bluuebunny/crossref_metadata_2025 huggingface dataset:
How social capital enabled healthcare access and navigation by vulnerable people during Covid-19
Authors: Zanni F
Published: October 2022

Background

Healthcare systems have become complex and fragmented, negatively affecting healthcare access and navigation. This is especially the case for socio-economically vulnerable people, who encounter organisational and administrative hindrances trying to access care. These difficulties have worsened during Covid-19. Scholarly literature recognises that - by moulding navigation practices - social capital may mediate between potential and realised access to healthcare. However, little is known about how this mediating work practically unfolds.

Methods

This case study aimed to understand how social capital might affect healthcare navigation practices. To do so, we investigated how the People’s Health Lab (PHL), a community-based organisation, supported socio-economically vulnerable people in navigating healthcare during the Covid-19 pandemic in Bologna, Italy. Nine months of participant observation were conducted both in person and digitally from July 2020 to March 2021. Twelve semistructured interviews were also conducted with volunteers of the organisation. Fieldnotes and interview transcripts were analysed through Thematic Analysis.

Results

PHL support activities addressed barriers to healthcare navigation by vulnerable people, which were found to be services fragmentation, bureaucracy and Covid-19 restrictions. Volunteers of the PHL connected vulnerable individuals to health services in manifold, flexible ways, working without standard operative protocols and relying on informal personal contacts within public services. This was found to be key in enabling navigation of healthcare during the first three waves of the pandemic.

Conclusions

Our study provides evidence about how structural, linking social capital - the material and nonmaterial resources mobilised through the relationships between heterogeneous groups (the People’s Health Lab, health authorities and vulnerable people) - can mediate access to fragmented healthcare systems by shaping navigation practices.

Key messages

• Contemporary healthcare systems – including universal ones – have become complex and fragmented, posing access and navigation challenges to their users, especially those socio-economically vulnerable.

• Linking social capital can mediate access to fragmented healthcare systems by flexibly mobilising material and nonmaterial resources through informal relationships between heterogeneous groups.
Promote equal access to COVID19 vaccination: strategies of the Local Authority Toscana SudEst, Italy
Authors: Marconi D , Magi S , Cotoloni C , Moscatelli C , Arniani S , Nisticò F , Nante N , Messina G
Published: October 2022

Background

In the area of the Local Health Authority Toscana Sud-Est (LHA) 13,5% of residents are foreigners. We aim to assess the impact of our intervention to COVID-19 vaccination coverage.

Methods

Since summer 2021, LHA has promoted vaccination sessions dedicated to foreign residents with free walk-in access, multilingual forms, flyers and TV interventions, cultural mediators and trained healthcare workers. We collected data about vaccination status of residents (28 December 2020-31 January 2022) and we analysed them using the software STATA to assess vaccine coverage by nationality and the effectiveness of our intervention. The results were adjusted for age and sex. We set significance level at p < 0.05.

Results

On 31 July 2021, 78% of Italian residents (N = 685289) had received the first dose of vaccine, compared to only 43% of foreign residents (N = 106370). There was a 35% gap. On 31 January 2022, after our intervention, 89% of Italian residents and 71% of foreign residents had received the first dose of the vaccine. The gap was 18%. On 31 January 2022, 50% of residents of all nationalities had received two doses of the vaccine. A significant difference between Italian and foreign residents is still observed after adjustment for age and sex (OR 0.41 95% IC 0.40-0.41). Vaccination adherence is lower in females than males, for both Italian (OR 0.90 0.89-0.91) and foreign residents (OR 0.82 0.79-0.84). This is accentuated within some ethnic groups: Macedonians, Kosovars, Pakistanis.

Conclusions

The creation of dedicated service guaranteed to reach a high vaccination coverage in all the nationalities and to reduce the gap between host and foreign residents. In foreigners it is lower than in the hosts, so it is necessary to investigate possible cultural factors that may influence hesitancy. A lower vaccination coverage in females, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap.

Key messages

• The creation of dedicated interventions guaranteed to achieve high vaccination coverage in all nationalities.

• A lower vaccination adherence in females than males, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap.
The age of chronic diseases onset – the results of the longitudinal study
Authors: Skybova D , Slachtova H , Tomaskova H , Klanova J , Madar R
Published: October 2022

Background

A current aging of the European population call questions into how to protect a high quality of health in the elderly which was the reason to establish the longitudinal HAIE Project. As the baseline information, the longitudinal ELSPAC study results were used. The aim of the analysis was to learn a life-course-dependent risk factors of the onset chronic diseases in middle-aged population.

Methods

The cohort includes data on both parents. Their number decreased during the follow up from 4,500 to about 1,000 parents. The selected questionnaire data of the cohort gained at consecutive intervals during the years 1990-2010 were analysed descriptively, according the distribution of data by respective statistical methods and survival analysis. Differences between curves were tested by log-rank tests (significance level of 5%). The SW Stata v.15 was used.

Results

The mean age of mothers (N = 823) at study entry was 25.0 years (SD = 4.86), the age of fathers (N = 385) 28.8 years (SD = 6.05). Good self-reported health has decreased continually over time from more than 80% in both parents aged 30 to about 50% in the age of mid-forties. Most parents suffered from back pain, hypertension, and joint pain. The prevalence of diseases has raised over time. Problems with hypertension begin in women from the age of 38 (39 in men) and there was no statistically significant difference by sex (p = 0.265). Survival analysis found a significant difference by sex for depression (p < 0.001) and physician-confirmed back pain (p < 0.001), which affect parents from 35 years (significantly more in women than men).

Conclusions

The processed analysis will refine the findings of the longitudinal Project HAIE (CZ.02.1.01/0.0/0.0/16_019/0000798) and subsequent projects monitoring the factors influencing healthy aging. The (C)ELSPAC studies are supported by the projects RECETOX RI (No LM2018121) and CETOCOEN EXCELLENCE (No CZ.02.1.01/0.0/0.0/17_043/0009632).

Key messages

• About 50% of the mid-forties aged population did not declare good self-reported health. They suffered mostly from back pain, hypertension, and joint pain. The diseases prevalence has raised over time.

• The onset of hypertension begin from the age of 38 (39) with no difference by sex, depression and physician-confirmed back pain start from 35 years of age, significantly more in women than men.
Pharmacist care in hypertension management: systematic review of randomized controlled trials
Authors: Gastens V , Tancredi S , Kiszio B , Del Giovane C , Tsuyuki R , Paradis G , Chiolero A , Santschi V
Published: October 2022

Background

Hypertension management remains a major public health challenge in primary care. Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension. Our objective is to systematically review the evidence of the impact of pharmacist care alone, or in collaboration, on BP amongst hypertensive outpatients compared with usual care. One major focus is to assess the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting.

Methods

In collaboration with a medical librarian, a systematic literature search was conducted for any article published up to 22.10.2021 in MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, and Trip databases. Randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients were included. The outcomes are the change in BP, BP at follow-up, or BP control. Results will be synthesized descriptively and, if appropriate, will be pooled across studies to perform meta-analysis. We published the study protocol in BMJ Open.

Results

A total of 1768 study records were identified by electronic database searching and loaded to the systematic review management software Covidence. After removal of duplicates, 1744 were independently screened based on title and abstract by two authors (VG, ST), and 242 full texts were evaluated. A total of 72 studies with 32641 patients are currently included for data extraction. These studies were published between 1973 and 2021 and conducted in different regions (North America: n = 34, Europe: n = 13, other: n = 25). The data extraction and analysis are ongoing. Results will be presented at the congress.

Conclusions

This systematic review provides updated evidence on the effect of pharmacist intervention on BP management. Heterogeneity in the effect of interventions will be carefully evaluated which will help the implementation of effective interventions in various healthcare settings.

Key messages

• Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management of hypertension.

• This systematic review provides updated evidence on the effect of pharmacist intervention on blood pressure management.
The association between body fat percentage and self-reported depression in the United Arab Emirates
Authors: Al Balushi M , Ahmad A , Javaid S , Ahmed L , Al Maskari F , Abdulle A , Ali R
Published: October 2022

Background

The United Arab Emirates Healthy Future Study (UAEHFS) is one of the first large prospective cohort studies in the region which examines causes and risk factors for chronic diseases among adult UAE nationals. The aim of this study was to explore the relationship between body fat percentage (BF%) and the eight-item Patient Health Questionnaire (PHQ-8) as a screening instrument for depression among the UAEHFS pilot study participants.

Methods

We analyzed the UAEHFS pilot data to investigate the association between BF% and PHQ-8 adjusted for age and gender. We used multivariate logistic ordinal regression model. To impute missing values, 100 multiple imputations (MI) were performed using multivariate imputation of classification and regression tree. The statistical analysis was performed using R Statistical Software (version 4.2.0)

Results

Out of 517 participants, data from 487 (94.2%) were analyzed after excluding participants who didn't fill out the questionnaires. The median age was 30 years (Interquartile Range: 23 - 38). There were more males (67.8%) than females in the UAEHF pilot data. Approximately, 64 (13.1%) of the participant reported depression. The prevalence of obesity was 35.2% in this study population. The estimated odds ratio of BF% from the fitted multivariate logistic ordinal regression model was OR = 1.046 (95% CI: 1.012-1.08), and OR = 1.03 (95% CI: 1.003-1.057) for the omitted data, and MI (sensitivity analysis) respectively.

Conclusions

High body fat percentage was statistically significantly associated with high risk of reporting depression. Additional research is needed, using the main UAEHFS data (after recruitment is complete), to further investigate the association between body fat percentage and depression.

Key messages

• Our results can help contribute to the knowledge based on current and potential population mental health in the UAE and Gulf Region.

• The main finding of this study that excess body fat is associated with an increased risk of developing depression and vice versa; thus, this could add to the future direction of mental health research.
Two-decade trends and factors associated with overweight and obesity among young adults in Nepal
Authors: Shakya S , Neupane S , Absetz P
Published: October 2022

Background

Young adults are vulnerable to obesity due to different life stresses and challenges, leading to risks of cardiovascular and metabolic disorders. Studies on the long-term trends of overweight and obesity, especially among young people in Nepal are scanty. The problems among this productive age group should be checked and prevented at the earliest. The study aimed to assess more than two decades of trends from 1996 to 2019 of overweight and obesity among Nepalese young adults (18-29 years) and the socio-demographic factors associated with it.

Methods

We utilized data from the nationwide Demographic and Health Survey (DHS) and WHO STEPwise approach to surveillance (STEPS) survey. These surveys adopted multistage stratified cluster sampling techniques and used house-to-house structured interviews for data collection. We assessed the prevalence of overweight (BMI 25-29.9 kg/m2) and obesity (BMI≥30 kg/m2) in 1996, 2001, 2006, 2011, 2012, 2016, and 2019 among 18,714 young adults in total, and evaluated the associated socio-demographic factors from the 2016 survey, using logistic regression model.

Results

The preliminary study findings showed that from 1996 to 2019, overweight in women increased from 1.5% to 17.0%, and obesity from 0.1% to 3.4%. For men, overweight rose from 14.4% to 16.6%, and obesity from 1.3% to 2.5% from 2012 to 2019. Higher age was associated with higher odds of overweight and obesity compared to a younger age. Men were less likely to have overweight (AOR: 0.68, CI: 0.53-0.88) and obesity (AOR: 0.42, CI: 0.23-0.78) compared to women. Moreover, urban residents had higher odds of having obesity (AOR: 2.35, CI: 1.25-4.44) compared to rural residents.

Conclusions

Overweight and obesity have rising trends among young adults in Nepal. Older age, female and urban residence were associated with higher odds of overweight and obesity. Therefore, the interventions targeted to the risk groups can help in curbing the increasing obesity trends in Nepal.

Key messages

• The information on trends and the factors associated with overweight and obesity may help to identify needs and opportunities to halt the rising obesity trend and prevent risk factors.

• The study findings can guide in formulating a national strategy to combat overweight and obesity among Nepalese youths.
Trends in incidence of cervical cancer in England, 1985-2019
Authors: Fox L , Bannister P , Memon A
Published: October 2022

Background

Worldwide, cervical cancer is the 4th most common cancer in women. The highest incidence is observed in Africa (25.6/100,000) and the lowest in North America (6.1/100,000). Over 99% of cases are caused by human papillomavirus (HPV). In the UK, HPV vaccination has been offered to school children aged 12-13 years since 2008. We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of cervical cancer in England during the past four decades.

Methods

Individual level data for women diagnosed with cervical cancer in England during 1985-2019 were obtained from the Office for National Statistics/Public Health England. Average annual incidence rates were calculated by two age categories (0-49, 50+ years) and all ages combined during the seven five-year time periods (1985-89 to 2015-19). The percentage change in incidence was calculated as change in the average annual incidence rate from the first (1985-89) to the last time period (2015-19). Index of Multiple Deprivation (IMD) quintiles (2015-19) were examined to determine the social gradient of the disease.

Results

During the 35-year study period, a total of 100,303 women with cervical cancer were registered in England. In women aged 0-49 years, the average annual incidence rates declined by about 20% (from 11.6/100,000 in 1985-89 to 9.3/100,000 in 2015-19), and in women aged 50+ years, the rates declined by about 64% (from 26.1/100,000 in 1985-89 to 9.5/100,000 in 2015-19). At all ages combined, the rate declined by 43%. With regard to the social gradient, about half of the cases occurred in women in the most deprived quintiles.

Conclusions

There has been a steady decline in the incidence of cervical cancer in England over the past four decades. These findings are consistent with reports from other Western countries. The finding of relatively increased risk of cervical cancer among women from most deprived communities needs further investigation.

Key messages

• Considering that over 99% of cervical cancers are potentially preventable, there is an urgent need to support low- and middle-income countries to roll out HPV vaccination programme.

• The difference in risk of cervical cancer by social gradient highlights the importance of reducing health and social inequalities.
The impact of smoking on immunological response to SARS-COV 2: a nationwide seroepidemiological study
Authors: Sahakyan S , Musheghyan L , Muradyan D , Sargsyan Z , Petrosyan V , Khachadourian V , Harutyunyan A
Published: October 2022

Background

Smoking influences cellular and humoral immune responses and affects the immune system by increasing inflammation and decreasing activity against infections. The current study investigates the association between smoking and immunological response to SARS-CoV-2 in the Armenian population.

Methods

We performed a nationwide cross-sectional seroepidemiological study among the adult population (≥18 years old) in Armenia. We used a multi-stage cluster random sampling to recruit participants from the capital city and all regions of Armenia. We invited selected participants to primary healthcare facilities to provide blood samples for antibody testing followed by a phone survey on demographic characteristics, smoking status, and other variables. Logistic regression analysis was used to test the relationship between smoking and having SARS-CoV-2 antibodies adjusted for other covariates.

Results

3483 people participated in the study (71% women). The total sample included 16.8% current smokers (n = 571), 8.6% past smokers (n = 294) and 76.4% never smokers (n = 2538). The prevalence of SARS CoV-2 antibodies among current smokers was statistically significantly lower as compared with never smokers (46.9% vs 73.4%, p-value<0.001). In the multivariable logistic regression model, the odds of having SARS CoV-2 antibodies among the current smokers was 70% lower (OR 0.30, 95%CI: 0.22; 0.40) compared to never smokers, when adjusted for demographic factors and the time of PCR diagnosis of COVID-19. No statistically significant difference was found between past smokers and having SARS CoV-2 antibodies.

Conclusions

In addition to being a risk factor for various chronic diseases, smoking weakens immune response to infectious diseases, including COVID-19, worsening the outcomes. The significantly lower level of antibody prevalence among smokers with previous PCR confirmed COVID 19 implies a poorer immune response to the infection and not a lower risk of getting the infection.

Key messages

• Smoking weakens immune response and contributes to a higher burden of infectious diseases, such as COVID-19.

• Lower level of antibody prevalence among smokers indicates a poorer immune response to the infection rather than a lower risk of getting the infection.
Treatment burden and associated factors: a population-based survey in Central Denmark Region 2017
Authors: Pedersen MH , Duncan P , Lasgaard M , Friis K , Salisbury C , Larsen FB
Published: October 2022

Background

Exploring treatment burden at a population level can provide evidence of the types of patients who need special attention and support. We aimed to determine factors associated with high perceived treatment burden in a population-based survey of adults living in the Central Denmark Region (23% of the Danish population).

Methods

The Danish Multimorbidity Treatment Burden Questionnaire (MTBQ) was included in the 2017 Danish population health survey. 28,627 individuals aged 25 years or over participated (64% response rate). Individuals who reported having one or more medical conditions or attending regular health check-ups were asked to complete the MTBQ. A global MTBQ score was calculated (range 0-100) and both the continuous scores and a four-category grouping of the scores into no, low, medium and high burden were used to statistically assess the association between treatment burden and sociodemographic and health-related factors.

Results

13,407 individuals completed the Danish MTBQ (mean age 59 years). Treatment burden was negatively associated with self-related health (rs = -0.45, P < 0.0001), health-related quality of life (rs = -0.46/-0.51, P < 0.0001) and positively associated with the number of long-term conditions (rs = 0.26, P < 0.0001) and perceived stress (rs = 0.44, P < 0.0001). Higher treatment burden was associated with young age, male sex, high educational level, unemployment, not living with a spouse/cohabitant, living with child(ren) and specific long-term conditions, including heart disease, stroke, diabetes and mental illness.

Conclusions

This is the first known population-based study of treatment burden. The findings provide important evidence to policy makers and clinicians about sociodemographic groups at risk of higher treatment burden. We recommend that patient-perceived treatment burden is included when evaluating interventions targeting patients with long-term conditions and multimorbidity and health-care system reorganisations.

Key messages

• Treatment burden is associated with poor health and health-related quality of life and, among others, young age, male sex, unemployment, not living with a spouse, and specific long-term conditions.

• We recommend that patient-perceived treatment burden is included when evaluating interventions targeting patients with long-term conditions and multimorbidity and health-care system reorganisations.
Comparing health insurance and survey data in estimating prevalence of chronic diseases
Authors: Mertens E , Peñalvo JL , Vandevijvere S
Published: October 2022

Background

Population prevalence of chronic conditions can be estimated from national health surveys and from administrative data sources such as insurance records. This study evaluated the agreement between the Belgian Health Interview Survey (BHIS) and the Belgian compulsory health insurance data (BCHI) in ascertaining chronic hypertension, hypercholesterolemia and diabetes in Belgium.

Methods

The most recent cycle of BHIS (2018) provided the self-reported prevalence of diabetes, hypertension, and hypercholesterolemia among a representative sample of Belgian adults. For BCHI, the chronic conditions were attributed for every individual in the BHIS reviewing the medication prescription records identified using the ATC/DDD system. These two data sources were linked through unique identifiers by STATBEL. Disease prevalence, measures of agreement, and measures of concordance were estimated. Logistic regression was performed to determine the factors affecting agreement between BHIS and BCHI’s disease classifications.

Results

Data linkage was done for 9,753 individuals aged 15 years and older. From the sample, BHIS and BCHI respectively identified 5.9% and 5.6% diabetes cases, 18% and 24% of hypertension cases, and 18% and 16% of hypercholesterolemia cases. The kappa coefficient between BCHI and self-reported diabetes, hypertension, and hypercholesterolemia was 0.79, 0.59, and 0.49, respectively. Gender, age, and subjective health significantly affected the agreement in chronic condition classification between BHIS and BCHI.

Conclusions

Data on reimbursed drugs is a potential alternative method in the surveillance of chronic diabetes. This procedure could be used in estimating disease prevalence but further validation is needed to evaluate its applicability and bias in other chronic conditions.

Key messages

• BCHI is a possible alternative data source for the surveillance of diabetes in the population.

• BCHI overestimated hypertension and underestimated hypercholesterolemia prevalence.
Cervical cancer rates in relation to the Roma population distribution in Slovakia in 2013 – 2020
Authors: Plančíková D , Melichová J , Sivčo P , Majdan M
Published: October 2022

Background

Globally, more than 300 000 women die due to cervical cancer (CC) each year despite its high preventability and treatability in its early stages. This study aimed to analyse CC rates at the regional level in Slovakia from 2013 to 2020 in relation to the distribution of the Roma population.

Methods

An ecological study was conducted using data obtained from the relevant national and regional authorities in Slovakia. Mortality, incidence, precancerous lesions incidence and the number of colposcopy and oncocytology examinations per 100 000 females 15 years and older were calculated. Linear regression models were performed in the R Project to assess associations between the rates and the estimated percentage of the Roma population at the regional level after adjusting for the unemployment, at-risk-of-poverty rate, and average disposable household income per month.

Results

CC mortality in Slovakia declined from 10.0 in 2013 to 7.1/100 000 in 2020 (p < 0.05). Average mortality ranged from 5.9 in the Presov region to 10.7 in Kosice. Incidence varied from 108 in 2019 to 160/100 000 in 2017, with the highest average rates in Bratislava and the lowest in Banska Bystrica (194 and 89/100 000). Precancerous lesions incidence rates significantly differed between the regions (400 in Kosice, 984/100 000 in Trnava). The average colposcopy and oncocytology examinations rates were found to be lower in Presov (177 and 226) and Kosice (166 and 223) compared to the other regions (318 and 283/100 000 on average). After adjusting for the selected factors, CC mortality (p < 0.05), incidence (p < 0.05) and both preventive examination rates (p < 0.01) were statistically significantly associated with the percentage of the Roma population.

Conclusions

Substantial differences in CC rates and preventive examinations were identified at the regional level in Slovakia. To eliminate CC in line with the WHO Global Strategy, suitable approaches to reaching those at the highest risk should be implemented.

Key messages

• Substantial regional differences in preventive examination and cervical cancer incidence and mortality rates were identified in Slovakia in relation to the distribution of the Roma population.

• Strategies to eliminate cervical cancer should be adjusted to the regional differences and seek alternative approaches for implementing screening in hard-to-reach communities at the highest risk.
Increasing urban health awareness using an interactive approach: evidence from a school-based study
Authors: Zjalic D , Nachira L , Lanza TE , Perilli A , Paladini A , Santoli G , Heidar Alizadeh A , Ricciardi W , Moscato U , Cadeddu C
Published: October 2022

Issue

Urbanization is a cause of climate change, as cities are where these changes are most visible. Climate change also leads to significant inequalities and health issues in urban settings. In this context, urban health promotion is mandatory to increase adaptive capacity. Since the late 1980s the World Health Organization (WHO) has emphasized schools’ role in promoting health, as they can play a crucial role in increasing health awareness to future urban inhabitants.

Description

The objective of this pre/post-interventional study is to measure the awareness of urban health and green spaces among high school students and to rise it through an educational intervention. Four interactive sessions were delivered to 319 students from 13 to 18 years old in a high school in Rome, Italy during spring 2022. Data was gathered anonymously and analysed using descriptive and inferential statistics.

Results

A total of 192 (60%) students successfully completed the pre/post-intervention surveys. An increase in students’ knowledge of urban health and urban green areas was observed. Before the intervention 11.8% of participants were aware of urban health, whereas after the intervention 87.5% were aware. A rise across different areas appeared to be related to how many times the teachers repeated that concept during the intervention. For topics discussed in more than one session, the increase in correct answers averaged 13.9%. Two different trends emerged from the data analysis: one whose post-intervention test improved on most of questions and one whose post-intervention test remained unchanged.

Lessons

The results of the present study suggest that school-based interventions using interactive approaches on climate change and urban health are effective for increasing the knowledge level of scholars on these topics, and can be a useful way to promote health in an urban setting. This type of approach maintains high levels of concentration and interest in most students.

Key messages

• Urban health training activities in schools are needed to empower youth who live in urban settings.

• Interactive sessions keep student concentration high and improve their participation.
Coping strategies and barriers to coping in climate- vulnerable Bangladesh: a qualitative study
Authors: Lilier K , Selim SA , Raihan ST , Islam R , Das J , Danquah I , Sauerborn R , Bärnighausen K
Published: October 2022

With the mental wellbeing of billions of people at risk due to climate change, more research is required to better understand mental health and psychological implications of climate vulnerability. This research contributes to understanding how people in climate vulnerable populations psychologically cope with stress with crucial implications for adaptation efforts. We conducted n = 60 qualitative in-depth interviews with men and women in Bhola, Bangladesh to elicit the lived experiences of a climate vulnerable population. We analysed data following the tenets of Grounded Theory. Through our inductive analysis, we found coping strategies where participants highlighted what they did when encountering stress, such as ‘Resignation’ or ‘Help Seeking'. Barriers to coping were, among others, limited ‘Efficacy', ‘Time’ or ‘Stigma'. We categorized coping strategies with barriers as high-barrier coping strategies and, those without reported barriers, as low- barrier coping strategies. High-barriers restricted participants - especially women - in their coping efforts and led them to using low-barrier coping strategies. Some low-barrier coping strategies can be interpreted as maladaptive if used frequently, as they are unhealthy and draw upon resources needed to adapt for the future. Maladaptive coping strategies can thus impede long-term adaptation by reducing motivation and the ability and willingness to act. To enable adaptive coping, we recommend lifting the barriers to coping through community-led interventions where community workers create platforms for sharing problems and knowledge, such as group support meetings. Sharing and discussing could strengthen efficacy and open new opportunities for functional, adaptive coping. As the negative impacts of climate change will be felt globally with more intensity and frequency, enabling adaptive coping and removing barriers to coping in frontline communities will be essential to supporting physical and mental wellbeing.

Key messages

• Barriers to adaptive coping strategies can lead people to using maladaptive low-barrier coping strategies, which draw upon resources needed for long-term adaptation.

• Enabling adaptive coping by lifting barriers to coping in climate vulnerable populations is crucial to strengthen adaptation efforts.
Exposure to PM2.5 and cardiovascular diseases in Portugal – the contribute of PMCardImpact project
Authors: Martins C , Lima L , Gonçalves S , Assunção R , Serranheira F , Viegas S
Published: October 2022

Particulate matter with a diameter of 2.5 μm or less (PM2.5) are one of the air pollutants more detrimental to human health, being responsible for around 400 000 premature deaths in Europe every year. The cardiovascular diseases (CVD) and air pollution are linked, with existing evidence of a causal relationship between exposure to particulate matter and cardiovascular morbidity and mortality. Under the scope of PMCardImpact, a national funded project, data collected from Portuguese air monitoring platform (2005-2021) (>60 stations) was used to estimate the attributable number of cases of acute myocardial infarction. The air monitoring data and parameters such as exposure-response factors will support the risk assessment in AirQ+ software (WHO Regional Office for Europe). Preliminary results showed that exceedances of Air Quality Directive in Portugal ranged between 0.1 % and 10.2% for PM10 and PM2.5 in 2019. Results obtained will include the number of cases of CVD attributable to exposure to PM2.5 in the Portuguese population. Four scenarios of exposure will be considered for presenting the results: current scenario of exposure, new WHO Air Quality guidelines, European Commission Air Quality Directive and lastly, a worst-case scenario. This assessment will be the starting point for calculation of the burden of disease of CVD that exposure to PM2.5 represent in Portugal. With a view to promote the science to policy interface, PMCardImpact project will make available to policy makers the needed supporting information to act, including actionable knowledge on air pollution trends and related health effects, to implement reducing air pollution policies.

This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021) and CESAM (UIDP/50017/2020 + UIDB/50017/2020 + LA/P/0094/2020).

Key messages

• PMCardImpact will make available to policy makers the needed supporting information to act to implement reducing air pollution policies.

• Risk assessment will allow to determine the number of CVD cases attributable to air pollution.
Health and medical apps - Same same but different? A review of definitions in public health and law
Authors: Maass L , Freye M , Pan C-C , Dassow H-H , Niess J , Jahnel T
Published: October 2022

The terms health app and medical app are often used interchangeably but do not necessarily mean the same. Medical apps can be regulated as mobile medical devices and therefore need to meet general safety and performance requirements. On the contrary, health apps are not part of this legal framework and do not need proof of their efficacy or guaranteeing data security. We need distinct definitions of health and medical apps to understand these terms better and regulate such technologies more effectively. We will provide an overview of health and medical apps definitions and a differentiation flowchart from public health and legal perspectives. A search in 6 databases identified 22 publications that defined health apps and 11 reports that described medical apps. The core elements of these definitions were identified through qualitative analysis. Health and medical apps share the same devices, technical functions and collect health data. While it can be highly challenging to decide which legal requirements have to be fulfilled by an app, we deem it unfit as a distinction criterion. It requires legal knowledge, which is neither suitable nor practical for users. However, medical device law is closely linked to the app’s intended medical or health purpose criteria, which allows a clear differentiation. Additionally, the difference in the user group can be used for separation. Our suggestion for the definition would be that health apps are software programs on mobile devices that process health-related data on/for their user. They can be used by every health-conscious person to maintain, improve or manage the health of an individual or the community. As an umbrella term, health apps include medical apps. They share the same technological functions and devices as health apps. Health professionals, patients, and family caregivers are the main user groups of medical apps. Due to the intended use for clinical purposes, medical apps can be regulated as mobile medical devices.

Key messages

• Separating apps based on legal regulation is impractical & can’t be expected from all stakeholders. Differencing between health and medical apps requires the user group and the health aim of the app.

• Health apps include medical apps. Since 2019, medical apps in Germany contain digital health applications (DiGA). Since 2022, medical apps partly include digital care applications (DiPA).
Gauging Public Health Literacy needs through Google Trends: the COVID-19 vaccination example
Authors: Rachadell J , Vareda R , Santos A
Published: October 2022

Background

The rollout of the COVID-19 vaccination program in Portugal was one of the most successful in the world. However, there was still a challenge for Public Health services to determine the health literacy needs of the population in the context of a new vaccine and the uncertainty of the pandemic. The goal of this study was to evaluate the usefulness of Google Trends data to gauge the health literacy needs of the general population during the pandemic.

Methods

A Google Trends search was performed for Portugal including 5 topics related to health literacy needs of the population (“vaccination”, “scheduling”, “isolation”, “booster dose” and “vaccination certificate” ) between the 28th of december 2019 and the 10th of march 2022. The variation shows the relative popularity of each term referring to the total number of Google searches during that period in a normalized scale of 0-100. The variation was compared to the number of doses administered daily in Portugal and key moments of the vaccination campaign as defined by the Directorate-General for Health in Portugal.

Results

The terms “vaccination” and “isolation” had a steady rise in popularity from December 2019 to January 2021. The term “vaccination” was the most popular search term with peak popularity in July 2021 and a downward trend followed by an ascent to a lower peak in popularity in January 2022. The terms “scheduling” and “vaccination certificate” both followed a similar pattern, though at lower popularity levels. The term “isolation” was low on popularity since February 2021, with a significant rise and peak in January 2022. This variation relates to key dates during the Portuguese vaccination campaign.

Conclusions

Google Trends data seems to correlate with key events during the Portuguese COVID-19 vaccination campaign. That data might be incorporated in the planning framework of health literacy activities for national and local Public Health services.

Key messages

• Google Trends might be an important source of information for public health teams.

• There is a need for further research into how Google Trends data can be incorporated with other sources of information to inform health literacy activities.
Social networks and health information sharing in COVID-19 pandemic
Authors: Phillips M , Weldon R , Patil U
Published: October 2022

Background

Understanding health information flow in social networks is important for designing effective health communications strategies and to achieve health literacy. Limited information is known about variation in social networks and health information sharing in the COVID-19 pandemic by demographic factors. Young people are of particular interest given their heavy exposure to digital media sources, which include considerable health misinformation.

Methods

Hawai'i (n = 324) residents between 18-35 completed a Spring 2021 online survey including questions on health information flow in social networks: (1) how many they talked to and (2) listened to about health. Two Poisson regression models were fit with gender, education, and race/ethnicity predicting social network size.

Results

Respondents were 67.6% female. Respondents discussed their own health with 2-3 people (M = 2.18, SD = 2.95) and listened to roughly the same number. Respondents who talked with a greater number of individuals about their own health were significantly more likely to have larger networks for listening to others (r (317) = .614; p< .001). In the model for discussing their own health, as education increased so did social network size. For the model predicting discussing others’ health, gender was significant (p = 0.003); women listened to 30.6% more individuals than men. Most (73%) respondents had conducted a recent digital health search for either themselves or someone else, including for parents, grandparents, and children. Facebook (63%) and Instagram (58%) were the most popular online sources for COVID-19 health information.

Conclusions

Understanding social networks and digital health sources in young people are important for designing effective health communications to reach all communities, especially those experiencing health inequities, given the amount of health misinformation circulating and the need to build trust in public health communication.

Key messages

• Social networks provide access to critical health information including information obtained from digital sources.

• Gender and education were important predictors of social network size in COVID-19 health communications.
Digital health activism of patients with chronic diseases: discursive strategies and themes
Authors: Dudina V
Published: October 2022

Background

On the Internet, there are many online communities where people living with chronic life-threatening diseases can discuss their problems. On the one hand, digital health activism promotes patient empowerment and could lead to better disease self-management. But, on the other hand, digital health activism raises concerns as it undermines the monopoly of expert medical knowledge. The objective of the research was to reveal the main discursive strategies and themes represented in Russian-language online communities for people with chronic life-threatening diseases. It could help to gain a better understanding of the purposes and effects of digital health activism on patients.

Methods

Data were collected through the popular Russian-language social networking site “Vkontakte”. We selected open groups with memberships of more than 1000 users devoted to HIV/AIDS, cancer, tuberculosis, and diabetes. Discourse analysis and thematic analysis were implemented.

Results

Revealed discursive strategies include the patients’ rights advocacy and resistance to the established order of health care. Three main types of discursive themes were identified:

a. Overcoming shortcomings of the health care system such as lack of qualified doctors, medicine shortage, and unethical behavior of health care personnel.

b. Overcoming the monopolization of expert medical knowledge and criticizing some treatment approaches.

c. Overcoming stigma and discrimination associated with disease both in healthcare settings and in everyday life.

Conclusions

Research on digital activism of patients with chronic life-threatening diseases makes it possible to identify hidden discrimination practices and patient rights violations in healthcare settings. Members of online patient communities turn from objects of care into informed active subjects who critically evaluate medical prescriptions, are active in finding the better treatment, and in defending their rights.

Key messages

• The research contributes to the revision of the paternalistic model of patient-doctor interaction.

• Attention to digital activism is important for the identification of hidden issues in healthcare.The research was supported by RSF (project No 22-18-00261).
STOBE: A Long-COVID Syndromic Study using Real-World data in Brazil
Authors: Cavalini H , Qin Z , Zhen Y , Shi J Q , Shetty A , Neves V , Delanerolle G , Phiri P
Published: October 2022

Background

The COVID-19 pandemic has changed the way infectious diseases are perceived. Global healthcare systems have faced challenges since the start of the COVID-19 epidemic, particularly in developing countries. Some individuals with an acute COVID-19 diagnosis have developed symptoms persisting beyond 90 days. Long-Covid is the new term for this syndrome (LC). LC, on the other hand, is poorly known and appears to cause a wide range of symptoms, particularly among Brazilian patients. As a result, utilizing retrospective data from patients in Petrolina, Brazil’s largest city in the northeast, we conducted an exploratory epidemiology study.

Methods

A retrospective, cohort study design was used with a real-world dataset. The primary aim was to evaluate the prevalence of LC within Petrolina. The sample size was 1,164 LC patients. A comparative and subgroup analysis was conducted to evaluate demographics, comorbidities, clinical symptoms, and mortality. A k means model was used to assess disease severity using a clustering analysis based on the presence of comorbidities.

Results

The prevalence of physical symptoms identified was 69·5%. The strongest physical symptom was fever with resultant of 64·09% followed by pain, 43·64%. The prevalence of autonomic and neurological symptomatology was 8·59% and 8·16% respectively. A higher prevalence of autonomic symptoms were reported among older men of Black and Caucasian in comparison to Pardo. Disease severity within the sample could be associated with the presence of comorbidities which were identified based on medication history. Pregnant women have high rate of comorbidities. 529 patients have at least one comorbidity and 28·73% of them are pregnant.

Conclusions

It is useful to evaluate symptoms although a definitive diagnosis of LC is essential. This study provides insightful information around LC within a Brazilian population to develop better infection control protocols, as well as future management of similar pandemics.

Key messages

• This study could potentially improve the prognosis and mortality among LC patients with comorbidities.

• Our findings could be combined with other regional datasets to predict pattern inferences of LC spread, prognosis and morbidity, including for multimorbidity and pregnant patients.