bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare accessibility of individuals at increased risk of STIs: a cross-sectional survey in Italy
Authors: Ferrari A , Orsi A , Sticchi L , Ogliastro M , Brucci G , Labate L , Pontali E , Notore G , Icardi G ,   Study Group PrE(P)VENZIONE 2023
Published: October 2024

Access to STI prevention and sexual health services in Italy, especially among vulnerable and marginalized groups, is inadequately documented. With the support of community organizations, a cross-sectional survey was conducted between September 2023 and March 2024 to assess health services accessibility among individuals at increased risk of STIs. A total of 1456 responses were analyzed. The respondents comprised 1327 (91.14%) cisgender men, 58 (3.98%) cisgender women, 11 (0.76%) transgender men, 10 (0.69%) transgender women, and 47 (3.23%) non-binary individuals. Overall, 93.8% were men who have sex with men, and 2.8% were women who have sex with women. Mean age was 38 (SD 12). Among respondents, 1284 (88.2%) had undergone HIV testing at least once [102 (7%) living with HIV; 45.1% diagnosed during prior year]. Overall, 563 (38.7%) had been diagnosed with at least one STI in the prior year. Chemsex was reported by 106 (7.3%), with 4.7%, 75.5%, and 35.5% using injective, inhaled or oral substances. Despite a high risk for STIs, 728 (50%) and 410 (28.2%) individuals, respectively, did not visit a specialist in infectious diseases or their primary care provider in the prior year. PrEP awareness was high: 1286 (88.2%) respondents were knowledgeable about it, but only 342 (23.5%) attended PrEP centers and 297 (20.4%) used it. Among PrEP users, 27 (7.9%) encountered difficulties obtaining the drug and 174 (50.9%) considered the cost prohibitive (before it became free). Additionally, 27 (7.9%) of those attending PrEP centers felt judged or disrespected. Overall, 1179 (80.9%) had heard of Mpox, and 1012 (69.5%) were aware of the vaccine, with 301 (20.6%) being vaccinated. Among those vaccinated, 18 (5.2%) felt judged or disrespected. Out of 55 (3.8%) individuals tested for Mpox, 13 (23.6%) tested positive, among which one reported feeling disrespected. The survey highlights critical gaps in healthcare access and awareness among individuals at increased risk of STIs in Italy.

Key messages

• In a final open-ended question, responders commented on various issues including high costs of services, insufficient provider training and the necessity for improved inclusion of LGBTQ+ individuals.

• The robust response from typically hard-to-reach groups underscores the pivotal role of community involvement in enhancing awareness and accessibility of sexual health services, fostering inclusivity.
Incentivization of Sexually Transmitted Infection Testing at a Large Public University
Authors: Farah R , Ferrara R , Hayden M , Holstege C
Published: October 2024

Background

According to the United States (U.S.) Centers for Disease Control and Prevention, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in 2022, with notable increases in gonorrhea and chlamydia. The highest rates of chlamydia, gonorrhea, and syphilis were found in men and women of college age. This study compared free STI testing events to usual care with regard to patient socio-economic factors and testing positivity rates.

Methods

The Department of Student Health & Wellness at a large, public university offers routine testing at a low cost, flat rate, including chlamydia, gonorrhea, hepatitis C Ab, syphilis and HIV testing. Two weeks of free testing were held during calendar year 2023. Utilization and positivity rates between free testing and regular testing weeks were compared using Pearson’s chi squared and Fisher Exact tests.

Results

A total of 8705 tests were performed during routine testing weeks with associated cost averaging 174 tests per week as compared to 1177 tests for the free testing weeks averaging 589 tests per week. Testing uptake during free testing weeks was higher among females (65.6% (n = 772) vs. 55.1% (n = 4797); p < 0.001) and minorities such as, Black or African American [11.3% (n = 133) vs. 9.4% (n = 813); p = 0.02], Hispanic [11.4% (n = 134) vs. 9.2% (n = 798); p = 0.02] and Asian [13.1% (n = 154) vs. 8.8% (n = 763); p < 0.001] when compared to testing during regular weeks. Chlamydial infection positivity rate was lower during the free testing weeks [1.8% (n = 7)] vs. [3.9% (n = 123); p = 0.04]. Gonorrhea, hepatitis C, HIV, and Syphilis positivity rates did not differ between the two testing periods.

Conclusions

Free STI testing in the context of a large, public university Student Health Department shows increased utilization. The establishment of free testing weeks was associated with an increase in female students and minorities use of testing services at a large public university.

Key messages

• Incentivization can improve STI testing utilization among university students.

• The establishment of STI free testing periods can increase the use of testing services among minority students and females.
Developing a nationwide dataset of UK veterans seeking help from sector charities
Authors: Serra G , Tomietto M , McGill A , Kiernan M
Published: October 2024

Background

The assistance to military veterans and their families in the UK is provided by both the NHS and over 1800 military charities. These charities count services using different definitions and reporting systems, so to date a national registry of service usage does not exist. The aim of the MONARCH study is to build a standardised registry of service usage data for the military charity sector, in order to identify patterns of use, gain insight on possible risk factors, and guide the allocation of resources.

Methods

Data is anonymised and a unique identifier is generated by adopting a Secure Hashing Algorithm, allowing both privacy protection and avoiding double counts. Data is standardised, and linked with an automated process to create an aggregated dataset. The dataset describes the population, using both a-priori and machine learning approaches (K-means clustering) to unveil different usage patterns. In addition, it will be linked to an online interactive dashboard.

Results

To date 5 national charities have shared data, for a total of 42,509 veterans with 128,423 needs. The mean age of beneficiaries was 60.1 years (SD 20.5), and 90% were male. 65% were receiving some other form of statutory benefit, 5% was homeless and 1% was imprisoned. 65% of the needs recorded concerned social wellbeing. 40% of veterans were helped at least in two different years. The k-means clustering approach based on the number of accesses, number of needs and repetition of need returned 4 subgroups of use that were identical to those created using a priori knowledge.

Conclusions

The dataset is the most comprehensive source of charity usage data in the UK to date. Service usage is generally homogenous among subgroups, but some differences were highlighted indicating that younger, non-officer veterans may be more at risk of presenting with more complex needs. These first useful insights can help allocate resources to build an effective preventive strategy for more complex cases.

Key messages

• The MONARCH dataset is the first comprehensive nationwide registry in the UK of military charity data.

• The understanding of usage patterns can lead to the design of targeted preventive strategies.
Inter-regional Hospital Patients’ mobility: Is co-operation better than competition?
Authors: Guarducci G , Moirano F , Nante N
Published: October 2024

Background

According to Italian law, citizens are free to choose their preferred place of care across the national territory. This study aims to analyze the associations between patients’ mobility between Tuscany (Italy) and other Italian regions and the complexity of Diagnosis Related Groups (DRGs) provided for these hospitalizations.

Methods

A retrospective study was conducted using 2019 Hospital Discharge Cards data of Tuscany provided by the Italian Ministry of Health. The surgical DRGs of each Major Diagnostic Categories (MDCs) were considered according to high specialty (HS) and non-high specialty (N-HS). For each MDCs, patients’ attractions, and escapes to bordering and non-bordering regions with Tuscany were associated with HS and N-HS surgical discharge DRGs by using the Odds Ratio. The analysis was performed using STATA software, and the significance level was set at 95%.

Results

For Digestive Diseases, patients from non-border regions were more likely to be attracted to Tuscan hospitals for HS DRGs (OR: 1.37 95%CI: 1.08-1.74; p < 0,05), while for Musculoskeletal Diseases those from non-border regions were less likely to be attracted for HS DRGs (OR: 0.51 95%CI: 0.47-0.56; p < 0,05). For Nervous Diseases (OR: 3.08 95%CI: 2.18-4.37; p < 0,05), for Ear, Nose, Mouth And Throat Diseases (OR: 2.41 95%CI: 1.52-5.03; p < 0,05) and for Hepatobiliary And Pancreas Diseases (OR: 4.55 95%CI: 2.71-7.68; p < 0,05), Tuscan patients were more likely to escape to non-border regions for HS DRGs, while for Musculoskeletal Diseases (OR: 0.76 95%CI: 0.68-0.84; p < 0,05) they were less likely to be admitted to non-border regions for HS DRGs.

Conclusions

The results suggest the necessity of establishing mobility agreements between regions, particularly for high-specialty DRGs. In fact, the provision of mobility care economically benefits the receiving (creditor) region, which provides the medical service, but is not advantageous to the patient’s region of residence (debtor).

Key messages

• Monitoring mobility flows is critical to improve identify possible lack of supply of resources.

• There is a need to develop interregional mobility agreements to ensure better cooperation between different regional health systems.
Characteristics of sick-listed employees diagnosed with a mental disorder in Germany
Authors: Starke F , Houkes I , Sikora A , Wegewitz U , de Rijk A
Published: October 2024

Purpose

Employees with mental disorders (MDs) are more likely to exit the labour market prematurely. In Western European countries, characteristics of employees diagnosed with a MD have not been reported comprehensively, hampering targeting the risk group and developing preventive interventions. The aim was to describe the socio-demographic, health, treatment, organisation, job and labour market characteristics of employees diagnosed with a MD in Germany and their gender differences.

Methods

This cross-sectional study uses baseline data from sick-listed (≥6 weeks) employees diagnosed with a MD, aged 20-60 years, who were patients in the German mental health care, and recruited in the context of a return to work (RTW) intervention evaluation trial (RTW-PIA study). Descriptive T-tests/Chi-2 tests were applied.

Results

484 individuals (58.5% female; 31% highly educated, average age 42.6) were included, of which 88.4% had affective disorders. Most were salaried employees working full-time, employed in large companies and having permanent contracts. 65.5% reported moderate depressions and the average work ability was 3.9 on a 0-10 scale. 74.2% had a positive RTW prognosis; 15.3% scored high levels of RTW self-efficacy. Gradual RTW (GRTW) was perceived the most important requirement for RTW (76.9%). More than 60% had discussed various work-related topics during therapy; further RTW-measures were prepared among 47.7%. Almost 60% received a recommendation for GRTW. Significant gender differences were found among the socio-demographic, health, job and labour market characteristics.

Conclusions

This study gives insights into a hardly investigated group. Almost two thirds had moderate depressions, 84.7% had low RTW self-efficacy and a very low average work ability. This highlights the vulnerability of persons with MDs in the labour market and suggest an urgent need for more work-related (health-)care. Gender differences need to be better addressed in mental health research.

Key messages

• Comprehensive knowledge of the characteristics of sick-listed employees diagnosed with MDs is crucial for targeting interventions to promote RTW.

• Moderate depression scores, low RTW self-efficacy and very low work ability highlight the vulnerability of persons with MDs in the labour market, suggesting an urgent need for more work-related care.
How do working conditions change for in-person versus digital work? The case of schoolteachers
Authors: MacEachen E , Hopwood P , Whitson J , Aurini J , Premji S , Miller M , AlMomani Y , Sultana I
Published: October 2024

Background

Telework has significantly increased in Europe and internationally in the aftermath of COVID-19 lockdowns, with estimates of 22% of Europeans now doing some form of telework. However, it is unclear how working conditions for the same job differ when work is conducted in-person versus digitally, and if occupational health risks can be considered as equal across formats. Our study addressed the profession of school teaching to examine online working conditions versus those for in-person teaching.

Methods

To allow for close consideration of employment contexts, a qualitative study was conducted. Focus groups and interviews took place in 2023-24 with 45 teachers and tutors who teach from kindergarten to secondary grades across Canada.

Results

We found that online teaching added to emotional labour of teaching work and involved new occupational exposures. These included challenges with engaging students via cameras and microphones, digital surveillance of teachers by parents and students, unwanted exposure to students’ intimate home lives, and technostress.

Conclusions

The work of being an online teacher was very different than teaching in-person, yet there has been slow recognition of working condition differences for understanding of OHS exposures and for collective agreements.

Key messages

• In the context of a significant expansion of telework, assumptions cannot be made that the job conditions and exposures are the same job when performed in-person or at-home.

• These differences will need to be recognized in job agreements and occupational risk assessments.
Heavy Work Investment (HWI) and Its Effect on Employees’ Physical and Mental Health
Authors: Inchi L
Published: October 2024

Background

Economic reality and centrality of work have led to employees investing much time and effort in work. However, The number of hours spent at work may not be the only explanation, and other characteristics, such as type of work, employees’ personality, economic status, motivations, etc., need to be considered. The Heavy Work Investment model (Snir & Harpaz, 2012) considers these variables and classifies employees into four types of investors. This study examines the physical and mental health consequences of each HWI group.

Methods

Participants (N = 962) were workers who came to a medical center for annual medical screenings. About 70% were males, and the average age was 50.13 years (SD = 9.53). They divided into 5 groups: Typical full-time workers (N = 208, 29.2%), ‘Needy’ (N = 111, 15.6%), ‘Employer directed’ (N = 111, 15.6%), ‘Workaholic’ (N = 192, 26.9%) and ‘Work devoted’ (N = 91, 12.7%). The personal data was cross-referenced with the respondents’ health data. Differences for categorical variables were examined with Chi-square analyses.

Results

‘Employer-directed’ employees, more than ‘work-devoted’ employees, perceived their health status as preventing them from performing mild activities. ‘Employer-directed’ and ‘needy’ employees, more than ‘work-devoted’ employees, perceived their health status as interfering with their social activities and their pain as interfering with their regular activities. ‘Workaholic’ employees suffered from more diseases than ‘work-devoted’ employees, and they were found to be 3.70 times more likely to be at a high risk of cardiovascular disease than typical full-time workers.

Conclusions

It is possible to anticipate types of health damage according to occupation type and develop occupation-adjusted health promotion programs. It is necessary to base labor laws on protecting employees’ health, particularly regarding time and workload’ outside of work’ in both hours (additional or flexible) and location (hybrid work).

Key messages

• Inspire organizations to be aware of potential injuries caused by HWI and promote the creation of intervention programs, potentially significantly improving employees’ health and well-being.

• Evidence for the necessary laws that protect employees’ health, particularly regarding time and workload ‘outside of work’ in both hours (additional or flexible) and location (hybrid work).
Association of Workplace Toilet Access with Urinary Tract Symptoms and Productivity Loss among Female
Authors: Lee Y M , Kang M-Y
Published: October 2024

Purpose

Lower urinary tract symptoms (LUTS) are prevalent among women, affecting not only their physical well-being but also their quality of working life. We investigate workplace toilet access related to LUTS among women in the Korean workforce.

Materials and methods

An online survey was conducted to determine the demographic characteristics, occupational risk factors, and urinary tract symptoms among employed Korean women. Occupational risk factors included three survey questions on access to toilets at work: A) enduring urinary symptoms at work; B) capability to use the toilet at will during work, and C) needing to use the toilet during work but were unable to. The LUTS were assessed using the overactive bladder symptom score (OABSS) and international consultation on incontinence questionnaire-urinary incontinence short form (ICIQ-SF). Health-related productivity losses (HRPL) were estimated using the work productivity and activity impairment (WPAI) questionnaire for urinary symptoms. Multiple logistic regression was used to determined the association between workplace toilet access and LUTS. In addition, generalised linear regression analysis was performed to assess HRPL according to workplace toilet access.

Results

Of the 1057 participants, 260 (24.6%) and 294 (27.81%) had overactive bladder and urinary incontinence, respectively. More than 50% reported poor access to toilet. Multiple logistic regression analysis showed that the lower the access to toilets in the workplace, the higher the incidence of LUTS and the higher HRPL.

Conclusions

Restricted access to toilets at work are associated with poor urinary health and loss of productivity. The results highlight the need for interventions to improve the workplace environment.

Key messages

• Restricted access to toilets at work are associated with poor urinary health and loss of productivity.

• The results highlight the need for interventions to improve the workplace environment.
Return to work after hip and knee arthroplasty: qualitative outcome from the Netherlands
Authors: Wouters N T , Wijnands KAP , Geilen I , van Tuijn I , Boonen B , Gielen C , Schotanus MGM
Published: October 2024

Background

Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are performed daily worldwide. More younger working-age patients are receiving a THA and/or TKA. Outcomes, including Quality-of-Life (QOL), patient satisfaction and Return-to-Work (RTW) are becoming more important and have implications for healthcare budget and health workforce. Clinical recovery pathways should improve patient outcomes and cost-effective care. Insight in patient experiences and expectations regarding RTW remains behind. This study aims to gain insight into influenceable factors in the recovery pathway after THA or TKA that could lead to improved care and enhanced patient participation.

Methods

In this single-center qualitative study, performed at Zuyderland Medical Center (Sittard-Geleen, the Netherlands), 12 patients (n = 6 THA; n = 6 TKA) aged under 65 years were approached to participate. During interviews 6-weeks after arthroplasty, this research explored their RTW experiences in both pre-, and postoperative, in- and outpatient settings.

Results

In total, 12 employed patients who received a THA (n = 6, mean age 56 ± 7.4 years; female: n = 4, 66%) or a TKA (n = 6, mean age 61 ± 2.6 years; female n = 3, 50%) participated. Own control regarding RTW and a minimal recovery time after the operation was necessary for all patients. During this time, focus on physical therapy and strengthening was most important. RTW was not expected to be the primary goal during the clinical recovery pathway. The RTW topic was said to belong to the occupational physician (OP) and employer. Patients however knowledge that the type of work should gain importance in the consultation room. Patients missed accessible communication between the orthopedic surgeon and OP.

Conclusions

Overall, patients are satisfied with the current clinical recovery pathway. Intercollegiate communication should be made more accessible. Own control and strengthening self-management in the RTW remain important for all patients.

Key messages

• Own control and strengthening self-management should have importance in the guidance of working-age patients after THA or TKA.

• Intercollegiate communication should be made more accessible.
Preparing a dataset for new life: cleaning a longitudinal study for new analyses and linkages
Authors: Morse A , Higgins K
Published: October 2024

Issue

The Belfast Youth Development Study (BYDS) was conducted from 2000-2010, comprising 7 waves of collection. The data contain valuable insights into the health and social lives of adolescents but were stored using inconsistent management practices and lacked a metadata crosswalk describing all variables and their content. Primary challenges to new analysts included shared questions entered using varying notations across waves of collection (“mother” and “yes” in a “mother lives at home” variable), single question responses stored wide across multiple variables, and a need for comprehensive metadata.

Description

Individual questions were un-joined from the linked dataset, cleaned using the tidyverse suite of packages in R, and then left-joined to the primary dataset. Where responses were recorded differently across years, scales were standardised across waves of collection. Questions were arranged in their original order to maintain dataset integrity.

Simultaneously, a crosswalk was created of each question, its old and new variable names, and its response scales. Rows for old variable names and response scales were collapsed into comma-separated values and deduplicated by the new variable names using the dplyr package.

Results

Following this work, the BYDS dataset is ready for new researchers to analyse and describe findings. A large grant has recently been awarded to conduct a new wave of data collection, the analysis of which will be enhanced by the cleaned dataset and its associated metadata.

Lessons

It is feasible and desirable to maintain older datasets through semi-automated practices facilitated through the tidyverse suite of packages in R. Improvements in data management since the initial digitisation of large datasets more than 20 years ago provide a framework for conducting this work.

Key messages

• The tidyverse suite of packages allow for low-burden cleaning and maintenance of important historical datasets to facilitate their ongoing use and preservation.

• There is value in supporting staff training on simple data management skills in R to support lower burden in data management practices.
Trade as a commerical determinant of health: The health impact of a free trade agreement on Wales
Authors: Green L , Silva L , Petchey L , Douglas M , Mcnamara C , Fletcher M , Clemens T
Published: October 2024

As a result of the UK’s withdrawal from the European Union (‘Brexit’), the UK can negotiate its own trade agreements for the first time in over 40 years. This includes the Comprehensive and Progressive Trans-Pacific Partnership Agreement (CPTPP). Public Health Wales undertook a mixed-method Health Impact Assessment (HIA) to assess the potential impact of the CPTPP on health, well-being and inequalities in Wales. It is only the second ever HIA carried out on a free trade agreement (FTA) globally. A literature review on the potential impact of the CPTPP on health was conducted. Qualitative interviews with cross-sectoral representation, such as the environment, were undertaken alongside the development of a community health and demographic profile. The HIA identified significant potential impacts across health determinants, e.g., employment, agricultural production and health care, as well as impacts on population groups, e.g., those on low incomes. The Investor State Dispute Settlement (ISDS) mechanism, economic uncertainty and loss of regulatory alignment were identified as potential pathways for health impacts to affect the population. The HIA highlighted trade as a key commercial determinant of health. The findings have been beneficial in informing policy and decision-makers to prepare for the implementation of the CPTPP and take action to maximise opportunities and prevent potential negative impacts. Communicating HIA evidence that links trade to health has also led to valuable cross-sector and cross-UK engagement and sparked a “rethinking” of trade through a well-being economy lens where health, well-being and sustainability are primary objectives. This work has demonstrated the value of a HIA approach to FTAs by mobilising a range of evidence through a transparent process, resulting in transferrable learning for others as well providing an entry point for public health to have direct engagement with trade negotiators and those participating in trade discussions.

Key messages

• Trade agreements are a key commercial determinant of health across health behaviour, policy and economy.

• Multiple population groups are affected by trade agreements both positively and negatively.
Loneliness and Social Isolation in Older Adults in Latvia and Iceland During COVID-19
Authors: Reine I , Miķelsone M , Guðmundsson H , Ivanovs A , Tomsone S , Guðmundsson H
Published: October 2024

Background

The COVID-19 pandemic has significantly impacted the mental health and wellbeing of older populations across Europe, exacerbating feelings of loneliness and social isolation, known risk factors for poor physical and mental health outcomes. This study aims to understand the extent and implications of these changes in Latvia and Iceland, providing essential insights for targeted public health interventions.

Methods

This comparative study utilized data from two key sources: the Survey of Health, Ageing, and Retirement in Europe (SHARE) for Latvia and the HL20 study for Iceland, focusing on individuals aged 67 and above. Both quantitative surveys were conducted during the pandemic, offering data on health status, loneliness, and social isolation. A novel approach was applied in analyzing older populations to standardize comparisons between the two distinct datasets. This methodological innovation is part of a bilateral EEA initiative FM2021/23 aimed at strengthening research collaboration between Latvia and Iceland. Descriptive statistics and the Pearson Chi-square test were used to compare outcomes between the two countries and within demographic subgroups.

Results

The study revealed stark differences between the two countries: 80% of Latvian older adults reported social isolation compared to 42.7% in Iceland. Similarly, 45% of Latvians experienced loneliness versus 30% of Icelanders. Significant associations were found between social isolation, loneliness, and deteriorating mental and physical health, with worse outcomes noted in socially isolated individuals.

Conclusions

Our findings demonstrate a clear link between social isolation and adverse health outcomes among the older adults, exacerbated by the COVID-19 pandemic. The study supports the need for proactive public health measures in Latvia and Iceland, including the development of community engagement programs and mental health support services tailored to the needs of older adults.

Key messages

• Study shows significant health impact of social isolation among older adults in Latvia and Iceland, highlighting urgent need for targeted public health interventions.

• Effective public health strategies and innovative digital outreach can mitigate adverse effects of loneliness and isolation observed in older populations.
Interrogating the environmental and social correlates of health risk behaviours in West Africa
Authors: Ajaero C , Fotso A
Published: October 2024

Background

Despite the high incidences of health risk behaviors (HRBs) in sub-Saharan Africa, studies on the contextual determinants of HRBs across countries are generally lacking, concentrated on isolated countries and often focus solely on specific health behaviors. Thus, this study investigated the environmental and social correlates of HRBs in West Africa.

Methods

Data was from post-2015 Demographic and Health Surveys in three West African countries of Benin, Mali and Nigeria. A composite outcome variable of health risk behaviors (HRBs) was derived from variables of tobacco smoking, intimate partner violence, overweight/obesity and risky sexual behaviors. The contextual variables were normalized difference vegetation index, precipitation, maximum and minimum temperatures, region of residence and population Density. Data analysis involved descriptive statistics, chi square test, geographical mapping, and multilevel logistic regression.

Results

The engagement in HRBs varied from 42.65% in Nigeria to 42.88% in Benin and 51.06% in Mali as there are spatial variations in the engagement in HRBs within different regions of these countries. There also existed significant variations in HRBs regarding age, education, employment status, wealth index, household size, place of residence, and region of residence in the three countries. In the contextual models of environmental and social factors, population density significantly increased odds of HRBs in the three countries, maximum temperature significantly increased odds of HRBs in Benin and Mali, while precipitation significantly increased odds of HRBs in Nigeria and Mali. Other factors which significantly increased odds of HRBs across the three countries were increase in age, wealth index, households with 9+ persons, and regions of residence.

Conclusions

These findings suggest that among other things, changes in lifestyles regarding the different HRBs should be emphasized in specific contextual situations

Key messages

• There are variations in engagement in health risk behaviours across the countries.

• Cliamte variables influence engagement in health risk behaviours.
Lipids and glycemia profiles in adults: the Italian Health Examination Survey 2023 - CUORE Project
Authors: Marcozzi B , Lo Noce C , Di Lonardo A , Vannucchi S , Morello M , Bernardini S , Galeone D , Bellisario P , Palmieri L , Donfrancesco C
Published: October 2024

Background

WHO recommends monitoring glycemic and lipid profiles in the population to control and prevent NCDs. The target for glycemic/diabetes is to halt the rise within 2025 (2010 as baseline). The Italian Ministry of Health (MoH) has strengthened prevention/health promotion and supported their periodic assessment through national health examination surveys (HESs), financed by MoH-CCM and conducted within the CUORE Project.

Methods

In 2023 a new HES started including the assessment of fasting serum glycemia, total and HDL cholesterolemia and triglyceridemia. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy and aged 35-74 years are available (687 men, 704 women). Glycemia and lipids profiles were assayed by a central lab. Elevated glycemia/diabetes (DM): glycemia ≥ 126 mg/dl and/or on medication. Elevated total cholesterol/hypercholesterolemia (HChol): total cholesterol ≥ 240 mg/dl and/or on medication.

Results

Glycemia mean level was 97 mg/dl (95%CI: 95-99) in men and 90 mg/dl (89-91) in women; DM resulted 10% (5-14) and 8% (4-12) respectively. Among those with DM, about 2 in 10 men and 1 in 10 women were unaware; about 2 and 3 of 10 were aware but not on medication, respectively. Total cholesterol mean level was 192 mg/dl (189-195) in men and 200 (197-202) in women; HChol resulted 24% (18-31) and 29% (22-36) respectively. Mean level of HDL cholesterol was 48 mg/dl (48-49) in men and 59 mg/dl (58-60) in women; mean level of triglycerides was 121 mg/dl (115-126) and 95 mg/dl (92-98) respectively. Among those with HChol, about 1 in 10 men and 2 in 10 women were unaware; about 2 of 10 were aware but not on medication.

Conclusions

Compared to 2008, these preliminary data showed a significant decrease of glycemia, total cholesterol and triglycerides means values both in men and women, as well as of DM and HChol prevalence, but improvements on their awareness and control are still necessary.

Key messages

• In the Italian adult general population significant improvements in lipids and glycemia profiles occurred compared to 15 years ago.

• The implementation of periodic health examination surveys is important for estimating indicators based on objective measurements and for estimating awareness and control of risk conditions.
Food additive monosodium glutamate and risk of cardiovascular diseases - NutriNet-Santé cohort
Authors: Hasenböhler A , Javaux G , Payen de la Garanderie M , Szabo de Edelenyi F , Agaësse C , De Sa A , Deschasaux-Tanguy M , Fezeu L , Srour B , Touvier M
Published: October 2024

Background

One may add monosodium glutamate (MSG) to food for its flavour-enhancing properties. However, its implication in long-term cardiovascular health is uncertain due to a lack of precise epidemiological evidence. This study aimed to investigate the associations between food additive glutamate exposures and cardiovascular disease (CVD) risk, including cerebrovascular disease (CVA) and coronary heart disease (CHD) risks in a large prospective cohort of French adults.

Methods

Participants (n = 108,932, 79.3% women, mean age=42.4 years, SD = 14.5) were 15 years old and above from the French NutriNet-Santé prospective cohort (2009-2023). We assessed dietary intakes using repeated 24h-dietary records and exposure to food additive glutamate using food composition databases and laboratory assays. We characterised associations between cumulative time-dependent continuous exposures to total glutamate, natural glutamic acid, MSG and risk of CVD, CVA, and CHD using multivariable proportional hazards Cox models adjusted for known risk factors for standardised increments of glutamate intake.

Results

During follow-up (median 7.92 years), 2397, 1113, and 1284 participants were diagnosed with CVD, CVA, and CHD respectively. Higher intakes of naturally occurring glutamic acid (HR per 3000 mg/d increment=1.08, 95% CI [1.01-1.16], p-value=0.03), food additive MSG (HR per 200 mg/d increment=1.05, 95% CI [1.01-1.09], p-value=0.03), and total glutamate (HR per 3000 mg/d increment=1.09, 95% CI [1.01-1.17], p-value=0.02) were associated with higher risks of CHD (p-value for non-linearity>0.6).

Conclusions

This large prospective cohort study revealed positive associations between exposure to the widely used glutamate food additives, especially MSG (E621) and CVD, CVA, and CHD risks.

Key messages

• This large prospective cohort study revealed positive associations between exposure to the widely used glutamate food additives, especially MSG (E621) and CVD, CVA, and CHD risks.

• If confirmed, our findings regarding MSG could lead to a re-evaluation of the safety of these food additives by European and international public health agencies to improve consumer protection.
Overdiagnosis of lung cancer in Chinese populations
Authors: Xie D , Zhang L , Hao L P , Xu W H , He N , Yang C , Zhang R X , Liu X , Chen H Q , Suo C
Published: October 2024

Background

Low-dose computed tomography (LDCT) has been widely-used in employee health examinations in China since 2011. This study was designed based on the Cancer Surveillance data to quantify the overdiagnosis of lung cancer due to the introduction of LDCT in Chinese populations.

Methods

This registry-based cohort study included 46,978 incident cases and 34,475 deaths of lung cancer from Pudong New Area of Shanghai, China, during 2002-2020. We calculated the age-standardized rates (ASR) and average annual changes (AAC) of mortality and overall, stage-specific and histological type-specific incidence by sex to evaluate the potential overdiagnosis of lung cancer. We further estimated the numbers and proportions of lung cancer cases attributable to overdiagnosis by sex and period based on the comparison between the shape of the age-specific curves with that prior to the introduction of LDCT in the populations.

Results

The ASR of incidence of lung cancer increased rapidly since 2011 in both men (AAC: 1.90%; 95%CI: 0.87, 2.92) and women (AAC: 4.40%; 95%CI: 3.19, 5.62), whereas the ASR of mortality declined persistently, with AAC of -0.12% (-0.64, 0.39) in men and -0.19% (-0.47, 0.09) in women. The upward trends in incidence were mainly observed in women, for early-stage cancer and for lung adenocarcinoma. Overall, the overdiagnosis rate of lung cancer grew from 22% in 2011-2015 to 50% in 2016-2020 in women. Further analysis demonstrated elevated numbers (proportions) of lung adenocarcinoma cases attributable to overdiagnosis, which increased from 182 (8%) in 2011-2015 to 827(22%) in 2016-2020 in men, and from 1,842 (85%) to 4,171 (89%) in women.

Conclusions

This registry-based cohort study observed considerable and increasing overdiagnosis of lung adenocarcinoma in Chinese men and women. Guideline is urgently needed to maximize the benefits of LDCT screening and reduce the potential overdiagnosis of lung cancer in the populations.

Key messages

• The secular trends in incidence and mortality of lung cancer in Chinese populations demonstrated the overdiagnosis since 2011, when the LDCT was used as a part of staff health examination in China.

• Overdiagnosis of lung cancer in Chinese populations increased incrementally over time and was mainly observed among women.
Socioeconomic background and childhood cancer survival in Germany – A nationwide register study
Authors: Wellbrock M , Borkhardt A , Ronckers C M , Spix C , Grabow D , Filbert A L , Wollschläger D , Erdmann F
Published: October 2024

Introduction

Evidence is accumulating that not all children with cancer have benefitted equally from diagnostic and therapeutic improvements and that socioeconomic conditions are also associated with prognosis - even in high-income countries where equal access to healthcare is presumed. We investigated the association between area-based socioeconomic background and childhood cancer survival in Germany with the ultimate aim to identify groups of children that may benefit from supportive interventions.

Methods

We identified all children with a first cancer diagnosis before the age of 15 years in 1997-2016 from the German Childhood Cancer Registry (N = 35,443). Based on individual residential address information (at diagnosis) we applied the German Index of Socioeconomic Deprivation as measure of area-based socioeconomic background. Using Cox proportional hazards models, we assessed the association between absolute area-based socioeconomic deprivation (AASD) and ten-year overall survival (OS) to estimate hazard ratios (HR) and corresponding 95% confidence intervals (CI).

Results

The Cox analysis (adjusted for diagnostic year, birth year and place of residence) revealed a null association for AASD and OS from all cancers combined (HR = 1.00, 95% CI 0.97; 1.03). Among children diagnosed with acute myeloid leukemia and germ cell tumors, a higher AASD (implying more severe levels of deprivation) was associated with worse survival, particularly pronounced in boys (HR = 1.18, 95% CI 1.01; 1.37; HR = 1.67, 95% CI 1.13; 2.45, respectively). The opposite was observed for childhood CNS tumours, yielding worse survival by decreasing AASD (HR = 0.93, 95% CI 0.88; 0.98) for both malignant and non-malignant CNS tumours.

Conclusions

Contrary to reports from other European countries, we found little evidence for pronounced social inequalities in childhood cancer survival in Germany based on a composite score, with inconsistent patterns across cancer types and age at diagnosis.

Key messages

• We found little evidence for pronounced social inequalities in childhood cancer survival in Germany on the area-based level.

• Our findings indicated inconsistent patterns of social inequalities across cancer types and age at diagnosis.and age at diagnosis.
Polycystic ovary syndrome and labor market attachment in Swedish women
Authors: Boldis V , Helgertz J , Grünberger I , Cederström A
Published: October 2024

Background

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of fertile age and is associated with several burdensome comorbidities. We use Swedish longitudinal register data to identify and compare clusters of employment trajectories among working age women, in order to investigate how PCOS affects labor market attachment.

Data and Methods

A cohort of 157,356 women born in 1975-1977 were followed annually between the ages of 30 and 39. Labor market states were constructed by combining detailed data on various types of earned income. PCOS was identified through national inpatient and outpatient registers. Sociodemographic covariates (civil status, region of origin, highest attained education, number of children) were measured at the age of 29 years. Sequence analysis was used to identify clusters of typical labor market trajectories. Multinomial logistic regression was employed to assess the associations between being diagnosed with PCOS and belonging to the identified clusters.

Results

Women with PCOS spent less time in employment and were more dependent on sickness benefits during the follow-up time than those without PCOS. Five clusters of trajectories were identified: stable employment, education into employment, labor market exclusion, continuous unstable position, long-term sickness. Compared to being in stable employment cluster, women diagnosed with PCOS were 97% more likely to experience long-term sickness (RRR (relative risk ratio): 1.97 [CI: 1.90-2.05]), and had 11% higher risk of belonging to education into employment (RRR: 1.11 [CI: 1.07-1.15]) and a 4% higher risk (RRR: 1.04 [CI: 1.00-1.09]) of experiencing labor market exclusion. The magnitude of the association increased for education into employment and labor market exclusion after adjusting for covariates.

Conclusions

PCOS can lead to disadvantaged labor market outcomes and better strategies are needed in order to prevent economic exclusion among women diagnosed with the condition.

Key messages

• PCOS leads to disadvantaged labor market outcomes.

• Women with PCOS may experience economic exclusion.
Health information seeking and health literacy in midwife-led care and the modern information environment
Authors: Wilhelm E , Calleja-Agius J , Kouis D , Petelos E , Vivilaki V
Published: October 2024

Background

This review reports on how midwives are affected by the modern digital information environment, including health misinformation, and how their knowledge or competencies assist them in navigating this for themselves and their clients, especially those who are more vulnerable and experience inequities in healthcare.

Methods

Leveraging a PRISMA-based systematic review, the project identifies the facilitators and barriers that the modern digital information environment poses to midwives and the care they provide to their clients. The search strategy of the peer-reviewed literature examines articles related to midwives and misinformation, social media, information environment, digital health, health information, migrant women and other related keywords that surface in searches. The timeframe from which published articles will be identified for possible inclusion are from Jan 1, 2020 to March 31, 2024.

Results

Both midwives and the clients they care for experience challenges in navigating the digital information environment and addressing health-related misinformation on reproductive health and pregnancy-related topics.

Conclusions

Midwives should receive strengthened training on digital literacy to improve the care they provide to clients and help their clients navigate a confusing and rapidly evolving information environment. Through digital and in-person interactions with their clients, midwives can improve their clients’ digital information, and health literacies.
How factchecking organizations can partner within public health for a healthier internet
Authors: Purnat T , Kajimoto M , Kalinic J , Stevanovic A , Mandic-Rajcevic S , Wilhelm E
Published: October 2024

Background

Health concerns, narratives and misinformation are growing in digital spaces, which makes them also a vulnerability to being hijacked by disinformation. A workshop was held at GlobalFact11, the global factchecking summit, to take a pulse among the participants on their exposure and work with health misinformation, provide a public health perspective on the role of factchecking, and equip participants with building a business case for developing health-related factchecking programmes.

Methods

A pre-summit survey of IFCN members and summit participants was conducted to better tune the design of the discussion in the workshop. The workshop included interactive polling and a discussion of case-based scenarios and real-world examples.

Results

A business case for investing into health-claim fact-checking can consider needs of public health organizations from a variety of perspectives. (1) The global health security agenda, and the politicization of health and hijacking in disinformation influence campaigns; (2) Contributing data for public health infodemic insights reports in formats that provide value to fact-checking in public health context; (3) Developing community resilience programmes by combining fact-checking with community-based interventions; (4) Building partnerships with public health organizations (for fact-checking, capacity building, community media and information literacy, research).

Conclusions

Many fact-checking organizations got involved in public health during the COVID-19 pandemic. However, they want to access more public health expertise, tools, and partnership modalities that would enable them a more sustainable effort in covering health topics, especially beyond infectious disease.