bluuebunny/crossref_metadata_2025 huggingface dataset:
There is no planet B: masks UVC disinfection to rise to the environmental challenge during COVID-19
Authors: Amodeo D , Marconi D , De Palma I , Petri C , Nante N , Messina G
Published: October 2021

Background

Since the outbreak of Sars-CoV-2 public health measures have been adopted globally, most notably the use of face masks has become essential and often mandatory. As a result, about 3.4 billion single-use face masks are estimated to be discarded daily worldwide. Due to waste mismanagement, the COVID-19 pandemic is severely impacting the environment, the ecosystem and therefore human health. We aimed to assess if UV-C light is an efficient tool for proper mask disinfection, to guarantee their safe reuse and reduce their waste.

Methods

In October 2020 we conducted a cross sectional study on KN95 masks. Various operators wore the masks during their shift in the laboratory for 8, 16 and 24h. Contact plates were used to measure microbial contamination on both surfaces of the masks at time T(0). Then, masks were placed into a UV-C box (volume of 0.012 m3, 40 UVC LED at 270nm at 3mW) for a treatment of 3 minutes. We repeated the sampling at time T(1). We incubated all plates at 36 °C and read them after 48h. We performed descriptive and inferential (Wilcoxon matched pair test) analysis with Stata. Significance level was set at p < 0.05.

Results

We always observed greater contamination on internal surfaces than external ones. At T(0) the medians of CFU on samples of internal surface were 212.7 (CI 95% 0-480.2) at 8h, 311.7 (0-683.1) at 16h and 404.7 (0-736.1) at 24h; at T(1), CFU reduced (p < 0.05) and were respectively 3.2 (0-6.2), 2 (0-5.9) and 50.6 (0-164.7). At T(0) the medians of CFU on external surface were 23.7 (0-48.4), 53.2 (0-143) and 24.3 (0-71.8); at T(1) they respectively reduced (p < 0.05) to 8.7 (0-25.2), 18.2 (0-70), 2.3 (0-6.1).

Conclusions

Results showed that UV-C is effective in mask disinfection although an uncomplete abatement of the microbial load. It could be due to the limited UV-C dose or to its difficulty to penetrate among the meshes of the mask. Further investigation is needed to find a sustainable solution for mask use.

Key messages

UV-C seems a valid disinfection tool for used KN95 masks. The development of strategies for proper disinfection of masks should be carried out to guarantee reusability and reduce waste production.
Self-reported mask wearing, social distancing and COVID-19 among middle-aged and older Europeans
Authors: O'Donovan MR , O'Caoimh R
Published: October 2021

Background

Two of the most important recommendations for preventing the spread of COVID-19 are mask wearing and social distancing. This study assesses the prevalence of these behaviors and their cross-sectional association with COVID-19 among middle-aged and older adults in Europe.

Methods

This study presents findings from the Survey of Health Aging and Retirement in Europe COVID-19 interviews conducted in 26 European countries in 2020. Frequent mask wearing and social distancing outside the home were categorised as “always” or “often” compared with “sometimes” or “never”. COVID-19 status (positive test or hospitalisation) was self-reported. Participants were excluded if they were nursing homes residents, aged <50 years or reported never leaving their home. A further 403 with missing data were removed. SPSS complex samples was used to adjust for survey weights and design. Logistic regression was used to adjust for potential confounding (country of residence, having close contacts with COVID-19 and household size).

Results

The sample (n = 40,647 aged 50-101), with survey weighting, had a mean age of 66 years, 52% were female and 0.8% reported positive for COVID-19. Frequent mask wearing was reported by 82% (range: 2% in Sweden to 99% in Czech Republic), and frequent social distancing by 96% (range: 82% in Slovakia to 99% in Spain). According to unweighted adjusted odds ratios frequent social distancing was associated with lower self-reported COVID-19 (OR: 0.43 95% CI: 0.24-0.76, p = 0.004). Applying survey weighting the adjusted odds ratios were 4.19 (3.07-5.71, p < 0.001) and 0.36 (0.09-1.47, p = 0.156] for mask wearing and social distancing, respectively.

Conclusions

The self-reported frequency of adherence to public health recommendations (mask wearing and social distancing) by middle-aged and older Europeans varied significantly between countries in the first year of the pandemic. Social distancing measures may be most effective in this population.

Key messages

This large survey found that the frequency of mask wearing and social distancing for adults aged ≥50 varied significantly across 26 European countries in the first year of the pandemic. Frequent self-reported social distancing was cross-sectionally associated with reduced self-reported COVID-19 infection. Further longitudinal research is needed.
Factors predicting loneliness among ageing populations in the Baltic states during Covid-19
Authors: Reine I
Published: October 2021

During Covid-19 social isolation has become more common worldwide, and elderly people might have experienced dramatically limited communication. The study was based on a sample of individuals aged 50+ from wave 7, wave 8 and Covid-19 add-on of the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2017-2020. The sample size consisted of 4429 respondents from Latvia, Estonia and Lithuania. In order to assess the effects of factors associated with the first wave of Covid-19 predicting an increase in the intensity of loneliness symptoms, a multivariate binary logistic regression was used, including several health determinants in the model. The results indicated that in Latvia, the main predictive factors for the increase in the intensity of loneliness, by the adjustment for other factors, were increased nervousness (OR 44.39; 95%CI 41.06-48.00) and interrupted or reduced contact with children (OR 1.82; 95%CI 1.76-1.88). In Lithuania, the main predictors for the increase in the intensity of loneliness were high levels of nervousness (OR 6.80; 95%CI 6.56-7.04), deterioration of health (OR 2.51; 95%CI 2.44-2.59) and limited daily activity due to health conditions (OR 2.11; 95%CI 2.05-2.18). In Estonia, the most relevant predictive factors for the increase in the intensity of loneliness were financial difficulties (OR 5.65; 95%CI 4.76-6.71), interrupted or reduced contact with parents (OR 5.42; 95%CI 4.38-6.71), increased nervousness (OR 4.15; 95%CI 3.50-4.92) and limited daily activity due to health (adjusted OR 7.75; 95%CI 6.60-9.11). A relationship between an increase in the intensity of loneliness was mainly related to increased nervousness during the first wave of Covid-19 in all Baltic states. However, reduced or interrupted social contacts and health related factors were also found to be important predictors for loneliness.

The study was performed within the project No. 1.1.1.2/VIAA/3/19/540 ‘Challenges of ageing in the Baltic Sea region'.

Key messages

Public health incentives should be aimed towards reducing Covid-19 related stress among ageing populations. Promotion of skills and access to digital communication would reduce loneliness among elderly.
Knowledge and attitudes related to the COVID-19: role of media communication and emotional factors
Authors: Covolo L , Della Vedova AM , Croce M , Zamperoni S , Nanni A , Sorosina S , Gelatti U
Published: October 2021

Background

The COVID-19 pandemic was characterized by difficult communication challenges due also to scientific uncertainty regarding the nature and management of the new coronavirus. The aim of the study was to assess the impact of media information on the population's COVID-19-related knowledge, behavior and emotional state.

Methods

In a cross-sectional study, data from July to September 2020 was collected via survey posted on social media (SM). It included also an analysis of participants' e-health literacy (e-HEALS), and depression, anxiety, and stress symptoms using DASS-21 tool.

Results

Of the 2,140 subjects, as a main source of information, 69% indicated institutional websites and 26% SM. Fifty-four percent believed expert information to be crucial in changing their behavior. However 30% of health professionals (HP) and 37% of non-HP found expert (scientists) communication hard to understand. Despite high education level (44.3% graduates), 19% denied knowing of the virus origin. Others believed the human manipulation theory (33% of the total and 29% of HP). The e-HEALS score in these subjects was lower than those reporting the natural origin of virus (28.4 ± 6.2 vs 30.5 ± 6.1, p<.001). Young people aged <35 y reported signs of depression (41%), anxiety (28%) and stress (36%) more than older participants (p=.0001). As for infection concern, it was higher in females (58% p<.001), those not living alone (56% p<.01), those living with a senior (62% p<.01) or with those at high risk of COVID-19 (64%p<.001). Greater worry meant stricter guideline adherence (hand washing 56% p<.0001; surface sanitation 42% p<.0001; social distancing 77% p<.0001) and mask usage before mandate (45% p<.0001).

Conclusions

Although the sample was overall well informed and followed preventive measures, institutional communication was found to be confusing especially by experts. The findings highlighted the strong psychological impact on the community, young people especially.

Key messages

The study confirms the importance of putting effort on population health literacy and more effective institutional communication strategies. Proactive and timely psychological interventions should be provided to address the mental health needs of the population resulting from the pandemic.
Mental health and lifestyle changes during the first month of lockdown in Greece
Authors: Papadakaki M , Tzamalouka G , Tzamaloukas D , Vasilakis E , Chliaoutakis J
Published: October 2021

Objective

The current study aimed to explore the views and perceptions of Greek citizens regarding the impact of the pandemic on various health, mental health, and social behavior parameters.

Methods

An online questionnaire was distributed in April 2020 to the general population in Greece, via university networks and popular social media.

Results

A total of 1045 participants completed the questionnaire (men 34.0%; mean age 40.3 years) from all geographical regions of Greece. Satisfaction was high with the overall governmental response to the pandemic (71.0%). Lack of confidence was noted by many respondents regarding the national health system's preparedness to meet the increased needs of patients during the crisis (44.7%) and mistrust was reported by a high percentage of participants for the media with the way they delivered the news (80.0%). “Fear” and “sleep disorders” were very prevalent psychological reactions to the pandemic (70.7%, 59.3% respectively). An increase was reported by many respondents regarding the use of new technologies (65.8%), social interactions via internet (54.8%), food consumption (32.7%) and care for personal health (31.0%). A decrease in sexual interaction with the partner (47.0%) and relaxation practices (31.0%) was reported by a significant number of respondents. Despite the huge impact on daily life, many participants (60.8%) reported their intention to comply with future restrictions, if necessary.

Conclusions

The pandemic has greatly impacted various aspects of daily life. Policy makers need to reconsider future action upon considering the huge societal costs against perceived benefits.

Key messages

COVID-19 outbreak placed a substantial burden on the mental health of the Greek population. Identifying individuals most at risk of serious mental health conditions, seems vital.
Croatian blood collection system amid the COVID-19 pandemic
Authors: Miskulin M , De Marchi P , Domacinovic T , Pavlovic N , Nujic D , Miskulin I
Published: October 2021

Background

Croatian blood collection system is based on voluntary donation, according to the recommendations of the World Health Organisation and the Council of Europe. The ongoing COVID-19 pandemic has influenced all the dimensions of human lives and the functional pattern of the health care systems in the whole world. The aim of this study was to investigate the influence of ongoing COVID-19 pandemic on Croatian blood collection system and to evaluate the main factors that influence voluntary blood donation practice in blood donors (BDs).

Methods

This cross-sectional questionnaire study was conducted in convenient sample of voluntary BDs from Split-Dalmatia County during the May 2020 to December 2020.

Results

The study sample consisted of 479 regular BDs, 88.5% males and 11.5% females, mean age 39.8±10.8 years. Majority of them had high school education and living with the partner (67.4% and 74.5%, respectively). During COVID-19 pandemic 71.0% of them continued with regular donations while 29% of them postponed their donation. According to the BDs knowledge regarding COVID-19 infection there were 88.9% of those with unsatisfactory and only 11.1% of those with satisfactory knowledge regarding this infection. The study revealed that females, BDs living alone and younger BDs (aged 18 to 43 years) had more frequently postponed blood donation during COVID-19 pandemic (P < 0.0001, P = 0.004 and P = 0.017, respectively). The study further showed that there was no correlation between BDs knowledge about COVID-19 infection and their blood donation practice during ongoing pandemic.

Conclusions

The study revealed that ongoing COVID-19 pandemic impacted the Croatian blood collection system via reduction in the practice of voluntary blood donations. Sociodemographic characteristics of BDs were the main factors that influence Croatian BDs voluntary blood donation practice during pandemic while their knowledge about COVID-19 infection was not correlated with their behaviour.

Key messages

The sustainability of the health care system during a pandemic depends significantly on the blood supply, which is why it is necessary to ensure that blood collection system is continually maintained. The knowledge of blood donors about COVID-19 infection needs to be improved in order to prevent spreading of the infection generally and especially within this highly important population subgroup.
Use of information from social networks and acceptance of the vaccine for SARS-COV2
Authors: Villegas Dominguez J , Ceballos Jimenez UR , Fragozo Espinoza NJ , Gasperin Islas J , Quevedo Flores M , Sanchez Soto S , Marquez Celedonio FG
Published: October 2021

Background

During the SARS-COV 2 pandemic, Mexico has dealt with different manifestations unrelated to the information that is disseminated in different media based on scientific evidence, which has generated anti-vaccine expressions based on information of dubious scientific quality.

Objective

To determine the association between the use of information from social networks and the acceptance of the vaccine for SARS-COV2. A comparative, observational, cross-sectional and prospective study was carried out in Veracruz, Mexico, between January and April 2021, including residents of this city over 18 years of age through a non-probability sampling through virtual surveys conducted in Google forms.

Results

704 subjects were included in the study, of which 426 (60.6%) were women. 93.9% of the participants stated that they would agree to be vaccinated when appropriate. The source of information most used by those who accept the vaccination were social networks (43%), and of these, Facebook is the one they use the most (42.7%) and where they find more information about COVID (52.0%), without However, the social network in which they most frequently take your information into account is tweeter (29.4%). The OR for not accepting to be vaccinated was 0.2 (95% CI 0.08-0.6) for those who use information mainly from tweeters, as well as for those whose neighbors are their main source of information OR 17.6 (95% CI 5.4-57.4), both with value of p < 0.05. Having as the main source of information other social networks, television, radio, medical or newspaper personnel, resulted in p values> 0.05 for not accepting the vaccine.

Key messages

Informal information decreases the likelihood of accepting the sarscov2 vaccine. Tweeter is a source of information that favors vaccination.
Evaluating adherence to future COVID-19 vaccination among elderly population in Israel
Authors: Halperin D , Schor A , Mashiach-Eizenberg M , Satran C , Ali Saleh O , Inchi L , Bord S
Published: October 2021

Background

On March 2020, COVID-19 was declared a global pandemic. It was perceived as an elderly issue in face of the high morbidity and mortality rates among people over 60 years old. Instructions regarding protective and preventative conduct were issued by the Israeli ministry of health, with emphasis concerning the elderly population. This study aimed at examining the adherence for future Covid-19 vaccine and its predicting factors among the elderly population in Israel.

Methods

A cross-sectional online survey was conducted in April 2020 among 1,797 Israeli respondents, aged 60 and above, via social media. The questionnaire assessed intentions to being vaccinated against the COVID-19 virus, attitudes and subjective norms regarding the disease and instructions issued by the ministry of health, adhering to these instructions, perception of threat, trust in the healthcare system, negative emotions and social support.

Results

Levels of willingness to future vaccination were extremely high (92%). Multiple logistic regression analysis found gender, level of religiosity, socio-economic status, perception of threat, social support, trust in the healthcare system, negative emotions and subjective norms regarding social distancing, as predictors of probability for future adherence to the vaccine.

Conclusions

The study findings point to future intention, in a time when an atmosphere of uncertainty regarding COVID-19 and its consequences is prevalent around the world. The adherence predictors are in concurrence with elements of the Health Belief Model and the Theory of Reasoned Action. Identifying the factors that predict future willingness to be vaccinated, may assist in developing ways to promote vaccination adherence against COVID-19, as well as against other illnesses.

Key messages

The results emphasize the importance of creating a supportive environment and shaping health-promoting attitudes among the elderly, as well as balanced and reliable threat communication of epidemics. Actual vaccination would depend on factors such as the pandemic severity at that time.
Brazil: The profile of COVID-19 deaths among Nurses
Authors: Guimarães-Teixeira E , Machado MH , Freire N , Barros AC , Costa R , Mello e Silva G , Pinto C , Sperry M
Published: October 2021

Health-care workers (HCWs) on the frontlines have a high risk of acquiring and dying from covid-19. Nursing professionals (NP) represent over half of HCWs in Brazil, a country with high morbidity and mortality from covid-19, above all in 2021. The absenteeism and death of nursing professionals due to covid-19 have a major impact on the workforce. As part of the research by Fiocruz on working conditions among HCWs, including those considered “invisible,” we have conducted this study of death among graduated nurses. Although they represent 4 out of 5 members of nursing teams in Brazil, the technicians and assistant nurses remains largely unseen and are covered by the “invisible” HCW study. We analyzed data from Federal Council of Nurses, publicized at the website Observatorio da Enfermagem. The sociodemographic profile, professional category and timeline of nursing professional deaths were considered. The time period of the study was from March 2020 to March 2021. A total of 670 professionals of the nursing team died, 200 of these were nurses. Among nurses: 59.5% were female and 81.5% were up to 60 years old. Our study registers a concentration of deaths in the North region. Despite having fewer registered professionals, it had the highest number of deaths (29.5%), and the Southeast had the second highest percentage (26.5%). A slow decline was observed until December, when Brazil experienced a “second wave” of Covid-19. Vaccination of Nurses began in late January 2021; therefore, there was not enough time to assess the impact on morbidity and mortality. The results of a study of almost 50 professional categories are under analysis and will be published shortly.

Key messages

This study is about death by COVID-19 among nurses in Brazil. This study is part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ.
Molecular detection of HEV in domestic pigs in Italy from Abruzzo and Molise regions
Authors: Scattolini S , Del Matto I , D'Angelantonio D , Rossi F , Chiaverini A , Piccioni R , Antoci S , Pomilio F , Migliorati G , Aprea G
Published: October 2021

Background

Hepatitis E virus (HEV) is a zoonotic pathogen transmitted through the faecal-oral route and it is responsible of disease in humans with more than 21.000 cases reported in the European Union (EU) over the last decade. It is a non-enveloped single stranded RNA virus that includes 8 genotypes; among these, genotypes 3 and 4 (HEV-3 and HEV-4) are the most prevalent in developed countries and infect both humans and some animal species such as domestic pigs. In this study, we investigated the prevalence of HEV in domestic pigs bred in Italy, in Abruzzo and Molise regions.

Methods

During the period October 2020-March 2021, 327 liver samples from individual pigs were analysed. In particular, 211 were collected in 1 slaughterhouse and originated from animals bred in Abruzzo in 8 different farms and 116 were collected in 7 slaughterhouses and originated from animals bred in Molise in 47 farms. The real time retro-transcriptase (RT)-polymerase chain reaction (PCR) technique was used to detect HEV by targeting the open reading frame (ORF) 3 region of the viral ribonucleic acid (RNA).

Results

None of the samples deriving from pigs bred in Abruzzo tested positive for the detection of HEV RNA. Instead, 4 samples from pigs bred in 2 different farms in Molise tested positive, showing a prevalence of 3.45%.

Conclusions

Pigs are considered important reservoirs for HEV virus. For this reason, it is opportune to investigate the role of these animals for better understanding their involvement in the human infection through the consumption of contaminated raw or undercooked pork-meat products. These findings need to be further investigated with in depth genomic characterization of positive RNA samples to highlight the role of the specific strains circulating in this region and to draw conclusions about connections between animals, potential contaminated food and human disease.

Key messages

The study paved the way for defining the role of pigs in the transmission of HEV virus to humans through the consumption of pork meat products. This study reports the prevalence of HEV in domestic pigs of Abruzzo and Molise regions, two Italian regions.
Vaccinations for migrants during and beyond the COVID-19 pandemic
Authors: Declich S , Dente MG , Tosti ME , De Ponte G , Marchetti G , Tavoschi L , Lopalco PL , Russo ML , Marceca M
Published: October 2021

Issue

Migrants have suboptimal vaccination coverage compared to the general population in destination countries due to several factors

-administrative barriers or lack of legal entitlements to health -health system barriers (language, lack of cultural sensitivity and community engagement capacity, vaccination costs) -lack of trust in the health system and misconceptions about vaccines due to misinformation or beliefs

Problem

Countries should develop national policies and ensure an inclusive, free of charge and proactive vaccination offer to migrants, irrespective of their legal status; and to extend this approach beyond the current pandemic and the sole COVID-19 vaccine

Results

To achieve COVID-19 global herd immunity all population groups, including migrants, needs to access vaccination. Tailored vaccination strategies, once devised, shall be applied to routine national vaccination plan to tackle health inequalities

Lessons

The following actions shall be implemented at national level

Action 1. Develop tailored and equitable approaches for PH vaccination services targeting migrants through:

-free of charge access -decentralization and outreach capacity of the health system -innovative service delivery models (mobile clinics, combined health services, mass vaccination) -health personnel and migrants participatory approach and engagement strategies

Action 2. Increase staff engagement through: -increasing health personnel's difference sensitivity -strengthening health personnel's communication capacities

Action 3. Increase migrants' health and vaccine literacy through:

-establishing vaccine literacy education programmes and strategies -offering health promotion educational interventions

Action 4. Monitor progress of inclusive vaccination offer by: -setting strategic goals, targets and indicators for national vaccination plans -expanding immunization information systems to monitor vaccination coverage, with appropriate disaggregation by migration status core variables

Key messages

Explicitly and proactively include migrants and displaced communities in vaccination plans and set up, test and implement new approaches in primary prevention and vaccination services. Extend this approach beyond the current pandemic and the sole COVID-19 vaccine in order to enhance preparedness to present and future health threats.
eLiteracy on covid among portuguese women: web-based survey study
Authors: Garcia T , Vareda R , Rachadell J
Published: October 2021

Background

Digital tools are recognized public health tools for literacy. Their effectiveness is relatively unknown - some studies describe 40% of adults with literacy levels below the necessary for optimal use. eLiteracy has been a buzzword during the pandemic, but we still don't understand who benefits from it. This study aims to understand the ability of women to identify and use COVID-19 online information and its link with knowledge and behavior

Methods

Web-based survey conducted on female adults. Coronavirus eHealth literacy scales measured skills to apply information (CoV-eHEALHS) and COVID-19−related knowledge, conspiracy beliefs, and adherence to protective behaviors (COVID-19 KAPs). Spearman correlation and Kruskal-Wallis tests were used to identify association between CoV-eHEALHS and COVID-19 KAP, and between these and age, income, and level of education

Results

Higher CoV-eHEALS were seen in higher level of education (χ2=17,03; p = 0,002), higher knowledge (β = 0,19; p = 0,000), lower conspiracy (β=-0,27; p = 0,000) and higher adherence to protective measures (β = 0,24; p = 0,000). Higher knowledge was seen in greater ages (β = 0,11; p = 0,000), higher education (χ2=36,40; p = 0,000) and greater income (χ2=19,96; p = 0,001). Lower conspiracy was seen in higher education (χ2=31,50; p = 0,000) and higher income (χ2=9,71; p = 0,046). Higher adherence to protective measures had no correlation with socioeconomical factors.

Conclusions

There was association between higher eHealth literacy and COVID-19 KAP, reinforcing public health stakeholders to invest on disseminating digital information. There were worse results in younger women of lower education and income, suggesting information should be adapted to this population

Key messages

Digitally disseminated information is important because of the association between higher eHealth literacy and knowledge and protective behavior. It should be adapted for younger women with lower levels of education and income to maximize results.
Challenges and solutions in adapting an AI-powered health management tool for South African
Authors: Kini N , Coltuneac C , Hartenstein V , Scholz J , Azadzoy H , O'Donnell L , Türk E
Published: October 2021

Background

Africa has the lowest density of healthcare workers in the world and artificial intelligence (AI) technology can assist doctors and patients to bridge that gap. This paper describes the 3 challenges we identified to adapt Ada, an AI-powered health management tool, to assist pregnant women and mothers in South Africa (SA).

Challenges and solutions

Localization

Maternal and child health challenges in SA differ from those in the West. We adapted Ada's knowledge base to account for regional differences in incidence and disease presentation. We optimized 51 maternal and pediatric health conditions.

Readability

An improved readability leads to better understanding of medical content. We calculated the readability score of Ada's consumer-facing medical content using the Automated Readability Index and deemed it too high (grade 11.0±1.8, range=5.8-17.5). Using Content Design London's Readability Guidelines, we reduced the readability score of Ada's content to below grade 8 (7.4±0.8, range=4.6-10.2) while maintaining medical accuracy.

Different approaches to AI

The majority of medical research is conducted in high-income countries and tends to recruit people with high literacy levels. This means the differences in underrepresented populations and low-income countries are not captured in medical research. When this data is applied to technology and AI, it can lead to bias. To reduce this bias, we use a white-box approach. This allows us to deliver solutions to meet the needs of a specific population. Using the expertise of medical doctors with clinical experience in low-income areas, we curated a medical knowledge base that was specific to our target population.

Conclusions

AI solutions can only improve health outcomes in low-income countries if they are designed and adapted with the needs of the local population in mind. By partnering with local health departments, AI health companies can assist doctors and patients to reduce the burden on vulnerable healthcare systems.

Key messages

White-box AI-approach makes it possible to build AI solutions that capture the differences in underrepresented populations and low-income countries. By partnering with local health departments, AI health companies can assist patients and doctors in reducing the burden on vulnerable healthcare systems.
Support for decision-making on sharing health data for research: are data counsellors relevant?
Authors: De Freitas C , Silva S , Machado H , Baptista MJ , Leão Teles E , Maia T , Amorim M
Published: October 2021

Background

The implications of sharing one's health data are far-reaching. Potential applications of health data range from the delivery of treatments tailored to individuals' characteristics to improvements in public health, while also posing concerns about privacy, social justice and equity. Making informed decisions about health data sharing thus requires thorough consideration of the scientific, ethical and personal implications of donations. This study assessed participants' preferences regarding decision-making about health data sharing for research, including the need for support by data counsellors.

Methods

This observational cross-sectional study includes 159 patients and 479 carers followed at two reference centres for rare diseases in a Portuguese academic hospital, between June 2019 and March 2020. Participants were asked about preferred modes of decision-making: deciding on their own, deciding with support from another person, or delegating the decision to someone else. Those who responded the last two options also reported who they would choose for support or delegation: family or friends; a data counsellor; a professional with no specific training on data counselling; other. Data were analysed using descriptive and inferential statistics.

Results

The majority of respondents would prefer to decide with support (62%), 37% would prefer to decide on their own and 1% would opt to delegate the decision of sharing health data. Among those who expressed a preference for support, 60% would like to rely on a data counsellor. Carers, older and higher educated participants, and those with upper white-collar occupations and who were satisfied with their own health were significantly more likely to select data counsellors as their preferred source of support when engaging in decision-making about health data sharing for research (p < 0.05).

Conclusions

This study supports recommendations for the creation of a new professional specialty of health data counsellors.

Key messages

Most participants express the need for support in making decisions about health data sharing for research, with 60% preferring support from a data counsellor. As a new professional specialism, health data counselling can help to advance informed public participation in health research.
The Global use of Telemedicine in Tropical Medicine: Where we are after COVID-19?
Authors: Salvador FGF , Lapão LV
Published: October 2021

Issue

The use of Telemedicine (TM) to provide remote care is an important strategic resource for reducing inequalities in access to Public Health globally. Many countries with a high prevalence of Tropical Diseases (TD) have an insufficient number of physicians, but this potential for remote assistance is still largely untapped.

Description of the problem

A Scoping Review was combined with the SWOT technique (Strengths, Weaknesses, Opportunities, and Threats), which is a strategic analysis tool that enables action planning based on the evaluation of the interaction between the internal capacities of a process and external influencing factors. The SWOT analysis matrix of this study was based on a bibliographic research on the topic of TM applied to the clinical management of TD. It sought to obtain a characterization of the current global scenario, identifying (I) the contexts in which initiatives are being implemented and (II) the main gaps in the evidence. The objective is to subsidize action planning by healthcare systems, taking advantage of the expansion pandemic trend.

Results

A Scoping Review selected 41 studies. As strengths, the advances in the development of m-health tools for clinical and epidemiological monitoring of TD stood out, as well as some successful local experiences in implementing targeted TM systems. Among the weaknesses are infrastructure limitations and a lack of international cooperation initiatives. As for the opportunities, the context of the COVID-19 pandemic increased the importance of the topic on the health systems agenda and boosted investments in the sector. Regarding the threats, the scarcity of specific clinical guidelines and protocols and robust evidence on cost-effectiveness may be highlighted.

Lessons

The incorporation of TM in the qualification of clinical care for TD can have a relevant impact on the improvement of global public health indicators. The experience in such services is still scarce but represents an opportunity.

Key messages

There is a relevant potential in using Telemedicine to improve global access to Public Health in TD endemic areas. To support telemedicine there is the need to raise the awareness of managers, health workers and researchers about innovation in Tropical Diseases.
Comparing Digital Health Strategies and COVID-19 Response in European Union Member States
Authors: Rachadell J , Garcia T , Vareda R
Published: October 2021

Background

In 2019, Digital Health was on the agenda of the European Union (EU) and its Member States (MS), and the digital health transformation of both healthcare services and Public Health has been well underway for several years. The COVID-19 pandemic crisis required an unexpectedly quick adaptation of social norms and exerted great pressure on healthcare and public health systems. Although implemented strategies and results have varied, Digital Health tools emerged as a fundamental aspect of the pandemic fight across the EU.

Methods

The objective of this study was to determine and compare Digital Health Strategies and COVID-19 Response in EU MS 43% had no interoperability with other apps. We analyzed the 27 MS of the EU and determined several parameters relevant before and during the pandemic: 1 - Preexisting national digital health strategy in 2019; 2 - COVID-19 General Information Website; 3 - Real time updated COVID-19 online dashboard; 4 - Mobile application for contact tracing; 4.1 - Mobile app launch date; 4.2 - Interoperability with other mobile apps; 5 - Shift to telemedicine; 6 - Official public health communication through social media; 7 - Dedicated COVID-19 Information System for Public Health Workforce. Information from publicly available sources.

Results

All EU MS had a preexisting digital health strategy before the pandemic, developed a dedicated COVID-19 General Information Website and a COVID-19 dashboard with real-time updates on relevant statistics. The majority of MS (79%) developed a mobile app for contact tracing (43% had no interoperability with other apps), and of those that had not developed an app as of April 30th 2021, 50% had one under development. Most apps were launched in the first trimester of 2021. Other results were heterogeneous.

Conclusions

In some aspects, there is a clear convergence between EU MS in the deployment of digital health tools to fight the COVID-19 pandemic.

Key messages

All European Union Member States used digital health tools to fight the COVID-19 pandemic. The success of national level deployment of specific digital health tools must be assessed in order to develop a more integrated digital health response plan at the European level in the future.
Sex differences in psychosocial resources among people with chronic pain and with pain more seldom
Authors: Samulowitz A , Hensing G , Haukenes I , Bergman S , Grimby Ekman AE
Published: October 2021

Background

Despite the importance of psychosocial resources such as self-efficacy and social support for pain coping, sex differences in populations with and without chronic pain, and the impact of psychosocial resources on pain prospectively is sparsely examined.

Methods

Data from the Health Assets Project, a longitudinal cohort study with two data collections (2008 and 2009) in Sweden was used. We analyzed self-efficacy, emotional and instrumental social support among 1155 people with chronic pain and 2855 people with pain more seldom, including sex differences and the interaction between pain and sex. Among people with chronic pain we examined prospective associations between self-efficacy and social support in 2008 and pain in 2009. All regression models were analyzed unadjusted and adjusted for age, education and place of birth.

Results

People with chronic pain had lower psychosocial resources than people with pain more seldom (p<.001). People with pain more seldom showed sex differences for all psychosocial resources (p<.001), people with chronic pain did not show sex differences for instrumental social support. In addition, the interaction between sex and pain was significant for instrumental social support (p=.006, p=.005). Men with pain more seldom had the highest prevalence of low instrumental social support. High compared to low instrumental social support in 2008 was associated with lower odds of chronic pain in 2009, especially for women (OR = 2.2, 95%CI=1.19-4.28). The association between pain 2009 and the interaction between sex and high emotional social support was significant (p=.040). Women with high compared to low emotional support 2008 had 55% higher chance to have pain more seldom 2009, men had a 28% lower chance.

Conclusions

People with chronic pain showed less sex differences in psychosocial resources, compared to people with pain more seldom. In addition, for women, social support was associated with lower pain frequency during one-year follow-up.

Key messages

Men and women with chronic pain reported more alike on psychosocial resources than men and women with pain more seldom. For women only, both high instrumental and high emotional social support were associated with lower pain frequency during one-year follow-up.
Cardiovascular diseases as a reservoir for latent deaths from drug addiction (exemplified by Moscow)
Authors: Semyonova VG , Zubko AV , Sabgayda TP , Evdokushkina GN , Ivanova AE
Published: October 2021

The life expectancy gap between Russia and post-industrial countries is mainly due to mortality from diseases of the circulatory system (DCS), primarily in working ages, substantiating the need for a program to reduce cardiovascular mortality, currently implemented in Russia. In general, this program has resulted in a multiple reduction in cardiovascular mortality in Russia, however, in 2015-2017, Moscow turned out to be the absolute outsider among the Russian regions in DCS mortality among males of young and middle working ages and a contrastive outsider among females: in ages 15-29 mortality increased 4.4-fold among males and 3-fold among females; in ages 30-44 - 2.1-fold and 2.0-fold, respectively. The purpose of the study is to identify causes of the abnormal increase in mortality in Moscow in 2015-2017. The study shows that, first, the abnormal dynamics were due to cardiomyopathy, unspecified (CU) (I42. 9): the CU mortality in ages 15-44 increased 20-fold in males and 10-fold in females; in ages 45-59 - 7-fold and 8-fold, respectively, resulting in the highest ever CU mortality in Russia. Second, the CU deaths were usually sudden, not predated by a long-term treatment: admissions one month prior to death were registered in about 1% of cases in both sexes. Third, similar processes with the same reference point (2015) have been reported for drug poisoning, the rates of increase are comparable: about 10-fold in ages 15-29, 13 and 29-fold in ages 30-44 and 7.5 and 4-fold in ages 45-59, respectively. Fourth, numerous studies have shown that drug addiction (DA) leads to cardiovascular disorders, especially cardiomyopathies. Official data show that total DA mortality in Russia in the 2010s ranged from 3,752 to 5,581, which hardly corresponds to the actual scale of the problem because of underestimation of DA deaths due to their transferring to a latent form. In Moscow, DCS and cardiomyopathy, unspecified, in particular are one of the reservoirs for DA latent deaths.

Key messages

Drug addiction (DA) leads to cardiovascular disorders, especially cardiomyopathies. As to the capital, DCS, CU in particular, are one of the latent reservoirs of DA mortality.
Nutritional risk factors for SARS-CoV-2 infection: prospective study from the NutriNet-Santé cohort
Authors: Deschasaux-Tanguy M , Bourhis L , Druesne-Pecollo N , Esseddik Y , Galan P , Hercberg S , de Lamballerie X , Carrat F , Touvier M ,   SAPRIS-SERO study group, Paris, France
Published: October 2021

Background

Many hypotheses were raised regarding a role of nutrition in COVID-19 (susceptibility to infection, disease severity) based on the importance of macronutrients, vitamins or minerals for a proper functioning of the immune system. Our objective was to study the associations between dietary intakes and the seroprevalence SARS-CoV-2 infection in a large population-based sample.

Methods

Our analyses included 7766 adults from the French NutriNet-Santé cohort who provided at least 6 valid 24h dietary records in the two years preceding the start of the COVID-19 pandemic in France (February 2020). An ELISA assay was used to detect anti-SARS-CoV-2 antibodies: 311 participants were positive and 7455, negative. Associations between dietary intakes and the seroprevalence of anti-SARS-CoV-2 antibodies were investigated using multi-adjusted logistic regressions.

Results

A lower seroprevalence of SARS-CoV-2 infection was associated to higher intakes of vitamin B9 (HR = 0.84 (0.72-0.98)), vitamin C (HR = 0.85 (0.75-0.97)), vitamin K (HR = 0.86 (0.74-0.99)), dietary fibres (HR = 0.84 (0.72-0.97)), and fruit and vegetables (HR = 0.84 (0.74-0.97)). Higher intakes of calcium (HR = 1.17 (1.01-1.35)) and dairy products (HR = 1.19 (1.06-1.33)) associated to a higher seroprevalence of SARS-CoV-2 infection. No association was observed with other food groups or nutrients or with the overall diet.

Conclusions

Based on exhaustive seroprevalence data in a large population-based sample, our results suggested that higher intakes of vitamin C, folates, vitamin K, dietary fibres and fruit and vegetables were associated with a lower susceptibility to SARS-CoV-2 infection.

Key messages

Higher intakes of vitamin C, folates, vitamin K, dietary fibres and fruit and vegetables were associated to a lower susceptibility to SARS-CoV-2 infection, assessed with exhaustive seroprevalence data. Beyond its established role in the prevention of non-communicable diseases, nutrition could also contribute to prevent some infectious diseases such as COVID-19.
Comparison of all-cause mortality in England with Europe and the USA: January 2020 to February 2021
Authors: Lomas J , Brown N , Fitzpatrick J , Fryers P , Barnard S
Published: October 2021

Background

Assessing mortality during the COVID-19 pandemic is vital for informing public health strategies and policy decision making. All-cause excess mortality provides an objective measure of the impact of the pandemic including both the direct and indirect effects. Our study considers the burden of mortality in the UK, Europe and the USA. We examine variation between countries, by age and sex. We explore the extent to which this variation is associated with COVID-19 case rates and other population characteristics.

Methods

The study is a secondary analysis of routine administrative population and mortality data. Weekly death occurrences and population estimates were obtained from Eurostat and national statistical agencies. Contextual information on COVID-19 case rates, population-level risk factors and healthcare were obtained from various open-source databases. Weekly age-standardised mortality rates (ASMRs) were calculated and presented relative to a baseline average from the preceding 5-year period. Relative cumulative (rc) ASMRs were then calculated to provide a comparable assessment of excess mortality at a point in time.

Results

Preliminary results show that, by end of the analysis period, England had an overall rcASMR of 10.09%. Higher excess mortality was identified for some countries (eg USA 14.58%) and lower - even below average mortality - for others (eg Norway -6.8%). Under 65 rcASMR showed substantial variation between countries. Cumulative COVID-19 case rates showed a moderate effect size (R2 = 0.51) when used to explain the proportion of variation observed between rcASMRs. Other population factors showed a smaller effect.

Conclusions

The burden of mortality experienced between countries and populations over the COVID-19 pandemic period has shown significant variation. Factors which may have contributed to the position of some countries should be further explored in order to inform ongoing management of Covid-19 and future pandemic events.

Key messages

Significant variation in all-cause excess mortality has been identified across the COVID-19 pandemic period between nations and particularly in younger age groups. COVID-19 case rates are associated with relative cumulative all-cause excess mortality among the nations assessed.