bluuebunny/crossref_metadata_2025 huggingface dataset:
What matters most to healthy older adults in treatment decision making: a discrete choice experiment
Authors: Hanewinkel V , van der Wal-Huisman H , Festen S , Schuurmann R , van Leeuwen G , Kooijman M A , Nogarede M , van Leeuwen B , Brandenbarg D
Published: October 2024

Introduction

Shifting to a patient centered approach is crucial for a sustainable healthcare system. Understanding individuals’ priorities is essential for personalized care, especially in critical illness. Treatment decisions are often aimed at disease-specific outcomes such as life extension or survival, while patient-specific outcomes like maintaining independence may be equally vital. How healthy older adults prioritize treatment outcomes in case of a critical illness is currently unknown. Enhanced insight into their priorities can refine healthcare policy, for more personalized care. This study investigated outcomes (attributes) prioritized in hypothetical decision-making by healthy adults over 50 yr.

Methods

We conducted a Discrete Choice Experiment with individuals aged ≥50, comparing six pairs of hypothetical treatments with five attributes: life expectancy, independence, pain, memory complaints and societal costs. Attribute utility was analyzed using a conditional logit model, and latent class analyses were employed to explore preferences in groups.

Results

In 333 participants (mean age 70 +/- 7.7) all attributes emerged as impactful with independence being strongest (p < 0.05). Increased life expectancy had positive utility, but only for a two-year increase. Negative utility was found for all other attributes except mild pain and memory complaints. Latent class analyses identified two groups (22.4% and 77.6%). Group one valued life expectancy more (p .019 vs .940), whereas the second group valued independence (p .058 vs.<.001 and societal costs (p.053 vs. <.001) more.

Conclusions

In a hypothetical case of life-threatening disease, for people aged ≥ 50 life expectancy was not the sole relevant outcome for treatment decisions; pain, independence and societal costs are important and should be discussed in clinical decision making or healthcare policy.

Key messages

• Older adults find patient-specific outcomes relevant for decision making.

• Societal costs are found relevant for decision making for treatment by older adults.
Community mental health care in Croatia: Mobile team for psychosocial support in the community
Authors: Štimac Grbić D , Štrkalj Ivezić S , Ištvanović A , Mužić R
Published: October 2024

The Republic of Croatia has initiated numerous reforms in the mental health care system in the community. Within the framework of EU JA Implement, a mobile team was formed to provide interventions in the community, that is, in the homes of persons discharged from psychiatric hospitals. The mobile team was formed during 2023. The team includes: one psychiatrist, leader and coordinator of the mobile team, three graduate nurses, a case manager, a social worker, three experienced experts who are employed in the team as peer workers, and one social pedagogue and psychologist. The wider composition of the team includes a psychiatrist who provides outpatient psychiatric treatment, who is familiar with the individual recovery plan and, if necessary, participates in the development of the plan. The goal of establishing a mobile team is to implement an individual recovery plan in the community, that is, in the patient’s home, using biopsychosocial interventions, with the aim of better and faster recovery of the user and inclusion in the community, as well as prevention of rehospitalization and disability. Before the patients home visits, the experts in the team were trained. 15 patients were included in the pilot project, with whom 96 home visits or interventions were carried out in the time period from the establishment of the team to April 2024. As a result of the effectiveness of the pilot project, in 2024, in accordance with the Strategic Framework for the Development of Mental Health until 2030, the Republic of Croatia adopted a new network of health institutions, within which 30 mobile psychiatric teams and 24 psychological teams at the primary level of health care are planned. Empowerment of users, engagement of people with experience in the implementation of interventions, increase in mental health literacy of the population and destigmatization are additional results of the implementation of mental health protection in the community through JA impleMENTAL.
Improving cooperation between Hospital and the Community Mental Health Services of Nicosia
Authors: Samartzis L , Chatzittofis A , Paradeisioti A
Published: October 2024

In order to accelerate psychiatric reform in Cyprus we took advantage of JA Implemental during the pilot implementation of Belgium best practices on facilitating the transfer of mental patients from mental hospital to the community mental health services. A multidisciplinary network has been organized between Athalassa Mental Hospital, that is the only mental hospital in the Republic of Cyprus performing 700 patients admissions yearly, and the Community Services of sector 1 and sector 2 of Nicosia Community Mental Services. The network meets regularly in order to facilitate therapeutic culture change in the direction of increasing the percentage of hospital patients that are motivated and prepared to be voluntarily moved for care by the community multidisciplinary teams. This is going to facilitate discharges from hospital, decrease duration of hospitalizations, decrease the frequency of hospitalizations and revolving door readmissions. This increased cooperation is being built on the basis of administrational procedures and clinical protocols that are based on multidisciplinary consensus. The evaluation starts multidisciplinarily in the hospital. A liaison community mental nurse takes part I the evaluation and motivation of the patients before the discharge from the hospital. A written informed consent process takes place in the hospital for the voluntary admission in the community mental health care setting. Also an effort is being made for early written referrals and appointments for community psychiatrist, psychologist, social worker and occupational therapist. This pilot action plan is going to increase cooperation of the mental hospital with the community mental health services, to decrease stigmatization and reform therapeutic culture to the direction of treatment in the community and recovery approach, according to Belgium best practices included in the JA Implemental project.
Differences in the work-family experience of mothers and fathers of a southern European country
Authors: Amaro J , Lucas R , Perelman J , Fraga S , Maia S , Pereira M , Mamelund S E , Matias M , Leão T
Published: October 2024

Background

The intense childrearing years often coincide with the heightened work demands and responsibilities of the career-building years. We aimed to evaluate the association between family-life stage and men’s and women’s experience of work and private demands, and the conflict between these demands.

Methods

We evaluated 3532 mothers and 731 fathers as part of the Portuguese population-based birth cohort Generation XXI (2018-2020). Data on family-life stage (exposure), work demands, private demands, and work-to-family conflict (outcomes) were retrieved at the 13-year follow-up wave, as well as data on sociodemographic and household characteristics. Family-life stage was operationalized according to the age of the youngest child: stage 1 (≤5 years), stage 2 (6-11 years), and stage 3 (≥12 years). Ordinal logistic regression models were used to estimate associations.

Results

Men reported more frequently long working hours, while women spent more time on household and child-related tasks. After adjustment for parents’ and household characteristics, mothers and fathers with younger children were more likely to report spending more time on child-related tasks (ORmothers = 1.83; 95%CI 1.44, 2.33; ORfathers = 2.36; 95%CI 1.41, 3.94), compared to those with older children. Fathers with younger children were also more likely to report spending more time on household tasks (OR = 2.20; 95%CI 1.30, 3.73 for routine tasks and OR = 1.75; 95%CI 1.03, 2.97 for sporadic tasks). Mothers exhibited a significant association between family-life stage and time-based work-to-family conflict when they had younger children (OR = 1.24; 95% CI 1.05, 1.47 for family-life stage 2 and OR = 1.28; 95% CI 1.00, 1.63 for family-life stage 1).

Conclusions

Both fathers and mothers with young children experienced increased private demands, but only mothers experienced work-to-family conflict. This reveals that family and working arrangements remain marked by a gendered pattern against women.
10.Q. Scientific session: Evolving landscape of scientific publishing practices: implications for public health
Authors:   Organised by: EUPHA-EPI,   Chair persons: Stefania Boccia (EUPHA-EPI), Alastair Leyland (EUPHA)
Published: October 2024

In the landscape of scientific publishing, questionable research practices pose significant threats to the integrity and reliability of health research. This is occurring alongside notable changes in both the quantity and quality of published work. This scientific session aims to dissect the implications of such changes and practices on public health, fostering a critical examination and encouraging proactive discourse among public health professionals, researchers, and policymakers. Meta-research can explore the nuances of publishing ethics and the idea behind this session is seeking to heighten awareness of these issues and initiate meaningful discussions among public health professionals on maintaining the integrity of scientific literature in the health domain. The session will delve into the complexities of contemporary publishing, including the proliferation of mega-journals, trends in retracted papers, journals delisted from scientific databases, and the disturbing trend of paper mills which produce fraudulent research papers. Each aspect will be scrutinized for its potential impact on the credibility of health research and the consequential risks to public health. Structured as an interactive panel discussion, the format of this session is designed to maximize engagement and foster an open exchange of ideas. Participants will be encouraged to contribute their experiences and perspectives after each of the three presentations, enriching the dialogue and enhancing collective understanding. The distinct topics presented will underscore the pervasive nature of publishing practices and malpractices across different aspects of health research, highlighting the interconnectedness of ethical challenges and their broader implications. This session will merge meta-research empirical evidence with practical repercussions, offering attendees a comprehensive perspective on how publishing ethics might be shaping public health outcomes. It aims to equip participants with the knowledge to identify dubious practices and advocate for higher standards in scientific publishing. Improving research integrity is a cornerstone for effective health policies and interventions. The subject matter is poised to stimulate debate, invite scrutiny, and inspire action. Through this discourse, the session will articulate key messages about the urgency of upholding ethical standards in publishing to safeguard health research, providing clear, actionable insights for attendees to implement in their respective fields

Key messages

• Unethical publishing practices endanger health research integrity and might have consequences for public health outcomes.

• Acknowledging good publishing practices and combating malpractices will foster higher ethical standards in health research.
11.F. Scientific session: If we build it, will they come? Evaluation of citywide park redesign and renovation in NYC
Authors:   Organised by: Center for Systems and Community Design CUNY (USA),   Chair persons: Terry Huang (USA), Katarzyna Wyka (USA)
Published: October 2024

Urban environments, such as parks, play a crucial role in shaping the health of their residents. However, the relationship between parks and health remains inconclusive. This workshop will present findings from the Physical Activity and Redesigned Community Spaces (PARCS) Study that examined the community health impacts of the Community Parks Initiative (CPI), a citywide park equity initiative of the New York City Department of Parks and Recreation (NYC Parks) that led to citywide park redesign and renovation across 67 low-income neighborhoods in NYC. Using a quasi-experimental design with socio-demographically matched control parks, we evaluated longitudinal changes in park use, physical activity, and psychosocial well-being as a result of CPI. There will be a total of 3 presentations. The first presentation will focus on the impact of CPI on park use before and after park renovation, relative to control parks, using data collected from the System for Observing Play and Recreation in Communities (SOPARC). Results showed that CPI led to a significant net increase in park use, especially among adults. The second presentation will report on changes in perceived stress pre- and post-renovation among adults. Results showed that a greater decrease in perceived stress was associated with a sustained high or increased park use frequency in the context of high-quality CPI intervention parks. In contrast, the same association was not found in lower quality control parks. The third presentation will showcase a study that demonstrated a significant increase in children’s physical well-being, a dimension of quality of life, at CPI vs. control sites. The analysis also showed that children in the lowest socio-economic group might have benefited the greatest from CPI. PARCS is one of the largest intervention studies on the effects of park renovation on health. This workshop will engage participants in considering how these insights can be translated into actionable programs and policies in service of community health and health equity. Findings from PARCS will help inform future public health and urban planning interventions in the use of the built environment to promote population well-being.

Key messages

• Urban park renovations may contribute significantly to community health, demonstrating a vital link between the built environment and public health.

• Investments in green spaces may enhance the physical and mental well-being of low-income urban communities, promoting social equity.
Vaginal self-sampling for HPV in the context of cervical cancer screening
Authors: Springe L , Kivite-Urtane A , Poplavska E , Zodzika J , Berza N , Bukova-Zideluna A , Curkste A , Parna K , Uuskula A
Published: October 2024

Background

Effective cervical cancer screening programme has the potential to improve disease outcomes, yet women’s participation rates in Latvia remain suboptimal. Utilizing vaginal self-sampling for HPV, a convenient method, has demonstrated efficacy in boosting participation in under-screened populations. We analysed sociodemographic factors, as well as health behaviours with the preference for vaginal self-sampling procedures for early detection of cervical cancer.

Methods

Cross-sectional survey (2021-2022) included 1313 women in Latvia. Sampling was done in the colposcopy clinic and among GP practices. In the univariate analysis cervical cancer examination preference (self-test or by a physician) was analysed in association sociodemographic factors, participation in the screening, HPV status, study group, and health-related behaviour. Financed by “Internal consolidation of RSU and external consolidation of RSU with LSPA” (No. 5.2.1.1.i.0/2/24/I/CFLA/005), The EU Recovery and Resilience plan and the state budget, Grant Nr. RSU-PAG-2024/1-0016.

Results

48.6 % (n = 538) of the women would prefer to use a vaginal self-test. Higher odds of the vaginal self-test preference were observed among Latvian (OR = 1.4 (1.1-1.8) vs other nationality women, but no other sociodemographic factors showed statistically significant associations. Women in the colposcopy study group (vs GP practices) were more likely to utilize self-sampling (OR = 1.8 (1.4-2.5). Non-participation in cervical cancer screening was related to 2.4 (1.6-3.6) higher odds of self-test preference, but knowledge about screening was related to 1.5 (1.1-2.0) times higher odds. Women who were HPV-negative were more likely to prefer vaginal self-test for HPV (OR = 1.4 (1.1-1.8) in comparison to HPV-positive women. Health-related behaviour did not show any associations.

Conclusions

Vaginal self-test for HPV can be effectively used to reach under-screened populations and enhance cervical cancer screening coverage.

Key messages

• The implementation of vaginal self-sampling for HPV testing has the potential to improve participation rates in cervical cancer screening programs among under-screened populations.

• Outreach and education activities tailored to specific target groups in population could enhance level of the cervical cancer screening uptake.
Urinary artificial sweeteners and breast cancer risk in women from the Moli-sani Study
Authors: Bonaccio M , Di Castelnuovo A , Costanzo S , Martinez C F , Ruggiero E , Troisi J , Cerletti C , Donati M B , de Gaetano G , Iacoviello L
Published: October 2024

Background

Artificial sweeteners (AS) are chemical substances developed by the food industry to reduce sugar and calories while maintaining sweetness. Cohort studies suggested an increased risk of certain cancers, including breast cancer (BC), associated with AS intake, however evidence exclusively relied on self-reported dietary data rather than objectively measured AS. We examined the association of urinary biomarkers denoting AS intake with BC risk in women from the large Moli-sani Study.

Methods

Using a case-cohort design, a sample of 987 middle-aged women (mean age 55±12 y) was randomly selected as sub-cohort and compared with 273 women with incident BC (26 of them also belong to the sub-cohort). A total of 6 commonly used AS (i.e. aspartame, acesulfame, saccharine, sucralose, cyclamate, and steviol glycosides) were measured through liquid chromatography-mass spectrometry in urinary samples (creatinine-adjusted concentrations; µg/mg) collected at baseline (2005-2010). The multivariable hazard ratios (HRs) were estimated through Cox regression models using the Prentice method, where each AS was dichotomized as absence/presence, independent of concentrations.

Results

The main urinary AS was saccharine (E954), contributing to 71% of total AS, followed by steviol glycosides (E960;11%). During a median follow-up of 13.2 y we identified 38 premenopausal and 235 postmenopausal incident BC cases. In multivariable-adjusted Cox analyses, none of the individual AS was associated with overall BC risk, nor was the total urinary AS (HR = 0.93; 95%CI 0.63-1.37 for 1-unit increment). Compared to absence, presence of sucralose (E955) in urine was linked to premenopausal BC (HR = 4.23: 95%CI 1.23-14.51; p = 0.022).

Conclusions

Urinary artificial sweeteners were not associated with BC risk. However, sucralose presence in urine was linked to a higher risk of premenopausal BC. Prospective, dose-related studies with larger sample size are warranted to possibly confirm our findings.

Key messages

• The presence in the urine of commonly used artificial sweeteners was not associated with breast cancer risk.

• Presence of urinary sucralose was linked to higher risk of premenopausal breast cancer.
The influence of living environments on subjective health literacy in fourth-graders in Germany
Authors: Bollweg T , Okan O
Published: October 2024

Background

Evidence suggests that worse family affluence is related to low health literacy in children. Still, for the targeted promotion of health literacy, a more nuanced understanding is needed of how living environments affect health literacy in early life. This study explores the relationships between health literacy and indicators of living environments in the neighborhood and at home.

Methods

A representative sample of 4th-graders (age 8-11) was surveyed from Oct. 2022 to Feb. 2023 in North Rhine-Westphalia, Germany. We included the HLS-Child-Q15 to assess subjective health literacy, 4 items about the neighborhood (e.g., “neighborhood is a good place to play outside” or “I often see people smoking in the neighborhood”), and 4 items about home (e.g., “there’s always fruit and vegetables at home” or “it’s important to my parents that I exercise”). The tendency to answer in a socially desirable way was controlled for with a validated scale. Likert-scale items were dichotomized for use in linear regression.

Results

n = 1085 students are included, 50.3% are female. The mean age is 9.5 years (SD=.6). The regression model explains 17.8% of variability in health literacy (corr. R²). Significant (p<.05) predictors for high health literacy were birthplace (Germany, not Germany), agreement to the statements “I often see people exercising in my neighborhood”, “my parents can answer all my question about health”, “there’s always fruit and vegetables at home”, “it’s important to my parents that I exercise”, but also social desirability scores. Family affluence was not a significant predictor.

Conclusions

In this sample of 4th-graders, subjective health literacy could not adequately be explained by family affluence. Indicators of living environments seem to be better suited to explore variability in health literacy. These findings can be used to explore entry points for the promotion of health literacy early in life and to identify groups at risk for low health literacy.
Cancer screening and surveillance bias
Authors: Tancredi Stefano
Published: October 2024

We will discuss the issue of surveillance bias, which arises when differences in the frequency of cancer are due to changes in screening and detection strategies rather than to differences in the true occurrence of cancer (2). This bias hampers the surveillance of scrutiny-dependent cancers, such as thyroid and prostate cancers and melanoma, leading to misinterpretations of cancer trends. Moreover, it can lead to the misinterpretation of potential risk factors for cancer occurrence, such as socioeconomic status.
Measuring communicative health literacy – a revision of the HLS19-COM-P scale
Authors: Finbråten H , Arabska Y , Bíró É , Charafeddine R , Kučera Z , Mancini J , Ochaba R , Schuetze D , Unim B , Bøggild H
Published: October 2024

Background

Communicative health literacy (COM-HL) is important for patients being able to actively participate in communication with health care professionals, such as physicians. The HLS19-COM-P scale was developed for measuring COM-HL in the M-POHL HLS19 survey. However, two items under-discriminated according to the Rasch model and the item set did not sufficiently capture the aspect of appraising health information. Consolidating both a long and short version into a single scale was deemed appropriate. Hence, this study aimed to develop a revised version of the COM-HL scale.

Methods

The revision and development of new items followed a Delphi process. Items that worked well psychometrically in the six-item version of the HLS19-COM-P were kept, and new items concerning appraising information were developed. The revised version of the scale has so far been translated into nine languages (BG, CZ, DE, FR, HU, IT, NO, SK, UA). Challenging translation terms underwent multiple discussions to ensure language consistency. The interpretability of items has been explored in cognitive interviews in six countries (AT, CZ, HU, IT, SK, and UA) so far. Items that were difficult to understand were revised and tested in new interviews. The evaluation of the scale’s psychometric properties is scheduled for May and June 2024.

Results

The revised scale consists of eight items - two items for each of the cognitive domains of accessing, understanding, appraising, and applying health information. One item in each of these domains focuses on the interactive aspect of communication. An instruction for translation of terms that were challenging to translate has been developed. Overall, the revised HLS19-COM-P was well accepted in the cognitive interviews. Results from the quantitative testing will be presented.

Conclusions

The adapted HLS24-COM-P scale developed for the M-POHL Health Literacy Survey 2024-2026, is a short and conceptually sound instrument for measuring COM-HL.
Implementation of polygenic risk scores in secondary prevention of (breast) cancer
Authors: van Rooij J
Published: October 2024

Utilizing polygenic risk scores to inform secondary prevention of breast cancer via population screening programs is one of the pioneering applications of genomics in public health applications. Over the last decade, polygenic risk scores for breast cancer have been developed and validated in various European populations (AUC ± 0.63, OR per Z unit ± 1.6, depending on the population). In some countries, the polygenic risk score has been integrated with decision modeling tools, such as CanRisk in the Netherlands, and low-level implementation into health and care systems has started. Implementation strategies vary, but generally consider initial implementation into high-risk populations, such as breast cancer families, in specialized clinical setting, such as academic medical centres, or specialized cancer clinics, referring relatives of patients to population screening based on comprehensive risk modelling, including polygenic risk scores. This route may be followed by other disease fields as well. The presentations outlines the current evidence and considerations on breast cancer genetic risk modelling, clinical pilot studies and the outline of step-wise implementation of such models to benefit secondary prevention programs. We start from the perspective of a single hospital, to the needed steps to upscale to national populations, both in diversity of these populations, as the throughput of genetic testing and counselling, until the harmonization and recalibration of various European healthcare models. We draw from examples of the Genotyping on all patients (GOALL), building cancer health platforms (CanHeal) and Genome of Europe (GoE) consortia.
Food poverty as a barrier for a healthy and climate-friendly nutrition in Austria
Authors: Lampl C , Schmidt A , Aigner E
Published: October 2024

Background

The food system plays a crucial role in promoting healthy and climate-friendly living. One fundamental aspect is accessibility. However, in Austria, there is a lack of systematic and regularly conducted studies on food system accessibility. To address this gap, a comprehensive study on food poverty has been conducted for the first time in Austria.

Methods

We used a mixed methods approach, combining expert workshops, a representative questionnaire survey (n = 2004) using the Food Insecurity Experience Scale (FIES), and focus groups (n = 20) with affected individuals.

Results

Approximately 12 percent of people living in Austria are affected by moderate and/or severe food poverty. These individuals struggle to afford sufficient quantities and quality of food due to financial constraints or limited access in general. Over four percent experience severe food poverty, leading to skipped meals or even days without food. People affected by food poverty would like to focus more on healthy shopping and quality of food (prioritizing fresh food over cheap high-processed food). The biggest hurdles relate to a lack of financial resources, too little time and a lack of affordable (healthy and climate-friendly) options.

Conclusions

Food poverty is a phenomenon in Austria that has received little attention to date. Public discourse often attributes nutritional problems to information gaps or individual competence, neglecting the impact of structural conditions. Addressing food poverty requires holistic approaches that avoid stigmatization. Recognizing it as a social, health, climate, and agricultural policy concern necessitates robust monitoring and considering the social and environmental aspects of nutrition holistically.
Review of national rare disease strategies: innovation driving change
Authors: Power V , Norris M , Swanton D , Reidy E , Spillane S , Ryan M , O’Neill M
Published: October 2024

Background

A rare disease affects fewer than 5 in 10,000 people. More than 6,000 known rare diseases affect up to 6% of the European population. A national rare disease strategy sets out a country’s plan to reduce disease burden and improve quality of care for people with rare diseases. This review, requested by the Department of Health in Ireland to inform a new national strategy, described national rare disease strategies in 13 selected countries.

Methods

Strategies published from 2013 to 2023 were identified via online searches for Austria, Australia, Denmark, England, Finland, France, Germany, Ireland, the Netherlands, Northern Ireland, Portugal, Scotland and Wales. National representatives were contacted to confirm the identified resources. Data were extracted for the domains of: aims, priorities, implementation, governance and funding models. Descriptive analysis and narrative synthesis was undertaken.

Results

Improving treatment and coordination of care was a common overall aim. Priorities noted in all strategies were: screening and diagnosis; access to healthcare and coordination of services; rare disease research; and patient representation and empowerment. Implementation details varied to reflect the national context and time of strategy development. More recently-developed strategies included more precise actions and greater emphasis on innovations in genomics than older strategies. Strategies were developed, implemented, monitored and evaluated via combinations of newly-established bodies and or existing health authorities. Six countries did not specify a funding model or dedicated budget for strategy implementation.

Conclusions

National rare disease strategy contents and implementation approaches varied between countries and reflected innovations over time. This review will inform the development of Ireland’s new national rare disease strategy.

Key messages

• This review provided insights into national rare disease strategies over a 10-year period.

• The findings will inform strategy development in Ireland, and are relevant to other countries.
The impact of tobacco retailers density reduction on smoking status of Belgian adults
Authors: Croes S , Guariguata L , Devleesschauwer B , Gorasso V
Published: October 2024

Background

Smoking being one of most impactful risk factors for causing non-communicable diseases (NCD) and consequently attributable death, represents an enormous public health issue. New policy interventions aimed at reducing smoking prevalence are planned in the Belgian Tobacco Free Generation plan. Within the plan, it is aimed to reduce the number of outlets that sell tobacco products, as a higher tobacco retail density (TRD) is believed to be linked to higher smoking prevalence. Using health impact assessment (HIA), this study aims to evaluate the policy before it is set in place.

Methods

For this intervention a 17% reduction in density was estimated according to the scoping review would be associated with an 0.39 percentage point reduction in prevalence. The Potential Impact Fraction (PIF) was calculated to assess the change in proportion of current smokers. Time series and projections of the Belgium Health Interview Survey provided data on the smoking status from 1997 untill 2040. The relative risk were retrived from the Global Burden of Disease 2021 study. Using data from the Belgian Burden of Disease Study, the avoidable burden was estimated.

Results

The policy is expected to reduce the density by 17 % by 2025, which results in a PIF for lung cancer of 0.92%, decreasing to 0.82% in 2040. The smoking prevalence would decrease from 12.62% to 12.23%. We estimated that this intervention would avoid the burden of more than 300 lung cancer cases and around 100 deaths in 2040.

Conclusions

The HIA in this study suggests that reducing TRD has a potential to contribute to achieving the objectives in Tobacco Free Generation plan. However, it should be noted that the impact is rather small, lower than 1% for most diseases. In addition, the actual impact may vary depending on the specific implementation of the policy and future smoking trends. Further research is needed to refine the effect size estimate based on the actual policy intervention details.

Key messages

• Reducing tobacco retail density can reduce the burden of smoking.

• Modeling limitations need further research to refine HIA results.
Heterogeneous courses of cardiovascular disease incidence in Europe 2000-2019 – what are the causes?
Authors: Stolpe S , Stolpe S
Published: October 2024

Background

Data from the Global Burden of Disease (GBD) project distributed by the Institute for health metrics and evaluation (IHME) include incidence and prevalence data for almost all countries in the world. In course of own research, the data on cardiovascular disease (CVD) incidence in Western European countries were analysed and revealed great variation in the course of CVD incidence, that is difficult to interpret. We want to present the different courses of CVD incidence for selected countries and discuss possible reasons for this diversity with the audience.

Methods

GBD data on CVD incidence and mortality for 25 European countries from 2000-2019 for men and women were to graphically display courses of CVD incidence for visual analysis.

Results

The course of CVD incidence in Western Europe is country-specific - and, within a country, even sex-specific. Yet, in many countries besides the Baltic states and Czechia, CVD incidence reaches a minimum in 2010, increasing afterwards again. Different patterns of incident courses were visible:

a) wave-shaped courses which increase e.g. in Austria, Belgium, France and in males in Finland only, but decrease for both sexes Germany, Norway, Portugal and Poland, and in males in Denmark

b) u-shaped courses in Spain, Great Britain, France, Italy, and for Finnish and Dutch females

c) linearly increasing for both sexes in Czechia, the Baltic states and in Swiss males

d) linearly decreasing for women Norway, Belgium, Denmark and Austria.

Conclusions

The patterns of CVD incidence in Europe are multitude and country-specific even between sexes, reaching a minimum in 2010 in most countries. The validity of analyses combining these different patterns for regional analyses of CVD incidence such as in GBD reports do not take account for this diversity. Unless these differences can be explained by country-specific prevention or risk factor profile, the validity of data on CVD incidence seems to be limited.

Key messages

• CVD incidence in Europe between 2000 and 2019 is country-specific changing and very heterogeneous.

• Analyses summarizing data for (Western/Eastern) Europe will miss this heterogeneity and might come to invalid conclusions regarding the development of CVD incidence.
A Delphi method approach to consensus - based translation of ‘Second Victim’ definition into German
Authors: Roesner H , Klemm V , Strametz R
Published: October 2024

Background

Healthcare providers involved in unanticipated adverse patient events, unintentional healthcare errors, or patient injuries, and who become negatively impacted, are defined as ‘Second Victims’. The term Second Victim has gained substantial attention since its inception around 2000, yet lacks a standardized definition in the German context. This study addresses this gap by proposing a consensus-based translation of the term into German, aiming to foster understanding and facilitate research comparability.

Methods

A Delphi method approach was employed, engaging a panel of German-speaking, clinically and scientifically active Second Victim experts. The study was conducted using an online survey and commenced with the reference of the consensus- and evidence-based definition from the European Researchers’ Network Working on Second Victim (ERNST) published in 2022.

Results

Nine out of eleven invited experts participated in the study, contributing to a robust consensus-building process. Through three Delphi rounds, a consensus rate of 90% was attained for the translation of the international definition of a Second Victim. The resulting definition provides a comprehensive understanding of the term within the German context.

Conclusions

This Delphi study establishes a formal consensus among recognized experts, delivering a German-language, evidence-based definition of the term Second Victim. It serves as a crucial foundation for understanding and further researching the Second Victim phenomenon within the German-speaking healthcare community.

Key messages

• Consensus-based German translation of Second Victim enhances clarity in healthcare discourse.

• Delphi method with German experts yields unified definition, promoting the coherence of patient safety research.
Effect of sustainable food habits on gut microbiota diversity: A pilot study
Authors: Tillander A , Halling Ullberg O , Toivanen S , Bälter K
Published: October 2024

Background

To reach climate goals, sustainable food habits are needed and a plant-based diet is more climate-friendly. However, analyses of food products show that the highest levels of pesticide residues have been found in vegetables, fruits and cereal. Further, pesticide residues have been seen to decrease microbiota diversity. Since microbiota diversity is linked to human health, understanding these dynamics is crucial. This study aimed to evaluate the effect of sustainable food habits on gut microbiota diversity.

Methods

An 8-week intervention study on sustainable food habits with participants randomized into three groups and assigned to different diets; climate friendly (n = 8), organic (n = 9) and control group (n = 9). Data was collected at baseline, at 4 weeks, and at 8 weeks and included a comprehensive meal questionnaire (Meal-Q), urine samples for pesticide analysis, and fecal samples for gut microbiota diversity. As intervention the groups attended four educational sessions about their specific diet. Linear mixed-effects models were used for data analyses.

Results

There was no indication of adverse effects of a climate friendly diet (p = 0.79) or an organic diet (p = 0.32) on gut microbiota diversity compared to the control group. Pesticide residues that showed negative effects on gut microbiota diversity were mepiquat (p < 0.05) and chlormequat (p < 0.05). The single food items that had adverse effects on gut microbiota diversity was Lemonade (p < 0.05), Juice (p < 0.05), and Brie cheese (p < 0.05).

Conclusions

Despite its small sample size, this study provides valuable insights, supported by an 8-week longitudinal design and comprehensive monitoring of dietary habits. Notably, both climate-friendly and organic diets showed trends toward increased gut microbiota diversity over time. These findings need to be confirmed in future studies with longer durations and larger sample size.

Key messages

• A climate-friendly diet not only benefits planetary health but also holds potential for individual health improvements.

• Increased intake of plant-based items did not reduce gut microbiota diversity.
Mental health problems identified in early school age and later mental health problems and disorders
Authors: Pant S W , Pommerencke L M , Jørgensen S E , Skovgaard A M , Pedersen T R , Madsen K R
Published: October 2024

Background

Poor mental health in childhood and adolescence youth is an important public health challenge. We aimed to examine the prospective association between mental health problems among primary school children and later diagnosed mental disorders and mental health problems in youth.

Methods

A prospective cohort study of children participating in school health nurse examination during first years of primary school (approx. 6 years) in 17 municipalities in the capital region of Copenhagen, Denmark, with follow-up until their 16th birthday. Baseline data included information from national population registers and school health nurse records. Outcome variables: mental disorders diagnosed at hospital from approx. age 6 until 16 years (N = 6,930) and school health nurse records of mental health problems at approx. age 16 (N = 11,250).

Results

Problematic relations to peers in early primary school was associated with later neurodevelopmental disorders, including intellectual disability, autism-spectrum disorder and disorders of hyperactivity and inattention (AOR=4.14, 95% CI 2.15-7.97), and poor home related well-being in youth (AOR=1.67, 95% CI 1.02-2.74). Poor school well-being in early primary school was associated with poor school well-being ten years later (AOR=1.67, 95% CI 1.19-2.34) as well as problematic relations to peers (AOR=1.83, 95% CI 1.08-3.10). Further poor general well-being in early primary school was associated with problematic relations to peers in youth (AOR=2.21, 95% CI 1.17-4.18).

Conclusions

School health nurses identify a group of children in the early years of primary school with mental health problems and an increased risk of later mental health problems and disorders, and therefore they play an important role in the early identification of children at risk.

Key messages

• Children with problematic relations to peers have up to a fourfold increased risk of later mental disorders.

• The school health nurses play an important role in the early identification of children at risk of later mental health problems.
Risk Profiles of Avoidable and Unavoidable Hospitalizations: a Swedish population-based study
Authors: Gentili S , Locatelli G , Bellocco R , Calderón-Larrañaga A , Rizzuto D , Lennartsson C , Hedberg Rundgren Å , Fratiglioni L , Vetrano D L
Published: October 2024

Background

Older adults frequently experience multiple hospitalizations, owing to their complex health and social needs. This study aims to comprehensively characterize the risk factors associated with avoidable and unavoidable hospitalization among older adults. Specific emphasis is placed on avoidable/unavoidable hospitalization originating from chronic or acute causes.

Methods

Data on 3,166 individuals aged ≥60 years were obtained from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), linked to the Swedish National Patient Register. Multistate models were used to investigate the risk profiles of participants experiencing their first and recurrent hospitalizations over 15 years. The Swedish National Board of Health and Welfare criteria were used to define avoidable/unavoidable hospitalizations.

Results

Women had a lower hazard of avoidable hospitalizations for chronic conditions as well as unavoidable hospitalizations (HR range 0.46-0.84). However, receiving informal care was associated with 88% increased hazard of avoidable hospitalizations due to chronic causes (95%CI 1.18-2.99), while receiving formal care was associated with 44% increasing hazard of avoidable hospitalization due to acute causes (95%CI1.04-1.98). Factors such as slow walking speed, multimorbidity, and polypharmacy were associated with a high risk of avoidable hospitalizations due to both acute (HR range1.27-3.03) and chronic (HR range1.63-2.54) causes.

Conclusions

Both clinical and functional factors have emerged as key predictors of avoidable hospitalization, underscoring the importance of comprehensive risk assessment and proactive healthcare management strategies to reduce the burden of hospital utilization in older adults.

Key messages

• Targeted interventions are essential to improve healthcare outcomes among older adults at risk of avoidable hospitalizations due to chronic and acute conditions.

• The study identified predictors such as slow walking speed, multimorbidity, and polypharmacy, underscoring the need for comprehensive risk assessment to prevent avoidable hospitalization.
Mortality related to different circulatory diseases: a multiple causes of death analysis, 2008-2022
Authors: Fedeli U , Casotto V
Published: October 2024

Background

Mortality from circulatory diseases significantly increased in 2020 compared to pre-pandemic years in many countries. However, data were mostly limited to the underlying cause of death and to the first phases of the pandemic. Analyses of any mention of a disease in death certificates (multiple causes of death approach, MCOD) are more robust to changes in coding rules/practices and to the role of COVID-19 as a competing cause of death.

Methods

Mortality records were extracted from 2008 to 2022 among residents of the Veneto Region (Northeastern Italy, 4.9 million population). Based on MCOD, age-standardized mortality rates (2013 European standard) were computed for ischemic heart diseases (IHD), cerebrovascular diseases (CVD), atrial fibrillation (AF), and hypertensive diseases (HD). The annual percent change (APC) was estimated through the pre-pandemic period (2008-2019), and change in rates during pandemic years were computed compared to 2019.

Results

Before the pandemic, rates were steeply declining for IHD (APC -5.1%; 95%CI -5.5, -4.6) and CVD (-4.0%; -4.4, -3.5); mortality related to HD reduced at a slower pace (-1.9%; -2.3, -1.4), whereas AF-related mortality was increasing (+1.0%; 0.1, 1.8). During the first year of the pandemic, the growth in mortality compared to 2019 was +26% for HD, +18% for AF, +13% for CVD and +12% for IHD. In 2021-2022, rates for CVD and IHD returned to pre-pandemic levels; rates for HD reduced with respect to 2020 but remained above the baseline; AF-related mortality was still increasing.

Conclusions

The pandemic differentially impacted mortality associated to different circulatory diseases, depending on pre-existing long-term trends (increasing for AF) and on susceptibility to severe COVID-19 disease (higher for HD). Continuous surveillance based on MCOD is warranted to properly assess changes in mortality associated to specific circulatory diseases after the end of the pandemic.

Key messages

• Multiple causes of death analyses are warranted to assess how the pandemic affected pre-existing long term trends in cause-specific mortality.

• Mortality related to different circulatory diseases increased in 2020, but pre-pandemic trends, the extent of the increase in 2020, and further changes observed in 2021-2022 largely diverged.