthen digital health literacy (DHL). This study examined differences in students’ DHL between those who learned the respective skills at school and those who did not.

Methods

Face-to-face interviews using a standardized questionnaire were conducted with N = 1,448 secondary schoolchildren (9-18 years) to assess their DHL. DHL was assessed using a translated and adapted version of the DHLI. Learning DHL skills in school was assessed using specifically developed items along the seven dimensions of the DHLI. Chi-squared test assessed associations of learning skills with sex, age and subjective family affluence. T-Tests indicated mean skill differences between students who learned the respective skill in school and those who did not.

Results

About 50% of students reported to have learned DHL skills in school. More girls than boys reported to learn skills to seek information (X2 (1) = 6.86, p = .009) and determine information relevance (X2 (1) = 6.92, p = .009). With increasing age and decreasing family affluence, more students reported to have learned DHL skills. On average, students who learned the respective skill in school also reported higher levels regarding operation skills t(1172.55) = 4.04, p < .001, adding self-generated content t(224.51) = 4.68, p < .001, information seeking t(1163.58) = 14.89, p < .001, determining relevance t(1257.21) = 12.19, p < .001, and evaluating reliability t(1200.06) = 14.38, p < .001.

Conclusions

Children and youth largely benefit from learning DHL in school. Nevertheless, there is a need to combine DHL interventions and measures with existing curricular requirements to ensure students’ skill acquisition from an early age.
Sociodemographic features of COVID-19 premature mortality: Serbian individual-level data evidence
Authors: Stevanović A , Šantrić-Milićević M , Todorović J , Mandić-Rajčević S , Rosić N , Bjelobrk G , von der Lippe E , Devleesschauwer B
Published: October 2023

Background

In Serbia, premature mortality due to COVID-19 usually has been assessed using aggregated mortality data, thus overlooking the impact of sociodemographic factors. Within the European Burden of Disease Network (COST Action CA18218), we examined the association between several sociodemographic factors and COVID-19 years of life lost (YLL) to reveal potential social inequalities.

Methods

The Statistical Office of the Republic of Serbia (SORS) has provided disaggregated, anonymized, and individual data on COVID-19 deaths in 2020 and 2021 from death certificates having U07.1 and U07.2 ICD codes as the main cause of death. Additionally, SORS remaining life expectancy and population size estimates were used along with sociodemographic data for each YLL case (sex, time and place of death, type of residential settlement, educational attainment, marital status, and economic activity).

Results

In the observed two-year period, 38,098 COVID-19 death cases were assessed, of which 72.8% were registered in 2021. The average YLL per death case was 12.51±7.62, and the median YLL was 11.50 (12.60±7.44 for men and 12.39±7.85 for women, p < 0.006). The multivariate linear regression indicated a significant association between the number of YLL and sex (B = 1.02, p < 0.01), residential area (B = 0.21, p < 0.01), educational attainment (B = 0.84, p < 0.01), marital status (B = 1.65, p < 0.01), employment (B=-7.02, p < 0.01) and place of death (B=-1.76, p < 0.01).

Conclusions

This study demonstrates social inequalities in COVID-19 premature mortality associated with the highest YLL among men, single persons, retired persons, and those with higher education status. We identify significant differences in YLL when comparing different regions.

Key messages

• Individual-level data reveals differences in premature mortality aggravated by social disparities.

• Policymakers should consider sociodemographic factors when designing COVID-19 prevention measures.
Impact of the transition to retirement on smoking habit: longitudinal results from SHARE project
Authors: Bertuccio P , Vigezzi G P , Mosconi G , Gallus S , Odone A
Published: October 2023

Background

In an ageing society, the impact of retirement on behavioural risk factors and health status needs to be carefully assessed. There are few longitudinal studies on the short-term and long-term effects of retirement on smoking habits.

Methods

A longitudinal study was conducted based on data from the Survey on Health, Ageing and Retirement (SHARE) collected between 2004 and 2020 in 27 European countries and Israel. A repeated measure generalized estimating equation (GEE) model was fitted to estimate the relative risks (RR) and corresponding 95% confidence intervals (CI) of smoking status and its intensity at seven different time periods before and after retirement.

Results

We selected a cohort of 8,998 individuals who were employed at baseline and retired during follow-up (median follow-up: 9 years; maximum: 16 years). Compared to the year of retirement, the RR for smoking was 1.59 (95% CI 1.44-1.76) 10 years before retirement and 1.35 (95% CI 1.25-1.46) from 5 to 9 years before retirement, and 1.18 (95% CI 1.10-1.27) from 1 to 4 years before retirement. Smoking habits decreased steadily after retirement, with a RR of 0.94 (95% CI 0.87-1.01) from 1 to 4 years after retirement, 0.76 (95% CI 0.69-0.84) from 5 to 9 years, and 0.58 (95% CI 0.46 to 0.74) 10 years or more after retirement. For ever-smokers, the estimated daily number of cigarettes smoked decreased from about 27 cigarettes/day at 10 years or more before retirement to 9 cigarettes/day at 10 years or more after retirement (p-trend <0.001).

Conclusions

Longitudinal data suggest that positive lifestyle changes and adaptations may occur as people reach retirement age. Further research is needed to better guide strategies that promote healthy ageing.

Key messages

• Our findings indicate that retirement has a positive impact on smoking habits, regardless of geographical and individual sociodemographic factors.

• This study is the first to examine the short- and long-term effects of retirement transition on risky behavior among a large European retiree cohort using SHARE data.
Management of pT1 CRC detected on the colorectal cancer screening programme (Basque Country. Spain)
Authors: Idigoras Rubio I , Azpiazu Maseda C E , Portillo Villares I , Sainz de Rozas Aparicio I , Bilbao Iturribarria I , Sanchez Garcia G , Ballester L L
Published: October 2023

Background

The Bowel Cancer Screening Programme (BCSP) started in 2009 with faecal immunochemical test (FIT, with cut-off 20µg/g faeces) every 2 years (for 50-69 year- olds). 2.518.715 people were invited until 2021. Participation rate was 70.4% with 5.3% positive rate and 92.7% adherence to colonoscopy. Colorectal cancer (CRC) detection rate was 2.28 ‰ with 70.6% found in initial stage. The PT1 (stage I) represented 40% of the total cancer detected (4,050 in the overall period).

Objectives

To compare the characteristics and management of pT1 CRC.

Methods

Retrospective cohort study including pT1 CRC Stage I diagnosed after colonoscopy in positive FIT from 2009-2017. Variables: sex, age groups, endoscopic and surgical treatment, CRC recurrence and survival. Chi-square, Logistic Regression, SPSS v.23.

Results

Of the 1,523 CRC detected, 585 were detected as pT1 and I stage (38.4%). 73.4% in men and by age group 59% over 60 years-old. 48.5% were treated with surgery and 51.5% with endoscopic resection. No significant differences were found adjusted by sex and age regardless of treatment. In 57.6% of patients under surgery, CRC was not reported by pathological analysis. All cases followed up by colonoscopy with variability in the number of surveillances over time. 4.1% (24) had CRC recurrence with 87% detected in the surveillance, no significant differences regardless of the treatment. 1.5% (9) died due to CRC progression.

Conclusions

Apart from the high number of CRC detected in early stages by the screening Programme, an important number of cases are reported as pT1 CRC. Endoscopic resection is one of the treatments of choice without significant impact either in recurrence of neoplasia or mortality. However, surgical procedure shows overtreatment because of the high number of cases without CRC after the procedure. Therefore, endoscopic resection could be the main choice to treat pT1 CRC.

Key messages

• Endoscopic resection is one of the treatment of choice without impact in recurrence for the pT1 CRC detected through the BCSP.

• The Basque BCSP obtains excellent participation rate, reflected in early detection and treatment of pre and malignant lesions.
The care trajectories leading to emergency dialysis start: a qualitative study
Authors: Raffray M , Vigneau C , Laude L , Campéon A , Bayat S
Published: October 2023

Introduction

Emergency dialysis start (EDS) is an important issue to understand and tackle in Chronic Kidney Disease (CKD) care. Late referral, absent previous nephrology care and higher comorbidity scores have been associated with EDS. However, how those factors happen and contribute to EDS remains unexplored. We conducted a qualitative study in France to identify and describe the mechanisms that shape the trajectories that lead to EDS, using patients, GPs and nephrologists perspectives.

Methods

Three groups of participants were recruited in Brittany, north-west France: Patients who started dialysis in emergency between 2017 and 2019, GPs and nephrologists. Maximum variation sampling approach was used based on patients’ socio-economic profiles and GPs’ and nephrologists’ years and settings of practice. Semi-structured interviews were conducted between 2017 and 2020. A crossed thematic analysis between the 3 groups of transcripts was performed, informing how EDS trajectories come to be.

Results

Twenty patients, 12 GPs and 18 nephrologists were interviewed. Five themes were identified: 1) Learning about dialysis, 2) Dialysis and nephrology care representations: a) an unacceptable biographical disruption, b) a dreadful invasive machinery, c) a straw that breaks the camel's back, 3) The gap between the “illness” perceived and the “disease” treated, 4) Slipping through the primary care prevention net, 5) the unavoidable unpredictability of CKD course.

Conclusions

This study shows how EDS is, in part, the results of an interplay between patients’ constructed representations of dialysis, relation with the medical sphere and CKD physiopathology. The results suggests a need for evaluation of kidney replacement therapy education programs and reinforcement of psychological care. Finally, results support ambitious mass prevention campaign focused on kidney health to counter the persistent negative representation of dialysis and seal off prevention cracks.

Key messages

• Emergency dialysis start is the result of an interplay between patients’ constructed representations of dialysis, relation with the medical sphere and CKD physiopathology.

• Evaluation of kidney replacement therapy education programs and reinforcement of psychological care as well as an ambitious prevention campaign focused on kidney health could contribute to reduce EDS.
English validation of the Living with long term conditions scale
Authors: Ambrosio L , Hislop-Lennie K , Serrano-Fuentes N , Driessens C , Portillo M C
Published: October 2023

Background

The English version of the living with long term conditions (LwLTCs) scale is a comprehensive person-centred measure that evaluates the complex process of living with long term conditions.

Objectives

To present the psychometric properties of the LwLTCs scale in an English-speaking population in people with different long term conditions.

Methods

An observational and cross-sectional study, with a convenience sample of 577 people living with osteoarthritis, diabetes mellitus type 2, chronic kidney disease, chronic obstructive pulmonary disease, chronic heart failure, and Parkinson's disease. Data collection was conducted between December 2021 and June 2022 across the United Kingdom via primary care surgeries and voluntary organisations. Psychometric properties including feasibility, internal consistency, confirmatory factor analysis, reproducibility, and content validity were tested.

Results

44.7% were female, the age range was 37-97 years (98 ± 9.65), 71.1% were married and 76.4% were retired. Internal consistency was excellent for the total score (ordinal alpha =0.90) but confirmatory factor analysis showed that the fit of the 5-domain structure improved significantly if items 2, 5, 10, 16, 18 and 23 were removed and item 24 reallocated.

Conclusions

This is the first validation study of the LwLTCs scale in an English-speaking population living with different long term conditions. Having a reliable and valid healthcare and social care outcome measure is essential to identify comprehensive and complex needs of people living with long term conditions. A shorter version of the LwLTCs scale is recommended to facilitate the implementation of person-centred pathways and more comprehensive care plans and evaluation in the national healthcare system.

Key messages

• Innovative comprehensive scale to evaluate the daily living.

• Reliable and valid health and social care outcome measure.
Prescription Trends for Hepatocellular Carcinoma Drugs are mirrored by Online Searches
Authors: Berning P , Schroer A E , Dzaye O
Published: October 2023

Background

Hepatocellular Carcinoma (HCC) is a major contributor to cancer-related deaths globally. Advancements in immune and molecular therapies have led to more targeted and safer systemic treatments for advanced and unresectable HCC, replacing the use of non-specific chemotherapies. This study aims to provide an overview of online search and prescription activity of drugs used for HCC.

Methods

Data from IQVIA National Prescription Audit, a comprehensive audit of nearly all monthly US prescription information, was collected from 2017 to 2022 for FDA-approved HCC drugs. Online searches for these drugs were analyzed for visual and quantitative (Spearman's) correlation.

Results

Online searches for HCC drugs in the US increased 1.17-fold between the first quarter(Q1) 2017 and Q4 2022, while prescriptions increased 5.93-fold during this period. Across first line therapies, lenvatinib was most used with a 27.62-fold increase(Q1 2019-Q4 2022), paralleled by a 1.52-fold increase in online searches. Sorafenib use, however, steeply declined by 17.56-fold(Q1 2019-Q4 2022). For second-line and later treatments, cabozantinib was most frequently applied with 3.04-fold increase and 1.62-fold rise in online searches(Q1 2017-Q4 2022). Immunotherapy prescriptions and online searches for pembrolizumab have surged from Q1 2017-Q4 2022, with an increase of 8.03-fold and 1.37-fold, respectively. Lenvatinib (r = 0.90), cabozantinib (r = 0.67), and pembrolizumab (r = 0.54) had the highest correlations between online searches and prescriptions, and all three showed increasing trends. Oncologists(72.40%) were the largest users of the across specialties in 2022, followed by physician assistants/nurse practitioners(16.53%).

Conclusions

Over a 5-year period, the utilization of HCC drugs in the US increased and prescription patterns changed due to positive trial results and guideline changes. There was a positive correlation between online searches and prescription trends for HCC drugs.

Key messages

• High correlation levels between online searches and prescriptions for HCC drugs with increasing usage.

• Online search data can mirror prescriptions trends for HCC drugs.
Perceived stress and psychosomatic complaints in Swedish youth
Authors: Brolin Låftman S , Östberg V
Published: October 2023

Background

Psychosomatic complaints are common in youth, and are often assumed to reflect stress. Previous studies have reported associations between perceived stress and psychosomatic complaints. The current study extends this research by examining the longitudinal links between perceived stress and psychosomatic complaints.

Methods

The data was derived from two survey waves of the Swedish cohort study Futura01, with participants aged ∼17-18 in 2019 (t1) who were followed up in 2022 (t2; n = 2708). Perceived stress was measured by Cohen's Perceived Stress Scale (PSS-4). Psychosomatic complaints were captured by three items on the frequency of stomach ache, headache and sleeping problems, which were added to an index. Sex stratified linear regression analyses were performed, controlling for parental education and parental country of birth, based on information from official registers. The longitudinal analyses were carried out using the first difference (FD) approach, regressing the change in psychosomatic complaints on the change in perceived stress.

Results

Females reported higher levels of stress and of psychosomatic complaints than males at both time points. There were cross-sectional associations between perceived stress and psychosomatic complaints at t1 (females: b = 0.40, 95% CI 0.36, 0.45; males: b = 0.33, 95% CI 0.29, 0.38) and at t2 (females: b = 0.40, 95% CI 0.36, 0.45; males: b = 0.33, 95% CI 0.29, 0.38). The FD analyses showed that increases in perceived stress were associated with increases in psychosomatic complaints (females: b = 0.19, 95% CI 0.15, 0.23; males: b = 0.19, 95% CI 0.14, 0.23).

Conclusions

This study provides further empirical support for the assumption that psychosomatic complaints can be regarded as stress-related. Decreasing stress and strengthening young people's resources and strategies to cope with stress may thereby help to reduce the risk of developing psychosomatic complaints.

Key messages

• Psychosomatic complaints are responsive to perceived stress and can thus be regarded as stress-related.

• Reducing stress and strengthening coping resources may increase well-being in youth.
Building a score of climate change mitigation potential in national food-based dietary guidelines
Authors: Aguirre Sánchez L , Teschner R , Lalchandani N , El Maohub Y , Suggs L S
Published: October 2023

Background

The food sector contributes to a third of global Greenhouse gas emissions. Food-based dietary guidelines (FBDG) are policy tools that provide food advice compatible with health. There is a growing effort to include environmental sustainability in dietary guidelines, but less is known about the extent to which different countries include dietary recommendations with climate change mitigation potential.

Methods

Based on a systematic review and quantitative content analysis of food-based dietary guidelines (FBDG), a Dietary Climate Mitigation (DCM) score was developed to assess and rank the climate change mitigation potential of dietary guidelines at three levels: food life cycle, dietary patterns, and food groups. To avoid an overestimation of recommendations with relatively lower climate mitigation potential, the overall DMC score assigns higher weights to the dietary patterns and food groups sub-scores, compared to the food life cycle sub-score.

Results

Of the selected 92 countries, 38 mention environmental sustainability in their dietary guidelines. The Dietary Climate Mitigation (DCM) score ranged 4-84 (median 31.14 IQR 19.71-39.14, score range 0-100). Scores were significantly higher in high-income countries, dietary guidelines published after 2010, and those that explicitly address environmental sustainability. The highest scores are those from Belgium-Flemish, Australia, Zambia, Israel, Spain, Netherlands, Seychelles, Denmark, Sweden, and United Kingdom. Food advice with high climate mitigation potential are less frequent than advice with relatively lower mitigation potential.

Conclusions

Future dietary guidelines can be more aligned to health and climate goals if they factor in the differential environmental footprints of food choices. Explicit inclusion of environmental considerations in dietary advice has grown, yet most guidelines can still evolve from pro-environmental (intent-based), to environmentally significant (impact-based) food advice.

Key messages

• While there is a growth in dietary guidelines that mention environmental sustainability, most countries have still a low coverage of food recommendations with high climate mitigation potential.

• To be compatible with planetary health, dietary guidelines can benefit from an impact-weighted approach to dietary advice.
Prenatal particulate matter exposure is linked with neurobehavioral development in early life
Authors: Cosemans C , Sleurs H , Madhloum N , Alfano R , Verheyen L , Vanbrabant K , Nawrot T S , Plusquin M
Published: October 2023

Background

Particulate matter (PM) is a major environmental health concern and there is growing evidence that early exposure to PM can have adverse effects on neurobehavioral development in children, including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). In this study, we hypothesized that prenatal PM2.5 exposure is linked with changes in neurobehavioral development in early life.

Methods

This study was part of the prospective ENVIRONAGE birth cohort and included 85 mother-newborn pairs. The Neonatal Behavioral Assessment Scale (NBAS) was administered to 1-2-month-olds to evaluate newborn's behavior. In addition, 392 children aged 4-6 years of the ENVIRONAGE cohort were included. The Strengths and Difficulties Questionnaire (SDQ) was used to assess the child's behavior. PM2.5 concentrations were determined by a high-resolution spatial-temporal method based on the maternal residential address. Multiple linear and multinomial logistic regression models were used to link prenatal PM2.5 exposure and neurobehavioral development in newborns and children, respectively.

Results

A 5 µg/m3 increase in PM2.5 concentration in early pregnancy was linked with lower scores for the NBAS range of state cluster (-0.22; 95% CI: -0.42 to -0.02; p = 0.03) in newborns aged 1-2 months old, as well as with higher odds of a child having peer problems (OR 3.90; 95% CI: 1.39 to 10.88; p = 0.01), higher total difficulties scores (OR 1.67; 95% CI: 1.01 to 2.78; p = 0.047), and abnormal prosocial behavior (OR 0.49; 95% CI: 0.25 to 0.98; p = 0.04) at age 4-6 years.

Conclusions

This study provides indications that prenatal PM2.5 exposure influences neurobehavioral development, both in newborns and in early childhood. This evidence suggests that reducing exposure to PM2.5 during pregnancy may be an important public health strategy for promoting optimal neurodevelopment in early life.

Key messages

• In utero PM2.5 exposure is related to changes in neurobehavior in newborns.

• Prenatal PM2.5 exposure is linked with higher chances of abnormal behavior in children aged 4-6 years old.
Exploring the Role of Active Assisted Living in the Continuum of Care for Older Adults
Authors: Bin Noon G , Hanjahanja-Phiri T , Dave H , Fadrique L X , Morita P P , Teague J
Published: October 2023

Background and objectives

Active Assisted Living (AAL) refers to internet-connected systems designed to improve quality of life, aid in independence, and create healthier lifestyles. As the population of older adults grows, there is a pressing need for additional supports in their daily lives and for non-intrusive, continuous, adaptable, and reliable health monitoring tools. AAL has great potential to support these efforts, but additional work is required to address the feasibility of the integration of AAL into care. The objective of this project is to address core issues with AAL system implementation, including user concerns, data governance, and clinical considerations.

Methods

To understand the concerns and opportunities regarding AAL, 18 group interviews were held with stakeholders representing different parts of an AAL ecosystem. Each group comprising several participants from the same organization. These were categorized as (1) care organizations, (2) tech developers, (3) tech integrators, and (4) potential care recipients or patient advocacy groups. Thematic analysis was then performed to identify key concerns.

Results

AAL systems may lead to improved support for care recipients through more comprehensive monitoring and alerting, greater confidence in aging-in-place, and increased care recipient empowerment. However, participants also raised concerns regarding the management and monetization of data emerging from AAL systems, as well as general accountability and liability.

Conclusions

Better role definition is needed regarding who can access data and who is responsible for acting on it. It is important for stakeholders to understand the trade-off between using AAL technologies in care settings and their costs, including loss of patient privacy and control.

Key messages

• AAL has excellent potential to support confidence in aging-in-place for older adults and their caregivers.

• It is critical to acknowledge the trade-off inherent in smart technology use between utility, cost, and encroachment on privacy.
Dual Factor Model: exploring different social sources and loneliness of adolescents in Luxembourg
Authors: Lopes Ferreira J , Mendes F G , Catunda C
Published: October 2023

Background

The Dual Factor Model (DFM) of mental health incorporates both subjective well-being (SWB) and psychopathology symptoms, proposing a more comprehensive approach to mental health. As such, four groups can be distinguished in accordance with the level of SWB and psychopathology symptoms: 1. complete mental health; 2. incomplete mental health; 3. incomplete mental illness; 4. complete mental illness. Social support and loneliness are known to influence both SWB and psychopathology symptoms. The aim of this study is to explore the odds of different sources of support and loneliness in the different mental health groups, as proposed by the DFM, in adolescents in Luxembourg.

Methods

A total of 7201 adolescents aged 11 to 18-years old participated in the 2022 Health Behaviour in School-Aged Children in Luxembourg. In order to categorize the DFM mental health groups, SWB was measured using the WHO-5 Index and anxiety symptomatology (GAD-2) was used for psychopathology symptoms. Social support (from family, peers, teacher and classmates) and loneliness were analyses using a multinomial logistic regression, adjusting for age, gender, family affluence and family composition.

Results

Adolescents who perceive a low (in comparison to good) classmate support and teacher support and feel lonely have an increasing chance of being in the Incomplete Mental Health, Incomplete Mental Illness and Complete Mental Illness (e.g. classmate support: OR = 1.69, OR = 2.19 and OR = 2.79, respectively).

Discussion

The lack of support from the school sources and feeling loneliness are the most important factors increasing the probability to be part of the Complete Mental Illness group. Prevention strategies should focus on improving the school setting conditions. School is a privileged place for health promotion, offering a comprehensive, sustained and effective means of intervention for the target population.

Key messages

• In Luxembourg, the four groups of the Dual Factor Model of mental health vary according to the source and level of support and loneliness.

• Low classmate and teacher support as well as feeling of loneliness contributes to Complete Mental Illness (low SWB and moderate to high symptomology of anxiety) in adolescents, in Luxembourg.
Transnational prenatal care among migrant women giving birth in Montreal, Canada
Authors: Merry L , KIM Y N , Urquia M L , Goulet J , Villadsen S , Gagnon A J
Published: October 2023

Background

Given the number of barriers that migrant women confront while accessing maternity care in receiving countries, it is expected that they may engage in and rely on transnational healthcare to maintain their health and well-being during pregnancy. The objective of this study was to estimate the prevalence and identify predictors of transnational prenatal care (TPC) (i.e., prenatal care from a healthcare professional in more than one country) among migrant women from low- and middle-income countries (LMICs) who gave birth in Montreal, Canada.

Methods

We conducted a secondary analysis (n = 2595 women) using data from the Migrant-Friendly Maternity Care (MFMC) - Montreal project. The MFMC study used a cross-sectional design. Data were gathered from recently-arrived (< 8 years) migrant women from LMICs via medical record review and interview-administration of the MFMC questionnaire postpartum during the period of March 2014-January 2015 in three hospitals, and February-June 2015 in one hospital. We used logistic regression modelling to identify socio-demographic, migration, health, and perceptions of care variables significantly associated to TPC (referent group were women who only received prenatal care in Canada).

Results

Four percent of women reported receiving TPC. Sixty-one percent of TPC women were from the Middle East/North Africa (vs. 42% among no-TPC women); top source countries were Tunisia, Algeria, Morocco, Lebanon, Egypt and Iran. Predictors of TPC included: ‘Not living with the father of the baby’ (AOR = 4.8, 95%CI 2.4, 9.8), ‘having negative perceptions of pregnancy care in Canada (general experiences)’ (AOR = 1.2, 95%CI 1.1, 1.3) and younger maternal age (AOR = 1.1, 95%CI 1.0, 1.1).

Conclusions

Migrant women may be motivated to return to the home country for healthcare during pregnancy due to a need for family and social support and/or to overcome access barriers and negative pregnancy care experiences in the receiving country.

Key messages

• To reduce the potential for harm and to ensure a continuity of care, healthcare providers should inquire about care, support and other services received outside of the country during pregnancy.

• Migrant women seeking care in their home country may address inadequacies regarding support and cultural preferences in prenatal care delivered in the receiving-country.
Sustainability of food purchases according to sociodemographic factors
Authors: Somaraki M , Rollet P , Recchia D , Vonthron S , Perrin C , Bricas N , Charreire H , Perignon M , Méjean C
Published: October 2023

While the nutritional quality and environmental impact of diets are widely assessed, different production modes (organic vs. conventional) remain understudied as for sustainability. The present study examines the associations between different dimensions of sustainability of food purchases and sociodemographic factors. Households (n = 462) were included in this cross-sectional study using quota sampling in Montpellier Metropolitan Area. Food items acquired over one month were registered in a food supply diary, and the expenditure share of each food group (including organic food) was estimated. Validated indexes estimated scores reflecting the nutritional quality and the environmental impact of food purchases according to these expenditure shares. Associations were tested for each sustainability dimension using linear and multinomial logistic regression models adjusted for sociodemographic factors (e.g. age, education, living area). The age of the household's reference person was consistently related to the sustainability dimensions of food purchases, albeit in different ways. While older age was associated with better nutritional quality (estimate for age >50 years vs. age between 30-50 [95%CI]=0.91[0.29;1.54]), it was associated with a higher environmental impact (estimate for age >50 years vs. age between 30-50 [95%CI]=1.84[0.95;2.73]). Households with a highly educated reference person (OR master's degree vs. lower education levels [95%CI]=1.59 [1.02;2.47] had a larger share of organic foods and those living around the city of Montpellier (OR vs. living in the city centre [95%CI]=0.44[0.24;0.81]) had a smaller share. Our findings highlight that sociodemographic factors relate to sustainability dimensions in different ways. In addition, we address organic food purchases, which provide insights into different aspects of sustainability. Taken together, the findings suggest that there are various levers for promoting healthy and sustainable diets at the consumer level.

Key messages

• Sustainability of food purchases relates to sociodemographic factors (i.e. age, education, and living location); different dimensions may be addressed.

• Mode of food production (i.e., organic) may provide insights in the context of sustainable diets.
How ready is the Italian healthcare system in the use of genomics? The B1MG Maturity Level Model
Authors: Baccolini V , Pitini E , Cicchetti A , Boccia S , Villari P
Published: October 2023

Background

The integration of genomics into healthcare systems allows to fulfilling the potential of Personalised Medicine for patients and citizens. This demands countries to make extensive adjustments in key areas, such as technical infrastructure, health professional competencies, or ethical and legal frameworks. Effective identification of current challenges and barriers to integrating genomics in the healthcare system is crucial to define a path toward sustainable implementation.

Methods

We applied the B1MG Maturity Level Model framework to assess the maturity of the Italian national health system (NHS) in key aspects of genomics implementation. From March to June 2022, 18 experts from academic and non-academic institutions that participate in the B1MG activities rated on a 5-point scale (from ad hoc to fully implemented) the level of maturity of 49 indicators grouped into eight domains: governance (I), economic aspects (II), ethics and legislation (III), public awareness (IV), workforce skills (V), clinical organization (VI), clinical genomics guidelines (VII), and data infrastructure (VIII). From July to September 2022, consensus procedures were carried out within each domain.

Results

Italy stands at a local level of genomics implementation in most indicators, but several regional and/or national initiatives are ongoing. Genomic medicine is considered a priority but still lacks updated strategies, governance, and investment plans. The highest maturity is reached for ethical and legal aspects, followed by domain VII. There is a strong need to invest in workforce training for some health professionals, citizen engagement, and literacy. Infrastructures to improve data security and fairification are still under development.

Conclusions

We defined the status of genomics implementation in the Italian NHS, drawing a comprehensive picture of all key domains and identifying areas for investment. Regional and national initiatives currently ongoing need to be monitored.

Key messages

• Italy stands at a local level of genomics implementation in most indicators, but several regional and/or national initiatives are ongoing.

• Genomic medicine is considered a priority but lacks updated strategies, governance, and investment plans.
Stakeholder perspectives on the 2020 global health strategy of the German federal government
Authors: Detering B , Namer Y , Saint V
Published: October 2023

Background

The second German Global Health Strategy was published in 2020 after a development process including a consultation with non-state stakeholders. To date, there has been no systematic investigation of these stakeholders’ perspectives regarding the consultation processes and strategy.

Methods

Semi-structured interviews were conducted with 11 German global health stakeholders involved in the consultation, with purposive sampling informed by a stakeholder mapping applying Clarke et al.'s (2018) situational analysis approach.

Results

The German government's initiative to consult stakeholders for the strategy development was positively perceived. Perspectives on the consultation process varied, especially regarding the framework conditions (e.g. time and resource constraints), structure and composition of the stakeholder groups (e.g. no adequate reflection of diverse positions) as well as the participatory nature and the representativeness of the stakeholders involved. A particular critique was the limited information provided about the strategy development process, especially once stakeholder position papers were submitted. The inclusion of climate change, human rights and health system strengthening were seen as strengths of the final strategy. Perceived exclusions or weaknesses were (forced) migration, health workforce and financing issues, which were attributed to disagreements in inter-ministerial coordination. The need for a concrete action plan and fostering coherence between ministries was seen as vital for the strategy's implementation. The strategy provides stakeholders with a way to strategically position and justify their own work, and their continued involvement in strategy implementation efforts is desired.

Conclusions

This study shows overall support for a participatory policy-making process and provides insights into stakeholder perspectives regarding the 2020 German Global Health Strategy, as well as ways future consultations can be strengthened.

Key messages

• Stakeholder perspectives on the 2020 German Global Health Strategy varied; identifying inclusion of social and planetary issues as strength, and exclusion of migration and an action plan as weakness.

• Future global health strategy development processes should consider participatory approaches, transparent communication and stakeholder representativeness in stakeholder consultation.
Food Insecurity, Disability and Age
Authors: Hadfield-Spoor M , Loopstra R
Published: October 2023

Background

Food insecurity is a growing public health concern. Disabled people are at higher risk of food insecurity than non-disabled people. Evidence suggests this diminishes for older people. We examine how the relationship between disability and food insecurity varies at different ages and explore the extent to which socio-economic factors account for and modify the relationship.

Methods

Data came from the fourth and fifth waves of the UK's Food Standards Agency's Food and You survey (n = 6,187), which contain data on disability and household food insecurity. We explored predicted probabilities of food insecurity from logistic regression models between disabled and non-disabled people for 10-year age cohorts. Stratified analyses, further explored differences in vulnerability to food insecurity at working age and 65+.

Results

Predicted probability of food insecurity for disabled people declined with age, as did the gap in risk between disabled and non-disabled people. The predicted probability of food insecurity among disabled people under 65 was 23% (95% CI: 19%-27%), whereas for disabled people 65+, it was 5% (95% CI: 3%-7%). Among people of working age, socio-economic factors explained some, but not all, of the increased risk of food insecurity associated with disability. Disabled people in full-time work were still significantly more likely to be food insecure than non-disabled people in work: 15% (95% CI: 11%-20%) vs 8 % (95% CI: 6%-9%) respectively. Among older adults, disabled people with savings were not at significantly higher risk of food insecurity, whereas those without savings were: 0.4% (95% CI: 0.4%-1%) vs 5% (95% CI: 3%-7%), respectively.

Conclusions

Findings indicate the increased risk of food insecurity for disabled people is partially explained by socio-economic factors. However, there is a need for further research to explain unobserved risk factors for food insecurity among disabled people of working age especially.

Key messages

• Socioeconomic factors play an important role in disabled people's increased risk of food insecurity.

• Observed socioeconomic factors alone do not fully explain increased risk of food insecurity among working age disabled people. More research is needed.