bluuebunny/crossref_metadata_2025 huggingface dataset:
Adipose-targeted overexpression of mitochondrial-targeted catalase does not improve cardio-metabolic parameters in mice with diet-induced obesity
Authors: Croft A J , Kelly C , Chen D , Murtha L , Sugito S , Boyle A , Sverdlov A L , Ngo D T M
Published: October 2021

Background

Obesity is associated with significant cardio-metabolic complications. Adipokines, and cytokines released from adipose tissue (AT) stimulate excessive mitochondrial production of reactive oxygen species (ROS). ROS-mediated oxidative modifications is associated with development of insulin resistance and impaired cardiac function. We hypothesised that adipose-targeted overexpression of mitochondrial-targeted catalase (AT-mCAT) could lead to improvement in diet-induced cardio-metabolic dysfunction.

Methods/Results

mCAT (floxed) and AdipoQ-Cre mice were crossed to generate mice overexpressing catalase with a mitochondrial-targeting sequence predominantly in AT (AT-mCAT). Wild-type (WT) and AT-mCAT male mice were fed normal chow (NC) or high-fat/high-sucrose (HFHS) diet (36%fat/34%sucrose) for 4 months. At endpoint, echocardiography showed reduced cardiac output in all groups v WT NC (p<0.05); reduced IVSd in AT-mCAT NC and HFHS groups v WT NC (p<0.01); reduced left ventricular ejection fraction in AT-mCAT HFHS v WT NC (p<0.05) and no differences in fractional shortening or E/A ratio between groups. Glucose tolerance tests (2g/kg) showed impairment in WT HFHS and AT-mCAT HFHS v WT NC (p<0.01, p<0.05 respectively). Triglyceride levels were increased in WT HFHS and AT-mCAT HFHS v WT NC (p<0.05). Analysis of hypertrophic signalling in cardiac tissues by ELISA showed p-AKT/total Akt levels were decreased in AT-mCAT hearts regardless of diet (WT NC v AT-mCAT NC p<0.01; WT HFHS v AT-mCAT HFHS p<0.05).

Conclusion

Our results confirm previous findings that diet-induced obesity is a systemic condition. Targeting adipose tissue with mitochondrial catalase may not be adequate to prevent development of cardio-metabolic dysfunction. More systemic approaches may be required to combat obesity-induced cardio-metabolic impairment.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart Foundation of Australia
Formation of human cardiomyocytes is impaired in a fibrotic environment: unravelling human cardiac regeneration
Authors: Ramkisoensing A A , Zhang J , Harlaar N , Pijnappels D A , De Vries A A F
Published: October 2021

Loss of myocardial tissue remains a leading cause of disease and death, as the adult heart has insufficient regenerative potential. The (pre-)clinical effects of inducing cardiac regeneration by cardiac cell therapy have been disappointing. This lack of success may result from the fact that it remains largely unclear how the receiving pathological microenvironment affects this process of cardiomyogenic differentiation of implanted cells, and thereby may (negatively) influence the therapeutic outcome. However, the tools to address this lacuna in a proper manner are lacking, as this requires tightly controllable and quantitative models of cardiomyogenic differentiation. Therefore, we have recently generated lines of conditionally immortalized human CMCs (ciCMCs) through doxycycline-dependent expression of SV40 large T antigen after genetic modification and subsequent clonal expansion. In these cells, proliferation and differentiation can be tightly controlled, allowing cardiomyogenic differentiation to be i) induced on cue, ii) precisely monitored and quantified, and iii) manipulated. The aim of this study is to improve our understanding of cardiomyogenic differentiation of guest (transplanted) cells in the context of the host (receiving) microenvironment. To create pathological microenvironments and study the effects on cardiac differentiation, co-culture experiments with human ciCMCs and cardiac fibroblasts were conducted in different ratios (10%, 30%, 60% and 90% ciCMCs). Cardiomyogenic differentiation was determined by immunostaining for cardiac specific markers and electrophysiological analysis by optical voltage mapping. After 12 days of co-culture with cardiac fibroblasts, the amount of ciCMCs that expressed the sarcomeric protein cardiac troponin T was significantly and increasingly reduced (P<0.01) in the groups with higher amounts of cardiac fibroblasts (39.4±3.9, 33±3.4, 25±1.9, 20.3±2.6, 5±1.7 for 100%, 90%, 60%, 30% and 10% ciCMCs respectively (%, mean±SD). Electrophysiological analysis showed a significantly reduced (P<0.01) conduction velocity in the co-cultures compared to the pure cultures of ciCMCs (19.1±2.1 vs 16.0±0.5, 15.8±0.9, 8.6±0.6, 5±1.67 for 100% vs 90%, 60%, 30% and 10% ciCMCs respectively (cm/s, mean±SD). However, no significant difference in conduction velocity was present between the groups with 10% and 30% ciCMCs and 30% and 60% ciCMCs present. In conclusion, a fibrotic environment has a negative effect on the formation of human cardiomyocytes as revealed by the use of ciCMCs. This not only emphasizes the need to consider the interaction between the guest (transplanted) cells and the host (receiving) microenvironment in cardiac regenerative medicine, but also offers new leads to increase the therapeutic potential of this strategy.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Leiden University Fund
Small nucleolar RNA SNORD3A: a potential new biomarker and molecular player in heart failure
Authors: Paolillo R , D'Apice S , Schiattarella G G , Holley C L , Della Corte A , Bancone C L , Esposito G G , Perrino C L
Published: October 2021

Background

Despite optimal therapy, heart failure (HF) remains a relentless and deadly disease. Given the relative inaccessibility of myocardial human tissues, identification of circulating biomarkers mirroring myocardial pathological signaling pathways, especially in peripheral blood mononuclear cells (PBMC) is expected to be extremely relevant. Small Nucleolar RNAs (snoRNAs) have been shown to play important roles in various cellular physiological processes. However, the connection between snoRNAs and pathological dysfunction in the heart or peripheral blood mononuclear cells (PBMC) is still poorly understood.

Purpose

To identify novel circulating PBMC biomarkers linked to myocardial dysfunction and HF.

Methods

Myocardial left ventricle (LV) samples and PBMC were obtained from patients affected by ischemic HF (HF, n=13) undergoing heart transplantation and control donors (CD, n=7) and analyzed by RNA sequencing analysis (RNASeq). SNORD3A expression levels in the different groups were evaluated by quantitative real-time PCR. HF was induced in 8-week-old wild type C57BL/6 mice by transverse aortic constriction (TAC). Sham-operated mice (sham) were used as controls. After twelve-week-TAC (12w) or sham operation, mice were anesthetized, cardiac function was analyzed by echocardiography, and cardiac/PBMC samples were collected after sacrifice. In order to test the role of SNORD3A in cardiomyocyte hypoxia, H9C2 cardiomyoblasts were transfected with SNORD3A-targeted antisense oligonucleotides (ASO) and cell survival was analyzed by cleaved caspase-3 and PARP1 immunoblotting.

Results

RnaSeq analysis identified a small set of genes differentially expressed in the heart and PBMC from HF patients. Among these, SNORD3A was up-regulated in cardiac and PBMC samples from HF patients compared to CD (Figure 1A-B). Similarly, in murine HF induced by 12w TAC, SNORD3A levels were increased by rtPCR, both in the heart and PBMC (Figure 1C-D). SNORD3A expression levels were also significantly increased in H9C2 cells exposed to in vitro hypoxia (Figure 1E). Interestingly, H9C2 transfection with SNORD3A-specific ASO significantly reduced hypoxia-induced SNORD3A upregulation and reduced hypoxia-induced cell death (Figure 1F-G).

Conclusions

In this study, we identify SNORD3A as a novel possible biomarker in human HF, similarly up-regulated in the heart and PBMC, induced by hypoxia in vitro and modulating cell survival.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): STAR GRANT Figure 1
The predictive power of biomarker macrophage migration inhibitory factor in patients with st- segment elevation myocardial infarction
Authors: Vishnevskaya I , Kopytsya M P , Storozhenko T Y E
Published: October 2021

Biomarkers have been taken one of the first places as diagnostic and prognostic tools in acute myocardial infarction (AMI). They are used both in the acute and in the long-term periods of the disease to predict various adverse events Their especially important property is the ability to predict the long-term adverse events of the disease, which can significantly improve the outcome. One of the promising biomarkers for the early adverse outcome prediction is the proinflammatory cytokine macrophage migration inhibitory factor (MIF).

Purpose

To determine the MIF significance in 1-year adverse outcomes prognosis after AMI.

Methods

130 ST-segment elevation myocardial infarction (STEMI) patients (72.6% male and 27.4% female) were enrolled, mean age was 58.25±1.22 years. Control group of 12 healthy volunteers included. All patients underwent a baseline investigation which includes standard electrocardiography, echocardiography with strain, angiography, and determination of marker of myocardial necrosis – cardiac troponin T. Also, the level of MIF, soluble suppression of tumorigenicity-2 (sST2), C-reactive protein determined during the first 12 hours after the STEMI, before the percutaneous coronary intervention (PCI), 6 hours, and 24 hours after the PCI. The endpoint was composite and included all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for unstable angina, acute decompensated heart failure. During 1-year follow-up 18% of patients reached the endpoint.

Results

The effect of several variables of clinical, instrumental and laboratory status were assessed on reaching the endpoint by patients. We have found that MIF level determined before PCI (AUC 0.73; p=0.003; 95% Cl: 0.613 – 0.826) might be a significant independent predictor of mortality with sensitivity (Se) 70% and specificity (Sp) 80%. MIF level 6 hours after PCI showed even better result (AUC 0.8; p=0.002; 95% Cl: 0.64 – 0.9; Se 74%, Sp 82%). MIF >3934 pg/ml associated with the highest risk of adverse events. For identification of the main risk factors for adverse outcome, we have used logistic regression method. The MIF level determined before the PCI was the most important to predict adverse outcomes (odds ratios is 1.0006, p=0,0038; x2=4.58). Areas under the ROC for the model was equal to 0.8; 95% Cl: 0.58 to 0.89). Neither sST2 nor CRP have not shown any significant results (p<0.05). According to the data of the Kaplan-Meier survival analysis, long-term survival after STEMI was significantly lower in patient with the level of MIF determined during the first 12 hours after the event more than 2988 pg/ml (Log-rank = −4,891, p=0.014).

Conclusions

Biomarker MIF has showed as an independent tool associated with the risk of adverse outcome 1 year after STEMI. MIF could be used in routine clinical practice to improve risk stratification of patients with STEMI.

Funding Acknowledgement

Type of funding sources: None.
1.B. Round table: Biological, socioeconomic, legal and environmental health determinants in the COVID-19 pandemic
Authors:   Organised by: EUPHA-IDC, EUPHA-LAW, EUPHA-INJ, WHO Venice Office,   Chair persons: Elena Petelos (EUPHA-HTA), Lara Tavoschi (Italy)
Published: October 2021

COVID-19 represents a concrete global health threat that has resulted in exacerbated inequalities, threatening progress towards SDG3, and particularly SDG 3.8, i.e. UHC - leave no one behind. Underlying differences in terms of health and social care system organisation, service provision models and pre-existing epidemiological context have resulted in heterogeneous scenarios for burden of disease (BoD) distribution, both in terms of COVID-19-specific outcomes, and because of collateral damage, not only across, but also within countries and regions. Individual proximal factors such as age, gender, ethnicity, socioeconomic position, underlying comorbidities and perception of risk have contributed to increased individual risk of acquiring the infection and of developing severe disease complications, including death. In addition, systemic issues, i.e., individual financial capacity, legal status, and acute versus chronic care needs have affected access both to care and commodity. From the global health perspective, we are also witnessing determinants threatening sustainable development, with tremendous differences in terms of capacity to combat the disease and deploy disease control measures, as well as ensure financial stability, economic growth and societal resilience. Ensuring equitable allocation of test, vaccines and medicines, and the development of comprehensive strategies necessitates a deeper understanding of those at most at risk, with due protection to those most vulnerable across the world. A comprehensive approach to tackle all these challenges, whilst ensuring due consideration is paid to ethical and legal issues, necessitates sound understanding of determinants, vulnerability with systematic measurement and interdisciplinary, cross-sectoral collaboration. This RT will bring the perspective of academia, researchers and practitioners in the field, and NGOs, offering insights on emerging research, practice and strategies. It aims to broker dialogue, to identify key steps to counter the damaging effect of inequities to social cohesion and system resilience, and to inform policy making and global public health actions.

Key messages

Biological, socioeconomic, legal and geographical determinants are at interplay, affecting the COVID-19 pandemic dynamics both in terms of immediate and delayed health outcomes. Assessing and weighing the links of various determinants and COVID-19 is essential to inform current and future policy decisions towards attaining UHC and to ensure an equitable, resilient society.
Depression and post-traumatic stress disorder symptoms during the COVID-19 pandemic in Italy
Authors: Rousset S , Camussi E , Piccinelli C , Senore C , Armaroli P , Giordano L , Ferrante G , Bert F , Siliquini R
Published: October 2021

Introduction

Social restrictions imposed by the Italian Government during the COVID-19 emergency might have had a significant impact on mental health. The purpose of this study was to estimate the prevalence of depressive and post-traumatic stress disorder (PTDS) symptoms in a sample of Italian citizens during the first COVID-19 pandemic wave.

Materials and methods

A cross-sectional survey was carried out between April and June 2020 using a snowball sampling. Depressive symptoms were explored through the Patient Heath Questionnaire-2 (PHQ-2), while the post-traumatic stress disorder (PTDS) was investigated through the SPAN (Startle, Physical arousal, Anger, Numbness) questionnaire. Poisson regression models were used to explore the association between the outcomes under study and sociodemographic/housing characteristics.

Results

A total of 10.758 interviews were collected and 7.847 (73%), complete for a minimum set of indicators (age, sex, area of residence), were included in the final analysis. The majority of the respondents were females (71%). Sample mean age was 48.6 years. The prevalence of depressive symptoms was 21.2% and that of PTDS was 43.8%. Symptoms of depression and PTDS significantly diminished across age groups, in particular in people over 70 years compared with people aged 14-29 years (PR 0.65, 95% CI 0.49-0.86). A higher prevalence was found in students compared with retired people, both for depressive symptoms (PR 1.49, 95% CI: 1.05-2.10) and PTDS (PR 1.31, 95% CI: 1.02-1.69).

Conclusions

Prevalence of depressive and PTDS symptoms was high, in particular among younger people and students. That could potentially lead to adverse mental health outcomes in the future, with serious public health consequences. As the pandemic emergency is not solved yet, it is necessary to implement preventive strategies in order to protect the mental well-being of particularly vulnerable subgroups in the population.

Key messages

The prevalence of psychological symptoms was high in this sample during the first wave of COVID-19 pandemic. The subgroups of the population at higher risk for adverse psychological outcomes were younger people and students.
Psychological trauma and unsafe behaviour during the COVID-19 pandemic
Authors: Cao Y , Siu JYM , Shum DHK
Published: October 2021

This study aims to explore the prevalence of psychological trauma arising from the COVID-19 pandemic, and level of engagement with preventative measures in the adult general population, about 1-year after the initial outbreak. Data was collected through a telephone survey in Hong Kong between December, 2020 to February, 2021, which comprised of the Revised Impact of Event Scale (IES-R), the Questionnaire of Knowledge, Attitudes and Practice Towards COVID-19 to measure routine preventions (e.g., wearing face mask), questions asking about willingness in receiving the COVID-19 vaccine, participation in voluntary testing, and demographical questions. Results suggested that the prevalence of possible PTSD was 12.4%. Respondents reported being compliant with the routine preventative measures most of the time. Unemployment, a lack of income, and lower educational attainment were associated with higher psychological trauma. Female gender, older age, higher educational attainment, and being married were associated with higher compliance with routine preventative measures. Middle-aged or older adults or people who were married were consistently more engaged with following the health advice of preventative measures, including a higher vaccine acceptance. Younger adults appeared to be less engaged with the preventative measures.

Key messages

The pandemic affects people's psychological health even after 1-year from the initial outbreak. Socio-demographic factors affect people's psychological and behavioral responses to the pandemic.
Digital health literacy and online information queries in Portuguese university students
Authors: Rosário R , Augusto C , Silva MJ , Martins S , Duarte A , Ramos N , Martins MRO , Fronteira I
Published: October 2021

Background

Worldwide there is an overwhelming amount of information about COVID-19 circulating online, also named infodemic. Misinformation (the unintentional) and disinformation (the intentional) spreading of false information have proven to be very dangerous to public health. Hence, more than ever, people need skills for searching, evaluating and integrating information related to health in daily life, i.e., health literacy. Until now, little is known about the digital health literacy of university students and their information-seeking behaviour. Hence, this study aimed to analyse the associations between university students' digital health literacy and online information queries during the beginning of the COVID-19 pandemic (and infodemic) in Portugal.

Methods

A cross-sectional study of 3.084 Portuguese university students (75.7% females), with an average age of 24.2 (SD = 7.5), was conducted using an online survey. We used sociodemographic data (sex, age, subjective social status) and the digital health literacy questionnaire adapted to the specific COVID-19 context. Online information queries included the topics related to SARS-CoV-2 and COVID-19 searched by students. Logistic regression models were performed.

Results

Online information queries (e.g., individual measures to protect against infection, current spread of the virus, current situation assessments and recommendations) were associated with an increased odds of achieving sufficient digital health literacy.

Conclusions

Online information queries related to epidemiological and public health topics are significantly associated with digital health literacy in times of COVID-19. Further studies are needed, including programs that improve digital health literacy among university students and increase the availability of high-quality content information.
Digital health literacy and information behaviour in university students in Finland
Authors: Sormunen M , Rouvinen H , Koivusilta L , Kinnunen J , Turunen H , Rimpelä A , Lindfors P
Published: October 2021

Background

During the COVID-19 pandemic, Internet and social media became important and fast sources of health information, leading to overabundance of both valid and invalid information. Digital health literacy (DHL) is a core competency for navigating web- and social media based COVID-19 information. This study is part of the global COVID-HL survey assessing DHL among university students.

Methods

Six universities from Eastern, Northern, Southern, and Western Finland participated in an online survey in May 2020. Five subscales from the DHL Instrument (DHLI), adapted to the context of the COVID-19 pandemic, were used. The data were analyzed using univariate and bivariate analyses.

Results

Mean age of the students (N = 3771) was 28 y. (females n = 2720). Students had searched information from the Internet for themselves and others (85,2%). Females had searched more than male, and the probability of searches increased with age. Majority of students (90,4%) considered information easy to find and 83,2% of students found it easy to use the information in decisions related to their health, males easier than female or diverse gender. The greatest difficulty was in assessing the reliability of information (24,0%). The sources for information seeking often were news sites, search engines, and websites of public bodies (64,8%, 50,5% and 44,1%, respectively). The topics that were most searched were spread of the coronavirus (90,1%), its symptoms (88,0%) and restrictions (87,7%). 86,3% of students considered the verified information very important.

Conclusions

Finnish students were rather confident in their DHL skills. However, almost every fourth had difficulties in assessing the reliability of the information, a key competence of DHL in the context of overabundance of information. This suggests that DHL, especially the competence of critically evaluate health related information, need to be strengthen among university students in Finland across different study subjects.
Survey on Living, working and COVID19
Authors: Gerstenberger B
Published: October 2021

Eurofound's e-survey, Living, working and COVID-19, provides a snapshot of the impact of the pandemic on people's lives. Two rounds of the survey were carried out in 2020, allowing for comparison between the situation in April 2020, when most Member States were in their first lockdown, and in July 2020, when society and economies were slowly re-opening. Eurofound completed a third round of the e-survey on 30 March 2021, as countries are still dealing with various levels of lockdown, while vaccine rollout programmes are underway. The findings of the e-survey in April 2020 reflected widespread emotional distress, financial concern and low levels of trust in institutions. Levels of concern abated somewhat in the July round, particularly among groups of respondents who were benefiting from support measures implemented during the pandemic. At the same time, the results underline stark differences between countries and between socioeconomic groups. Young people are emerging as some of lockdown's biggest losers who report the lowest levels of well-being in the 2020 rounds. Women also faced a disproportionate impact and remained less optimistic about their future than men - this gap widening further between April and July 2020. The survey results confirm the upsurge in teleworking across all countries during the COVID-19 pandemic, and show what this means for work-life balance and elements of job quality. Also in this respect the pandemic affected women more than men. In particular, the burden of care responsibilities increased during the pandemic for women. The third round of the survey will show whether life satisfaction, happiness and optimism, and trust in institutions have improved or deteriorated and whether inequalities continue to grow as the pandemic impacts differently on different groups. First insights from the European Working Conditions Survey - extraordinary edition 2021 will show how workers perceived their work situation in spring 2021.
EU-OSHÁs perspective on occupational safety and health in the Covid-19 pandemic
Authors: Schneider E
Published: October 2021

In July 2020, EU-OSHA published the results of a comprehensive research project on the exposure of workers to biological agents at work and the related health problems. Although the research was initiated long before the pandemic, researchers had highlighted pandemic preparedness as an issue, as well as the general lack of monitoring of serious infectious diseases. The research also made evident a lack of awareness among workplace actors of the risks from exposure to biological agents at work, although a detailed legislative framework has been in place for many years, and consequently a lack of prevention measures at work, which became evident after the pandemic broke out. It highlighted the need for public health and occupational safety and health organisations to cooperate to mitigate the impact of the pandemic. The presentation will focus on the links between the research findings and the developments during the pandemic. It will furthermore present guidance produced by EU-OSHA and other relevant actions, with a view on the legislation that is in place. It will cover biological agents exposure as well as telework and ergonomic issues arising from it.
How are countries supporting health workers? Data from the COVID-19 Health System Response Monitor
Authors: Williams G , Scarpetti G , Bezzina A , Vincenti K , Grech K , Kowalska-Bobko I , Sowada C , Furman M , Gałązka-Sobotka M , Maier CB
Published: October 2021

Background

Health workers have been at the forefront of treating and caring for patients with COVID-19. They were often under immense pressure to care for severely ill patients with a new disease, under strict hygiene conditions and with lockdown measures creating practical barriers to working. This study aims to explore the range of mental health, financial and other practical support measures that 36 countries in Europe and Canada have put in place to support health workers and enable them to do their job.

Methods

We use data extracted from the COVID-19 Health Systems Response Monitor (HSRM). We only consider initiatives implemented outside of clinical settings where COVID-19 patients are treated, and therefore exclude workplace provisions such as availability of personal protective equipment, working time limits or mandatory rest periods.

Results

We show that countries have implemented a range of measures, ranging from mental health and well-being support initiatives, to providing bonuses and temporary salary increases. Practical measures such as childcare provision and free transport and accommodation have also been implemented to ensure health workers can get to their workplace and have their children looked after. Other initiatives such as offering continuing professional development credits for knowledge learnt during the crisis were also offered in some countries, albeit less frequently.

Conclusions

While a large number of initiatives have been introduced, often as ad-hoc measures, their effectiveness in helping staff is unknown in most countries. The effectiveness of these initiatives should be evaluated to inform future crisis responses and strategies for health workforce development.
Building a roadmap for the evaluation of a National Health Plan: the experience of Portugal
Authors: Costa L , Costa A , Mexia R , Rosa A , Santos J , Dias C , Caldas de Almeida T
Published: October 2021

Issue

The National Health Plan (PNS) 2012-2016 (extended until 2020) is the Portuguese strategic health document that presents the direction of intervention within the Health System. A final evaluation of PNS was foreseen, with National Institute of Health Dr Ricardo Jorge (INSA) being responsible for carrying out this task. The experience gained by INSA in defining a roadmap to be used in this process can be important in steering other actors to policy evaluation.

Description of the problem

In order to analyze the impact of policies, it is necessary to collect evidence that can evaluate the results achieved, and more importantly, identify gaps in implementation and evaluation issues. Herein, we aim to present the methodological approach developed to pave the way to the final assessment of PNS.

Results

As part of the Biennial Collaborative Agreement 2016-2017, WHO sponsored a high-level technical consultative process with relevant experts to address the condition for defining the work plan. It was devised to undertake: i) A scoping review based upon data collected from PNS implementation evidence mapping; ii) A qualitative analysis of the perception from main stakeholders on PNS impact and their expectations. Thus, a matrix of evidence was built to analyze the alignment of PNS at national and local levels, and with the main health framework targets and indicators. Also, online surveys and face-to-face interviews were done with key stakeholders in order to identify evidence gaps and critical factors for the successful PNS implementation, among others.

Lessons

To characterize its implementation and impact on citizens' health, a sound PNS evaluation should be guided by clear assessment questions, supported by validated tools and complemented by international guidance. In addition, a long-term consultative process with key stakeholder support is required to properly identify opportunities, priorities, and outcomes.

Key messages

Institutionalization of an evaluation process as part of public policies life cycle is a powerfull tool to foster learning and crucial to achievement of proposed goals. A clear structure to support the policy evaluation approach is mandatory to guarantee impartiality, independence and transparency on the overall process.
Undergraduates' perception of health risk of body arts: results of an Italian multicentre study
Authors: Marotta D , Gallè F , Valeriani F , Liguori G , Romano Spica V , Vitali M , Protano C
Published: October 2021

Background

In the last decades, body art practices such as tattooing and piercing have known an increasing popularity, mainly in young people. These procedures are associated with infectious and non-infectious health risks. The aim of this multicenter study was to evaluate the knowledge of health risks related to body art procedures among undergraduate students from ten Italian universities.

Methods

A cross-sectional study was performed on undergraduate students attending universities in northern, central and southern Italy. An anonymous questionnaire was administered to the participants for collecting their socio-demographic characteristics and for assessing their knowledge about health risks associated with tattoos and piercing.

Results

A total of 2985 students (mean age 23.15 ± 3.99, 73.9% females) completed the questionnaire. 775 (25.9%) of them were from northern Italy, 906 (30.3%) from the Centre and 1324 (44.4%) from the South. More than 90% of the sample were aware that tattoo/piercing procedures can cause health problems. However, the mean values of correct answers about the health risks associated to body art practices were low (5.38 ± 2.39 on a total of 11 correct answers for tattooing and 5.93 ± 3.12 on a total of 14 for piercing). Higher knowledge of the health risks related to tattooing was found among those attending university since more than four years (p < 0.001), life science courses (p < 0.001) and residing/living in the university area (p = 0.023). Those attending North/Centre universities (p < 0.001), since more than 4 years (p < 0.001), life science courses (p < 0.001), and those with graduated father (p = 0.013) had better knowledge of the health risks related to piercing.

Conclusions

These results show a lack of knowledge about health risks related to body art practices in the sample. Educational interventions on this issue targeted to youth are needed in Italy.

Key messages

Undergraduates do not show a good knowledge of health risks related to tattooing and piercing. Educational interventions are needed to raise youth awareness and knowledge of health risks of body art.
1.Q. Workshop: Novel digital tools and approaches to improve migrant health in European primary care services
Authors:   Organised by: St George's University of London (UK), ESGITM,   Chair persons: Sally Hargreaves (UK), Teymur Noori (Sweden)
Published: October 2021

Some migrant populations in European countries face a disproportionate burden of infections (tuberculosis, latent tuberculosis, HIV, hepatitis, parasitic infection) and be under-immunised. Reducing the burden of infection is a key regional priority, yet there are major shortfalls in current practice, and a need for novel approaches. The ECDC has recently called for innovative implementation strategies within primary care, to look beyond single disease programmes, and to encompass a wider group of at-risk migrants. In this workshop we will explore some recent developments, including the use of novel digital tools to guide clinical decision making in primary care, and new approaches to latent TB screening. New approaches are urgently needed to strengthen screening and vaccination programmes and support routine data collection. We will seek audience participation in sharing models of best practice from across Europe and better defining innovative implementation approaches to improve screening and vaccine coverage in migrant populations, and review successes and challenges.

The workshop will start with 15 minute presentations by each of the 3 speakers (to include a short Q&A after each talk). This will then move into a 15 minute audience discussion centred around seeking specific feedback on examples of innovation, good practice, and lessons learned across EU/EEA countries in approaches to strengthening uptake of screening and catch-up vaccination in migrant populations.

Key messages

There is a need to better define more effective strategies in primary care to strengthen screening for infection and improve vaccine coverage in migrant populations Digital tools and other approaches have been developed that can facilitate timely identification of key infections, that could contribute to improving health outcomes
How democracy alters our view of inequality and what this means for wellbeing
Authors: Gugushvili A , Reeves A
Published: October 2021

Income inequality is associated with poor health when economic disparities are especially salient. However, political institutions may alter this relationship because democracies (as opposed to autocracies) may be more inclined to frame inequalities in negative rather than positive ways. Living in a particular political system potentially alters the messages individuals receive about whether inequality is large or small, good or bad, and this, in turn, might affect whether beliefs about inequality influence health. Further, media coverage of economic inequality may negatively affect health if it contributes toward the general perception that the gap between rich and poor has gone up, even if there has been no change in income differentials. In this study, we explore the relationship between democracy, perceptions of inequality, and self-rated health across 28 post-communist countries using survey and macro-level data, multilevel regression models, and inverse probability weighting to estimate the average treatment effect on the treated. We find that self-rated health is higher in more democratic countries and lower among people who believe that inequality has risen in the last few years. Moreover, we observe that people in democracies are more likely to learn about rising inequality through watching television and that when they do it has a more harmful effect on their health than when people in autocracies learn about rising inequality through the same channel, suggesting that in countries where there is less trust in the television media learning about rising inequality is not as harmful for health. Our results indicate that while democracies are generally good for well-being, they may not be unambiguously positive for health. This does not mean, of course, that inequality is good for health nor that, on average, autocracies have better health than democracies; but rather that being more aware of inequality can negatively affect wellbeing

Key messages

While democracies are generally good for well-being, they may not be unambiguously positive for health. Being more aware of inequality can negatively affect wellbeing.
Risk factors for severe and fatal COVID-19 among patients admitted to an Italian hospital
Authors: Agodi A , Montineri A , Manuele R , Noto P , Castiglione G , Grassi P , Mattaliano AR , Maugeri A , Barchitta M ,   EPIRADIOCLINF group
Published: October 2021

Background

The epidemic of COVID-19 has spread dramatically affecting more than 140 million people and leading to more than 3 million deaths. We aimed to investigate what factors pose a risk for disease severity and death.

Methods

We prospectively included patients with laboratory-confirmed COVID-19 from San Marco Hospital (Catania, Italy), who had been admitted by Dec 31, 2020. Demographic, clinical, treatment, and laboratory data, were collected and compared between severe and non-severe patients, as well as between survivors and non-survivors. We used univariable and multivariable methods to explore the risk factors associated with disease severity and death.

Results

Overall, 463 patients were included, of whom 33.7% had severe disease and 14.0% died in hospital. Patients with severe disease were older (p < 0.001) and more likely to have had heart failure (p = 0.038). With respect to the risk of death, increasing age, hypertension, diabetes, ischemic heart disease, atrial fibrillation, heart failure, chronic obstructive pulmonary disease, cancer, and chronic renal failure were more common among non-survivors than survivors (p-values<0.05). In particular, a logistic regression model confirmed age (OR = 1.14; 95%CI=1.10-1.20; p < 0.001) and heart failure (OR = 14.8; 95%CI=2.7-80.8; p = 0.002) as the main risk factors for death. The comparison between the first and the second waves of the epidemic did not reveal differences in demographic and clinical characteristics, however, the treatment approach has changed significantly.

Conclusions

The risk of severe and/or fatal COVID-19 was higher among older patients with comorbidities. These findings lay the foundation for prediction models that could inform shielding policies and vaccine prioritisation strategies.

Key messages

The risk of severe and fatal COVID-19 is substantially elevated among older patients with previous comorbidities. These findings are important to inform shielding policies and vaccine prioritisation strategies.
Prospective analysis of gender-related characteristics in relation to cardiovascular disease
Authors: Bolijn R , Kunst AE , Appelman Y , Galenkamp H , Moll van Charante EP , Stronks K , Tan HL , Van Valkengoed IGM
Published: October 2021

Background

Cardiovascular diseases (CVD) are a major public health problem in men and women worldwide. Differences in CVD incidence between men and women have been widely reported, although explanations for these differences remain unclear. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly explain how these differences arise. We aimed to establish the associations between selected gender-related characteristics and CVD incidence.

Methods

We linked baseline data of 18,058 participants without CVD from the population-based, multi-ethnic HELIUS study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands in 2013-2018. Using Cox regression analyses, we studied associations of time spent on household work, doing home repairs, primary earner status, type of employment, performing a male-dominated or female-dominated occupation, and desire for emotional support with CVD incidence, overall (with or without adjustment for sex) and stratified by sex. Analyses were adjusted for age, ethnicity, and socioeconomic status.

Results

In the fully adjusted analyses, most gender-related characteristics were not associated with higher CVD incidence, overall and among men. In women, homemakers had a higher hazard for CVD compared to fulltime workers (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.35-4.04), whereas those spending a moderate amount of time on household work had a lower hazard for CVD than those spending little time (HR 0.56, 95% CI 0.34-0.95).

Conclusions

Although most gender-related characteristics were not associated with CVD incidence in men, being the homemaker and time spent on household work were associated with CVD incidence in women. Thus, attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies.

Key messages

Some gender-related characteristics are relevant for cardiovascular disease risk, particularly in women. Attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies.
Health-related QoL and fatality in CHD patients: findings from a national cohort study, Turkey
Authors: Emli Alpay E , Dinc G , Sakarya S , Ergor G , Sozmen K , Ekinci B , Unal B
Published: October 2021

Background

Although strong association between self-reported health and coronary heart disease (CHD) exists, health related quality of life (HRQOL) has not been conceptualized as a predictor for fatality in CHD patients. We investigated whether HRQOL may predict the risk of death in six years in CHD patients.

Methods

There were overall, 614 of CHD cases in the national representative Chronic Diseases and Risk Factors Survey in Turkey, 2011. Baseline self-reported health data on EuroQol- 5 Dimension (EQ-5D) and a Visual Analog Scale (VAS) were used from the same survey. The cases were followed-up for all-cause and CHD specific fatality (ICD-10 diagnostic codes: I20- I25) through electronic health records by 2017. Kaplan Meier and Cox regression models were used for data analysis. Age and sex adjusted HRs [aHR 95% CIs] were estimated for having some or extreme problems in EQ5D domains and VAS.

Results

Median follow-up years (IQR) was 6.46 (6.39-6.47). The number of deaths from all causes and CHD were 103 and 26, respectively. Age and sex adjusted HRs for all causes fatality were statistically significant for some or extreme problems in usual activities [2.48 (95%CI 1.60-3.83)], in pain/comfort [2.28 (95% CI 1.44-3.62)], in self-care [2.25 (95% CI 1.46-3.46)] and in mobility [1.85 (95% CI 1.16-2.96)]. Age and sex adjusted HRs for CHD specific fatality were statistically significant for some or extreme problems in self-care [3.45 (95% CI 1.48-8.07)] and pain/comfort [3.07(95% CI 1.19-7.93)]. VAS was negatively associated with overall fatality.

Conclusions

In CHD cases, poor self reported health might be a good indicator for overall and CHD specific fatality in 6 years. Especially having some or extreme problems in selfcare and pain/comfort are closely related with overall fatality as well as CHD specific fatality.

Key messages

There are strong relationships between HRQOL and all causes fatality as well as CHD specific fatality. Poor self- reported health might be a predictor for overall and CHD specific fatality in CHD cases.
Impact of air pollution on health in South-East Europe
Authors: Belis C , Van Dingenen R , Klimont Z , Dentener F
Published: October 2021

The Western Balkans (WB; Albania, Bosnia and Herzegovina, Kosovo*, Montenegro, North Macedonia and Serbia) is a region next to the European Union where the levels of air pollution are among the highest of Europe and transboundary pollution with neighbouring countries is frequent. The estimated PM2.5 average exposure index in the WB is above the exposure concentration obligation (20 µg/m3) of Directive EU/2008/50. In this study, the TM5-FAst Scenario Screening Tool (TM5-FASST) was used to estimate the trends of air quality impacts on health, from 2000 to 2050 in the WB. To that end, five ECLIPSE 6b emission scenarios with different assumptions on population growth, deployment of technologies and policies were compared. Mortality from PM2.5 and ozone were calculated using the integrated exposure-response model (IER) and a log-linear exposure-response function, respectively, in line with the Global Burden of Disease assessment for 2017. The implementation of the maximum feasible reduction (MFR) scenarios in the WB would lead to a decrease in the mortality associated with PM2.5 of 49% - 65% in 2050 compared to the current legislation baseline (CLE). On the contrary, no further control (NFC) scenarios would cause an increase in PM2.5 mortality of 16% - 21% in 2050 compared to the CLE. Furthermore, compared to the CLE baseline in 2050, lack of action would lead to an 11% - 21% increase in mortality in neighbouring countries, due to transboundary pollution originating in the WB region. As a whole, the study confirms that implementing the adopted policies would lead to a reduction of the air pollution impacts in the coming decades and provides estimates of the maximum benefits expected from ambitious policies and the impact of not implementing the currently adopted ones.

(* This designation is without prejudice to position on status and is in line with the UNSCR 1244/99 and the ICJ Opinion on the Kosovo declaration of independence.)
Delivering on the Green Deal’s zero pollution ambition for health
Authors: Stauffer A , Perroud S , Matkovic V
Published: October 2021

As part of an integrated approach, the EU Green Deal also includes a zero pollution ambition for a toxic-free environment. This is a much needed and overdue commitment to address the significant environmental health burden from pollution in Europe. Air pollution alone leads to 400,000 premature deaths annually, and the extent of the health harm from chemicals pollution, or effects from combined exposures are still under investigation. The next months will show if the EU Commission can deliver on their ambition, with the launch of a zero pollution action plan for air, water and soil, and the speed of the process to revise the EU's ambient air quality standards. In addition, the World Health Organization (WHO) is expected to launch updated air quality guidelines, following a scientific review which showed greater health harm from poor air quality. The presentation will provide an overview of the policy opportunities for public health professionals to be engaged in, to make the health case for zero harm from pollution, and zero delay in stopping pollution. A particular emphasis will be placed on showcasing the need for zero financing of pollution, as major investments for transformation under Just Transition and green recovery schemes are underway.