bluuebunny/crossref_metadata_2025 huggingface dataset:
Achieving atomically ordered GaN/AlN quantum heterostructures: The role of surface polarity
Authors: Wu Yuanpeng , Zhou Peng , Xiao Yixin , Sun Kai , Wang Ding , Wang Ping , Mi Zetian
Published: October 2023

Interface engineering in heterostructures at the atomic scale has been a central research focus of nanoscale and quantum material science. Despite its paramount importance, the achievement of atomically ordered heterointerfaces has been severely limited by the strong diffusive feature of interfacial atoms in heterostructures. In this work, we first report a strong dependence of interfacial diffusion on the surface polarity. Near-perfect quantum interfaces can be readily synthesized on the semipolar plane instead of the conventional
c
-plane of GaN/AlN heterostructures. The chemical bonding configurations on the semipolar plane can significantly suppress the cation substitution process as evidenced by first-principles calculations, which leads to an atomically sharp interface. Moreover, the surface polarity of GaN/AlN can be readily controlled by varying the strain relaxation process in core–shell nanostructures. The obtained extremely confined, interdiffusion-free ultrathin GaN quantum wells exhibit a high internal quantum efficiency of ~75%. Deep ultraviolet light-emitting diodes are fabricated utilizing a scalable and robust method and the electroluminescence emission is nearly free of the quantum-confined Stark effect, which is significant for ultrastable device operation. The presented work shows a vital path for achieving atomically ordered quantum heterostructures for III-nitrides as well as other polar materials such as III-arsenides, perovskites, etc.
Quantifying the ultrafast and steady-state molecular reduction potential of a plasmonic photocatalyst
Authors: Warkentin Christopher L. , Frontiera Renee R.
Published: October 2023

Plasmonic materials are promising photocatalysts as they are well suited to convert light into hot carriers and heat. Hot electron transfer is suggested as the driving force in many plasmon-driven reactions. However, to date, there are no direct molecular measures of the rate and yield of plasmon-to-molecule electron transfer or energy of these electrons on the timescale of plasmon decay. Here, we use ultrafast and spectroelectrochemical surface-enhanced Raman spectroscopy to quantify electron transfer from a plasmonic substrate to adsorbed methyl viologen molecules. We observe a reduction yield of 2.4 to 3.5% on the picosecond timescale, with plasmon-induced potentials ranging from

−

3.1 to

−

4.5 mV. Excitingly, some of these reduced species are stabilized and persist for tens of minutes. This work provides concrete metrics toward optimizing material–molecule interactions for efficient plasmon-driven photocatalysis.
Genome evolution and initial breeding of the Triticeae grass
Leymus chinensis
dominating the Eurasian Steppe
Authors: Li Tong , Tang Shanjie , Li Wei , Zhang Shuaibin , Wang Jianli , Pan Duofeng , Lin Zhelong , Ma Xuan , Chang Yanan , Liu Bo , Sun Jing , Wang Xiaofei , Zhao Mengjie , You Changqing , Luo Haofei , Wang Meijia , Ye Xingguo , Zhai Jixian , Shen Zhongbao , Du Huilong , Song Xianwei , Huang Gai , Cao Xiaofeng
Published: October 2023

Leymus chinensis
, a dominant perennial grass in the Eurasian Steppe, is well known for its remarkable adaptability and forage quality. Hardly any breeding has been done on the grass, limiting its potential in ecological restoration and forage productivity. To enable genetic improvement of the untapped, important species, we obtained a 7.85-Gb high-quality genome of
L. chinensis
with a particularly long contig N50 (318.49 Mb). Its allotetraploid genome is estimated to originate 5.29 million years ago (MYA) from a cross between the Ns-subgenome relating to
Psathyrostachys
and the unknown Xm-subgenome. Multiple bursts of transposons during 0.433–1.842 MYA after genome allopolyploidization, which involved predominantly the Tekay and Angela of LTR retrotransposons, contributed to its genome expansion and complexity. With the genome resource available, we successfully developed a genetic transformation system as well as the gene-editing pipeline in
L. chinensis
. We knocked out the monocot-specific miR528 using CRISPR/Cas9, resulting in the improvement of yield-related traits with increases in the tiller number and growth rate. Our research provides valuable genomic resources for Triticeae evolutionary studies and presents a conceptual framework illustrating the utilization of genomic information and genome editing to accelerate the improvement of wild
L. chinensis
with features such as polyploidization and self-incompatibility.
Direct laser synthesis and patterning of high entropy oxides from liquid precursors
Authors: Castonguay Alexander C , Nova Nabila Nabi , Dueñas Lauren M , McGee Shannon , Lodhi M J K , Yang Yang , Zarzar Lauren D
Published: October 2023

High entropy oxides are a class of materials distinguished by the use of configurational entropy to drive material synthesis. These materials are being examined for their exciting physiochemical properties and hold promise in numerous fields, such as chemical sensing, electronics, and catalysis. Patterning and integration of high entropy materials into devices and platforms can be difficult due to their thermal sensitivity and incompatibility with many conventional thermally-based processing techniques. In this work, we present a laser-based technique, laser-induced thermal voxels, that combines the synthesis and patterning of high entropy oxides into a single process step, thereby allowing patterning of high entropy materials directly onto substrates. As a proof-of-concept, we target the synthesis and patterning of a well-characterized rock salt-phase high entropy oxide, (Mg0.2Co0.2Ni0.2Cu0.2Zn0.2)O, as well as a spinel-phase high entropy oxide, (Mg0.2Ni0.2Co0.2Cu0.2Zn0.2)Cr2O4. We show through electron microscopy and x-ray analysis that the materials created are atomically homogenous and are primarily of the rock salt or spinel phase. These findings show the efficacy of laser induced thermal voxel processing for the synthesis and patterning of high entropy materials and enable new routes for integration of high entropy materials within microscale platform and devices.
Neural network Gaussian processes as efficient models of potential energy surfaces for polyatomic molecules
Authors: Dai J , Krems R V
Published: October 2023

Kernel models of potential energy surfaces (PESs) for polyatomic molecules are often restricted by a specific choice of the kernel function. This can be avoided by optimizing the complexity of the kernel function. For regression problems with very expensive data, the functional form of the model kernels can be optimized in the Gaussian process (GP) setting through compositional function search guided by the Bayesian information criterion. However, the compositional kernel search is computationally demanding and relies on greedy strategies, which may yield sub-optimal kernels. An alternative strategy of increasing complexity of GP kernels treats a GP as a Bayesian neural network (NN) with a variable number of hidden layers, which yields NNGP models. Here, we present a direct comparison of GP models with composite kernels and NNGP models for applications aiming at the construction of global PES for polyatomic molecules. We show that NNGP models of PES can be trained much more efficiently and yield better generalization accuracy without relying on any specific form of the kernel function. We illustrate that NNGP models trained by distributions of energy points at low energies produce accurate predictions of PES at high energies. We also illustrate that NNGP models can extrapolate in the input variable space by building the free energy surface of the Heisenberg model trained in the paramagnetic phase and validated in the ferromagnetic phase. By construction, composite kernels yield more accurate models than kernels with a fixed functional form. Therefore, by illustrating that NNGP models outperform GP models with composite kernels, our work suggests that NNGP models should be a preferred choice of kernel models for PES.
A Simple HPLC-UV Method for Ivosidenib Determination in Human Plasma
Authors: Gando Yoshito , Yasu Takeo
Published: October 2023

Ivosidenib is used for the treatment of acute myeloid leukemia (AML) with isocitrate dehydrogenase 1 (IDH1) mutations. However, increased blood concentrations of ivosidenib are associated with a risk of a prolonged QT interval in patients with AML. Therapeutic drug monitoring in patients with AML with IDH1 mutation offers the potential to improve treatment efficacy while minimizing toxicity. In this study, we developed an efficient high-performance liquid chromatography–ultraviolet (HPLC-UV) method for the quantification of ivosidenib in plasma. Human plasma samples (50 μL) were processed by protein precipitation using acetonitrile, followed by chromatographic separation on a reversed-phase column with an isocratic mobile phase of 0.5% KH₂PO₄ (pH 4.5) and acetonitrile (45:55, v/v) at a flow rate of 1.0 mL/min, with ultraviolet detection at 245 nm. Calibration curves were linear over the range of 0.25–20 μg/mL with a coefficient of determination (r2) of 0.99999. Intra-day and inter-day precision were 1.20–8.04% and 0.69–4.20%, respectively. The assay accuracy was −2.00% to 1.93% and recovery was >91.2%. These findings support the effectiveness of the newly developed HPLC-UV method for the quantification of ivosidenib in human plasma. This simple and cost-effective method is expected to expand ivosidenib monitoring in laboratories lacking LC–MS/MS instruments.
The vector error correction index model: representation, estimation and identification
Authors: Cubadda Gianluca , Mazzali Marco
Published: October 2023

This paper extends the multivariate index autoregressive model to the case of cointegrated time series of order (1,1). In this new modelling, namely the vector error-correction index model (VECIM), the first differences of series are driven by some linear combinations of the variables, namely the indexes. When the indexes are significantly fewer than the variables, the VECIM achieves a substantial dimension reduction with reference to the vector error correction model. We show that the VECIM allows one to decompose the reduced-form errors into sets of common and uncommon shocks, and that the former can be further decomposed into permanent and transitory shocks. Moreover, we offer a switching algorithm for optimal estimation of the VECIM. Finally, we document the practical value of the proposed approach by both simulations and an empirical application, where we search for the shocks that drive the aggregate fluctuations at different frequency bands in the US.
The impact of COVID-19 on health service utilization in sub-Saharan Africa: a scoping review
Authors: Tannor E , Quentin W , Busse R , Opoku D , Amuasi J H
Published: October 2023

Background

The COVID-19 pandemic has affected health systems and impacted health service utilization (HSU) globally. The aim of this scoping review is to synthesize the available evidence on HSU in sub-Saharan Africa during the COVID-19 pandemic focusing on (1) changes in HSU compared to the pre-pandemic period, (2) changes in HSU amongst particular patient groups studied, and (3) identify factors determining changes in HSU as a result of the COVID-19 pandemic.

Methods

The Scoping review is guided by the methodological framework developed by Arskey and O'Malley. We have searched for relevant studies in PubMed(MEDLINE), EMBASE, Scopus and Web of Science and for grey literature on governmental and organizational websites. Search terms combined synonyms for three main concepts: (1) ‘COVID-19 pandemic’, (2) ‘health service utilization’, and (3) ‘sub-Saharan Africa’. Two reviewers independently screened articles at the title and abstract stage for inclusion into full text screening for data extraction. We provide a general descriptive overview, tabular summaries and thematic analysis of the extracted data.

Results

We identified a total of 21,440 titles. After removal of duplicates, 14,626 titles and abstracts are currently being screened. Data extraction and analysis will be completed before the conference. We will provide a comprehensive overview of studies on health service utilization during the COVID-19 pandemic conducted in sub-Saharan Africa. We will describe the settings and methods used by identified studies, analyze the types of diseases studied (communicable, non-communicable, and injuries), and present the discussed reasons for changes in health service utilization.

Conclusions

This review is the first to describe the impact of the COVID-19 pandemic on HSU in sub-Saharan Africa. Understanding the effects of the pandemic on HSU is important to support the development of better policies for pandemic preparedness and response in the region.
“Health is a serious game”: Gamification as a tool for primary prevention in Public Health
Authors: Tesi B , Donia P , Covelli A , Aloise I , Renzi E , Massimi A , Villari P
Published: October 2023

Background

Gamification, according to literature, is the use of game design elements in non-game contexts. Rewards (e.g. points, badges and rankings) are a gamification strategy to entice users to complete required tasks and could be useful for Public Health (PH) interventions to promote healthy lifestyles. This study aims to find out which gamification approaches are most useful in PH.

Methods

We investigated PubMed, Scopus and Web of Science databases to conduct our systematic review, including articles published up to February 3, 2023. Prisma Statement 2020 guidelines were used. No time limits were included. Only articles in Italian or English that discussed gamification interventions in PH, effectiveness and user satisfaction were taken into account. The quality of the studies will be assessed using the NIH quality assessment tool.

Results

327 articles were found, 27 of which were included in the review. Pre-post studies were the most included (n = 12), conducted in Europe (n = 7) and USA (n = 6). The target population was mainly young adults and teens (n = 7). Most gamification interventions involved physical activity (n = 13), nutrition (n = 5) and smoking cessation (n = 2). Overall, the interventions proved to be all effective, but the ones about physical activity were the most useful, engaging and with longer-lasting results over time. Where satisfaction was assessed (n = 16), users gave positive feedback.

Conclusions

The research outcomes have shown how gamification may engage not only individuals, but masses, using game design elements in different Public Health areas. The implementation of gamification tools in PH is an innovative intervention that often uses graphic language to simplify and deliver messages to all kinds of users. Gamification is easy to use and could be a good strategy for primary prevention, to support a sustainable behavior change following the game period. More large scale controlled trials are needed in order to confirm these results.

Key messages

• Gamification is an important tool in public health useful for primary prevention.

• The mass appeal of gamification can reach many users leading to healthier lifestyles, especially among young adults.
Promoting men's health through sports clubs: a rapid realist review
Authors: Timm A , Van Hoye A , Sharp P , Andersen T H , Krustrup P , Hansen L , Corsten K H , Iversen P B , Rod M H , Klinker C D
Published: October 2023

Background

Traditional health promotion interventions have failed to engage men. Sports clubs offer male-friendly health promotion settings for men, but little is known about implementable intervention strategies and subsequent effects. This rapid realist review (RRR) aims to identify context, mechanisms and effects of health promotion interventions targeting men by or in collaboration with sports clubs.

Methods

The RRR methodology was developed in collaboration with a panel of Danish practice and policy representatives and international academics. A systematic literature search was conducted in February 2023 for studies published after 2013 in MEDLINE, Embase, and SportDiscus databases and through grey literature sources. Included studies: 1) targeted men aged 18+ years, 2) reported health promotion outcomes, and 3) were delivered primarily by or in collaboration with sports clubs.

Results

Fifty-two studies were included. Preliminary analyses indicate that interventions delivered through sports clubs show promise for engaging men with high cardiometabolic risk and producing favorable health outcomes. Preliminary findings from the realist synthesis show that if men felt a strong attachment to the sports club (context), it resonated with their feelings of social identity which outweighed a former reluctance to attend health programs (mechanism), and thus increased the men's likelihood for program engagement and health behavior change (outcome).

Conclusions

Our study indicates that men's health promotion through sports clubs is emergent. While great strides have been made to increase men's involvement in health promoting activities by delivering interventions through sports clubs, research has predominantly focused on select behaviours (e.g., physical activity), sub-groups (e.g., sports fans) and predominantly Caucasian, overweight, middle-aged men.
Mapping provision and evaluation practices in local community health and wellbeing programmes delivered by professional sports clubs in the United Kingdom: A practice-based targeted review
Authors: Brazier J , Foster C , Towsend N , Murphy J , Northcote M , Smith A
Published: October 2023

Professional sports clubs (PSCs) are potentially effective settings for health promotion, however, their role within policy is unclear. Potential reasons include lack of awareness about existing provision of health and wellbeing (H&W) programmes delivered, and adequacy of monitoring and evaluation (M&E) practices. This review aimed to: (i) map the provision of H&W programmes delivered by PSCs in the United Kingdom (UK); and (ii) explore current M&E practices of PSCs and consider the policy implications of this. To conduct this practice-based targeted review, websites from eight professional sport leagues were hand-searched for programmes and impact reports, amounting to the inclusion 116 PSCs. Suitable programmes were quantified, whilst impact reports were analysed via inductive documentary content analysis. Results identified 127 H&W programmes that met our inclusive criteria. A total of 36 impact reports were retrieved, presenting engagement figures and anecdotal case studies as the most common evaluation methods. Additionally, 43 H&W impact statements were identified within the impact reports, but only 14 were aligned to specific H&W outcomes. None were supported by measurement-tool-driven data, and reporting of data collection timeframes and participant numbers were also rare. Findings illuminate the provision of H&W programmes delivered by UK-based PSCs and their health promotion priorities. However, the H&W aims of programmes are typically vague, measurement tools are rarely used, and evaluations are usually anecdotal which may limit the potential uptake of these programmes and PSCs generally in relevant public health policy. Further research is thus needed on the challenges faced when seeking to monitor and evaluate programmes effectively and to build a stronger evidence base for the use of PSCs as vehicles of health promotion.
The experience of racial discrimination among ethnic minority healthcare professionals in Ireland
Authors: Thompson C
Published: October 2023

Background

Racial discrimination towards ethnic minorities permeates healthcare systems of many countries. This study aimed to strengthen the understanding of the experience of racial discrimination among ethnic-minority healthcare professionals in Ireland. The objective was to explore the lived experience of racial discrimination and its impact on the health and well-being of nurses and doctors in this local context.

Methods

Interpretative Phenomenological Analysis was used to explore participants' experiences. Purposive and snowball sampling strategies were used to recruit sixteen ethnic minority nurses and physicians, working in diverse roles across Irish private and public healthcare sectors. In-depth semi-structured interviews were employed to collect data. A brief questionnaire was used to obtain information on participants’ demographic profiles.

Findings

Ethnic minority healthcare professionals experienced racial discrimination from colleagues, patients, and families; and this discrimination was interpersonal, structural, and institutional. Three core themes, and a number of related sub-themes, were identified; including: (1) Experiences of racial discrimination ((a) overt and subtle, (b) excessive reporting, (c) lack of safe space and trust, (d) being overlooked), (2) Responses to racial discrimination ((a) navigating racism, (b) tolerating in silence, (c) surviving and thriving, (d) seeking support); and (3) Impact of racial discrimination ((a) psychological impacts, (b) physical impacts, and (c) financial impact).

Conclusions

This study demonstrated that ethnic minority healthcare professionals have experienced racial discrimination in the Irish healthcare setting, which significantly impacted their health and well-being. By giving voice to these healthcare professionals, this study highlighted challenges facing Irish healthcare systems and the need for drastic change.
Are there social inequalities in caesarean section rates in Europe?
Authors: Smith L , Farr A , Zurriaga O , Cuttini M , Verdenik I , Vidal Benedé M J , Kearns K , Sakkeus L , Philibert M , Scott S
Published: October 2023

Background

Lower socioeconomic status (SES) is strongly associated with adverse perinatal health outcome, such as preterm birth and stillbirth. We investigated whether the caesarean section (CS) rate, which may reflect a greater prevalence of maternal health complications, was also higher in disadvantaged populations.

Methods

The study uses aggregate routine birth data from European countries collected with the Euro-Peristat federated analysis protocol. We analysed CS rates (total births by CS/total births) by SES from 2015 to 2020. Mothers’ education level (primary/lower secondary; upper secondary; postsecondary) was the preferred SES indicator; if unavailable, parents’ occupation or area-based deprivation scores were used and harmonised into three groups (low, medium, high).

Results

17 countries provided data on maternal education, 5 on area-based deprivation, 1 on parents’ occupation. CS rates ranged from 16.7% (Lithuania) to 48.5% (Cyprus) in the low SES group and from 16.8% (the Netherlands) to 55.2% (Cyprus) in the high SES group. Patterns across SES groups were diverse, with greater use of CS in higher SES groups (Croatia: 19.6%, 24.1%, 26.7% and Ireland: 30.3%, 33.4%, 35.5% for low, medium and high SES respectively), whereas elsewhere, more disadvantaged SES groups had higher CS rates: Italy: 37.1%, 35.2%, 33.7%, Denmark: 22.0%, 21.9%; 19.8% and Luxembourg: 34.5%, 33.2%, 29.9%. In some countries, rates were similar across groups (France: 21.3%, 20.7%, 21.3% and the Netherlands: 17.2%, 17.0%, 16.8%). Risk ratios of CS in low versus high SES groups ranged from 0.74 (95% CI R0.70-0.77) in Croatia to 1.15 (95% CI 1.12-1.19) in Luxembourg.

Conclusions

Our results do not show that CS was consistently associated with social disadvantage. Instead, we found surprising variations in the SES gradient between countries, raising questions about CS practices and their interaction with maternal characteristics in European countries.
Adverse childhood experiences, social participation and multimorbidity risk in Europe
Authors: Deschenes S , Simmons C , Elsden E , McInerney A , Lowry E , Rodrigues R
Published: October 2023

Background

Adverse childhood experiences (ACEs) are linked to multimorbidity, but evidence from longitudinal research on potential macro and micro-level protective factors is lacking. We investigated the associations between ACEs, social participation, national health expenditure, and their interactions, with the risk of developing multimorbidity in later life.

Methods

Data from 25,885 adults aged 50+ from 15 countries in the Survey of Health, Ageing and Retirement in Europe (SHARE) were analyzed. ACEs (separation from parents, household dysfunction, hunger, property loss) and social participation (community, political, religious, or charity participation) were measured in Waves 3 (2009) and 4 (2011), respectively. Multimorbidity was defined as the simultaneous presence of two or more conditions (diabetes, cancer, heart disease, stroke, depression) in Waves 5-8 (2013-2019). Country-level health expenditure per capita (2011) was included. Multilevel logistic regression models nested within countries tested associations and interactions in unadjusted and adjusted (n = 14,478) analyses.

Results

16.3% developed multimorbidity, 19.3% reported ACEs, and 47.7% were socially active in their communities. ACEs, social participation, and health care expenditure were each uniquely associated with the odds of incident multimorbidity, and results held when adjusting for sociodemographic and lifestyle factors (OR = 1.32, 95% CI = 1.18,1.47; OR = 0.86, 95% CI = 0.78, 0.94; OR = 0.9998, 95% CI = 0.9997,0.9999, respectively). Multiple imputation for missing covariates demonstrated similar results. No significant interactions were found.

Conclusions

ACEs were associated with increased multimorbidity risk, and although social participation and health expenditure were associated with lower risk, they did not mitigate the impact of ACEs. Policies aimed at preventing ACEs and promoting social participation among older adults may be beneficial in reducing the risk of multimorbidity in later life.

Key messages

• ACEs are associated with an increased risk of multimorbidity in later life.

• While social participation and greater national health expenditure are associated with lower multimorbidity risk, these factors do not mitigate the impact of ACEs.
Migrant workers in European informal health care settings
Authors: Trummer U
Published: October 2023

Care for the elderly in Europe increasingly depends on migrant carers, both in institutionalised and informal care settings. For the latter, the vulnerability of migrant carers working in private households has been described in several studies. Austria is a EU member state that made attempts to legalise the grey labour market of home care by several legislative changes, providing a framework of regulations to foster inclusion of migrant care workers into schemes of social protection. It can serve as an example how attempts of inclusion also make room for in-built mechanisms of exclusion, and how public health issues are related to economic considerations of a “care market”, with migrant workers as important, yet rather voiceless, stakeholders.
One Health good practices across the European Region: the co-production of a Compendium
Authors: Dente M G , Robbiati C , Pireddu R , Marcheggiani S , Maugliani A , Riccardo F , Mantovani A , Seravesi S , Simonelli M , Bertinato L
Published: October 2023

Issue/problem

The international and scientific community has been calling for many years to strengthen prevention and preparedness to threats at the human-animal-environment interface by integrating a systemic approach, such One Health (OH). Furthermore, the COVID-19 pandemic highlighted the importance of OH to enhance health security. However, at the national level, governments are delaying the integration of OH in their public health systems or in national health plans.

Description of the problem

The WHO Regional Office for Europe is supporting the elaboration of a Compendium of operationalized and/or implemented OH practices within the Region, highlighting enabling factors and lessons learnt to promote OH adoption, in line with the One Health Joint Plan of Action 2022-2026 (OH JPA) of the Quadripartite Organizations. The Compendium is part of the efforts of the WHO European Region 2024-2030 strategy and it responds to the recommendations of the 2021 Pan-European Commission on Health and Sustainable Development.

Results

OH practices within the European Region are identified through a rapid review and are validated with stakeholder interviews to select those concretely supporting OH operationalization and implementation. The practices are described according to the following characteristics: country, sector, OH JPA action track, OH principles, disciplines and stakeholders involved. Specific additional attributes, like innovation, sustainability, efficacy, replicability and advancement of the Sustainable Development Goals (SDGs), are supporting the process of inclusion in the Compendium.

Lessons

Lessons learned from the practices provide a framework for action to scale up OH within the Region and globally. Collective action for OH operationalization and implementation in preventing, preparing for, detecting, and managing health threats at national and local level is advanced, supporting the achievement of key SDGs, with an up-to-date vision according to the OH JPA.

Key messages

• OH good practices within the European Region are collected in a Compendium to promote and guide OH approaches integration in national plans and to enhance health security in the Region and globally.

• The Compendium supports multisectoral and multistakeholder actions for OH operationalization and implementation, with an up-to-date vision supporting the OH JPA and the achievement of key SDGs.
Barriers to the effective implementation of One health policies against AMR in the EU
Authors: Dates M , Davies M
Published: October 2023

Funded by the EU4Health 2021 Programme, Tetra Tech conducted a study for the European Commission on the “Barriers to the effective implementation of policies against antimicrobial resistance (AMR)” in the EU Member States, Norway and Iceland. The study provides input to support the EU's overall goal to combat AMR by improving the development and implementation of One Health national action plans (NAPs) which, in turn, shall contain effective measures in infection prevention and control and prudent use of antimicrobials. The research was conducted under the following study areas: development and implementation of One Health NAPs, infection prevention and control (IPC) measures in hospitals and long-term care facilities (LTCFs); antimicrobial stewardship measures (AMS) in hospitals, LTCFs, primary care and pharmacies. The research revealed some common problems across all countries, such as insufficient funding to deliver on the measures foreseen in the NAPs, the shortages of qualified staff at all levels of care, the lack of measures targeting LTCFs specifically, the limited involvement of pharmacies in AMS, and the disruptions caused by the COVID-19 pandemic in the health sector. The barriers affect each country differently but they are nevertheless common to all, independently of their size and socio-economic situation. Limitations to deliver on the NAPs objectives were also due to lack of other resources besides funding and staff: old infrastructure, insufficient material and equipment, as well as testing capacity, inadequate information systems. Other barriers identified include: limited political focus and awareness of the challenges brought by AMR; lack of operational plans for delivering on the NAPs; lack of harmonised indicators for monitoring the implementation of plans; limited coverage of AMR, AMS and IPC in education and training; and limited public awareness of AMR.

Key messages

• Countries face common barriers to the effective implementation of One health policies against AMR, such as lack of dedicated funds, shortages of qualified staff, and disruptions caused by the pandemic.

• Actions are needed for improving the implementation of One Health national action plans in the EU, including effective measures in infection prevention and control and prudent use of antimicrobials.
Incidence and persistence of post-COVID condition in children – a matched cohort study in Germany
Authors: Ehm F , Wende D , Loser F , Vivirito A , Menzer S , Batram M , Buschmann T , Sarganas G , Scheidt-Nave C , Schmitt J
Published: October 2023

Introduction

Long-term health effects of COVID-19 have been investigated by several large cohort studies. As most of these studies have been conducted in adults, data on the incidence and persistence of post-COVID-19 condition (PCC) among children and adolescents are still limited.

Methods

Using routine healthcare data from statutory health insurance in Germany, children and adolescents with laboratory-confirmed COVID-19 in 2020 were matched to controls (neither documented nor clinically suspected COVID-19) and followed for incident health conditions until 2021-09-30. To study PCC in children we considered selected health outcomes including malaise/fatigue (R53), dyspnea (R06.0), and cognitive dysfunction (F06.7, U51, R41), developmental delay (F80-89), adjustment disorder (F43), chronic fatigue syndrome (CFS; G93.3), and altered smell/anosmia (R43). The incidence of PCC was determined based on the lack of related diagnoses in the 12 months preceding the index quarter. For each outcome incidence rate ratios (IRR) were estimated using Poisson regression.

Results

At 3-month-follow-up, about 40% more individuals with COVID-19 suffered from at least one of the specified health conditions compared to controls. IRR were highest for smell/anosmia and CFS. IRR were generally higher among adolescents (≥12 years) than among younger children. Only a minority of PCC diagnoses persisted for 12 months within the COVID cohort. Diagnoses were more frequently persistent in the younger age group after one year.

Conclusions

Despite that long-term consequences of COVID-19 are less common and usually less severe in children, a considerable share of those diagnosed with PCC still suffered from specific symptoms 12 months after acute infection. Considering the high number of infected persons our findings suggest a relevant PCC related burden for health care even among children and adolescents.

Key messages

• In routine healthcare data adolescents showed stronger associations between COVID-19 and post COVID-19 related ICD-10 diagnoses than children < 12 years of age.

• Serious ICD-10 diagnoses persisted for a longer time in younger children than adolescents.
Adoption of a multicomponent intervention to improve HPV vaccination in France: a mixed methods study
Authors: Bocquier A , Bruel S , Gagneux-Brunon A , Gauchet A , Le Duc-Banaszuk A S , Michel M , Mueller J E , Thilly N ,   PrevHPV Study Group
Published: October 2023

Background

HPV vaccine coverage (VC) in France has always been lower than in most high-income countries. As part of the PrevHPV project, we developed and evaluated a school-based multicomponent intervention to improve HPV VC among French adolescents. We assessed the adoption of the PrevHPV intervention among secondary schools and its associated factors.

Methods

We carried out a pragmatic cluster randomized controlled trial (April 2021-June 2022) in 14/25 French school districts. The cluster was the municipality. Municipalities were eligible if there was only one secondary school and most inhabitants aged 11-14 years attended this school. We then contacted the head of the school to ask him/her to participate in the study. Based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, we described municipalities’ exclusions, schools participation and associated factors (Chi2, t-tests). We also used qualitative data from six focus groups with participating school staff to explore facilitators and barriers to adoption at the school level.

Results

Compared to non-eligible municipalities (n = 2658), eligible ones (n = 1205) were smaller, less urban and deprived, with lower accessibility to general practitioners. Out of 346 randomly selected municipalities, 91 (26%) accepted to participate. Participating schools were smaller and located in more deprived municipalities than non-participating ones. During the trial, 31/91 (34%) schools discontinued intervention; we did not identify any characteristic associated with discontinuation. Qualitative data showed that several contextual factors can influence adoption at the school-level: human resources (school staff availability, turnover and attitudes towards vaccination, especially for school nurses); material (e.g. computer equipment) and financial resources; parents’ attitudes towards vaccination.

Conclusions

These results can guide policy making on school-based HPV vaccine promotion in France and Europe.

Key messages

• The PrevHPV project is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France.

• Should the intervention prove effective, these results are expected to help stakeholders scale-up the school-based PrevHPV intervention in France and other European countries.
Dilemma, an innovative public health scientific animation for the youth, France, 2022
Authors: Arsandaux J , Savès M , Ouaraz C , El Hajj Z , Moulin C , Prévot-Held M , Joly P , Montagni I , Pariente A , Mathoulin-Pelissier S
Published: October 2023

Background

The spread of disinformation and institutions distrust increases individuals difficulty to adhere to public health recommendations. How citizens can critically appraise health information is a major public health matter and a need to favor health democracy. In this field, to both enhance curiosity and critical thinking, young people represent a population with specific needs for innovative approaches.

Objectives

To provide 15-24y people a space for experimentation and discussion on public health concepts, a multidisciplinary experts team created the “Dilemma” scientific animation that uses a playful approach. Trained young facilitators guide participants through four games (on proportions, risk/protective factors, scientific estimation, benefit/risk ratio). We assessed the program using mixed method (self-questionnaires; focus groups) to answer the following questions: can the approach generate curiosity and participation among young people? Is it effective in improving health literacy and confidence in control over one's own well-being?

Results

Dilemma was launched in a French region in Nov 2022 targeting high-school students; preliminary results are presented for 67 participants from a Bordeaux technical high school (extended results are awaiting). Of these, 76% were satisfied, 82% felt they improved their critical thinking skills and 79% their curiosity. Facilitators’ fun and friendly nature was an important aspect in participants’ satisfaction. However, they reported difficulties in remembering the messages behind the games and asked for more calm and shorter texts. No effect was found on health literacy or internal locus of control.

Conclusions

Dilemma shown promising results on how science animations on public health could interest young people. It should develop more games and closer collaboration with school teachers to improve its effectiveness. Fun aspects and peer support needs to be considered for future actions.

Key messages

• The scientific public health animation Dilemma shows promising results in increasing curiosity and critical thinking of the youth.

• Using playful scenarios could contribute to favor health democracy.
Monitoring the healthiness of food environments in supermarkets and out-of-home settings
Authors: Poelman M P , Dijkstra S C , Djojosoeparto S K , Winkel D , Linnebank C , Seidell J C , de Vet E , Kamphuis CBM
Published: October 2023

Background

Food environment transformations are needed to improve population diets. Systems to monitor food environment transformations are often lacking, but can be useful to assess retail and food-service performances over time. Therefore, we aimed to measure the healthiness of supermarkets and out-of-home settings, including the assortment, price promotions, in-store promotions, and food marketing to children.

Methods

Web-scraping techniques were used to collect data on food assortment (n = 37761 products) for 6 supermarket chains (market value=72%). All products were categorized by food group and whether they contributed to a healthy diet (yes/no). During 8 weeks, price-promotions were collected for 8 supermarket chains (n = 23239 promotions). To identify instore promotions (n = 7757 products) and food marketing to children (14 product categories, n = 2,681 products), 40 supermarkets (8 chains) were visited. Similar data was gathered for out-of-home settings.

Results

80% of the food assortment and 80% of the products featuring in supermarkets’ price- and in-store promotions were not supportive of a healthy diet. In addition, 73% of the check-outs offered snacks, but lacked healthy options. 97% of the food marketing to children was for products not supporting healthy diets. The top five most available food products in supermarkets were: non-alcoholic beverages, alcohol, sweets, biscuits, meat, and poultry (36% of the entire assortment). Non-alcoholic drinks, sweets and confections, alcoholic beverages, dairy, and ready-to-eat meals were the most featured products in price-promotions. Even less supportive observations were found for out-of-home settings.

Conclusions

Dutch food environments primarily consist of products and promotions that do not contribute to a healthy diet. Regular monitoring is needed to identify whether policies are effective to improve food environments.

Key messages

• The current food assortment, price promotions, in-store promotions, and food marketing to children of supermarkets and out-of-home settings are not supportive of healthy food choices.

• Monitoring food environments can be useful to assess retail and food-service performances over time, and to identify whether policies are effective to improve food environments.
SARS-CoV-2 in freshwaters used for irrigation in the agro-urban environment of Milan (Northen Italy)
Authors: Tesauro M , Terraneo M , Consonni M , Fappani C , Gori M , Colzani D , Amendola A , Lai A , Masseroni D , Tanzi E
Published: October 2023

Background

During the COVID-19 pandemic, water has played a key role in epidemiological monitor of SARS-CoV-2. Our study aimed to verify if ﬂood spillways activity during heavy rain events could be a source of SARS-CoV-2 contamination of a rural canal and consequently of human infection.

Methods

A total of 12 water samples (2L) were collected in four sampling campaigns conducted in 2022 (April, September, November, and December) during heavy rainfall. An automated sampler located in an irrigation stream collected 250mL of water at intervals of 10’ for 80’ since the spillways activation (sample A), then every 20’ for 160’ (sample B), and finally every 30’ for 240’ (sample C). Each sample was pre-filtered and concentrated by tangential flow ultrafiltration according to an in-house protocol. The presence of SARS-CoV-2 and Pepper Mild Mottle Virus (PMMoV, internal control) RNA was investigated by real time RT-PCR. SARS-CoV-2 viability was tested on VERO E6 cell culture, verifying the cytopathic effects and the viral load by real time RT-PCR every 24 hours for 7 days.

Results

PMMoV RNA was detected in all specimens assessing RNA quality. Although SARS-CoV-2 RNA was detected in all samples, except in those of November and in April sample C, there was no evidence of cytopathic effect or active replication in cell culture. RNA concentrations were generally low (0.27-6.95 gc/µL) but slightly higher in samples A than in B and C.

Conclusions

Despite the limited number of samples collected during the experimental campaign and due to the severe drought that affected Northen Italy, our results suggest that spillways activation could be a source of SARS-CoV-2 contamination in freshwaters, but there was no evidence of risk to human health. The detection of small concentrations may be associated with the circulation, during the monitoring, of the Omicron variants, which rarely cause gastrointestinal symptoms.

Key messages

• Spillways activation could be a source of SARS-CoV-2 contamination.

• Both environmental diffusion and infectivity of SARS-CoV-2 were investigated to better understand the risk of disease for humans.
Improving vector-borne disease control in Albufeira
Authors: Sá R , Dinis V , Edmundo A , Carvalho Costa I , Figueiredo V , Almeida S , Fonseca A , Lopes C , Rodrigues V , Correia M
Published: October 2023

The Albufeira Health Centre (CSA) comprises various functional units within primary healthcare. Recognizing the limited awareness of colleagues regarding the Vector Surveillance Network (REVIVE), responsible for entomological surveillance of mosquitoes, ticks, and sandflies, the Public Health Unit (USP) initiated a project to improve coordination and knowledge sharing. Implemented in April 2023, the project involved a multidisciplinary team. Informational materials on vector surveillance and control, clinical guidance for common vector-borne diseases (VBDs), tick collection protocols, and specimen registration forms were distributed. A video highlighting entomological surveillance and strategies for prevention and control was disseminated. To date, the project has recorded 45 views of the video (51%). A questionnaire distributed among the target population revealed that only 20% had knowledge of the epidemiological importance of vectors in the Algarve region. None were familiar with REVIVE or its work. Furthermore, participants were not acquainted with the Aedes albopictus mosquito species. Regarding ticks, 20% felt confident in tick removal, but none were aware of the tick genera in the Algarve region. Only 20% were aware of notifiable vector-borne diseases through SINAVE. Training sessions on this topic were suggested. The project emphasized the significance of communication and collaboration among healthcare professionals in the prevention and control of vector-borne diseases. It highlighted the need for continuous education on VBDs, surveillance techniques, and control measures. This innovative project can serve as a model for healthcare centres and countries, contributing to global efforts to improve the response to vector-borne diseases. The project's outreach extended to the Municipal Albufeira Animal Welfare Centre. A new questionnaire will be distributed to gather additional insights and enhance the impact of the project.

Key messages

• The project aims to improve integration of primary healthcare services for vector-borne diseases, increasing awareness and training for healthcare professionals.

• This innovative project promotes prevention culture and replicable adaptations for improved response to vector-borne diseases.