bluuebunny/crossref_metadata_2025 huggingface dataset:
Air Pollutants and Ovarian Reserve: A Systematic Review of the Evidence
Authors: Zupo R , Castellana F , Nawrot T , Lampignano L , Bortone I , Giannico O V , Gruszecka Kosowska A , Sardone R
Published: October 2024

Background

Growing evidence points to an association between ambient air pollution and decreased human reproductive potential. The aim of this study was to systematically review the association between air pollutants and female ovarian reserve.

Methods

The literature was searched in six electronic databases through August 2023. Screening of the 75 articles retrieved for inclusion criteria resulted in the selection of 12 human observational studies that evaluated the effect of environmental pollutants on markers of female ovarian reserve. The study protocol was registered on PROSPERO (registration code CRD42023474218).

Results

The study design of selected studies was found to be cross-sectional (2 of 10), retrospective cohort (7 of 10), prospective cohort (2 of 10), and case-control (1 of 10). The study population was equally distributed between Asians (60%) and Americans (50%) with an Italian minority (10%). The main findings showed a higher body of evidence for the environmental pollutants PM2.5, PM10, and NO2, while a low body of evidence for PM1, O3, SO2, and a very low body of evidence for benzene, formaldehyde, and benzo(a)pyrene, yet consistently showing significant inverse association data. The overall methodological quality of the selected studies was rated moderated across the 14 domains of the NIH toolkit.

Conclusions

Increased exposure to air pollutants seems to be associated with reduced female ovarian reserve with evidence being strongest for pollutants such as PM2.5, PM10, and NO2. More evidence is needed to draw conclusions about causality.

Key messages

• Increased exposure to air pollutants seems to be associated with reduced female ovarian reserve with evidence being strongest for pollutants such as PM2.5, PM10, and NO2.

• Global environmental policy programs are urgently needed to reduce the risks associated with reduced fertility such as reduced birth rates or the use of assisted reproductive technologies.
Impact of organisational injustice on health and wellbeing of female police: A meta-ethnography
Authors: Illias M , Riach K , Demou E
Published: October 2024

Background

Female police officers face more bias, discriminatory treatment, and insufficient support compared to male officers, resulting in poorer health outcomes. This meta-ethnographic review investigates beyond individual responsibilities to explore the dimensions of policing, and their effects on the health and well-being of female police officers.

Methods

The study reviewed qualitative and mixed-method studies (2000-2022) on the health and well-being of female police officers. Ten databases were searched using keywords related to health, well-being, women, police, and qualitative study. Twenty-one papers were synthesised, analysed, and interpreted using a seven-phase inductive and interpretative meta-ethnographic approach.

Results

The data analysis unveiled a distinct outcome, indicating a strong correlation and significant impact of organisational injustice on the health and well-being of women in law enforcement. Our research findings imply that organisational injustice, including procedural, relational, distributive, and gendered injustice, notably affects the health and well-being of female officers, with mental health being frequently cited, followed by effects on social, workplace, and physical health. Furthermore, the consequences of these four types of organisational injustice, alongside related cultural, systemic, and structural risk factors, reach beyond the immediate health and well-being of individual female officers. They also hinder various aspects of their professional lives, such as career advancement and maintaining a healthy work-life balance, potentially exacerbating long-term health and well-being issues.

Conclusions

This review emphasizes addressing organisational injustice and related cultural, systemic, and structural determinants in policing for healthier work environments for female officers. Policy makers must scrutinize gender-neutral policies affecting women, enabling transformative action for safer, supportive, and healthier workplaces.

Key messages

• Organisational injustice in various forms, significantly impact health and wellbeing of female police officers, necessitating policy reforms.

• Addressing organisational injustice embedded in seemingly gender-neutral policies and practices, is vital for ensuring equitable treatment and health promotion of female police officers.
Greenspace and mental health research – the question of scale
Authors: Schmid H , Freymüller J , Senkler B , Lopez Lumbi S , Hornberg C , Zerbe S , McCall T
Published: October 2024

Background

Greenspaces have been proven to promote mental health and wellbeing. Research is conducted in diverse fields with various methods. However, studies and theoretical concepts frequently fail to address or define the scale of the environment in question. Furthermore, the different types of greenspace at the same scale are often inconsistently or inaccurately defined. Such limitations may impede the comparability of results and interdisciplinary understanding. The aims were therefore: 1. To provide a quantitative overview of the combinations of greenspace and mental health measures used at the ecological scales; 2. To embed the results in the existing theoretical background.

Methods

A systematic search and a scoping review were conducted, applying an PEO framework. The data was charted with an extraction table and analysed with regard to the ecological scales which are: landscapes, ecosystems/land-use types, and species/natural elements.

Preliminary Results

Generally, distinct greenspace measures are used at different scales, while the mental health measures do not show such a clear pattern. The “landscape” scale is most often assessed via GIS approaches. The scales “ecosystems” and “species” are mostly investigated via interventions. Overall, the “ecosystems” scale is the most frequent in both research and theory. Qualitative mental health measures often focus on ecosystems. However, the qualitative theoretical concepts are based on landscapes, e.g. Therapeutic Landscapes. Species and natural elements are rarely directly addressed by both studies and theories.

Conclusions

We propose increased attention to the types and scales of green and nature at both the theoretical and the practical research level. Established ecological scales can provide a common basis for interdisciplinary research and improve the comparability of studies. This can elucidate the potential differences in the impact of the diverse forms and dimensions of nature on human health.

Key messages

• The methods employed to assess the relation between greenspace and mental health vary according to the ecological scale. Ecosystems are the main focus in research and theory, species the least.

• The type and scale of nature should be considered in environmental health research and theory. Established ecological scales can provide a basis for interdisciplinary comparability and understanding.
Unveiling mercury exposure sources in e-waste recycling with biomonitoring - A Portuguese case study
Authors: dos Reis Gomes L , Martins C , Fernandes M , Viegas S
Published: October 2024

Background

Mercury (Hg), a global pollutant, poses risks to both human and environmental health. The management and recycling of electrical and electronic waste (e-waste) is recognized as having the potential to promote workers’ exposure to this pollutant. Human biomonitoring (HBM) is a tool that can be used to evaluate exposure and monitor the health of workers. The objective of this study was to characterize exposure of workers from an e-waste recycling company and to analyze the relevance that HBM holds in the detailed characterization of exposure.

Methods

A cross-sectional observational study was conducted using data collected within the framework of the European Human Biomonitoring Initiative (HBM4EU). Data from environmental monitoring (settled dust) and biological monitoring (urine and hair) of 30 workers potentially exposed to Hg were analyzed in comparison with 12 unexposed workers from other occupational settings (controls).

Results

Exposed workers did not exhibit significantly higher concentrations of Hg in urine when compared to control workers. We found a significantly positive correlation between the concentration of Hg in urine (ρ = 0.688; p ≤ 0.001) and hair (ρ = 0.470; p ≤ 0.01) and the consumption of fish and shellfish.

Conclusions

Diet appears to be the most significant source of Hg in this context. These results suggest the importance of information and dietary habits to prevent mercury exposure. HBM stands out as an essential tool for identifying the most relevant exposure sources and risk management measures for workers and the general population.

Key messages

• Diet appears to be the most significant Hg source in workers from a Portuguese e-waste company.

• HBM stands out as essential for identifying the most relevant exposure sources and risk management.
Adapting the Place Standard Tool for Border Regions: The Euregional Approach
Authors: Van Der Zanden B , Mekel O , Struß M
Published: October 2024

The Place Standard Tool (PST) is a well-established tool that helps policymakers and communities discuss which aspects of a place - like buildings and transportation or the the way people are involved in decision making concerning their surroundings - need attention in order to improve public health. Even though the PST is widely used in many countries, it primarily focuses on a national level, overlooking the fact that 35% of EU citizens live in border regions. Many people living in these areas cross national borders for work, school, or social activities, so their everyday lives span more than one country. Using this tool to develop policies may ignore the real needs of border residents or even exclude their views, which can have a significant impact on their lives. To address this, the euPrevent Active Citizenship Participation (ACP) project adjusted the tool for a cross-border setting in the Euregio Meuse-Rhine (EMR). In this project, the German version of the StadtRaumMonitor, which is based on the PST, was modified to include questions that reach beyond national borders. This adaptation encourages people to respond to questions not just from a national perspective, but also to reflect on their experiences in neighboring countries. It was further translated into the four languages: French, German, Dutch and English, and made available online across the entire border region, which is home to nearly 4 million people. Moreover, the Euregional PST was effectively tested with local and cross-border citizen panels, and it’s set to become a key element in creating a sustainable framework for citizen participation within the EMR. And although this Euregional PST was initially developed for the border regions of the EMR, the modifications are such that the tool can be applied in no matter which European border region. Thereby, the Euregional PST offers a way to create policies that truly reflect the diverse needs and realities of border citizens, all over Europe.

Key messages

• The Cross-border Place Standard Tool EMR is easy to apply for a broad spectrum of stakeholders in border regions and applicable to all border regions in Europe.

• The tool helps preventing policy issues by considering the entire context of people living in border areas.
Occupational exposure to nickel or hexavalent chromium and the risk of lung cancer (SYNERGY)
Authors: Behrens T , Ge C , Vermeulen R , Kendzia B , Olsson A , Kromhout H , Peters S , Siemiatycki J , Straif K , Brüning T
Published: October 2024

Background

Hexavalent chromium (Cr(VI)) and nickel (Ni) are known occupational carcinogens, with frequent exposures, for example, in welding-related activities. However, limited evidence exists on the exposure-response relationship of Cr(VI) or Ni with lung-cancer risk. We estimated lung-cancer risks based on quantitative indices of occupational exposure to each metal, and their interaction with smoking habits.

Methods

Fourteen case-control studies from Europe and Canada (16,901 cases, 20,965 control subjects) were pooled. A measurement-based job-exposure matrix was used to estimate year- and region-specific exposure levels for Cr(VI) and Ni, which were linked to the study subjects’ occupational histories. Odds ratios (OR) and 95% confidence intervals (CI) were calculated, adjusting for study, age group, smoking, and exposure to other occupational lung carcinogens.

Results

The OR for the highest quartile (>99.5 μg/m3-years) of cumulative exposure to Cr(VI) in men was 1.32 (95% CI 1.19-1.47) and for nickel (highest quartile >78.1 μg/m3-years) OR = 1.29 (95% CI 1.15-1.45). Corresponding effect estimates in women were slightly lower. The joint effects of Cr(VI) and nickel with smoking were generally greater than additive.

Conclusions

We observed positive exposure-response relationships in the low-dose range of Cr(VI) and Ni exposures, based on a large study population including detailed information on smoking habits and a measurement-based job-exposure matrix. Although, we cannot rule out a combined classical measurement and Berkson error structure that may have caused bias in our risk estimates, our results provide empirical evidence to further specify preventive measures at the workplace in order to protect workers from hazardous substances.

Key messages

• Relatively low cumulative levels of occupational exposure to Cr(VI) and Ni were associated with increased ORs for lung cancer, particularly in men.

• Important empirical insights for the prevention of cancer at the workplace can be drawn from the results.
Association between body mass index and mental health status among community-dwelling older adults
Authors: Nien Y H , Hsiao C F , Wu Y Z , Hsieh H L , Tseng C H , Chou Y C
Published: October 2024

Background

Maintaining a better physical and mental health status is an important issue for older adults in their later life. Although obesity has been suggested to reduce the risk of mood disorders in older adults, the findings are controversial. Thus, we aimed to investigate the association between body mass index (BMI) and mental health status among older adults in Taipei City and to elucidate risk factors contributing to mood disorders.

Methods

The elderly health examination database was obtained from the Department of Health, Taipei City government, from 2005 to 2016. A total of 80,121 older adults underwent at least two publicly funded health examinations, with 398,416 visits. We used the Brief Symptom Rating Scale (BSRS-5) questionnaire to estimated relative risks among potential risk factors with the generalized estimating equations (GEE) model to measure the mental health status of older adults. Mood disorders were defined as a score of ≥ 6 on BSRS-5. BMI, age, education level, gender, living alone, income status, number of chronic diseases, smoking, drinking, and exercise were included as covariates.

Results

Older adults who are overweight or obese have a lower risk for mood disorders (adjusted odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.79 - 0.85), while those underweight have a higher risk (OR = 1.31; 95% CI = 1.21 - 1.41). Other results show that being male (OR = 0.66; 95% CI = 0.63 - 0.69), higher education (OR = 0.72; 95% CI = 0.69 - 0.75), and have exercise habits (OR = 0.73; 95% CI = 0.70 - 0.76) were all positively correlated with better emotional status. However, low income (OR = 1.24, 95% CI = 1.14 - 1.35) and having more chronic diseases (OR = 1.99, 95% CI = 1.87 - 2.11) were all correlated with poor mental status among older adults.

Conclusions

Keeping an appropriate weight or even being overweight might be beneficial for older adults. In addition, encouraging older adults to maintain exercise habits can also help improve mood disorders.

Key messages

• Keeping an appropriate weight or even being overweight might be beneficial for older adults.

• Encouraging the elderly to maintain exercise habits can also help improve mood disorders.
The trends of arterial hypertension and ischemic heart disease in Lithuanian population (1983-2023)
Authors: Radisauskas R , Luksiene D , Kranciukaite-Butylkiniene D , Sileikiene L , Tamosiunas A
Published: October 2024

Background

During the past two decades, in Lithuania, the morbidity and mortality from circulatory system diseases such as ischemic heart disease (IHD) have been increasing. The increasing incidence of IHD can be linked to the IHD prevention program implemented in Lithuania, which was launched in 2005. This study aimed to determine and evaluate the prevalence of IHD, their risk factors, and trends among middle-aged (45-64 years) urban males and females in Lithuania over the last 40 years.

Methods

During our study, the changes in the prevalence of arterial hypertension (AH) and IHD, among Kaunas city inhabitants aged 45-64 years in six population-based cohorts (1982-1983 (n = 1660), 1986-1987 (n = 1152), 1992-1993 (n = 824), 2001-2002 (n = 978), 2006-2008 (n = 4604) and 2023 (n = 554)) were analyzed. AH was defined when the arterial blood pressure was ≥140/90 mmHg or a person had taken antihypertensive drugs during 2 weeks. IHD was defined when a person had a previous myocardial infarction (MI) and/or ischemic changes on electrocardiogram (ECG) were assessed by Minnesota codes. The prevalence of AH and IHD changes were evaluated using regression analysis.

Results

During 1983-2023, the prevalence of AH among males aged 45-64 significantly increased from 58.7% (1982-1983) to 72.7% (2023) (p = 0.04), but among females aged 45-64 the prevalence of AH tended to decrease from 63.0% (1982-1983) to 50.9% (2023) (p = 0.18). The prevalence of IHD among males aged 45-64 was without significant changes and was from 14.4% (1982-1983) to 13.6% (2023) (p = 0.7), but among females aged 45-64 the prevalence of IHD significantly decreased from 21.7% (1982-1983) to 16.6% (2023) (p = 0.04).

Conclusions

From 1983 to 2023, among Lithuanian middle-aged urban males, the prevalence of AH significantly increased, but the prevalence of IHD was stable, meanwhile, among Lithuanian middle-aged urban females the prevalence of AH tended to decrease, but the prevalence of IHD significantly decreased.

Key messages

• From 1983 to 2023, among Lithuanian middle-aged urban males, the prevalence of AH significantly increased, meanwhile among females - tended to decrease.

• Over 40 years, the prevalence of IHD among Lithuanian males was without significant changes, but among females - significant decreased.
Regional deprivation and suicide mortality in Germany
Authors: Belau M
Published: October 2024

Background

Regional deprivation has been shown to be an important determinant of suicide risk. However, little is known about regional differences in suicide mortality in Germany.

Methods

Data from cause of death statistics (2015 to 2021) were analyzed. Regression analysis for data with negative binomial distribution was used to examine the association between the German Index of Multiple Deprivation 2015, covering 401 districts and district-free cities in Germany, and suicide mortality.

Results

The adjusted rate ratio for suicide in the most deprived deprivation area compared to the least deprived area was 1.18 (95% CI [1.72, 2.00]). A sensitivity analysis shows similar rate ratios for men (1.99 (95% CI [1.80, 2.18])) and women (1.69 (95% CI [1.49, 1.92])), but a higher rate ratio for rural areas (2.29 (95% CI [2.04, 2.57])) compared with urban areas (1.51 (95% CI [1.36, 1.68])).

Conclusions

The findings suggest that regional deprivation is associated with suicide mortality, and call for a more targeted approach to suicide prevention in deprived regions.

Key messages

• Study reveals higher suicide rates in deprived regions in Germany.

• Study calls for tailored prevention strategies to address this disparity.
Integrated sentinel surveillance of influenza, SARS-CoV-2, RSV and respiratory viruses in Serbia
Authors: Dimitrijevic D , Jovanovic V , Milinkovic M , Protic J , Grego E , Maris S
Published: October 2024

Introduction

Integrated sentinel SARI surveillance of influenza, SARS -CoV-2 and RSV has been established in Serbia since 2021-2022 influenza season. Nine sentinel hospitals in 3 cities participated in the SARI surveillance system. The aim of this study is to provide a review of integrated sentinel surveillance of SARI in Serbia in 2023-2024 influenza season, from October 2023 to April 2024.

Methods

On a weekly basis, both epidemiological and virological data were collected. Surveillance is be conducted year-round. Specimens were tested for influenza, SARS-CoV-2,RSV and other respiratory viruses. Respiratory disease wards, intensive care units (ICUs) and pediatric wards were all represented. Real time polymerase chain reaction (RT-PCR) was used.

Results

From October 2023 to April 2024, a total of 1571 SARI cases were reported with 100% recorded age. Of these, 35% were 0-4 years old, 16% were 5-14, 6% were 15-29, 14% were 30-64, 18% were 65-79 and 11% were 80+. Among these cases, 1002 (64%) respiratory specimens were collected. The number of positive samples for influenza was 294 (29%). The positivity rate was 10% for SARS-CoV-2 and 19 % for RSV. The highest proportion of laboratory-confirmed influenza cases was 67% in week 04/2023. Then above 50% in week 05/2023 and 06/2023. Type A viruses was predominated, accounting for 97% of all influenza SARI detections. Activity was dominated by A(H3) with 42% positivity rate. Also, collected swabs were tested for rhinoviruses, positivity rate was 26%, for adenoviruses, 12%, for human metapneumovirus, 7% and for parainfluenza 3 viruses, 4%.

Conclusions

Sustaining and intensified effective integrated surveillance for influenza, SARS-CoV-2,RSV and other respiratory viruses in Serbia is the priority especially in the frame of International Health Regulations. In this way, we improve national capacity for preparedness and emergency response to national and cross-border public health threats.

Key messages

• Building and maintaining integrated respiratory surveillance that can rapidly integrate the surveillance of a new viruses is crucial.

• Establishing well structured surveillance of severe acute respiratory infections, strengthening and expanding respiratory viral surveillance is one the base pillars preparation for future pandemics.
Using Social Network Analysis during COVID-19 contact tracing in Libya, 2020
Authors: Gebril J , Danis K , Emahbes T , Aqeehal H , Alarbi A , Ahlab H
Published: October 2024

Background

Social network analysis (SNA) may provide valuable insights into individual-level transmission dynamics, allowing for targeted contact tracing interventions. We used SNA to understand the variability in SARS-CoV-2 transmission at the case level during the first wave in Libya.

Methods

We analyzed the spread of COVID-19 in Libya from March to August 2020 using contact tracing data from 287 confirmed cases. We created a network to visualize the transmission patterns, representing each case as a node and connections as links. We focused on direct contacts identified through contact tracing and calculated network measures such as out-degree centrality, in-degree centrality, and betweenness centrality. Gephi software was used for data visualization and understanding the network structure.

Results

Of the 287 COVID-19 cases, 264 (92%) had nodes with zero outdegrees, indicating that they did not contribute to infection transmission. The remaining 23 (8%) had non-zero out-degree measures and transmitter infection to other cases, 10 (4%) of whom were super-spreaders (outdegree≥5) causing 70% of the transmission. Six (2%) had no epidemiological contact, indicated by zero in-degree centrality measures; 63% had zero betweenness centrality measures, suggesting they did not act as intermediaries connecting separate transmission chains within the network. The network contained nine clusters of connected nodes, with the largest having 91 (24%) cases; the mean path length between cases was 1.846, and the network diameter was 4.

Conclusions

The study revealed distinct clusters of connected cases, along with the presence of super-spreaders. This network structure underscores the critical role of early identification and isolation of individuals with high transmission potential to effectively contain outbreaks. This revised conclusion directly references the findings of nine clusters and super-spreaders, demonstrating how these results support the importance of early intervention.

Key messages

• Social network analysis identifies clusters and super-spreaders in COVID-19 transmission, emphasizing the need for targeted interventions.

• Connected clusters and super-spreaders highlight the importance of contact tracing and early isolation for effective control of COVID-19 outbreaks.
Breast implant illness in women with implant-based reconstruction after breast cancer
Authors: Lieffering A S , Hommes J E , van der Hulst RRWJ , Rakhorst H A , Verheij R A , Mureau MAM , Ramerman L
Published: October 2024

Background

This study investigated the association between silicone breast implants and health symptoms (Breast Implant Illness (BII)) in women with implant-based breast reconstruction after breast cancer. While there is increasing evidence of an association with BII in cosmetic breast augmentation cases, for women with implant-based breast reconstruction this is unknown.

Methods

Retrospective cohort study of 254 women who underwent implant-based reconstruction after breast cancer and a control group of 487 women who underwent breast-conserving therapy or simple mastectomy. We linked Dutch Breast Implant Registry data (2015-2019) and general practice electronic health records data (2014-2022) to study the occurrence of thirteen BII-related health symptoms in general practice and the number of consultations for these symptoms one year before to three years after breast surgery.

Results

Over the three years following implantation, no significant differences in symptom occurrence were observed compared to both the year before implantation and the control group. Women with breast implants did not have more consultations compared to the control group during follow-up. However, there was an increased likelihood of multiple consultations in the first and second years post-implantation compared to before implantation (≥3 consultations first year OR = 2.10, p = 0.005; second year OR = 1.70, p = 0.048; ≥5 consultations first year OR = 2.57, p = 0.02).

Conclusions

This study found no evidence for BII in women with implant-based reconstruction after breast cancer. Despite certain limitations in examining BII in this specific patient group, these findings add valuable information to the decision-making process of breast cancer patients considering reconstructive options.

Key messages

• This is the first study on BII that focused solely on women with breast implants for reconstruction after breast cancer.

• No evidence of BII was found in this patient group.
Unequal effects of adolescent health behaviors on adult cardiometabolic conditions: a cohort study
Authors: Noor N , Jackisch J , Chiolero A , Harris K M , Carmeli C
Published: October 2024

Background

Health behaviors in adolescence could have a life-long effect on cardiometabolic health and differ by parental socioeconomic conditions. Adopting a life course perspective and a causal inference framework, we aimed to quantify the differential effect of adolescent unhealthy behaviors on adult cardiometabolic conditions by parental financial situation.

Methods

Using the National Longitudinal Study of Adolescent to Adult Health in the United States (n = 3,772), we estimated conditional causal effect by parental financial situation through inverse probability-weighted marginal structural models. Exposures were adolescent health behaviors (dietary habits, cigarette smoking, alcohol consumption and physical activity) and the effect modifier was parental financial situation (difficulty paying bills vs. no difficulty), both measured at ages 12-19 (1994-1995). Outcomes were cardiometabolic conditions (hypertension, stroke, cardiac failure, diabetes, chronic kidney disease), measured at ages 33 - 43 (2016-2018) using biomarkers and self-reports.

Results

There were 1,206 participants with cardiometabolic conditions after 20 years of follow-up. Alcohol consumption among adolescents with parental financial difficulty led to 325 more cardiometabolic cases (95% confidence interval: 2 - 647) compared to alcohol consumption by their peers without financial difficulty. This differential effect is driven more by cardiovascular conditions (hypertension, stroke, or cardiac failure) than by metabolic conditions (diabetes or chronic kidney disease). There were no differential effects of dietary habits, cigarette smoking and physical inactivity on the occurrence of adult cardiometabolic conditions.

Conclusions

Public health initiatives targeting alcohol consumption during adolescence could mitigate socioeconomic inequalities in adult cardiometabolic conditions.

Key messages

• Socioeconomically disadvantaged adolescents are more susceptible to the long-term detrimental health effects of alcohol consumption.

• These susceptible groups may need targeted interventions to mitigate the cardiometabolic effect of alcohol consumption.
3.G. Scientific session: Making WHO European Region the Healthiest Online Environment for children: Restrict harmful marketing
Authors:   Organised by: WHO/Europe, EUPHA, Joint Action Prevent Non-Communicable Diseases and Cancer,   Chair persons: Kremlin Wickramasinghe (Denmark), Amandine Garde (EUPHA-LAW)
Published: October 2024

Children spend a significant amount of their time daily on digital devices using online services. While this can bring many advantages and benefits, it also entails dangers if not the online environment is not effectively regulated. Exposure to marketing of harmful products and services, particularly towards children, remains a pervasive challenge, despite the extensive evidence base documenting its negative impacts. This session will give an overview of integrating behavioural sciences with public health which suggested promising avenues for addressing the complexities of harmful digital marketing to children. Additionally, current tools developed by WHO Regional Office for Europe and Joint Actions, which Member States can use to address novel challenges like brand marketing will be presented. The tools help to map, monitor and regulate the digital marketing exposure of unhealthy foods and brands to children in their country. One focus will be on the need to objective monitoring of marketing exposure to inform policies and ensure that they are fit for purpose. This is particularly challenging, as traditional monitoring tools struggle to keep up with automated, targeted and personalized advertisements. Due to the complexity to successfully restrict marketing exposure to children, strong collaborations are needed. Collaborative efforts of the Joint Action PreventNCD and the WHO Europe will be presented. Specific goals set by the Joint Action, as well as the importance of a sustainable approach will be highlighted. A discussion on the way forward will focus on how tangible impact can be created in the WHO European Region.

Key messages

• Need for effective tools to address novel challenges and successfully monitor and regulate harmful marketing to children.

• Need for integration of behavioural science and strong collaborations to create real impact.
Using English General Practice Patient Survey data to explore Long Covid prevalence
Authors: Woodrow M , Ziauddeen N , Smith D , Alwan N A
Published: October 2024

Background

High global burden of Long Covid (LC) has significant implications for population wellbeing, health/social care and the economy. We aimed to assess prevalence of LC, the level of uncertainty general practice (GP) patients felt about whether they were experiencing it and patient characteristics associated with LC.

Methods

This is a secondary data analysis of GP Patient Survey 2023 data (759,149 participants aged 16+yrs in England). The outcomes included self-reported LC, and being unsure about having LC. Identity and socioeconomic characteristics were explored in relation to these outcomes using univariable and multivariable regression analyses.

Results

4.8% of respondents described themselves as having LC, and 9.1% were unsure whether they had it. Patient age (highest odds at 35-54 years), sex (females more than males), ethnicity (highest odds in Gypsy or Irish Traveller), sexual orientation (increased odds in gay or lesbian or bisexual compared to heterosexual), religion, smoking, carer status, parental status, having a long-term condition, and area-level index of multiple deprivation (higher odds in more deprived areas) were all significantly associated with reporting having LC in the multivariable model compared to answering that question with ‘no’. Generally, similar patterns of association to the above were observed in those who answered the Long Covid question with ‘unsure’ compared to those answering ‘no’, except for parental status and sexual orientation which were not significantly associated with the outcome in the multivariable model.

Conclusions

This study quantitatively highlights the high levels of uncertainty among primary care patients around experiencing LC, and the unequal distribution of LC burden among population groups. Our findings underline the need for better public health and primary care messaging to raise awareness around LC and ensure that those needing support can access services, particularly those already disadvantaged in society.

Key messages

• There are high levels of uncertainty about having Long Covid among people attending primary care services.

• There is unequal burden of Long Covid in England underlining the need for improved awareness and access to support, particularly for minoritised groups.
Evaluation of food pattern behaviours following nutritional education for health professionals
Authors: Barocco G , Croci E , Bucci F G , Forciniti G , Longo T , Steinbock D , Fedele R , Marsi A , Occoni E
Published: October 2024

Background

The “Work Programme - UN Decade of action on nutrition 2016-2025” highlights the importance of implementing Recommendation 19 of the Second International Conference on Nutrition of FAO and WHO related to nutrition education interventions (NEI) for health professionals (HP), in order to develop nutritional skills based on national dietary guidelines and coherent policies relating to food. The Local Health Agency integrated with Trieste University (ASUGI), since 2009, has performed 25 NEI with the formation of 910 HP. Post pandemic, the content of ASUGI’s last 5 NEI, programmed by the prevention plan of the Autonomous Region of Friuli Venezia Giulia, was aligned with the principles of the European Farm to Fork Strategy linked to Sustainable Healthy Diets (SHD).

Objectives

The objectives of the training programme (TP), approved for Continuing Medical Education, was to change and evaluate food pattern behaviour (FPB) of HP (n = 200) to adhere to the SHD. TP was characterized by a systemic view on complex interconnections between nutritional and sensorial food value, sustainability of food chain systems, evolution of urban food environments, as contexts into which SHD choices can be applied. The 2 days training, spread over 14 hours with 40 participants, concluded with interactive work and experiences to applied knowledge and beginning to make informed healthy dietary choices in practice.

Results

6 months after the conclusion of TP it was reported that the percentage of HP who consumed the recommended portions of fruits and vegetables had increased from 62% to 70% and from 28% to 35% respectively, while those who consumed no cured meats, red meats or legumes, changed from 24% to 35%, from 19% to 25%, from 6% to 3% respectively.

Conclusions

The evaluation of the TP systemic structure has shown its effectiveness in improving some healthy FPB of HP and the importance of applying a continuous improvement process of the program to better adhere to the whole SHD.

Key messages

• The systemic and integrated structure of nutritional education intervention programs for health professionals contributes to improving their healthy food pattern behaviour.

• The relationships between complex policies of food systems and the 17 SDGs included in the training programs on nutrition education are useful for promoting adherence to healthy and sustainable diets.
Trend of body mass index and its impact on glycemic control in Finnish patients with type 2 diabetes
Authors: Wang Z , Lavikainen P , Wikström K , Laatikainen T
Published: October 2024

Background

Obesity prevalence has increased in Finland and is prevalent in patients with type 2 diabetes (T2D). Understanding the trend in body mass index (BMI) and its impact on glycemic control helps in the assessment of treatment strategies for T2D. We aimed to investigate the current trend in BMI among Finnish patients with T2D and the glycated hemoglobin (HbA1c) control across different BMI categories.

Methods

Regional data on electronic health records (EHRs) covering all public health care in North Karelia, Finland, were used. Patients with T2D (ICD-10 code E11) in 2012-2022 were identified from EHRs. In each study year, patients with ≥1 measurement of BMI and HbA1c were included in data analysis. Generalized estimating equations regression analyses were performed to evaluate the trends.

Results

The annual number of patients in the analyses ranged from 5149 to 10216 in 2012-2022. The unadjusted mean BMI remained stable. However, an increasing trend in BMI was observed in the age-adjusted model and remained unchanged with further adjustment for sex, duration of diabetes, and antidiabetic medication use, reflecting the aging of the patient population and lower BMI in aged patients. Patients with higher BMI had higher HbA1c levels in 2012-2022. The increasing trends in HbA1c over time were observed across different BMI categories (except for the obsess class III) accounting for age, sex, and duration of diabetes. However, a decreasing trend in HbA1c was found in the obese class III category with further adjustment for antidiabetic medication use, along with the highest usage rates of the new antidiabetic medications during the follow-up.

Conclusions

Our findings suggest that weight management requires increased attention in Finnish patients with T2D and is also important for better glycemic control. Multimodal treatment, including effective lifestyle counseling, self-care support, and medication management, is needed.

Key messages

• More attention and resources are needed to achieve optimal weight control.

• Weight management could aid in better glycemic control.
The higher education’s role in the multisectoral evolution of the diabetes mobile unit programme
Authors: Smith D
Published: October 2024

Background

The global prevalence of obesity and diabetes is increasing. Overweight and obesity during early childhood increase the risk of developing type 2 diabetes. The diabetes mobile unit (DMU) programme is a collaborative initiative between the Bahrain Diabetes Society, the Royal College of Surgeons in Ireland (RCSI) Medical University of Bahrain, the Ministry of Education, and other stakeholders.

Objectives

To develop a sustainable educational programme to empower nursing and medical students to educate schoolchildren on healthy lifestyle choices and potentially reduce the risk of obesity and type 2 diabetes.

Results

The DMU programme is incorporated into the undergraduate nursing and medical curricula. It fosters experiential learning in public health education and promotion, encourages trainee-trainer mentorship, and cultivates essential graduate skills, thus enhancing their career prospects. Since 2012, the programme inducted 300 staff and students and educated 7,000 children. In 2023, the programme was re-launched in alignment with RCSI’s three strategic pillars: learning and teaching, research, and community engagement. The programme expanded its stakeholders’ network and incorporated strategies to promote interprofessional learning among staff, students, and alumni. The outcome of these endeavours included publishing an interactive storybook, creating innovative educational tools, and ongoing research.

Conclusions

This novel programme highlights the role of higher education in promoting multisectoral collaboration for public health awareness initiatives. The key to the programme’s success is synchronizing education, research and community engagement in higher education curricula and various contexts.

Key messages

• Multisectoral collaboration is essential in developing evidence-based and culturally congruent programmes.

• Linking education, research, and community is vital to achieving sustainable development goals.
Professional health literacy of health professions in Austria - results of the HLS-PROF-AT study
Authors: Schuetze D , Strassmayr C , Link T , Griebler R
Published: October 2024

Background

Health professions play a crucial role in strengthening the health literacy (HL) of the population - provided that they themselves have the necessary professional HL. This encompasses competencies related to information and knowledge management, conveying information and knowledge, patient involvement and shared decision-making, and professional digital HL. In 2022 and 2023, data on professional HL were collected in Austria.

Methods

Nearly 4,400 healthcare professionals (doctors, nurses, physiotherapists, pharmacists, midwives, dieticians) were asked about their challenges across the four domains of professional HL. A score was calculated for each domain, with five additional subscores for the domain conveying information and knowledge. The relationship between socio-demographic, job-related and organisational characteristics and professional HL were investigated using T-tests, variance analyses and multivariate regression models.

Results

The greatest challenge for all healthcare professions is supporting patients in dealing with digital information, followed by conveying information and knowledge. Apart from pharmacists, the least difficulties were found in the domain patient involvement and shared decision-making. Furthermore, the results demonstrate that a high level of professional HL is associated with more favourable organisational conditions for HL-promoting patient communication and (very) good preparation in training for the tasks of professional HL. There is no systematic correlation between professional HL and years of professional experience.

Conclusions

Overall, healthcare professionals rated their professional HL positively. However, the results also highlight areas for improvement. Alongside promoting professional HL in the context of (further) training, it is important to enhance organisational framework conditions for promoting patients’ HL - ideally supported by initiatives to promote the organisational HL in healthcare organisations.

Key messages

• The greatest challenge for the health professions surveyed is to support patients in dealing with digital information and to convey information and knowledge to their patients.

• Good preparation in training for the tasks of professional HL and favourable organisational conditions for HL-promoting patient communication are associated with a higher professional HL.
Low health literacy is associated with health-related institutional mistrust beyond education
Authors: Heraclides A , Hadjikou A , Kouvari K , Karanika Ε , Heraclidou I
Published: October 2024

Background

Institutional mistrust, the lack of confidence and overall suspicion towards authorities or systems, usually governmental, but also extending to the health sector, poses a major obstacle towards public health policies and actions. Lower educational attainment has been linked to higher mistrust, but the role of health literacy in particular remains unclear.

Methods

Cross-sectional study in the general adult population of Greece and Cyprus following proportional quota sampling (January 2022 to May 2023). The current analysis is based on a sub-sample of 292 participants, with complete information on health literacy (main exposure, assessed via the validated HLS-EU-Q16) and health-related institutional mistrust (main outcome, assessed via a new culturally adopted questionnaire comprising 11 items). Multiple linear regression was used to determine associations between the aforementioned factors, adjusting for educational attainment and other potential confounders.

Results

Exploratory factor analysis revealed 3 health-related institutional mistrust dimensions, towards: (a) governmental authorities and the media (i.e., the system), (b) doctors and other health professionals, and (c) the scientific community. Health literacy was negatively associated with all mistrust dimensions, with associations being particularly strong with mistrust towards the system (B, 95% CI per unit increase in the HL scale: -0.87, -1.58; -0.15) and the scientific community (-0.71, -1.11; -0.32). These association remained robust to adjustment for educational attainment and other sociodemographic factors.

Conclusions

Mistrust towards a perceived system, comprising the government and media, as well as towards the scientific community on health-related matters, is higher among individuals with low health literacy, irrespective of educational attainment. Enhancing health literacy could act as a novel target for public health approaches aiming to tackle health-related institutional mistrust.

Key messages

• Health-related institutional mistrust is a complex phenomenon, which appears to have different dimensions, relevant to the perceived system, health professionals, and the scientific community.

• Low health literacy is an independent predictor of health-related institutional mistrust, rendering it a novel target for attempts towards reversing this phenomenon and its adverse health consequences.