bluuebunny/crossref_metadata_2025 huggingface dataset:
How the EU animal welfare legislation can tackle AMR – a One Health perspective
Authors: Pegger T , Haager D , Jamal N , Heidbuechel K
Published: October 2023

The development of antimicrobial resistance (AMR) is linked to the imprudent use of antimicrobials and is fuelled by industrial farming, accounting for 70% of antimicrobial use. Tackling AMR requires a One Health approach that addresses the root causes of high antimicrobials use in intensive farming and generates co-benefits for human, animal and environmental health. On intensive farms animals are mostly of high-yield breeds and are exposed to stressors, which leads to immunosuppression, increasing susceptibility to infections that need antimicrobial therapy. To combat AMR the EU Commission adopted legislation prohibiting the use of antimicrobials to compensate for poor husbandry and management. However, there is a gap in policy regarding animal welfare improvements necessary to reduce the need for antimicrobials. We assess how the EU animal welfare legislation, under revision, can contribute to filling this gap by providing the regulatory framework for improvements needed to reduce antimicrobial use. Methods include literature review and expert interviews in an approach that integrates knowledge across the human-animal-environmental sectors. Improvements in husbandry and management (lower stocking density, outdoor access, genetic diversity, etc.) positively impact animal health and welfare, consequently reducing susceptibility to infections and antimicrobial use. By prescribing these improvements the revised animal welfare legislation can have a synergistic effect with the Veterinary Products Regulation, in line with the Farm to Fork strategy, and provide the regulatory framework for higher animal welfare standards that reduce antimicrobial use. The positive correlation between higher animal welfare and the reduced need for antimicrobials demonstrates the urgency of improving welfare in farming as a key strategy to limit AMR. It builds the case for an ambitious revision of the EU animal welfare legislation to protect animal and human health in line with One Health.

Key messages

• The revised EU animal welfare legislation can become a relevant policy in tackling AMR by providing the regulatory framework for high animal welfare standards neded to reduce antimicrobials in farming.

• Tackling AMR requires a One Health approach addressing the root causes of high antimicrobial use in intensive farming: the poor welfare of animals, which increases their susceptibility to infections.
Adolescents’ meaning and implications of Health and Health Literacy
Authors: Andrade C , Helder Rocha Pereira H , Duarte A , Silva H , Freitas L , Lalanda M , Saboga-Nunes L
Published: October 2023

Introduction

Understand how concepts are integrated, what they mean and how they influence action, is a symbiotic movement between social representations, society achievements and personal ease in terms of interaction with the “other”. Little is known about adolescents’ concepts development like “health” and “health literacy”. The aim of this presentation is to share a show case on how adolescents incorporate and reflect into their social practices the socialization process of concepts development and how this influence their attitudes towards sustainability.

Methods

A population cross-sectional study included (n = 1009)) children enrolled in the 7th and 10th grade in the school year 2018/2019 of six schools in Ponta Delgada, Azores. Several indicators like anthropometric data, water intake, HL levels (using the HLS-EU-PT questionnaire) were collected with the CrAdLiSa online self-administered questionnaire. Also qualitative data was collected regarding the meaning of the concepts of Health and Health Literacy.

Results

Health is defined as Good functioning of the body (5.5%); Absence of disease (7.5%); State at a moment (9.5%); Adopting a healthy lifestyle (11.5%); Well-being (physical, psychological, social) (32.3%); A Resource / Asset to be preserved (33.7%); Health Literacy is defined as Knowing how to make health decisions based on information (5.7%); Set of books/documents on health (9.4%); Others (11.3%); Learning to be healthier (22.6%); Reading about health issues (22.6%); Having knowledge about health (28.3%)

Conclusions

Adolescents view on Health and Health Literacy reflect the society's processes of meaning making of these two categories and further interaction regarding the theoretical background and practical consequences of these social representations reflect a needed field of interaction toward a sustainable approach.
Influence of emotions and inflation on food and drink purchase: An ethnography among Danish families
Authors: Duus K , Tjørnhøj-Thomsen T , Krølner R F
Published: October 2023

Background

Families’ food and drink purchases are highly related to intake which affects several health outcomes. Various factors influence grocery shopping e.g., price, preferences, promotion, and availability. However, few studies have explored the relationship between these and how they are affected by major societal changes. This study aims to elaborate on perceived and observed influences on families’ food and drink purchases from a systems perspective during the inflation in 2022.

Methods

We performed an ethnographic study using semi-structured, shop-along, and photo-elicited interviews with families from September 2022 to January 2023. Fifteen families with children aged 0-21 participated in at least two interviews, resulting in 37 interviews for analysis. We analysed the data using the principles of abductive analysis. We focused on the unexpected research finding that a seemingly mundane behaviour - such as grocery shopping - invoked many different emotions in the participants.

Findings

Preliminary findings indicate that food and drink purchase is an emotional and private activity. The participants, for example, showed signs of and expressed embarrassment with their choices. Some participants expressed frustration, discomfort, and fear of being tricked concerning grocery shopping, while others associated it with joy, excitement, and inspiration, which influenced their selection of food items. Families experienced changing their shopping behaviour due to the rising inflation. Many faced the question of whether their regular choices, e.g., ecological products, were worth the extra cost. This new need for balancing personal values with economic considerations was often followed by negative emotions e.g., feeling like a bad parent.

Conclusions

Our preliminary findings indicate that families’ overall feeling about grocery shopping influence their purchase of food and drink items and that grocery shopping can be related to both negative and positive emotions.

Key messages

• Grocery shopping and deciding which food and drink to buy is an emotional behaviour.

• Healthy retail intervention must account for the influence of emotions on food and drink purchase behaviour.
Changes in active commuting and changes in work ability and recovery from work
Authors: Kalliolahti E , Gluschkoff K , Haukka E , Lanki T , Jussila J J , Halonen J I , Salo P , Oksanen T , Ervasti J
Published: October 2023

Background

Active commuting (walking or cycling) to work may be a feasible way to increase physical activity and improve health and wellbeing also at work. There is increasing evidence on the health benefits of active commuting, but little is known about longitudinal associations between active commuting and work ability, and recovery from work.

Methods

We conducted an observational cohort study of 16,776 public sector employees who responded to the Finnish Public Sector study in 2020 and 2022. Within- and between-individual associations of changes in active commuting with changes in self-rated work ability and recovery from work (scale from 0 to 10) were examined using hybrid modelling. The change in active commuting was assessed with a repeated self-report of weekly frequency of commuting by walking or cycling that was multiplied with the daily commuting distance. While the within-individual part of the hybrid model accounts for all time-invariant confounders, both parts of the model were adjusted for time-varying confounders including socio-economic factors, body mass index, and health behaviors, and the between individual part with sex and age (birth year) (time-invariant).

Results

After adjustments, a 10 km weekly increase in active commuting was associated with a slight improvement in work ability in both within- and between-individual analyses (unstandardized B = 0.02, p = 0.01; unstandardized B = 0.03, p = 0.001, respectively). Similar increase in active commuting was associated with slightly improved recovery from work in between-individual analysis (unstandardized B = 0.03, 95%, p = 0.001), but the association was not replicated in within-individual analysis.

Conclusions

Our findings suggest that an increase in active commuting may have some potential for improving work ability, albeit the increase needs to be rather large to achieve even a small improvement in work ability. The results for recovery from work were inconclusive.

Key messages

• An increase in active commuting may improve work ability.

• No conclusive evidence supporting that an increase in active commuting enhances recovery from work was found.
One Health strategies for addressing antimicrobial resistance: an exclusive emphasis on Bulgaria
Authors: Vankova D , Kapincheva I , Micheva I , Boncheva P , Mihaylova S , Kanalev R , Ivanov D , Veleva N , Vladimirova M , Paunov Ts
Published: October 2023

Antimicrobial resistance (AMR) is a public health challenge, primarily driven by the excessive use of antibiotics (ABs). While the European Union (EU) has successfully reduced ABs consumption since 2009, Bulgaria (BG) reports an increase in ABs use in both community and hospital settings. According to the 2021 Eurobarometer, the consumption rate of ABs among Bulgarians is twice as high as that in Germany, with a significant number taking ABs without a prescription. Moreover, only 41% of Bulgarians are aware that ABs do not kill viruses, and 30% took ABs for COVID-19 (as compared to 1% in Finland). This highlights an urgent need for interventions to tackle AMR in BG, using One Health (OH) approaches that consider the complex interplay between human, animal, and environmental health. The data presented aims to alert a wide range of stakeholders that AMR is not just a clinical or national issue but it has cross-border implications. It emphasizes the role that everyone must play in preserving the efficacy of ABs.

Strategies for sustainable OH solutions: Researchers and educators should incorporate AMR and OH in their core responsibilities, providing relevant training and raising community awareness regarding prudent ABs use. Encouraging integrative medicine approaches, including traditional practices such as phytotherapy, can help delay the ABs prescriptions. Research is also necessary to support OH legislative changes that restrict ABs sales. Particularly, Bulgaria is among the few EU countries that have not approved an OH Action Plan against AMR or an inter-sectoral OH mechanism between veterinary, food, and health authorities. OH remains relatively unfamiliar in BG. Despite this, there is a political will to develop national OH policies, as demonstrated in the recently adopted National Health Strategy 2030. Urgent actions are needed to address AMR in BG. Using EU's AMR activities as a model, this analysis is a step towards a regional OH project.

Key messages

• AMR is a pressing public health problem in Bulgaria with cross-border implications. One Health strategies are needed urgently to address it. EU's AMR activities can be a model.

• Bulgarian researchers, educators, and policymakers must make AMR their central responsibility. OH Action Plan against AMR and an inter-sectoral collaboration are the keys to success.
A cluster of Histamine Fish Poisoning associated with the ingestion of tuna
Authors: McGlacken T , Kelly S , O'Connor K , Murray H , Mullaney C
Published: October 2023

Histamine fish poisoning, also known as scombroid poisoning, arises from the improper handling and refrigeration of scombroid fish that contain naturally occurring histidine such as tuna, mackerel and swordfish. Histidine is converted to histamine when these fish inadequately chilled. Histamine fish poisoning is generally associated with levels greater than 500 mg/kg but poisonings have been observed at lower levels (e.g. >200 mg/kg). European legislation states that scombroid fish species should be tested for the presence of histamine and mean values should be < 100mg/kg. The authors report an outbreak of probable histamine fish poisoning in three individuals following ingestion of tuna. The tuna was bought in a local store. It was cooked and eaten by the 3 cases at home for their evening meal. Symptom onset occurred between 30 minutes and two hours after ingestion and included flushing, facial/lip swelling, an itchy rash and palpitations. All three cases attended the Emergency Department (ED) requiring oral or Intravenous (IV) anti-histamine and/or oral steroids and IV fluids. Fortunately, all cases recovered fully and were discharged from the ED. The public health actions that were taken, crucially included rapid coordination with the Environmental Health Service (EHS). Temperature control is the crucial step in preventing histamine fish poisoning. The Food Safety Authority of Ireland and the Irish Sea Fisheries Board highlight the importance of proper handling and chilling of fish from time of catch through to transportation, processing, storage and distribution. This report highlights the importance of timely and coordinated public and environmental health responses to histamine fish poisoning cases. National Clinical Guidelines are currently being developed in conjunction with the Irish Association for Emergency Medicine (IAEM) on the Management of Histamine Fish Poisoning/Histamine Poisoning in Adult Patients.

Key messages

• Environment and Health.

• Food governance.
Temporality shaping lessons learned from COVID-19 - Follow-up study of Finnish pandemic governance
Authors: Viita-aho M , Janhonen K , Paananen H , Kihlström L , Tynkkynen L-K
Published: October 2023

Background

Public health crises require and offer unique opportunities for learning. Despite abundant “lessons learned” -literature on the COVID-19, follow-up research designs are scarce. To fill in this gap we analyse how key national level decision-makers in Finland discuss the lessons from COVID-19 at its’ different stages, since they are in key positions to develop health system preparedness and crises response policies based on lessons from past shocks.

Methods

The qualitative interview study includes unique follow-up data on Finnish national-level decision-makers’ interpretations of the lessons learned from COVID-19. The interviewees represent key ministries, other governmental organisations with responsibilities in pandemic governance, expert organisations and authorities responsible for preparedness. The data were collected from the same informants 1) at the acute stage of the epidemic in Finland (2021, n = 21) and 2) after the vaccination coverage was at high level and the acute stage of the epidemic had passed (2022-2023, n = 16). Analyses included abductive and thematical content analyses.

Results

The lessons learned from COVID-19 were defined differently at different stages of the pandemic. In addition, the possibilities to assess or implement the lessons or reform the system were hampered by scarce resources and the political agenda already shifting to other crises and challenges. Results further showed the short-term nature of many of the crisis measures taken during the acute stage.

Conclusions

The follow-up design enabled analysis of the nature of the lessons learned during and after the acute stage of COVID-19. Temporal framing of data illustrated the changing and emergent nature of the lessons learned, highlighting the need for broad ranging analyses across multiple time spots and crisis cycles in the future. Scarce human and financial resources in the health system compel to focus on most topical issues, hampering long-term development.

Key messages

• Preparation for future crises requires practical measures during normal times.

• Comprehensive analyses of lessons learned beyond a single crisis cycle supports continuity of crisis preparedness and management.
The COVID-19 Movement Restrictions and Impact on Shelter Accessibility: Central African Republic
Authors: Young-Jin K , Kyoung-Beom K , Hui Won J , Souphavanh D , Jin-Won N
Published: October 2023

Background

The coronavirus disease(COVID-19) has been spread worldwide since 2019, posing significant challenges to the socio-economies and healthcare system of many countries. During COVID-19, sanitation facilities such as water, shelter, food, and health service are required to prevent the spread of coronaviruses and others. However, The multiple factors of Central African Republic(CAR) such as low human development index, limitation of health resources, and unstable financial capacity are a barrier to stopping the spread of the COVID-19. Also the government conducting the COVID-19 vaccination campaign since 2021, experiencing difficulties due to poor road conditions and insecurity. These cannot appropriately response to the coronavirus spread. Therefore, this study was conducted to investigate the effect of COVID-19 movement restrictions on shelter accessibility in CAR.

Methods

This study analyzed 11,723 crisis-affected households from the 2020 Central African Republic Multi-Cluster Needs Assessment survey data. This survey was conducted between June to August 2020 by the Racial and Ethnic Approaches to Community Health(REACH) Initiative and geographically covered all sub-prefectures of the country. Complex sampling design weighted multivariable binary logistic regression analysis was performed.

Results

It was found that shelter accessibility was possible when there was a movement restriction (p < 0.05). In the case of IDPs compared to HOST (p < 0.01), and the higher the number of household members (p < 0.05), the more difficult it was to access shelter.

Conclusions

In response to the spread of COVID-19 in CAR, humanitarian actors have conducted a variety of preparedness activities. Relief agencies have also adjusted operations to continue the delivery of shelter, food, health, livelihoods, and including movement restrictions. Therefore, although movement restrictions were implemented, the other activities such as increasing accessibility to shelter was also conducting.

Key messages

• This study was conducted to investigate the effect of COVID-19 movement restrictions on shelter accessibility in CAR.

• There are many preparedness activities for stop the spread of COVID-19 in CAR. So even if the covid-19 movement restriction was conducting, the relief work (delivery of shelter) also implemented.
An exploration of access to healthcare for women experiencing homelessness in Northern Ireland
Authors: McNeill S , O'Donovan D , Hart N
Published: October 2023

Background

People experiencing homelessness have poorer health than the general population. Therefore, they are more likely to struggle with accessing healthcare, described in the Inverse Care Law. To date, there has been no peer reviewed research published from Northern Ireland on the topic of homelessness and health. Data published in recent reports shows a rise in the number of women experiencing homelessness in Northern Ireland. This research asks about the nature of access to healthcare for women experiencing homelessness in Northern Ireland and how can it be improved.

Methods

Semi-structured interviews were conducted with women experiencing homelessness, hostel staff and healthcare staff. Following the interviews, a stakeholder workshop was hosted to gather views from stakeholders in policy, planning and healthcare education. Data were analysed following Reflexive Thematic Analysis.

Results

There were 19 participants interviewed. All participants were female. Healthcare and hostel staff experience ranged from 1 year to over 30 years and included staff from each of the Health Trusts around Northern Ireland. The interviews were followed by a stakeholder workshop with 13 participants representing various groups and organisations. Preliminary themes constructed during Reflexive Thematic Analysis include health and social care complexities, awareness of services and needs, relationships, system design and connectedness.

Conclusions

Preliminary conclusions confirm both supply and demand side barriers for access to healthcare for women experiencing homelessness in Northern Ireland, also included are recommendations for practice in Northern Ireland to improve this access journey. There is need for increased awareness of services for and needs of WEH, through improving service navigation and providing training for health and hostel staff. Alongside this, is the need for improved connectedness between services, both with referral and data sharing.

Key messages

• Women experiencing homelessness have complex health and social care needs that impact how they access healthcare.

• This research is the first of it’s kind in Northern Ireland and provides insights into how to improve access to healthcare for women experiencing homelessness.
Review the Primary Health care for Travellers Projects (PHCTPs) in he Eastern Region
Authors: Quirke B , Collins M , Kavanagh L , Kelleher C
Published: October 2023

Issue/Problem

Minority ethnic minority groups globally experience similar health challenges in accessing appropriate health services. Irish Travellers are a Minority Ethnic group who experience health inequalities. Our objective is to review the PHC model adapted for Travellers to identify the appropriate elements, resources, standards and principles required to develop, implement and sustain an effective model of good practice in PHCTPs.

Description of the Problem

We reviewed 10 PHCTPs in the Eastern region. Different methods were used taking cognisance of literacy and experience levels among Traveller Community Health workers (TCHWs), Project Coordinators and Steering group members. Scoping exercise conducted to review the literature and collate project reports; questionnaires designed for Coordinators and steering group members; Regional workshops and focus groups were run with PHCTP coordinators and TCHWs these included SWOC analyses; Spider graphs and graffiti wall exercises.

Results

The scoping exercise showed improvements in levels of satisfaction and utilisation of health services by Travellers in its areas; TCHWs were very enthusiastic about their training and experience of working in the projects. Focus on replicating the outcomes of the original PHC model but not the process involved to engage Travellers; Project Coordinators require further training to develop skills to improve the capacity, training standards and scope of the projects. Results fed back to all the groups and the collation and analysis informed the development of a Good Practice guide for a sustainable model of PHCTP.

Lessons

Development of culturally appropriate information and services in partnership with marginalised communities; work with rather than for; respect the expertise that each partner brings to the project.

Key messages

• A sustainable model of good practice identified for Primary Health care for Traveller Projects to facilitate expansion.

• Highlights value of PHC as a model for adaptation for other minorities/settings.
The chronic diseases and health-related quality of life among nursing home residents in Armenia
Authors: Muradyan D , Giloyan A , Harutyunyan T , Petrosyan V
Published: October 2023

Background

The study assessed the impact of chronic diseases (and each of them) on health-related quality of life (HRQoL) and each of the eight domains of HRQoL in nursing home residents in Armenia.

Methods

In 2021, a cross-sectional study surveyed 313 nursing home residents using a structured interviewer-administered questionnaire to collect data on socio-demographics, chronic diseases, HRQoL, smoking, and sleeping disorders. An ophthalmic examination was conducted to assess visual impairment (VI).

Results

The participants mean age was 72.5 years. The most common chronic diseases were bone/joint diseases, hypertension, and heart diseases. In the adjusted analysis having at least one chronic disease, sleeping disorder, and VI were negatively associated with the total score of HRQoL. Stroke was negatively associated with all domains of HRQoL in the adjusted analysis. Chronic bone/joint and heart diseases were associated with almost all domains of HRQoL except emotional well-being and social functioning (for the former) and role limitation due to physical and emotional problems, and social functioning (for the latter). Chronic renal diseases significantly decreased scores in the domains of energy/fatigue, emotional well-being, pain, and general health, while chronic respiratory diseases/asthma decreased scores of social functioning and pain in the adjusted analysis.In the adjusted analysis having two or more chronic diseases was negatively associated with all domains of HRQoL, with pain (β = -36.3, p < 0.001), role limitation due to physical health (β = -29.0, p < 0.001) and physical functioning (β = -26.5, p < 0.001) being the most affected domains.

Conclusions

Chronic diseases significantly decreased HRQoL among participants, with stroke and bone/joint diseases having the broadest impact on HRQoL domains. Strategies should be developed for the adequate management of chronic diseases. Those with multiple chronic diseases should be priority targets for such interventions.

Key messages

• Stroke and bones/joints diseases have the broadest impact on HRQoL domains.

• Having two or more chronic diseases significantly decreased HRQoL in all domains, particularly affecting pain, role limitation due to physical health, and physical functioning.
Exploring attitudes of people with chronic conditions towards telerehabilitation: A qualitative study
Authors: Barry Walsh C , Cahalan R , Hinman R S , O’ Sullivan K
Published: October 2023

Background

Patient attitudes towards telerehabilitation have been explored in condition-specific cohorts. However, less is known about how patients perceive generic group telerehabilitation programmes for a range of chronic conditions. The aim of this research is to explore the attitudes of people with a range of chronic health conditions towards group-based telerehabilitation, and the acceptability of generic telerehabilitation programmes.

Methods

We conducted a qualitative research study using semi-structured focus groups via videoconferencing software. A purposive sample of 18 people with chronic health complaints including cardiorespiratory, neurological and musculoskeletal conditions were recruited. The sample included both those who had (n = 11), and had not (n = 7), previously engaged in telerehabilitation programmes. An online questionnaire collected demographic information and data regarding previous telerehabilitation participation and preferences. Focus groups were conducted via videoconferencing, in accordance with the Consolidated Criteria for Reporting Qualitative Research Checklist, and analysed using thematic analysis following Braun and Clarke's methodology. Findings were triangulated with quantitative questionnaire data.

Results

Four focus groups were conducted including participants with chronic cardiorespiratory (n = 8), neurological (n = 6) and musculoskeletal (n = 4) conditions. Three themes were identified regarding telerehabilitation: 1. Benefits and Facilitators 2. Challenges and Barriers, and 3. Preferences

Conclusion(s)

Telerehabilitation is convenient for people with chronic conditions, however, concerns exist regarding technology and the limitations of this healthcare delivery method. The role of telerehabilitation is valued, and future programmes should acknowledge patient preferences including a hybrid model of care, exercise and educational content, social interaction, and synchronous components.

Key messages

• Patients value the role of telerehabilitation in the future as an adjunct to traditional in-person rehabilitation, not as a replacement.

• The acceptability of a generic telerehabilitation programme for a group of people with a range of chronic conditions remains unclear, and may differ between groups.
Differences in breast cancer incidence between women with and without disabilities in South Korea
Authors: Kang H Y , Oh J K
Published: October 2023

Backgrounds

Breast Cancer (BRC) is a leading cause of morbidity and mortality in women. BRC incidence has steadily increased in South Korea. Women with disabilities encounter multiple challenges in accessing cancer prevention and diagnosis. This study aims to estimate the incidence of BRC among women with and without disabilities in South Korea.

Methods

We analyzed 2.87 million women aged ≥30 years in 2002 who participated in the National Health Screening Program in 2002-2003 retrieved from the National Health Insurance Database (NHID). Disabilities were identified by the disability registration data in the NHID from 2002-2019. BRC incidence was determined by the National Cancer Registry in 2003-2019; for women with disabilities, BRC diagnosed after registering disability were included. Age-standardized incidence rates (ASRs) and ratios (SIRs) compared to incidence in the general population were estimated for those with and without disabilities.

Results

During the follow-up period (2003-2019), incident cases were 2,605 (0.9%) and 46,267 (1.8%) among 296,689 women with- and 2,576,182 without disabilities, respectively. Women without disabilities had a 1.65 times higher risk of BRC than those with disabilities. The BRC risk in women with disabilities (SIR = 0.59, 95% CI 0.57-0.62; ASR = 58.2 per 100,000) was lower than the general population. However, women without disabilities (SIR = 0.98, 0.97-0.99; ASR = 96.0 per 100,000) were similar to the general population. Women with disabilities were less likely to undergo BRC screening (RR = 0.92, 0.92-0.92) and more likely to have advanced stages than women without disabilities. Even though the incidence was higher among women without disabilities, BRC mortality was similar between the two groups.

Conclusions

Women with disabilities had a lower BRC incidence but a similar mortality rate to those without disabilities. Lesser accessibility to healthcare services in women with disabilities may partly explain the lower incidence rate.

Key messages

• Women with disabilities had a lower incidence but a similar mortality rate of BRC compared to women without disabilities.

• Women with disabilities were less likely to undergo BRC screening and more likely to have advanced stages than those without disabilities.
Effect of urban green space on parental sleep quality in the two years after childbirth
Authors: Chen P A , Hsu H W , Zou M L , Lin W Y , Wu C D , Chen Y H
Published: October 2023

Background

Green spaces are beneficial for sleep quality, particularly for maternal sleep quality, which in turn affects maternal health as well as the growth and development of offspring. However, few studies have examined the effect of green space on parental sleep quality, and even fewer have utilized the Normalized Difference Vegetation Index (NDVI). This study thus aims to explore the impact of urban green spaces on parental sleep quality during the two years after childbirth.

Methods

Participants were selected from the Longitudinal Examination across Prenatal and Postpartum Health in Taiwan cohort study. The study recruited and followed participants from early pregnancy to 6 years postpartum at five hospitals in Taipei since 2011. Participants who had used hypnotics were excluded. Sleep quality was assessed using self-reported questions at 24 months postpartum. Urban greenness was assessed using NDVI within a designated radius (250, 750, and 1500m) of participants’ residences during both the pregnancy and postpartum. Data were analyzed using multiple logistic regression.

Results

Out of the 804 pairs included in the analysis, we observed that an increase of 0.1 units in NDVI within a 1500m radius during pregnancy and postpartum periods (0-24 months) was associated with a 1.24 and 1.25-fold increase in maternal better sleep quality (95%CI:1.07,1.43 and 1.08, 1.43, respectively), after adjustment. These findings were consistent for both NDVI_250m and NDVI_750m. However, we did not find any association between NDVI and paternal sleep quality at any radius or time period.

Conclusions

We highlight a positive association between exposure to urban green spaces during perinatal periods and better maternal sleep quality. These findings have implications for parents in choosing their living environment, as well as for policymakers in urban planning and environmental improvement initiatives to promote both maternal and child health.

Key messages

• Urban green spaces have a positive impact on maternal sleep quality from pregnancy to postpartum periods.

• The residential environment is critical to facilitate sleep quality and promote maternal and child health.
Using mixed methods to better assess the effects of citizen sensing on individual behaviors
Authors: Dardier G , Jabot F
Published: October 2023

Citizen sensing initiatives have multiplied in recent years as a way to better understand and act upon urban air pollution at the individual level. However, assessing their effects on behaviors remains a challenge. In 2019, a multidisplinary academic team conducted a research on a French initiative where volunteer citizens were equiped with fine particle micro-sensors, and mobilized mixed methods to assess its impacts on individual practices. A cross analysis of quantitative data from the micro-sensors (3001 measure sessions from 73 sensors) and qualitative data from the volunteers (70 interviews and 49 questionnaires) was performed to analyze the strategies of capture deployed by the volunteers and the impact of the initiative on individual behaviors. Each data set analysis established a relationship between the ways in which volunteers use the sensors and the evolutions of the initiative. Their cross analysis strengthened this relationship and enriched its understanding by identifying the mechanisms at play: volunteers’ capture behaviors over time and space are determined by their initial drive to participate in the initiative, the support they receive to use the sensor, understand the data and relate it to personal concerns, and their sense of belonging to a community of clean air ambassadors. The confrontation of data sets also helped nuance the declarative statements of volunteers regarding behavior change and identify common patterns in the process of adoption (types of new behavior, triggers and maintenance over time). This research confirms that mixed methods are relevant to evaluate the effectiveness of citizen sensing initiatives since they can be used to both assess their effects on individual behaviors and try to explain those changes. The work also highlighted the current limitations of mixed methods implementation (methodological issues and getting people from different disciplines to work together) and protocols for future research were recommended.

Key messages

• Mixed methods can both enhance the impacts of citizen sensing on individual behaviors, health literacy and collective empowerment, and allow researchers to better assess those impacts.

• Mixed methods require the fusion of conceptual and methodological frameworks from different disciplines in a transdisciplinary perspective, those needing new partnerships built on mutual trust.
Food policy impacts on greenhouse gas emissions from food system activities in Ireland 1990-2018
Authors: Stanley I , Murrin C
Published: October 2023

Food systems encompass interconnected actors and activities that bring food from farm to fork and the broader environments (economic, societal and natural) they are embedded in. Food systems operate at high cost to human and environmental health. 20-30% of total human-created greenhouse gas (GHG) emissions globally are attributable to food system activities. The agri-food sector plays a vital role in the Irish economy. In 2021 agri-food exports valued €18.7 billion and provided 7.1% of jobs in Ireland. Economic growth in the sector has come at the expense of the environment. In 2018 Ireland had the highest GHG emissions from food systems per capita in the EU. This paper presents an overview of GHG emissions from Irish food system activities 1990-2018. Data from the Emissions Database for Global Atmospheric Research were used to examine changes in food system emissions (Mt C02-equivalent(eq)) over time (1990-2018). Shares of total emissions by system stage (land use, production, processing, packaging, retail, transport, consumption and food waste) were also analysed. Food and agriculture policy developments were mapped to changes in emissions over time. After a decline from 2000 to 2011, food system emissions in Ireland are trending upwards. Total food system emissions in Ireland in 2018 measured 34Mt (C02-eq), accounting for 52% of all Irish emissions. 84% of food system emissions arose from production. Packaging and transport of food represented 3.7% each and consumption amounted to 0.84%. Increasing sustainability in the food system requires an understanding of where and how emissions arise across the whole system. Research on Irish food-related emissions has focused on agriculture and land use but little is published on activities later in the system. Estimating GHG contribution across the Irish food system this analysis provides important information for targeted policy development for mitigating food system impacts on climate change and health.

Key messages

• By estimating GHG contribution across the Irish food system this analysis provides important information for targeted policy development for mitigating food system impacts on climate change.

• Increasing sustainability in the food system requires an understanding of where and how emissions arise across the whole system.
Feasibility, acceptability & preliminary efficacy of a digital preconception intervention: OptimalMe
Authors: Brammall B R , Garad R M , Teede H J , Harrison C L
Published: October 2023

Background

Women's health prior to pregnancy is an increasing area of public health focus. Lifestyle interventions in preconception may be an ideal to target lifestyle behaviours that impact preconception and pregnancy health. However, there are limited interventions initiated prior to pregnancy. This study assesses the feasibility, acceptability and preliminary effectiveness of a digital healthy lifestyle behaviours intervention in women planning a pregnancy.

Methods

Participants were provided digital health and lifestyle information, health checklist, goal setting tools and virtual health coaching (telephone or video conference). Feasibility was defined as 1) recruitment of eligible participants who expressed interest, 2) retention from baseline through delivery (attending both preconception coaching sessions), and 3) adherence, based on attending one health coaching session, using the digital goal setting tool and accessing at least one information article. Acceptability was based on program components evaluated as helpful/very helpful. Preliminary intervention efficacy was based on participants attending a preconception consultation with a genera l practitioner (GP).

Results

Women (n = 298) planning a pregnancy within 12 months were recruited. Feasibility objectives were met, with 60% (n = 298/494) recruitment, 76% (n = 227/298) retention and 85% (n = 252/298) adherence. Evaluation demonstrated high levels of acceptability: digital module (95% n = 205/216), physical activity/diet information (90% n = 195/216), preconception health information (91% n = 195/215), coaching (92% n = 198/216), lifestyle SMSs (72% n = 153/213) and self-weighing (74% n = 159/215). Since the intervention, 73% (n = 159/217) had visited their GP in preparation for pregnancy.

Conclusions

The OptimalMe preconception intervention demonstrated feasibility, high acceptability and efficacy in women planning a pregnancy. This supports future digital health interventions in preconception; pregnancy results pending.

Key messages

• Interventions prior to pregnancy are limited, yet women’s health prior to pregnancy is an increasing area of public health focus.

• Digital health interventions are feasible and acceptable for preconception health and lifestyle health promotion for women planning a pregnancy.
2.M. Workshop: Fostering integrated care through a large-scale structural health system reform in Finland
Authors:   Organised by: Finnish Institute for Health and Welfare, European Observatory on Health Systems and Policies, EUPHA-HSR,   Chair persons: Ilmo Keskimäki (Finland), Johan Hansen (EUPHA-HSR)
Published: October 2023

Several countries have introduced health system reforms to foster integrated care within their health systems and in some case also between health and other welfare services such as social care. These integrated care initiatives have included reorganization of the work of professionals, developing patient pathways and removing barriers for organisations to work together. Comprehensive structural reforms to foster integrated care have not been that common. In health systems, like in public policy in general, small, micro-level reforms are common but only seldom large-scale structural reforms are enacted. Also integrated care is often fostered through small-scale reforms which are not always even scaled up from the local or regional level to national level policies. In Finland a large-scale structural reform was introduced in 2023 which can be marked as one of the most comprehensive health system reform in Europe over the past decades. As a result of the reform the responsibility for organizing health care, social services and rescue services was transferred from over 300 municipalities to 22 health and social care authorities which all get funding from the state. A key tool in pursuing the reform has been to implement administrative and financial integration both in terms of vertical integration within health system and horizontal integration between health care and social services. The workshop uses the Finnish health system reform as a case study to present how integrated care can shape the health reform agendas and implementation of the reform. We discuss how structural reformation can foster integrated care at patient level and how the rather radical restructuration of the Finnish health system looks from the wider European perspective.

Key messages

• One of the most comprehensive health-system reforms in Europe over the past decades was introduced in Finland in 2023.

• The radical structural health-system reformation can foster integrated care at patient level and offers a learning opportunity to other European health systems.
What a journey! – A short history of the Finnish health care and social service reform and administrative integration of health care and social services
Authors: Tynkkynen L
Published: October 2023

Finland is a Nordic welfare state with universal access to tax-funded health care. While the health system performs relatively well when measured in terms of avoidable mortality, several measures indicate that access to care, especially primary care, is poor. There are also relatively large geographical and socioeconomic inequities in access, utilization, and quality of services. To tackle these issues, a process to reform the health system was initiated in the early 2000s. However, it was not until 2021 when the large-scale reform of the system was enacted and not until 2023 when the new structure was implemented. The process involved several different reform proposals which all shaped the outcome of the reform. The key feature in almost all the reform proposals and in the final reform plan has been fostering vertical integration in health care and horizontal integration of health and social services both at the level of administration and organization as well as through processes and patient pathways. In this presentation we describe the history of the Finnish health and social care reform process and discuss, how integrated care as a policy idea and tool has shaped the reform agenda and reform proposals.
Integration of Social Return on Investment with Health Impact Assessment and evaluation frameworks
Authors: Ashton K , Cotter-Roberts A , Dyakova M , Green L
Published: October 2023

Background

To enable sustainable investment in public health to aid recovery from the COVID-19 pandemic and other global adversities, it is necessary to incorporate social, economic and environmental outcomes and value measurement into decision-making processes. Holistic frameworks, such as Social Return on Investment (SROI), look to capture this through understanding stakeholder impact and committing to valuing and monetizing their perceived outcomes. However, opportunities for conducting standalone SROI analyses may be limited due to resources. A solution is to undertake an SROI analysis alongside other analytical frameworks, impact assessments or evaluation methods.

Methods

In 2023, two innovative case studies in Wales, United Kingdom, integrated SROI into evaluations and assessments. The first is in conjunction with a Health Impact Assessment (HIA) on a sexual health self-testing service in a prison setting, while the second is in combination with an evaluation of a breastfeeding and infant nutrition programme.

Results

SROI offers a broad framework through which to integrate a holistic health economics lens to different types of evaluation and impact assessment. Traditional evaluations and HIA share common elements with SROI, for example developing a theory of change in evaluations and the screening and scoping stages of a HIA. Learning reflections for future integration were identified, for example ensuring quality assessment approaches align and ensuring design is scoped to enable effective integration from study outset.

Conclusions

SROI is the predominant tool used to assess the wider value of policies or programmes by identifying and evaluating holistic outcomes which have traditionally been difficult to measure. However, opportunities for standalone SROI studies may be limited for several reasons. As demonstrated, integrating SROI into different methods and approaches offers the opportunity to expand thinking on understanding value in a resource efficient way.

Key messages

• Social Return on Investment (SROI) can be effectively integrated into different evaluation approaches and Health Impact Assessment.

• Integration of approaches has been shown to be resource efficient and beneficial to better understanding value and impact on health and well-being.