bluuebunny/crossref_metadata_2025 huggingface dataset:
Green List Prevention - An Evidence Registry for Prevention and Health Promotion in Germany
Authors: Walter U , Brender R , Bremer K , Groeger-Roth F
Published: October 2023

Introduction

Evidence-based prevention and health promotion will be supported by practice-relevant evidence registries. The Green List Prevention provides an overview of evidence-based prevention programs for children and youth in Germany. It was modeled after the U.S. Blueprints for Healthy Youth Development in the context of the Communities That Care community prevention system. Programs are reviewed for conceptual, implementation, and evaluation quality and are categorized into three levels of evidence: (1) effectiveness theoretically well established, (2) ∼ likely, (3) ∼ proven. The Green List Prevention is used in communities, at state and national levels, and research. This paper provides insight into its content, keywording and enhancements.

Methods

To characterize the evidence-based programs, an inductive-deductive procedure was used to form 14 super- and 33 subcategories with 226 characteristic attributes. Based on these, all registry entries were categorized and summarized descriptively.

Results

The 100 programs listed (4/2023) address not only the primary target group of children and adolescents, but also secondary target groups (mainly teachers n = 53, guardians n = 46, educators n = 19) and are located in different environments (mainly school n = 61, family n = 28, kindergarten n = 23). Behavioral prevention on violence including bullying n = 64, addiction n = 47 and mental health n = 34 are in the foreground; topics such as nutrition (n = 3) and physical activity (n = 2) are little represented. Social and life skills programs (n = 61) and training for guardians (n = 25) are listed particularly often.

Conclusions

The Green List Prevention provides an overview of effective prevention and health promotion interventions for different contexts. Its current expansion to rate environmental and behavioral prevention measures on nutrition and physical

Key messages

• The Green List Prevention enables stakeholders to make a targeted selection of evidence-based programs and offers practice-relevant information e.g. main focus, program formats, implementation.

• The evidence register Green List Prevention supports evidence-based prevention and health promotion in Germany.
3.L. Round table: Vaccine Literacy and vaccination uptake for newly arrived migrants and people living in prisons
Authors:   Organised by: Infectious Diseases Control Section, Italian National Institute of Health, University of Pisa, Sapienza University of Rome (Italy),   Chair persons: Lara Tavoschi (Italy)
Published: October 2023

Health systems are complex and health organisations are often structured and operate in ways that make access to vaccination services difficult and inequitable for some marginalized populations. In addition, professionals may not be equipped to identify and address the cultural and social needs of these groups of people. The concept of vaccine literacy (VL) emphasizes that VL is not simply knowledge of vaccines, but also development of a less complex health system for communicating and offering vaccines as a conditions of a functioning health system (Ratzan, 2011). Newly arrived migrants (NAM) and people living in prisons (PLP) are two populations with overall low vaccination rates compared to the general population. Efforts to change this situation must emphasize activities not only geared toward increasing individual vaccine literacy, but more importantly supporting the system to become more vaccine literate. The general aim of the “Access to Vaccination for Newly Arrived Migrants -AcToVax4NAM” project is to improve the responsiveness of health systems in terms of vaccination literacy, making the conditions for access to vaccinations more equitable and guaranteed. Similarly, the “Reaching the hard-to-reach: increasing access and vaccine uptake among the prison population in Europe -RISE-Vac” aims to improve the health of people living in prisons in Europe by promoting staff and prisoners’ VL, enhancing vaccine offer and increasing vaccine uptake. During the workshop, AcToVax4NAM and RISE-Vac will discuss strategies and tools developed within these two EU co-funded projects (3rd EU Health Programme) to address vaccine literacy at the organizational and individual level for the particular target groups.

Key messages

• Individual and organisational vaccine literacy are equally important to increase vaccine uptake and vaccination coverage among disadvantaged communities.

• Intersectoral and multidisciplinary approaches are needed to tackle inequalities in access to prevention services including vaccination services.
Vaccine Literacy and “whole-of-prison” approach to increase vaccine uptake and vaccine coverage in prison settings
Authors: De Vita E
Published: October 2023

Prison settings are complex when it comes to healthcare services. The remit of healthcare provision may be with Ministry of Health or Ministry of Justice or combination of the two. Prison staff is also composed of custodial staff, HCW working in prison and other professionals, including educators, psychologists, etc. Within prison population deprived communities are overrepresented, and individuals often have multiple and complex health needs. Yet, equivalence to care between community and prisons is upheld by UN and European Prison Rules. In order to increase VL in prison, interventions need to respond to the existing complexity, tackling individual as well as organisational levels. Within RISE-Vac, tools have been prepared to engage prison staff and prison population. Participatory approach were used to conceptualised and develop the materials. An overview of the material content and development process will be provided, with a focus on the package tailored to PLP and the engagement of people with lived experience of incarceration.
Identifying high-risk subgroups for self-harm in young people
Authors: McEvoy D , Brannigan R , Walsh C , Arensman E , Clarke M
Published: October 2023

Self-harm in adolescents and young adults (AYAs) is the result of a complex interaction of biological, psychiatric, psychological, social, and cultural risk factors. A lot of research has already been conducted to identify the risk factors for self-harm in AYAs. On the other hand, there has been less research conducted on the simultaneous effects of, and the interactions between, multiple risk factors for self-harm in heterogeneous AYA individuals. In this study, we conducted a latent class analysis (LCA) of three waves from the Growing Up in Ireland (GUI) longitudinal cohort study at ages 13, 17 and 20 to identify homogenous subgroups of AYA individuals who exhibit similar risk markers for self-harm at these three time points. Then, we evaluated the risk that these subgroups ever self-harmed by age 17, self-harmed at age 20, or were persistently self-harming across both time points. The most at-risk group appeared to be the individuals aged 17 who had been diagnosed with depression/anxiety. Compared to the low-risk-marker group, the ‘diagnosed with depression/anxiety’ group had a 30-fold risk of self-harm at age 17, and 32-fold risk of persistently self-harming by age 20. The ‘undiagnosed but high depression’ group at this time point was also at significant risk of self-harm. This research enables us to understand which risk markers tend to co-occur together and will help to identify high-risk groups for self-harm both clinically and in the community. An investigation of risk markers like this can potentially be used in the design of public health interventions to reduce the burden of self-harm, and indeed suicide, in young people.

Key messages

• We identified sub-groups of young people with a high-risk of self-harm and suicide from the general population.

• These identifiable sub-groups can inform intervention policies and strategies for prevention programmes both in clinical and non-clinical settings like schools.
Quantifying missed opportunities in health sector for women and girls victims of violence in Albania
Authors: Ylli A , Sant Fruchtman C , Revenga Becedas R , Wallenborn J , Qirjako G , Cobos Munoz D
Published: October 2023

Health facilities are important contact points for victims of violence against women and girls (VAWG) in need of care. In Albania relevant data about health sector utilization remain scarce. This is a first attempt aiming to quantify missed opportunities for survivors of VAWG at the health system. We used a sample of 151 victims of VAWG, residents of Tirana Capital, retrieved from the dataset of Counseling Line for Women and Girls, a non-governmental agency. All cases were victims of physical violence during 2018-2022. For each case in the sample, health records for the same period were traced in Tirana hospitals and primary health care (PHC) facilities medical registries. Hospital records were traced for all 151 cases, while PHC records were completed only for the cases with a national ID. No case of VAWG was formally registered or reported by health services in Tirana in the 5 years prior to survey. Nonetheless, 51.5% of survivors had used PHC services and 20.4% had used hospital services during the same period. 8.6% had been at the emergency service of Trauma Hospital with acute symptoms of physical body harm and 12.5% had received obstetric-gynecologic care. The average number of visits at PHC for the women using the services was 3.3, ranging from 1 to 15 visits during 5 years. The most common reasons for the visits at PHC were chronic conditions (28.7%), followed by infection diseases (22.%) and mental illness (16.5%). Health sector opportunities to provide specific treatment and support to victims of VAWG are missed at multiple levels in Albania. While piloting integrated health and social care at selected PHC facilities in the country provide a good momentum for responding to some of the unmet needs, a more comprehensive agenda for the health sector should address physician's failure to identify and deal with VAWG as a health problem.

Key messages

• Health sector opportunities to provide specific treatment and support to victims of violence against women and girls are missed at multiple levels in Albania.

• Interventions in the health sector should address physician's failure to identify and deal with violence against women and girls as a health problem.
Pressure, bullying and low social support predict depressive symptoms and self-directed violence
Authors: Stea T , Bonsaksen T , Smith P , Kleppang A L , Steigen A M , Leonhardt M , Lien L , Vettore M V
Published: October 2023

Background

More in-depth evidence about the complex relationships between risk and protective factors and mental health among adolescents has been warranted. Thus, the aim of the study was to examine the direct and indirect effects of experiencing pressure, bullying, and low social support on depressive symptoms and self-directed violence in adolescence.

Methods

A cross-sectional study was conducted in 2022 among 15 823 Norwegian adolescents, aged 13-19 years. Structural Equation Modelling was used to assess the relationships between socioeconomic status, pressure, bullying, social support, depressive symptoms, self-harm and suicide thoughts.

Results

Poor family economy and low parental education predicted high pressure, bullying, low parental support and depressive symptoms in males and females. Further, high pressure predicted depressive symptoms among males and females, and self-harm and suicide thoughts among females, but not males. Bullying predicted depressive symptoms, self-harm, and suicide thoughts among males and females. Low parental support predicted bullying, depressive symptoms, self-harm and suicide thoughts among males and females, and high pressure among females, but not males. Low teacher support predicted high pressure, depressive symptoms, whereas low friends support predicted bullying, depressive symptoms and suicide thoughts among males and females, and self-harm among males, but not females. Results also showed that depressive symptoms predicted self-harm and suicide thoughts among males and females. Finally, pressure, bullying and depressive symptoms were the main mediators by which family economy, parental education, friends support, teacher support and parental support predicted self-harm and suicide thoughts.

Conclusions

Low socioeconomic status, pressure, bullying and low social support were important predictors of depressive symptoms and self-directed violence among Norwegian adolescents through direct and indirect mechanisms.

Key messages

• These results also provide increased knowledge about how multiple risk and protective factors across domains impact both depressive symptoms, self-harm and suicide thoughts among adolescents.

• This study highlights the importance of policies aiming at reducing economic and social inequalities, as they may also improve youth mental health.
Risk factors for domestic violence during the COVID-19 pandemic-a multi-country longitudinal survey
Authors: Palantza C , Witteveen A B , Patanè M , Pinucci I , Sijbrandij M
Published: October 2023

Background

A pressing public health issue exacerbated by the COVID-19 pandemic is domestic violence. The lockdowns harshened its major risk factors, such as financial strain, substance use, low social support, and also confined victims with their abusers. Cross-sectional studies confirm most of these associations, but longitudinal evidence is lacking. We investigate the association of domestic violence victimisation with these factors across the stages of the pandemic internationally and the characteristics linked with first vicitmisation in the pandemic.

Methods

We used four waves of an online survey of the adult general population of 14 countries in five continents in May 2020-May 2022 (N = 6051). Partner and child abuse were assessed with single items, sociodemographics and COVID-19 related data with Likert-type items, substance use and social support with validated scales. The Oxford Lockdown Stringency Index was used. Differences by onset of violence were tested with chi-squared, ANOVA and Kruskal-Wallis tests, and the associations with mixed effects logistic regression.

Results

Results are preliminary. Survivors with onset of violence before and during the pandemic were quite similar and differed from those not victimised in financial strain and social support. Social support (OR .83 CI .76-.91), employment status, especially unemployed (OR 5.24 CI 1.98-13.87), and polysubstance abuse (OR 2.22 CI 1.25-3.95) significantly predicted violence across time controlled for demographics. Lockdown stringency had no significant effect (OR 1.0 CI .98-1.01).

Conclusions

The findings are in line with the literature and clarify that the most robust financial strain proxy across time is unemployment. Pre-existing demographic, economic and health-related vulnerabilities remain impactful across countries and individuals, so screening by healthcare providers for victimisation should be targeted and policies should focus on maintaining financial stability, particularly in the long run.

Key messages

• The socio-economic repercussions of the COVID-19 pandemic are more impactful than confinement on the long-term risk of domestic violence internationally.

• Cases of domestic violence with onset during the pandemic show similar socio-economic vulnerabilities as those with onset before.
Factors associated with discrimination in GPs’ decisions towards migrants with mental health problems
Authors: Duveau C , Wets C , Delaruelle K , Demoulin S , Dauvrin M , Lepièce B , Ceuterick M , De Maesschalck S , Bracke P , Lorant V
Published: October 2023

Background

Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of individual (e.g. age and ethnicity), interpersonal (e.g. provider trust), and organizational (e.g. perceived workload) factors on general practitioners’ (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with a MB and for a depressed patient without a MB.

Methods

An experimental study was carried out in which GPs were shown one of two video-vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797) had to decide on their diagnosis, treatment, and referral. ANOVA and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables.

Results

Overall, we found that there were ethnic differences in GPs’ decisions regarding diagnosis and treatment recommendations (F = 3.56, p < 0.001). GPs also considered the symptoms of the patient with a MB less severe (F = 7.68, p < 0.01) and were less likely to prescribe a combination of medical and non-medical treatment to patients with a MB (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was malingering or exaggerating his distress.

Conclusions

This paper showed that GPs’ trust in their patients and GPs’ workload affect ethnic bias in medical decisions. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs’ trust in their migrant patients.

Key messages

• This research provides an insight into the discriminatory decisions made by GPs in mental healthcare.

• Future research should take interpersonal and organizational factors into account when developing new interventions to improve quality of care for migrants with mental health problems.
Reproducing differential racialisation: social triage in migrant mental health services in England
Authors: Mladovsky P
Published: October 2023

In England, coverage for treatment of post-traumatic stress disorder (PTSD), a health condition that disproportionately affects forced migrants, is universal, in principle provided free of charge to all. Yet, multiple informal access barriers typically arise and informal systems of social triage may emerge. Using intersectional analysis, this study asks what political and moral rationalities inform social triage in the NHS. It is particularly attentive to how and why a supposedly universal service reproduces differential racialisation, in which multiple and co-existing populations are stratified and ranked as more or less belonging to a nation. Fieldwork was conducted in two waves, in 2015-2016 and in 2019-2021. It included six months of participant observation in an NGO; 21 semi-structured interviews with health professionals across 16 different NHS and NGO service providers, purposively sampled until saturation was reached; six interviews with mental health commissioners and national policymakers; and analysis of grey literature. Transcripts and fieldnotes were analysed inductively to identify themes using NvivoR1. Results were validated by interviewees. Despite being covered, undocumented migrants and asylum seekers were systematically excluded from NHS PTSD services, through social triage. People with refugee status were prioritised. Mental health care providers consciously and subconsciously reproduced differential racialisation, which generated health inequality. This was facilitated by: austerity; omitting immigration status in measurement of health inequality; securitisation of mental health services and minoritised Muslim populations; and bifurcated activism in which the forced migrant sector was disconnected from established struggles to combat racism in mental health care. Policies extending coverage to undocumented migrants and asylum seekers must be accompanied by extra monitoring, as well as financial, political and social support to service providers.

Key messages

• Health professionals informally, but systematically, reproduce differential racialisation in the rationing of health care through practices such as obfuscation and silencing critique.

• Informal systems of social triage erode universal health coverage. This is exacerbated in contexts of austerity, where health professionals use their discretion to ration limited resources.
Mortality gradient by education: differences between natives and immigrants in Italian Census cohort
Authors: Ventura M , Leone S , Di Napoli A , Petrelli A , Pappagallo M , Grande E , Frova L
Published: October 2023

Background

A socioeconomic mortality gradient, favourable to the most advantaged social groups, has been documented in both high migratory pressure (HMPCs) and highly developed Countries, including Italy. However, little is known on how this association differs between natives and immigrants. This study aimed at comparing the mortality gradient by education among these population groups, evaluating differences for macro-area of origin or citizenship.

Methods

Using a longitudinal design, the 2011 Census population was followed up to 2019. All-cause mortality was retrieved by record linkage with the Causes of Death register. The association of education (as the main exposure) and social class (based on the Erikson and Goldthorpe classification) with mortality was evaluated in subject aged 30-64, separately by sex, citizenship/macro-area of origin. Mortality rate ratios (MRR) and 95% confidence intervals were estimated using negative binomial regression models, adjusted for age and area of residence.

Results

23,572,516 subjects (7% immigrants from HMPCs) and 410,746 deaths (3% from HMPCs) were analysed. Among natives, a mortality gradient by education was observed (low/high MRR: 2.37[2.16-2.60] males; 1.79[1.64-1.96] females), whereas a weaker association without trend was found for HMPCs immigrants (MRR: 1.12 [1.00-1.25] males; 1.12[1.00-1.26] females). A higher mortality for less educated was observed for males from Romania, India, China, and for females from Central-Eastern Europe, Sub-Saharan Africa and Central and South America. A lower mortality was found for the least educated from Morocco.

Conclusions

The higher mortality among less educated subjects is confirmed among natives, while it is less evident in immigrants from HMPCs. However, differences observed between citizenships, macro-areas of origin, and sex, highlight the need for social policies accounting for specific risk factors and cultural specificities affecting correct lifestyles and health services access.

Key messages

• A mortality gradient by education was found among natives in Italy, whereas a weaker association without trend was observed for immigrants from high migratory pressure Countries.

• The differences observed between citizenships or macro-areas of origin, and sex, highlight the need for social and health policies culturally oriented to specific target population.
Regulatory approaches to front-of-pack nutrition labelling
Authors: Gokani N
Published: October 2023

Even though nutrition labelling has been regulated by the EU since the 1990s, the tactics of industry, with the support of a minority of Member States, have prevented effective measures on front-of-pack nutrition labelling (FoPNL). In its Farm to Fork Strategy, the European Commission committed to introduce legislative proposals for harmonised front-of-pack nutrition labelling by the end of 2022. The deadline has passed and no indications appear of matters moving forward. This is even more concerning for public health as the current regulatory framework prohibits interpretive FoPNL, fails to guide Member States towards well-designed schemes, and prohibits schemes becoming mandatory.
Identifying quantitative evidence-based parameters to monitor emerging resistance to new antibiotics
Authors: Arieti F , Garlasco J , Magrini E , Tebon M , Compri M , Babu Rajendran N , Pezzani M D , Tacconelli E
Published: October 2023

Background

Antimicrobial resistance (AMR) has a major public health burden, and newly-approved molecules have shown fast emerging of resistance. This study aims at assessing and developing an innovative framework to monitor and benchmark emerging resistance to new antibiotics in Europe.

Methods

Within the European ECRAID-Base project and the EPI-Net platform, data were extracted at two levels: reporting of emerging resistance to the 12 new antibiotics approved by EMA since 2012 and related outbreaks, and active resistance monitoring in national surveillance systems in 32 European countries. The burden of emerging resistance was measured through the following indicators: time lag between approval and first resistance report, average number of outbreaks, trend in the number of yearly publications standardised by the logarithm of the total number and weighted by the pooled resistance rate, and inclusion of new antibiotics in national surveillances.

Results

Overall, 956 articles reported resistance to new antibiotics since 2012. Resistance to ceftolozane-tazobactam (CLZ-TAZ) was the most reported, followed by ceftazidime-avibactam (CAZ-AVI); resistance to eravacycline and delafloxacin was less reported. For 6 antibiotics, resistance occurred within one year of approval. Out of 35 surveillance systems reviewed, only 13 (in 12 countries) included at least one new antibiotic; CLZ-TAZ and CAZ-AVI, monitored in 11 and 12 countries respectively, were the most surveyed. Resistance trends showed greater increase for imipenem-relebactam, CAZ-AVI, and meropenem-vaborbactam. Nine outbreaks were detected, including 136 patients: CAZ-AVI was responsible for the highest number of outbreaks (five).

Conclusions

Resistance was detected to new antibiotics, yet very few countries have active monitoring systems to detect it. Appropriate monitoring and benchmarking of emerging resistance to new antibiotics is pivotal to support careful antibiotic policies at country and global level.

Key messages

• Emerging resistance to new antibiotics was assessed through quantitative parameters: some drug combinations would deserve further attention, given the increased resistance reports and surveillance gap.

• Analysis of these parameters might suggest that combinations of existing agents are prone to developing resistance, and hence support focusing research on the development of novel-class drugs.
Individual exposure to multiple pollutions (air, noise, ELF-EMF) in daily-life microenvironments
Authors: Salmon A , Bouland C
Published: October 2023

Introduction

Environmental pollutions are numerous and ubiquitous. Urban citizens are continuously exposed to several kind of pollutions. To assess these exposures and identify they sources, data collection at an individual level gives a more detailed picture of the multiple exposure and the microenvironments to which it is attributable [1,2,3,4].

Protocol

The study combines individual measurements of exposures of 490 Brussels inhabitants, reporting on their localization and duration, and perception of health and quality of life. The protocol integrates 3 main tools:

1. Portable devices measure individual exposure during 24 hours of a normal weekday.

a. Airbeam 2® measures PM1, PM2.5 and PM10 every 1sec.

b. Smartphone measures noise levels every 1sec., registers GPS data and is equipped with the application Aircasting® to transfer data.

c. EMDEX II® measures 50Hz electromagnetic fields every 3sec.

2. A diary reports the environments in which the participant is staying every 15min.

3. A questionnaire (standardized and based on the literature questions) focuses on socio-economic aspects, lifestyle, perception of health, and perception and knowledge of exposure.

Preliminary Results

Means of exposure of noise levels by microenvironments: kitchen= 51,31 (6,13) dB, living room = 46,04 (6,71) dB, dining room = 48,39 (8,00) dB, sleeping room = 28,95 (5,24) dB.

Means of exposure to PM 2.5 by microenvironments: kitchen= 14,62 (49,47) µg/m3, living room= 14,68 (64,58) µg/m3, dining room = 19,51 (94,26) µg/m3.

Conclusions

With further analysis, the data collected will allow characterizing each type of environment reported (for ex.: living room, kitchen, park, car, biking in the city, ...) regarding their exposure to multiple pollutants combined(air, noise, low-frequency electromagnetic fields). Next to the study of the scientific literature, the results will enable target recommendations on exposure prevention, considering the potential synergies due to co-exposures.

Key messages

• A detailed knowledge of multiple exposures at an individual level and their sources is neccessary to tackle the issue.

• Exposure to different type of pollutions impact similar systems of the human organisms and studies on their combined effects and potential synergies are relevant.
Detection and management of tuberculosis in Tunisia: challenges and outcomes
Authors: Mansouri A , Bouguerra H , Belkahla M , Gzara A
Published: October 2023

Introduction

Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. In Tunisia, where TB remains endemic, the national control program ensures free vaccination, free outpatient TB treatment in addition to early detection of cases and directly observed treatment short course. However, available data on these activities and outcomes are limited. The objective of this study was to describe the evolution of TB detection and management indicators and outcomes from 2018 to 2021.

Methods

We analyzed data collected part of the epidemiological investigations of notified cases and active search for cases over a period of 4 years (2018-2021). In each governorate, dedicated teams collect samples from cases’ contacts for microscopic sputum examination for screening and ensure patients’ follow-up. All data related to contact tracing, treatment and outcomes were collected, entered and analyzed using SPSS-21.

Results

The number of screened cases decreased from 30337 in 2018 to 16045 in 2021. The number of investigations of reported cases also decreased; from 2408 in 2018 to 1295 in 2021 (proportion of 74.6% to 48.9% respectively). However, the percentage of positives increased from 1.4% to 2.1%. In 2021, therapeutic success was recorded among 81% of cases (compared to 86% in 2018). From 2018 to 2021, there was an increase in three indicators: fatality rate (1.55 to 2.53%), discontinuation of treatment (from 2.5% to 3.2%) and the proportion of multidrug-resistant TB cases (0.45 to 0.69%).

Conclusions

Despite free care and treatment, our study showed challenges in the prevention and management of TB. Several activities of the national tuberculosis program have decreased, probably due to the pandemic, as noted in general preventive and care activities worldwide. More education and awareness efforts should be made, not only for patients and their contacts, but also for health care professionals, to be more vigilant in early case detection and continued treatment.

Key messages

• Several activities of the national tuberculosis program have decreased from 2018 to 2021, probably due to the pandemic.

• From 2018 to 2021, there was an increase in the fatality rate, discontinuation of treatment and multidrug-resistant TB cases.
Unraveling COVID-19 investigation hurdles with viral genomics
Authors: Sá R , Isidro J , Borges V , Duarte S , Vieira L , Gomes J P , Tedim S , Matias J , Leite A
Published: October 2023

In the context of a COVID-19 outbreak, identifying transmission chains is crucial for effective public health response. However, relying solely on epidemiological investigation can lead to misidentification of links. This study aimed to assess the concordance between epidemiologically linked cases and viral genetic profiles in the Baixo Vouga Region of Portugal, from March to June 2020. We conducted a retrospective analysis of 1925 COVID-19 cases, of which 1143 were assigned to 154 epiclusters. Viral genomic data was available for 128 cases. We used this data to assess the accuracy of the initial transmission dynamics reconstruction, identify misidentified links, and resolve sporadic cases. Public health authorities identified two large epiclusters with a central role in disease spread, but the genomic data revealed that each epicluster included more than one transmission network. The increasing size of epiclusters and their extension to densely populated settings triggered the misidentification of links. Genomics also helped resolve some sporadic cases and misidentified directions of transmission. The epidemiological investigation had a sensitivity of 70%−86% in detecting transmission chains. Our findings demonstrate the challenges associated with the epidemiological investigation of hundreds of community cases in the context of a massive outbreak caused by a highly transmissible and new respiratory virus. We recommend incorporating viral genomics into outbreak investigations to improve the accuracy of transmission chain reconstructions. This could lead to the development of more effective public health actions such as prevention activities, policies, and surveillance systems. The innovative use of genomics in epidemiological investigations can have a significant impact on public health outcomes.

Key messages

• Large COVID-19 epiclusters and densely populated settings led to misidentified links. Epidemiological investigation had 70%−86% sensitivity to detect chains.

• Using viral genomics in outbreak investigations can improve accuracy of transmission chain reconstructions, helping to resolve misidentified links and sporadic cases.
Neighborhood deprivation and household socioeconomic status as risk factors for diabetes in Brussels
Authors: Van der Heyden J , Missine S , Charafeddine R , Demarest S
Published: October 2023

Background

Socioeconomic (SE) differences in diabetes prevalence have been shown both at the individual and neighborhood level. Disentangling the role of SE determinants of diabetes at different levels can help to identify more targeted strategies to reduce SE differences in diabetes prevalence. As contextual factors may differ it is important to explore this in different settings. In this study we investigated the association of diabetes with household socioeconomic status (SES) and neighborhood deprivation in Brussels taking into account individual risk factors.

Methods

The study sample included participants ≥ 15 years of the Belgian National Health Interview Survey (HIS) 2013 and 2018 residing in Brussels (n = 5045). Information on neighborhood deprivation, assessed through a composite indicator (income, employment, nationality,..), was linked to the HIS data. A multilevel analysis was conducted to assess the association of self-reported diabetes with household SES and neighborhood deprivation adjusting for age, sex, obesity, nationality and country of birth.

Results

The overall prevalence of diabetes in the study sample was 6.8%. Individual risk factors associated with a higher diabetes prevalence were older age, obesity and being born outside the EU. Belonging to a household with a low income (OR 2.3;95% CI 1.2-2.5 - ref. highest income group), low education at household level (OR 1.6;95% CI 1.0-2.5 - ref. highest education group) and living in a deprived neighborhood (OR 2.0, 95%CI 1.3-3.1 - ref. living in wealthy area) were all independently associated with a higher diabetes prevalence.

Conclusions

Neighborhood deprivation and low household SES are independent risk factors of diabetes. Actions to reduce SE differences in diabetes prevalence should take into account determinants at the individual, household and neighborhood level. Further research should explore the role of environmental risk factors to explain the higher diabetes prevalence in deprived areas.

Key messages

• Differences in diabetes prevalence between rich and poor neighborhoods remain when accounting for individual characteristics and household socioeconomic status.

• Environmental factors may explain the higher diabetes prevalence in deprived neighborhoods.
Vulnerability to heatwaves: a scoping review of prevention programs. Results from the ENBEL project
Authors: Mazzalai E , De’ Donato F , De Sario M , Michelozzi P
Published: October 2023

Background

This study, conducted as part of the European ENBEL project (Horizon 2020), aims at synthesising the scientific evidence on heat health preventive measures targeting vulnerable populations, considering other environmental co-exposures, such as air pollution, wildfires and droughts.

Methods

A scoping review was performed on Medline and Embase (Ovid) through search terms on clinical and social vulnerabilities, health outcomes (morbidity, mortality, hospitalisation), heatwaves, droughts, air pollution, wildfires, and preventive measures. Records in English published between 2000 and 2023 were included and screened according to PRISMA guidelines.

Results

8608 records were retrieved, 5895 of which screened after duplicate removal. 51 were included in the qualitative synthesis. The interventions, mainly targeting workers (from agriculture, healthcare, waste management, firefighting and military sectors) and school athletes, were the most evaluated preventive measures. The role of hydration, rest in the shade, cooling cloths and food, and acclimatisation procedures were highlighted for both groups. On the other hand, local prevention plans, mainly from high-income Countries, focused on the elderly, adults in poor health conditions, homeless and institutionalised people. The implemented measures concentrate on cooling interventions, provision of health care and social services, education and information campaigns. Regarding co-exposures, a study on prevention for firefighters and one on the implementation of Clean Air Centres in California for people vulnerable to heat and smoke were retrieved. A search of the grey literature will be performed to avoid publication bias.

Conclusions

There is still limited evidence on the effectiveness of preventive measures aimed at protecting vulnerable subgroups from heat-related health effects. The present findings can help orient the public health agenda and research priorities on climate changes adaptation measures.

Key messages

• Heatwaves are more frequent due to climate change, putting vulnerable population at risk. Developing plans and programs aimed at reducing negative health outcomes related to heat should be a priority.

• Hydration, rest, and acclimatization procedures reduce heat-related illnesses in workers and athletes. Local prevention plans for the elderly show the role of education and information.
The burden of ischemic stroke due to air pollution in ten European countries
Authors: Vojvodic K , Todorovic J , Terzic Supic Z , Stojisavljevic S , Devleesschauwer B
Published: October 2023

Background

Stroke is one of the leading causes of disability worldwide and there are many reports that the higher risk of ischemic stroke is associated with air pollution. It is noted that the adverse effects of air pollution on health are still invisible and not enough communicated to patients and health professionals.

Methods

Within the European Burden of Disease Network (COST Action CA18218), we analyzed Disability-Adjusted Life-Years (DALY) rates associated with ischemic stroke per 100,000 among all ages attributable to air pollution. Estimates were taken from the Global Burden of Disease Study 2019, for ten countries with the highest DALY rates per 100,000 ischemic strokes in 2019: Bulgaria, North Macedonia, Montenegro, Georgia, Serbia, Romania, Ukraine, Russian Federation, Bosnia and Herzegovina and Latvia.

Results

The highest DALY rate per 100,000 ischemic strokes was in Bulgaria (7016.81), followed by North Macedonia (5773.40), Montenegro (5119.61), and Georgia (4967.42). The highest DALY rate attributable to air pollution was in North Macedonia (1462.61), followed by Bulgaria (1240.13), Montenegro (1052.21), and Serbia (1037.41). The highest percentage of ischemic stroke attributable to air pollution was in Bosnia and Herzegovina (25.66%), North Macedonia (25.32%), Serbia (21.23%), and Montenegro (20.55%).

Conclusions

Air pollution is a significant contributable factor in the prevalence of ischemic stroke. In observed countries, more than 20% of the ischemic stroke burden is attributable to air pollution. The highest DALY rate attributable to air was in Balkan countries.

Key messages

• The highest DALY and the highest percentage of ischemic stroke attributable to air pollution were in Balkan countries.

• There is an emerging need for public health regulations and policies in order to reduce air pollution and stroke.
The role of health insurance literacy in the process and outcomes of choosing an insurance policy
Authors: Holst L , Brabers AEM , Rademakers JJDJM , de Jong J D
Published: October 2023

Background

Several countries have healthcare systems that require their citizens to make informed and thoughtful decisions about which health insurance policy fits their needs and preferences best. There are indications that citizens do not always have sufficient skills, so called health insurance literacy (HIL), to do this. This can lead to citizens being sub-optimally insured, suffering inadequate coverage and facing unexpected costs. This study aims to investigate whether the level of HIL among Dutch citizens is related to the way in which they experience the process of choosing a policy, and furthermore whether it is related to their health insurance choices.

Methods

A mixed-mode questionnaires was distributed to 1,500 participants of the Nivel Dutch Health Care Consumer Panel in February 2020. The response rate was 54% (n = 806). Regression analyses were performed to gain a better understanding of the association of HIL with the process and outcomes regarding the choice of a health insurance policy.

Results

Respondents with a low HIL, in comparison to those with a high HIL, find choosing a health insurance policy more often difficult, not interesting, and boring, and less often consider it important and worthwhile (p < 0.01 for all). Also, they make less use of their opportunity to switch from one health insurer to another (p < 0.05). However, they do opt for a supplementary insurance policy and a voluntary deductible to the same extent as respondents with a high HIL.

Conclusions

The level of HIL among Dutch citizens is related to the way they experience the process of choosing a health insurance policy, and to the extent to which they switch from one health insurer to another, but not to their health insurance choices. It is important to get a better understanding of the barriers citizens with a low HIL experience during this process, and of their needs and preferences.

Key messages

• The level of HIL is related to the way Dutch citizens experience the process of choosing a health insurance policy.

• Compared to those with a high HIL, Dutch citizens with a low HIL switch health insurers less often, but opt for a supplementary policy and a voluntary deductible to the same extent.
Skills4 Health Literacy– Nordic project promoting capacity building on health literacy and dementia
Authors: Wångdahl J , Sørensen K , Gramstad A , Hoffrén-Mikkola M , Korsbakke Emtekær Hæsum L ,   For the Skills4 Health literacy Consortium
Published: October 2023

Background

An increasing proportion of the population is living with dementia and need health- and social care. People with limited health literacy have difficulties with accessing, understanding, appraising, and applying health information to promote and maintain health. Knowledge about how to promote health literacy is limited among health- and social care providers although such knowledge is important to be able to work person-centered and to reduce the risk of unequitable health and health care. As a response to this, the Erasmus+ project Skills 4 Health Literacy is conducted in the period 2022-2025. The project's overall aim is to meet the needs of higher education institutions in training future and current health and social care professionals, through digital education technologies, to promote health literacy capacity-building when supporting persons at risk of dementia to deliver relevant and personalized interventions.

Methods

A review of research, policies, and curriculums, and four focus group discussions and 14 individual interviews with experts from with a wide range of social and health care sites in Denmark, Finland, Norway, and Sweden.

Results

We developed a competence profile for health- and social care workers highlighting which knowledge, skills, and abilities they need to promote and take health literacy into account when working with people at risk of dementia and relatives to those. Thereafter, we developed, and pilot tested health literacy courses (1 classroom-based, 1 traditional online and 1 MOOC) based on this competence profile, in three of the Nordic countries.

Conclusions

There is a need for health literacy training among health- and social care workers in the Nordic countries. This project suggests a consensus-build competency profile to further develop the capacity building within health and social care and dementia with regards to health literacy training.

Key messages

• Health- and social care workers in the Nordics who meet elderly need training in health literacy.

• A competence profile and health literacy courses have been developed to meet those needs.
Health literacy and unhealthy lifestyle behaviors in older adults: does social connectedness matter?
Authors: Wieczorek M , Meier C , Kliegel M , Maurer J
Published: October 2023

Background

Given the high prevalence of low health literacy (HL), the lifestyle-related morbidity, and the importance of the social environment in later life, we aimed to investigate the association between HL and unhealthy lifestyle behaviors and explore the moderating role of social connectedness in this relationship in a population-based sample of adults aged 58+.

Methods

We used data from 1,455 respondents to Wave 8 (2019/2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) in Switzerland. Current smoking, risky alcohol consumption, suboptimal daily consumption of fruits/vegetables, and lack of engagement in physical activity were considered to derive the number of unhealthy behaviors. Three HL categories were defined based on the HLS-EU-Q16 score: inadequate, problematic, and sufficient. Social connectedness was assessed using the Social Connectedness Scale. Associations were examined using Poisson regression models, controlling for sociodemographic and health characteristics and including an interaction term between HL and social connectedness to test the moderation hypothesis.

Results

Overall, 72.2% of respondents reported at least one unhealthy behavior, 6.6% had inadequate HL, and 19.8% were socially isolated. Respondents who had inadequate HL were more likely to have a higher number of unhealthy behaviors than those with sufficient HL (Average marginal effect (AME)=0.22, p < 0.01). We found a significant interaction between HL and social connectedness (p = 0.04), with a stronger positive association between inadequate HL and the number of unhealthy behaviors in socially isolated individuals (AME=0.34, p < 0.05).

Conclusions

Greater social connectedness seems to buffer the positive association of low HL with unhealthy lifestyle behaviors in older adults. Implementing tailored interventions aimed at improving HL may foster the adoption of healthy lifestyles, especially in socially isolated older individuals.

Key messages

• Social connectedness may mitigate the negative impact of low HL on the number of unhealthy behaviors, highlighting the importance of social reserve in making healthy lifestyle choices in later life.

• Implementing HL-tailored health-promoting lifestyle interventions, including family or community components, would help tackle the double burden of low HL and unhealthy behaviors in older adults.