bluuebunny/crossref_metadata_2025 huggingface dataset:
Threats and humiliation in the workplace
Authors: Lindert J , Sisenop F , Agay-Shay K , Etzel R , Mollica R , Baccarelli A A
Published: October 2023

Background

Threats and humiliation in the workplace and related mental health consequences are a serious public health problem. The aim of this study was to investigate the relationship between threats and humiliation at the workplace and mental health of scientists.

Methods

We analysed de-identified data from environmental scientists who had responded to an online survey about self-identified threats and humiliation at the workplace and mental health. Eligible were scientists who were members or former members of the International Society of Environmental Epidemiology (ISEE). Generalized linear models were used to study cross-sectional associations between threats and humiliation at the workplace and self-reported health, depression, anxiety and stress symptoms.

Results

Of those contacted, 1,907 opened the invitation (50·6%), and 627 participated (32·9%) [64·4% female (n = 397); 35·6% male (n = 219)]. For this study we included those who answered to the threats and humiliation questions (n = 500; 64·2% (n = 321) females and 35·8% (n = 179 males). Of those 15·0% (n = 61/345) reported poor health, 17·0 (n = 66) depression; 24·7% anxiety and 31·9% (N = 122) stress symptoms. 77.4% female and 68.9% males reported at least one humiliation event at their workplace. Threats were most common among females, those who were 18 to 30 years old, and not professors; humiliation was most common among females. Exposure to threats (e.g. being put on leave) and humiliation (e.g. being excluded) were associated with worse self-perceived health, and more symptoms of depression, anxiety, and stress in a statistically significant dose-response relationship.

Conclusions

Threats and humiliation at the workplace are frequent among health scientists. These exposures are associated with mental health conditions. The findings suggest that prevention and intervention policies aimed to reduce threats and humiliation at the workplace may contribute to promoting mental health of scientists.
Knowledge and attitudes towards LGBT people and their healthcare needs among doctors in two selected hospitals in Sri Lanka
Authors: Chandraratne N , Wijerathne UHSN , Wijesekara S , Wijesekara DATV , Wijesundara WMAC
Published: October 2023

Introduction

The sexual and gender minority (SGM) community is subjected to discrimination in healthcare settings due to the lack of knowledge and hostile attitudes among healthcare professionals globally. This study assesses the knowledge and attitudes of doctors in two hospitals in Sri Lanka towards SGM people & identifies various factors associated with their knowledge & attitudes.

Methods

This cross-sectional study was conducted among 112 Medical Officers in two Sri Lankan hospitals. Data were collected through an online self-administered survey created using the modified SEKHQ (Sex Education and Knowledge about Homosexuality Questionnaire) & AHQ (Attitudes Towards Homosexuality Questionnaire). The response rate was 97.3% (N = 109). Cutoff scores were created to determine whether the knowledge and attitudes were ‘good’, & we used the Pearson correlation to assess their relationship. The association between attitudes and various factors was analyzed using the t test and we report p-values under 0.05.

Results

The preliminary results indicated that most Medical Officers had ‘good’ knowledge (70.6%; n = 84) & attitudes (94.5%; n = 103) toward SGM people. A moderate & positive linear correlation (r = 0.567) between knowledge & attitudes was noted, such that better knowledge aligned with better attitudes. Sociodemographic factors, such as sex, marital status, & hometown of the participants, & professional factors, such as years of experience & graduation from university, showed no association with attitudes. In contrast, a strong association between self-perceived religiosity (higher religiosity) & negative attitudes was identified (p < 0.05).

Conclusions

The knowledge and attitudes of doctors in the selected hospitals are satisfactory, & knowledge is a possible tool in shaping the attitudes toward the SGM community in Sri Lanka. Self-perceived religiosity harmed attitudes, which calls attention to specific education efforts needed among more religious providers.
A new Norwegian Injury Registration System as a starting point to assess the burden of injuries in Norway
Authors: Lund Johan
Published: October 2023

Introduction

The police register is the main database for monitoring traffic injuries. A study made by Safe Traffic in Norway found that only one of three severe traffic injuries is registered in this register. For giving more complete data, a health-based injury monitoring system was established in 2022 for a period of five years, financed by the traffic safety authorities.

Methods

An Injury Minimum Data Set (MDS) is collected from all injuries that are treated in ten hospitals and seven municipality AEDs in the primary health care, a representative sample of all medically treated injuries in Norway. By recording the unique birth number of the patient, double registrations are deleted. When fully developed, this system will register about 50 % of all injuries treated in the hospitals as in- and out-patients, and about 10 % of all injuries in the primary health care system in Norway. Max AIS (Abbreviated Injury Scale) and diagnosis (ICD-10 - hospitals, and ICPC-2 - primary health care) are among the registered variables for each injury. Based on the ICD-10 codes, long term disability weights (DW) can be calculated (Gabbe et al 2014). Then the injury burden of injuries in Norway can be shown by: 1) Threat to life: a) minor (AIS 1), b) moderate (AIS 2) and c) serious, (AIS 3+, including AIS 4-6). 2) Threat of disability: a) low, b) medium and c) high probability of long-term disability.

Results

Data from 2023 seems to be complete enough to enable calculations of the annual injury burden in Norway.

Future work

There is a need to establish internationally agreed disability weights to enable comparisons across countries. And to establish conversions from ICPC-2 codes to ICD-10 codes for enabling calculations of DWs of injuries treated in the primary health system.
Mediation analysis
Authors: McHugh-Power J
Published: October 2023

Understanding mechanisms between the urban environmental exposome and cognitive functioning outcomes is a key aim of the SPACE project. Structural equation modelling (SEM) offers a framework in which to consider potential mechanisms identified in DAGs (see IAP, Presentation 1) and evaluate their contribution to total effects between the environment and cognitive functioning. SEM allows multiple regression-based pathways to be computed simultaneously, meaning that variables can flexibly be specified as both outcomes and predictors in one overarching model. Another advantage of SEM is its use of latent modelling, which reduces measurement error (particularly useful in a multivariate context with many variables). This presentation will provde a brief introduction to SEM, latent modelling, and mediation analysis. Using state of the art approaches to assessing mediation with longitudinal data in a SEM framework, and with data from waves 1 and 2 of NICOLA, we will then discuss the application of mediation in SEM to relevant paths identified in the DAGs, including psychosocial and behaviour mediators (e.g. depressive symptoms, social isolation, physical activity). Finally, we will proceed through a worked example (the path from the urban environmental exposome, via depressive symptomatology as a mediator, to cognitive functioning as an outcome), and discuss a specific advantage of SEM mediation analysis: model modification.
7.F. Workshop: Local physical activity policy evaluation: state of the art, tools and methods and future directions
Authors:   Organised by: University of Limerick (Ireland), French Society of Public Health (France),   Chair persons: Aurélie Van Hoye (Ireland)
Published: October 2023

Insufficient physical activity (PA) is one of the most significant risk factors for chronic diseases and premature mortality worldwide. Public policies are recognized as upstream factors providing system change beyond individual changes. Policies have been recognised as an effective way to increase population PA levels, as they support the development of evidence-based interventions and programs in different domains, that help create a ‘healthy’ PA environment and enhanced PA opportunities. Previous studies have shown an important impact of PA promotion policies at local level (municipalities), but insufficient research and tool development has been realised on PA policies beyond national level. First, the workshop will briefly describe the scientific state of the art on local PA promotion policies evaluation, based on results from a literature review. Second, the panel will present the CAPLA-Santé, a policy evaluation tool designed by a stakeholders’ group in France, based on the Health Enhancing Physical Activity Policy Audit Tool of the World Health Organisation, to comprehensively review local PA policies. The final version of CAPLA-Santé contains 21 items divided into six sections: 1. Overview of HEPA stakeholders in the local government area, 2. Policy documents, 3. Policy contents, 4. Funding and political engagement, 5. Studies and measures relating to physical activity in the local government area, and 6. Progress achieved and future challenges. CAPLA-Santé allows the collection and in-depth analysis of local level policies to assess the progress in promoting PA and intersectoral collaboration as well as identifying successful policy levers and remaining challenges. Third, the panel will illustrate its use in 5 countries worldwide (Finland, France, Germany, Japan and Romania), summarising findings and explaining how such tools allow cross-cultural comparison. Fourth, panellists will discuss the challenges and success in using such tools and provide insights on how these tools can serve as capacity building for policy makers and to draw recommendations, as well as cross-cultural comparisons.

Key messages

• The workshop will provide key advise on how to monitor local physical activity policies.

• The workshop will equip participants with tools to face the challenge of local physical activity policy evaluation.

Speakers/Panelists

Petru Sandu

Cluj School of Public Health, Babes-Bolyai University in Cluj-Napoca, Cluj-Napoca, Romania

Anne Vuillemin

Université Côte d’Azur, Nice, France

François Berdougo

Société Française de Santé Publique, Laxou, France

Peter Gelius

FAU Erlangen-Nürnberg, Erlangen, Germany
From evidence-based health prevention registers to best practices in implementation: how to succeed and tailor an effective prevention program?
Authors: Gouffe-Benadiba L , Arwidson P
Published: October 2023

The role of evidence-based prevention registers and “best practice portals”, aiming at health enhancing behaviour changes and reducing social inequalities, are even more important in the post COVID era. Evidence-based practices are interventions for which there is consistent scientific evidence asserting that they improve health outcomes for a specific population at time T in setting S. Adaptation and dissemination are the next challenges for decision-makers whereas there is no scientific consensus on a universal dissemination and adaptation model. Best practice portals should help to disseminate evidence-based interventions in health prevention. Therefore specific skills for adapting and implementing programs in local settings are needed. Models for dissemination remain complex for field practitioners and local stakeholders. Nevertheless, effective implementation can be achieved by supporting the local practitioners and stakeholders with scientific standards in prevention research including a delivery system, an organizational capacity, a support system and a strong training and technical assistance.

In this workshop, we will briefly present:

1. The implementation of evidence-based interventions (Unplugged, ICAPS Intervention centred on adolescents’ physical activity and sedentary behavior) or experimented for adaptation (Panjo: Nurse-family partnership, PSFP: Strengthening Families Program, Good Behavior Game, MBCP: Mindfulness-based childbirth and parenting).

2. The lessons learned from the implementation of these interventions. The required conditions for dissemination include readiness assessment, affordability of training and manuals, targeted audience, materials, supportive training and assistance. Fidelity monitoring tools must be provided for field practitioners who face the dilemma to adapt evidence-based program respecting its unchangeable core components (fidelity vs. flexibility in adapting an evidence-based intervention).
The fossil fuel industry's suppression of public knowledge surrounding the toxic effects of benzene
Authors: Crosbie E
Published: October 2023

Individuals working in industries that produce or use benzene, a chemical compound known to produce chronic health effects including leukemia and death, are occupationally exposed to the highest levels of benzene. It is much less known how corporations, and in particular Shell Oil Company, suppressed public health information and formed relationships to promote false data to influence legislation and standards regarding benzene. We conducted archival research in the UCSF Chemical Industry Documents Library by reviewing the Benzene collection which contains 4,025 Shell Oil Company internal documents (1920s-1990s). We conducted standard snowball keyword search methods and thematically coded for major events, individuals, and relationships regarding the suppression of benzene. In 1949, Shell executives privately admitted that there was no safe level of exposure to benzene. During the 1950s, Shell unsuccessfully attempted to find cheaper alternatives to replace benzene used in petroleum. As scientific evidence emerged regarding the health harms of benzene in the 1960s and 1970s, government regulatory agencies increasingly proposed regulations to minimize benzene exposure. In response, Shell executives funded research to downplay benzene exposure to workers. Shell also used these studies to suppress and misdirect emerging evidence. Meanwhile Shell developed internal employee handbooks and monitoring programs to minimize any threats of company liability instead of dropping the usage of benzene. Internal Shell documents reveal the company suppressed public knowledge surrounding the toxic Effects of benzene since the 1940s. Governments should ban the use of benzene to protect the health and safety of workers.
8.I. Skills building seminar: Improving your elevator pitch: convincing a policymaker in a matter of seconds
Authors:   Organised by: EUPHA, EUPHAnxt,   Chair persons: Maaike Droogers (EUPHA), Monica Brînzac (EUPHAnxt)
Published: October 2023

Many public health researchers aspire their scientific findings to contribute to evidence-informed policies. However, realising this translation of evidence into policy is often experienced as a challenge. This is no surprise, as typical researchers’ activities - from data collection and analysis to publishing scientific articles - is a totally different ballgame than getting your messages across to policymakers. Additional skills are required by public health researchers in order to let their research findings make their way into health policies. One of those skills is to be able to pitch your work when meeting a policymaker e.g. in an elevator. In this skills building seminar high scoring abstract submitters will be invited to present their work in maximum 60 seconds to a panel of policymakers and politicians. Following the learning by doing approach, this hands on session will not only be a learning experience for the presenting researchers, also the audience will learn, as each pitch will receive feedback on the spot from the panel of real policymakers and politicians. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work?

Since a number of years the European Public Health Association (EUPHA) has been organising skills building seminars on the elevator pitch. Building forward on those previous four successful and well-attended workshops, the current workshop will follow up on this series and take forward where the previous editions ended. Lessons learned at the previous elevator pitch workshops:

- Have a clear ask (keep it simple) and show enthusiasm.

- Appeal to the policymaker's own interests and priorities.

- Spell out how action will be beneficial for the policymaker.

- Be aware of upcoming elections.

- Build a relationship with the assistants of politicians.

- Consider the ‘policy window’.

- Make the comparison with the policy plan.

- Propose an action the politician should undertake.

- Identify the relevant stakeholders and groups affected by the problem.

For this fifth edition we take the elevator pitch to the next level. Whereas previous editions allowed pitches up to 2 minutes, the current seminar will set the timer at 60 seconds. The previous editions showed that keeping the pitch very short was more successful. The session will be wrapped up by a key note with reflections on the pitches exercise and linking this to what the literature says about influencing healthy policy making.

Key messages

• The elevator pitch is a useful skill to have for public health researchers to facilitate the outcomes of their research feed into health policies.

• There are numerous tools available to effectively communicate public health messages to policymakers and promote evidence-informed policy making.
Parental education, ADHD in family and ADHD diagnosis incidence in Finnish children and adolescents
Authors: Volotinen L , Metsä-Simola N , Remes H , Martikainen P
Published: October 2023

Background

Lower parental education is linked to higher incidence of attention-deficit hyperactivity disorder (ADHD) diagnosis in offspring, as is having ADHD in family, but these associations are rarely studied together. We examined whether parental education predicts offspring ADHD diagnosis differently for children and adolescents with or without ADHD family members.

Methods

We used Finnish total population register-based data on individuals born between 1994-2003 with non-migrant background. We followed 228,247 boys and 217,866 girls for first ADHD diagnosis, measured from health care or medication registers, in childhood (4-12) and adolescence (13-17), and identified ADHD for biological parents or full siblings. We used Poisson regression to examine differences in diagnoses separately by offspring sex and age group.

Results

Preliminary results show that boys are more often diagnosed for ADHD in childhood and girls in adolescence, but incidence is higher for boys in both age groups. Among boys and girls without ADHD family members, lower parental education is associated with higher incidence in both childhood and adolescence. Among those with ADHD family members, lower parental education predicts higher incidence in childhood, but in adolescence the differences by parental education even out for boys, and for girls, higher parental education predicts higher incidence.

Conclusions

While lower parental education predicts higher ADHD diagnosis incidence in general, for adolescents in ADHD families, higher parental education seems to increase the likelihood of getting diagnosed -particularly for girls. This suggests that adolescents in ADHD families with lower parental education may remain without ADHD diagnosis if they are not diagnosed as children. Support measures should be developed to ensure equal access to diagnosis and care irrespective of age, gender and family background.

Key messages

• Lower parental education predicts higher ADHD diagnosis incidence in general. Yet, adolescents in ADHD families with lower educated parents may remain underdiagnosed.

• Support measures should be developed to guarantee equal access to ADHD diagnosis and care regardless of family background.
The overweight epidemic increasingly hits children of lower educated parents in Belgium
Authors: Vandevijvere V , Charafeddine R , Demarest S
Published: October 2023

Background

Childhood overweight has a negative impact on children's (mental) health. Although the prevalence of overweight among children is high in Western countries, the increasing trend seems to be levelling off since 2000. The purpose of this study is to examine this trend over the past two decades in Belgium and whether this trend differs by the parents’ socioeconomic status (SES).

Methods

Data from the Belgian Health Interview Survey (HIS), a representative cross-sectional household survey conducted in 1997, 2001, 2004, 2008, 2013 and 2018, was used. Study participants include children aged 2-17 years. The highest educational level among parents is used as a proxy for SES and is dichotomized into lower (at most a higher secondary degree versus high (higher education). Since the BMI (kg/m2) in children is instable, age/sex-specific cutoff points are used to estimate the weighted prevalence (95% confidence interval) of self-reported overweight (including obesity), by SES and year. Significant differences (p<.05) of the association between overweight and SES 1997 is assessed through logistic regression controlled for age and sex using 1997 as reference year.

Results

The overall prevalence of overweight among children is significantly higher in 2018 (19.0% (16.4-21.6%)) than in 1997 (13.6% (11.2-16.0%)), but no difference compared to the intervening years. Among the lower educated, this prevalence increased from 16.8% (13.2-20.4%) in 1997 to 27.8% (23.3-32.4%) in 2018; and among the high educated from 8.8% (6.0-11.5%) to 12.9% (10.0-15.8%). Compared to 1997, the difference between the low and the high educated increased significantly since 2008.

Conclusions

Two decades of HIS have shown that the SES is becoming an even more important risk factor for overweight among children. Health promotion on nutrition and physical activity at school has the potential to reach children from all socioeconomic backgrounds, making it an important means of tackling health inequalities.

Key messages

• Efforts to monitor the evolution of overweight and its determinants among (deprived) children.

• Health-promoting schools are a nice initiative to reduce overweight among (deprived) children.
Unintended consequences of pandemic measures for refugees in camp-like settings
Authors: Sarma N , Biallas R , Biddle L , Hintermeier M , Gottlieb N , Mohsenpour A , Bozorgmehr K
Published: October 2023

We present the results of a review that focused on refugees, asylum-seekers and internally displaced persons living in camps or accommodation centres, given their often closed character and crowded living arrangements. We systematically review the evidence on unintended consequences of public health and social measures (PHSMs) implemented in such settings. Relevant articles were identified in major academic databases from 12/2019 to 02/2023. Empirical studies reporting the results of PHSMs implemented to curb Covid-19 infections in camp-like settings were included. Following abstract and full-text screening, the described effects of PHSMs were extracted, distinguishing intended from unintended policy outcomes by their knowability (anticipated/unanticipated), value (positive/negative/neutral), distribution (subgroups/equity), and temporality. The “unintended outcomes evaluation approach” proved useful to identify unintended consequences of pandemic measures and examine the nature of their effects. Yet, few studies aimed at unintended outcomes, with these often being chance findings. The evidence reported thus often required some interpretation to capture and construct potential causal pathways from PHSMs to unintended outcomes. Preliminary results suggest that strict lockdown measures had negative effects on the mental health of individuals in camp settings, who already face a high burden of mental illness. Moreover, reduced economic and bureaucratic activities threatened the livelihood of individuals in camp settings through suspending asylum procedures, withdrawal of social and medical support, and the absence of legal economic opportunities. PHSMs thus drove individuals further into precarity, while the benefit of lockdown measures in this setting remains uncertain. Our review highlights the lack of research on unintended outcomes of public health measures, while demonstrating the importance of considering such outcomes for an equitable pandemic response.
A EU-Africa partnership to co-design a training intervention to scale-up access to surgery in Africa
Authors: Pittalis C , Drury G , Mwapasa G , Borgstein E , Cheelo M , Kachimba J , Chilonga K , Brugha R , Lavy C , Gajewski J
Published: October 2023

Background

The EU Global Health Strategy recognises that a skilled workforce is critical to advance universal health coverage. In response, our consortium brought together researchers, academics and clinicians from Ireland, the UK, the Netherlands, Malawi, Zambia and Tanzania to co-design a surgical workforce training and supervision intervention for district hospital teams aimed at scaling-up access to essential surgery in rural East Africa. Participatory action research (PAR) informed intervention design, incorporating the needs of frontline surgical providers and tailoring the training to meet identified gaps. This is the first study of this type in global surgery.

Methods

PAR workshops were held in Malawi, Zambia and Tanzania in 2017-2019 with key stakeholder groups: local authorities, professional associations, hospital managers and multi-disciplinary representatives of surgical teams from 67 district and referral hospitals. Through semi-structured discussions, qualitative data were collected on participants’ perceptions and experiences of barriers to safe and timely surgical and anaesthesia care, challenges in referral systems, and district surgical teams’ training and supervision needs. Data were compared for themes across sites and cadres.

Results

District surgical providers reported: a lack of in-service training, lack of access to mentoring and a demand for feedback on referrals. Participants prioritised training needs that could be addressed through regular in-service training and supervision visits from referrals to district hospitals to be delivered over the intervention period. Participants used findings in an action-planning cycle to develop country- and site-specific training plans for each research site.

Conclusions

Our approach to surgical capacity building, utilising both European and African expertise, has resulted in a demand-driven in-service training and supervision programme, now included in the participating countries’ national health strategies.

Key messages

• The inclusive, participatory approach to surgical system strengthening employed by our study enabled the co-design of a locally relevant, contextualised intervention.

• Our study generated lessons on how to rebalance power dynamics in European-African health partnerships.
Childhood obesity
Authors: Scazzina F
Published: October 2023

Obesity is one of the world's most challenging public health problems. The phenomenon of childhood obesity is increasing in industrialized and emerging countries, with the major impact of the onset of diseases in adolescence and adulthood. The high prevalence of youth obesity is associated with increasing rates of diabetes, hypercholesterolaemia, non-alcoholic fatty liver disease and hypertension, which are risk factors for the development of cardiovascular disease in adulthood, the leading cause of chronic non-communicable disease deaths according to the World Health Organization. A healthy diet associated with an active lifestyle is a valuable tool for the prevention, management and treatment of many diseases, including obesity. In this sense, it is most effective to intervene in the paediatric population in order to establish correct eating habits from the earliest years of life that support current and future nutritional well-being. Among the various nutritional strategies to combat obesity and associated comorbidities, the Mediterranean Diet (DM) has been identified as the most effective. Educational actions to improve dietary behaviour and increase awareness of the health benefits associated with a traditional MD must be designed at school, home and clinic level. Better policies that create a new environment for children and grown-ups to choose better diets and lead active and healthy lives in every country of the WHO European Region are needed.
Health inequalities in type 2 diabetes: contributions of exposures in the residential environment
Authors: Albers J D , Koster A , Sezer B , Meisters R , Schram M T , Eussen SJPM , Dukers NHTM , Stehouwer CDA , Lakerveld J , Bosma H
Published: October 2023

Background

People with lower socioeconomic position (SEP) have higher risk of type 2 diabetes (T2D). Besides genetic predisposition, the exposome shapes this risk. This includes exposures in the residential environment. We explored the relationships between SEP, the residential food environment, walkability, greenspace, and T2D.

Methods

Cross-sectional and longitudinal data from 9188 participants were analyzed. Prevalent T2D was measured by an oral glucose tolerance test. Incident T2D was self-reported in annual follow-up questionnaires. Education, income, and occupation were measured as indicators of SEP. The residential environment was operationalized by address level Food Environment Healthiness Index (FEHI), number of fast-food outlets (FF), walkability index (WI), and proportion of greenspace (GS). Logistic regression and survival analyses were used to model the associations between SEP, the environment and T2D. The proportion of mediation of the association between SEP and T2D was estimated in a causal mediation analysis using a simulation approach.

Results

Over a median follow-up of 6.2 years, 207 incident cases were identified. Lower SEP was associated with higher risk of T2D. Hazard ratios (HR) were 2.0 (95%CI 1.6-2.6), 1.8 (1.4-2.3) and 1.8 (1.2-2.6) for an interquartile range decrease (IQR) of education, income, and occupation, respectively. HRs for IQR changes of the environmental factors were: FEHI 1.2 (1.0-1.4), FF 0.9 (0.8-1.0), WI 1.2 (1.0-1.6) and GS 1.2 (1.0-1.4). Regression on prevalent T2D yielded similar results. Lower SEP was associated with a less healthy environment (e.g., FEHI -0.08 (-0.10--0.06) for education). Environmental exposures mediated between 0.3% (-8.6-8.6) and 8.5% (2.3-27.4) of the longitudinal associations.

Conclusions

Lower SEP was associated with prevalent and incident T2D. People with lower SEP lived in a slightly less healthy residential environment. Some of the SEP-T2D association could be mediated by the environment.

Key messages

• A less healthy residential food environment, lower walkability and less green space might mediate some of the association between SEP and T2D.

• More research is needed to clarify the extent to which environmental pathways contribute to health inequalities.
The environmental pollution role in increasing the incidence of thyroid cancer in Tuscany (Italy)
Authors: Cartocci A , Bosco R , Cevenini G , Golinelli D , Messina G , Nante N , Capezzone M
Published: October 2023

Background

The incidence of thyroid cancer (TC) in Italy is one of the highest in Europe; the reason for this is unclear. Some studies investigated the potential role of toxic elements related to geological and/or anthropogenic sources in increasing the incidence of TC. The aim of our study is to further investigate the connection between higher TC incidence and environmental pollution; that is fundamental to implement prevention practices and to increase awareness of environmental issues.

Methods

The Tuscany Cancer Registry provided us the number of cases of TC patients for all the provinces of Tuscany during the period from 2013 to 2017. Provinces were grouped in exposed/unexposed to several environmental pollutants. In particular, they were stratified based on the presence of mines, on the presence of geothermal plants and on the ministerial classification in “contaminated sites” and no “contaminated sites”, i.e. areas in which an alteration of the characteristics of the environmental soil matrix, subsoil and groundwater has been ascertained such as to represent a risk to human health. Rate ratios (RR) and their 95% confidence interval (CI) were estimated.

Results

Contaminated sites have significantly higher incidence then uncontaminated ones (male RR: 1.2, CI: 1.05-1.364, p = 0.008; female RR of 1.12, CI: 1.03-1.21, p = 0.009). Similar results were obtained stratifying for the presence of mines (male RR: 1.25 CI: 1.12-1.40, p < 0.001; female RR: 1.35, CI: 1.26-1.45, p < 0.001) and then of geothermal plants (male RR: 1.22 CI: 1.06-1.40, p < 0.001; female RR: 1.40, CI: 1.29-1.52, p < 0.001).

Conclusions

Further laboratory experiments are needed to confirm the connection between specific pollutants and TC. If these findings will be confirmed a stringent legislation and environmental polices have to be taken to reduce the TC incidence. In this way, also the cost of healthcare management of patients with TC can be reduced.

Key messages

• Pollutants could affect both the environment and people health.

• The prolonged exposure to pollutions could increase thyroid cancer incidence.
Health impact assessment of the chemical exposome in European children
Authors: Rocabois A , Philippat C , Crépet A , Vrijheid M , Slama R
Published: October 2023

Background

We aimed to assess the impact of the chemical exposome on the health of European children since previous health impact assessments (HIA) were limited to a few chemicals.

Methods

74 out of 484 substance-outcome associations had an overall level of evidence at least likely and were therefore considered for HIA. For 51 of the 74 associations, dose-response relationships were identified from systematically searched meta-analyses or epidemiological studies. For 41 of these, exposure levels were compatible for HIA. Exposure levels were based on biomarker concentrations assessed in 1301 pregnant women and children of the HELIX cohorts in 6 European countries. The baseline burden of disease were from national estimates of the World Health Organisation for 8 outcomes. The attributable burden of disease was estimated by combining exposures and dose-response relationships and expressed in terms of population attributable fraction, disability-adjusted life years (DALYs) or variations in mean level for quantitative health outcomes. Associated uncertainty was taken into account using Monte-Carlo simulations.

Results

Each substance harmful for cognition or birth weight entailed an average estimated decrease in Intellectual Quotient by 1.7 points (95% confidence interval (CI) 0, 4.3) and in birth weight by 57 g (95%CI 0, 138). The chemical exposome entailed 1.65 (95%CI 0.63; 2.90) DALYs for 1,000 children per year. The main contributors to the impact were perfluoroalkyl substances, other persistent organic pollutants and tobacco. The impact was mainly due to neurodevelopment (0.4 DALY), congenital heart defects (0.6 DALY), respiratory health (0.4 DALY) and sudden infant death syndrome (0.3 DALY).

Conclusions

Our study is one of the largest HIA in terms of number of chemicals considered. The results exclude urban exposures such as air pollution and are probably largely underestimated because of a lack of data on dose-response relationships and baseline burden of disease.

Key messages

• Chemical exposures (mainly perfluoroalkyl substances, persistent organic pollutants, metals and tobacco) contribute to the burden of disease in European children.

• Chemical exposures have an impact on fetal and infant death, neurodevelopment, cardiometabolism, respiratory and reproductive health of children.
Development and validation of a photograph-based instrument to assess nutrition literacy: the NUTLY
Authors: Sousa S , Albuquerque G , Severo M , Costa A R , Moreira P , Lunet N , Padrão P
Published: October 2023

Background

Most instruments measuring nutrition literacy are difficult to apply to less educated people, or assess theoretical knowledge, not necessarily evaluating the ability to make healthy food choices. We aimed to develop and validate a photograph-based instrument to assess nutrition literacy (NUTLY) among adults in Portugal.

Methods

NUTLY assesses the ability to identify the food with the highest energy/sodium content from sets of three photos (two foods with similar content and one with higher content). A version of 79 sets was obtained after a stepwise process involving expert and lay panels. It was applied to a sample representing different age, gender and education level groups (n = 329). We assessed internal consistency (Cronbach's α) and associations between each test item (set of three photos) and the overall score, defined as the sum of correct answers (latent trait models); sets performing worse were excluded. Reproducibility was assessed after one month (n = 158). To assess construct validity, NUTLY was compared to the Medical Term Recognition Test (METER) and the Newest Vital Sign (NVS), and across groups with varying education and training in nutrition/health. Latent class and Receiver Operating Characteristic (ROC) analyses were used to define the cut-off point.

Results

The final NUTLY includes 48 sets (energy: 33; sodium: 15; α = 0.74). Mean scores were highest in nutritionists (39.9), health professionals (38.5) and decreased with decreasing education (p < 0.001). Those with adequate nutrition literacy (based on NVS) showed higher NUTLY scores (37.9 vs. 33.9, p < 0.001). For METER, the differences were not significant. Reproducibility was high (ICC=0.77). The Area Under the ROC Curve was 0.97. Adequate nutrition literacy was defined as a NUTLY score≥35 (sensitivity: 89.3%; specificity: 93.7%).

Conclusions

NUTLY is a valid and reliable tool for assessment of nutrition literacy, with the potential to be adapted to other cultures and specific population groups.

Key messages

• A new photograph-based nutrition literacy measuring tool was developed and validated in Portugal, overcoming some limitations of previous instruments.

• In the future, this instrument could be used as part of a public health surveillance system, and as a tool to assess the success of nutrition education interventions.
Quantifying Metabolic Food Waste in Ireland from Excess Food Intake
Authors: Krah C , Bahramian M , Burke D , Hynds P , Priyadarshini A
Published: October 2023

Background

The Republic of Ireland (ROI) currently reports the second highest prevalence of adult obesity in Europe, with >25% of the adult population classified as obese. Concurrently, a concomitant increase has been reported for the risk of cardiovascular diseases and several cancers. While there has been extensive research on the health impacts of excess food intake, of the resulting food waste, also known as metabolic food waste (MFW) and its associated environmental impact has received little attention. Accordingly, the current study sought to estimate quantities of MFW from excess food intake among the Irish adult population and resulting global warming potential. Body weight and diet information were collected in a survey of 920 people across ROI. The excess fat of overweight (OW) and obese (OB) individuals was calculated and converted to excess calories using the Composition of Foods Integrated Dataset (CoFID 2021). The energy content (calories) of the food items was used to estimate the quantities (kg) of food consumed to gain the excess fat. Having derived the kg of food/MFW, the associated Global Warming Potential (GWP) was calculated.

Results

Calculated MFW were 50.84 kg/cap/yr and 122.2 kg/cap/yr for the OW and OB populations, respectively. Dairy produce accounted for the highest annual MFW in both groups (12.0 kg/cap (OW), 28.6 kg/cap (OB)), followed by cereals/grains (9.0 kg/cap, 21.5 kg/cap) and potatoes (7.1 kg/cap, 17.0 kg/cap). Calculated annual GWP of food items highlight dairy produce as having the highest GWP v (66.8 CO2 eq/kg for OW and 160.5 CO2 eq/kg for OB), followed by red meat (36.2 CO2 eq/kg for OW and 87.1 CO2 eq/kg for OB) and white meat (24.1 CO2 eq/kg for OW and 57.8 CO2 eq/kg for OB).

Conclusions

The Irish adult diet is characterized by high consumption of cereals/grains and dairy produce, with the annual volume of MFW generated by obese individuals more than twice the annual volume of food (52kg/cap) disposed of by individuals at home

Key messages

• Managing the consumption of dairy and meat products could accomplish two important goals: the promotion of environmental sustainability and the enhancement of public health.

• In addition, managing obesity from the dietary stand point will encourage sustainable consumption and food security.
Conceptualizing the Supersetting approach and presenting Tingbjerg Changing Diabetes
Authors: Stougaard M , Termansen T , Stjernqvist N W , Tetens A , Tørslev M K , Bloch P
Published: October 2023

Background

Health and ill health are created in the settings where people live. Thus, health inequity is strongly linked to the social, cultural, and environmental contexts of people's everyday lives. In disadvantaged neighbourhoods, residents generally have poorer health than the general population, especially when it comes to type 2 diabetes (T2D) and mental illnesses. Meanwhile, studies show positive health outcomes of multilevel, multicomponent participatory community interventions pointing towards the need for increased health promotion and prevention of T2D in local communities.

Conceptualisation

This session presents the Supersetting, an intervention strategy for multilevel, multicomponent community interventions. The Supersetting strives to attain synergistic effects from coordinated actions carried out across multiple settings. Stakeholder participation is a core element of a Supersetting. Consequently, a Supersetting initiative must work with a comprehensive organisation structure for dialogue, decision-making, coordination and action between citizens, civil society organisations, public authorities and their institutions, private sector corporations, and researchers.

Instead of predefined and meticulously planned actions, the Supersetting approach builds on five overarching principles guiding the development and implementation of interventions. These are 1) integration, 2) participation, 3) empowerment, 4) context-sensitivity and 5) knowledge.

Case

The Supersetting has mainly been implemented in the long-term strategic health promotion imitative Tingbjerg Changing Diabetes (TCD), which aims to create well-being and promote good, healthy lives while preventing T2D in the disadvantaged neighbourhood of Tingbjerg, Denmark. Data on T2D from national health registers will be presented.

Conclusions

The Supersetting approach is a relevant, context sensitive conceptual framework for developing initiatives for sustainable impact in community health promotion.
Exploring fluoride-free content on Twitter: A topic modeling analysis
Authors: Lotto M , Zakir Hussain I , Kaur J , Butt Z A , Cruvinel T , Morita P P
Published: October 2023

Social media discussions about the hypothetical side effects of fluoride-containing products have contributed to forming and strengthening health beliefs underpinning the anti-fluoridation movement. Given the importance of content analysis in mitigating online misinformation, this study aimed to investigate fluoride-free content on Twitter. Firstly, 21,169 tweets published in English between May 2016 and May 2022 concerning the keyword ‘fluoride-free’ were collected using the Twitter API. After the data preprocessing, Latent Dirichlet Allocation (LDA) topic modeling was conducted to identify the salient terms and topics inside the collected tweets. Then, the similarity between topics was calculated by an intertopic distance map. Furthermore, an investigator manually reviewed a sample of tweets that featured the most representative word groups associated with particular topics to determine the main issues. Finally, additional data visualization was performed using Elastic Stack software to analyze the total count and relevance of each topic related to fluoride-free records over time. The topic modeling analysis demonstrated a significant distance between the topics from a coherence score of 0.542, confirming the identification of three different issues: ‘healthy lifestyle’ (topic 1), ‘consumption of natural/organic oral care products’ (topic 2), and ‘recommendations for using fluoride-free products/measures’ (topic 3). Moreover, the number of fluoride-free publications decreased between 2016 and 2019 but increased again in 2020. Thus, recent increases in fluoride-free tweets appear driven by public concerns about adopting a healthy lifestyle, including the consumption of natural and organic products. Therefore, public health authorities, health professionals, and legislators must acknowledge the dissemination of fluoride-free content on social media to implement effective strategies to counteract its potential harm to the population's oral health.

Key messages

• People are concerned about the hypothetical side effects of fluoride-containing measures and products.

• The consumption of fluoride-free content on social media is associated with adopting a healthy lifestyle.
The role of task shifting in mitigating health workforce shortages - the ambitions and results of the TaSHI project
Authors: Koder F
Published: October 2023

The shortage in the health workforce is a long-standing phenomenon while the importance of the human factor in health is constantly increasing. The COVID-19 pandemic has further increased the burden of the health sector, the workload, the stress and the risk of burnout. At the same time, the pandemic acted as a catalyst as professionals had to take on new roles, join new teams and increase collaboration with other health professionals. Task shifting can reduce the workload and skill-mix imbalances by sharing and redistributing tasks between health professionals, involving patients and the digital ecosystem. Task shifting can be an effective way to improve cultural sensitivity and openness thereby increasing a positive working environment. Moreover, task shifting can enlarge resilience while addressing HWF shortages and geographical imbalances, particularly in remote rural areas. TaSHI “Empowering EU health policies on Task SHIfting” aims to provide a novel understanding and up-to-date knowledge on task shifting, transferability and uptake of good practices in implementation. The project performs (regional) pilots in five European countries (Estonia, Italy, Lithuania, the Netherlands and Norway). It gathers evidence and data on the different types of task shifting in primary care, mental health care, wound care and eye care including the role of telemedicine and digital health. Through the involvement of health professionals TaSHI delivers a collection of good practices, useful tools and methods through case studies of the pilot experiences, producing a guidebook on task shifting supporting implementation, with practical training materials and curricula, and a set of recommendations. The deliverables on tangible solutions aim to support EU Member States at national, regional and organisational level to implement their own actions and promote sustainability of practices adapted to local settings. TaSHI project is co-funded by the Health Programme of the EU.