bluuebunny/crossref_metadata_2025 huggingface dataset:
How common is emergency department as a death place in Portugal and who is more likely to die there?
Authors: Sanguedo B , Gomes B , Lopes S
Published: October 2024

Background

Most people would prefer to die at home but most die in hospitals or other healthcare settings. Some of the latter deaths may have taken place in Emergency Departments (EDs), as EDs are a major hospital gateway. However, EDs have not been consistently categorised as a place of death (PoD) across countries. Portugal is an exception. This study aimed to examine trends in deaths at EDs in Portugal from 2015 to 2021, identifying who is more likely to die at the ED.

Methods

We obtained national death certificate data on PoD for 2015 to 2021 from the the Portuguese General-Directorate for Health. We analysed the percentage of deaths taking place at the ED by sex, age group (0-17y, 18-49y, 50-69y, 70-79y, ≥80y), underlying cause of death (cancer, dementia, and other causes) and year of death.

Results

804.971 people died in Portugal from 2015-2021 (50.1% male; 0.4% aged 0-17y, 58.0% aged ≥80y; 23.3% died from cancer, 5.6% from dementia, and 71.1% from other causes). Of these, 13.2% died at the ED. The percentage of ED deaths was higher in female (13.7% vs. 12.8% in male), in adults (13.3% vs. 9.0% in children), in those dying from dementia (15.7% compared to 9.6% in cancer and 14.3% in other causes). The percentage of ED deaths rose from 10.6% in 2015 to 14.3% in 2021, increasing steadily over time (average 0.6 percentual points per year, representing 1069 additional deaths per year).

Conclusions

One in every ten deaths in Portugal happens at ED and this is increasing. Patients with non-cancer conditions are more likely to die at the ED, in particular those dying from dementia. To understand if this reality compares with other countries, we are developing a pioneering international classification of place of death which includes the ED. Funding: European Research Council (agreement nr. 948609).

Key messages

• Emergency department (ED) is a significant PoD in Portugal and has increased from 10.6% to 14.3% (2015-2021). Non-cancer patients, especially those with dementia, more likely to die at ED.

• This study highlights the need for an international place of death classification to compare emergency department death trends across countries.
Performance and trend of core measures among oral cancer patients: A population-based cohort study
Authors: Wang Z C , Chen Y Y
Published: October 2024

Objectives

This study explores the performance and trend of core measures, which were established as evidence-based indicators to assess and improve the quality of care for oral cancer patients.

Methods

This retrospective cohort study uses the National Health Insurance Research Database (NHIRD), Taiwan Cancer Registry, and Cause of Death Statistics, provided by the Health and Welfare Data Science Center (HWDC), Ministry of Health and Welfare (MOHW). The study population was adult patients hospitalized for oral cancer surgery with stage I-IV between 2014 and 2021. The trend tests and the generalized linear mixed model (GLMM) were applied.

Results

A total of 23392 oral cancer patients were enrolled. The core measure set used in this study included five indicators (two process-related and three outcome-related indicators). Process indicators’ mean achievement rates significantly increased from 82.6% to 85.7% (p = 0.018, trend test). On the other hand, most patients demonstrated good achievement rates to the outcome indicators (98.9% to 99.3%) (p = 0.218, trend test). Overall indicators’ 100% achievement rate increased over time from 62.9% in 2014 to 66.2% in 2021 (p < 0.001, trend test). Subgroup analyses were performed by age, stage, and comorbidity score. The analysis of the GLMM revealed that the 100% achievement to overall indicators was positively associated with age<45, not-low socioeconomic status, body mass index ≥ 24, squamous cell carcinoma, recent treatment year, treated with surgery only, negative surgical margins, and receiving care in a high-volume hospital (all p < 0.01).

Conclusions

The results highlight a significant measurable improvement in the quality of oral cancer care. However, there is still room for enhancement in process indicator performance.

Key messages

• The results highlight a significant measurable improvement in the quality of oral cancer care.

• There is still room for enhancement in process indicator performance.
Impact of bundled payments on healthcare use and costs for cardiovascular diseases in the Netherlands
Authors: Dros J T , van Dijk C E , Verheij R A , Bos I , Meijboom B R
Published: October 2024

Background

Bundled payments for patients with cardiovascular diseases (CVD) aim to enhance primary care utilization in the Netherlands. This study assesses changes in healthcare utilization patterns and costs for CVD between 2015 and 2019, while investigating the potential association with bundled payment adoption.

Methods

We studied patients at very high risk for CVD using routinely recorded nationwide healthcare data. Multilevel logistic- and gamma regressions were conducted to assess healthcare utilizations patterns between 2015 and 2019, and the impact of bundled payments on the likelihood of receiving medical specialist care and the height of associated costs.

Results

The odds of medical specialist involvement declined over time for the 148,876 patients included in our study. This decline was significantly associated with practices’ use of bundled payments. Medical specialist costs did also significantly decrease between 2015 and 2019, and patients in practices with the highest level of bundled payments had significantly lower medical specialist costs. When general practice costs were included however, healthcare costs per patient stayed the same, both over time and stratified by use of bundled payments.

Conclusions

Our findings suggest an association between bundled payments and specialized healthcare use, potentially facilitating the transition to primary care. While we found no evidence for costs savings, our findings do support a reduction in spending growth.

Key messages

• We evaluated the impact of bundled payments as a means to facilitate integrated care, and found that bundled payments were associated with lower uptake of specialized medical care.

• We found no cost savings were found, but findings do support reduced spending growth.
Pharmacist care for hypertension management among patients with diabetes: a systematic review
Authors: Gastens V , Tancredi S , Bonnan D , Kiszio B , Del Giovane C , Tsuyuki R T , Paradis G , Chiolero A , Guénette L , Santschi V
Published: October 2024

Background

Improving blood pressure (BP) control is of major importance among patients with diabetes, due to their high risk of micro- and macrovascular complications. Community-based models of care with the involvement of pharmacists and other nonphysician healthcare providers can help manage hypertension. We aimed to estimate the effectiveness of pharmacist interventions, alone or in collaboration, on BP among outpatients with diabetes and hypertension.

Methods

We conducted systematic searches of randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients with hypertension and diabetes compared to usual care. The outcome was the systolic and diastolic BP change or BP control. We performed a meta-analysis with random effects models and results are presented by mean difference along with relative 95% CI.We will perform subgroup analyses for the types and intensity (duration, frequeny) of pharmacist interventions, patients’ characteristics, and healthcare settings. The protocol was registered in PROSPERO (CRD42021279751) and published in an open-access peer-reviewed journal.

Results

Out of 2048 study records identified by electronic database searching, we included 9 studies, with 5067 participants, published between 2008 and 2022. These studies were conducted mainly in North America (n = 5; other regions: n = 4). The intervention was led by the pharmacist in 78% of the studies and in collaboration with other healthcare providers in 22%. Pharmacist intervention included patient education in 67%, healthcare providers education in 11% of studies and feedback to healthcare providers in 44% of the studies. Systolic and diastolic BP were reduced after pharmacist intervention by -5.6 mmHg (95% CI: -10.6 to -0.6) and -4.1 mmHg (95% CI: -7.1 to -1.2) respectively. Additional analyses will be presented at the congress.

Conclusions

Pharmacist interventions improve blood pressure control in hypertensive diabetic outpatients.

Key messages

• Recent hypertension guidelines recommend pharmacist involvement in hypertension care management.

• This systematic review provide updated evidence on the effect of pharmacist interventions on hypertension management of patients with diabetes.
Effectiveness of pictorial-warning intervention to reduce consumption of sugar-sweetened-beverages
Authors: Afreen A , Patnaik S
Published: October 2024

Background & Aims

Limited research have looked at pictorial-health-warnings (PHW) for sugar- sweetened beverages (SSB), despite the potential for behaviour change that pictorial warnings on tobacco products hold. This study aimed to examine how visual warnings impacted parents’ decisions to buy SSB for their children.

Materials and methods

All residents dwelling in the communities and local vendors available were subjected to a ten-week multi-strategy intervention by randomized stepped-wedge controlled trial to support the introduction of PHW labels. Stepped implementation of a two-week PHW intervention was delivered in a randomly selected order at one-week intervals. Follow-up data were collected for all three sectors two weeks following the completion of the PHW intervention in the third sector. The trial outcome was determined by comparing the overall perception change towards SSB among parents between the baseline and follow-up periods for three sectors combined. Secondary outcomes included reactions to the trial labels, attitudes toward SSB, and intentions to serve their child SSB.

Results

PHW led to a 30 % (-37.12%, -22.37%) reduction in purchases of SSB, along with lower intentions to serve SSB to children, higher thoughtfulness about the harms of SSB, more perceived control of healthy eating decisions, stronger negative emotional reactions, lower perceived healthfulness of SSB for their child, and greater injunctive norms to limit SSB for their child (all p < 0.05). No differences by sector or within sector were found between pre and post-intervention in the appeal of SSB or perceived tastiness of SSB (all p > 0.05). Nearly 53% of participants reported being more in control of making healthy eating decisions.

Conclusions

Warnings on SSB are a promising policy approach to reduce sugary drink purchasing. This evidence will support the health service adoption of implementation strategies to support PHW labels across the entire country.

Key messages

• Warnings on SSB are a promising policy approach to reduce sugary drink purchasing.

• Support the health service adoption of implementation strategies to support PHW labels across the entire country.
Association between bisphenol A exposure and cardiometabolic outcomes: a longitudinal approach
Authors: Costa S A , Severo M , Lopes C , Torres D
Published: October 2024

Background

Increased cardiometabolic risk is associated with abnormalities in blood biomarkers profile and adiposity measurements. Some substances found in the food matrix or the environment, called endocrine-disrupting chemicals, may impair cardiometabolic health in the yearly and later stages of life. Bisphenol A (BPA) is a food contaminant that migrates from food contact materials and may act as an endocrine disruptor, negatively affecting human health. The present work aims to assess the longitudinal association between BPA exposure and cardiometabolic outcomes.

Methods

Data from the four waves of the Portuguese population-based birth cohort Generation XXI were used (n = 3138). Dietary data were collected by 3-d food diaries, using the FoodEx2 classification system to describe the reported foods. BPA daily exposure was estimated using a random forest model, combining dietary information with urinary BPA measured in 24-h urine from a subsample, used to predict the remaining sample’s BPA exposure. The generalised least squares model was used to test the associations between BPA and cardiometabolic outcomes.

Results

Blood insulin and HOMA-IR presented a significant longitudinal association with BPA daily exposure after adjustment for important variables and energy (0.06 SD(0.03, 0.09); 0.05 SD(0.02, 0.08) respectively). The same findings were observed for fat mass and waist circumference (0.03 SD(0.01, 0.06); 0.06 SD(0.04, 0.08), respectively). For z-BMI, a significant cross-sectional and longitudinal association was found (0.03 SD(0.01, 0.04); 0.02 SD(0.00, 0.04), respectively).

Conclusions

This was the first study assessing the association between BPA exposure and health outcomes from childhood to adolescence. We found an association between BPA exposure and an increased blood insulin level, insulin resistance, fat mass percentage, waist circumference and z-score of body mass index. Our results point to the need to reduce exposure to BPA in the early stages of life.

Key messages

• BPA exposure was estimated using direct and indirect methods.

• BPA can impair cardiometabolic outcomes from the early stages of life, such as higher blood insulin level, insulin resistance, fat mass, waist circumference, and body mass index.
Dietary inflammatory potential: a comprehensive approach to the inclusion of flavonoids
Authors: Martins S , Correia D , Carvalho C , Costa S A , Lopes C , Torres D
Published: October 2024

The Dietary Inflammatory Index (DII) has been widely used to estimate dietary inflammation. However, most studies do not consider the six classes of flavonoids (6F) included in the original DII. This study aimed to develop two new tools, the Complete-DIP (CDIP) and Short-DIP (SDIP), to estimate the Energy-adjusted Dietary Inflammatory Potential (DIP) in adults while exploring the benefit of including the 6F. An open-access reference population (RP) was created from the Global Dietary Database (GDD) to calculate DIP. CDIP considered 38 food parameters (FP), whereas SDIP excluded the 6F and considered 32 FP. CDIP and SDIP were estimated for 3501 participants aged 18-84 from the IAN-AF. FP intake z-scores were calculated using FPs from the RP. Centred percentiles were multiplied by the FP’s inflammatory effects (IE) to obtain FP-specific DIP, which were then summed to achieve the individual DIP. IE were retrieved from the literature. Lower DIP values indicated more anti-inflammatory diets. Linear regressions assessed the association between sociodemographic factors and diet quality (measured with the Healthy Eating Index (HEI)) with DIP. Pearson’s test evaluated the correlation between CDIP and SDIP. The mean and standard deviation for CDIP and SDIP were 0.00±2.17 and 0.02±1.74, respectively. Men had more pro-inflammatory diets than women using CDIP (β = 0.354[95%CI:0.209,0.499]), but this effect was not statistically significant when using the SDIP. Older adults had more anti-inflammatory diets than adults (CDIP: β=-0.668[95%CI:-0.850,-0.486]; SDIP: β=-0.548[95%CI:-0.529,-0.076]). Participants with lower diet quality (Q1 of HEI vs Q4) had higher DIP (CDIP: β = 2.309[95%CI:2.116,2.502]; SDIP: β = 2.185[95%CI:2.037,2.334]). A very strong correlation between the CDIP and the SDIP was observed (r = 0.94). Results suggest that CDIP and SDIP may be equally successful in estimating dietary inflammation. However, the advantage of adding the 6F to evaluate the DIP needs further research.

Key messages

• This study created two open-access energy-adjusted dietary inflammatory potentials (DIP), with and without flavonoids.

• Results suggest that flavonoids may not be essential for accurate DIP estimations.
Correlates of food insecurity among university students in a low socioeconomic area
Authors: Dehove H , Mofakhami M , Julia C , Peneau S , Bellicha A
Published: October 2024

Background

The prevalence of food insecurity (FI) is high and suggested to be growing among university students, with potential detrimental effects on their health status and academic performances. This cross-sectional study aims to identify the socioeconomic, demographic and lifestyle factors associated with FI among university students in a disadvantaged area.

Methods

An anonymous online survey was conducted from Nov 2022 to Jan 2023 among students enrolled at University Sorbonne Paris Nord, located in a low socioeconomic area in France. FI was assessed with one question distinguishing 2 levels of FI: quantitative (i.e. not having enough to eat) and qualitative (i.e. not having the desired food). This abstract focused on quantitative FI. To improve the representativeness of the sample compared to the total student population of the university, sample weights were used according to gender, study level and speciality, whether they were undergoing initial training or not, or obtained their baccalaureate abroad or not. Multivariable multinomial logistic regression models were used to identify factors associated with FI.

Results

A total of 5068 students provided valid answers (20% of the target population), 66% of whom were women, and 12% and 36% reported quantitative and qualitative FI, respectively. Being a man, an undergraduate, having obtained a baccalaureate abroad, not living in the family home, not receiving food from family, having no household food-heating facilities, reporting financial difficulties, relying on food charity and eating alone on a regular basis were positively associated with quantitative FI (P < 0.0001). Those reporting quantitative FI were more likely to report academic difficulties.

Conclusions

This study shows a high prevalence of FI in this student population and identifies several associated factors. Identifying students at greater risk of FI is an important first step to design and evaluate public health interventions.

Key messages

• The different socio-economic backgrounds of university students imply important food insecurity disparities among them.

• University students present several factors associated with food insecurity, which should be considered when addressing food insecurity in this population.
Veggies4myHeart – educational project to promote vegetable knowledge and consumption in preschoolers
Authors: Novo R , Edra J , Vieito L , Simões Dias S , Lages M , Guarino M P , Braga-Pontes C
Published: October 2024

Vegetable consumption among children is below recommended. Given the critical role of vegetable consumption in health promotion, it is essential to identify effective strategies to promote this intake. The Veggies4myHeart project aims to increase vegetable knowledge and consumption in preschool children through nutrition education strategies (NES). Veggies4myHeart is a prospective longitudinal study with children aged 2 to 6 years who attend preschools in the Leiria district. A questionnaire was applied to the parents to characterize the sample. NES were used: children’s story, digital game, vegetable-themed sticker booklet and the food wheel. The intervention consisted of 5 food education sessions, each focusing on one selected vegetable (lettuce, carrot, red cabbage, cucumber, and tomato). Sessions to assess knowledge and consumption of vegetables were held pre-and post-intervention. Knowledge was evaluated through a taxonomic categorization questionnaire. Consumption was assessed by recording the number of portions of each vegetable consumed. Wilcoxon test was used to compare pre-and post-intervention vegetable knowledge and consumption. ANOVA test was used to compare NES. Between 2018 and 2024, 649 children (52,5% female, mean age 4,36 ± 0,942) from 17 preschools participated. After the intervention, there was a statistically significant increase in vegetable knowledge (p < 0,001) and a statistically significant increase in the consumption of vegetables (p < 0,001). There are statistically significant differences between NES, with the digital game having greater vegetable knowledge (p < 0,001) and consumption (p < 0,001) than the others. The Veggies4myHeart project effectively increased vegetable knowledge and consumption in preschoolers. It is essential to continue the intervention to promote consumption and familiarity with vegetables, as well as the involvement of parents and preschool teachers, due to their prominent role as models for acquiring healthy eating habits.

Key messages

• The NES used proved useful, contributing to increased knowledge and consumption of vegetables.

• The Veggies4myHeart project is an asset for preschool-aged children to become familiar with vegetables.
Impact of the COVID-19 pandemic on lifestyle’s behaviours of school-aged children in Portugal
Authors: Rito A , Figueira I , Mendes S , Buoncristiano M , Williams J
Published: October 2024

Background

COVID-19 pandemic impacted children’s daily routines. Based on this, WHO Collaborating Centre for Nutrition and Childhood Obesity in collaboration with WHO Regional Office for Europe coordinated the study about the impact of COVID-19 on lifestyle’s behaviours of school-age children in Europe, where 17 Member States participated, including Portugal.

Methods

Cross-sectional study was conducted within the sixth round of COSI Portugal, following a WHO common methodological protocol, during 2021-2022 school year. A national representative sample of families with children 6-8 years old were included and asked to report on variables comparing two periods: pre and during the COVID-19 pandemic.

Results

5139 families participated. 11.4% reported a worsening of their perceived wealth and the percentage of fathers and mothers working full- or part-time decreased (74.6% to 68.7% and 70.6% to 59.6%, respectively) during pandemic. Children’s consumption of sweets (19.4%), savoury snacks (13.8%), fruit (11.9%) and vegetables (7.1%) increased, and sugary soft drinks (13.8%) decreased during pandemic. Family behaviours with the highest increases during pandemic were “eating together as a family” (35.4%), “cooking meals together with your child” (33.6%), “buying food in large quantities” (33.6%) and “eating home-cooked meals” (29.1%). Approximately, one in four parents reported children’s physical activity decreased and almost one in two reported an increase in recreational screen time. Parents who perceived their child as overweight during pandemic doubled (f7.9% to 14.6%). Children’s well-being behaviours that worsened more during pandemic were “having fun with friends” (44.3%), “got on well at school” (27.9%), “feel full of energy” (23.8%) and “feel fit and well” (22.2%).

Conclusions

These observations underscore the need to “build back better” post-pandemic with a focus on preventing and controlling childhood obesity and its determinants.

Key messages

• Portuguese children experienced negative impacts of the pandemic in their lifestyle behaviours, particularly on their physical health and well-being, with a report of a poorer socioeconomic situation.

• This study and its findings give us a first-of-its-kind view into the physical and mental outcomes of the pandemic on school-aged children with a focus on the long-term, high-risk disease of obesity
Heat-related risk in outdoor workers in the context of climate change: a systematic review
Authors: Rossi M F , Pulvirenti A , Leone R , Gualano M R , Borrelli I , Santoro P E , Moscato U
Published: October 2024

Background

Climate change is one of the paramount challenges in the current global health setting. From an occupational health perspective, outdoor workers are amongst the most vulnerable populations to climate change and heat-related risk. A systematic review was performed, aiming to assess heat-related health outcomes in outdoor workers.

Methods

The research query was structured using the Population, Intervention, Comparison and Outcome (PICO) model, and including synonyms and Medical Subject Headings (MeSH) terms for the following keywords: “outdoor workers”, “climate change”, and “occupational risk”. The systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements, screening three databases (PubMed, Web of Science, and Scopus).

Results

After duplicate removal and title and abstract screening, the final screening by full-text resulted in 10 included studies. The included studies were performed mostly on construction (included in 5 studies, 50.0%) and agriculture (in 5 studies, 50.0%) workers. Eight studies (80.0%) had a majority of male workers, while one (10.0%) had a majority of female workers, and one study (10.0%) did not report on the gender ratio. Four of the included studies (40.0%) reported a high prevalence of heat-related symptoms, ranging from 64.0% to 90.3% of workers. Three studies (30.0%) showcased a prevalence of heat-related symptoms in less than 50% of workers (ranging from 11.6% to 47.5%). Three studies (30.0%) evaluated odds ratio, highlighting an increased odds ratio of heat-related symptoms in outdoor workers.

Conclusions

This systematic review highlights heat-related stress in outdoor workers as an important occupational risk. Mitigation and prevention strategies should be developed and implemented at a company, national, and supra-national level, to ensure the safety and wellbeing of outdoor workers worldwide.

Key messages

• A systematic review was performed to assess risks related to climate change in outdoor workers. Heat-related symptoms were reported with a high prevalence, ranging from 64.0% to 90.3% of workers.

• Mitigation and prevention strategies should be developed and implemented at a company, national, and supra-national level, to ensure the safety and wellbeing of outdoor workers worldwide.
Accounting for adaptation when projecting climate change impacts on health: a review of methods
Authors: Cordiner R , Wan K , Hajat S , Macintyre H
Published: October 2024

Exposure to high and low temperatures can cause harm to health. Temperature related health effects are likely to increase in the future, due to global warming, unless populations can adapt to a warming environment. Adaptation occurs through multiple mechanisms, however, the amount that populations may adapt to rising temperatures is unclear. There are currently a variety of methods used to include adaptation in projections, but it is unclear how underlying assumptions are made and whether they are based on evidence. With increasing interest from decisionmakers around implementation of adaptation strategies, an important step in responding to climate change will be to understand how adaptation can statistically be incorporated when estimating future health burdens. A systematic scoping review was conducted to identify all quantitative methods to include adaptation in studies projecting future temperature-related health impacts under climate change. Approaches employed in studies were coded into methodological categories. Advantages and disadvantages of each method were also explored, along with the empirical basis for model assumptions. Eight methodological categories were identified from the included fifty-nine studies. More recent methods of including adaptation in projections use a combination of approaches or modelling adaptation based on specific adaptation strategies or socioeconomic conditions. The most used approaches in the literature to model adaptation are heat threshold shifts and reductions in the exposure-response slope. Just under 20% of studies were categorised as using an empirical basis for statistical assumptions. Including adaptation in projections considerably reduced the projected temperature-mortality burden in the future. Researchers should ensure that all future impact assessments include adaptation uncertainty in projections and assumptions are based on empirical evidence where possible.

Key messages

• Including adaptation in future projections considerably affects temperature-related mortality numbers.

• All future impact assessments should include adaptation uncertainty and assumptions should be based on evidence where possible.
A systematic review of health outcomes of public transport use by older adults
Authors: Dilian O , Beckers C , Davidovitch N , Martens K
Published: October 2024

Background and Aim

Public transport use has been linked to several health benefits in the general population, and is crucial for older adults’ mobility, due to an age-related decline in mobility, and particularly the ability to use other transport modes. The objective of this systematic review is to determine what is known about the physical and mental health outcomes of public transport use by older adults and to identify remaining gaps in the literature.

Methods

Five electronic databases were searched in April 2023, with an update in January 2024: Pubmed, Scopus, Web of Science, Ageline and Transport Research International Documentation (TRID). Included were studies that were in English, contained a measure of public transport use as exposure, and any health outcome, including mental or physical health, physical or cognitive function, morbidity, or mortality, among people aged ≥ 60 years.

Results

Of a total of 2247 unique records that were screened, the full text of 20 was assessed for eligibility and 11 were identified as eligible. Citation search identified two additional studies, amounting to a total of 13 included studies. Significant health outcomes described in assessed studies were decreased obesity and depressive symptoms, and to a lesser extent increased gait speed and cognitive function.

Conclusions

Initial evidence suggests a positive impact of public transport use on obesity, depressive symptoms, gait and cognitive function, although available research was limited in context and methodology. Further research should focus on determining causality between public transport use and health, and be conducted in more diverse contexts. Transport and urban planners, as well as policymakers, should consider the implications of public transport on the health and independence of older adults.

Key messages

• Public transport use is linked to reduced obesity and depression among older adults. Links with other health outcomes were reported in several studies, but evidence is scarce.

• Current research is limited in terms of quantity, scope, and design. Future research should be conducted in wider contexts, encompass a broader range of health outcomes, and address reverse causality.
Isolation of Shewanella algae from blue crabs (Callinectes sapidus) in Northwestern Adriatic Sea
Authors: Rubini S , Massella E , Bertasi B , Mangeri L , Dell’Orfano G , Russo S , Sampieri M , Tiralongo F , Taddei R
Published: October 2024

Blue crab (Callinectes sapidus) is one of the last reported invasive species that have colonized the Italian coasts, in particular the lagoons of the northern Adriatic Sea. Their massive presence is compromising shellfish farming, causing a serious economic crisis among the valley populations. To limit the economic damage, blue crabs have been introduced as human food in the Italian markets. This study aimed to evaluate the microbiological contamination of blue crab as potential risk to human health. From July 2023 to April 2024, 72 blue crabs were collected in coastal lagoons and 5-6 nm from the coast of the Emilia Romagna Region. Microbiological analysis revealed Shewanella algae as one of the most commonly identified microorganisms (18/72, 25%). Shewanella was isolated on Chromagar Vibrio™ and TCBS after an enrichment step in Alkaline Saline Peptone Water. Colony morphology, Gram stain, and biochemical tests (oxidase, catalase) sustained Shewanella identification, later confirmed by MALDI-TOF MS (MALDI Biotyper® Sirius, Bruker Daltonics). S. algae is a Gram-negative, rod-shaped, aerobic microorganism widely distributed in seawater, freshwater, and soil. In humans, it is considered an opportunistic pathogen, especially in people with impaired immune systems. Shewanellosis has been strongly associated with seawater exposure and typically arises in hot months. Clinical manifestations include skin and soft tissue infections, otitis media, keratitis, biliary tract infections, vertebral discitis, and bloodstream infections. Notably, in the last years, S. algae infections have increased globally, even in healthy young people. The present study suggests blue crabs as a potential source of S. algae throughout the year. The increasing identification of S. algae in marine waters worldwide, as well as in marine-derived foods like blue crabs, underscores the growing importance of S. algae as an emerging pathogen and its impact on public health.

Key messages

• Shewanella algae is an opportunistic pathogen, increasingly isolated in marine water and seafood.

• Blue crab is an invasive species that has recently conolonised the Italian coasts.
Taxing animal-based food products: A qualitative framing analysis of the media debate in Germany
Authors: Leibinger A , Moerschel K S , Hagge A , Hawkins B , von Philipsborn P
Published: October 2024

Background

In most high-income countries, consumption of animal-based food products exceeds levels recommended for health and environmental reasons. Although taxes can reduce the consumption of animal-based products, they are politically controversial. In recent years, various tax models and motivations for these have been discussed. Our study seeks to identify key arguments and policy actors in the German media debate on the taxation of animal-based products, shedding light on emerging narrative frames surrounding tax models and motivations.

Methods

We conducted a qualitative analysis of German media coverage on taxes and levies influencing the price of animal-based foods. We analyzed 488 articles from 10 national newspapers and eight trade press journals published between February 2019 and July 2023. Employing an inductive approach, we identified the actors involved in the debate and common frames and arguments around various tax proposals.

Results

We found broad consensus on a need for change due to inadequate animal welfare conditions, while environmental and health arguments are more contested. Significant debate surrounds the suitability of taxation as the preferred policy instrument. Furthermore, doubts are raised about a tax’s effectiveness and appropriate revenue allocation. Framing of the tax often emphasizes potential negative impacts on domestic production and product affordability. Additionally, concerns about various unintended consequences and the overall unpopularity of taxation emerge as prominent themes.

Conclusions

The taxation of animal-based products for health and environmental reasons is still highly contested in the media debate in Germany. Many, but not all arguments commonly raised against such taxes may be considered spurious from an evidence-based public health perspective. Proponents of such taxes may seek to address existing concerns through appropriate policy design and communication strategies.

Key messages

• Taxation of animal-based foods may help to align consumption with levels recommended for health and environmental reasons, but adoption and implementation is hindered by political controversy.

• Objections common in the public debate on such taxes could be addressed with appropriate policy design alleviating justified concerns, and with communication strategies countering spurious arguments.
A scoping review on sociodemographic inequalities in breast cancer screening attendance in Germany
Authors: Pedrós Barnils N , Härtling V , Singh H , Haug U , Schüz B
Published: October 2024

Background

Organized breast cancer screening (BCS) programs are effective measures among women aged 50-69 for preventing the fifth cause of death in Germany. However, still participation rates have not yet reached EU standards. It is unclear which and how sociodemographic factors are related to BCS attendance. This scoping review aims to identify sociodemographic inequalities in BCS attendance among 50-69-year-old women following implementing the Organized Screening Program in Germany.

Methods

Following PRISMA guidelines, we searched the Web of Science, Scopus, MEDLINE, PsycINFO, and CINAHL. We included primary studies with a quantitative study design and reviews examining BCS attendance among women aged 50-69 with data from 2005 onwards in Germany. Harvest plots depicting effect size direction for the different identified sociodemographic inequalities were developed.

Results

We screened 476 titles and abstracts and 33 full texts. In total, 27 records were analysed, 14 were national reports, and 13 peer-reviewed articles. Eight sociodemographic variables were identified and summarised in the harvest plots: age, education, income, migration status, type of district, employment status, partnership cohabitation and health insurance. Older women, women with lower incomes and migration backgrounds who live in rural areas and lack private insurance, respond more favourably to BCS invitations. However, from a lifetime perspective, these associations only hold for migration background, are reversed for income and urban residency, and are complemented by partner cohabitation. Finally, women living in the federal states of Lower Saxony, Saxony, Mecklenburg-Western Pomerania, Saxony-Anhalt, and Thuringia showed higher attendance rates in the last two years.

Conclusions

High-quality research is needed to identify women at higher risk of not attending BCS in Germany, particularly as the overall attendance rate still falls below European standards.

Key messages

• High-quality research is needed to identify women at higher risk of not attending BCS in Germany, particularly as the overall attendance rate still falls below European standards.

• Women without migration background, high income, living in rural areas, and not cohabitating with their partners are at higher risk of never attending BCS in Germany.
Utilization of paternity and parental leave in Italy: the parents’ perspective
Authors: Zambri F , Di Stefano V , Di Nolfi A , Vatta B , Lubbock A , Marzella M , Chapin E M , Preziosi J , Tambascia G , Giusti A
Published: October 2024

Background

In recent years, there has been a focus on the role of fathers in childcare within public debates and social policies. Maternity, paternity, and parental leaves are essential tools for active father involvement in family life. The study aims to describe the fathers and mothers’ perspective about the use of two types of leave (paternity and parental) by fathers.

Methods

As part of the European project 4E (Early, Equal, Engaged, Empathetic) PARENT (CERV-2022-DAPHNE No. 101095956), a cross-sectional study was carried out using an online questionnaire addressed to parents between August and December 2023.

Results

A total of 3,811 mothers and 720 fathers participated. Sixty percent of mothers and 57% of fathers came from the North, with the majority having a high level of education (74% and 58%, respectively). Seventy-three percent of fathers reported using paternity leave, with most cases from the public welfare system (59%). Overall, most of mothers (91%) and fathers (89%) do not consider the current duration of leave adequate nor do they agree with the traditional division of family roles. Additionally, 69% of mothers and 72% of fathers believe that fathers should have more leave, but also that mothers need more months for breastfeeding. The logistic model shows that for fathers: low education level (ORadj 0.34, 95% CI 0.13-0.86), living in the Center (ORadj 0.49, 95% CI 0.28-0.87) and Southern Italy (ORadj 0.32, 95% CI 0.15-0.64), and acceptance of traditional family role division (ORadj 0.30, 95% CI 0.14-0.65) reduce the likelihood of using paternity leave. Similar results were observed in case of mothers’ responses. Furthermore, living in Southern Italy reduces the likelihood of using parental leave for both fathers (ORadj 0.24, 95% CI 0.09-0.69) and mothers (ORadj 0.67, 95% CI 0.49-0.92).

Key messages

• Maternity, paternity, and parental leaves are crucial for facilitating active father participation in family life.

• It is important to implement inclusive policies that ensure equitable access to paternity and parental leave, thereby promoting active father involvement in childcare.
Identification of different types of nicotine product users: results from a cluster analysis
Authors: Kramer I , van Westen-Lagerweij N A , Cornelissen E , Lize N , Hopman EPC , Croes E A
Published: October 2024

Background

Smoking cessation interventions often target people that use nicotine products as one homogenous group. However, heterogeneity exists among people who smoke and/or use e-cigarettes. The aim of the current study was to characterize clusters of nicotine product users based on their use and motives.

Methods

The study included 2000 people who smoke and/or use e-cigarettes aged ≥18 years in the Netherlands. Respondents were recruited from a large survey-panel between August and October 2023. The questionnaire consisted of questions on demographics, product use/frequency, and motives to use nicotine products and motives to quit. A cluster analysis was used to identify the number and nature of subgroups reporting similar product behavior and/or motives. Analyses were weighted to correct for imbalances between the survey sample and the population of the Netherlands.

Results

Four clusters were identified. Cluster 1 ‘socially-influenced smoker’ (13%) had a greater proportion of men, participants indicated using a variety of products and often try a product if they have seen other people using it. Cluster 2 ‘party smoker’ (5%) was characterized by participants being young, mostly smoke during a social event, and indicated that drinking alcohol is a reason to smoke/use a nicotine product. Participants in cluster 3 ‘coping-driven smoker’ (43%) were more often women, use nicotine products to reduce stress, to relax and regulate mood. Cluster 4 ‘Inveterate smoker’ (39%) mainly contained participants of older age and endorsed smoking due to pleasure and habit and see smoking as part of their identity. The socially-influenced smoker had the highest intention to quit (67%), and the inveterate smoker the lowest (35%). Among all clusters, improving health was reported as most important reason to stop using nicotine products.

Discussion

Classifying nicotine product users into subgroups based on their use and motives could lead to more appropriate smoking cessation interventions.

Key messages

• People who use nicotine products are not a homogenous group, but can be divided into different clusters based on their product use and motives.

• Classifying people that use nicotine products into subgroups based on their use and motives could lead to more appropriate smoking cessation interventions.
Changes of lifestyle and mental health among COVID-19 situation: resident-centered health promotion
Authors: Shibata T , Koyano M , Hiraga C , Shimizu Y
Published: October 2024

Background

Yuzawa town, located in the Niigata prefecture of Japan, is famous for its hot springs and ski resorts. A sustainable action plan for resident-centered regional health promotion (Yuzawa family health plan) was initiated in 2002. Surveys have been conducted every five years. This study aims to evaluate changes of their habits and mental health status between in 2017 and in 2022.

Methods

The survey of Yuzawa family health plan was conducted in 2017 and in 2022. Questionnaires were composed with living alone, living with marriage partner, living with son or daughter, living with grandchildren, living with brother or sister, health consciousness, attention to health, health concern, awakening in a morning, clockwork life, fitness habits, smoking, taking alcohol, anxiety, loneliness, consultation, resolve suffering, economic problem, handle stress, taking a rest, risk breaching, communication, life satisfaction, talking with family, job at home, intercommunion with friends, greeting with neighbors, relationship with neighbors, occupations, good sleep, taking breakfast, nutritional balance, mastication status, confirmation of food compositions, exercise habits, yearly health check-up, dental check-up, brushing teeth habits, and sleep satisfactions. Chi square tests were used to evaluate changes between in 2017 and in 2022. This study was approved by the ethics committee of Tokyo Women’s Medical University.

Results

Passive smoking, intercommunions with neighborhood and friends, exercises, and Salt reduction awareness reduced in 2022. Talking with family, taking a rest, attention to health, clockwork life, and sleep satisfactions increased.

Conclusions

Many changes were shown between in 2017 and in 2022. Because elderly has been able to use a mobile phone, loneliness was not increased. But numbers of elderly living alone have been increased from 2002. Health promotion programs giving health information for elderly is needed.

Key messages

• Many lifestyle changes were shown between in 2017 and in 2022.

• Passive smoking reduced. Taking a rest and attention to health increased.
Citizen needs towards personalised medicine and genetic testing: results from a European survey
Authors: Porcelli M , Beccia F , Causio F A , Proto L , Tona D M , Di Pumpo M , Van El C , Calabrò G E , Pastorino R , Boccia S
Published: October 2024

Introduction

Personalised Medicine (PM) aims to tailor diagnostic and therapeutic pathways for patients. Despite technological advancements in this field, public awareness of PM remains limited, representing a barrier to its clinical integration.

Methods

We conducted a survey across eight European Countries (France, Germany, Hungary, Italy, Netherlands, Poland, Romania, Spain) via the private platform YouGov, in April 2023. Our web questionnaire explored knowledge of PM, willingness to embrace it, and trust in information delivered by mass media.

Results

Of 6,581 respondents, approximately 42% lacked sufficient knowledge of PM and genetic testing, while 36.3% found information about the topic not easily accessible. Healthcare providers were the most trusted source of information (according to 80% of responders), followed by educational institutions (71.4%). Education, age, and gender significantly influenced the acceptance of PM and mass media trust, highlighting the association between high education level, readiness to embrace PM, and high trust in academic sources of information. Additionally, age, gender, and geographical location influenced the perception of PM and genetic tests in various ways across Europe. Despite the geographical differences, 63.2% of respondents want to know more about PM, and 60% support its implementation in clinical practice.

Conclusions

Although the growing interest in PM genetic, and -omics technologies, large sections of the population still lack access to information and understanding, indicating a disconnection between technological advancements and public awareness. The study emphasizes the importance of providing focused citizen engagement initiatives to implement PM approaches. Citizen participation in defining personalised diagnostic and therapeutic pathways is vital to empower individuals and enable them to make informed health choices.

Key messages

• Understanding European citizens’ attitudes and needs regarding Personalised Medicine is crucial for creating policies and facilitating access to new technologies and treatments.

• Despite limited knowledge, European Citizen recognize the importance of Personalised Medicine for their health, seek further understanding, and place trust in Academic Sources of Information.