bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the feasibility and accuracy of remote mobile app-based self-reported atrial fibrillation risk factor assessment in patients with atrial fibrillation: TeleCheck-AF results
Authors: Hermans A N L , Gawalko M , Van Der Velden R M J , Verhaert D V M , Betz K , Hemels M E W , Steven D , Duncker D , Gupta D , Manninger M , Lodzinski P , Crijns H J G M , Pluymaekers N A H A , Hendriks J M , Linz D ,   TeleCheck-AF investigators
Published: October 2021

Background

Previously, we introduced the TeleCheck-AF approach, which is an on-demand mobile health (mHealth) infrastructure incorporating mobile app-based heart rate and rhythm monitoring as well as mobile app-based self-reported atrial fibrillation (AF) risk factor assessment to allow comprehensive remote AF management through teleconsultation. Herein, we evaluated the feasibility and accuracy of remote mobile app-based self-reported AF risk factor assessment in AF patients.

Methods

In our University Medical Center, 545 patients were managed within the TeleCheck-AF project by an on-demand heart rate and rhythm mHealth infrastructure through teleconsultation. Patients were asked to fill in a short mobile app-based 10-item questionnaire related to AF risk factors. A reminder to complete the questionnaire automatically popped-up after the following four heart rate and rhythm recordings. Furthermore, patient's medical history was retrieved from the electronic health records (EHRs).

Results

Out of 545 patients, 542 (99.4%) patients (217 female, age 67 (59–72) years) completed the mobile app-based 10-item questionnaire and were included in this analysis. The number of patients with diabetes mellitus was similar in the EHRs and mobile app-based questionnaire (both 11.3%, p=1.000). There was no significant difference in the number of patients who had a medical history of transient ischemic attack (TIA)/cerebrovascular accident (CVA) and artery disease (coronary artery disease and peripheral artery disease) in the EHRs and mobile app-based questionnaire (11.4% vs 12.2%, p=0.608 and 14.8% vs 13.3%, p=0.366, respectively). Heart failure was more frequently reported in the mobile app-based questionnaire compared to the EHRs (33.4% vs 14.0%, p<0.001). A total of 260 (48.0%) patients had a diagnosis of hypertension verified in EHRs and only 239 (44.1%) patients reported hypertension in the mobile app-based questionnaire (p=0.044). There was no significant difference in number of patients with CHA2DS2-VASc-score ≥2 between the EHRs and mobile app-based questionnaire (64.2% vs 66.1%, p=0.275). The accuracy of mobile app-based assessment of diabetes mellitus was 85.4%, of TIA/CVA 78.9%, of artery disease 60.9%, of heart failure 78.8%, and of hypertension 89.3%.

Conclusion

Patient self-reported AF risk factors by a remote mobile app-based assessment is feasible and may be useful for future digital trials and comprehensive remote AF management through teleconsultation.

Funding Acknowledgement

Type of funding sources: None.
Digital therapautic effective in managing metabolic syndrome parameters
Authors: Colwell N , Sheppard A , Egan J
Published: October 2021

Introduction

Lifestyle change is a class one therapeutic indication for persons with overweight, obesity, metabolic syndrome and cardiovascular risk factors including type II diabetes, hypertension and dyslipidaemia. There is synergism in reducing multiple cardiovacular risk factors simultaneously. Currently there is a need for a formalised prescribed digital therapeutic to enact lifestyle change optimally. We have developed a real-time telemedicine lifestyle change digital therapeutic for persons with these conditions with substantive positive impact on weight, Body Mass Index (BMI), blood pressure (BP), and metabolic syndrome parameters.

Purpose

To evaluate a digital lifestyle change therapeutic in subjects with metabolic syndrome parameters in primary care, corporate and pharmacy settings.

Methods

Cohorts of patients were enrolled through primary care physician referrals and in corporate or pharmacy settings; in a GDPR compliant format between 2015–2020 (n=323). The programme offers patient education, guideline dietary recommendations and lifestyle advice specific to the patients requirements via smartphone, tablet or computer. Nudge psychology educational videos, compliment exercise monitored by a smart device and weight loss recorded by a wireless scales. Point of care bloods were tested pre and post-enrollment. Asynchronous dietary advice from a dietician, peer to peer support and an artificial intelligence chat-bot are available at all times via a smartphone application. Statistics used was student two-tailed t-test comparing pretest parameters to those post lifestyle intervention.

Results

Cohort results are delineated below. As the programme underwent refinement more parameters were added. Nevertheless similar trends are seen in each cohort with statistically meaningful reductions in weight, BMI, systolic and diastolic blood pressure, HbA1c and lipids obtained.

Reductions in HbA1c and systolic blood pressure approach or equate with those obtained using drug monotherapy. Moreover the patients Quality of Life is improved.

Conclusion

A real-time internet-based prescribed lifestyle digital therapeutic results in clinically meaningful reductions in weight, BMI, blood pressure, HbA1c and lipids. Results in various cohorts are similar, indicating a reproducible effect of this cost effective scalable digital therapeutic across a spectrum of metabolic risk factors in a variety of settings.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): RedicareDiabetes Ireland Table 1
New era of education: mobile learning of coronary guidewires in cardiovascular medicine
Authors: Kyaw H , Vengrenyuk A , Johal G , Goel S , Sharma S , Kini A
Published: October 2021

Background

Online education has transformed the way we teach and learn, especially in the midst of a global pandemic. Multiple devices, including coronary guidewires, are required to perform a successful coronary intervention, and understanding the engineering aspect of coronary guidewire technology is paramount.

Purpose

We aim to develop and evaluate a novel teaching tool/mobile learning app to understand a complex guidewire architecture and appropriate wire selection based on a lesion characteristics.

Methods

A guidewire is incredibly complex, consisting of a multitude of technologies allowing a range of tip softness, trackability around curves, and precise torque control. Despite operator preference, the process of choosing an appropriate coronary guidewire has gone mostly unchanged. We envisioned developing the GuidewireAID app with three main parts: 1) wire basics, 2) lesion-based guidewire selection, and 3) cased-based approach. Appropriate teaching cases were selected from a large-volume catheterization laboratory and divided into non-chronic total occlusion (non-CTO) and CTO. Non-CTO cases include simple, calcified, angulated, and bifurcation lesions, as well as thrombotic occlusion and tortuous vessels (Figure 1). Each case is described and analysis is offered on how to select an appropriate wire, followed by teaching points pertinent to the topic.

Results

Twenty-three detailed clinical cases and more than a hundred wires are illustrated in the GuidewireAID app. Case presentation, angiographic analysis, and a thorough understanding of wire characteristics allows the operator to know which wire to use and when it is time to switch, especially when dealing with complex coronary cases.

Conclusion

The GuidewireAID app will help fellows in training (FIT), early career interventionists, and practicing interventional cardiologists understand the complex aspects of a coronary guidewire and appreciate how their nuances could overcome real-world clinical challenging scenarios.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Lack of knowledge on acute stroke in children, adolescents and adults from public schools
Authors: Salles I C , Gouvea G B , Calderaro M , Monteiro V S , Correa R F , Silva S N M F , Shinohara H N I , Umeda I I K , Aikawa P , Carvalho H B , Mansur A P , Carmona M J C , Semeraro F , Bottiger B W , Nakagawa N K
Published: October 2021

Introduction

Stroke is an important cause of disability and death in adults worldwide. However, it is preventable in most cases. This community-based study investigated students' stroke knowledge, emergency medical services (EMS) activation, associated risk factors, warning signs and symptoms, and prior experience from different educational levels.

Methods

We conducted the survey with a structured questionnaire between March 2019 and December 2020.

Results

Students from the elementary school (n=1,187, ∼13 y.o., 14% with prior experience, 51% women), high school (n=806, ∼17 y.o., 13% with prior experience, 47% women) and University (n=1,961, ∼22 y.o., 9% with prior experience, 66% women) completed the survey. Among the students, the awareness of stroke general knowledge, associated risk factors, and warning signs and symptoms varied between 42–66%. When stimulated, less than 52% of the students associated stroke with hypercholesterolemia, smoking, diabetes, and hypertension. When stimulated, 62–65% of students recognised arm weakness, facial drooping, and speech difficulty; only fewer identified acute headache (43%). Interestingly, 67% knew the EMS phone number; 81% were willing to have stroke education included at school, and 75.2% found it essential and mandatory. Female, higher education and prior experience were associated with higher scores of stroke risk factors (OR: 1.28, 95% CI: 1.10–1.48; OR: 2.12, 95% CI:1.87–2.40; and OR: 1.46, 95% CI: 1.16–1.83; respectively), and signs and symptoms (OR: 2.22, 95% CI: 1.89–2.60; OR: 3.30, 95% CI: 2.81–3.87; and OR: 2.04, 95% CI: 1.58–2.63; respectively).

Conclusion

Being female, having prior experience, and a higher educational level increase the identification of associated risk factors and warning signs and symptoms. Stroke awareness should be emphasized among schoolchildren and adolescents.

Funding Acknowledgement

Type of funding sources: None.
Zfhx3 decreases expression of cardiac Nav1.5 channels and inhibits sodium current
Authors: Caballero R , Camara-Checa A , Rubio-Alarcon M , Crespo-Garcia T , Dago M , Nieto-Marin P , Marin M , Salguero R , Toquero J , Tamargo J , Cebrian J , Delpon E ,   ITACA Consortium
Published: October 2021

Background

Zfhx3 (zinc finger homeobox 3) is a transcription factor (TF) encoded by the ZFHX3 gene. GWAS and gene-based association studies showed that ZFHX3 is one of the major atrial fibrillation (AF) susceptibility-conferring genes. The sodium current (INa), carried by Nav1.5 channels encoded by SCN5A, is responsible for atrial and ventricular action potential depolarization and determines cardiac excitability. Zfhx3 interacts with other TFs, such as Tbx5 and Pitx2c that increase and decrease INa, respectively. However, the effects of Zfhx3 on cardiac INa are currently unknown.

Purpose

We aimed to determine the effects of Zfhx3 on the INa on HL-1 cardiomyocytes.

Methods

cDNAs encoding human Zfhx3 together or not with Pitx2c or Tbx5 were transfected in HL-1 cells. Endogenous Zfhx3 expression in HL-1 cells was silenced by means of siRNAs. INa was recorded at room temperature using the whole-cell patch-clamp and luciferase reporter assays, qPCR and Western-blot (WB) analyses were also conducted.

Results

Expression analysis of RNA-seq data from human ventricular (n=432) samples (GTEx) demonstrated that Zfhx3 mRNA can be detected in the adult working myocardium. Transfection of Zfhx3 strongly reduced peak INa density (from −75.0±6.6 to −30.9±2.9 pA/pF; n≥26, P<0.001). In contrast, Zfhx3 silencing augmented INa density compared to cells transfected with scrambled siRNA (from −65.9±8.9 to −104.6±10.8 pA/pF; n≥8, P<0.05). Neither Zfhx3 expression nor silencing modified time and voltage dependence of activation and inactivation or the reactivation kinetics. Zfhx3 significantly reduced transcriptional activity of human SCN5A, PITX2 and TBX5 minimal promoters and, consequently, the mRNA and protein expression levels of Nav1.5, Pitx2c, and Tbx5 were diminished (n≥6, P<0.05). In cells transfected with Zfhx3 together with Pitx2c, but not with Tbx5, INa density was significantly smaller than in cells expressing WT Zfhx3 alone (n≥15, P<0.05). Further WB experiments demonstrated that Zfhx3 increased the expression of Nedd4–2 ubiquitin-protein ligase, which ubiquitinates Nav1.5 channels and favors their proteasomal degradation.

Conclusions

Zfhx3 inhibits INa as a result of a direct repressor effect on the SCN5A promoter, the modulation of Tbx5-increasing and Pitx2-decreasing effects on the INa, and the enhancement of Nav1.5 channel degradation. We propose a novel and complex mechanism that regulates the expression of sodium channels and the density of the INa, which are critical for the control of cardiac excitability.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministerio de Economía y CompetitividadComunidad Autόnoma de Madrid
Kynurenic acid- a key metabolite protecting the heart from an ischemic damage
Authors: Entin-Meer M , Bigelman E B , Pasmanik-Chor M P C , Dassa B D , Gross A G , Itkin M I , Malitsky S M , Dorot O D , Pichinuk E P , Dezorell N M , Keren G K
Published: October 2021

Background

Myocardial ischemia is a major cause of death in patients with renal dysfunction. In order to identify a key metabolite which may protect cardiac function following renal injury, we have recently performed a metabolomics profiling analysis of LV lysates and plasma samples derived from animals that underwent an acute kidney injury (AKI) 1 or 7 days earlier, versus sham-operated controls. The analysis revealed that the kynurenic acid (kynurenate, KYNA) metabolite levels are highly elevated in all tested experimental samples relative to control.

Purpose

We wished to analyze whether KYNA may protect cardiomyocytes' survival and cardiac function upon an ischemic event and if so, to characterize whether the protecting effect may be linked to better preservation of the cardiac mitochondria.

Methods

Cellular viability of H9C2 rat cardiac myoblasts grown under normoxic or anoxic conditions with or without KYNA was determined by flow cytometry following Annexin-PI staining. The mitochondrial structure of the cells was determined by live cell staining with green (FITC) and deep red (Cy5) mito-tracker dyes. The potential effect of the metabolite on cardiac function following acute MI was tested in a murine model by echocardiography followed by histological staining of the cardiac sections with Picro Sirius Red.

Results

KYNA given at 10 mM concentration hardly affected the viability of H9C2 grown under normoxia, however the metabolite rescued the viability of the anoxic cells by 63% and largely improved their mitochondrial structure. Moreover, KYNA diluted in the drinking water of post-MI animals (250mg/ml), highly enhanced their cardiac recovery compared to untreated-animals as determined by echocardiography and collagen staining.

Conclusions

1. KYNA may represent a key metabolite absorbed by the heart following AKI.

2. KYNA can enhance cardiac cell viability following an ischemic event both in vitro and in vivo in a mechanism which is mediated, at least in part, by protection of the cardiac mitochondria.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Weizmann Institute-Tel-Aviv Sourasky Medical Center joint research grant KYNA's protection of cardiac cells
The effect of canakinumab on COVID19-associated cardiomyocyte contractile dysfunction and arrhythmias
Authors: Dimai S , Semmler L , Stachelscheid H , Pieske B M , Heinzel F R , Hohendanner F
Published: October 2021

Background

Cardiac injury associated with cytokine release occurs in almost 20% of SARS-CoV-2 positive patients during hospitalization and mortality is particularly high in these patients. Cardiac enzyme (e.g. troponin or creatinine kinase (CK)) elevations are a frequently reported finding, indicating myocardial damage and arrhythmias are the cause for ICU transfer in up to 12% of patients. However, the mechanistic role of COVID19 associated cytokine-storm for the concomitant cardiac dysfunction and associated arrhythmias is unclear. In addition, the role of anti-inflammatory therapy approaches to mitigate this cardiac dysfunction remains elusive.

Methods

We investigated the effects of COVID19-associated inflammatory response on cardiac cellular function as well as its cardiac arrhythmogenic potential in rat and induced pluripotent stem cell derived cardiomyocytes (iPSc-CM). Moreover, we evaluated the therapeutic potential of the IL1-beta antagonist Canakinumab using state of the art in-vitro confocal and ratiometric high-throughput microscopy.

Results

Isolated rat ventricular cardiomyocytes were exposed to control or COVID19 plasma from intensive care unit patients with severe ARDS and impaired cardiac function (LVEF 41±5%; 1/3 of patients on veno-venous extracorporeal membrane oxygenation; CK 154±43 U/l). Cardiomyocytes showed decreased Ca2+ transient amplitudes and altered baseline Ca2+ concentrations leading to impaired cellular contractile function upon electrical field-stimulation and exposure to patient plasma (n=276 control and 359 COVID19 cells; Fura). In addition, we used iPSc-CM to explore the long-term effect of patient plasma on cardiac electrical and mechanical function in a translational setting (24h incubation; Fluo). In iPSc, spontaneous Ca2+ release events (i.e. Ca2+ waves and Ca2+ sparks) were more likely to occur upon incubation with COVID19 plasma and nuclear as well as cytosolic Ca2+ release were altered. Co-incubation with Canakinumab had no effect on pro-arrhythmogenic Ca2+ release or Ca2+ signaling during excitation-contraction coupling but influenced cellular automaticity upon prolonged electrical stimulation.

Conclusion

Plasma derived from COVID19 patients exerts acute cardio-depressant and chronic pro-arrhythmogenic effects in rat and iPS-derived cardiomyocytes. Chronic co-incubation with Canakinumab had no beneficial effect on cellular Ca2+ signaling during excitation-contraction coupling.

Funding Acknowledgement

Type of funding sources: None.
Influence of highest dominant frequency area on fibrillation dynamics and frequency spectrum on electrograms
Authors: Sanchez De La Nava A M , Rios-Munoz G R , Gomez-Cid L , Grigorian-Shamagian L , Fernandez-Santos M E , Arenal A , Atienza F , Fernandez-Aviles F
Published: October 2021

Introduction

Highest Dominant Frequency (HDF) has been extensively described as one of the descriptors for Atrial Fibrillation (AF) and some studies also describe the total area activating at this frequency. However, the influence of this area on the registered power spectrum of the electrogram is usually not explained.

Objective

To describe the role of the highest Dominant Frequency Area (DFA) on the electrogram signal.

Methods

HL1 cell line monolayers were used as AF in vitro model and cultured on p35 plates (N=15) until confluence was reached. Optical mapping was performed to evaluate the electrophysiological activity of the samples employing Ca2+ transient quantification and activation frequency (Hz). Pseudo electrograms were calculated from the recorded signals and their frequency spectrum was evaluated.

Results

Two different groups were identified during the study: a group in which the DFA was higher than 0.2% of the total area (hDFA) and a group in which it was lower (lDFA). For hDFA cultures, the ratio between the DF of the catheter and the culture was significantly higher in the hDFA group (0.90±0.18; 0.47±0.13; p-value <0.0001), indicating that more complex scenarios lead to dissociation between the HDF of the tissue and HDF registered on the electrogram. This relation is identified in Figure 1, where the R2 values for both cases are 0.99 and 0.62 respectively. Figure 2 shows two examples with different DFA and the respective Ca2+ signals, electrograms, and power spectrum density of both signals, exemplifying how lDFA cases can lead to a mismatch between the power spectrum density of the optical mapping signal and the electrogram.

Conclusions

Complex arrhythmic scenarios identified as lDFA present a low correlation between the power spectrum registered on the culture and the electrogram, whereas samples in which the DFA is large, the DF from the catheter presents high correlation ratios among both signals, suggesting that clinical scenarios with high variability on the electrophysiological substrate may be difficult to interpret.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III and Ministerio de Ciencia Innovaciόn y Universidades Figure 1. HDF from tissue vs EGM-HDFFigure 2. Example of two cultures
What is strategic litigation?
Authors: Hesselmann Marlies
Published: October 2021

This presentation is an introduction to strategic litigation for public health professionals. It will review the opportunities offered by legal action on environmental issues, with examples from past successes. It will consider opportunities in Europe for legal action in both national courts and in international courts and tribunals. Procedural issues affecting the choice of forum will be discussed, such as ‘standing' (the right to initiate a legal action or participate in the proceedings), admissible evidence, the possible orders available if the case is successful, and the costs and risks involved. What if we don't win? Was it still worth it? Broader public engagement and advocacy opportunities will be noted.
Preventive and risky health behavior of Swiss university students during the COVID-19 pandemic
Authors: Zysset A , Volken T , Dratva J ,   on behalf of the HES-C Study group
Published: October 2021

Background

Young adults are not considered a risk group for contracting COVID-19, but they are disproportionately affected by pandemic containment measures compared to other age groups. University students were confronted with abrupt changes both in their personal and academic lives. The “Health in Students during the Corona pandemic” study (HES-C) investigated the health and health behavior, concerns and views in students of the Zurich University of Applied Sciences. In the current analyses, we focused on COVID-19 related preventive behaviors, alcohol and marijuana consumption during the pandemic.

Methods

All students of the Zurich University of Applied Sciences (N = 12,429) were invited to a voluntary repeated cross-sectional open cohort survey which took place from the April 3 2020 (T0) to January 25 (T5), covering two university semesters with overall 6 surveys. Participation rates varied from T0 20% to T5 13%.

Results

While overall adherence to containment measures was high, men yielded lower adjusted odds (OR; 95%-CI) of adherence regarding the following measures: social distancing (0.68; 0.53-0.87), non-utilization of public transport (0.74; 0.56-0.97), 5-person limit for social gatherings (0.47; 0.35-0.64) and the stay at home rule (0.64; 0.51-0.82). In addition to gender, factors associated with adherence were information source and perceived susceptibility to the virus. Out of 80% who reported having drunk alcohol during the last 30 days at T0, 31% engaged at least once in binge drinking (>5 beverages) and 18% consumed more than usual. Marijuana was consumed by 11%, of which 27% reported higher use during the lock-down than before. Longitudinal data on risk behavior and factors associated with risk behavior and changes in behavior are currently being analyzed and will be presented.

Conclusions

Public health communication targeting university students should not only address pandemic related preventive behavior but also risk behavior during the pandemic.

Key messages

The pandemic has led to increased risky health behavior among certain students. Public health communication targeting university students should not only address pandemic related preventive behavior but also risk behavior during the pandemic.
Climate Change in Wales and its health impact: Who is vulnerable and how?
Authors: Green L , Edmonds N
Published: October 2021

In April 2019, Wales declared a climate emergency. Public Health Wales commissioned a Health Impact Assessment (HIA) to be carried out to assess the potential impact of Climate Change (CCh) on the population of Wales and inform key strategic decision makers to understand/plan for the potential differential health and inequalities impacts that may occur from CCh. A comprehensive mixed-method HIA was conducted over a 6 month period in 2019/2020. A review of peer-reviewed evidence on the potential impact of CCh/climate change events on health and population groups and a review of grey literature on direct impacts such as the environment, mental wellbeing and health care settings was conducted. 2 stakeholder workshops, qualitative interviews, a community health profile utilising sources such as the National Survey for Wales were also carried out. All findings were analysed, synthesized and collated into a report. Vulnerability is a critical aspect of population health and the HIA findings identified a range of positive and negative impacts on specific population groups which highlights their vulnerability to climate change. This includes children and young people; older people; coastal and rural communities and those on low incomes. These are often not explicitly highlighted in other environmentally focused assessments. The HIA also indicated significant potential impacts across the determinants of health including excess heat/cold; flooding; economy; access to services; mental well-being; and community resilience. The findings have informed decision-makers to prepare for CCh plans/policies using an evidence-informed approach and particularly to address who may be disproportionately negatively affected. The work has demonstrated the importance of HIA to assess significant, complex policies by mobilising a range of evidence through a transparent process, explicitly considering the impact on vulnerable groups, resulting in transferrable learning for others.
Risk communication during COVID-19: a comparative analysis of four countries
Authors: Weishaar H , Geurts B , Mari-Saez A , Delamou A , Jegede AS , Legido-Quigley H , Cristea F , Rocha C , Boklage E , El-Bcheraoui C
Published: October 2021

Background

Risk communication (RC) is fundamental to ensuring public engagement in public health emergencies. Existing studies describe the mechanisms that integrate RC into emergency responses, but knowledge about which governing structures and policies are needed to ensure effective RC in public health emergencies is lacking. We compare RC across four epidemiological, socio-political, and geo-economic settings and identify key structural factors that can lead to effective RC in public health emergencies.

Methods

A multisite international study was implemented using qualitative research methods in Germany, Guinea, Nigeria, and Singapore. We mapped and assessed RC governing structures, drawing on a document review and semi-structured key informant interviews with 155 stakeholders involved in the design and implementation of RC strategies at national and sub-national levels.

Results

A comparative analysis of the content, process, actors, and context of the distinct RC structures in the four countries as well as related strengths and weaknesses are presented. Early integration of RC into preparedness and response plans alongside the use of previous experiences and structures are key to effective implementation of RC during public health emergencies. A lack of coordination increases the risk of parallel structures, missed opportunities, duplication of resources, and public confusion due to a cacophony of messages. Building on previous experiences of outbreaks and on existing structures and relationships can help governments to more quickly mobilise effective RC strategies during pandemics.

Conclusions

RC is key to effective pandemic responses and can help to reduce infection and transmission. Yet, considerable potential exists for countries to improve RC in public health emergencies. Learning from mistakes and successes during COVID-19 can help improve RC strategies and governing structures and prepare for future pandemics.

Key messages

Strengthening RC preparedness and response enables governments to more effectively implement the International Health Regulations. COVID-19 provides ample learning opportunities to improve communication in public health emergencies.
Design, protocol, and perspectives of the MADRE-REA study
Authors: Maugeri A , Barchitta M , Magnano San Lio R , La Rosa MC , Favara G , Guarnera L , Riela PM , Battiato S , Agodi A
Published: October 2021

Background

Unhealthy diet during pregnancy poses serious risks for both mothers and children, representing an important Public Health issue. Although Epigenetics offers a plausible explanation of the transgenerational pathway from mother to child, it is still necessary to understand if maternal epigenetic aging increases the risk for adverse outcomes in newborns. In this scenario, the “MAternal Diet, Risks and Epigenetic age during pregnancy: a Real-world Ecological momentary Assessment” (MADRE-REA) study aims to evaluate the relationship between maternal diet, epigenetic age and risk for adverse pregnancy outcomes in a mother-child cohort.

Methods

We will develop a smartphone-based ecological momentary assessment (EMA) of dietary, behavioral, physical, and sociopsychological information of 400 pregnant women recruited by the “Mamma & Bambino” cohort (Catania, Italy). Women will be asked to complete 6 waves of EMA during the 2nd and 3rd trimesters of pregnancy, and 3, 6, 9 and 12 months after delivery. Each wave consists of a 7-day assessment based on a signal-contingent approach, which prompts participants to record dietary consumption and other information. We will also examine maternal epigenetic age at recruitment and at delivery, using the DNAm PhenoAge.

Results

The novelty of the MADRE-REA study lies in the opportunity to apply a smartphone-based EMA to capture the complexity of dietary intake during and after pregnancy. Moreover, expected findings will help to understand if maternal behaviors and other exposures might affect epigenetic age, and hence if the eventual accelerated biological aging might be associated with health and disease in newborns.

Conclusions

This study could disentangle the relationship between maternal diet, epigenetic aging, and adverse outcomes, laying the foundation for future strategies to reduce the burden of disease in newborns throughout their life. The study is funded by the Italian Ministry of Health (Bando Ricerca Finalizzata 2019).

Key messages

The application of a smartphone-based tool could overcome limitations of traditional methods to assess dietary behaviors in the periconceptional period. Uncovering the relationship between maternal diet and epigenetic aging could provide the molecular basis for future strategies against adverse pregnancy outcomes.
1.I. Workshop: Capturing access challenges in health care: can the vignette methodology help?
Authors:   Organised by: European Observatory,   Chair persons: Dimitra Panteli (Belgium), Ewout Van Ginneken (Germany)
Published: October 2021

Access to health care is a key performance dimension for health systems. Around 3% of the EU27 population experienced unmet need for health services in 2019 (Eurostat 2021). However, this average hides significant differences across and within countries, between income groups, levels of education and socio-economic categories. While some of the reasons for unmet need are more personal (no time, fear of doctor, etc.), the most common factors are health system-related. Although self-reported unmet need and other existing indicators, including catastrophic spending and impoverishing out-of-pocket spending, provide a general picture of the state of accessibility in EU Member States in relation to factors such as age, income or education, they do not necessarily reveal specific gaps in access or coverage that are linked to other characteristics or specific services. This workshop discusses a new method to measure access to health care, which was developed by the Observatory on Health Systems and Policies to support the European Commission's DG SANTE and the Expert Group on Health Performance Assessment (HSPA) in developing their work on more refined performance measures for health care system access across Europe. The work builds on the findings of a 2019 survey by the Observatory and its Health System and Policy Monitor (HSPM) network on “Gaps in Coverage and Access in the European Union”, which identified a range of vulnerable groups facing access hurdles. The overall goal is to provide a ‘proof of concept' to see whether a vignette approach could add to existing indicators, particularly regarding the differentiation between population coverage and realised access to care. A vignette is a short case study of an individual designed to simulate key features of a real-world scenario, which is then presented to relevant professionals to solicit their hypothetical response. Our workshop first discusses the vignette method developed for this purpose (presentation 1) before sharing the interpretation of results of two of the four vignette pilots that were carried out, that is, the vignette on stroke (presentation 2) and the vignette on palliative care for cancer patients (Presentation 3). The workshop will conclude with a moderated audience discussion about the pros and cons of the vignette method as opportunities to scale up the vignette approach.

Key messages

The vignette approach can identify gaps in coverage and access as well as differences in treatment and quality not identified by other indicators. The vignette approach can help explain how access contributed to suboptimal health outcomes, enabling the formulation of targeted policies.
1.L. Workshop: Assessment of substance abuse in different populations
Authors:   Organised by: EUPHA-PMH,   Chair persons: Marija Jakubauskiene (EUPHA-PMH), Jutta Lindert (EUPHA-PMH)
Published: October 2021

Substance abuse is a growing public mental health issue. Recent data from Global Burden of Disease study demonstrate that age standardized DALYs rate attributed to drug use disorders has increased by 25% in age group of 25-49 years during 1990-2019 (Lancet 2020; 396 1204-22). Standardized DALY rate due to alcohol use disorders reduced by 1/5 in this age group during the last 30 years, however it remains among the top 20 causes leading to greatest losses of DALYs in this age group. European countries persist to have high burden of diseases due to substance abuse. Social ecological model enables to structure individual, family, community and broader societal risk factors for substance abuse in specific groups within society. Some European countries (e.g. Germany) face increased migration especially from the war affected countries like Syria. Respective refugees and migrants may demonstrate higher substance abuse (alcohol and drug abuse) prevalence as an outcome of traumatic exposures and reflect the attempts to escape past and present experiences. In other countries (e.g. Lithuania), who still reflect transitional societies, substance abuse rates remain high due to psychosocial stress and structural barriers to implement effective prevention. Identification of risk factors may alleviate targeted and tailored prevention. The aim of the workshop is to systematize substance abuse risk factors in specific population groups based on socio-ecological framework applying different methodological approaches. There is a knowledge gap in culturally sensitive and translated into different languages instruments which assess substance use in refugee populations, especially from the Arabic countries. Therefore, a systematic review results on culturally sensitive substance abuse screening and assessment instruments among refugee populations will be presented. The qualitative study conducted in Germany will provide findings and insights on substance abuse perceptions among Syrian migrants and refugees. Understanding the explanatory model of Syrian refugees could inform future interventions to prevent substance abuse and design tailored interventions. Assessment of the behavioral risk factors related to injecting dug use in Lithuanian population using respondent driven sampling technique will be presented. Identifying individual and social risk factors may lead to targeted and effective prevention.

Key messages

Context specific knowledge of substance use is necessary for prevention including past and present factors. As refugee populations continue to grow, adequate screening instruments for substance abuse/dependence are needed.
Benchmarking physical activity and nutrition policies in Europe: lessons from the CO-CREATE project
Authors: Oldridge-Turner K , Vlad I , Kokkorou M , Fanian D , Klepp K-I , Helleve A , Fismen A-S , Harbron J , Hendricks G , Allen K
Published: October 2021

Background

Global research shows a strong link between physical activity, nutrition and the risk of developing non-communicable diseases. To increase physical activity and healthy eating, governments must design and implement a comprehensive set of policy actions across a range of areas. The MOVING and NOURISHING benchmarking tools were developed to identify gaps and assess the strength of actions taken by national governments in these complex policy areas.

Methods

The benchmarking tools value the strength of policy design based on policy attributes that are evidence-informed and aspirational. Both tools were applied to five countries participating in CO-CREATE, a European Commission-funded project: Netherlands, Norway, Poland, Portugal and UK. Physical activity and nutrition policies in each of these countries were identified based on a comprehensive country scan, with a set methodology.

Results

The benchmarks assessed the strengths and weaknesses in the design of policies across the NOURISHING and MOVING policy areas. They identified where there was scope for improvement within a policy area. For example, the tools helped evaluate the design of health related-food taxes in Norway, Poland, Portugal, and UK and allowed a cross-country comparison of these policies. When comparing the overall policy environment across all countries, we found an overall lack of policies promoting access to open/green spaces and weaknesses in designing restrictions on marketing unhealthy foods to children.

Conclusions

The benchmarking tools can inform the development and implementation of policies which promote physical activity and healthy eating. They were developed for the European context but are also being tested on relevant policies in South Africa. They can be used by governments, policymakers, researchers and civil society to identify areas of physical activity and nutrition policy that are weak and require government action.

Key messages

Benchmarking nutrition and physical activity policy can identify gaps and assess the strength of actions taken by national governments in these complex policy areas. The NOURISHING and MOVING benchmarking tools can be used by governments, policymakers, researchers and civil society various to inform policy-making in nutrition and physical activity.
The role of mobile apps for pregnancy and postnatal care in promoting maternal and child health
Authors: Brunelli L , De Vita C , Cenedese F , Cinello M , Paris M , Samogizio F , Bava M , Dal Cin M , Zanchiello S , Stampalija T
Published: October 2021

Background

Within the growing availability of health apps worldwide, apps for pregnancy and postnatal care still raise critical issues. The content they provide might rise some concerns in terms of quality, completeness, as well as practical implications for effective prevention and health promotion. This study aims at evaluating free pregnancy and postnatal care apps available in Italian language, shedding light on the main shortcomings and future challenges in this public health field.

Methods

Between July and November 2020, a multidisciplinary research group conducted a systematic review on iOS and Android stores. Data about information, functionalities and technical features of the apps were collected through a 71-items questionnaire including six domains: pregnancy and postnatal care and counselling, reminders and push notifications, notes and records, social support, and technical features.

Results

From 684 identified apps, 22 were deeply analyzed. Resulting apps did not include most desirable features, with just one achieving the 50% of them. The most lacking domain was postnatal care and counselling (17.3%), with particularly scarce information about immunizations that mothers or newborns need (9.1%). Information about free-of-charge and upon payment clinical exams during pregnancy is also absent in half of the apps. Moreover, most apps did not provide users social support with other mothers nor with the healthcare professionals (95.5%). Finally, just one app was CE marked as a medical device.

Conclusions

The identified gaps highlight large room for improvement in the use of pregnancy and postnatal care apps for prevention and health promotion. More efforts are needed to design and implement increasingly high-quality apps providing information related to preventive or diagnostic medical practices, as well as social and certified mechanism to interact with healthcare staff.

Key messages

Increase in use of pregnancy and postnatal care apps should be considered as an opportunity for public health in terms of prevention and health promotion. Providing appropriate information as well as social mechanism to interact with healthcare staff could help to direct mothers and mothers-to-be to the most suitable screening and therapeutic paths.
Vaccine hesitancy among healthcare providers during COVID-19 pandemic
Authors: Algabbani F , Algabbani A
Published: October 2021

Public trust in vaccines is a major global health issue. This study aims to assess the vaccine acceptance among healthcare workers and their confidence and hesitancy of the COVID19 vaccine. This was a multicenter cross-sectional survey conducted among healthcare providers in Riyadh, the capital of Saudi Arabia. Data collection was carried out between October and November of 2020 through a web-based survey. COVID19 vaccine hesitancy was assessed using eight structured items adapted from the 5Cs. About 34.6% (95% CI: 27.6%-42.4%) of participants were willing to vaccinate against COVID-19 and 44% (95% CI: 36.5%-51.9%) will recommend the vaccine to their patients. About 45% of participants were neutral regarding vaccine safety and 40% were neutral regarding vaccine effectiveness. Almost 70% believe that the duration of clinical studies of the COVID-19 vaccines affects their confidence in the efficacy and safety of the vaccine. Those who never hesitated or delayed taking any of the recommended vaccination were more likely to be willing to vaccinate COVID-19 (OR 5.46, 95% CI: 2.49-11.98). Assessing the level of vaccine confidence in the population and associated factors will help implement an effective national vaccine program to enhance vaccination uptake and control COVID19 spread during this pandemic.

Key messages

Vaccine hesitancy is challenging vaccination goals at the national and global level. Hesitancy from the population toward vaccine and concerns regarding its safety and efficacy was observed with the development of a novel vaccine for COVID19 a newly emerged infection.
Cost of hospitalization for ischaemic heart and cerebrovascular diseases in Belgium
Authors: Gorasso V , Vandevijvere S , Van der Heyden J , De Bacquer D , Devleesschauwer B , De Smedt D
Published: October 2021

Background

Cardiovascular diseases (CVDs) are the leading cause of global mortality and a major contributor to disability. According to European Cardiovascular Disease Statistics, in 2017 there were 108.7 million people living with CVDs in Europe resulting in about 4,681 disability-adjusted life years per 100,000 inhabitants. Among these, ischaemic heart and cerebrovascular diseases (IH&CBD) represent the highest burden in terms of morbidity, mortality and health care costs. CVDs were estimated to cost the EU €210 billion a year, where 28% was attributable to IH. The aim of this study was to assess the financial burden at societal level of IH&CBD in Belgium based on hospital discharge data, considering that inpatient hospital care costs accounted for about 51% of the total healthcare costs in CVDs.

Methods

IH&CBD were identified based on ICD-10 codes following the definition provided in the Global Burden of Disease study in 2017. IH: angina pectoris (AP) I20 and I25, acute myocardial infarction (AMI) I21-I24; CBD I60-I68. Mean annual number of patients and direct hospitalization costs from 2016 to 2018 were retrieved from the Belgian hospital discharge dataset, considering both primary and secondary diagnoses.

Results

Within the observed diseases, AP was the most common reason for hospitalizations with an average of 41,439 hospitalized patients per year. Yearly, 27,630 patients were hospitalized for CBD and 14,928 patients were hospitalized for AMI. The yearly hospitalization cost for AP and AMI in Belgium was on average respectively €219,688,254 and €133,343,881. CBDs accounted for the largest direct hospitalization cost with €301,900,539 per year.

Conclusions

In Belgium, on average almost 84,000 people are hospitalized yearly due to IH&CBD; On average, Belgium spends around €655 million a year for these hospitalizations.

Key messages

IH&CBD represent a high health and financial burden in Belgium. Since IH&CBD can be linked to several behavioral risk factors, this burden could be reduced with target health interventions.
Mental health inequalities in disruptions across multiple domains during COVID -19: an investigation in 12 population-based longitudinal studies
Authors: McElroy E , Di Gessa G , Maddock J , Green MJ , Thompson EJ , Davies HL , Mundy J , Stevenson AJ , Kwong ASF , Patalay P
Published: October 2021

Disruptions related to the COVID-19 pandemic and its associated virus suppression measures have affected many worldwide but those already suffering from psychological distress may have been especially vulnerable. We investigated associations between pre-pandemic psychological distress and disruptions to healthcare, economic activity, housing, and cumulative disruptions. Data were from 59,482 participants in 12 UK longitudinal adult population surveys with both pre-pandemic and COVID-19 surveys. Participants self-reported disruptions since the start of the pandemic to: healthcare (medication access, procedures, or appointments); economic activity (negative changes in employment, income or working hours); and housing (change of address or household composition). Logistic regression models were used to estimate associations between pre-pandemic standardised psychological distress scores and disruption outcomes. Findings were synthesised using a random effects meta-analysis with restricted maximum likelihood. Approximately one to two thirds of study participants experienced some form of disruption during the pandemic. One standard deviation higher pre-pandemic psychological distress was associated with: increased odds of any healthcare disruption (odds ratio: 1.30 [95% CI: 1.20-1.40]; I2: 65%); increased odds of experiencing any economic disruption (1.11 [1.03-1.16]; I2: 61%); no associations with housing disruptions; and increased likelihood of experiencing a disruption in at least two domains (1.25 [1.18-1.32]; I2: 38%) or one domain (1.11 [1.07-1.16]; I2: 32%) compared to no disruptions. Associations did not differ by sex, ethnicity, education, or age. Individuals suffering from psychological distress pre-pandemic may need additional support to manage stressful life disruptions. Considering mental ill-health was already unequally distributed in the UK population, this may exacerbate existing inequalities related to sex, ethnicity, education and age.