bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a low-cost, at-home device for early detection of chronic kidney disease
Authors: Valencia Rivero K , Muñoz Pinzón D , Caviativa Castro Y , Jaramillo Guzmán V , Álvarez Salazar C , Perea Rodríguez R , Sánchez Güette L , Valero Inerarity A , Hernández Garay A , Cruz Quiroga L
Published: October 2023

Chronic kidney disease (CKD) is classified according to patient's kidney state and functionality. Stage 1 represents the initial renal damage, maintaining normal function, while Stage 5 indicates end-stage of CKD, marked by renal insufficiency and the need for dialysis or transplant. Patients in the early stages of CKD may be asymptomatic, but may experience symptoms as fatigue, weakness, and a general feeling of unwellness as the disease progresses, making diagnosis accessibility an essential aim of the health system. A low-cost and home-based device accompanied by a mobile app were developed as an early indicator of CKD, using colorimetry to determine the creatinine levels and chromogens in urine deposited in the device, designed using a solution of picric acid, sodium lauryl sulphate, borate solution, and sodium hydroxide. A range of chromogens was assigned to creatinine concentrations, calibrated by analysing diluted creatinine samples in triplicate, taking 1.2 ml of the sample and adding defined amounts of alkaline picrate according to the calibration curve. The absorbances were recorded at 45, 60, and 180 seconds for each of the creatinine samples combined with alkaline picrate in the creatinine analysis. Finally, the curves corresponding to each time were compared, providing a final absorbance to each creatinine level by subtracting the blank curves’ values. The chromogen is obtained according to the patient's health status, and compared in a database in the application, displaying the possible health status of the kidneys, without providing a diagnosis, but rather an early alert of the kidneys state and approximate glomerular filtration rate. The device has the potential to offer an early diagnosis accessible to all population with a history or risk of CKD. Early detection of CKD may improve patient health through frequent medical appointments, medication, dietary restrictions, and lifestyle changes.

Key messages

• Early stages of CKD can go unnoticed by patients and physicians, making early diagnosis a valuable tool.

• At-home health devices can be designed for the early detection of CKD.
Increased temperatures and child health outcomes: a systematic review
Authors: Faurie C
Published: October 2023

Background

Increased ambient temperatures and extreme heat events are well-established risk factors for increased mortality and morbidity. Most studies to-date have focused on the effect of high temperature on adult populations. However, the paediatric population is vulnerable to increased temperatures, due to a combination of physiological and social vulnerabilities characteristic of children. This presentation will present the findings of a systematic review and meta-analysis on increased heat and childhood health risks.

Methods

A literature search was carried out of three scientific databases: Pubmed, Embase, and SCOPUS. The data was pooled and summarised in statistical meta-analysis, and presented as relative risk (RR) scores. Subgroup analyses by disease category, gender, and climate group were carried out. Studies not meeting criteria for statistical meta-analysis were summarised in narrative review.

Results

There is evidence that increased heat increases all-cause mortality in the paediatric population. Increased heat is a risk factor for morbidity throughout the childhood years, from increased rates of preterm birth, to increased adolescent mental health presentations. There is evidence that heat increases the risk of SIDS, respiratory, heat illness, renal disease, mental health, and infectious diseases in children. The majority of studies which quantified the relationship between increased heat and illness do not separate children from adults in statistical analyses.

Conclusions

There is a substantial body of evidence demonstrating that children have higher rates of morbidity and mortality as a result of higher than usual temperatures. Further research is required into the effects of global warming on child health, and more research is needed to establish protective factors. Researchers in environmental health should consider sub-group analyses on children to identify risks particular to this vulnerable population

Key messages

• Children are at increased risks of multiple diseases in hot temperatures or heatwaves.

• More research is needed into the unique impact of climate change on children.
Heat exposure and heat stress in outdoor workers: a review of measures in published studies
Authors: Estephan C , Fakih L , Nuwayhid I , Habib R R
Published: October 2023

Background

Increased ambient air temperatures resulting from climate change led to higher heat levels for outdoor workers. Heat exposure refers to ambient environmental heat exposures; while heat stress also considers the clothing type and the metabolic rate resulting from physical activity. We reviewed the types of heat exposure/stress measures used in published studies.

Methods

A literature review was conducted to identify and examine measures of heat exposure and heat stress in outdoor workers.

Results

The most common indices measuring heat exposure/stress in occupational health include the Wet Bulb Globe Temperature (WBGT), Environmental Stress Index (ESI), Heat Index (HI), Humidex (HD), and Discomfort Index (DI). HI, HD and DI account for ambient air temperature and relative humidity surrounding workers. WBGT accounts for air temperature, radiant temperature, humidity, speed of air movement, and adjusts for clothing and metabolic rate. ESI considers factors like WBGT except for speed of air and does not account for clothing and metabolic rate. Both ESI and WBGT fail to consider the risk of dehydration resulting from excessive sweating in hot work environments. HI, HD and DI measure heat exposure but not heat stress as they do not account for the metabolic rate; also, they do not consider radiation and may underestimate the potential danger of working in excessive heat. These indices are considered simpler to use than WBGT. However, WBGT is more precise and covers environmental factors influencing heat exposure/stress. Questionnaires are also used to assess workers’ perceptions of heat exposure and self-reported health impacts. Their findings, in general, have not been comparable due to the heterogeneity of questions used.

Conclusions

Although WBGT is recommended for accurate measures of heat exposure/stress, its high cost has been a deterrent for workplaces in low-income countries. Projects with low financial resources opt for simpler and cheaper measures of heat.

Key messages

• The use of reliable devices is necessary to measure and monitor heat exposure in outdoor work.

• It is desirable to generate homogenous results for the comparability of study findings in occupational health research.
Health Literacy of a Migrant community in Portugal on environmental health risks
Authors: Machado R , Garcia M , Serra I , Tiago V
Published: October 2023

Background

Social, cultural and environmental factors are crucial for the health of migrants. Health Literacy is a fundamental contribution, giving them greater capacity and making it possible to reduce health inequalities. The aim of this study was to characterize the perception and behavior of a migrant community residing in Portugal, in view of the health risks resulting from the environmental conditions in which they live, and to identify their level of Health Literacy.

Methods

Cross-sectional, descriptive, exploratory study. Data collection was obtained through the application of the “Health Literacy Questionnaire” (Osborne, 2013), complemented with sociodemographic and environmental indicators referring to the physical space and social context of residence. The questionnaires were applied to a sample of the population, coming from Portuguese-speaking African countries, with 101 participants. Data analysis involved measures of descriptive and inferential statistics.

Results

Of the data obtained, 77.2% reported having problems with humidity in their homes, with poor behavior in terms of heat (64.4%) and cold (90.1%). 76% reported insect and rodent infestations inside their homes. The presence of stagnant water (43.6%), organic waste (29.8%) and poor electrical networks (26.9%) were the main environmental problems identified. About Health Literacy, “Feeling understood and supported by health professionals’ and “Finding good health information”, registered lower levels, with the remaining ones being generally below the average of the scale. internal consistency ranged between 0.71 and 0.92.

Conclusions

Data analysis showed the precariousness of housing and the inadequacy of support infrastructure, with inherent environmental risks to health. The existence of low levels of Health Literacy was found in most of the domains considered. The results supported and justified the elaboration of a community intervention project with the involvement of local partners.

Key messages

• Knowing the environmental determinants is essential for disease prevention and health promotion.

• Health Literacy is an indispensable vehicle for reducing inequalities in migrant populations.
Tackling climate crisis through systems thinking: PERSIST, a pilot project in an Italian high school
Authors: Zjalic D , Nachira L , Perilli A , Lombardi G S , Cadeddu C
Published: October 2023

Background

The climate crisis is today's most important global health threat. In Europe, the Mediterranean region represents a climate hotspot. Education plays a crucial role in preparing the population for future climate impacts on health: it provides the tools to implement social and individual attitudes for climate change mitigation; it facilitates the development of skills and attitudes for adaptation, and it stimulates critical understanding of climate change.

Objectives

The PERSIST project aimed to improve awareness of the environmental emergency and provide tools to tackle the complex relationships between human activity, climate crisis and health, stimulating pro-environmental behaviours through systems thinking. Three meetings with students from a scientific high school in Rome between March and April 2023 were provided, using systems thinking, group activities and discussions. A pre- and post-intervention questionnaire was administered to measure knowledge, attitudes, and pro-environmental behaviours. The anonymously collected data were processed using descriptive statistics.

Results

Ten classes between 1st and 4th grade took part in the project. The valid responses to the pre- and post-intervention questionnaires were 222 and 211, respectively. The preliminary analysis suggests improvements in knowledge and attitudes and a broad appreciation of the intervention, with 78,1% of students who found the project engaging. There were no changes in the ecological emotions referred by the students.

Conclusions

An interactive approach and the use of complex systems improves students’ knowledge and attitudes towards the climate crisis, without increasing negative ecological emotions. This pilot project can guide similar, repeatable projects in other schools and countries.

Key messages

• Education is fundamental in tackling the health impacts of climate change.

• Training young people on health and climate crisis issues could improve their adaptive capacities.
5 year public health impacts of an urban greenway, Belfast, Northern Ireland: Causal Loop Diagram
Authors: Hunter R , Garcia L , Clewley N , Hafezi M , Hilton J
Published: October 2023

Background

The development of large scale urban green space infrastructure, such as a new urban greenway, provokes a cascade of changes abating a series of public health impacts, in the realms of: health, society, economy and the environment. The relationships between these factors sustain reciprocal and dynamic influence with potential to generate a virtuous cycle. However, such long-term impacts and their inter-relationships are poorly understood.

Methods

We aimed to co-develop a shared understanding of the public health impacts of the Connswater Community Greenway with multi-sectoral stakeholders 5 years post-implementation. Objectives were to (a) build shared understanding of the complex system influencing the public health impact of the Connswater Community Greenway, and (b) identify and explore priorities, opportunities, and actions to improve future impacts. We undertook Group Model Building workshops with people representing relevant stakeholders involved in the development and/or maintenance of the Connswater Community Greenway, and local residents living on or along the greenway.

Results

23 participants were involved in the workshop included local governmental agencies, local residents, advocacy groups, private sector, and researchers. Stakeholders produced a systems map detailing the public health impacts of the Connswater Community Greenway 5 years post-implementation. Key impacts included increased in mental wellbeing, sense of community pride, increased biodiversity, increased economic investment in the local area. Participants identified a range of priority actions that, in their view, could impact and help reshape the system and influence the future impacts of the greenway.

Conclusions

The CLD was reflective of the various stakeholders’ experience, knowledge, perceptions, and views about the factors, and the inter-relationships between these factors, of the public health impact of the Connswater Community Greenway at 5 years post-implementation.

Key messages

• Systems thinking approaches can help identify the public health impacts and plausible causal pathways of green space interventions.

• 5 year impacts of an urban greenway included improvements in the realms of health, wellbeing, the environment, the economy and society.
What health risk factors are brought by the most popular Lithuanian influencers in social networks?
Authors: Basijokas R , Austys D
Published: October 2023

Background

Considering that content created by influencers in social networks might act as risk factor to health, we aimed to assess the prevalence of lifestyle-related risk factors in posts published by Lithuanian influencers on Facebook and Instagram.

Material and methods

All publicly available posts created by 12 most popular Lithuanian influencers on Facebook or Instagram between 1 Jan and 31 Dec of 2022 were included. The content analysis of the posts was performed in the structured manner. Information about foods, smoking, alcohol, physical activity, body type and mental health factors was registered and compared between the networks.

Results

A total number of 4075 posts were analysed. 30% of the posts presented foods. Among these posts, fast food was presented in 8.9%, sweets - in 45%, fried food - in 60%, vegetables - in 67%, fruits and berries - in 45%, cereals - in 44%, milk and dairy products - in 10%, eggs - 3%, meat - in 28%, seafood - in 14% and food supplements - in 1%. Sweets more often were presented on Facebook (15% vs 12%), fast food - on Instagram (4% vs 2%). Alcoholic beverages were presented in 3% of posts, more frequently - on Instagram (7% vs 1%). Smoking was presented in 0.4% of the posts, more frequently - on Instagram (0.8% vs 0.2%). Physical activity was presented in 10% of the posts. Slim body was presented in 2% of the posts, overweight body - in 16%, obese - in 2%. Barely covered body was presented in 10% of posts, more frequently - on Instagram (15% vs 6%). Aesthetic procedures were presented in 31% of posts, more frequently - on Instagram (46% vs 20%). Luxury was presented in 10% of posts, more frequently - on Instagram (17% vs 6%). Bullying was observed in 4% of posts, more frequently - on Facebook (5% vs 3%).

Conclusions

Presentation of fast food, smoking, alcohol, slim body, aesthetic procedures and luxury was more frequent on Instagram, sweets, overweight body, bullying and physical activity - on Facebook.

Key messages

• Both healthy and unhealthy foods are presented with similar frequency on social networks – this might lead to the overconsumption of unhealthy foods.

• Although the prevalence of risk factors was observed on both social networks, some of them were more often in Facebook, some – on Instagram. This should be taken into account during the interventions.
Patients’ attitudes towards remote primary healthcare services in Lithuania
Authors: Kaseliene S , Jankauskaite I , Sauliune S
Published: October 2023

Background

One of the largest changes that had to be implemented in the healthcare system worldwide in response to the COVID-19 pandemic was the introduction and expansion of remote healthcare services. The aim of this study is to evaluate attitudes of patients of primary healthcare institutions to the remote healthcare services in Lithuania.

Methods

A cross-sectional study was conducted in February - March 2023. A total of 313 patients of primary healthcare facilities in Vilnius city (Lithuania) aged 18-75 years were anonymously surveyed (response rate 78.3%). Chi-square and z tests were used to determine a relationship between two categorical variables (α = 0.05).

Results

78.8% of respondents report satisfaction with the quality of remote healthcare services. 74% of did not experience any technical difficulties during their most recent consultation. Most of patients agree that remote healthcare services save time (85.9%) and money (60.7%), as well as reduce the risk of contracting infectious diseases (62%). However, 61.9% of patients believe that remote services may increase the risk of medical errors. 53% believe that the accessibility of healthcare has improved with the introduction of remote services, and 82% of patients think that such services should constitute up to 50% of all healthcare services. Patients believe that the quality of remote healthcare services would improve with the advent of video consultations. Patients’ opinions about remote healthcare services significantly depend on their gender, employment status, and education (P < 0.05).

Conclusions

Patients are satisfied with the quality of remote healthcare services. They have already discovered the benefits of remote healthcare, however, this requires changes to the existing legal framework.

Key messages

• Attitudes of patients towards the integration and quality of remote primary healthcare services are positive.

• According to many respondents, remote healthcare services should make up to 50% of all services provided.
Bringing an EU Joint Action to TikTok: the case of eCAN
Authors: Hermida E P , Hans Cano E , Ela-Aguilar S , Ferro T
Published: October 2023

Issue

The Joint Action (JA) on strengthening eHealth including telemedicine and remote monitoring for health care systems for cancer prevention and care (eCAN) is a project co-funded by the European Union from 2022 to 2024. The Work Package on Communication (WP2) disseminates the JA's activities and outputs. Social media (SM) is one of the pillars of the communication strategy to promote eCAN and engage target audiences. Although the health sector is often present on LinkedIn, Twitter and Facebook, there are few examples of TikTok use in this area, making it difficult to identify role models.

Description of the problem

After reviewing other JA's communication channels, eCAN opens six SM accounts and divides them into two groups: written-content focused (Facebook, LinkedIn & Twitter) and audiovisual-content focused (Instagram, YouTube & TikTok). The TikTok account aims at innovating the way EU initiatives communicate and disseminate results. At the same time, it is meant to try to achieve a broader scope of audiences by exploring original means to reach them.

Results

Main results of eCAN's TikTok account for the period mid-January to mid-April 2023*: Followers: 18; Likes: 181; Comments: 1; Nº of posts: 10; Views: 3.355

* Data to be updated with results up to mid-October at the conference.

Lessons

WP2 faces the barrier of reducing the gap existing in bringing healthcare literacy and scientific accuracy into the much less rigid format TikTok is, particularly regarding cancer and telemedicine outreach. Besides, this social network's rules and algorithms might be challenging in terms of achieving visibility. The success of dissemination strategy depends on an adequate planification of what contents need to be communicated altogether with what the best formats should be used to widen the audiences while maintaining the project's reliability.

Key messages

• The eCAN JA is the first initiative to incorporate TikTok as a platform for disseminating the projects updates, outcomes and issues related to telemedicine, cancer and digital transformation.

• This project explores new tools to be used in the health sector and within EU initiatives for reducing the gap in bringing health literacy and scientific accuracy to broader audiences.
Design of infrastructure for visualising and benchmarking patient data from general practice (CARA)
Authors: Garzon-Orjuela N , Garcia Pereira A , Vornhagen V , Stasiewicz K , Parveen S , Amin D , Porwol L , Vellinga A
Published: October 2023

Background

Patient Management Software (PMS) is commonly used for patient consultations. PMS supports individual patient data storage but accessing and using aggregated information is challenging. CARA set out to provide an infrastructure to enable Irish general practitioners (GPs) to understand their patient population, disease management and prescribing through dashboards. This paper explains the design and development of the CARA infrastructure.

Methods

The first exemplar dashboard focused on antibiotic prescribing to develop and showcase the proposed infrastructure. The data integration process involved extracting, loading and transforming de-identified patient data into data models. These, in turn, feed the interactive dashboards for GPs to visualise, compare and audit their data.

Results

The architecture of the CARA infrastructure includes two main sections: the ELT process (extract, load and transform anonymous patient data into data models) and a REST API (which provides the security barrier between the data models and their visualisation on the CARA dashboard). CARAconnect was created to facilitate data extraction and de-identification of patient data from the practice database.

Conclusions

CARA includes two dashboards, a practice overview and an exemplar dashboard focused on antibiotic prescribing which includes an audit tool as well as filters (within practice) and between-practice comparisons. Next steps will include the development of additional dashboards for topics such as chronic disease and mental health.

Key messages

• CARA developed a sustainable infrastructure to enable Irish GPs to better understand their patient population and management through dashboards.

• CARA infrastructure consists of CARAconnect to extract and de-identify data, a common data model (to combine data from different PMS systems), and CARA dashboards for use in Irish general practice.
Barriers for successful implementation of telemedicine in developing countries: the Colombian case
Authors: Valencia Rivero K , Muñoz Pinzón D , Caviativa Castro Y , Jaramillo Guzmán V , Álvarez Salazar C , Perea Rodríguez R , Sánchez Güette L , Valero Inerarity A , Hernández Garay A , Cruz Quiroga L
Published: October 2023

Implementation of telemedicine programs in Latin America has been documented in different reports, finding that Mexico, Chile and Colombia are the countries with the highest public coverage. Nevertheless, efforts made in Colombia in this regard are considered insufficient, and previously unidentified factors have delayed the full progress of this technology in the country. An integrative review was conducted in PubMed and ScienceDirect databases, and Colombian governmental repositories between 2011 and 2021. A total of 135 articles were processed in Rayyan QCRI software to characterize the telemedicine adoption process in Colombia. Published works in this area concern the economical evaluation of telemedicine services, focusing in estimating costs for its implementation, but cost-benefit, cost-effectiveness and cost-utility studies are needed for a complete policy in this regard, which should discuss important factors as infrastructure, current legislation, financing of public actors, availability of scientific evidence for decision-making, and political will. Finally, once the project is underway, monitoring, evaluation, and adaptation of the systems must be guaranteed to ensure the planned objectives and desired benefits are met, and barriers to the effective use of the project are overcome. Successful implementation of telemedicine programs in developing countries should consider several aspects. First, complexity, adaptability, compatibility with existing work practices, and cost of the project. Second, stakeholders must be included. Third, standards for interoperability, security, and privacy must be established to improve project acceptability and implementation. Fourth, sufficient financial and legislative support must be secured to support the project. Fifth, planning must be considered to ensure that the health system is ready for the project. Sixth, necessary education must be provided to all project stakeholders.

Key messages

• E-medicine barriers were identified to prompt its implementation in developing countries.

• Boost healthcare access, reduce costs, and enhanced disease surveillance is possible through telemedicine.
Artificial Intelligence Chatbots for medical training in Public Health: a tool to explore
Authors: Baglivo F , De Angelis L , Casigliani V , Arzilli G , Privitera G P , Rizzo C
Published: October 2023

Background

Artificial intelligence (AI) is a rapidly developing field with the potential to transform various aspects of healthcare and public health including medical training. During the ‘Hygiene and Public Health’ course for fifth-year medical students, a practical training session was conducted on vaccination using AI as an educational supportive tool. Before receiving specific training on vaccination, the students were given an online questionnaire on vaccination. After completing the questionnaire, a correction of each question was performed using AI chatbots.

Objectives

The main aim was to identify whether AI chatbots can be considered as educational support tool for training in public health. Secondary objective was to assess performance of 6 different AI chatbot models.

Results

The questionnaire consisted of 15 items selected from the Italian National Medical Residency Test (years 2015-2022) on the topic of vaccination. 36 medical students participated in the training, achieving a mean score of 8.22/15 on the quiz (range:3-15,median:8). 6 different AI chatbot models (3 modes of BingChat, ChatGPT, ChatSonic, and YouChat) were asked the same questions and achieved a mean score of 12.17/15 (range:10-15,median:11.5), ranking in the top 25% of medical student scores. During the class, the answers provided by the AI chatbots were evaluated with the students, paying particular attention to the completeness of the information, reliability of the sources cited, and use of technical language.

Conclusions

AI chatbots have shown to be efficient tools for retrieving bibliographic references from the web and answering questions related to specific topics such as vaccination. However, it is important to note that they cannot be considered more intelligent than students, as they may not perform as well when faced with situational questions. The responsible and critical use of AI should be integrated into medical education to ensure its effective utilization.

Key messages

• AI chatbots use as support tool in public health medical training should be further investigated and endorsed.

• AI chatbots could be a helpful resource for medical students in terms of researching and revising their knowledge.
Long-Term Efficacy of primary care combining a mobile healthcare application with human coaching
Authors: Ju H , Kang E
Published: October 2023

Background

Chronic diseases have become a global burden, and digital self-healthcare using mobile devices has gained importance in managing these conditions. However, barriers to implementing mobile self-management healthcare applications in current primary care system, and previous research has focused on short-term effects. This study aims to evaluate the long-lasting effect of combining human coaching with mobile self-management healthcare applications for chronic disease patients in primary healthcare services.

Methods

The study recruited 178 patients with chronic diseases from participating primary care clinics. The intervention group (N = 128) received a 12-week mobile self-management healthcare application service combined with traditional primary care, while the control group (N = 50) received only traditional healthcare. The Noom application was used, with two weekly human coaching sessions by a nutritionist. A telephone survey on weight changes was conducted one year after the intervention.

Results

The intervention group showed a greater weight loss compared to the control group during the intervention period (Intervention: -1.29 ± 2.94 vs Control: -0.38 ± 1.72, P-value 0.002). Although there was no statistically significant difference in additional weight change between the two groups during the follow-up period, the difference in weight loss during the intervention period was maintained (Intervention: -2.16 ± 5.54 vs Control: -1.06 ± 3.24, P-value: 0.008). Additionally, among the intervention group continuously for 1 year using the health management application, the average weight loss was higher than the other groups.

Conclusions

Combining a mobile self-management healthcare application with human coaching has long-lasting effects and can be effective in primary healthcare services. This suggests that such an approach has the potential to be a treatment option in current primary healthcare systems, but further large-scale long-term studies are needed.

Key messages

• This study suggests that using mobile self-management healthcare apps with human coaching can be an effective long-term treatment option for chronic disease patients in primary healthcare services.

• The combination of the two methods may provide better outcomes than traditional healthcare services alone.
Social Medi(a)cine: Use of a social media group for medical advice and education post covid-19
Authors: Peled-Raz M , Bleicher I , Tzemah S
Published: October 2023

Background

‘Ask an M.D’ is a private Facebook group, created in 2018, which grew dramatically during the Covid-19 pandemic, now serving over 52,000 members. It is a platform for asking medical questions, answered pro-bono, by about 180 physicians and pharmacists.

Methods

An anonymous questionnaire was posted on the group's page, inquiring about members’ demographics, consultation topics, scope of group's usage, and their reasons for using it. We also collected administrative data, tracking posts’ distribution over time, engagement in posts written by others and members’ demographics.

Results

The group grew from 5,000 to 19,000 members between 9.2019 and 9.2020. It now features 4,800 posts, 30,000 written responses, and 55,000 reactions yearly. 19,000 members viewed the questionnaire and 920 (∼5%) answered it. Respondents’ mean age was 37(18-70), 85% female and 18% live in the county's periphery. An overwhelming 66% had an academic degree. Only 1% did not finish high school. 61.5% ever consulted the group (36% once a year while 60% 2-5 times a year). Common fields of consultation were OBGYN (20%), Pediatrics (15%) and Dermatology (11%). 99% of respondents read other members’ consultations in the group. Reasons for using the group in last consultation were seeking second opinion (36%); long scheduled appointment (34%); sense of urgency (28%); 8.5% didn't know whom to consult, 7% were embarrassed of their doctor and 4% didn't understanding their doctors’ explanations.

Conclusions

Covid-19 emphasized the need for an available and reliable online source of medical consultation. Yet, a gap in access to medical information and consultation still exists and should not be viewed as a circumstantial occurrence. ‘Ask an M.D''s impact goes beyond mere individual consultations, as most members read others’ public consultations in addition to their own. Lack of online literacy serves as a barrier to usage of this type of tool among the less educated. These are preliminary results.

Key messages

• Reliable and accessible professional consultation on social media platforms is a timely and important health promotion tool.

• Utilization of such platforms should be embraced and encouraged, while striving to heighten online literacy and use amongst less educated groups.
Dissemination of health-related technologies in Germany between 2020 and 2022
Authors: Hannemann N , Babitsch B
Published: October 2023

Background

Health systems are facing major changes due to digitalization. ICTs offer the potential to improve healthcare, but the impact on health inequities is unclear. Therefore, the following research question will be addressed: How will health-related technologies be used in Germany between 2020 and 2022 and are there age- and gender-specific differences?

Methods

This analysis is based on three cross-sectional online surveys conducted in 2020 (N = 1570) and in 2022 (N = 1200; N = 1850). The sample is representative for age, gender, and federal state according to Eurostat. Participants indicated whether they used (yes/no) online booking for medical appointments (OB), video consultation (VC), and app-based transmission of health data to health insurers (DT). In 2020, participants were asked if they had used such technologies before and during the COVID-19 pandemic. For the stratified analysis, a Chi2-test was used.

Results

Before COVID-19, 34.5% of the participants used OB, 4.1% VC, and 18.8% DT. VC and DT differed by age, OB by gender only. In May 2020, there was a decrease in use of OB (21.6%) and DT (12.0%), but not VC (5.4%). Age-related differences existed for VC and DT. In March 2022, an increased usage was observed for all technologies (OB: 40.4%, DT: 22.3%, VC: 7.1%). Gender and age differences occurred for VC, but for age only for OB and DT. An increased use was also observed in autumn 2022 (OB: 57.6%, DT. 35.4%, VC: 11.1%). The usage of such technologies continued to vary by age and gender, with one exemption: no gender-specific differences appeared for VC.

Conclusions

With the exception of the onset of the COVID-19 pandemic, an increased diffusion of health-related technologies has been observed, accompanied by an elevated availability of such technologies after the pandemic. Although the diffusion of such technologies increased from 2020 to 2022, age- and gender-specific differences regarding their usage seem to emerge and tend to consolidate.

Key messages

• Between 2020 and 2022, an increased utilization of health technologies can be observed, which goes hand in hand with an expanded diffusion of such technologies in the German health system.

• Not all population groups participate in digitization in the same way. Whether these differences will contribute to health inequities needs to be closely examined.
Automated surveillance system for surgical site infections from hospital discharge letters
Authors: De Angelis L , Baglivo F , Arzilli G , Baggiani A , Gemignani G , Calamita L , Rocchi D , Grassi N , Ferragina P , Rizzo C
Published: October 2023

Background

The surgical site infection (SSI) occurs in the part of the body where the surgery took place within 30 days. In Europe, 1-10% of surgical patients develop a SSI. Clinical reporting can play an important role in identifying SSIs, but these clinical data should be integrated into surveillance systems to increase their performances. We aim at developing an automated surveillance system to identify SSIs from unstructured text of hospital discharge letters (HDLs).

Methods

We extracted a sample of 2020-2021 HDLs from the University Hospital of Pisa (Italy) and we used a set of 60 keywords to select only HDLs including surgery and infection related terms. Using a positive wound swab test as a proxy for suspected SSI, we performed a record-linkage between HDLs and laboratory data for 2021. We compared the number of records with suspected SSIs before and after the filtering, to assess its sensitivity. Filtered HDLs have been manually labeled by qualified operators in 3 classes: SSI, No SSI, or SSI caused by a prior hospitalization.

Results

From 63,609 HDLs in our sample, 22,625 were filtered through keywords. In the pre-filtered dataset (only 2021), 255 patients have at least a positive wound swab test. 92% (235/255) of the patients with a suspected SSI were included after the filtering. In a preliminary analysis, after the labeling of 9,385 HDLs (41% of the dataset) we identified 340 SSIs (3,6%), of which 254 (85%) were caused by a prior hospitalization.

Conclusions

The labeled dataset will be used to train a natural language processing classification algorithm, able to identify suspected SSIs from HDLs. The keyword filtering can be a useful support to reduce the number of HDLs that need to be manually labeled.

Key messages

• Keyword filtering is the first step for an automated surveillance system of surgical site infections from hospital discharge letters.

• Labeling is time-consuming but necessary for the development of a natural-language-processing-based surveillance system for surgical site infections.
Relation between mortality and physical activity levels or sedentary behavior: Proof cohort
Authors: Dupré C , Brégère M , Berger M , Pichot V , Celle S , Bongue B , Barthélémy J C , Roche F , Hupin D
Published: October 2023

Although moderate-to-vigorous physical activity has been proven to be effective in preventing major chronic diseases, the most recent epidemiological studies now focus on low-intensity physical activity, due to the need to promote all activities. However, the evidence currently remains weak. The objective of the study is to clarify the effects of different levels of physical activity and sedentary behavior on mortality. The different levels of physical activity were assessed by a validated self-administered questionnaire (POPAQ) covering different types of physical activity in the previous 7 days. Medical history and examinations were taken during each clinical visit to determine clinical events. The relationships between the intensity of physical activity (light, moderate to vigorous) as well as periods of physical inactivity in relation to mortality or cardiovascular events were analyzed by splines and COX models. Of the 1011 65-year-old subjects initially included in 2001 (60% women), the last 18-year follow-up is now completed since 2019. A total of 197 deaths (19.2% including 77 cardiovascular deaths) and 195 cardiovascular events (19.3%) have been reported. The means (standard deviation) of moderate or intense activity, light or sedentary activity were respectively 1.2 h/d (0.3), 5.8 h/d (1.1) and 6.6 h/d (2.3). For all-cause deaths, as well as cardiovascular deaths, splines were significant for light (p = 0.04 and p = 0.01) and moderate to vigorous (p < 0.001 and p < 0.001) activities, but not for sedentary lifestyle (p = 0.24 and p = 0.90). However, there is a significant reduction in cardiovascular events when the sedentary time decreased from 10.9 to 3.3 h/d. The PROOF cohort study shows a clear dose-response relationship between the dose of light, moderate to vigorous and sedentary behavior with mortality and cardiovascular events. These results provide evidence to support the inclusion of light physical activity in future activity guidelines physical.

Key messages

• Relationship between the dose of light, moderate to vigorous and sedentary lifestyle with mortality and cardiovascular events.

• Importance of inclusion of light physical activity in future activity guidelines physical.
Nutrition and food supply after the Covid-19 pandemic: results from the Specchio cohort study
Authors: Baysson H , Pullen N , Lamour J , Zaballa M , Guessous I , Stringhini S
Published: October 2023

Background

To contain the COVID-19 pandemic, countries put in place lockdown measures, causing disruption of daily life and changes in lifestyle. Our objective was to explore whether potential changes in diet quality and food supply persisted after the release of lockdown measures, and how these differed according to individual characteristics.

Methods

The analysis relies on the Geneva (Switzerland) population-based Specchio cohort. In March 2022, an online questionnaire was designed to characterize health behaviors. Nutrition-related changes were assessed through two questions “Today, compared to before the pandemic, would you say that the quality of your diet:

• Improved • Improved slightly • Did not change • Deteriorated slightly • Has deteriorated” and “Comparing the current period with that before the pandemic, have you significantly changed your habits regarding your food supply? •Yes •No.” Nutrition-related changes and their determinants were investigated using logistic regression.

Results

The analysis included 4065 participants (response rate 46%). Mean age was 54 years, 59% were women. 17% of participants reported that their diet had improved or slightly improved compared to before the pandemic. Our results showed a clear age gradient, with younger participants having higher odds of reporting an improved diet (aOR 0.98 (0.97-0.98) per year, p < 0.001). Participants who reported not paying attention to their health did not report an improved diet (aOR 0.29 (0.16-0.49), p < 0.001); those who reported significant changes in their food supply habits had greater odds of reporting they improved their diet (aOR 3.37 (2.76-4.11), p < 0.001). The most popular changes were going more frequently to markets or to small shops. We found no significant differences by sex or by education.

Conclusions

As reported from other countries, our results showed improved diet quality compared to before the pandemic in certain population subgroups, mainly due to changes in local food supply.

Key messages

• Favorable changes in diet quality and food supply during the Covid-19 pandemic were observed in certain population subgroups.

• With health behavior changes due to pandemic, including nutrition, digital population-based cohorts such as Specchio become a rich resource to produce novel and timely evidence over time.
Putting blood donors at the heart infectious disease surveillance
Authors: Butler D , Waters A , Coyne D , Williams P , O'Flaherty N , Hervig T
Published: October 2023

Issue

The emergence of SARS-CoV-2 brought with it an urgent need to generate accurate and real-time surveillance data. The Irish Blood Transfusion Service (IBTS), along with many blood establishments worldwide undertook SARS-CoV-2 serosurveillance studies using residual blood donor serum. This response highlighted the role that blood donors can play in informing public health policy.

Description

In September 2020 the IBTS undertook a SARS-CoV-2 seroprevalence study using blood donor specimens to track the ‘first-wave’ of the COVID-19 pandemic in Ireland. We utilised our operational capacity for sample collection and screening to quickly generate seroprevalence data. In 2021, the newly established National Serosurveillance Program (NSP) in Ireland invited the IBTS to collaborate on a SARS-CoV-2 serosurveillance study in blood donors which has continued into 2023.

Results

This response has led to an enhanced relationship between the IBTS and public health in Ireland and has highlighted a possible future role for the IBTS in providing ‘real-time’ seroprevalence data to policy-makers. This data can be used to inform decision-making in relation to infection prevention and control strategies including vaccination policy.

Lessons

This practice highlights the role that blood establishments can play in informing public health policy and indicates that this role could be expanded in the future in the cases of both emerging infections and vaccine preventable diseases. Blood donor studies offer a unique opportunity to screen healthy populations for the presence of antibodies to infections on a national level and with the opportunity for longitudinal sampling of returning donors.

Key messages

• The relationship between blood establishments and public health should be further explored in the future to support infectious disease surveillance programmes.

• Blood donor studies can provide vital baseline data of healthy populations.
Prevalence of overweight among Tunisian adolescents: Trend analysis 1996-2016
Authors: Zribi M , Zoghlami N , Elati J , Traissac P , Aounallah-Skhiri H
Published: October 2023

Background

Overweight among adolescents is a growing public health concern worldwide, and Tunisia is no exception. However, prevalence trends of overweight among Tunisian adolescents have not been well documented. This study aimed to determine prevalence trends of overweight among adolescents in Tunisia between 1996 and 2016.

Methods

Data were collected from three national surveys conducted in Tunisia between 1996 and 2016. The first was conducted in 1996 (n = 729). The second was the Epidemiological Transition and Health Impact in North Africa Survey (TAHINA-2005, n = 1019), and the third was the Tunisia National Health Examination Survey (THES-2016, n = 482). All surveys used a similar methodology and included a representative sample of the Tunisian population. Overweight was defined as Body Mass Index≥ 85th percentile. STATA software was used for statistical analysis and chi-squared test for trend was performed.

Results

A total of 2230 participants was enrolled (sex ratio=0.99). The prevalence of overweight among adolescents increased from 10.8% (4.3% for boys and 17.7% for girls) in 1996 to 18.9% (17.2% for boys and 20.7% for girls) in 2005, then to 30.5% (22% for boys and 39.2% for girls) in 2016. Linear trend test concluded to significant increase in overweight prevalence estimated at 179.6% in two decades. The results showed a significant effect of time on overweight prevalence (p < 10-3), as well as a significant effect of sex group (p < 10-3). The model estimated that the prevalence of overweight increased by 1.29% per year from 1996 to 2016. The odds of overweight increased significantly over time, with an Odds Ratio (OR = 1.79, (95% CI: 1.39-2.30)) for TAHINA survey and (OR = 2.80 (95% CI: 2.21-3.55)) for THES survey.

Conclusions

Our study showed a significant increase in the prevalence of overweight among Tunisian adolescents over the past two decades. It is crucial to refine the analysis of associated risks to develop targeted interventions and adapt current policies.

Key messages

• The prevalence of overweight increased significantly among Tunisian adolescents in the past two decades.

• Targeted interventions and policies to address this issue are therefore urgent.