bluuebunny/crossref_metadata_2025 huggingface dataset:
How are the three environmental threats challenging health systems’ resilience?
Authors: Viegas S
Published: October 2024

Background

Known avoidable environmental risks cause about one quarter of all deaths and disease burden worldwide, amounting to at least a steady 13 million deaths each year. Indeed, diseases caused by the environment weigh heavily on health systems. These not only harm directly human health increasing the burden of disease but also potentiate other threats, by acting as drivers (e.g. pandemics, antimicrobial resistance). In addition, the increased burden due to these environmental threats also put in risk the capacity of health systems to adapt to the new healthcare needs and to provide a proper answer to the diseases caused by other health determinants.

Methods

Based on a review of the literature, the presentation addresses the question of potential options in public health climate action at the interface of environmental sustainability and health systems sustainability and resilience. It identifies possible priority areas in order to guarantee environmental and healthcare sustainability.

Results

Approaches that focus on treatment of individual diseases rather than improvement of environmental determinants of health will be insufficient to tackle the triple environmental crises of climate change, biodiversity loss and pollution. Single-determinant approaches are unlikely to achieve expected improvements, given the complex interaction of environmental factors.

Conclusions

Approaches that are more integrated are required to address the root causes of disease and guarantee health systems sustainability, which are often defined by policies in key sectors other than health, such as the environment. Multi-sectoral actions are needed to prevent and mitigate the threats to human health from the ongoing and interconnected environmental crises of climate change, biodiversity loss and pollution, contributing to a Planetary Health perspective on health systems’ resilience.
Cross-country price comparison of institutional long-term care: In search of suitable data
Authors: Brzozowska Z , Zuba M , Gredinger G
Published: October 2024

Background

In European ageing societies, the national expenditure on institutional long-term care (LTC) has been growing for decades, currently exceeding 1% of the GDP in many countries. At the same time, however, comparative analyses of (day) prices in the nursing and residential care facilities (NRCFs) are still lacking. The data reported by international databases vary substantially in the services they cover which makes cross-country comparisons very difficult.

Methods

We combine publicly available data from Eurostat (System of Health Accounts), OECD and national sources on the number of recipients of LTC in NRCFs, the number of beds in NRCFs and the expenditure on LTC in NRCFs in over 20 European countries. Our aim is to compute internationally comparable daily prices of LTC in NRCFs using gross-costing approach. We first validate the data by cross-checking and documenting which health care functions and providers are reported by each country. Second, based on that we identify countries with comparable data and, third, perform a cross-country comparison of the daily spending on LTC in NRCFs.

Results

The reported data vary substantially with respect to their coverage. For instance, while some countries include NRCFs for all disabled people at all ages, others focus only on the NRCFs for the elderly. The ways the beds and the recipients are counted also show substantial variation. Moreover, we found inconsistencies in the reported numbers not only between but also within countries.

Conclusions

The considerable cross-country diversity in the LTC provision within the NRCFs poses inevitable challenges to international standardised reporting. Our analysis shows, however, that at least some of the challenges can be overcome by, e.g. improving the consistency of the reported numbers at the country level.

Key messages

• A consistent definition application markedly improves the comparability of data on LTC in NRCFs.

• Given the rising demand for and economic importance of the LTC sector standardised data on NRCF services are greatly needed.
Employees’ work ability during returning to work with common mental disorders: a mixed methods study
Authors: Sikora A , Stegmann R , Schröder U B , Schulz I L , Wegewitz U , Bültmann U
Published: October 2024

Background

A main goal during the return to work (RTW) process after a long-term sickness absence due to common mental disorders (CMDs), is to restore and maintain an employees’ work ability to enable sustained work participation. To date, surprisingly little research has examined the concept of work ability during the RTW process with CMDs. To better understand how to restore employees’ work ability during RTW with CMDs, both quantitative and qualitative research is needed. The goal of this mixed methods study is to expand the understanding of restoring work ability during the RTW process with CMDs.

Methods

In this mixed methods follow-up study of N = 286 participants, work ability was quantitatively assessed with the Work Ability Score (WAS, range 0-10) at five measurement points (0, 6, 12, 18 and 30 months) during 30 months of follow-up. In a sub-sample, the qualitative work ability experiences of N = 32 participants were jointly analysed with their quantitative work ability ratings at 6 and 12 months.

Results

In the joint analysis, three groups of qualitative work ability experiences together with their respective quantitative work ability ratings emerged: Employees with (1) poor work ability (WAS 0-3), who did not RTW yet and described great difficulties in coping with everyday life; (2) moderate work ability (WAS 4-6), who mainly did RTW, but still showed a certain level of fragility; and (3) good to very good work ability (WAS 7-10), who mainly returned within 12 months and reported many individual and work accommodations to restore and maintain their work ability.

Conclusions

The joint evaluation of work ability ratings and experiences allowed a deeper understanding of restoring work ability during the RTW process. This knowledge may help occupational health professionals and other key RTW stakeholders to provide more tailored support during the RTW process and to promote a sustainable RTW for employees with CMDs.

Key messages

• Restoring and maintaining the work ability of employees with common mental disorders during the return to work process is crucial for their sustained work participation.

• Achieving a good to very good work ability helps returning employees with common mental disorders to ‘stay and thrive’ at work again.
Labor market participation in people with intellectual disability – a follow-up study in Sweden
Authors: Staland-Nyman C , Tideman M , Luthra R
Published: October 2024

Background

Work is vital to people’s health and quality of life. The Convention on the Rights of Persons with Disabilities affirms the right to work on an equal basis with others including an opportunity to earn a living by work, but evidence shows that people with intellectual disability (ID) are at greater risk of unemployment and social exclusion. Due to the lack of comprehensive data for longitudinal follow-ups, information on long-term labor market participation (LLMP) in people with ID is scarce. This study aimed to investigate factors of importance for LLMP in individuals with ID in Sweden.

Methods

The study was based on data from the upper secondary school for pupils with ID between 2001 and 2020 (N = 26,905) and from the longitudinal integrated database for health insurance and labor market studies. A sample of gainfully employed in 2011 (n = 2,719), was followed with respect to LLMP until 2020. Odds ratios (ORs) with 95% confidence intervals (CI) for associations between educational, sociodemographic, and work factors and LLMP (i.e. gainful employment throughout the follow-up), were estimated stratified on sex.

Results

LLMP was twice as likely in men compared with women, OR 2.06 (1.78-2.58) as was work in the private sector. Factors of significance for LLMP in men and women alike were: completed national education program, OR 3.40 (3.06-3.86) and OR 2.91 (2.40-3.54), parents’ education; compulsory school in mothers’, OR 1.22 (1.06-1.41) and 1.24 (1.00-1.55) and in fathers’ OR 1.35 (1.17-1.56) and 1.49 (1.20-1.85), while municipality of residence was significant only in men, OR 1.30 (1.10-1.56).

Conclusions

Public health prevention for disadvantaged groups requires accurate and up-to-date knowledge. Using unique register-based data, this is the first study on LLMP in people with ID in Sweden. Knowledge on what social determinants may strengthen LLMP is important since limited LLMP increases the risk of missing out on health benefits that employment may offer.

Key messages

• There was a significant gender difference in long-term labor market participation in people with intellectual disability in Sweden.

• There is a need for increased knowledge on what social determinants may strengthen long-term labor market participation in people with intellectual disability.
Risk of death after type of intimate partner violence (IPV) involvement
Authors: Urquia M , Trask B , Scatliff N , Au W
Published: October 2024

Background

Most studies have focused on women’s intimate partner violence (IPV) victimization but perpetration and bi-directional violence remain understudied.

Methods

Using linked criminal justice and population registers in Manitoba, Canada, we assessed the risk of death according to the role in IPV incidents (accused-only, victim-only, bidirectional, none). In this retrospective matched cohort study, we assembled a cohort of 212,068 adults who were followed from April 2004 to March 2023 to assess IPV incidents and subsequent death. Those involved in an IPV incident were 1:3 matched to persons with no history of IPV based on birth year, sex and marital status at the time of the incident.

Results

Men comprised 85% of accused-only, 21% of victim-only, and 50-51% in the other two groups. Overall, compared to those without IPV involvement, the adjusted Hazard Ratios for all-cause mortality were 1.38 [95% Confidence Intervals (CI): 1.28, 1.49] for accused-only, 1.39 (1.29, 1.50) for victim-only and 1.45 (1.19, 1.77) for bidirectional IPV. The associations were stronger among women, particularly that of bidirectional violence [1.24 (0.97, 1.60) among men and 1.92 (1.39, 2.66) among women]. Similar patterns were found for intentional mortality [0.96 (0.56, 1.64) among men and 2.43 (1.27, 4.65) among women].

Conclusions

There are clear sex inequities in IPV involvement. Any type IPV involvement is associated with higher risk of death, particularly among women, who comprise most of the victims.

Key messages

•  Any type IPV involvement is associated with higher risk of death, particularly among women, who comprise most of the victim.

• Use of linked criminal justice data allows studying the consequences of IPV victimization, perpetration and bidirectional violence and monitor gender inequities over time.
Signal detection and assessment supporting syndromic surveillance during the UEFA EURO 2024
Authors: Schranz M , Estupinan Mendez J , Schlump C , Markus I , Heese H , Charfeddine N , Diercke M , Ullrich A
Published: October 2024

Background

Mass gatherings like the UEFA European Football Championship in Germany pose a challenge for public health, elevating the risk of infectious disease outbreaks. The Robert Koch Institute (RKI) is performing intensified surveillance during this event, including data from emergency departments (ED). So far, no standardised process for signal detection, their assessment and communication exists for ED surveillance.

Methods

We reviewed the literature to identify an appropriate signal detection method for ED surveillance. We tested different aggregation levels of the ED data, to ensure sufficient quality with sparse categories. After consulting with international experts, we defined a standardized process for signal assessment. We developed an interactive dashboard to investigate anomalies by further analysing the ED data.

Results

We used the Farrington Flexible algorithm, but expanded its functionality to perform daily instead of weekly monitoring. Aggregating to federal state level or in five age categories provided enough daily data for the algorithm. During the assessment, identified signals will be automatically scored based on pre-defined criteria (e.g. excess number of cases, reoccurrence in previous days). Signals with a high score will be forwarded to an epidemiological assessment, where they are manually evaluated based on standardised questions (e.g. expected seasonality, disease severity). Surveillance experts at RKI discuss them further and decide the course of communication and possible further measures. We developed an interactive dashboard in which signal detection and assessment is visualized.

Conclusions

Syndromic surveillance using ED data is used as an information source for early warning during a mass sporting event in Germany. Signal detection enables the identification of potential outbreaks, while the standardized assessment process ensures an efficient way to prioritize and steer communication efforts across public health services.

Key messages

• Syndromic surveillance using signal detection has previously proven valuable to detect potential outbreaks of infectious diseases during mass gatherings.

• A standardised signal assessment process including an automatic and manual component ensures a sustainable and efficient way to prioritize possible incidents and steer public health communication.
Parental childhood vaccine hesitancy and the National Vaccination Programme, in Portugal
Authors: Gomes F , Soares P , Goes A R , Santos A J
Published: October 2024

Background

Despite the invaluable contribution of vaccination to Public Health, vaccine hesitancy is increasing in the European Union. Several factors are associated with parental childhood vaccine hesitancy (PCVH). In Portugal, there are no known studies specifically addressing vaccine delay in infants.

Objectives

We aimed to estimate the proportion of parental childhood vaccine hesitancy (PCVH) up to 12 months of age in Portugal, and to determine vaccination (confidence and information) and National Vaccination Programme (NVP) associated factors.

Methods

We performed a cross-sectional study on a convenience sample, using an anonymous online questionnaire directed to parents of children up to 17 months old, living in Portugal. We performed an exploratory factor analysis, followed by logistic regression. We obtained crude (OR) and parental vaccination status’ adjusted odds ratios (aOR).

Results

PCVH proportion was estimated at 1.8% (95%CI: 1.0%-3.0%; n = 790). The exploratory factor analysis resulted in five dimensions: 1. vaccine confidence; 2. access to enough/reliable information about vaccines; 3. access to NVP; 4. vaccination schedule; 5. trust in healthcare professionals’ information about vaccines. Vaccine confidence (aOR=0.29, 95%CI: 0.14-0.54), vaccination schedule (aOR=0.31, 95%CI: 0.15-0.58) and trust in information about vaccines provided by health professionals (aOR=0.30, 95%CI: 0.16-0.53) were protective dimensions of PCVH.

Conclusions

The low proportion of PCVH observed is consistent with the high immunisation coverage in Portugal. Vaccination schedule, trust in vaccines, and in the information provided by healthcare professionals are factors associated with lower vaccine hesitancy. This highlights the importance of trust and healthcare professionals in maintaining high vaccination coverage in Portugal.

Key messages

• Parental childhood vaccine hesitancy (PCVH) proportion was 1.8%. Vaccine confidence, vaccination schedule and trust in information provided by health professionals were protective factors of PCVH.

• Trust in vaccines and in healthcare professionals seem to play a key role in keeping a high immunisation coverage in Portugal.
The information layer: shaping data into meaning with interactive tools
Authors: Schmidt M , Gorasso V , Van den Borre L , Scohy A , Devleesschauwer B , De Pauw R
Published: October 2024

Valorization and interpretation of health data are contingent upon a robust analytical framework. This framework encompasses essential processes such as data cleaning, validation, and the critical evaluation of bias and missing data. A nuanced understanding of these factors is crucial for contextualizing data through stratification, developing comprehensive analysis plans, and addressing interactions, covariates, and confounders. Such meticulous methodologies guard against ‘data fishing expeditions’ that could otherwise lead to erroneous conclusions. Healthybelgium.be exemplifies our approach for deciding on appropriate levels of data aggregation and stratification. This study serves as a foundation for deriving conclusions and formulating hypotheses regarding the health status of the national and various sub-populations. Our discussion will cover the limitations of the questions that can be answered with the available data, the resulting opportunities for data enhancement, and the subsequent valorization of findings for knowledge advancement. Furthermore, we will present the interactive tools (through the use of R Shiny) developed by Sciensano to disseminate information broadly, making it accessible and comprehensible to diverse audiences. These tools embody a balance of strength and limitation, facilitating an informed dialogue among stakeholders. The ongoing refinement of these tools, influenced by continuous learning and insights, exemplifies our commitment to evolving public health intelligence.
The social gradient in institutional trust from 2011–2019 in the general population in Norway
Authors: Ihlebaek C , Stenmarch C , Nordboe ECA , Skipstein A
Published: October 2024

Background

Trust is described as the glue of healthy societies. Although Norway is among the countries with the highest levels of trust in public institutions, the increasing socioeconomic differences observed may threaten levels of institutional trust. Therefore, we aimed to investigate such differences in the general population between 2011 and 2019.

Methods

A repeated cross-sectional study was conducted using data on the general population in Østfold county from 2011 (N = 16673) and 2019 (N = 15935). Differences in trust toward five public institutions (healthcare system, school system, labour and welfare administration (NAV), police, and municipal council) by educational level were investigated with Chi-square tests. Logbinomial regression analyses were used to examine potential changes in high trust over time. Gender and age were included in the analyses as control variables.

Results

A relatively high proportion of the general population reported high levels of trust to the health care system (2011: 71%; 2019:80%), police (2011: 73%; 2019:77%), and the school system (2011: 64%; 2019:66%), whereas a lower proportion reported high levels of trust to NAV (2011: 37%; 2019:41%) and the municipal council (2011: 45%; 2019:36%). Both in 2011 and 2019 a clear social gradient in institutional trust was found for all institutions (p < 0.05). There was a significant increase in the level of trust in the health care system (low education:RR=1,10; middle:RR=1,12; high:RR=1.06) and a significant decrease in trust in the community council (low:RR=0,77; middle:RR=0,80; high:RR=0,83) in all educational groups from 2011 to 2019. The level of trust in NAV increased significantly in the highest education groups, while a non-significant decrease was shown in the low educational group.

Conclusions

The persisting social gradient in institutional trust is worrying as trust is an important factor in ensuring inclusion, social capital, democracy, and health and wellbeing.

Key messages

• Institutional trust is an important factor in ensuring inclusion, social capital, democracy, and health and wellbeing.

• The lower levels of institutional trust found in low educational groups could be of particular concern as these groups might be more dependent on the different parts of the welfare system.
Feasibility of using comparative risk assessment for chemical burden of disease assessments
Authors: Plass D , Beloconi A , Bessems J , Buekers J , Kienzler S , Purece A , Sanchez G , Vounatsou P
Published: October 2024

According to the WHO, about 22% of global disability-adjusted life years (DALYs) can be attributed to environmental risks. However, comprehensive DALY estimates for chemicals are still lacking. In this study, we present a first assessment of the disease burden due to chemicals performed within the European Topic Centre on Human Health and the Environment. We selected the chemicals (groups) lead, cadmium, PFAS, pyrethroids, phthalates, and bisphenol A and estimated the disease burden for 15 risk-outcome pairs. The feasibility of using the comparative risk assessment (CRA) approach was tested, and where possible, DALYs were calculated. Data gathered within HBM4EU were used for exposure assessment. For the case studies, we selected countries with available data on both exposure and health effects. It was feasible to use the CRA, however, a major limitation was the availability of exposure data from human biomonitoring studies in EU countries. E.g. for lead, the disease burden was only calculated for a maximum of 3 countries per health outcome. Here, for mild intellectual disability, the highest number of DALYs was estimated for Germany, with 950 DALYs/1 m. persons aged 3-11 years. For PFAS, a larger set of countries was considered with the highest burden estimated for IQ-loss with 437 YLDs/1 m. babies born in France. Further, the burden due to phthalates was estimated for selected metabolites in up to 19 countries. The highest burden was estimated for the metabolite DEHP and diabetes mellitus, with about 1,324 YLDs/1 m. women in Poland (≥ 25 years). The experience from the analyses supported the feasibility of using CRA for quantifying the burden of disease due to chemicals based on HBM data. The results show that a significant burden can be attributed to the 6 chemicals in the selected European countries. However, exposure data are available only for a small group of European countries, which hampered a European-wide assessment.
Alcohol policy and alcohol-attributed disease burden in Finland and the Baltic countries 1995-2019
Authors: Månsson A , van der Velde L , Karlsson T , Beekmann L , Jonsson Stenberg E , Haagsma J , Castelpietra G , Agardh E , Allebeck P
Published: October 2024

Introduction

Alcohol remains a significant contributor to mortality and morbidity in Finland and the Baltic countries, particularly among men. This study aimed to assess alcohol policy restrictiveness in this region from 1995 to 2019 using a modified version of the Bridging the Gap (BtG-M) policy scale and examine its association with alcohol-related disease burden.

Methods

The study utilised national statutory laws to score policy restrictiveness (higher BtG-M scores mean stricter policies) and age-standardised rates of disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) and deaths per 100,000 from the 2019 Global Burden of Disease Study (GBD). Spearman correlation tests and panel data regression models were applied to assess the association between policy scores and burden of disease.

Results

Finland maintained a high BtG-M score, while the Baltic countries experienced recent increases from initially lower scores. Alcohol-related disease burden showed an inverse association with policy changes in these countries. Strongest association was seen between the BtG-M score and DALY rates attributed to injuries. Premature mortality among men constituted the largest proportion of disease burden. Discussion and

Conclusions

Despite challenges in accessing and comparing policy data over time, we showed a strong association between alcohol policy and alcohol-related harm in Finland and the Baltic countries. This study is one of the first to use the BtG-M scale to monitor changes in alcohol policies over time and their relationship to alcohol-related harm using GBD methodology. The study highlights the effects of national alcohol policies on levels of alcohol-related harm.

Key messages

• This study stands out due to its longitudinal study design, which quantitatively compares the level of alcohol policy restrictiveness in Finland and the Baltic countries from 1995 to 2019.

• Our study suggests that shifts towards more restrictive alcohol policies are linked to reduction in alcohol-related harm in Finland and the Baltic countries.
Commercialization of scientific misconduct: the challenge of paper mills
Authors: Abalkina A
Published: October 2024

According to an estimate, there are at least 400,000 papers in the scientific literature originating from paper mills, which are for-profit companies that guarantee the publication of low-quality papers. There is evidence that such papers are accompanied by various forms of scientific misconduct, including plagiarism, image duplication, falsification, and fabrication of data. These papers are cited and included in systematic reviews and meta-analyses, which have negative consequences for science and related disciplines. The scientific community has fragmented knowledge on paper mills, and many paper mills go undetected. Current resources of stakeholders are not sufficient to detect and prevent journals from publishing fraudulent papers. The goal of this presentation is to raise awareness of the paper mills problem and to discuss general ‘red flags’ of such papers, as well as possible measures to prevent editors and journals from publishing them. These measures may include open peer review, editor training, research on paper mills, improvement of detection methods, and united actions by stakeholders.
Training and capacity building on the effects of climate change on health: a need to up-scaling
Authors: Chambaud L
Published: October 2024

The need to develop training on the effects of climate change on health is obvious, as the awareness on this topic is growing but the knowledge is not enough disseminated. ASPHER has taken several initiatives to address this subject. Among them, three activities deserve to be highlighted: in cooperation with the GCCHE, we have set up an intensive online course with a great success (nearly 1.000 participants in each of the 10 sessions). With the same partner we have conducted a survey in all SPHs members of our network, to be able to map training activities in the European Region and follow their development. We also work with the European Observatory on climate change and health to reinforce capacity building at European level.

But this is not enough and we have to go faster and further in several directions:

- by linking more closely multidisciplinary research and training, as knowledge is evolving quickly;

- by developing specific training for all public health trainees. This is why we need to incorporate this topic in public health core curriculum;

- by having some modules tailored to different publics: public health professionals, health professionals, but also local, national and European decision-makers and stakeholders.

To conduct these activities, we have to reinforce our different partnerships and create a powerful alliance at the European level.
Frequent park use is associated with reduced stress after citywide park renovation
Authors: Thompson R L , Wyka K E , Huang TTK
Published: October 2024

Background

Quality parks have the potential to promote well-being in urban communities through reduced stress. The impact of parks on stress may be greater among individuals who use parks frequently. Using pre- and post-renovation data from the Physical Activity and Redesigned Community Spaces (PARCS) study, we evaluated the role of citywide park renovation in the association between park use and perceived stress.

Methods

PARCS evaluated the impact of the NYC Community Parks Initiative, which led to the renovation of dozens of previously disinvested neighborhood parks throughout NYC. Longitudinal data on park use and the Perceived Stress Scale (PSS) from 162 adults residing within 0.3 miles of 31 renovated park sites and 151 adults living near 21 socio-demographically matched control parks were analyzed. Linear mixed-effects difference-in-difference (DID) regression was used to assess the association between park use frequency at follow-up and change in PSS over time in intervention vs. control conditions (2- and 3-way interactions). Models were adjusted for age, education, children in household, marital status, and public housing.

Results

Both intervention and control groups experienced significant declines in PSS over the study period (2016-2022) [Intervention= -2.88 (95% CI -4.10,-1.67), Control=-3.16 (95% CI -4.43,-1.90)]. We found no net difference in change in PSS between the intervention and control groups overall [DID=0.28 (95% CI -1.47,2.03)]. However, there was a significant 3-way interaction of time x park use x intervention (p < 0.05). Among participants in the intervention group, those who had high park use at follow-up experienced a significantly larger decrease in PSS compared to those with low park use [DID=-2.92 (95% CI -5.34,-0.49)]. Within the control group, there was no difference in PSS change by park use frequency [DID=1.05 (95% CI -1.48,3.59)].

Conclusions

Park renovation was a pre-condition to the benefit of frequent park use on stress reduction.
Clinical recommendations for polygenic risk score-enhanced breast cancer screening: Can.Heal project
Authors: Taha A , Matt McCrary J , van Rooij J , Lahousse L , Paoletti F , Pascucci E , Vaht M , Pastorino R , Pezzullo A M , Boccia S
Published: October 2024

Background

The application of polygenic risk score (PRS) in breast cancer (BC) screening presents promising opportunities. Developing recommendations for future use and research on this topic is a key focus of the EU4Health project: Building the EU cancer and public health genomics platform (Can.Heal). We aim to provide these recommendations based on the analysis of available evidence through a transparent and rigorous development process.

Methods

The recommendations adopt the GRADE evidence to decision methodology, leveraging an evidence review team and a multidisciplinary panel of nine experts. A systematic review is being conducted to evaluate the evidence for PRS in BC screening, in the domains of benefits and harms, acceptability, feasibility, equity and cost-effectiveness.

Results

Regarding benefits and harms of adding PRS to BC standard screening, we identified 63 relevant articles. Forty-five (71%) discussed benefits, while 14 (22%) addressed harms. Forty-two (67%) were observational studies, 18 (28%) modeling studies and 1 non-randomised control trial (2%) that examined the diagnostic accuracy of PRS-enhanced screening for relative BC risk prediction using measures such as net reclassification index and area under the curve. Lastly, two modeling studies (3%) assessed the clinical utility of PRS-enhanced screening in terms of life years gained, BC deaths averted. The other domains are under examination. The panel convened to redefine the research question and outcomes of interest and will reconvene to assess the certainty of evidence collected, and subsequently to draft recommendations.

Conclusions

The integration of PRS into BC screening shows potential benefits in improving risk prediction. Ongoing trials, such as Wisdom and MyPEBS, are studying the clinical utility of integrating PRS in BC screening. The approach taken by the Can.Heal aims to ensure that the recommendations are based on a thorough and balanced evaluation of the available evidence.

Key messages

• The Can.Heal project aims to formulate policy and research recommendations for breast cancer screening using PRS through a thorough evidence review.

• Upcoming PRS recommendations rely on expert opinion and modeling studies.
Can mobile apps facilitate more sustainable and healthier diets? A systematic review
Authors: Curtin E , Green R , Brown K A , Scheelbeek P
Published: October 2024

Background

One third of all greenhouse gas emissions come from the food system, and current diets are insufficient to meet environmental and public health goals. Digital health apps offer promise to change behaviour, but little is known about the effects of different types of apps. This systematic review assessed the effectiveness of mobile apps in facilitating dietary changes across adults from high-income countries.

Methods

Seven electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Global Health, GreenFILE, Web of Science), two trial registries (Cochrane Trials and Clinicaltrials.gov), and Google were systematically searched for intervention studies aiming to facilitate dietary change. Interventions were characterised by their use of messaging (e.g., motivational statements) and personalised features (e.g., tailored nutrition advice). Outcomes for three food groups were synthesised through meta-analysis.

Results

Of the 5261 identified records, 21 met the eligibility criteria and were included. Interventions, recruiting 73,973 participants in total, lasted from three days to six months. Overall positive changes were observed in daily servings of fruit and vegetables (0.59, 95% CI 0.20, 0.99), legumes (0.05, 95% CI 0.01, 0.08), and meat (-0.14, 95% CI -0.23, -0.05), remaining significant after removing non-randomised controlled trials. Changes in fruit and vegetable intake were more pronounced for users of apps with messaging components (0.75, 95% CI 0.18, 1.32) and personalisation (0.67, 95% CI 0.16, 1.19), and meat intake changes were larger for messaging-based apps (-0.21, 95% CI -0.27, -0.15) than apps without these features.

Conclusions

Our findings suggest to practitioners and policymakers that mobile apps could be a useful and innovative way to change behaviour. Within a wider behaviour change approach, apps could help facilitate diets that meet food-based dietary guidelines, are predominantly plant-based, and are protective of environmental and human health.

Key messages

• Overall, the results from 21 studies showed positive dietary changes towards more fruits, vegetables, and legumes and less meat consumption following the use of mobile apps.

• Apps including messaging and personalised elements appeared most effective and may be important for driving changes in fruits, vegetables, and meat consumption.
Antidepressant medication before and after exiting paid work: a population-based study from Sweden
Authors: Lallukka T , Alexandersson K , Farrants K
Published: October 2024

Background

Exiting paid work can be linked to changes in mental health. However, antidepressant medication as an indicator of mental disorder has not been studied in a population that continues working longer. We aimed to explore trajectories of antidepressant medication before and after exiting paid work, among people in paid work at least until age 66. We then examined how sociodemographic factors and prior sickness absence and disability pension (SADP) were associated with such trajectories.

Methods

We included all people living in Sweden 2005-2020, aged 65-70 and in paid work 2010 based on income (N = 32,849, 39% women). All participants were in paid work at least 2005-2011, exited work during 2012-2015 and were not in paid work 2016-2020. We used register microdata for five years before and five years after exiting paid work and included a range of sociodemographic factors at the exit year as well as number of SADP days/year due to mental diagnosis (ICD-10) prior to work exit. We used group-based trajectory modelling to examine developmental patterns in antidepressant medication (ATC-code N06A) and average marginal effects to study factors that were associated with each trajectory.

Results

A majority, 89.5% did not have any antidepressant medication during the study period. Among those with such medication, two latent trajectories were identified: 94% had constant use and 6% increasing use. Having any SADP due to mental diagnoses before work exit was the most consistent determinant of belonging to the trajectories of increasing or of constant use of antidepressant medication, even after full adjustments. Older age at work exit was associated with a lower likelihood of belonging to increasing antidepressant medication trajectory.

Conclusions

Exit from paid work did not result in any major changes in the developmental patterns in antidepressant medication. Prior SADP was the most consistent determinant of antidepressant medication even after exit from paid work.

Key messages

• Most people working until aged 66 or older had no antidepressant use and among those who did, the use was stable. Only in a small group such medication increased, already before their work exit.

• Sickness absence or disability pension days with mental diagnoses before work exit was associated with both increasing and constant antidepressant medication trajectories after the work exit.
The “noise” of suicide attempts – relating LGBTQ+-specific vs. non-specific factors
Authors: Pfister A , Bomolo N J , Kuhnert T , Guillet R , Kupferschmid S , Bourquin C , Michaud L
Published: October 2024

Background

Despite the numerous research on the determinants and risk factors of suicide attempts, an understanding of suicide attempts as a process that holistically captures the perspectives of the actors involved is still lacking. Our study, therefore, aimed to better understand, from different perspectives, how (process) and why (subjective meaning, patterns of interpretation) (a) suicide attempt(s) among LGBTQ+ youth happen and to relate LGBTQ+-specific vs. non-specific factors.

Methods

From 2021 to 2024, we interviewed LGBTQ+ youth in Switzerland who had attempted suicide between the ages of 14 and 25. As part of a multi-perspective approach, we also interviewed people from their social environment where possible. Data were collected and analysed using Grounded Theory Methodology, including theoretical sampling. The final sample consisted of 41 people: 7 bisexual/lesbian cis women, 4 bisexual/gay cis men, 15 trans/non-binary people of different sexual orientations, 3 heterosexual cis people, and 12 people from their social environment.

Results

Sexual orientation and gender identity (SOGI) emerged as either background or foreground “music” of the suicidal processes. In some LGBTQ+ youth, SOGI were key factors influencing their suicidality, e.g. experiencing a major lack of acceptance and barriers to accessing gender-affirming transition (foreground music type). In others, suicidality was mainly related to other aspects than SOGI, especially fundamental ones such as unsafe familial circumstances or sexualised violence, which were accentuated by SOGI-related factors e.g. feeling a lack of belonging (background music type). Further, a mixed type was identified, with SOGI and non-SOGI-related factors being equally important for suicide attempt(s).

Conclusions

Our study implies the need to adapt health promotion, suicide prevention, and early detection and intervention strategies according to the identified types of suicidal processes.
A call to action about promoting healthy sleep among children
Authors: Keys Elizabeth
Published: October 2024

Infancy is an ideal time to engage parents in foundational sleep health promotion, as many parents have concerns about infant sleep. However, recent work suggests most Canadian public health resources on infant sleep does not meet clear communication criteria and that these resources often only focus on sleep safety, rather than broader sleep health. Information is also limited with respect to how parents can manage infant sleep difficulties. While eHealth intervention programs can increase the accessibility of evidence-based pediatric sleep health information, recent parental feedback indicates that usability, personalization, and flexibility are key factors in facilitating use. Additional co-design workshops with care providers and parents provided critical guidance on the need to develop more inclusive infant sleep interventions, consistent with previous literature. This guidance suggests infant sleep interventions should be culturally humble and non-judgmental, inclusive of parenting partners, and provide credible, timely, and meaningful information.
Strengthening Global Health Security: The Role of the International Health Regulations in Monitoring and Controlling Vector-Borne Diseases
Authors: Subtil I , Estrada J , Gomes L , Morais M , Correia M , Correia P , Durão J , Quelhas Q , Adrego T , Alho A M
Published: October 2024

Vector-borne diseases pose a significant global threat, with approximately 500 million reported cases annually, affecting previously unaffected regions due to climate change and increased international travel. This presentation brings insights from two scoping reviews examining the implementation and operationalization of the International Health Regulations (IHR) in preventing the spread of vector-borne diseases. The first review analysed strategies and policies adopted at continental and national levels and identified four major categories of measures: surveillance and epidemic intelligence, Declaration of Public Health Emergency of International Concern, measures in Points of Entry, and vaccination status. Surveillance systems vary widely across countries, with severe asymmetries in their implementation. The COVID-19 pandemic facilitated the adoption of screening measures and collaboration with airlines and travel agencies, highlighting the importance of early detection and response. An additional review focused on the contribution of IHR to public health action in monitoring and controlling vector-borne diseases. It emphasised the prioritisation of preventive measures related to travel and borders, including vector surveillance. Environmental changes, particularly socio-ecological and climate factors, influence the recurrence of outbreaks, creating the need for enhanced epidemic intelligence. Both reviews underscored the importance of cooperation between institutions and countries in effectively monitoring and controlling vector-borne diseases. Assessing core capacities under the IHR enables readiness levels in outbreak response to be measured, promoting concerted action tailored to each epidemiological context. As the world faces ongoing health challenges, it is imperative for State Parties to refine their core capacities in alignment with the lessons learned from the COVID-19 pandemic, ensuring a robust global response to future infectious disease outbreaks.
5.Y.2. Alcohol intoxication among adolescents in Italy, Belgium and The Netherlands
Authors:   Organised by: EUPHA-PMH,   Chair persons: Johan Bilsen (EUPHA-PMH), Guido Van Hal (Belgium)
Published: October 2024

Excessive drinking behavior poses a significant risk to the health of adolescents and contributes to high social and health costs. It is also well-documented that engaging in risky drinking behavior at a young age increases the likelihood of developing alcohol use disorders and other mental health disorders later in life. Therefore, the timely development of adequate interventions to prevent and reduce such behavior is an important public health task. The initial step here is to gather comprehensive data on the phenomenon. Studying alcohol intoxication data among adolescents is an important source in this context. In the Netherlands, data on alcohol intoxication in adolescents have been routinely collected for several years, leading to a successful transmural framework aimed at supporting these young individuals and their parents. As countries are at varying stages in addressing this issue, the objective of this workshop is to facilitate mutual learning about effective prevention initiatives targeting problematic alcohol use in young people. The workshop will feature presentations from four studies representing three countries: Italy, Belgium, and the Netherlands. Allegra Ferrari from Italy will discuss alcohol-related emergencies among adolescents admitted to an emergency department in Genoa, emphasizing the importance of urgent interventions to mitigate adolescent alcohol use. Hanna van Roozendaal from Belgium will present data from both retrospective and prospective studies on adolescents with acute alcohol intoxication in Antwerp hospitals, exploring the feasibility of follow-up interventions. Louise Pigeaud from the Netherlands will share data from a cohort of individuals under 18 years presented with acute alcohol intoxication symptoms at an emergency department between 2015-2023 to monitor trends in admission characteristics. Finally, Guido van Hal will focus more in depth on the differences and similarities in adolescents accessing emergency care for acute alcohol intoxication in Italy, Belgium and The Netherlands. The workshop will conclude with an open discussion on topics such as the necessary data to be registered for minors with acute alcohol intoxication, the most effective methods for preventing/reducing alcohol intoxication in these age groups, and the potential transferability of the successful Dutch transmural framework to other countries.

Key messages

• Acute alcohol intoxication and problematic alcohol use in minors can lead to significant alcohol-related issues in adulthood.

• Collecting and analyzing high-quality data can facilitate the development of interventions aimed at reducing and preventing alcohol-related issues in adolescents.
Differences and similarities in adolescents accessing emergency care for acute alcohol intoxication in three urban regions in Italy, Belgium, and The Netherlands
Authors: Van Hal G , Pigeaud L , van Roozendaal H , Ferrari A , de Veld L , Orsi A , van der Lely N
Published: October 2024

Background

Excessive drinking among adolescents in Western Europe is prevalent, posing significant health risks and societal costs. Early initiation of alcohol use and binge drinking are associated with adult alcohol use disorders. Collecting comprehensive data on adolescent drinking patterns is crucial for developing effective prevention strategies.

Methods

To gain insight into the demographic and clinical characteristics of acute alcohol intoxication (AAI), we analysed emergency department access data of adolescents aged 14-17 years presenting with AAI symptoms from 2015-2023. Three urban regions were included: the Reinier de Graaf Gasthuis in Delft (The Netherlands), eight combined hospitals in Antwerp (Belgium) and the IRCCS San Martino Hospital in Genoa (Italy).

Results

A total of 1841 patients with symptoms of AAI were included. The mean age of patients in the Netherlands was statistically significant younger than in Italy and Belgium (15.7 compared to 15.9 and 16.0 years old, respectively). Moreover, the blood alcohol concentration was higher in the Netherlands and Belgium compared to Italy (2.0‰ compared to 1.95‰ and 1.8‰ respectively). The distribution of sex was nearly equal in the Netherlands, while statistically significant differences were observed with a higher proportion of males in Italy (54.8%) and Belgium (56.8%). Combined drug use was lower in Belgium with 10.0%, compared to 13.4% in The Netherlands and 14.7% in Italy. The most common reason for admission was ‘reduced consciousness’ in the total population (45.2%).

Conclusions

This is one of the first international studies which combines data on AAI in minors. In the future, efforts should be made to establish a common European database where records of AAI can be stored and analysed more efficiently for prevention purposes.