bluuebunny/crossref_metadata_2025 huggingface dataset:
Dual trajectories of insomnia symptoms and BMI and their associations with cognitive functioning
Authors: Etholén A , Kouvonen A , Hänninen M , Kulmala J , Rahkonen O , Mänty M , Lallukka T
Published: October 2023

Introduction

Insomnia symptoms and high body mass index (BMI) are separately associated with poorer cognitive functioning. However, little is known about dual associations of sleep and obesity, and the changes in subjective cognitive functioning. We used a person-oriented approach to identify these dual trajectories and their associations with changes in subjective cognitive functioning.

Methods

Repeated surveys of the Helsinki Health Study (n = 2360, 79% women,40-60 years at baseline) were used to identify developmental patterns of insomnia symptoms and BMI (2000-2017) and changes in subjective cognitive functioning (2017-2022). Subjective cognitive functioning was inspected in three dimensions: memory, concentration, and learning ability problems. Latent group-based dual trajectory modeling and logistic regression analysis were used.

Results

Regarding dual trajectories of insomnia and BMI, three latent groups were selected for each. Insomnia symptoms defined as: stable low, decreasing and increasing symptoms; and BMI as: stable healthy weight (BMI < 25), stable overweight (BMI 25-29.9) and stable obesity (BMI ≥ 30). While BMI and insomnia symptoms can develop together, this study suggests that the higher likelihood of reporting poorer memory, concentration, and learning ability problems, is explained by insomnia symptoms at all levels of BMI. Thus, BMI was not associated with cognitive functioning, while increasing insomnia symptoms were associated with poorer perceived cognitive functioning for all measures examined (odds ratios ranged from 1.8 to 2.9, all statistically significant)

Conclusions

Dual development of insomnia and overweight is possible, but only insomnia seems to be associated with changes in subjective cognitive functioning at all BMI levels. A potential intervention point to prevent or postpone cognitive decline in later life starts likely years or even decades before retirement, when the risk factors emerge or start to increase.

Key messages

• The association between dual trajectories of insomnia symptoms and BMI and subjective cognitive decline is dominated by insomnia symptoms.

• Our results showed that developmental patterns of insomnia symptoms are associated with decline in subjective cognitive functioning.
Comparison of response patterns in national surveys among Finnish adult population in 2020 and 2022
Authors: Parikka S , Ikonen J , Tolonen H , Lundqvist A
Published: October 2023

Background

Self-administered survey questionnaires are an important data collection tool in public health research and epidemiology. These questionnaires can be completed electronically, which allows larger sample size and faster speed of data collection while reduced cost. Yet, a web survey might be a less feasible for older individuals. We evaluated the response patterns in the two recent surveys in 2020 and 2022.

Methods

We analysed the data from FinSote 2020 (n = 31,817) and Healthy Finland 2022 (n = 30,307) surveys in Finland. In both, invitees (aged 20+) were contacted four times via postal letter. A concurrent mixed-mode approach allowed for the invited individuals to complete either a web questionnaire or an identical paper questionnaire. In both surveys, the oldest age group (75+) received a paper questionnaire three times and those aged 20-54 years received it only once. In 2022, the survey design was changed so that a paper questionnaire was sent twice (instead of three times) for those aged 55-74 years compared to 2020.

Results

The overall response rate was 47 % both in 2022 and 2020. Persons aged 75 + rarely responded to web questionnaire, less than 10 % answered in web. Instead, among persons aged 20-54 years, around 80 % completed the web survey. The response mode for the web survey increased significantly from 32% to 46% for two years period. The largest increase in the proportion which completed the web survey was found in respondents aged 55-74 years (from 19 % to 49 %). In them, however, the response rate declined from 60 % to 58 %.

Conclusions

In mixed-mode surveys, push-to-web approach can shift respondents to a web survey without greatly impacting response rate. However, without offering a paper questionnaire, older people are likely to be missing resulting potentially biased estimates.

Key messages

• Completing survey in web has increased recent years. This may be partly due to COVID-19 pandemic that led to a shift towards use of digital apps and online services.

• The move to the web-based surveys save the costs without impacting response rates.
Perceived discrimination and mental health among Syrian refugees in Norway: A cross sectional study
Authors: Dadras O , Diaz E
Published: October 2023

Introduction

Discrimination in the host country can be related to the mental health of refugees. This study assessed the association of discrimination with Syrian refugees’ mental health in Norway.

Methods

This cross-sectional study used data from the Integration for Health project (2022-23) in which 154 Syrian refugees who resettled in Norway in 2018-19 (n = 464) were interviewed after informed consent. Perceived discrimination was assessed by four questions adopted from the refugee post-migration stress scale (RPMS) in four domains: discrimination by authorities, nationality, race, and at work/school, and a composite variable with two alternative responses (never/rarely, sometimes/often) was created. Mental health was measured as psychological distress on HSCL-10 scale (scores>1.85), and post-traumatic stress symptoms on HTQ scale (scores>2.5). Chi-square and logistic regression assessed the relationship of perceived discrimination with mental health in separate models adjusted for age, sex, education, income, and marital status. To account for non-response, outcome-specific sampling weights were calculated and applied.

Results

The mean age was 39 years. Almost half (54%) were female. An estimated 12%, 15%, 14%, and 13% of participants, sometimes or often experienced discrimination by authorities, colleagues at work/school, nationality, or race respectively. The prevalence of psychological distress and PTSD symptoms was 28% and 5%, respectively. The perceived discrimination was significantly associated with higher psychological distress and PTSD symptoms.

Conclusions

Syrian refugees in Norway who have experienced discrimination are more likely to suffer from psychological distress and PTSD. Future policies and interventions should aim at promoting social inclusion and the implementation of anti-discrimination policies.

Key messages

• There is a strong association between perceived discrimination and poor mental health.

• Future policies and interventions should aim at promoting social inclusion and implementation of anti-discrimination policies in employment, housing, and education.
Inequalities in accessing COVID-19 healthcare for migrants and ethnic minorities: a systematic review
Authors: Bellini A , De Marchi C , Tosti M E , D'Angelo F , Declich S , Scarso S , Mazzalai E , Marchetti G , Sabato M , Marceca M
Published: October 2023

The COVID19 pandemic has had a major impact on lower socioeconomic groups and minorities in terms of risk of SARS-CoV-2 infection, morbidity and mortality. It was defined as a syndemic because of its interaction with pre-existing socioeconomic determinants of health, worsening health outcomes. The study aims to investigate whether Migrants and Ethnic Minority populations (MEMs) faced more inequalities in access to prevention, diagnosis and treatment for COVID19 compared to the native population in the WHO European region. We conducted a systematic review searching the following databases: Medline, Embase, Biosis, Scisearch, Esbiobase. Quantitative and quali-quantitative studies on MEMs’ access to healthcare for COVID19 in the WHO European Region published from January 2020 to February 2022 were eligible. A total of 19 studies were included, around 65% of the studies were conducted in UK. Most studies (11) investigated vaccine hesitancy, five were about vaccine execution, three on access to information and to testing for COVID19. All studies reported greater vaccine hesitancy among the target population compared to white ethnicity and all of those investigating vaccination uptake pointed out that MEMs had lower odds of being vaccinated; finally, MEMs population resulted to face more difficulties in accessing COVID19 information and testing. These findings highlight the inequalities MEMs population faced accessing healthcare services for COVID19. Social determinants of health are one of the main factors involved in the genesis of health inequalities: a framework of structural racism leading to lower trust in government choices, together with a disadvantaged socio-economic status, determined inequalities in accessing healthcare services and health information. Our study underlines the need for policymakers to prioritize strategies for building trust and engage MEMs, and to overcome the socio-economic barriers when designing health promotion programs.

Key messages

• MEMs population faced higher barriers to the access to vaccination, turned out to be more vaccine hesitant and faced more difficulties in access to Covid-19 information and testing.

• The study underlines the need of finding strategies for building trust and engage ethnic minorities, and to overcome the socio-economic barriers when designing health promotion programs.
Orthodox Jews and factors affecting COVID-19 vaccination: Lessons learned for public health
Authors: Shapiro E
Published: October 2023

Background

Orthodox Jews in general, and Haredi (often called Ultra-Orthodox) Jews in particular, have been disproportionately harmed by the COVID-19 pandemic and are typically less vaccinated. However, not enough is known about causal factors, especially social and religious factors, and the interactions between them.

Aim

To determine what influences COVID-19 vaccination among Orthodox Jews in the U.S..

Methods

U.S. Orthodox Jewish communities across seven states were surveyed using a convenience sample. Questions were asked about COVID-19-related behaviors and attitudes, religious behaviors and attitudes, information sources, trust in health experts, and sociodemographics. The primary outcome measure was vaccination status. Descriptive analyses and multivariable modified Poisson regressions were performed.

Results

There were 3,249 respondents. Haredi Jews were less likely to vaccinate than other Orthodox Jews but more likely to have had COVID-19 and believe vaccination was unnecessary. Distrust of COVID-19 information from health experts was high across communities, highest for Haredi Jews. Multivariable regressions showed significantly reduced risk of not being vaccinated across communities when friends were vaccinated and when spiritual leaders supported vaccination. Impact of personal doctors endorsing the vaccine was more limited. Concerns about COVID-19 vaccine safety, but not effectiveness, impacted vaccination rates.

Discussion

Trust-building and increased cultural competence can help public health systems and other health entities work more effectively with Orthodox Jews, especially Haredim. The social environment of these groups, including friends and spiritual advisers, may also be underutilized pathways to increasing vaccination. These steps can potentially reduce health inequalities and improve health in these communities not only for COVD-19 but other health issues in the future.

Key messages

• Religious attitudes and beliefs can affect vaccination rates for a number of reasons.

• There is a need for increased trust and greater partnership between the faith-based and public health communities.
CLIMIGRANT: An educational resource about climate change, human movements and health
Authors: Merry L , Hunt M , Hurlimann T , Schriever S , Tzoneva T
Published: October 2023

Background

Climate change in combination with other social, economic, and political factors, can result in population displacement, relocation or migration, which may be forced or may be a voluntary adaptation strategy. For some, however, moving is not an option due to a lack of access to resources, capacity and power. These experiences have implications for health. Our objective was to develop an educational resource to raise awareness about climate change and their impacts on human movement and health.

Methods

This project was an initiative of the Quebec Population Health Research Network, in Quebec, Canada. A survey was distributed to 28 network members who have diverse expertise, including migration, climate change, environmental sciences, law, ethics, and public health, to identify key themes and messages to convey, and to gather supporting references and materials. A workshop was subsequently held with 10 survey participants to brainstorm ideas for the content, approach and format. A core working group then developed CLIMIGRANT in consultation and collaboration with a number of experts.

Results

Two illustrated stories (for a general public, including children) and an online course (for students, frontline workers, researchers and other stakeholders) were developed in English and French (available at Climigrant.org). Each provides an overview of how climate induced disasters or environment changes can result in inequitable and complex situations regarding migration/relocation. They also highlight the number of health consequences, both physical and psychological, and challenges related to addressing these. Solutions for prevention and adaptation are presented as well. The resource illustrates how anyone can be affected by climate change, regardless of where they live and conveys a message of solidarity and collective responsibility.

Conclusions

CLIMIGRANT can be used to inform and educate a broad population on climate change, human movement and health.

Key messages

• A diversity of methods can be used to raise awareness about climate change, human movements and health.

• Anyone, anywhere can be impacted and displaced by climate change and we all have a role to play in addressing climate change and its impacts.
How School Food Environments Influence Food Choices: Evidence from Citizen Science and Focus Groups
Authors: Gell S , Pejkovic E , Heiss R
Published: October 2023

Background

Adolescents, as lucrative targets of food producers, encounter high-choice school food environments that offer an excess of highly processed foods. However, there is limited data on the actual food supply inside and around Austrian schools, adolescents preferences, and how it affects their food choices. To bridge this gap, our study employs an innovative mixed-methods approach to explore adolescents’ food choices.

Methods

In Study 1, we conducted a citizen science study with students as volunteer scientists who categorized 953 food items from 144 food suppliers in and around their schools based on the Austrian food pyramid. Study 2 explored students’ food preferences in four focus groups with 25 students (11 male, 14 female) aged between 12 and 15, each conducted at a different school in Tyrol. We then correlated the results of individual preferences with the documented food supply.

Results

The results of Study 1 revealed that the food supply in the investigated schools was predominantly categorized as unhealthy. The students classified 46% of the items as ‘unhealthy,’ 32% as ‘intermediate,’ and only 22% as ‘healthy.’ In Study 2, we identified three influential factors in students’ food choices: 1) individual factors (such as taste and preferences), 2) social factors (such as interactions with peers), and 3) structural factors (such as physical environment and accessibility).

Conclusions

The study indicates that current school food environments are dominated by unhealthy products, which cater to unhealthy preferences among adolescents. To address this issue, policies should aim to create accessible and fun spaces where food supplies are presented in an attractive way. This includes providing areas where students can mingle and express their identities.

Key messages

• Attractive presentation of healthy foods in locations, which cater to the social needs of adolescent students, are key to foster and consolidate healthy food choices.

• Improve accessibility and supply of healthy food choices in school food environments.
Food in the community daycare center: is it all about nutrition?
Authors: Avraham R , Davidovitch N , Shapira S
Published: October 2023

Background

As the world's population continue to age, it's crucial to prioritize interventions that enhance quality of life, well-being, and health of older people. Sustainable environments that fulfill basic needs such as food and nutrition can aid in meeting the social needs of seniors, including belonging, autonomy, independence, and safety. The study aims to understand the experiences and meanings of eating and dining among seniors in community daycare centers, and how they support their social needs, with to goal of identifying effective strategies for promoting their health and well-being.

Methods

This qualitative study involved conducting seven focus groups of seniors (n = 23); interviews with settings managers (n = 7); and observations carried out between May to November 2022. Through content analysis, we identified key categories and themes that emerged from the data.

Results

The analysis revealed three main themes related to the experiences and perceptions of food and nutrition among seniors at the daycare center: (1) personal needs: seniors expressed a need for autonomy in selecting food, building menus, and choosing sitting arrangements. They also emphasized the importance of having access to hot and balanced meals (food security) that reflected their cultural and personal preferences. (2) Social needs: the need for companionship during mealtimes (comparing to eating alone at home), being cared for, and participation in social events such as dining out or attending picnics and parties. (3) Health-related needs: customized and healthy diets, education on healthy eating habits, and the use of reusable dishes and food waste reduction strategies to support environmental sustainability.

Conclusions

Meeting the personal, social, and health-related needs of seniors through better food planning and service can improve their well-being and quality of life, and contribute to public health.

Key messages

• Eating and dining in seniors’ settings is not only about nutrition but also about preserving health and well-being.

• Interventions should focus on the opportunities that dining provides.
UK food system vulnerability to climate change: scoping review of food system indicators
Authors: Turner G , Green R , Law C , Cornelsen L
Published: October 2023

Background

Climate change poses a future risk to the UK's food supply and food security, both in terms of domestic production and imports. Direct climate impacts on crop yields affect food production, nutrient composition and bioavailability whereas indirect supply chain impacts affect access and affordability of food. Indicators and methods for measuring the UK food system vulnerability are essential for understanding climate change impacts.

Aim

To identify potential indicators for monitoring climate change impacts on food systems (relevant to UK) and compare with current UK processes for impact monitoring.

Methods

A scoping review was conducted to identify climate-related food system indicators across 4 domains: food supply, food environment, food consumption and food waste. Nine electronic databases were searched for published articles in peer-reviewed journals. Grey literature searches included Google Scholar, Government websites and organisations. Thematic analysis of indicators was carried out by food system domain, methods, spatial level and outcome.

Results

After screening 5,260 articles, 54 papers were analysed and presented 752 climate-related food system indicators. Most indicators were in the food supply (n = 505) or food consumption (n = 139) domain. Thematic analysis of indicators revealed key themes as crop yields, water availability, biodiversity and soil health, production and supply, imports/exports, supply chain disruption, food price impacts, affordability, nutrition, food security, food waste. A vast range of indicators are available to monitor UK food system vulnerability to climate change, however, currently only climate impacts on food supply processes are extensively monitored compared with impacts to food environment or consumption.

Conclusions

To support policy makers in implementing food system interventions to mitigate the impacts of climate change, data, indicators and monitoring mechanisms are critical for UK decision-making.

Key messages

• To support policy makers in implementing food system interventions to mitigate the impacts of climate change, data, indicators and monitoring mechanisms are critical for UK decision-making.

• Monitoring the climate impacts on food systems and food security requires systematic, rigorous data collection across all domains of the food system to protect health.
Suburban Blues: Urbanicity, healthcare service mix and spatial patterns of admissions for depression
Authors: Berger M , Zuba M , Simon J
Published: October 2023

Objectives

Medical practice variation is a key target for policy makers aiming to improve the efficiency of healthcare delivery. Studies point to strong regional variation in healthcare utilization in Austria which seems to be a by-product of institutional rules and healthcare service mix rather than variance in epidemiology.

Methods

We use a set of routine healthcare data on hospital admissions for depressive episodes (ICD-10 F320-F329) of adult Austrian patients from 2009 to 2014 on the municipality level to explore spatial patterns of supply-induced demand by nearby hospitals (“Roemer's law”) in hospital admission rates. The dataset covers 99,844 hospital episodes of 69,555 patients in 2,114 municipalities. We estimate a random effects spatial autoregressive model to regress log hospital admission rates on hospital supply and urbanicity as proxies for the municipalities’ healthcare service mix alongside a set of relevant socio-economic/-demographic characteristics.

Preliminary results

Hospital admission rates per 1,000 inhabitants in the population for depressive episodes vary strongly between municipalities (min=0, max=37.7, mean=1.9, SD = 1.8). We find higher admission rates in the population of suburban municipalities (0.10, 95%-CI: 0.58 - 0.13) and municipalities with hospitals (0.07, 95%-CI: 0.01 - 0.1), regardless of hospital type and size. The spatial structure suggests positive spill-over effects on the hospital admission rates between neighbouring municipalities.

Conclusions

Our results suggest that high admission rates are a seemingly suburban phenomenon and that healthcare service mix is a driving factor for admission rates. Though it is not clear whether the regional variation in medical practice reflects under- or oversupply of hospital care, promoting timely access to primary care and early-stage treatments may reduce the burden of avoidable hospitalizations for patients and public budgets, and close a gap of unmet need for care of vulnerable populations.

Key messages

• Hospital admission rates for depression of adults per 1,000 inhabitants in the population for depressive episodes vary strongly between municipalities.

• Hospital supply and urbanicity are major driving factors of the spatial patterns in regional varation of hospital admissions.
Strengthening Infectious Disease Control and Pandemic Preparedness in The Netherlands
Authors: Versteeg S , De Munter A , Linthorst M
Published: October 2023

The COVID-19 pandemic showed the importance of a strong public health system. During the pandemic, infectious disease control departments of Dutch Regional Public Health Services (RPHSs) reached their limits. In preparation for new large outbreaks and pandemics, investments must be made in strengthening infectious disease control departments at RPHSs. In March-May 2022, the 25 RPHSs established a programme to reinforce their infectious disease control departments in 2023-2024. The programme addresses current vulnerabilities and focuses on five pillars: increasing staff capacity (1), improving cross-regional monitoring and surveillance (2), strengthening public health research infrastructure (3), improving cross-regional collaboration (4) and increasing training opportunities for professionals (5). The Dutch Ministry of Health, Welfare and Sport is funding the two-year (2023-2024) national programme, assisting the 25 RPHSs to address regional and cross-regional vulnerabilities with 75 million euro. The programme started in January 2023 and already resulted in the start of new national consultation structures and the employment of many new infectious disease professionals, whilst considering task rearrangement of medical and non-medical professionals. RPHSs are working together with national partners to strengthen cross-regional monitoring and surveillance. A national consortium, together with infectious disease professionals at RPHS, is currently working on scientific knowledge enhancement and innovation in the public health work field. The programme provides national education opportunities and investigates career prospects of public health professionals. The programme provides insight in regional similarities and differences and identifies strengths and needs to improve infectious disease control. Outcomes of the programme are used by RPHSs and their national partners to determine what is needed for structural strengthening of infectious disease control departments.

Key messages

• The 25 Dutch RPHSs work together to strengthen infectious disease control.

• The programme contributes to reinforcement, innovation and further professionalisation of the infectious disease control.
PEP-flute selfcare in epidemic respiratory infectious diseases – high societal impact at low cost?
Authors: Mollerup A , Henriksen M , Larsen S C , Bennetzen A S , Simonsen M K , Kofod L M , Weis N , Heitmann B L
Published: October 2023

Background

The COVID-19 pandemic has led to worldwide increases in mortality and disrupted healthcare systems. The necessary countermeasures have adversely affected our lives, both mentally and economically. Home-based interventions to help individuals with early COVID-19 overcome the disease with fewer symptoms are needed. This study explored if self-care using positive expiratory pressure (PEP) as airway clearance is effective in reducing respiratory symptoms and, thus hypothetically prevent COVID-19 associated pneumonia.

Methods

This open-label, randomized trial (ClinicalTrials.gov:NCT04530435) recruited community dwelling adults from Capital Region and Region Zealand in Denmark from 6 Oct 2020 to 26 Feb 2021. Eligible participants (verified SARS-CoV-2 infection, COVID-19 symptoms, and able to perform self-care) were randomized to usual care or to PEP-flute self-care (PEP thrice daily) as an add-on to usual care. PEP-flutes were delivered by express mail and instructions given by video-links. The primary outcome was a change (analyzed by repeated measures mixed linear models) in self-reported symptom severity from baseline to day 30, as assessed by the COPD (chronic obstructive pulmonary disease) assessment test (CAT). Another outcome was the perceived effect of PEP-selfcare.

Results

The PEP self-care group (n = 190) had significantly lower symptom severity (group difference -1.2 points (95% confidence interval -2.1 to -0.2; p = 0.017)) at day 30 compared to the usual care group (n = 188). The PEP self-care group reported less chest tightness, less dyspnea, more vigor, and higher level of daily activity. When asked, “How do you describe the PEP-flute effect?”, 30% (n = 56) from the PEP group reported PEP-use to provoke coughing of phlegm. No serious adverse events were reported.

Conclusions

In early COVID-19, PEP-flute self-care was effective in reducing respiratory symptom severity among community dwelling adults and may have a future societal impact at a low cost.

Key messages

• We advocate for more research in self-care interventions to confirm if campaigns and handouts of PEP-flutes to mobilize the citizens’ selfcare are suitable public health responses to the next pandemic.

• More research is needed to establish efficacy of non-drug interventions like PEP-selfcare for airway clearance to prevent pneumonia.
AZD7442 utilization for Pre-Exposure Prophylaxis Against COVID-19 in a French Early Access Program
Authors: Artaud C , Majed L , Fabry-Vendrand C , Taylor S , Ferreira C , Dube S , Thabut G , Suau D , Lahouegue A
Published: October 2023

Background

AZD7442, a combination of 2 neutralizing antibodies, has been shown to reduce symptomatic COVID-19 risk by 83% at 6 months among high-risk individuals in a Phase 3 trial (PROVENT). The French Health Authorities authorized AZD7442 use in immunocompromised patients through Early Access Program (EAP). Eligibility for EAP was serological anti-spike levels of < 260 BAU/ml and very high risk of severe COVID. This abstract aims to describe the AZD7442 eligible population in France and characterize AZD7442 uptake in the EAP.

Methods

This is a retrospective observational database analysis of the EAP data. Demographics, and clinical characteristics of participants are described.

Results

27,782 patients were included in the EAP between 12/15/2021 and 11/30/2022. AZD7442 was mostly prescribed by onco-hematologists (24.2%), followed by nephrologists (19.9%), internal medicine specialists (15.6%), and rheumatologists (6.5%). 50% of participants were over 65 years, 54.7% were male. The majority (96.7%) had received at least three vaccine doses at inclusion. Most common comorbidities were cancer (34.9%), chronic kidney disease (23.7%), hypertension (23.2%), cardiovascular disease (19.4% >2CV factors), and diabetes (9.2%). 6 months follow-up data were available for 2106 patients.

Conclusions

In the EAP, health care professionals prioritized IC patients at the highest risk of severe COVID-19, consistent with the authorization granted in France. However, based on the approved criteria, HCP have the potential to broaden the use of AZD7442 among different IC groups which can lead to more equitable access. The large size of the EAP presents an opportunity to generate evidence regarding the effectiveness of AZD7442. Lack of follow up data highlights the need to enrich the EAP data to study relevant effectiveness endpoints as COVID-19 hospitalizations and mortality. An innovative observational comparative study is planned by combining EAP data and French National Claims database SNDS.

Key messages

• These findings could guide future efforts to implement COVID-19 prophylaxis measures.

• The large size of the EAP presents an opportunity to generate evidence regarding the effectiveness of AZD7442.
Towards SDG30: Fighting HCV with a screening program in Lombardy
Authors: Meloni A , Piccinelli S , Marrocu C , Odone A , Cereda D
Published: October 2023

Background

The third Sustainable Development Goal, specifically in target 3.3, identifies fighting HCV as a priority.

It is estimated that in Italy more than 200.000 patients eligible for HCV treatment are not being treated and 20% are not aware of the infection. Lombardy region to promptly identify and treat patients affected, developed a screening program to be offered to all patients born between 1969 and 1989. Healthcare facilities were divided into first and second-level centers and the campaign was designed in 2 phases: at the first level centres patients were screened with blood tests, if positive they were contacted by second level structures to get a diagnostic test and if confirmed positive to start the therapeutic approach.

Methods

The screening program started in June 2022 and consisted of an opportunistic offer of free testing for serum anti-HCV antibodies in the context of any healthcare performance offered to eligible patients. Data were uploaded and collected on a web database from which second-level centers could obtain data of positive patients to contact them and set appointment for confirmation tests.

Results

As of 31st December 2022 120,193 individuals underwent HCV screening in 75 screening centers in Lombardy. The mean age was 44 years, 65.2% were females, and 83.7% were tested at outpatient blood collection centers. 604 (0.50%) patients tested positive with mean age 47 (±5). HCV-RNA was detectable in 125 out of 441 (28.3%) anti-HCV positive subjects with available HCV-RNA. Patients with active HCV infection were aged 46 (±6) and were mostly males (56.8%). Overall, the prevalence of active infection in the general population was 0.10% and was higher in elderly.

Conclusions

The prevalence of active HCV infection in the general population born between 1969 and 1989 in Lombardy was low. Considering the higher prevalence of active infection in the elderly population, an extension of the screening offer to patients born between 1949-70 could be evaluated.

Key messages

• Prevalence of active HCV infection in screened population is low.

• Extending the screening offer may result in higher number of positive results and more people directed towards treatment.
SARS-CoV-2 incidence and hospitalisation in South Tyrol (Italy): a population-based ecological study
Authors: Cristofor C D , Lorenzon A , Palandri L , Uguzzoni F , Lozza F , Poluzzi R , Rizzi C , Bertoli P , Zerzer F , Righi E
Published: October 2023

Background

Literature associating SARS-CoV-2 spread to environmental variables such as altitude, tourism, vaccination adherence and demographics, is inconclusive and contrasting. This study aimed at studying these relationships during the first unrestricted winter in South Tyrol, a multicultural Italian alpine province.

Methods

An ecological study was performed, based on the 20 districts of the area. Data about incidence and hospitalization between November ’21 and February ’22 was collected and associated to geographical, demographic and health-related characteristics via bivariate analyses.

Results

Incidence (range: 15% - 22%) and hospitalization (range: overall = 0.09% - 0.26%/ intensive care unit (ICU) = 0 - 0.06%) varied widely among districts. Incidence showed positive correlations with average altitude (Rho=0.62, p < 0.001), tourist amount (0.54, p < 0.04) and average family size (0.66, p < 0.005); whereas negative ones with vaccination coverage (-0.62, p < 0.04) and population density (-0.44, p < 0.05). Similar trends were observed for ICU admissions. Incidence was significantly higher in Ladin speaking districts and lower in Italian ones, while ordinary wards admission appeared lowest in Ladin districts and higher in the Italian ones, as well as close to main cities and hospitals.

Conclusions

Living in urban districts, geographically and linguistically closer to the Health Authorities, may have played a protective role against infection and severe disease, through an increased adherence to public health preventive measures. The concomitant higher rate of admissions might be due to the easier access to the structures. By contrast, infection spread was higher in rural and sparsely populated districts, associated with greater winter tourism and family sizes, but also characterized by lower herd immunity and institutional closeness. More attention should be paid to communities with special needs (geographical and cultural) to ensure equitable means for future pandemics.

Key messages

• Living in urban districts may protect against infection spread through increased adherence to public health preventive measures, and facilitate hospitalisations due to easier access to the structures.

• More attention should be paid to communities geographically and culturally distant from Public Health Institutions to ensure equitable means for future pandemics.
Embracing Possibilities and Change With a Relational Approach to Leadership
Authors: Ferren Melora D.
Published: October 2023

In this column, Kay Kennedy, DNP, RN, NEA-BC, CPHQ, chief executive officer for Leadership, LLC, shares how her career journey and the relationships that she built along the way led to a contemporary nursing leadership theory called Human-Centered Leadership.
Mendel's closet: genetics, eugenics and the exceptions of sex in Edwardian Britain
Authors: Brooks Ross
Published: October 2023

This article situates formative Mendelian and chromosomal precepts and rhetoric as an integral part of ‘reproductive’ physiology and the broader sexological terrain in Edwardian Britain. Alongside the discovery of ‘internal secretions’ (hormones), the discovery of the sex chromosomes, made around the same time as the rediscovery of Mendel's laws of heredity at the turn of the twentieth century, transformed the ways in which questions about sex determination and sex development were considered. Approaches were diverse as leading biologists including William Bateson, Leonard Doncaster, Reginald Crundall Punnett, Geoffrey Watkins Smith and their interlocutors negotiated the multiple, often conflicting, sociopolitical interpretations, uses and abuses that Mendelian approaches to sex were amenable to. Most contentiously, it was recognized that any credible model of sex biology had to account for all manner of sex phenomena, including parthenogenesis, intersexualities and transformations of sex, and that it was the variations of sex that best provided insights into the otherwise hidden mechanisms that shaped sex characteristics. Such a move, however, embroiled the new sexological genetics and the developing discipline of ‘reproductive’ physiology with vexed debates about feminism, homosexuality and eugenics. The article charts how the ensuing tensions played out across scholarly and popular platforms, including Britain's newspapers.
ICTV Virus Taxonomy Profile: Amnoonviridae 2023
Authors: Koonin Eugene V. , Krupovic Mart , Surachetpong Win , Wolf Yuri I. , Kuhn Jens H.
Published: October 2023

Amnoonviridae is a family of negative-sense RNA viruses with genomes totalling about 10.3 kb. These viruses have been found in fish. The amnoonvirid genome consists of 10 segments, each with at least 1 open reading frame (ORF). The RNA1–3 ORFs encode the three subunits of the viral polymerase. The RNA4 ORF encodes a nucleoprotein. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the family Amnoonviridae, which is available at ictv.global/report/amnoonviridae.
Knowledge and attitudes towards dementia care among healthcare workers in Somaliland: a need assessment survey
Authors: Duale Mohamed Abdilahi , Gebremariam Tewelde Tesfaye
Published: October 2023

The present pilot survey assessed the levels of healthcare workers’ knowledge of dementia and attitudes towards dementia care in Somaliland. Between June and July 2023, we administered an adapted online survey with 30 Alzheimer’s disease Knowledge Scale (ADKS) true or false statements and 10 Dementia Care Attitude Scale (DCAS) Likert-scale items. The reliability of the Likert-scale DCAS items was assessed using Cronbach’s alpha. A Chi-square, Mann-Whitney U-test, and independent sample t-test were used to assess the relationship and differences of the outcome variables (knowledge and attitude) across the healthcare workers’ baseline information. The mean ADKS score was 18.7 (SD = 3.1). Out of 107 healthcare workers who completed the survey, 49.5% had high dementia knowledge (score ≥18.7). The participants’ median (IQR) attitude score was 34 (25, 39), and 46.7% (50 of 107) had a positive attitude towards dementia care. In conclusion, health professionals in Somaliland had low levels of knowledge and negative attitudes towards dementia care.
Antibody-conjugating nanogel (Conjugel) with two immune checkpoint inhibitors for enhanced cancer immunotherapy
Authors: Chae Yun Jin , Lee Kang-Gon , Oh Doogie , Lee Su-Kyoung , Park Yongdoo , Kim Jongseong
Published: October 2023

Cancer immunotherapy by immune checkpoint inhibitors (ICI) acts on antitumor responses by stimulating the immune system to attack cancer cells. However, this powerful therapy is hampered by its high treatment cost and limited efficacy. Here, we show the development of an antibody-conjugating system (Conjugel) that potentiates the efficacy of bispecific immunotherapy that simultaneously targets CTLA-4 and PD-L1. The Conjugel, consisting of highly deformable nanogels and antibody-binding protein, was loaded with two ICI monoclonal antibodies (mAb). Compared with mAb treatment alone, treatment with a bispecific Conjugel loaded with the both ICIs significantly decreased both the survival of MCF-7 and MDA-MB-231 breast cancer cellsin vitroand the size of 4T1-Luc2-derived orthotopic syngeneic tumorsin vivo. Furthermore, the ICI-loaded Conjugel was less toxicin vivothan the combination treatment delivered as a bolus. Our findings have important implications for Conjugel-based immunotherapy, developing the safer and higher efficacy of ICIs to treat breast cancers.
Activation of Complement by Human Fibrin Clots: involvement of C1q and factor H
Authors: Kang Yu-Hoi , Varghese Praveen M. , Pondman Kirsten , Kishore Uday , Sim Robert B.
Published: October 2023

The classical pathway of the complement system is activated by the binding of C1q in the C1 complex to the target activator including immune complexes. Factor H is regarded as the key downregulatory protein of the alternative pathway of complement. However, C1q and factor H both bind to target surfaces via charge distribution patterns. For few targets, C1q and factor H compete for binding to common or overlapping sites. Factor H, therefore, can effectively regulate the classical pathway activation by such targets, in addition to its previously characterized role in the alternative pathway. Both C1q and factor H are reported to recognize “foreign” or altered-self materials. Clots, formed by the coagulation system, are an example of altered self. Factor H is present abundantly in platelets and is a well-known substrate for FXIIIa. Here, we investigated whether clots activate the classical pathway of complement and whether this is regulated by factor H. We show here that both C1q and factor H bind to fibrin formed in microtitre plates as well as fibrin clots formed underin vitrophysiological conditions. Both C1q and factor H become covalently bound to fibrin clots and this is mediated via FXIIIa. We also show that fibrin clots activate the classical pathway of complement, as demonstrated by C4 consumption and membrane attack complex detection assays. Thus, factor H downregulates the classical pathway activation induced by fibrin clots. These results elucidate the intricate molecular mechanisms through which the complement and coagulation pathways intersect and have regulatory consequences.
Simulation of adaptive immune receptors and repertoires with complex immune information to guide the development and benchmarking of AIRR machine learning
Authors: Chernigovskaya Maria , Pavlović Milena , Kanduri Chakravarthi , Gielis Sofie , Robert Philippe A. , Scheffer Lonneke , Slabodkin Andrei , Haff Ingrid Hobæk , Meysman Pieter , Yaari Gur , Sandve Geir Kjetil , Greiff Victor
Published: October 2023

Machine learning (ML) has shown great potential in the adaptive immune receptor repertoire (AIRR) field. However, there is a lack of large-scale ground-truth experimental AIRR data suitable for AIRR-ML-based disease diagnostics and therapeutics discovery. Simulated ground-truth AIRR data are required to complement the development and benchmarking of robust and interpretable AIRR-ML methods where experimental data is currently inaccessible or insufficient. The challenge for simulated data to be useful is incorporating key features observed in experimental repertoires. These features, such as antigen or disease-associated immune information, cause AIRR-ML problems to be challenging. Here, we introduce LIgO, a software suite, which simulates AIRR data for the development and benchmarking of AIRR-ML methods. LIgO incorporates different types of immune information both on the receptor and the repertoire level and preserves native-like generation probability distribution. Additionally, LIgO assists users in determining the computational feasibility of their simulations. We show two examples where LIgO supports the development and validation of AIRR-ML methods: (1) how individuals carrying out-of-distribution immune information impacts receptor-level prediction performance and (2) how immune information co-occurring in the same AIRs impacts the performance of conventional receptor-level encoding and repertoire-level classification approaches. LIgO guides the advancement and assessment of interpretable AIRR-ML methods.
Sleep spindle density and temporal clustering are associated with sleep-dependent memory consolidation in Parkinson’s disease
Authors: Lahlou Soraya , Kaminska Marta , Doyon Julien , Carrier Julie , Sharp Madeleine
Published: October 2023

Sleep is required for successful memory consolidation. Sleep spindles, bursts of oscillatory activity occurring during non-REM sleep, are known to be crucial for this process and, recently, it has been proposed that the temporal organization of spindles into clusters might additionally play a role in memory consolidation. In Parkinson’s disease, spindle activity is reduced, and this reduction has been found to be predictive of cognitive decline. However, it remains unknown whether alterations in sleep spindles in Parkinson’s disease are predictive of sleep-dependent cognitive processes like memory consolidation, leaving open questions about the possible mechanisms linking sleep and more general cognitive state in Parkinson’s patients. The current study sought to fill this gap by recording overnight polysomnography and measuring overnight declarative memory consolidation in a sample of thirty-five Parkinson’s patients. Memory consolidation was measured using a verbal paired-associates task administered before and after the night of recorded sleep. We found that lower sleep spindle density at frontal leads during non-REM stage 3 was associated with worse overnight declarative memory consolidation. We also found that patients who showed less temporal clustering of spindles exhibited worse declarative memory consolidation. These results suggest alterations to sleep spindles, which are known to be a consequence of Parkinson’s disease, might represent a mechanism by which poor sleep leads to worse cognitive function in Parkinson’s patients.

Statement of significance

Sleep — particularly spindle activity — is critical for memory consolidation, a core cognitive process. Changes to the architecture and oscillations of sleep are well documented in Parkinson’s disease (PD) and have been associated with worse overall cognition. However, whether altered sleep plays a causal role in this relationship, by directly interfering with sleep-dependent cognitive processes, or whether it represents a mere epiphenomenon of advancing disease, remains unknown. Our study is the first to investigate a possible direct relationship between sleep and cognition in PD. We show that sleep spindles and their temporal clustering into ‘trains’ relate to impairments in overnight declarative memory consolidation in patients. These findings are an important first step towards identifying modifiable sources of cognitive impairment in PD.