bluuebunny/crossref_metadata_2025 huggingface dataset:
Dementia in migrants living in Lazio region, Italy: prevalence and population characteristics
Authors: Angelici L , Acampora A , Cascini S , Cacciani L , Canevelli M , Cova I , Contoli B , Pomati S , Bellomo G , Bargagli A
Published: October 2024

Background

Given ongoing demographic and epidemiological transitions, dementia prevalence is expected to rise among both native populations and migrants. Understanding this phenomenon is crucial for healthcare planning. This study, part of the IMMIDEM project (GR-2021-12372081), aims to estimate dementia prevalence in Lazio by migrant status.

Methods

A cross-sectional study was conducted on individuals aged ≥50, living in Lazio and receiving assistance from the Regional Health Service as of December 31, 2022. A validated algorithm based on Health Information Systems identified patients with dementia. Migrant status was defined by Country of birth, categorized as native Italians, migrants from Highly Developed Countries (HDCs) and from High Migratory Pressure Countries (HMPCs). Age-standardized prevalence of dementia was estimated overall and by migrant status, and 95% confidence intervals (CI) were calculated. Dementia population characteristics were described and compared according to migrant status using χ2test.

Results

The study included 3,976,160 individuals: 88.9% Italians, 1.7% migrants from HDCs, and 9.4% from HMPCs. Among them, 38,708 had dementia, with a prevalence of 8.48‰ (CI: 8.39-8.57). Dementia prevalence by migrant status was 8.68‰ (CI: 8.58-8.77) in Italians, 6.90‰ (CI: 6.19-7.62) in HDCs migrants, and 5.73‰ (CI:5.37-6.10) in HMPCs migrants. Demographic traits across migrant categories reveal distinct age and gender patterns, with more elderly Italians and a higher male percentage among migrants. From a clinical perspective, Italians showed a higher percentage of circulatory system diseases than migrants (23.5% Italians, 19.2% HDCs, 18.7% HMPCs, p = 0.001), along with a greater percentage of anti-dementia drug prescriptions (54.4% Italians, 50.9% HDCs, 47.4% HMPCs, p < 0.001).

Conclusions

The study found lower dementia prevalence among migrants compared to native Italians, with reduced access to healthcare services, especially in individuals from HMPCs.

Key messages

• The dementia prevalence in migrants is lower than in native Italians.

• These findings suggest potential underdiagnosis and undertreatment, urging policymakers and healthcare providers to address these healthcare disparities.
Improving breast cancer care post-pandemic from the patient perspective
Authors: Myers C , Bennett K , Cahir C
Published: October 2024

Background

Since the onset of the pandemic, breast cancer (BC) services have been disrupted in most countries. The purpose of this qualitative study is to explore the unmet needs, patient-priorities, and recommendations for improving BC healthcare post-pandemic for women with BC and to understand how they may vary based on socio-economic status (SES).

Methods

37 women were invited to take part in follow-up semi-structured qualitative interviews in early 2023. The interviews explored their perspectives of BC care since the easing of COVID-19 government restrictions, including unmet needs, patient-priorities, and recommendations specific to BC care. Thematic analysis was conducted to synthesize each topic narratively with corresponding sub-themes. Additionally, variation by SES was analysed within each sub-theme.

Results

Of the 28 women who participated in interviews, 39% were categorized as high-SES, while 61% were categorized as low-SES. Women expressed unmet needs in their BC care including routine care and mental and physical well-being care, as well as a lack of financial support to access BC care. Patient-priorities included: developing cohesion between different aspects of BC care; communication with and between healthcare professionals; and patient empowerment within BC care. Recommendations moving forward post-pandemic included: improving the transition from active to post-treatment; enhancing support resources; and implementing telemedicine where appropriate. Overall, women of low-SES experienced more severe unmet needs, which resulted in varied patient-priorities and recommendations.

Conclusions

As health systems are recovering from the COVID-19 pandemic, the emphasis should be on restoring access to BC care and improving the quality of BC care, with a particular consideration given to those women from low-SES, to reduce health inequalities post-pandemic.

Key messages

• The pandemic has impacted BC services considerably and this study has identified a range of unmet needs, patient-centered priorities, and recommendations.

• Particular consideration needs to be given to those women from lower socioeconomic groups, in order to reduce health inequalities, which have been further exacerbated by the pandemic.
Compliance of physical activity among adults with metabolic syndrome with the WHO recommendations
Authors: Radionova Z , Birdanova V
Published: October 2024

Introduction

Low physical activity is a leading factor in 6% of deaths worldwide. In Bulgaria, it contributes to the deterioration of the health status of the population and determines 4.3% of the global burden of diseases. Over 70% of Bulgarian adults have insufficient physical activity during their free time. The aim of the study is to measure and assess the level of physical activity among adults with metabolic syndrome with the World Health Organization (WHO) Global recommendations.

Methods

A comparative study of the physical activity of a representative sample of 200 individuals with metabolic syndrome aged 54.7±10.5 from Pleven region was made with the WHO Global recommendations on physical activity for people living with chronic conditions. Modified Physical activity Questionnaire (PAQ) for adults was used for assessment of the physical activity. Data were processed with IBM SPSS v. 25.

Results

The weekly frequency of the vigorous-intensity physical activity (VIPA) was 1,61 days with a weekly duration of 215 minutes, which met the WHO recommendations on physical activity for people living with chronic conditions, but 64% of the respondents had none and only 26% had VIPA on 2 and more days a week. More than half of the respondents (55%) had none moderate-intensity aerobic PA. From the remaining, 34% had this type of PA on 3 and more days a week with duration of 225 minutes, which met the WHO recommendations. Walking more than 10 minutes a day on 5 and more days a week had 69% of the respondents (40 minutes/day). Only 12% had none walking. Only 2% stated that the physical inactivity is the most important cause for the rise of many non-communicable diseases.

Conclusions

More than half of the respondents had none vigorous- and moderate-intensity PA but the PA of the remaining met the WHO recommendations. Although physical inactivity is among the risk factors for the rise of many non-communicable diseases, contributing to death, it was not recognised by the respondents.

Key messages

• Walking is the most important physical activity for the adults with metabolic syndrome.

• Increasing the duration of walking should be encouraged and supported to manage the metabolic syndrome.
The interplay between healthy lifestyle and body mass index in metabolic syndrome
Authors: Jääskeläinen T , Lehtoranta L , Palosaari T , Männistö S , Kaartinen N E , Lundqvist A , Lahti J
Published: October 2024

The prevalence of metabolic syndrome (MS) tends to increase as body mass index (BMI) increases. However, the interplay between BMI and overall healthy lifestyle in MS remains unclear. We aimed to examine the association between healthy lifestyle and MS in BMI categories. Data comprised participants aged 30-64 years from the Healthy Finland Survey representing the Finnish adults (n = 2027). Information was collected through health examination measurements, blood sampling and questionnaires in 2023. Healthy Lifestyle Score (HLS) was defined as: 1) vegetables and fruits several times/day; 2) adherence to physical activity recommendations; 3) sufficient sleep duration; 4) no current daily smoking; 5) no risky alcohol drinking. Total score ranged 0-5; categorized as 0-2 (unhealthiest), 3, 4-5 (healthiest). MS was defined as exceeding risk limit in ≥ 3 of the following conditions: waist circumference, fasting glucose, triglycerides, blood pressure and HDL-cholesterol. BMI (kg/m2) was categorized as normal weight (<25), overweight, and obesity (≥ 30). Weighted prevalence and 95% confidence intervals (CIs) stratified by sex were calculated considering sampling design and non-response. In both sexes, the prevalence of MS was lowest in those with normal weight and healthiest lifestyle (men 7%; 95% CI 2-11; women 9%; 6-13) and highest in those with obesity and unhealthiest lifestyle (m 86%; 80-92; w 67%; 56-78). In men, the prevalence of MS decreased within each BMI class as HLS scores increased, but the difference between healthiest and unhealthiest lifestyle was greatest in those with normal weight (7% vs. 26%) and lowest in those with obesity (71% vs. 86%). In women, the differences were greatest among those with overweight. Obesity and unhealthy lifestyle together form a major risk factor for MS. Differences in the prevalence of MS according to lifestyle were evident especially in men with normal weight or overweight, but decreased when the obesity threshold was exceeded.

Key messages

• Obesity is strongly linked to the high prevalence of metabolic syndrome but maintaining a healthy lifestyle is important regardless of body mass index.

• The results indicate the importance of multifaceted prevention influencing lifestyle factors and supporting weight management to enhance the cost-effective prevention of metabolic risk accumulation.
Developing new methods for patient care pathway assessment for breast cancer patients in Hungary
Authors: Surján C , Surján G , Horváth Z , Dombrádi V , Belicza É
Published: October 2024

Issue

The idea of progressive healthcare models is to treat patients preferably in one location as close to their homes as possible. This contradicts the demands of efficiency: to centralise the availability of expensive procedures and highly specialised staff. Healthcare systems need to navigate between these challenges, especially in public health issues such as cancer care.

Description of the problem

Achieving the best possible health outcomes requires evidence-based policies that find balance between the demands of accessibility and efficiency. Therefore, we aimed to set up a methodology to review the healthcare model and assess patient movements across the system. We analysed the roaming paths of breast cancer patients diagnosed in Hungary in 2017. Inter-hospital roaming was represented as a graph: hospitals were the nodes, patient movements from one hospital to another were directed edges. This allowed us to apply network analysis: modularisation, weighted degrees calculation, etc. We then introduced the measure of terminality. A hospital is terminal in a given pathway if it is the last new one, i.e. all hospitals visited later had already been visited before. Terminality is defined as the proportion of terminal events among all pathways that cross a given hospital. The rationale of this is that the last hospital in cancer pathways is usually not the highest level one: after advanced treatments, patients are often referred back to local hospitals.

Results

Testing the method on Hungarian breast cancer patients we observed that results fit our prior expectations. The official ranking of hospitals on the progressivity scale (reflecting the availability of advanced treatments) shows sufficient agreement with terminality. Minor differences may point to situations where the healthcare system does not work fully according to regulations.

Lessons

Our methodology is recommended for system level patient pathway analysis in order to develop evidence-based healthcare policies.

Key messages

• Graph representation of inter-hospital patient roaming supports evidence-based policy developments for more efficient patient pathways in cancer care, regardless of the healthcare system design.

• The applied new network analysis methodology can help assessing the real life processes of cancer care in a healthcare system through identifying the specifics of inter-hospital patient movements.
Sarcopenia and associated factors among older adults at high risk of dementia
Authors: de Sousa D , Costa A R , Vicente M , Cruz V T , Padrão P
Published: October 2024

Background

Sarcopenia and dementia share pathophysiological pathways and risk factors, including advanced age, physical inactivity, unhealthy diet, smoking and diabetes. Older adults at high risk of dementia may face increased susceptibility to sarcopenia, which can also exacerbate cognitive decline. Thus, this study aims to estimate the frequency of sarcopenia and its associated factors within this vulnerable population.

Methods

This cross-sectional analysis includes data from a subset of older adults (≥65 years of age) enrolled in the MIND-Matosinhos randomized controlled trial, a community-based cognitive decline prevention program. Per the European Working Group on Sarcopenia in Older People, probable sarcopenia is defined as low muscle strength (handgrip strength <16 kg for women and <27 kg for men). Sociodemographic, lifestyle and health-related data were collected via structured questionnaires. To assess factors associated with sarcopenia, odds ratios (OR) and respective confidence intervals (95% CI) were estimated using logistic regression.

Results

A total of 157 participants (58.6% female), with a median age of 73 years (range: 65 to 85 years), were included. The overall prevalence of sarcopenia was 21.7% (n = 34). After adjusting for sex, age and education, inadequate adherence to Mediterranean Diet (MD) (OR = 10.90; 95% CI:1.41-84.52), current smoking status (OR = 5.06; 95% CI:1.06-24.18) and poorer self-perceived health (OR = 2.74; 95% CI:1.03-7.28) were positively associated with sarcopenia. No other statistically significant associations were found.

Conclusions

The observed sarcopenia frequency underscores the need for enhanced screening and management of this condition in community settings and among those at dementia risk. Inadequate adherence to MD, smoking and poor self-perceived health, seem to be associated with sarcopenia in older adults at high risk of dementia. Sarcopenia prevention should involve a holistic approach to promoting a healthy lifestyle.

Key messages

• Sarcopenia was observed in 21.7% of older adults at high risk of dementia, indicating a significant burden on this vulnerable population.

• Inadequate adherence to the Mediterranean diet, smoking and poor self-perceived health were associated with sarcopenia.
Effect of climate change on West Nile virus transmission in Italy: a systematic review
Authors: Lorenzon A , Granata M , Verzelloni P , Tommasi L , Palandri L , Paduano S , Bargellini A , Righi E , Malavolti M , Filippini T
Published: October 2024

Background

West Nile Virus (WNV) is a pathogen transmitted by mosquitoes of the Culex genus, affecting both humans and animals such as horses and birds. The prevalence of WNV infection has increased dramatically in recent years in Europe, especially in Italy, and has been related to climate and environmental changes linked to global warming. Our review aims to assess the relation between the spread of WNV in Italy and the different climate change-related factors.

Methods

We conducted a literature search in the PubMed, Web of Science, Embase and Scopus databases, actualised as of 20 February 2024, using as search terms WNV, its vectors and climate change, and limiting our analysis to studies conducted in to avoid an overly heterogeneous setting. We registered the review in PROSPERO (CRD42023430636).

Results

Of the 252 unique records retrieved, we eventually included 25 articles after full-text screening. These studies were published between 2011 and 2023 and evaluated the distribution of WNV or its vectors according to various climatic and environmental factors. Despite rather heterogeneous results, we found a consistently positive association with temperature, especially spring temperature, agricultural land use, demography, and soil moisture, and a negative one with evapotranspiration and wind, while the relationship with other environmental variables and water cycle-related factors was weak, null or conflicting.

Conclusions

Despite some inconsistencies in the results, likely related to differences in study methodologies as well as complex environmental interactions, we found unequivocal evidence that climate change-related factors, such as the lengthening of the warm season, extensive farming, and invasive human activities towards natural environments, favour WNV spread in Italy. Consequently, actions against global warming and preservation of natural environments may counteract the WNV epidemic.

Key messages

• WNV epidemic seems to be linked to specific climate change-related factors, such as the lengthening of the warm season, extensive farming, and invasive human activities towards natural environments.

• Actions against global warming and preservation of natural environments may counteract WNV spread.
Climate change health challenges – a study on heat health-related adaption measures in Germany
Authors: Grewe H A , Kind C
Published: October 2024

Problem

Increasing extreme heat events of summer 2003, 2010 and 2015 induced a rising impact on heat health morbidity and mortality in Germany. A considerable proportion of urban population is affected by thermal discomfort due to the urban heat island burden during summer, particularly vulnerable people at risk. Concerted action to develop appropriate heat health adaptation measures is needed.

Description

As part of the National Adaptation Strategy to Climate Change an expert working group published ‘Recommendations for Action for the Preparation of Heat Action Plans’ for Germany in 2017. A first country-wide project had been conducted between 2019 and 2023 which investigated the status and impact of current or planned Heat Health Action Plans (HHAP), and adaptation measures appropriate to protect and prevent human health. As part of this project an online survey was conducted in May/June 2020 on the awareness and degree of use of the 2017 recommendations and the development and implementation of HHAP.

Results

This survey had been carried out to assess the current state of affairs as well as factors of success and barriers in the development and implementation of HHAP, with a particular focus on municipal environment and health administrations. In total 116 questionnaires had been responded, mainly by participants from the environment sector (53%), and 32% from the public health sector. More than half of the respondents indicated to be aware of the recommendations (very well-known at the federal state level: 90%, at county level known by 43%), which were identified as very helpful by 81%. Respondents from large cities (> 100 000 inhabitants) were main contributors to the study (41 of 81 large cities replied; 34 rural counties responded).

Key messages

• The 2017 recommendations had been identified and used to start with HHAP.

• Decision makers should develop structures for regulations that anchor HHAP as a nationwide instrument to be established timely.
Finding cool spaces in Frankfurt/Main–a heat protection measure for the population of a major city
Authors: Duggan K , Christ A , Maraslioglu M , Sauer A , Böddinghaus B
Published: October 2024

With the European continent heating up faster than ever, cities are facing major challenges protecting their population from the effects of climate change. Heat can have devastating effects on people’s physical and mental health with particular significance for the known vulnerable groups - the elderly and young children, people with pre-existing conditions, those who are pregnant and those who cannot protect themselves sufficiently for various reasons plus of course people working outdoors. Following the 2003 heat wave, the city of Frankfurt/Main registered a significant rise in mortality and morbidity, leading the Health Protection Authority to be increasingly concerned with heat-related health problems in the Frankfurt metropolitan area. The city has since developed various systems to protect the population from extreme heat and developed an all-encompassing climate change action plan (CCAP). Part of the CCAP is the provision of cool spaces to provide refuge from the heat for the public and implementation of this project started in the summer of 2022. However, with no legislative basis on which to build such a platform, some creative measures were required to ensure its success. Here, we will not only present the challenges we faced but the solutions we found - and the results of our currently ongoing evaluation of the actual use of our cool spaces to help other cities make their journey to similar measures easier. Starting with a brief overview of the CCAP, we will show the cool spaces’ place within the strategy, followed by our original plan of action and what happened when this plan came into contact with the reality of life in a large and diverse city. We will touch on climate injustice and the difficulties in reaching those parts of the population who actually need protection the most. Finally, we present our evaluation strategy and results together with the adjustments we are considering in moving forward with this climate change protection measure.

Key messages

• (Establishment of) climate change adaptation measures should urgently be enshrined in law.

• Health inequality corresponds to climate inequality and continiously challenges adaptation measures.
Contributing to healthier populations by reducing energy poverty via innovative financial models
Authors: Costa Ruiz B , Lucas R , Ferrando Garcia M
Published: October 2024

Issue/problem

Energy poverty is a major challenge affecting 9.3% of the EU population (EUROSTAT 2022). Health problems attributable to energy poverty include respiratory diseases, heart attacks, stroke, and mental disorders. Governments must act quickly and intervene with policies and programmes that reduce energy poverty and promote citizens' health and well-being.

Description of the problem

We propose Social Impact Bonds (SIBs), a new family of instruments that address serious social challenges, to finance interventions targeting energy poverty,improving the health and well-being of households in a context of limited public resources. For this purpose, data from interventions to increase energy efficiency and combat energy poverty implemented during one year in 6 pilot sites in the framework of the EU project WELLBASED are used. First, a compliance check will be carried out, followed by an estimation of the costs, savings, and benefits of the application of SIBs to finance energy poverty reduction interventions with an impact on health.

Results

The results of the analysis will show whether the intervention to reduce energy poverty meets the necessary characteristics for a SIB to be implemented. In addition, the possible key actors that could lead its implementation are identified.

Lessons

If the interventions for the reduction of energy poverty carried out under the WELLBASED project are successful, SIBs could be considered as a valuable alternative to finance interventions that combat energy poverty and increase the well-being of citizens. Key knowledge on how to apply SIBs makers to tackle a serious social issue with important consequences on health will be at disposal of (EU and worldwide) local authorities and policy.

Key messages

• Energy poverty is a public health issue, requiring urgent support measures.

• SIBs fund interventions via public-private collaboration to fight energy poverty and boost citizen wellbeing.
The role of Public Health during an emergency: the 2023 flood in the Emilia-Romagna Region
Authors: Monti M , Fabbri M , Silvestrini G , Golfera M , Angelini R
Published: October 2024

Issue

Major meteorological events like floods are a primary issue for public health. In May 2023, the Emilia-Romagna Region (Italy) was hit by a major rainfall: more than 4.5 billion m3 of rainwater, more than 30 rivers overflowed, 36.000 displaced people, 17 casualties. Public health is called upon to mitigate health consequences with an epidemiological approach in the pre-disaster phase to better address the population; through rapid need assessment during the response phase; and through health surveillance and tracking systems in the post-disaster phase.

Description of the problem

A continuous epidemiological approach throughout the emergency was applied. Rescue: coordination for rescue and sheltering of displaced people (especially from flooded healthcare structures); veterinarian intervention for livestock assistance; carcass removal. Assistance: hygienic controls in shelters; distribution of a handbook with instructions for flooded residents and volunteers to prevent potential injuries and infectious disease outbreaks; immunization campaigns, primarily against tetanus and HAV. Health surveillance: monitoring of ER accesses and hospitalizations, notification of communicable diseases, syndromic surveillance. Post-emergency management: VBDs monitoring and preventive treatment, waste management, bathing water surveillance.

Results

A rapid need assessment was critical for the coordinated effort with other intervention forces, like the Civil Protection. A prompt risk communication ensured simple and clear information, mitigating the risks of exposure to floodwater. More than 10.000 vaccine doses were administered. The syndromic surveillance proved valuable in monitoring post-flood health trends.

Lessons

Several measures were implemented thanks to healthcare workers and volunteers. Nonetheless, a better and faster reaction is possible if disaster management protocols are already available. This experience must increase future preparedness of PH services.

Key messages

• Public health intervention is crucial in all phases of an emergency, to take care of the affected population and to prevent further health issues.

• The public health response needs to be well-timed, long-lasting, and supported by a clear and well-defined risk communication to population and health workforce alike.
Cross-sectoral interventions to promote health-supportive urban environments
Authors: Longo G , Angelini P , Chiaranda G , Comini S , Dorato E , Ganapini M S , Monti M , Nerozzi B , Soracase M , Venturelli F
Published: October 2024

Background

As dealing with the complexity of urban living conditions becomes more and more evident and urgent, it is fundamental to promote cross-sectoral interventions that allow cities to become more inclusive and supportive of health. The Emilia-Romagna region, Italy, has promoted a participatory initiative to structurally integrate health into urban planning tools, identifying a framework of tailored urban indicators linked to locally perceived population health issues.

Methods

Through internal discussion and systematic literature research, a set of urban planners, epidemiologists, and public health experts from regional offices, local health services, universities, and environmental protection agencies identified the urban and health dimensions most suitable for embedding population health into city planning. The result was summarised in a preliminary working paper, which included a matrix of associations between urban features and health dimensions framed according to the DPSEEA framework. Its applicability was then tested in a participatory process (March-May 2024) involving urban planners and public health departments of 7 different sized municipalities.

Results

A group of epidemiologists identified local-level computable indicators for the health dimensions already included in the matrix or added at request. Each municipality focused on specific topics based on local priorities: 3 groups assessing their already-approved urban plans and looking for computable urban indicators; the others integrating their under-construction plans with local health indicators.

Conclusions

The need for professional contamination and cross-sectoral interventions is significant. Epidemiological support is pivotal in integrating different professional languages and reading health data. The outputs of this experience will contribute to a technical document outlining how to incorporate health promotion into urban planning tools and practice while actively considering the local context.

Key messages

• Although the development of a common vocabulary can be difficult, multidisciplinary collaboration is essential in promoting a model for integrating health promotion into urban planning.

• Local municipalities’ involvement in the experimentation can improve the model’s applicability by taking into account territorial specificities.
Eco-friendly treatment: a win-win for patients, health systems, and the planet. Rapid scoping review
Authors: Piso B , Kien C , Klerings I , Grandt L , Daxenbichler J , Harlfinger J , Toromanova A , Sommer I
Published: October 2024

Background

As the fifth-largest CO2 emitter globally, the healthcare industry must act to mitigate its environmental impact. This includes de-implementing low-value care and adopting eco-friendly innovative treatment alternatives. Our study aims to explore existing research on the environmental effects of these actions and the outcome measures utilized.

Methods

We conducted a rapid scoping review following a pre-published protocol, searching Ovid MEDLINE® and Scopus (Elsevier) from January 2015 to June 19, 2023. Initially, dual abstract and full-text screening was performed, followed by a single review. Data extraction was cross-checked by a second reviewer. Findings were narratively described using summary statistics.

Results

We analyzed 182 articles, primarily life cycle assessments and modeling studies (92 out of 182), with only one study being a randomized controlled trial. The research covered various healthcare practices, including consultation methods/telemedicine (32%), surgical and medical device usage (26%), medication (25%), surgical procedures (19%), as well as diagnostic tests, screening, and imaging (13%). The main sustainability strategies mentioned were ‘Rethink’ (99%) and ‘Reduce’ (81%), with ‘Reuse’ (32%), ‘Recycle’ (19%), and ‘Refuse’ (10%) being less utilized. Environmental outcomes reported included global warming (88%), resource consumption (27%), and chemical hazards (23%). Most studies were conducted in Europe (48%), followed by the USA (37%), with 75% published after 2020.

Conclusions

The environmental impact of healthcare is a pivotal area for public health action and fortunately, it is also emerging as a significant research field. Utilizing methodological approaches less common in evidence-based healthcare research underscores the necessity for innovative interdisciplinary collaboration and capacity building. The most pressing research gap lies in the impact of de-implementation strategies (“refuse”) targeting low-value care practices.

Key messages

• Measuring the environmental impact of healthcare demands the development of novel cross-disciplinary research methods and collaborations.

• De-implementing low-value care represents a future win-win scenario for patients, the financial viability of healthcare systems, and global environmental sustainability.
Long-term exposure to PM2.5 and mortality among Japanese community-dwelling adults
Authors: Michikawa T , Nishiwaki Y , Nitta H ,   IPHS Ibaraki Prefectural Environmental Health Study Group
Published: October 2024

Background

Long-term exposure to PM2.5 (particulate matter with a diameter of 2.5 μm or smaller) is a risk factor for mortality and cardiovascular disease including stroke. However, there was limited evidence for the association between PM2.5 exposure and stroke in Asia where the major cardiovascular disease is stroke. Additionally, the causal association between PM2.5 and respiratory disease is still unresolved. The aim of this study was to investigate the association between long-term exposure to PM2.5 and all-cause, cardiovascular, and respiratory disease mortality in a Japanese community-based prospective cohort.

Methods

This study included 46,974 participants (19,707 men; 27,267 women) from the second cohort of the Ibaraki Prefectural Health Study. The participants were followed up from baseline survey (in 2009) to 31 December 2019. We confirmed underlying causes by death certificates. Using the PM2.5 concentrations estimated by the inverse distance weighting methods based on ambient air monitoring data, administrative area level concentrations were assigned to each participant. The hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality using a Cox proportional hazard model were presented.

Results

We identified 2,789 all-cause deaths during the 470,178 person-years of follow-up. PM2.5 exposure had no significant association with all-cause and cause-specific mortality. The multivariable-adjusted HRs per 1 μg/m3 increase in the PM2.5 concentration were 0.94 (95% CI = 0.80-1.12) for coronary heart disease, 0.92 (95% CI = 0.81-1.04) for stroke and 1.09 (95% CI = 0.97-1.23) for non-malignant respiratory disease.

Conclusions

We observed little evidence of increased risk of all-cause and cause-specific mortality by long-term exposure to PM2.5 whose concentrations ranged from 8.3 to 13.1 μg/m3. A somewhat increased trend for non-malignant respiratory disease mortality may not be negligible.

Key messages

• We found little evidence of increased risk of all-cause and cause-specific mortality by long-term exposure to PM2.5.

• Somewhat increased tendency for non-malignant respiratory disease mortality associated with PM2.5 exposure was observed.
Built environmental characteristics, physical activity in neighbourhoods of Accra, Ghana
Authors: Effah E S , Nai A , Bardos H
Published: October 2024

There is increasing evidence that characteristics of the built environment can influence residents’ lifestyles, physical activity thereby influencing the development of obesity and non-communicable diseases even in low- and middle-income countries. The aim of this study is to describe the characteristics of the built and the social environment of neighbourhoods of Accra, Ghana, and to explore association between neighbourhood characteristics and the physical activity of the residents. A cross-sectional study was conducted in Accra, 12 neighbourhoods were randomly selected based on high and low values of residential density and socioeconomic status. Sociodemographic, household and neighbourhood information were collected with an adapted questionnaire of NEWS (Neighbourhood Environment Walkability Scale) for Africa. Physical activity was assessed by WHO Global Physical Activity Questionnaire and social cohesion by the Perceived Neighbourhood Social Cohesion Questionnaire. Differences between variables by neighbourhood types were analysed using Chi square test and Kruskal Wallis test. Generalized linear model was performed to determine the association between neighbourhood characteristics and residents’ physical activity. The built environmental characteristics of different neighbourhood types and the physical activity of the residents showed significant differences. The associations indicated that individuals living in high residential density neighbourhoods had increased levels of engaging in physical activities. Land use mix, street connectivity, safety, aesthetics and social cohesion of neighbourhoods showed correlation with physical activity of residents. The built environment and social characteristics of neighbourhoods can influence the lifestyle and physical activity of residents in Accra, Ghana.

Key messages

• High residential density neighbourhoods correlated with higher level of physical activity.

• Land use, street connectivity, safety and aesthetic of neighbourhoods and social cohesion showed correlation with physical activity.
The Impact of Poor Air Quality on Hospitalisation of Multi-morbid Patients: A Systematic Review
Authors: Hassan N , Mohamed L , Ahmed A , Baxter C , Wilson S , Tolley C , Namdeo A , Slight R , Slight S P
Published: October 2024

Background

Exposure to poor air quality worsen existing health conditions, particularly amongst vulnerable patients, leading to increased healthcare utilization. We conducted a systematic review to explore the impact of exposure to poor quality on healthcare requirements in multi-morbid patients.

Methods

We searched six major databases (Medline via Ovid, Embase via Ovid, Web of Science, CINAHL, Global Health, and Scopus) using search terms grouped into sets relating to ‘air pollution,’ ‘multimorbidity,’ “association” and ‘hospitalisation.’ We were interested in the impact of common air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) and articles were screened independently by two researchers. The review was registered with The International Prospective Register of Systematic Reviews (CRD42022369757) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

A total of nineteen studies were included. All six air pollutants increased hospitalisation amongst multi-morbid patients, especially those with diabetes and cardiovascular comorbidity. Females and the elderly (>65 years old) were the most vulnerable to the effects of air pollution, with an increase in hospitalisations of 9.23% and 6.35% when exposed to PM2.5 and PM10, respectively. Patients >65 years had a higher likelihood of hospitalisation for ischemic and haemorrhagic stroke when exposed to PM2.5 or PM10 at warm season. Patients (≥70 years) who had cardiovascular and pulmonary comorbidity were 3.9% more likely to be hospitalised for a cardiopulmonary event with a rise in NO2 levels. We found an intersectional effect (referred to as “the CADC effect” - Climatic changes, Air pollutant, Demographics, Chronic conditions) that influenced the likelihood of hospitalisation.

Conclusions

Future research is required to further understand this CADC effect in other high-risk population.

Key messages

• Females, elderly, those with cardiovascular, and pulmonary comorbidity are at the highest risk of hospitalisation with poor air quality.

• The CADC effect explains the intersectional effect between hospitalisation in multimorbid patients, patients demographics and chronic conditions, and air pollution and temperature effects.
Environment, climate, socio-economics & restrictions impact on COVID-19 in Northen Italy
Authors: Palandri L , Rizzi C , Vandelli V , Filippini T , Carrozzi G , De Girolamo G , Russo M , Soldati M , Righi E , Lugli C
Published: October 2024

Up to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, and most of them focused on viral spread rather than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. Our population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (n.68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021. Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. Several significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. Our findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly.

Key messages

• Evaluating simultaneously four exposure domains on COVID-19 outcomes informs public health policy for future pandemic management.

• The comprehension of risk factors associated with severe outcomes, such as hospitalization and mortality, is pivotal for planning responses to similar health emergencies in the future.
An intervention on climate change anxiety and pro-environmental behaviours in Italian young people
Authors: Lombardi G S , Zjalic D , Di Russo M , Perilli A , Congedo G , Nachira L , Cadeddu C , Innocenti M , Bruno S , Fioravanti G
Published: October 2024

Background

The climate crisis greatly affects mental health, often leading to climate change anxiety. In Italy, there is a lack of research and school programs to help manage climate anxiety and other climate-related psychological consequences. The aim of the CAMBIO CLIMA project is to evaluate the levels of eco-anxiety and pro-environmental behaviours (PEBS) in a sample of Italian middle and high school students, before and after a tailored intervention on the climate crisis.

Methods

The intervention involves one hundred middle and high school classes from three Italian regions. The students will complete a set of surveys, including psychometric scales and questions on socio-demographic factors and climate change awareness. The students will then participate in a two-hour online workshop. A video will be shown at the beginning to raise awareness about climate change. The instructor will ask the students which solutions could be found to solve specific problems caused by climate change. The instructor will then propose and explain a list of PEBS that students can implement to fight against climate change. Finally, students will be invited to put into action these behaviours. A week after the intervention, students will be asked to take part in a post-intervention survey, completing the same set of questionnaires they completed at enrolment.

Results

Currently, the research team is in the preparatory stage, establishing contacts with schools and organizing materials for the online workshop. The intervention is scheduled for the upcoming school year.

Conclusions

The intervention, focused on enhancing the sense of self-efficacy, is expected to increase the resilience of adolescents, making them less vulnerable to the impact, both direct and indirect, of climate change on mental health. The project is funded by PRIN: PROGETTI DI RICERCA DI RILEVANTE INTERESSE NAZIONALE - Bando 2022 (Prot. 2022N22J5F).

Key messages

• Climate change has a disproportionate impact on young people.

• It is essential to plan adequate school programs that stimulate the sense of awareness and encourage PEBS simultaneously.
Sanitary Surveillance Program for pools in Matosinhos, Portugal
Authors: Barbabela R , Maia M A , Jesus A S , Abreu Gomes C , Silva J G , Balazeiro M , Sousa F , Duarte G , Fernandes A , Queiroz Almeida D , Penedos Oliveira D , Pinheiro V , Rodrigues N
Published: October 2024

The use of pools for sports, recreational, and therapeutic activities has increased over time. It is important to ensure and control the quality of the water and surrounding areas, as well as the hygienic-sanitary conditions of these spaces. The ‘2018 Pool Sanitary Surveillance Program’ of the Portuguese Northern Regional Health Administration proposes the surveillance of water quality, teaching accessories, and surfaces. The aim of this investigation is to conduct microbiological analysis of the teaching accessories and surfaces in public pools in the municipality of Matosinhos and assess if this program has improved the results for water quality, teaching accessories, and surfaces from 2018 to 2023. The environmental health team of our Public Health Unit performed swabs of the teaching accessories and surfaces of all seven public pools in Matosinhos for microbiological analysis. The swabs were performed in 2018 (21), 2019 (48) and 2023 (42). During each visit, three random points were selected for analysis. In 2019, 31 rugs (64,6%) were analysed, but in 2023 only 10 (23,8%) were rugs. It was found that rugs had the highest contamination by P. aeruginosa (94,4%), fungi (60,8%), and the only sample with coagulase-positive Staphylococci. There was a decrease in samples from twelve to six with P. aeruginosa and an increase from 22 (46.8%) to 29 (69.0%) with fungi from 2019 to 2023. Bacterial colonies grew in 20 samples (95.2%) in 2018, 44 (91,6%) in 2019, and 42 (100%) in 2023. All water samples collected for the evaluation of microbiological parameters outlined obtained compliant results. Fungal and P. aeruginosa detection indicate a potential risk to the health of pool users. A quality report with corrective measures was produce for each pool in each visit. Surveillance of pool water, teaching materials and surrounding surfaces, is crucial to ensure water quality and safety. By doing so, we may lower the risk of disease transmission and protect the population’s health.

Key messages

• To ensure the safety of pool users is a public health challenge. It would be relevant to have legislation that addresses this issue.

• To survey pools and its surroundings and accessories must be a continuous task, allied with literacy to management and users.
Exposure to microplastics via hemodialysis: differences between women and men
Authors: Fiore M , Bivona F , Palella M , Fatuzzo P M , Zanoli L M , Timperanza C , Longo V M , Lo Cicero L , Oliveri Conti G , Ferrante M
Published: October 2024

Background

Hemodialysis (HD) may contribute to microplastics (MPs) burden in dialysis patients. The aim of the study was to estimate any differences in exposure to MPs between cases (on dialysis patients) and controls (not on dialysis patients), investigating any sex differences.

Methods

We organized a case-control study. Both cases and controls were recruited at the Policlinic “G. Rodolico-San Marco” Hospital Nephrology Unit. Preparation and determination of MPs smaller than 10 µm in blood samples were carried out using a patented method (Italian Patent n. 102018000003337-07 March 2018, European Patent n.3788344 20 July 2022) and SEM-EDX electron microscopy analysis, respectively.

Results

A convenience sample was recruited including 15 dialysis (60.0% women) and 10 not on dialysis patients (60.0% women) with a median (IQR) age of 77.0 (59.0-83.0) in dialysis patients and 65.5 (49.3-79.0) in those not on dialysis. No significant differences were found between cases and controls on the consumption of bottled water (100% vs 80%, p = 0.07), bagged foods (93.3% vs 70%, p = 0.12) unlike the use of drugs (100% vs 70%, p = 0.02). Women in general declared a greater use of drugs than men (F 93.3%, M 80.0%, p = 0.32). Dialysis patients had higher MPs levels than non-dialysis patients [9132(4896-15847) vs 3554(1661-7340), p-value=0.06]. In particular, female dialysis patients had values comparable to males [9132 (4665-17205) p/d vs men: 10438 (3672-16699) p/d] while non-dialysis female patients had higher levels than males [3274 (1681- 7814) p/g vs 1661 (1661-3354) p/g]. No difference was detected about the diameter of the MPs (IQR) [dialysis patients 4.28 (3.72-4.66) µm vs non-dialysis patients [4.67 (4.15-5.08) µm].

Conclusions

Future studies must focus on studying the relationship between exposure to MPs and their levels in dialysis patients as well as investigating the differences between men and women and the possible consequences of dialysis as a further source of exposure.

Key messages

• On dialysis patients, both men and women, had higher MPs exposition compared to not on dialyzed ones.

• Not on dialysis women had higher MPs levels than not on dialysis men.