bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term clinical outcomes informed by artificial intelligence-enabled single-lead ECG detection of reduced ejection fraction
Authors: Alrumayh A , Kelshiker M A , Sau A , Mansell J , Almonte M , Chhatwal K , Bachtiger P , Peters N S
Published: October 2024

Background

* Reduced left ventricular ejection fraction (LVEF) is linked to poor clinical outcomes (1, 2).

* Despite its increasing prevalence, reduced LVEF is often undetected due to resource-limited echocardiography and lack of suitable point-of-care diagnostic tools.

* Previous studies have shown that an artificial intelligence-enabled electrocardiogram (AI-ECG) algorithm can accurately identify patients with reduced LVEF, but may also offer novel insights on long-term prognosis (3, 4).

Purpose

We aimed to determine if an AI-ECG algorithm designed for detecting reduced LVEF can also independently predict 2-year major adverse cardiovascular events (MACE) and all-cause mortality.

Method

* A retrospective multicentre observational study investigating the ability of AI-ECG to predict long-term clinical outcomes (i.e. over two years' follow up).

* Analysis included a total of 1,007 consecutive unselected patients attending for routine echocardiography, with a single-lead ECG recording performed at the same time.

* An AI-ECG algorithm, designed to identify impaired LVEF, was applied to each single-lead ECG.

* Occurrence of MACE and all-cause mortality associated with AI-ECG results (Figure 1) was investigated using Cox regression; evaluating performance of AI-ECG results as a classifier (0 or 1) and as a probability score (0 to 1).

* The study was approved by the UK Health Research Authority (reference 21/LO/0051).

Results

* The mean age was 62.3 years. 52.4% of patients were male and 57.5% of patients were White.

* Appropriately, patients with a positive AI-ECG had a higher MACE rate compared to those with a negative AI-ECG (34.2% vs. 11.9%; adjusted hazard ratio (aHR) 2.02; 95% CI, 1.46 – 2.81; p < 0.005), primarily driven by increased mortality (23% vs. 9.6%; p < 0.0001; aHR 1.65; 95% CI, 1.12 – 2.43) and heart failure hospitalization (14.5% vs. 1%; p < 0.0001) – Figure 2.

* AI-ECG probability score (per 10% increase) was significantly associated with MACE (aHR 1.17; 95% CI, 1.09 – 1.25; p < 0.005) and all-cause mortality (aHR 1.11; 95% CI, 1.02 – 1.20; p = 0.01).

* Importantly, sub-analysis of AI-ECG for those who have a normal LVEF (i.e. ≥50%) continued to show association between positive AI-ECG and MACE (27.2% vs. 11.9%; p < 0.0001; aHR 1.70, 95% CI 1.17 – 2.48) and all-cause mortality (20.4% vs. 9.6%; p < 0.0001; aHR 1.53, 95% CI 1.00 – 2.36).

Conclusion

An AI-ECG algorithm designed to identify impaired LVEF can identify patients at risk of MACE and all-cause mortality from single-lead ECG screening – regardless of their LVEF.

Such results may enable further risk stratification for cardiovascular investigations through the simple addition of single-lead ECG recording.
Longitudinal changes in the prevalence of indicators for the precursor stage B of heart failure: results of the STAAB study
Authors: Morbach C , Gelbrich G , Schmidbauer L , Sahiti F , Chen M , Cejka V , Frantz S , Heuschmann P U , Stoerk S
Published: October 2024

Background

The ACC/AHA guidelines on heart failure (HF) use selected echocardiographic signs of structural heart disease (SHD) as well as NT-proBNP levels to define the precursor stage B of heart failure in asymptomatic individuals.

Purpose

To study the change in prevalence over time of echocardiographic signs of SHD or elevated NT-proBNP levels in clinically inapparent individuals of the general population.

Methods

The STAAB study investigates precursor stages of HF in the general population of a medium-sized city in Germany (source population 124,297 inhabitants as of 2011 census). Participants, stratified for sex and age (30-79 years), were recruited between 12/2013 and 10/2017 from the source population if they had no preceding HF diagnosis and were followed for 2-4 years. Echocardiographic signs of SHD were (for exact definitions see table): left ventricular (LV) hypertrophy, LV dilation, reduced LV ejection fraction. Subjects with history of myocardial infarction, significant LV valve disease or symptomatic HF (Framingham criteria) were excluded.

Results

Of 4,965 subjects included at baseline, 3,684 (74.2%; mean age 55.2 years, 52.7% women) with at least one paired measurement were analysed. The changes observed over time in the prevalence of echocardiographic signs of SHD and elevated NT-proBNP levels are displayed in the table. Prevalences of echocardiographic signs of SHD increased (significantly for LVEF and LV dilation, trend for LV hypertrophy). Addition of NT-proBNP increased the cross-sectional prevalences, but not the change in prevalence of potential HF precursor stages.

Conclusion

The net incidence of clinically inapparent echocardiographic signs of SHD increased over time at a rate consistent with the prevalence observed for clinically apparent HF in the general population. Of note, not all echocardiographic findings will eventually result in symptomatic HF, and the classification is influenced by measurement errors. However, our data support the concept of HF precursor stages.
Clinical Implications of NT-proBNP trajectory following Sacubitril/Valsartan initiation
Authors: Takigami Y , Ishii S , Iida Y , Ikeda Y , Nabeta T , Ako J , Nasu T , Kanaoka K , Kagiyama N , Kida K , Fujimoto W , Kikuchi A , Ijichi T , Shibata T , Matsumoto S
Published: October 2024

Introduction

Serum N-terminal pro–B-type natriuretic peptide (NT-proBNP) values after initiating Sacubitril/Valsartan is considered as a favorable prognostic factor, and widely used for risk stratification in patients with heart failure (HF). However, the relationship between the trajectory of serially measured NT-proBNP values and cardiovascular events in patients with HF who are treated with Sacubitril/Valsartan remains uncertain.

Purpose

This study aimed to reveal the prognostic association of an NT-proBNP trajectory after initiating Sacubitril/Valsartan and subsequent cardiovascular outcomes.

Methods and Results

A Japanese nationwide multicenter study was conducted on HF patients who initiated Sacubitril/Valsartan. Out of the 995 patients enrolled, we excluded 561 patients who were undergoing assessment of BNP or who lacked a complete set of NT-proBNP measurement. Finally, 434 patients included this study, and were divided into three groups based on NT-proBNP trajectory as follows; the ‘sustained-responder’ group (n = 129, 30%) : which exhibited a reduction of NT-proBNP by ≥10% at 1 month and further reduction of ≥10% at 3 months; and the ‘transient-responder’ group (n = 161, 37%), with ≥10% reduction at 1 month but not at 3 months; and the ‘non-responder’ group (n = 144, 33%), which did not achieve ≥10% reduction at 1 month. The mean age was 68 years, with females comprising 29%. In the ‘sustained-responder’ group, the age was significantly younger, and the duration of heart failure was significantly shorter. There were no significant differences in the mean systolic blood pressure, mean Sacubitril/Valsartan dose at each measurement points among the 3 groups. During follow-up of 456 (IQR, 371-549) days, the primary endpoint, which was either cardiovascular death or hospitalization of HF occurred in 78 of 434 patients (18%). The Kaplan-Meier analysis showed that the ‘sustained responder’ group experienced significantly lower event rate among the 3 groups (Log-rank p<.001). Additionally, an analysis that set a landmark time at 3 months post-initiation of Sacubitril/Valsartan showed that the ‘sustained-responder’ group experienced significantly fewer events than the ‘transient-responder’ group (Log-rank p=0.039) (Figure.1). Also, the ‘sustained responder’ was observed to have a better prognosis in a subgroup with LVEF<50%, but not in patients with LVEF ≥50%. (p value for interaction=0.035) (Figure.2).

Conclusions

This study revealed that sustained reduction of NT-proBNP was associated with a reduced risk of cardiovascular death or hospitalization for HF. The periodic NT-proBNP monitoring and the patterns of NT-proBNP during treatment with Sacubitril/Valsartan may be helpful in optimizing HF therapy and understanding the prognosis of HF.Figure.1Figure.2
Health burden and costs attributed to the carbon footprint of health systems in the European Union
Authors: Chen-Xu J , Corda M O , Varga O , Viegas S
Published: October 2024

Background

Health systems have an environmental impact of around 4.6% of global emissions, contributing to aggravating the climate crisis. However, the health impact of the carbon emissions originated by health systems is not regularly assessed. We aim to estimate the health burden and associated costs of the carbon footprint of health systems across the European Union (EU).

Methods

We calculated DALYs and associated costs based on human health damage factors (DALYs/kg-CO2e) by considering four scenarios. Three scenarios for shared socioeconomic pathways (S1 - high growth, S2 - baseline, and S3 - low growth) represented variations of global society, demographics, and economics until 2100. A fourth scenario (S4) considered the current EU’s 55% reduction goal of greenhouse gas emissions. The healthcare sector’s emissions per capita (in CO2-equivalent) in 2019 were extracted from the Lancet Countdown, and population data were retrieved from Eurostat for the same year.

Results

In the EU, 365,047 DALYs (95%CI: 194,692-535,403) are expected to be caused by health systems’ emissions at baseline (S2). In an S1 scenario, the burden would slightly decrease to 315,374 DALYs (95%CI: 170,355-462,393), whereas a S3 scenario would increase 486,730 DALYs (95%CI: 243,365-681,422). If EU’s carbon goals are met, the burden could be substantially reduced to 164,271 DALYs (95%CI: 87,611-240,931). The monetisation of DALYs can result in costs amounting to 25.6 billion euros.

Conclusions

CO2 emissions from health systems are expected to significantly impact human health. It is therefore of the utmost importance to ensure that EU climate policies for healthcare buildings are in line with the Paris Agreement. This will require the implementation of climate mitigation programmes within the health sector and a review of clinical practices at the local level.

Key messages

• The carbon footprint of health systems is estimated to significantly impact health, with high economic burden.

• EU climate policies for healthcare buildings and procurement must be aligned with the Paris Agreement.
The NHS London Legacy and Health Equity Partnership: Evaluation of an equity lens framework
Authors: Zuriaga-Alvaro A , Inskip J , Johnson E , Kamau L , Wilson J , Weil L G
Published: October 2024

Background

Disparities in COVID-19 vaccination uptake emphasised stark inequalities linked to ethnicity and deprivation, highlighting lack of trust and access barriers. London health leaders committed to create a community-centred legacy through the development of the NHS Legacy and Health Equity Partnership (LHEP); A novel 2-year programme aiming to close the equity gap in vaccinations, screening and access to health, focused on underserved communities, delivered in collaboration with London partners and communities. LHEP focused on 12 unique programmes with a key role of system leadership. Outputs included 15 reports, 6 conference presentations, 7 academic publications, 6 community workshops and 5 toolkits including development of an overarching LHEP framework aiming for long-term legacy.

Methods

An evaluation was designed to assess the benefits and limitations of the programme and framework through 16 semi-structured interviews and 5 focus groups delivered with key stakeholders. Ethical approval was obtained from the UKHSA Research Ethics Group. Data was coded inductively and drawn into themes.

Results

LHEP was said to add value through a) a dedicated team championing health equity and visible focus of leadership within the equity space b) fostering community engagement enabling dialogue between health systems and communities c) advocating co-production, building trust, focusing on communities in vulnerable circumstances d) programme innovation and agility d) drawing from COVID-19 lessons and disseminating learning. Interviewees stressed a legacy beyond vaccinations, establishing London as a blueprint for others.

Conclusions

Lessons were drawn into the ‘LHEP Approach for Health Equity’, a concise framework to guide partners to embed health equity, gathering 4 key tenets to ensure ‘no community is left behind’; data, evidence and learning; commitment from leaders and strong partnerships, allow for innovation and consider sustainability and communities at the centre.

Key messages

• Legacy and Health Equity Partnership is a 2-year multistakeholder programme aiming to tackle inequalities for the diverse communities of London that built evidence and led system change.

• Evaluation stressed the impact of establishing London as a blueprint to follow and a framework to guide and support partners striving for health equity.
Novel approach to combining interview and register data – Case: social security and pediatric cancer
Authors: Näsi E , Teittinen A , Perkiö M , Kokkinen L
Published: October 2024

A parallel examination of interview data and register data provides a more holistic overall picture of social security needs and use than any one type of data alone. In our study, we aimed to build a comprehensive understanding of the benefit and service needs of parents whose child is diagnosed with cancer. Conducting solely interviews would have provided subjective perceptions of individuals in the midst of a challenging life situation, but the data would have lacked information of the participants’ documented use of social security benefits and services. On the other hand, utilizing solely register data, would have provided an objective overview of actual service use. However, register data alone would not have shed light on whether the benefits and services received were sufficient from the recipients’ point of view. In our study, parents’ interviews and their register data from the Social Insurance Institution of Finland (Kela) offered complementary perspectives on the same life situation. Parents’ interviews provided information on support needs, service experiences as well as service deficits. The same families’ register data was used with their permission producing exact data on the insurance benefits and services that the family had applied for and received. The interviews were analysed as chronologically progressing narratives while the data received from Kela was depicted on timelines. When conjoined, the interview and register data formed a comprehensive picture of the benefit and service needs and use of families, whose child had cancer. In addition, this kind of triangulation revealed service deficits that were acknowledged by the interviewees and identified also through the register data. We argue, that combining subjective interviews together with institutional register data allow researchers to identify issues in the service system, which require improvements from the recipients’ and the system’s perspective.

Key messages

• The use of multiple types of data allows researchers to construct a holistic understanding of individuals’ social security needs and use.

• Combining interview and register data allows researchers to identify issues in the service system, which require improvements.
Sick-leave trajectories among people sickness absent with stress-related diagnoses; cohort studies
Authors: Gemes K , Petterson E , Farrants K , Friberg E , Nilsson K , Sjölund Andoff S , Alexanderson K
Published: October 2024

Background

Stress-related disorders are common sickness absence (SA) diagnoses in many Western countries. Knowledge of SA and disability pension (DP) patterns among people with such SA is needed. Thus, the aim was to identify future SADP trajectories among people with a new SA spell due to stress-related diagnosis and to examine sociodemographic and health-related factors associated with identified trajectories.

Methods

Using microdata from nationwide registers, we included all people living in Sweden with a new SA spell >14 days due to stress-related diagnoses (ICD-10 code F43) in 2011 (N = 32,417) or 2018 (N = 65,511), respectively. These two cohorts were followed prospectively for 13 months from the SA spell start, to identify trajectory groups of mean SA/DP days/month using group-based trajectory modeling. We used multinomial logistic regression to explore associations between sociodemographic and health-related predictors and trajectory membership.

Results

We identified the following SA/DP trajectories in both cohorts: steep drop (30.6% and 35.9% of all included in 2018 and 2011, respectively); fluctuating (8.7%, 11.2%); fast decrease (25.5%, 24.4%); medium decrease (18.1%, 13.1%); slow decrease (10.8%, 7.3%), and constant high (6.2%, 8.0%). Compared to the steep drop trajectory, individuals in the other trajectories were more likely women, older, and had prior SA/DP or secondary outpatient healthcare visits. Starting the SA spell full-time was the strongest predictor for the slow decrease and constant high trajectory, and previous SA or diagnosis of other mental disorders were predictors of the constant fluctuating and constant high trajectory.

Conclusions

The similarity of the identified trajectories in the two cohorts is a strength. The results reveal the diversity of future SA/DP in this patient group, indicating the importance of identifying patients at risk of long-term SA who might need further interventions early in the process.

Key messages

• In two population-wide cohorts with a new sickness absence (SA) spell with stress-related diagnoses, six trajectories of SA/disability pension days were identified during the 13-month follow-up.

• Most of those in the cohorts had trajectories that ended with no SA/DP after 13 months, while two trajectories, including 15-19% of individuals, showed high or varying SA/DP days during the follow-up.
A Multi-Modal Approach for A Healthier Weight and More Active Lifestyle
Authors: Ochieng B
Published: October 2024

Background

Obesity and overweight has been increasing globally and in the UK over the last few years, bringing along a wide array of challenges in health and wellbeing. Not only do they take a heavy toll on those affected, but obesity and overweight-related ill-health is costing the UK National Health Service £6.1 with projected costs to run up to £9.7 billion in 2050. This project aimed to apply artificial intelligence to identify the predictive indicators for obesity and co-create an intervention with public health practitioners and stakeholders.

Methods

Using health and wellbeing public health population data from the 2015, 2018 and 2022 from a city in the East Midlands, we applied artificial intelligence that uses machine learning techniques to discover insights, find hidden patterns and discover relationships in the data about engaging in physical activity and a healthy diet. The data on dietary choices and physical activity preferences were further analysed using advanced machine learning techniques.

Results

The outcomes from our machine learning process revealed patterns of physical activity engagement and diet from specific locations, along with a range of demographic variables that influence individuals’ patterns of physical ability and dietary practices. These findings, which will be presented in detail, have been integrated into a comprehensive city map. This map not only showcases opportunities for engaging in a healthy lifestyle but also aids in prioritising interventions in areas of greatest need.

Conclusions

The AI technology we employed allowed us to parameterise and generalise our findings with the possibility of scaling up the machine learning approach to other similar datasets. The findings facilitated the development of bespoke training for public health officers working with underserved communities, further demonstrating the impact of applying AI to inform the design of public health interventions.

Key messages

• Applying Artificial Intelligence to public health data has the potential to inform the development of effective interventions and increase precision.

• Using AI in public health data can generate new insights into population health and well-being and inform public health policy.
Health impacts methodology in the European Commission
Authors: Van Rij V C , Schaefer A
Published: October 2024

The state of play in the implementation of health impacts methodology within European Commission impact assessments reveals both advancements and challenges. The Commission has acknowledged the significance of assessing health impacts and has provided a generic methodological description, as outlined in Tool #32 of the Better Regulation guidelines. However, translating this guidance into practical application encounters obstacles stemming from challenges intrinsic to the policy in question, a lack of skills and knowledge, data gaps, and complexities in establishing causal links. In EU policymaking, health impacts are consistently appraised in relevant Impact Assessments across various policy areas, but the methodological intricacy varies. In the fields of public health, occupational safety, and environmental protection, econometric modelling is often employed to quantify potential health impacts rigorously. This involves sophisticated analytical tools designed to capture the complexity of the interactions. Conversely, in areas where the link between policies and health outcomes is less direct (e.g. food safety) or where data limitations pose challenges, a more qualitative appraisal is applied. This acknowledges the limitations in precisely quantifying health impacts and focuses on providing a nuanced understanding of potential health effects based on available information.
Digital Health Interventions’ Impact on Health Literacy: A Systematic Review
Authors: Causio F A , Fakhfakh M , Kaur J , Sert B , Gandolfi S , Di Pumpo M , De Angelis L , Berionni A , Mackey T , Cascini F
Published: October 2024

In the digital era, health literacy is crucial for informed health decisions and outcomes. This systematic review evaluates the effectiveness of digital health interventions (DHIs) in enhancing health literacy, as defined by the World Health Organization. We included a variety of studies, such as cross-sectional studies, surveys, and case reports, focusing on interventions like mobile health apps, online platforms, and telehealth services. Our search, adhering to PRISMA guidelines, spanned databases like PubMed, IEEE, and ACM, covering publications from 2013 to 2023. From 1,029 initial articles, 58 met our inclusion criteria after rigorous screening and duplicates removal. Our findings highlight that DHIs, including multimedia tools and remote sessions, significantly bolster health literacy across diverse populations. However, the impact varies due to the digital divide, influenced by factors like age and socioeconomic status. This review underscores the potential of DHIs in public health and the necessity to address accessibility to reduce health disparities. The full synthesis of data and methodological details will be discussed in the presentation, aiming to guide future digital health strategies and policies.

Key messages

• Digital Interventions Enhance Health Literacy Across Diverse Populations.

• Addressing the Digital Divide to Ensure Equitable Access to Health Benefits.
Curricular innovations to address inequalities in global health education
Authors: Sbaiti M , Abbara A , Al-Haffar M , Budhathoki S , Wihba K , Cardoso Pinto A , Streule M
Published: October 2024

Background

Global Health education (GHE) has expanded dramatically, with new degrees and expanded competencies in medical curricula. Yet, Global Health (GH) is also going through significant reckoning and debate around inequalities in the field. GH degrees are predominantly based in high-income countries and inaccessible to most global majority students. Some suggest GH education itself contributes to reproducing inequalities in GH. Thus, both educators and policy-makers require evidence and tools to support more representative and authentic educational experiences which can adequately equip our future graduates.

Objectives

To present educational innovations which gesture towards responding to the stark inequalities in Global/Public Health education. These include a unique project that experiments with disrupting current power dynamics through co-design and co-delivery of a curriculum on Syrian healthcare by colleagues with lived experience, and a student-staff partnership to integrate self-reflexivity and positionality (SRP) in curricula at Imperial College London (UK).

Results

Qualitative data shows that the Syrian Curriculum has resulted in enhanced student experience, being consistently cited as a highlight of the curriculum, whilst alsoenhancing inclusivity for many students. SRP supplemented this by providing students with tools to engage in open, respectful discussions and critically reflect on personal biases that impact class dynamics.

Conclusions

These projects provide tools for educators and policy-makers across European universities to address current challenges in GH education. Nonetheless, these innovations should principally be seen as tools to reflect and advocate for fundamental changes towards more representative structures in GH.

Key messages

• Curriculum innovations offer key tools to address inequalities in GHE, enhancing student experience/inclusivity.

• Yet, these remain limited without fundamental change towards a more representative sector.
Lesson learned from a co-designed vaccination initiative with undocumented people in the Netherlands
Authors: De Vos Klootwijk L , Kersten C A
Published: October 2024

Issue/ problem

‘The coronavirus does not take document status into account’. The COVID-19 pandemic highlighted the importance of equal healthcare access for all. Yet, undocumented people face numerous personal and practical barriers in accessing health. Ensuring the protection of the most vulnerable is a global concern.

Description of the problem

In 2021, a regional initiative aimed to remove barriers and create a trusted environment for undocumented people to receive vaccinations. This collaborative effort included public health departments, NGO’s, community groups, (self) organized migrant organizations, GP’s and embassies. Regular meetings identified the population’s needs. A medical doctor was made available 24/7 to address questions and concerns. Actions were undertaken to build trust, foster collaborations between health authorities and communities and to improve vaccine service access and design.

Results

Working in partnership fostered trusted, multi-sectorial relationships, resulting in a vaccination initiative that met the diverse needs of the undocumented people. Widespread community-driven outreach through flyers and social media reached those who normally are not reached. Supported by over 40 volunteers, three vaccination events were organized in which 693 doses were administered. All parties made their contribution, e.g. with different migrant communities providing hot meals. The initiative began at the grassroots level in the communities and was then executed in partnership with the involved parties, making it highly successful.

Lessons

Inclusive engagement, addressing concerns and sharing clear information not only supports trusted relationships but also strengthens social cohesion. Collaborating directly with the communities ensured the initiative was tailored to their needs, thereby lowering the barriers for accessing healthcare. Achieving this success required a foundation of trust, mutual respect and a collective commitment from all involved.

Key messages

• Codesigning vaccination initiatives with the communities is essential for success.

• Trusted partnerships, community involvement and mutual commitment were key elements for lowering barriers to accessing health.
The role of sociodemographic factors on herpes zoster vaccine uptake among hard-to-reach populations
Authors: Diedenhofen G , Colaiocco G , Adamo G , Amoriello Lamberti P , Gherardi S M , Trani F , Zuccaro O , Isidori C , De Angelis G , Fano V
Published: October 2024

Background

The anti-Herpes Zoster (HZ) vaccination program was expanded with the adjuvated recombinant vaccine (HZR) in the Lazio Region, Italy, in 2022, restricting its use only to certain categories at risk due to pathological conditions, such as dialysis patients or immunocompromised individuals. This study focuses on the role of clinical and socio-demographic factors on HZR vaccine uptake within the fragile resident population of the Local Health Authority Rome 2 (ASL RM2).

Methods

This population-based, retrospective cohort study leveraged data from various registries and databases. The study population comprised 835,779 individuals aged ≥18 years who were both RM2 residents and registered with an RM2 general practitioner (GP). Among these, 143,242 individuals with at least one chronic condition were assessed for vaccination uptake using a multivariate logistic model, exploring associations with gender, age, nationality, marital status, household size, and level of deprivation.

Results

At the conclusion of the study period, a small fraction (1.5%) of the fragile subjects had received at least one dose of the HZR vaccine, and a majority (78%) completed the vaccination course of two doses. The analysis indicated that vaccine adherence was significantly higher in males (OR = 1.15) and individuals aged 65 + (OR = 1.13) while lower among residents in areas of medium (OR = 0.61) and high deprivation (OR = 0.44) and with specific living arrangements - widowed people living alone (OR = 0.66) and families ≥ 6 people (OR = 0.63).

Conclusions

The ASL RM2 vaccination strategy for hard-to-reach individuals includes an integrated approach, with the engagement of local healthcare facilities and hospitals. Despite these efforts, lower adherence in socioeconomically disadvantaged fragile patients suggests a pressing need for targeted communication strategies and interventions to ensure equitable access to the HZ vaccine, as these groups are more vulnerable to developing chronic diseases.

Key messages

• Socio-demographic factors significantly influence Herpes Zoster vaccine uptake in hard-to-reach populations, with lower adherence in socially deprived groups.

• Tailored, equity-driven approaches are essential for enhancing vaccine coverage among hard-to-reach fragile individuals, mitigating the higher disease risks in these communities.
Is health being considered by funding towards climate adaptation and mitigation?
Authors: Pinho-Gomes A , Jamart L
Published: October 2024

Introduction

Funding is essential to build climate resilience in public health and healthcare systems and enable populations to adapt to the increasing impacts on climate change on health across the globe. This study aimed to investigate how health has been considered by the projects supported by the Green Climate Fund (GCF), created by the Paris Agreement to support climate adaptation and mitigation.

Methods

Adaptation, mitigation, and cross-cutting projects funded by the GCF between 2021 and 2023 were included. Information was collected for the percentage of funding allocated to health adaptation by cross-cutting and adaptation projects. For mitigation projects, information was extracted on the extent to which health co-benefits were considered.

Results

The 69 adaptation and cross-cutting projects funded by the GCF in 2021-2023 contributed $226 million towards adaptation, of which $59 (26%) million were for health adaptation. There was an increase in the funding provided by the GCF to adaptation from $1 million in 2021 to $156 million in 2023. Funding for health adaptation increased from $178,000 in 2021 to $42 million in 2023. Of the co-funding provided by beneficiaries, $637 million contributed to adaptation and $165 (26%) million to health adaptation. There was an increase in co-funding for adaptation provided by beneficiaries from $131 million in 2022 to $506 million in 2023, with funding for health adaptation increasing from $23 (18%) million to $142 (28%) million. Among the 48 mitigation and cross-cutting projects, 15 did not mention health, 13 mentioned did not correctly articulate health co-benefits, 11 identified specific health co-benefits, and 9 correctly labelled and measured health co-benefits. The main co-benefits derived from reducing air pollution.

Conclusions

Among the projects funded by the GCF, funding for health adaptation remains a small proportion of the adaptation funding and health co-benefits are rarely considered by mitigation projects.

Key messages

• The proportion of adaptation funding provided for the health sector remains low.

• Health co-benefits are seldom considered and measured by climate mitigation projects.
Does perceived neighbourhood social cohesion moderate the effects of demographic changes on health?
Authors: Sauzet O , Schäffer M
Published: October 2024

Small-area characteristics changes over time may be associated with health. Various theories have been proposed to explain small-area effects on health, including those concerning social capital. The effect of small-area demographic changes on health are very little researched and hardly anything is known about their relationship with social cohesion. We use longitudinal data from the German Socio-Economic Panel linked to demographic measures at county level. We explore the association between 5-year changes in the proportion of over 65 and of 18-24 years-old and physical and mental health and the moderating effect of perceived neighbourhood social cohesion (SC) using random intercept models. Control variables include education, income, and relevant baseline measures. Included are all participants with a 6-year continuous exposure to their county of residence. The main outcomes are the physical and mental health components (PCS, MCS) of the SF-12. We included 21,239 persons up to 6 times in 399 counties. 5-year changes in the over 65, of 18-24 and measure of SC are associated to MCS and PCS. Significant interactions between the changes in over 65 and social cohesion are seen for MCS only in rural areas and some interactions are significant for PCS. For MCS there are no interactions between social cohesion and the changes in 18-24. Important interaction effects for PCS: for those exposed to a small decrease in 18-24, an increase in one unit of SC is associated with an increase of 1.71 (95% CI[1.38, 2.03]) PCS units. For those exposed to a large decrease this effect is lower by 0.88 PCS units. Exposition to some demographic changes have the effect to reduce the positive effects of perceived social cohesion on health. Thus, demographic changes appear to be health stressors. The evidence shown by this work need to be further developed by considering smaller scales but the evidence opens up a new range of possible intervention targets to reduce health inequalities.

Key messages

• County level demographic changes are associated with physical and mental health and certain exposition to changes reduce the positive effects of perceived neighbourhood social cohesion.

• Social cohesion can be an intervention target to reduce small-area health inequalities, population changes can annulate positive effects. This must be accounted for in public health interventions.
Outdoor artificial light at night and risk of conversion from mild cognitive impairment to dementia
Authors: Filippini T , Costanzini S , Chiari A , Urbano T , Despini F , Tondelli M , Bedin R , Zamboni G , Teggi S , Vinceti M
Published: October 2024

Background

A few studies have suggested that exposure to lighting during night hours, i.e. light at night (LAN), may increase the risk of dementia. In this study, we aimed to evaluate the association between exposure to outdoor artificial LAN and risk of conversion to dementia in an Italian cohort of subjects with mild cognitive impairment (MCI).

Methods

We recruited subjects with a diagnosis of MCI at the Cognitive Neurology Clinic of Modena Hospital in the period 2008-2014, and we followed these subjects up to 2021 for conversion to dementia. We collected their residential history and we assessed LAN exposure at subjects’ residences using satellite imagery data available from the Visible Infrared Imaging Radiometer Suite (VIIRS) for the period 2014-2022. Using a Cox-proportional hazards model adjusted for relevant confounders, we computed the hazard ratio (HR) of dementia with 95% confidence interval (CI) according to increasing LAN exposure through linear, categorical, and non-linear restricted-cubic spline models.

Results

Out of 53 recruited subjects, 34 converted to dementia of any type including 26 Alzheimer’s dementia. In linear regression analysis, LAN exposure was positively associated with dementia conversion (HR 1.03, 95% CI 1.00-1.06 for 1-unit increase). Using as reference the lowest tertile, subjects at both intermediate and highest tertiles of LAN exposure showed increased risk of dementia conversion (HRs 2.26, 95% CI 0.88-5.85, and 2.89, 95% CI 1.10-7.58). In spline regression analysis, the risk linearly increased up to a LAN exposure of 30 nW/cm2/sr, above which a plateau seemed to be reached. Results were almost confirmed when limited to conversion to Alzheimer’s dementia, except for an almost linear relation.

Conclusions

Our findings suggest that exposure to outdoor artificial LAN may increase conversion from MCI to any type of dementia, especially above 30 nW/cm2/sr, while such relation appears to be almost linear for Alzheimer’s dementia.

Key messages

• Light at night exposure above 30 nW/cm2/sr was associated with risk of conversion to dementia.

• Light at night showed almost linear association with risk of conversion to Alzheimer’s dementia.
Mediterranean diet score linked to cognitive functioning in women: evidence from the Czech Republic
Authors: Hrezova E , Stefler D , Pikhart H
Published: October 2024

Background

Evidence suggests that adherence to the Mediterranean diet (MED) may be beneficial in preventing cognitive decline, although findings are inconsistent. We aimed to explore this association in the Czech population of older adults.

Methods

A total of 6,028 males and females from the Czech arm of the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study were included in the analysis. Dietary data were collected using a food frequency questionnaire, and MED was calculated based on nine food groups. The MED score ranged from 0 to 16 points and was categorized into three groups: 0-7, 8-10, and 11-16 points. Cognitive function was measured using four tests assessing verbal memory and learning, verbal fluency, and attention, mental speed and concentration, from which single z-scores were computed. The composite score of cognitive function was computed as the mean of z-scores. The cross-sectional associations between MED and composite score of cognitive function were analyzed using multivariate linear regression.

Results

Females with a dietary score of 8-10 points (Beta=0.05, 95% CI: -0.002; 0.097), and those with a score of 11-16 points (Beta=0.08, 95% CI: 0.016; 0.140) had a higher composite cognitive score than women in lowest adherence group. Looking at specific domains, women in the highest adherence group had significantly better immediate verbal memory (Beta=0.12, 95% CI: 0.031; 0.205) and delayed recall (Beta=0.12, 95% CI: 0.027; 0.212), respectively, than those in the lowest adherence group. There were no associations in males.

Conclusions

Higher adherence to the MED was associated with better cognitive functioning in verbal memory and composite cognitive score in Czech females. The results suggest that the Mediterranean diet may help to improve cognitive functioning in older women. #NGEU

Key messages

• Findings suggest that Mediterranean diet may be beneficial in cognitive functioning in older women.

• Higher adherence to the Mediterranean diet is connected to better cognitive function particularly in verbal memory domain.
Leveraging Behavioural Insights to Create Healthier Online Environment for Children
Authors: Nagyova I
Published: October 2024

Issue/Problem

The proliferation of digital marketing poses a significant threat to children’s health and well-being, necessitating innovative solutions grounded in cross-disciplinary systems approach.

Description of the problem

Children’s exposure to harmful digital marketing is pervasive, influencing their preferences, behaviours, and health outcomes. Traditional regulatory approaches often fall short in addressing the dynamic nature of online advertising, exacerbating the challenge. Without effective interventions, children remain vulnerable to the detrimental effects of marketing for unhealthy products and services, undermining public health efforts.

Results

Integrating behavioural sciences with public health suggests promising avenues for addressing the complexities of harmful digital marketing to children. The WHO KidAd app is a ground-breaking tool designed for objective monitoring of digital marketing. Coupled with evidence-based behavioural strategies such as nudges, choice architecture, and social norms, policymakers can influence decision-making in favour of healthier choices, thereby reducing the impact of harmful marketing. By understanding the decision-making processes and behavioural patterns involved, policymakers can design targeted interventions to mitigate exposure and protect children.

Lessons Learned

The application of behavioural sciences in public health policy-making yields valuable lessons. Firstly, personalized and contextually relevant interventions resonate more effectively with target audiences, enhancing their efficacy. Secondly, leveraging behavioural insights allows for the design of interventions that complement existing regulatory frameworks, filling gaps in enforcement and compliance. Thirdly, interdisciplinary collaboration between public health experts, policymakers, and behavioural scientists is essential for developing evidence-based strategies tailored to the digital landscape’s evolving challenges. [Grant: APVV-22-0587]

Speakers/Panelists

Amandine Garde

Law & Non-Communicable Diseases Unit, Liverpool, UK
Adverse Reaction Reports for Skincare: Zero
Authors: Morales Morales D , Espinosa Tabitas M , Villegas Dominguez J E , Cruz Duarte V , Viñas Dozal J C , Chávez Castillo S D , Carranza Promotor G J , Perez Villenueva M
Published: October 2024

Introduction

Suspicions of Adverse Drug Reactions (sADRs) facilitate public health authorities in making decisions regarding the safety of various drugs in the market, thus it is important to be acquainted with these data in our population.

Objectives

To identify suspicions of adverse reactions due to skincare product use among adults in Veracruz, Mexico.

Methods

A cross-sectional, prospective, and descriptive study was conducted, including subjects over 18 years old residing in the metropolitan area of Veracruz, Mexico. A self-administered questionnaire was utilized to identify suspicions of adverse reactions due to skincare product use and their notifications.

Results

607 subjects participated, with a mean age of 24.61 (±9.85), comprising 78.25% females and 21.75% males. The prevalence of sADRs identified by patients was 37.2%; however, 44.3% reported experiencing skin redness, 42.7% reported burning sensation, and 31.6% noted changes in their skin becoming oilier. 70.20% claimed awareness of potential adverse effects of the products they use, and 37.2% reported experiencing some adverse reactions, with 76.6% indicating that adverse reactions noticed on their skin disappeared upon discontinuing the product. None of the participants notified sADRs upon identifying them.

Conclusions

Not all participants in this study recognize sADRs as adverse effects, indicating the possibility that patients may have experienced adverse reactions without being aware of them, as they may not relate the product to the reaction

Key messages

• The notification of sADRs is a regulated activity in Mexico, so we must promote its implementation at all levels, since they are fundamental for public health decisions.

• We must carry out educational activities on skin care in order to prevent SADRs or so that the doctor provides care in a timely manner, since the patient does not recognize them.
Determinants of Long COVID illness duration and service use-an Irish retrospective cohort study
Authors: Carney P , McGuire F , Carroll C , Kavanagh P , Fallon U
Published: October 2024

The Follow-up After Disease Acquisition (FADA) study is a retrospective cohort study of COVID-19 recovery, aimed to characterise the nature and severity of Long COVID (LC) in an Irish community-based sample. Duration analysis is conducted applying Cox’s proportional hazards model to those self-reported recovered from LC (n = 577) and a Gompertz distribution parametric model, determined best fit by AIC, for those still ill with LC (n = 928) at time of survey completion. A negative binomial model is estimated to understand the variation of services accessed for LC. The Hazard in this instance is recovery(<1 = contributing factor to duration). Factors significantly contributing to duration of illness are never married (Hazard Ratio (HR):0.689;p:0.01) higher physical activity levels prior to first C-19 infection (HR:0.964; p:0.06) and number of COVID-19 infections (H:0.926;p:0.07). Those that contract more recent variants are likely to recover quicker from their LC illness (baseline Wildtype. Alpha HR:1.7;p:0.0; Delta HR:3.36;p:0.0; Omicron HR:3.8; p:0.0). In variation of services used for LC, there are some major differences between those self-reporting as recovered from LC at time of survey completion and those still ill. Of those recovered, men, those sickest with LC and sick longest use a wider variation of services. Single people use a significantly narrower range of health services to combat their illness. For those still ill higher education, higher levels of physical activity pre COVID-19, healthcare workers, higher rates of comorbidity, those sick longest and those whose health has been most impacted by LC use a wider variation of services. A poorer health rating negatively impacts variation of services accessed for LC illness. More recent strains of COVID-19 are significantly less likely to lead to LC, this offers hope for the future, albeit more research is required to investigate factors to improve recovery rates for those already experiencing LC.

Key messages

• Those with Long COVID that recover quickly are fundamentally different to those that do not.

• The number of COVID-19 infections is a key indicator of length of Long COVID illness, we need to protect our most vulnerable and put appropriate safeguards in place for healthcare provision.