bluuebunny/crossref_metadata_2025 huggingface dataset:
Multimorbidity patterns in older migrants and natives across Europe
Authors: Jang S Y , Oksuzyan A , van Lenthe F J , Loi S , Myrskylä M
Published: October 2023

Background

Multimorbidity patterns in immigrants may differ from the native population due to their biological traits and experience in origin and receiving countries. This study addresses the descriptive patterns of multimorbidity by gender and immigration background and compares the prevalence of each multimorbidity pattern between immigrants and natives.

Methods

This study utilizes longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from waves 2 to 8 in individuals aged 50 to 79 from 28 European countries. We estimate the prevalence of single chronic diseases and two-disease combinations. Further, we estimate the risk ratio of the estimated prevalence between immigrants and natives for comparison.

Results

This study finds varying multimorbidity patterns based on immigration background. Our results show that combinations including stomach ulcers or diabetes are distinctly more prevalent in immigrants than in natives for both genders, except for the “diabetes-cardiovascular” patterns among men. Further, we observe a higher prevalence of the “dementia-diabetes” combination among immigrant men at their younger ages, which eventually converges toward the native level in older age groups. However, these patterns of multimorbidity combinations in immigrants versus natives vary by origin and the receiving country.

Conclusions

A chronic health condition in the immigrant population can have a stronger amplifying or buffering effect on the risk of having another chronic disease than their native-born counterparts.

Key messages

• Multimorbidity patterns in immigrants differ from the native population due to their biological traits and experience in origin and receiving countries.

• A chronic health condition in the immigrant population can have a stronger amplifying or buffering effect on the risk of having another chronic disease than their native-born counterparts.
Sexually and Non-sexually Transmitted Infections and The risk of Prostate Cancer
Authors: Sawaya M , Cordinaduverger E , Lamy P , Rébillard X , Tretarre B , Menegaux F
Published: October 2023

Introduction

Prostate cancer (PCa) is by far the most common type of cancer among men in western countries. However, relatively little is known about its etiology despite the high morbidity and mortality rates, where only advanced age, ethnicity, and family history of prostate cancer are well-established non-modifiable risk factors. It has been suggested that chronic inflammation may be involved in the development of prostate carcinogenesis. Therefore, our objective was to investigate the role of sexually and non-sexually transmitted infections in the occurrence of prostate cancer with a specific interest in the aggressive types based on data from EPICAP.

Methods

EPICAP is a population-based case-control study conducted in the département of Hérault, France, between 2012 and 2014. A total of 819 incident cases and 879 controls were interviewed face-to-face using a standardized questionnaire gathering information on known or suspected risk factors of prostate cancer and personal history of specific sexually and non-sexually transmitted infections: Gonorrhea, Syphilis, Trichomonas, Herpes, Mononucleosis, Epstein Barr, Varicella-zoster, and Dengue. Odds Ratios (OR) and their 95% confidence interval were estimated using multivariate unconditional logistic regression.

Results

No association emerged for the history of sexually transmitted infections (OR 1.04, 95%CI: 0.84-1.25) and non-sexually transmitted infections (OR1.09, 95%CI: 0.89-1.34) and the risk of prostate cancer. Even for all the infections studied separately, there was no association with the risk of low-grade or high-grade prostate cancer.

Conclusions

Our results showed that sexually or non-sexually transmitted infections do not seem to be risk factors for prostate cancer in the EPICAP study. Therefore, further investigation is needed to help advance our understanding of the role of chronic inflammation in the etiology of prostate cancer, with a particular focus on its most aggressive types.
Health inequality and protective factors for post COVID-19 condition among older adults in Europe
Authors: Ohno M , Dzúrová D
Published: October 2023

Background

COVID-19 affected people and countries disproportionately and continues to impact health of people. The aim of this study was to investigate protective health and social factors for post-COVID conditions in adults aged 50 years and older in Europe using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE), which were collected from June to August 2021.

Methods

A study sample of 1,909 respondents who self-reported a positive COVID-19 test result was included in our multiple logistic regression models. Binary logistic regression was performed to assess whether having no post COVID-19 condition was associated with sociodemographic factors (sex, age, education and region) and health-related factors (BMI, comorbidity and COVID-19 vaccination status).

Results

In the fully-adjusted model, male sex (OR 1.54; CI1.24, 1.90), having tertiary or higher education (OR1.42; 95% CI 1.05, 1.92), healthy weight (BMI 18.5 to 24.9 kg/m2)(OR 1.46; 95% CI 1.11, 1.93), no underlying health condition (OR 1.68; CI 1.31, 2.15), COVID-19 vaccination (OR 1.39; CI 1.11, 1.75) and living in countries other than Visegrad group (OR 2.03; CI 1.53, 2.69) showed protective effects against post COVID-19 conditions. BMI in the high education group (mean 26.7 kg/m2) differed significantly as compared to medium (mean 28.3 kg/m2) and low education groups (mean 28.7 kg/m2). BMI of respondents without comorbidity (mean 26.5 kg/m2) was significantly lower than respondents with comorbidities (ranging from 27.4 to 29.0 kg/m2). Significant differences were observed in education levels and BMI between the Visegrad group and Non-Visegrad group (p<.001).

Conclusions

Our study suggests that high education attainment is a predictor for no post COVID-19 conditions and is associated with lower BMI and fewer underlying comorbidities. Health inequality associated with education attainment was particularly relevant in the Visegrad group.

Key messages

• Maintaining healthy weight and vaccination may protect older adults from post COVID-19 condition.

• Our results highlight health inequality in which BMI was associated with comorbidities and educational attainment.
Consulting a midwife when not pregnant: what happened in France after the 2009 reform?
Authors: Franc C , Panjo H , Roquebert Q
Published: October 2023

Background

While access to gynecologists in France has become very difficult for most women, demography of midwives is dynamic (+ 10.5% between 2013 and 2018), especially in ambulatory positions. In the same time, in 2009, a healthcare reform in France extended the skills of midwives. While they have been historically associated to care for pregnancy and childbirth, midwifes have been authorized from then to intervene for the gynecological follow-up of non-pregnant women. This paper explores how this reform affects the probability of women to consult a midwife when not pregnant, and the heterogeneity of this effect according to women's characteristics.

Data and Methods

Using longitudinal administrative data on the healthcare consumption of French women, we reconstruct pregnancy periods and control for a rather large number of individual characteristics (age, health status, outpatient care expenses, rate of extra fees born, region, index of a taxonomy of the French living areas, etc.). We use a generalized estimating equations (GEE) probit regression model to study the change in the probability of non-pregnant women aged 15 to 55 to consult a midwife between 2007 and 2017.

Results

We find that the probability of consulting a midwife for reasons other than pregnancy increases after the 2009 reform, particularly since 2012, and increasingly so. This increase is particularly important for women having a recent pregnancy, suggesting that midwives are their own “sales representatives”. The increase is also especially high in rural areas and deprived periurban areas. It can be related to the very poor healthcare supply in these two types of areas that are both characterized by a low supply of care, particularly for healthcare specialists.

Key messages

• The 2009 reform broadening the scope of midwives’ skills is illustrated in practice through an increase in the use of midwives outside pregnancy by all women and this concerns all types of territories.

• the increase appears rather slow, given the significant rationing of gynecological care in many areas due to financial barriers and lack of professionals.
The Gender gap in the Tuscany Regional Health System
Authors: Marconi D , Serafini A , Golinelli D , Nante N , Marinari D , Faraoni N
Published: October 2023

Background

According to the Italian Ministry of Health, the presence of women in the National Health System has increased. While women now represent the majority (69%) of healthcare workers (HCW) in Italy, and females make up 50% of medical doctors, only 18% of health unit directors are women. In Tuscany, there are 56.207 HCW, 72% of which are women. The objective of this study was to investigate the role of gender in the healthcare workforce, taking into account the issues of sharing caring responsibilities.

Methods

Between January and February 2022, the Tuscany Regional Institute for Economic Planning conducted a cross-sectional study among its HCW. An internally validated questionnaire was sent to the HCW to investigate working life, in particular schedule shift (fulltime or parttime) and night shifts; data were collected online anonymously and then analyzed with STATA. We performed logistic regression adjusting for age, gender, having children (<14 yo) and caring for a family member.

Results

15.631 HCW answered the questionnaire: 76% were female, 23% were male and 1% preferred to not specify their sex. 73% of women and 65% of men have at least one child. 18% of women and 13% of men have at least one child and care for a family member. Those who have at least one child (adjOR=1.52 95%CI 1.26-1.83) or care for a family member (aOR 1.49 1.27-1.75) are more likely to work part-time, especially women (aOR 2.33 1.87-2.91). Moreover, those who have at least one child (aOR=0.90 0.83-0.97) or care for a family member (aOR 0.89 0.82-0.96) are less likely to work the night shifts, especially women (aOR 0.90 0.83-0.98).

Conclusions

Our analysis shows that under the same conditions, women end up sacrificing their work more than their male colleagues. It is necessary to implement policies that encourage equitable sharing of caring responsibilities, fostering fairer work opportunities for women in the health system, including in positions of leadership, to overcome the gender gap.

Key messages

• The gender gap persists in the health personnel system.

• It is necessary to encourage equitable sharing of caring responsibilities, ensuring women hold leadership positions.
Learning health systems in rehabilitation care - findings and recommendations from a scoping review
Authors: Torok Z , Christophers L , Hudson C , Carroll A
Published: October 2023

To meet the challenges posed by an aging population and changing health needs, healthcare systems require transformative action at a systemic level. One solution is to create “learning” health systems (LHS) that generate and apply evidence, innovation and quality to improve the provision of care. Given the lack of research focusing on operationalizing LHSs and the predominance of acute care studies, this scoping review aimed to fill this gap by exploring how LHS frameworks have been conceptualized and operationalized in rehabilitation organizations. The review was conducted according to the JBI guidelines and Arksey & O’Malley methodological framework. Comprehensive search was performed across 5 databases to capture the extent of the literature on this topic specific to rehabilitation. Following screening and data extraction, qualitative content analysis and thematic mapping was employed to explore the selected studies (n = 26). Results were reported in accordance with PRISMA guidelines. Studies conceptualised LHS as organizational infrastructure that supports continuous learning by integrating clinical care and research. It aims generate new knowledge by capturing data from every clinical encounter and applying it to practice through iterative learning cycles, characterized by three phases: Data to Knowledge, Knowledge to Performance, and Performance to Data. Four themes emerged regarding the operationalization of LHS in rehabilitation: creating a functioning data infrastructure; facilitating research; promoting an organizational culture of learning; and person-centredness. This study is the first scoping review on LHSs in the context of rehabilitation, employing a systematic and rigorous process to capture the relevant literature. The review identified key transformational steps to become a LHS e.g., generation, dissemination and implementation of new institutional knowledge and early stakeholder engagement. Findings can be applied across non-acute health settings.

Key messages

• This is the first scoping review on LHSs in the context of rehabilitation.

• The findings will aid organisations in non-acute health settings with the transformational process of becoming LHSs.
Very high intensity of the bronchiolitis epidemic during the 2022-2023 season in France
Authors: Forgeot C , Verrat B , Vaux S , Viriot D , Casério-Schönemann C
Published: October 2023

Background

During epidemic seasons, bronchiolitis affects young children with a large burden in emergency departments (EDs). Following the beginning of the COVID-19 pandemic and 2 perturbed seasons, the aim of this study was to assess the burden of bronchiolitis in EDs in terms of visits and post-discharge hospitalisations in 2022-23 compared with the pre-COVID seasons.

Methods

Santé publique France, collects ED data through OSCOUR® (95% of French ED visits). ED visits with a medical diagnosis of bronchiolitis (based on ICD-10 codes) in children under 2 years of age (yo) were included. The burden of the 2022-23 epidemic season (from 2022-W36 to 2023-W16) was compared with that of the pre-COVID seasons (2015-16 to 2019-20), by age group, in terms of visits and hospitalisations after discharge, in particular in intensive care units (ICUs) (annual data and means).

Results

In 2022-23, 99,864 ED visits for bronchiolitis and 31,505 post-discharge hospitalisations were registered for children under 2 yo (vs. respectively +49% and +44% compared to the pre-COVID seasons). It represented 15% of all ED visits and 33% of all hospitalisations after discharge of this age group (vs. 10% and 23% pre-COVID). Among children under 1 year, distribution of bronchiolitis ED visits by age group remained relatively stable in comparison with pre-COVID seasons. For children under 6 months, bronchiolitis accounted for 27% of all ED visits (19% pre-COVID), 45% of all hospitalisations (35% pre-COVID) and more than 70% of hospitalisations referred in ICU during 7 weeks (2 weeks pre-COVID).

Conclusions

The 2022-2023 bronchiolitis epidemic was of extreme intensity in France with a highest impact than for pre-covid seasons and leading to saturation of EDs. These findings were consistent with an increase in respiratory illness in children during the 2022-23 winter season, and raised questions about the impact of the COVID-19 pandemic on their epidemiology and a potential decrease of immunity.

Key messages

• Beside a very high intensity for the 2022-23 bronchiolitis epidemic, distribution of ED visits by age group remained relatively stable among children under 1 year.

• In 2022-2023, among children under 6 months, during nearly two months (7 weeks), more than 70% of hospitalizations after discharged referred in ICU were due to bronchiolitis.
The burden of cardiovascular disease associated with PM2.5 exposure in the Portuguese population
Authors: Martins C , Corda M , Lima L , Assunção R
Published: October 2023

Background

Exposure to air pollution has been associated with increased mortality, premature mortality, and morbidity. A causal relationship between fine particulate matter (PM2.5) exposure and cardiovascular morbidity and mortality was demonstrated by the American Heart Association. In 2020, exposure to PM2.5 concentrations above limits defined by World Health Organization was responsible for 238,000 and 2,600 premature deaths in the European Union and in Portugal, respectively.

Aim

To estimate the impact on cardiovascular diseases (CVD) attributable to exposure to PM2.5 between 2010 and 2020, expressed as years of life lost (YLL), in Portugal.

Methods

National Statistics databases were used to collect the number of cardiovascular mortality cases between 2010 and 2020. The atmospheric levels of PM2.5 were obtained from Online Database on Air Quality of the Portuguese Environment Agency. When PM2.5 data were absent, PM10 data were used to estimate the PM2.5 concentration through the ratio: PM2.5/PM10=0,65. The burden of disease was estimated as YLL. The YLLs due to PM2.5-associated stroke and IHD in the Portuguese adult population, older than 30 years, were determined using the population-attributable fraction (PAF).

Results

YLLs per year for stroke and IHD were estimated as 41,489.60 (95% CI: 34,610.68 - 48,368.52) YLL and 27,573.44 (95% CI: 24,939.94 - 30,206.93) YLL respectively. Between 2010 and 2020, the crude number of YLL in mainland Portugal due to PM2.5 exposure-associated stroke and IHD decreased. The YLLs for IHD and for stroke are higher for men than for women. However, for stroke, the YLLs do not demonstrate as significant a difference as for IHD.

Conclusions

These findings provide evidence of the impact of air pollution on human health, which are crucial for decision-making.

Acknowledgments

This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021).

Key messages

• Exposure to PM2.5 has a significant health impact concerning cardiovascular mortality.

• Estimating burden of disease contributes for the decision making and environmental policies.
Correlates of psychotic experiences in gender-diverse youth in Ireland: A population-based survey
Authors: Hoey J , Fleury R , Dooley N , Power E , Cannon M
Published: October 2023

Epidemiological studies have shown that psychotic disorders are more prevalent in transgender and non-binary (TR/NB) individuals compared to their cisgender (i.e., male & female) counterparts (CIS). Despite this, little research exists that examines the association between gender diversity and psychotic episodes (PEs), with implications for public health policy. This study examines the prevalence of, and the factors associated with, PEs in both CIS and TR/NB adolescents in Ireland. The study is a cross-sectional analysis of the 2021 Planet Youth survey completed by secondary school students in Cavan, Monaghan and North Dublin. The outcome of interest was self-reported episodes experienced by students at least once over their lifespan, using the 7-item Adolescent Psychotic-like Symptom Screener. Of 4406 students who completed the questionnaire, 3877 identified as CIS and 169 identified as TR/NB. TR/NB cohorts reported higher levels of PEs (M = 4.6, SE = .206, CI = 4.2, 5.0) than CIS (M = 2.6, SE = .027, CI = 2.5, 2.6), z = -6.393, p < .0001). In both cohorts, PEs positively correlated with the incidence of serious arguments with parents (CIS: rs = .210, p < .0001; TR/NB: rs = .202, p = .0374), being bullied (CIS: rs = .227, p < .0001; TR/NB: rs = .360, p = .0002) and the occurrence (CIS: rs = .288, p < .0001; TR/NB: rs = .303, p = .0016) and disclosure (CIS: rs = .208, p < .0001; TR/NB: rs = .305, p = .0015) of suicidal thoughts. Additionally, PEs were negatively correlated with feelings of safety at home, school and in the neighbourhood (CIS: rs = -.283, p < 0001; TR/NB: rs = -.279, p = .0037). These findings indicate that further research is needed to examine how psychosocial stressors may operate as trauma and contribute to clinical symptoms in TR/NB youth. Results from the Planet Youth survey suggest that more attention needs to be paid to the mental health needs of gender diverse youth and policy makers must be cognisant of this.

Key messages

• Gender diverse youth in Ireland report a higher prevalence of psychotic symptoms compared to cisgender youth.

• Gender diverse youth reported feeling less safe at home, at school and in the neighbourhood compared to their cisgender counterparts.
Health literacy in migrants: the SPRINT2 project
Authors: Zanobini P , Lorini C , Tizzi G , Caldès M J , Bonaccorsi G
Published: October 2023

Introduction

Migrants generally reported lower levels of health literacy (HL) thus increasing their difficulties in accessing and interacting with the healthcare system. This study, carried out within the SPRINT2 project, aims to assess the HL level of 2 samples of asylum seekers and refugees residing in Tuscany, and to examine the relationship among HL, educational interventions, COVID-19 risk perception and preventive behaviours

Materials and Methods

Questionnaires were administered to a sample of refugees and asylum seekers (group A) between June and September 2021 and to another sample between April and September 2022 (group B) which participated at least in one health-related educational intervention. The Italian version of HLS-EU-Q16 was used to measure HL

Results

Among 171 subjects belonging to group A 25% had an inadequate HL level. Group B consisted of 102 respondents of which 37% had an inadequate HL level. Group B compared with group A had higher percentages of respondents who considered COVID-19 a serious health problem (58.8% vs 41.1%), very likely to be infected by SARS-COV-2 (58.2% vs 29.6%) and who thought quarantine compliance (89.7% vs 75.9%), the use nasopharyngeal swabs (78.4% vs 61.2%), and to get COVID-19 vaccination (89.4% vs 66.1%) were very important preventive measures. HL was found to be significantly associated (p < 0.05) with COVID-19 risk perception and propensity for handwashing, face mask use, and social distancing. At multivariate logistic analysis, low educational level and residing in Italy for less than 2 years were found to be predictors of inadequate HL level (OR 2,7 CI 95% 1,22-6,13; OR 3,9 CI 95% 1,93-7.79, respectively).

Conclusions

Our findings suggest that HL and educational interventions are important factor to improve healthy behaviours. Structured educational interventions to increase HL levels will be an important contribution in the process of inclusion and integration of migrants thus reducing health related inequalities.

Key messages

• The level of health literacy among migrants is most influenced by their educational level and length of stay in Italy.

• Health literacy and educational interventions are important factor to improve healthy behaviours.
Engaging Czech-Slovak Roma women in the co-creation of an antenatal care information resource
Authors: Lie M , Claisse C , Karchnakova Z
Published: October 2023

Background

Czech-Slovak Roma women in the UK suffer barriers to antenatal care such as stigma contributing to reduced engagement with health services. There is a scarcity of research and intervention studies with this population. This study aims to co-create an antenatal care community information resource with a group of these women through participatory research. Women's stories of their pregnancy journeys would be able to provide an understanding of their maternity needs, to inform design considerations for a prototype of an antenatal care information resource.

Objectives

1. To understand Roma women's needs in pregnancy, childbirth, and maternity services through storytelling

2. To share with women publicly available antenatal information resources such as pregnancy apps

3. To co-create a low-resolution paper prototype of an antenatal care information resource that meets their needs

Research activities

1. Six two-hour workshops with 6-8 women supported by a peer researcher and an interpreter.

2. Two workshops focused on the co-creation of an antenatal information resource.

3. Design-based participatory methods and thematic analysis, culminating in a community event and webinar for public and professional stakeholders.

Findings

The women's pregnancy journeys covered several topics such as unplanned pregnancies, nausea and vomiting, pregnancy loss and birth trauma. Through all these, the main message they wished to convey was the need for women in the community to overcome the stigma of seeking help for their mental health. Our information resource developed using a co-creative participatory approach, signposts Roma women to reliable information and healthcare provision potentially reducing poor maternal and perinatal health outcomes. This study could be replicated in other marginalized newly arrived groups of migrant women to facilitate timely uptake of antenatal and mental health support services.

Key messages

• Czech-Slovak Roma women face stigma in seeking help for their mental health during pregnancy.

• Roma women can be supported to overcome stigma through design-based participatory research.
Cost comparison of vitamin D from egg biofortification: the case of Slovenia study
Authors: Kukec A , Vičič V , Pandel Mikuš R
Published: October 2023

Introduction

Various food fortification possibilities have been suggested to prevent vitamin D deficiency. The aim of this article is to compare cost of direct vitamin D fortification, hen egg biofortification and individual supplementation.

Methods

The cost comparison was done for the Slovenian population over >1 of age (n = 2,050,916). The demographic data was sourced from Statistical office of Slovenia. The economic evaluation was done using the cheapest prescription drug and cheapest food supplement. Unfortified hen egg has total vitamin D efficacy (combined efficacy of cholecalciferol and dietary 25(OH)D3) of 2.4 μg/1 egg. For the production of one vitamin D fortified egg with total vitamin D efficacy of 11.98 μg/egg, Browning and Cowieson used feed containing 36.2 μg cholecalciferol and 9.99 μg of 25(OH)D3. The milk and yoghurt can be fortified by direct addition during manufacture. For the economic analysis, the prices of vitamin D3 and feed grade 25(OH)D3 were provided by DSM Nutritional Products.

Results

The economic comparison of the annual cost of 10 μg vitamin D/d/person was EUR 6.17 for prescription drugs, EUR 6.37 for food supplements, EUR 0.09 for direct milk fortification and EUR 0.12 for egg biofortification with vitamin D. The annual cost of 10 μg vitamin D/d/person for Slovenia (n = 2,050,916) would be EUR 12.66 million for prescription drugs, EUR 13.06 million for food supplements, EUR 0.18 million for direct milk fortification and EUR 0.26 for egg biofortification with vitamin D.

Conclusions

In Slovenia, vitamin D drug prescriptions amounted to EUR 6.03 million in 2020. Considering the low cost of fortification, even a slight decrease in drug dosage due to the effect of fortified food could bring substantial savings. Regulatory challenges in EU and projected intake of vitamin D using egg fortification alone and in combination with milk fortification was described in article Vičič et. al..

Key messages

• Vitamin D fortification is a cost-effective way of increasing vitamin D intake in the population.
Investigating the risk benefit balance of dairy consumption in the Danish population
Authors: Jakobsen L S , Davydova A , Pires S M , Pilegaard K , Devleesschauwer B
Published: October 2023

Background

Sustainability and health concerns are driving dietary shifts globally, including changes in consumption of dairy products. Dairy provides essential micronutrients e.g., calcium, iodine, and B12 vitamin, and are a source of high-quality protein. They have also been associated with increased risk of diseases. We estimated the health risk-benefit balance of changes in dairy consumption in the Danish population, formulated as three possible consumption scenarios.

Methods

We applied a risk-benefit assessment approach to compare the health impact of current consumption with the impact of three alternative scenarios (AS) of dairy consumption. We accounted for beneficial and adverse health impacts associated with dairy and micronutrients and estimated disability adjusted life years (DALY) caused or prevented by the theoretical changes in consumption. Data were collected from the Danish food consumption survey, literature and the Global Burden of Disease Study.

Results

Results showed that a decrease in consumption of dairy in the overall population from current intake to 270 g/day (AS1) would lead to a loss of 4,865 healthy years annually (3,434; 6,344). The health outcomes contributing more were intellectual disability (men) and type 2 diabetes (women). Negative impacts were larger in men than women. Decreasing consumption would also lead to a higher proportion of women below recommended intake of iodine and of children of calcium. In contrast, increasing consumption to 500g/day (AS2) or to estimated optimal consumption for each health outcome (AS3) would lead to a health benefit (3,853 and 11,354 DALYs averted, respectively). We will present results of scenario analyses and discuss impact of assumptions.

Conclusions

Our estimates emphasize the need to quantify impacts of dietary changes, including health risks and benefits. They will be useful to inform public health policies that consider both sustainability and health impacts of dietary transitions.

Key messages

• We estimate that the Danish population will loose approximately 5000 healthy life years annually if dairy intake is decreased from the current level.

• We argue that our assessment provide quantitative evidence of the trade-offs of shifts in dairy product intake.
Regional and temporal patterns of Italian COVID-19 mortality
Authors: Sanmarchi F , Golinelli D , De Girolamo G , Rucci P , Stoto M A
Published: October 2023

Background

Italy responded to COVID-19 with stringent lockdowns and a mass vaccination campaign. We describe the temporal and regional impact of these measures on mortality, along with social-behavioral correlates.

Methods

The analysis uses National Ministry of Health data on COVID-19 mortality (CM), excess mortality (EM), and vaccine uptake, along with survey data. We calculate avoidable mortality (AM) as observed mortality minus the lowest regional EM rate in each period.

Results

In 2020-21 EM was 180,169, of which 76% were counted as COVID-19. This fraction varied from 13% in the South in Jun-Oct 2020 to 140% in the Northeast in Mar-Jul 2021. Impact varied across Italy, with EM and AM highest in the North during the first and second waves (Feb-Jun 2020 & Nov 2020-Feb 2021) and in the South afterwards (Mar-Dec 2021). After the first wave, there were 33,587 avoidable deaths, 41% of which were in the South. Higher rates in the North in Nov 2020-Feb 2021 were possibly due to less social distancing (e.g. avoiding social events and staying home from work/school), perhaps because residents of the North are more likely to be employed in private industry, which were more likely than public agencies to remain open. Higher rates in the South after Mar 2021 were possibly due to lower trust in hospitals and reduced vaccine uptake, particularly among those aged 80+.

Conclusions

Official CM was differentially under-reported, so EM estimates provide a more robust picture of regional and temporal patterns of COVID-19 deaths. Mortality was high in the North in the second as well as first wave. It was high in the South afterwards (Mar-Dec 2021), accounting for 41% of avoidable mortality.

Key messages

• Excess mortality estimates provide a more robust understanding of regional and temporal patterns of COVID-19 deaths than reported COVID-19 deaths.

• Heterogeneous impact of COVID-19 was associated with differences in preventive habits, trust levels, and vaccine uptake.
Documenting experiential knowledge on harm reduction to improve support for alcohol users in France
Authors: Georgelin B , Bouhier F , Delescluse T , Gaspard S , Soudier B , Bernard C , Couteron J-P , Daimé P , Berdougo F
Published: October 2023

Background

Experimentations in France referring to the harm-reduction paradigm aim to deliver more efficient support to vulnerable alcohol consumers who don't look for consumption cessation. They take place both in healthcare (addictology centers) and social care facilities. Harm-reduction applied to alcohol use (HRA) cause debates within scientific and policy-making communities. Yet, few research details what innovating HRA interventions (HRAI) offer and how they work. The project SeRra (2020-2022) aimed to capitalize - i.e. to collect, document and circulate - experiential knowledge from field practitioners on HRAI to bridge that gap.

Methods

Steered by a multidisciplinary committee, SeRra followed 7 steps: 1/ identify and select HRAI nationwide; 2/ meet with practitioners for in-depth interviews on HRAI (development, implementation, effects); 3/ analyze, 4/ write and 5/ publish a capitalization form per HRAI. We 6/ drafted a cross-case analysis, 7/ debated with experts and practitioners, to formulate practice and policy recommendations.

Results

We capitalized 28 HRAI, including: projects of drug-use centers, emergency housing, specialized social work teams, new therapeutic education programs, etc. Projects often combined implementing institutional and organizational changes to align with HRA, with offering improved one-to-one support, and advocacy for HRA. HRAI improved wellness scores and access to prevention and care. Ultimately, HRAI improved empowerment and inclusion of vulnerable alcohol users. We identified levers and barriers to implement HRA practices. We formulated recommendations to keep improving HRA individual support methods and evaluation. More practitioners shall access training to gain relevant HRA skills.

Conclusions

Successful HRAI experiences during Covid lockdowns drove French authorities to support further dissemination of HRAI. capitalization forms circulating among practitioners and recommendations in our final report benefit implementation efforts.

Key messages

• New harm-reduction approaches improve access to care and inclusion of vulnerable alcohol consumers. SeRra details experiences in social & medical settings and offers insights on dissemination levers.

• Attention must be brought to experiential knowledge as it proves useful to improve professional practices. SeRra confronts experiential knowledge and expertise to further innovation and dissemination.
Avoidable mortality contributes to the European Union’s life expectancy and lifespan dispersion gaps
Authors: Hrzic R , Vogt T
Published: October 2023

Background

Mortality differences between established (EMS) and post-2004 European Union member states (NMS) remain large. Contributing to this gap are deaths avoidable through prevention (preventable mortality) or adequate medical treatment (treatable mortality). This study examined the potential of reduced avoidable, preventable, and treatable mortality to close life expectancy and lifespan dispersion gaps between EMS and NMS.

Methods

Death and population counts were extracted from the WHO Mortality Database to calculate age and cause-specific mortality rates for each EU member state for 2005-2014. Causes of death were categorised as avoidable, amenable, and preventable based on the OECD/Eurostat lists of preventable and treatable causes of death. The gaps in life expectancy at birth and life span dispersion between EMS and NMS were estimated where: 1) all amenable, preventable, and avoidable deaths were averted across the EU, and 2) NMS achieved the same level of avoidable mortality as EMS.

Results

Averting all avoidable deaths throughout the EU would reduce the life expectancy gap between EMS and NMS from 4.4 to 2.4 years for women and 7.4 to 3.3 years for men. The difference in lifespan dispersion would be reduced from 0.9 (favouring EMS) to 0.1 years (favouring NMS) in women and from 1.5 years to 0.3 years (favouring EMS) in men. Were NMS to achieve the avoidable mortality observed in EMS, the life expectancy gap between EMS and NMS would fall from 4.4 to 2.5 years for women and from 7.4 to 3 years for men, while the difference in lifespan dispersion would be reduced from 0.9 to 0.3 years in women and from 1.5 years to 0.3 years in men.

Conclusions

NMS achieving the avoidable mortality observed in EMS would have halved the life expectancy gap and almost eliminated the life span dispersion gap between EMS and NMS during 2005-2014. Effective exchange of best practices in prevention and treatment could transform mortality differences across the EU.

Key messages

• This is the first study to examine the potential of reduced avoidable, preventable, and treatable mortality to close the life expectancy and lifespan dispersion gaps between EMS and NMS.

• Achieving the avoidable mortality observed in established EU member states in post-2004 EU member states would greatly reduce mortality differences across the EU.
Community health needs in Ukraine in the war context
Authors: Fenchak A , Gerasimova A
Published: October 2023

The full-scale russia's invasion in Ukraine caused the migration of people, partially destroyed the medical infrastructure, disrupted access to services, so there is a need to connect people tocare. The e-tools allow to monitor the capacities of the healthcare system and utilization of services. However, there is insufficient data on the population's needs. The CHNA was conducted in March-May 2023 in 16 communities across 8 regions of Ukraine. It was based on the adapted methodology of the Philadelphia Healthcare Federation and applied the following research methods: statistical analysis of the operating PHC facilities, availability of medical staff, and current gaps in service delivery; structured survey of the community residents; FGDs with community decision makers and residents; in-depth interviews with heads of PHC facilities. The assessment results demonstrated limited access to healthcare services in remote settlements, and thus the need to develop new formats of healthcare provision. The study showed a difference in the perception of PHC services accessibility between decision makers and the population. The biggest need identified was for MHPSS services for IDPs and local residents. CHNA is critical to inform programming. To improve access to essential services, the USAID Public Health System Recovery & Resilience project will support new approaches to PHC service delivery, including through mobile teams and task shifting to expand the role of nurses. To increase availability of MHPSS services, the project builds the capacity of the workforce and supports the delivery of evidence-based interventions such as mhGAP, CETA, Selfhelp+, CBT.

Key messages

• The developed CHNA is an effective tool for decision-makers to understand the main gaps in the availability of health services and to develop targeted interventions, especially in times of war.

• Community-based MHPSS interventions are critical in time of war.
Assessing health insurance literacy in Switzerland: first results from a measurement tool
Authors: Bardy Tess L C
Published: October 2023

Background

Health insurance literacy (HIL) is crucial for individuals to make informed-decisions and navigate complex choice-based health insurance systems. However, there is a lack of evidence on HIL in countries outside the US, with Switzerland no exception.

Methods

Using the HILM-CH, a survey instrument developed to measure HIL in Switzerland, this study first describes the answers to the HILM-CH. Second, the study uses ordinary least squares and quantile regressions to investigate the associations between the HIL score and demographic, socioeconomic, health, and preference factors in the German, French, and Italian Swiss regions.

Results

A third of the population faces difficulties in finding health insurance information. Understanding it and managing the financial aspects of the Swiss health insurance system pose the biggest barriers to the population. The HIL score significantly and positively correlates with age and financial risk, while non-Swiss individuals have lower HIL scores. No association was found between HIL, gender, education and time preference. There is a small health gradient, with more doctor visits associated with higher HIL in the lowest quantiles of the HIL score. Similarly, wealthier individuals in the Swiss German part of Switzerland have a higher HIL when choosing their health insurance.

Conclusion

This study provides important insights into Swiss HIL and its associated factors. These findings contribute to the international literature on HIL and highlight the importance of understanding variations in HIL and various factors in choice-based health insurance systems.
Ovine invasion: sheep as protest objects and animal agents in the Larzac campaign
Authors: Smith Andrew W M
Published: October 2023

In their posters and in their protests, the peasants of the Larzac deployed sheep to help them fight back against the French Army’s plans to expropriate them from the land as part of the expansion of a local military base. In Paris, as in regional courtrooms, sheep served as a visible and disruptive contrast to urban modernity, emblematized in ovine invasions which invited animals to make themselves heard (and smelt) in courtrooms, townhalls and even beneath the Eiffel Tower. This article considers sheep as objects and agents of protest in the Larzac campaign, showing how they embodied contested visions of rural modernity, offered both opportunities for and shaped new methodologies of protest, and came to characterize the way in which this pacifist campaign resonated internationally.
Truth-telling, Ancestral Remains and the Establishment of a National Resting Place in Australia
Authors: Payne Anne Maree , Norman Heidi
Published: October 2023

ABSTRACT∞

This article explores the potential for truth-telling and healing created by the recently announced National Resting Place for Indigenous Ancestral Remains in Australia. The return of Indigenous Ancestral Remains provides the opportunity to make redress for past wrongs, and to reflect on the attitudes which informed the dehumanizing practices of their past collection and display. Indigenous Ancestral Remains are critical to truth-telling in Australia as by their very existence and materiality they disrupt colonial narratives about terra nullius. However, human remains are also a powerful reminder of the limits of human rights processes. We consider the potential of the National Resting Place as a new Australian site of truth and memory to disrupt the traditional ‘museum’ model and to restore the dignity and respect owing to previously objectified human remains.
Homogeneous multigrid for HDG applied to the Stokes equation
Authors: Lu Peipei , Wang Wei , Kanschat Guido , Rupp Andreas
Published: October 2023

We propose a multigrid method to solve the linear system of equations arising from a hybrid discontinuous Galerkin (in particular, a single face hybridizable, a hybrid Raviart–Thomas, or a hybrid Brezzi–Douglas–Marini) discretization of a Stokes problem. Our analysis is centered around the augmented Lagrangian approach and we prove uniform convergence in this setting. Beyond this, we establish relations, which resemble those in Cockburn & Gopalakrishnan (2008, Error analysis of variable degree mixed methods for elliptic problems via hybridization. Math. Comput., 74, 1653–1677) for elliptic problems, between the approximates that are obtained by the single-face hybridizable, hybrid Raviart–Thomas and hybrid Brezzi–Douglas–Marini methods. Numerical experiments underline our analytical findings.
Motivic Atiyah-Segal Completion Theorem
Authors: Tabuada Gonçalo , Van den Bergh Michel
Published: October 2023

Let $T$ be a torus, $X$ a smooth separated scheme of finite type equipped with a $T$-action, and $[X/T]$ the associated quotient stack. Given any localizing ${\mathbb {A}}^{1}$-homotopy invariant of dg categories $E$ (homotopy $K$-theory, algebraic $K$-theory with coefficients, étale $K$-theory with coefficients, $l$-adic algebraic $K$-theory, $l$-adic étale $K$-theory, semi-topological $K$-theory, topological $K$-theory, periodic cyclic homology, etc), we prove that the derived completion of $E([X/T])$ at the augmentation ideal $I$ of the representation ring $R(T)$ of $T$ agrees with the classical Borel construction associated to the $T$-action on $X$. Moreover, for certain localizing ${\mathbb {A}}^{1}$-homotopy invariants, we extend this result to the case of a linearly reductive group scheme $G$. As a first application, we obtain an alternative proof of Krishna’s completion theorem in algebraic $K$-theory, of Thomason’s completion theorem in étale $K$-theory with coefficients, and also of Atiyah-Segal’s completion theorem in topological $K$-theory (for those topological $M$-spaces $X^{\textrm {an}}$ arising from analytification; $M$ is a(ny) maximal compact Lie subgroup of $G^{\textrm {an}}$). These alternative proofs lead to a spectral enrichment of the corresponding completion theorems and also to the following improvements: in the case of Thomason’s completion theorem the base field $k$ no longer needs to be separably closed, and in the case of Atiyah-Segal’s completion theorem the topological $M$-space $X^{\textrm {an}}$ no longer needs to be compact and the $M$-equivariant topological $K$-theory groups of $X^{\textrm {an}}$ no longer need to be finitely generated over the representation ring $R(M)$. As a second application, we obtain new completion theorems in $l$-adic étale $K$-theory, in semi-topological $K$-theory and also in periodic cyclic homology. As a third application, we obtain a description of the different equivariant cohomology groups in the literature (motivic, $l$-adic, morphic, Betti, de Rham, etc) in terms of derived completion. Finally, in two appendixes of independent interest, we extend a result of Weibel on homotopy $K$-theory from the realm of schemes to the broad setting of quotient stacks and establish some useful properties of semi-topological $K$-theory.
On Effective Log Iitaka Fibrations and Existence of Complements
Authors: Chen Guodu , Han Jingjun , Liu Jihao
Published: October 2023

We study the relationship between Iitaka fibrations and the conjecture on the existence of complements, assuming the good minimal model conjecture. In one direction, we show that the conjecture on the existence of complements implies the effective log Iitaka fibration conjecture. As a consequence, the effective log Iitaka fibration conjecture holds in dimension $3$. In the other direction, for any Calabi-Yau type variety $X$ such that $-K_{X}$ is nef, we show that $X$ has an $n$-complement for some universal constant $n$ depending only on the dimension of $X$ and two natural invariants of a general fiber of an Iitaka fibration of $-K_{X}$. We also formulate the decomposable Iitaka fibration conjecture, a variation of the effective log Iitaka fibration conjecture which is closely related to the structure of ample models of pairs with non-rational coefficients, and study its relationship with the forestated conjectures.