bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptive multivariate dispersion control chart with application to bimetal thermostat data
Authors: Noor-ul-Amin Muhammad , Sarwar Muhammad Atif , Emam Walid , Tashkandy Yusra , Yasmeen Uzma , Nabi Muhammad
Published: October 2023

Adaptive EWMA (AEWMA) control charts have gained remarkable recognition by monitoring productions over a wide range of shifts. The adaptation of computational statistic as per system shift is the main aspect behind the proficiency of these charts. In this paper, a function-based AEWMA multivariate control chart is suggested to monitor the stability of the variance–covariance matrix for normally distributed process control. Our approach involves utilizing an unbiased estimator applying the EWMA statistic to estimate the process shift in real-time and adapt the smoothing or weighting constant using a suggested continuous function. Preferably, the Monte Carlo simulation method is utilized to determine the characteristics of the suggested AEWMA chart in terms of proficient detection of process shifts. The underlying computed results are compared with existing EWMA and existing AEWMA charts and proved to outperform in providing quick detection for different sizes of shifts. To illustrate its real-life application, the authors employed the concept in the bimetal thermostat industry dataset. The proposed research contributes to statistical process control and provides a practical tool for the solution while monitoring covariance matrix changes.
Plant strategies for greatest height: tapering or hollowing
Authors: Kanahama Tohya , Sato Motohiro
Published: October 2023

The tapered form and hollow cross-section of the stem and trunk of wild plants are rational mechanical approaches because they facilitate the plant simultaneously growing taller for photosynthesis and supporting its own weight. The purpose of this study is to clarify the advantages and disadvantages of tapering and hollowing from the perspective of the greatest probable height before self-buckling. We modelled woody plants using tapering or hollow cantilevers, formulated the greatest height before self-buckling, and derived a theoretical formula for the greatest probable height considering tapering and hollowing. This formula theoretically explains why almost all plants exhibit a tapered form: it allows for a greater height at an earlier growth stage than a hollow cross-section.
Complex network analysis techniques for the early detection of the outbreak of pandemics transmitted through air traffic
Authors: Fragua Ángel , Jiménez-Martín Antonio , Mateos Alfonso
Published: October 2023

Air transport has been identified as one of the primary means whereby COVID-19 spread throughout Europe during the early stages of the pandemic. In this paper we analyse two categories of methods – dynamic network markers (DNMs) and network analysis-based methods – as potential early warning signals for detecting and anticipating COVID-19 outbreaks in Europe on the basis of accuracy regarding the daily confirmed cases. The analysis was carried out from 15 February 2020, around two weeks before the first COVID-19 cases appeared in Europe, and 1 May 2020, approximately two weeks after all the air traffic in Europe had been shut down. Daily European COVID-19 information sourced from the World Health Organization was used, whereas air traffic data from Flightradar24 has been incorporated into the analyses by means of four alternative adjacency matrices. Some DNMs have been discarded since they output multiple time series, which makes it very difficult to interpret their results. The only DNM outputting a single time series does not emulate the COVID-19 trend: it does not detect all the main peaks, which means that peak heights do not match up with the increase in the number of infected people. However, many combinations of network analysis based methods and adjacency matrices output good results (with high accuracy and 20-day advance forecasts), with only minor differences from one to another. The number of edges and the network density methods are slightly better when dynamic flight frequency information is used.
Proteomic characterization of aging-driven changes in the mouse brain by co-expression network analysis
Authors: Tsumagari Kazuya , Sato Yoshiaki , Aoyagi Hirofumi , Okano Hideyuki , Kuromitsu Junro
Published: October 2023

Brain aging causes a progressive decline in functional capacity and is a strong risk factor for dementias such as Alzheimer’s disease. To characterize age-related proteomic changes in the brain, we used quantitative proteomics to examine brain tissues, cortex and hippocampus, of mice at three age points (3, 15, and 24 months old), and quantified more than 7000 proteins in total with high reproducibility. We found that many of the proteins upregulated with age were extracellular proteins, such as extracellular matrix proteins and secreted proteins, associated with glial cells. On the other hand, many of the significantly downregulated proteins were associated with synapses, particularly postsynaptic density, specifically in the cortex but not in the hippocampus. Our datasets will be helpful as resources for understanding the molecular basis of brain aging.
Effect of the phosphorylation structure in casein phosphopeptides on the proliferation, differentiation, and mineralization of osteoblasts and its mechanism
Authors: Zhong Wanying , He Jian , Huang Wen , Yin Guangling , Liu Guo , Cao Yong , Miao Jianyin
Published: October 2023

Our study demonstrated that the highly phosphorylated casein phosphopeptide (residues 1-25) P5 efficiently promoted proliferation, differentiation, and mineralisation of MC3T3-E1 cells, and its phosphorylation structure also efficiently induced EGFR binding.
Nutritional composition, health-promoting effects, bioavailability, and encapsulation of tree peony seed oil: a review
Authors: He Wen-Sen , Wang Qingzhi , Zhao Liying , Li Jie , Li Junjie , Wei Na , Chen Gang
Published: October 2023

TPSO stands out not only for its abundance of n-3 PUFAs but also for the presence of various important minor components that offer diverse health benefits. TPSO holds great potential as a superior oil that deserves global recognition and promotion.
Dehydroabietane-type bifunctional organocatalysts in asymmetric synthesis: recent progress
Authors: Zhang Zhen-Wei , Liu Shao-Wu , Huang Hong-Ping , Xie Yu-Hang , Huang Ruo-Chen , Deng Yan-Qiu , Lin Ning
Published: October 2023

Dehydroabietane-type bifunctional organocatalysts derived from rosane-type diterpenes of dehydroabietic acid (DHAA) and dehydroabietylamine (DA) have been utilized in a wide variety of highly enantioselective reactions.
Regularized Multioutput Gaussian Convolution Process for Chemical Contents Data Imputation in Sintering Raw Materials
Authors: Liu Wei , Chen Cailian , Li Junpeng , Guan Xinping
Published: October 2023

Chemical contents, the important quality indicators are crucial for the modeling of sintering process. However, the lack of these data can result in the biasedness of state estimation in sintering process. It, thus, greatly reduces the accuracy of modeling. Although there are some general imputation methods to tackle the data lackness, they rarely consider the interoutputs correlation and the negative impacts caused by incorrect prefilling. In this article, a novel sparse multioutput Gaussian convolution process (MGCP) modeling framework is proposed for data imputation. MGCP can flexibly mine the relationships between the outputs by a convolution of a sharing latent function and different Gaussian kernels. Moreover, the penalization terms are designed to weaken the false relationship between these outputs. To generalize the MGCP to a long‐period case, dynamic time warping term is introduced to keep the global similarity between the original and estimated time series. Compared with several existing methods, the proposed method shows great superiority in sintering raw material contents estimation with real‐world data.
Stellenwert der Zementaugmentation in der Tumorchirurgie der Wirbelsäule
Authors: Osterhoff Georg , Heyde Christoph-Eckhard
Published: October 2023

Die Wirbelsäule ist nach Leber und Lunge einer der wichtigsten Manifestationsorte für metastasierende Tumor-Erkrankungen. Metastasen der Wirbelsäule können zu Schmerzen, neurologischen Ausfällen und eingeschränkter Lebensqualität führen. Die Augmentation der befallenen Wirbelkörper mit Knochenzement hat sich als wirksame Behandlungsoption zur Schmerzbehandlung, Stabilisierung und Verbesserung der funktionellen Ergebnisse bei Patienten erwiesen. Weitere Anwendungen von Knochenzement in der Tumorchirurgie der Wirbelsäule sind die Augmentation von Pedikelschrauben und der Wirbelkörperersatz, selten auch bei der operativen Behandlung von Primärtumoren.

Ziel dieser Übersichtsarbeit ist es, einen umfassenden Überblick über die aktuelle Evidenz zur Verwendung von Knochenzement in der Tumorchirurgie der Wirbelsäule zu geben, einschließlich Indikationen, Techniken, Ergebnissen und potenziellen Komplikationen.
Using organic semiconductors to restore vision
Authors: Palivela Ananya
Published: October 2023

Organic bulk heterostructure junctions can be used as a retinal prosthetic in patients with retinal pigmentosa and age-related macular degeneration.
Sectorial descent for wrapped Fukaya categories
Authors: Ganatra Sheel , Pardon John , Shende Vivek
Published: October 2023

We develop a set of tools for doing computations in and of (partially) wrapped Fukaya categories. In particular, we prove (1) a descent (cosheaf) property for the wrapped Fukaya category with respect to so-called Weinstein sectorial coverings and (2) that the partially wrapped Fukaya category of a Weinstein manifold with respect to a mostly Legendrian stop is generated by the cocores of the critical handles and the linking disks to the stop. We also prove (3) a ‘stop removal equals localization’ result, and (4) that the Fukaya–Seidel category of a Lefschetz fibration with Liouville fiber is generated by the Lefschetz thimbles. These results are derived from three main ingredients, also of independent use: (5) a Künneth formula (6) an exact triangle in the Fukaya category associated to wrapping a Lagrangian through a Legendrian stop at infinity and (7) a geometric criterion for when a pushforward functor between wrapped Fukaya categories of Liouville sectors is fully faithful.
In forma pauperis: Indentured Servitude, the Right to Counsel, and White Citizenship in the Seventeenth-Century Chesapeake
Authors: Suranyi Anna
Published: October 2023

Indentured servitude was an exploitative form of coerced labor in England’s American colonies, but indentured servants were expected to join settler society after completing their terms of indenture, and they possessed clearly defined legal rights and protections in both English and colonial laws, even during their period of servitude. The masters and mistresses of indentured servants sometimes engaged in physical abuse and contractual fraud, but servants could sue their masters or mistresses in court without owing fees, a status termed in forma pauperis. Courts facilitated servant lawsuits and heeded procedural fairness, bringing in compensated witnesses, searching archival records, and even providing pro bono lawyers. It appears that most servants won their cases against their masters and mistresses, obtaining their freedom, their withheld freedom dues, or reimbursement for overlong terms of servitude. Indentured servants’ lawyers affirmed that their clients were rights-bearing members of society, persuasively utilizing terms such as ‘justice’ and ‘equity’ to represent their cases. The access of servants to legal recourse, the courts’ commitment to ensure due process and legal representation, and the frequent victories of servants over their masters demonstrated that indentured servants were regarded as valued members of colonial society in the Chesapeake, and in other colonial regions. Unlike enslaved people, who possessed neither legal rights nor access to the courts, white indentured servants possessed inherent, though limited, rights of freeborn subjects, even if from disenfranchised groups, such as women, children, or those of Irish origin. The legal and social distinctions between servitude and slavery began arising half a century before Bacon’s Rebellion in the 1670s, which is conventionally assumed to be a watershed event in the division between indentured servitude and slavery. The affirmation of the rights of indentured servants developed in parallel with the growth of slavery, and contributed to developing ideals of white citizenship.
Homeologue differential expression in the flavonoid biosynthetic pathway underlies flower colour variation in natural and synthetic polyploids of Nicotiana tabacum (Solanaceae)
Authors: McCarthy Elizabeth W , Landis Jacob B , McCoy Abigail G , Lawhorn Amber J , Kurti Amelda , Xu Yimin , Giovannoni James J , Litt Amy
Published: October 2023

Homeologue expression bias occurs when one progenitor copy of a gene is expressed at a higher level than the other in allopolyploids. Morphological variation, including differences in flower colour, exists between natural and synthetic allopolyploids of Nicotiana tabacum and their progenitors. In this study, we use a comparative transcriptomic approach to investigate gene expression differences as well as homeologue bias in the flavonoid biosynthetic pathway (FBP) in these accessions. We do not observe reciprocal homeologue bias between dark and light pink allopolyploids, but the production of light pink flowers is correlated with high FLAVONOL SYNTHASE:DIHYDROFLAVONOL-4-REDUCTASE (FLS:DFR) ratio at 60% of anthesis length due to delayed activation of DFR in these accessions. We do find that natural allopolyploids have stronger homeologue bias than synthetic allopolyploids in both FBP genes and across the transcriptome. While there is no overall subgenome dominance, there is a bias towards expression of N. tomentosiformis homeologues in FBP genes; however, the magnitude of this bias is reduced in allopolyploids compared to the progenitors, suggesting that N. sylvestris homeologues play an active role in the development of flower colour in N. tabacum allopolyploids. In addition, synthetic allopolyploids tend to exhibit trans regulation of homeologues whereas natural allopolyploids often have evolved cis-regulatory differences between homeologues since their origin.
Declining Search Frictions, Unemployment and Self-Employment
Authors: Denderski Piotr , Sniekers Florian
Published: October 2023

In most OECD countries, unemployment rates show no trend, which is puzzling if advancements in information and communication technologies decrease labour-market frictions. We show, both analytically and quantitatively, that accounting for the secular decline in self-employment rates solves the puzzle. While declining labour-market frictions can theoretically explain these trends, we provide contradictory causal evidence that the roll-out of broadband internet has increased self-employment and decreased unemployment rates. We reconcile these observations with a new model featuring frictions in both labour and goods markets. We explain falling self-employment and non-trending unemployment quantitatively by labour-market frictions declining relatively more than goods-market frictions.
On the path to an equitable and sustainable digital future for European health systems
Authors:   Organised by: WHO Regional Office for Europe Moderators: Natasha Azzopardi Muscat (WHO/Europe)
Published: October 2023

Equitable, patient-centred approaches are at the centre of WHO/Europe's regional digital health action plan 2023-2030 which was approved by Member States of the European Region at the 72nd session of the WHO Regional Committee. The Action Plan specifically identifies the need for WHO to “identify and examine the main impacts that gender and equity present in the adoption and scaling of digital health solutions in the Region.”

The session will be organised as a round table discussion to examine to inequalities surrounding access to, and the use of data and digital technologies in health care and public health. Panellists will firstly discuss the factors which give rise to inequalities in access and use of data and digital technologies in health and then examine strategies for how the digital transformation of health systems going forward can address these barriers. They will be asked to reflect on the future of digital health systems in Europe and the ethical, policy, legal and technical actions required to ensure trust, safety and equitable access to health services and data digitally.

Finally, in line with the theme of the conference, panellists will be asked to extend the discussion to reflect upon the use of digital technologies in the context of sustainability and how the public health community can drive thinking around the agenda for the green digitalization of health.

Moderator:

Natasha Azzopardi Muscat, Director Division of Country Health Policies and Systems, WHO Regional Office for Europe

Speakers/Panellists:

Alisha Davies, Head of Research and Development, Health and Care Research Wales, United Kingdom

Anna Odone, President EUPHA Digital health section

David Novillo Ortiz, Regional Adviser, Data and Digital Health, WHO Regional Office for Europe
Food security and trajectories of childhood overweight: Results from the Growing Up in Scotland Study
Authors: Miall N , Tulloch L , Pearce A
Published: October 2023

Background

Inequalities in childhood obesity have widened since 2010 in Scotland, raising concerns for future adult and child health. Increasing food insecurity may contribute to the trend, however evidence for an association with childhood overweight is mixed. We estimate the association between food insecurity and trajectories of overweight among primary school aged children in Scotland.

Methods

Data were from 1824 children in the Growing Up in Scotland Study, a nationally representative cohort born 2004/5. Height and weight were measured at ages 4, 6, 8 and 10 years, and classified as overweight/obese using age and sex standardised cut-offs. Observed trajectories included: never, always, increasing, decreasing, and mixed patterns of overweight (including obesity). Associations between household food insecurity, measured at age 2, and overweight trajectory were estimated using multinomial regression (never overweight as baseline), adjusted for area deprivation, lone parenting, and mother education.

Results

Most children were never overweight (54.8%), while 12.6% were overweight throughout. Children with high household food insecurity (6.2%) had nearly twice the risk of experiencing persistent overweight (including obesity) than those with no food insecurity (RRR 1.84, 95% CI 1.02-3.30). Additional analysis showed an even larger association for persistent obesity (RRR 2.53, 95% CI 1.06-6.08). Risk of experiencing increasing, decreasing or mixed patterns of overweight were also elevated. Associations were similar for boys and girls.

Conclusions

Food insecurity is associated with persistent childhood overweight and obesity. The cost-of-living crisis has exacerbated barriers to accessing healthy, nutritious food. Interventions to tackle childhood food security are vital to avoid storing up future health inequalities.

Key messages

• The cost-of-living crisis is exacerbating food insecurity among UK families.

• Food insecurity is associated with persistent overweight and obesity during childhood in Scotland.
Healthiness and sustainability of food service in healthcare settings in Germany
Authors: Lambrecht N J , Pörtner L M , Schlenger L , Gabrysch S
Published: October 2023

Background

Current dietary patterns threaten individual and planetary health. Healthcare settings can set a positive example for dietary change, but data on the quality of food they offer is scarce. The aim of our study was to assess the environmental footprint and nutritional quality of food service in hospitals and nursing homes in Germany.

Methods

We collected 6-12 months of food procurement data and all available meal plans from three nursing homes and two hospitals in Germany. Procured food items were categorized into 50 food groups (e.g., potatoes, beef, apples), and the environmental footprint was calculated (i.e., land use, greenhouse gas (GHG) emissions, acidification, eutrophication, and water use) using life-cycle analysis factors based on a recent meta-analysis. Lunches from a representative week were broken down into their constituent ingredients and analyzed for adherence to the Planetary Health Diet (PHD) using an established dietary index (PHDI).

Results

Preliminary analysis of one nursing home and one hospital showed that animal-source foods (ASF) accounted for 70% of overall GHG emissions and land use and 76% of water use, primarily from beef, pork, milk, and cheese. Among plant-based foods, coffee disproportionately contributed to the environmental footprint. Red meat accounted for 30-45% of lunch calories consumed (13-25% of weight) and potatoes accounted for 20-24% of calories (31-35% of weight), whereas vegetables and legumes combined accounted for 11-15% of calories (33-35% of weight). Nursing home meals achieved 61 and hospital meals 71 out of 150 points on the PHDI.

Conclusions

Healthcare institutions in Germany have poor adherence to the PHD, with up to two-thirds of calories derived from red meat and potatoes. Unsurprisingly, ASF account for the majority of the institutions’ environmental food footprint. Policies to make healthcare foodservice more environmentally sustainable while ensuring nutritional adequacy are urgently needed.

Key messages

• Foodservice in German hospitals and nursing homes is neither healthy nor environmentally sustainable.

• Policies are needed to improve healthcare food service for individual and planetary health.
Environmental Impact of Diets in 10 European countries
Authors: Alves R , Perelman J , Chang K , Millett C
Published: October 2023

Background

A growing consensus suggests that dietary changes have the potential to lessen the environmental impacts of food production. We performed a cross-country comparison of dietary patterns and their associated environmental impact in Europe, including by socio-demographic factors.

Methods

We analyzed pooled cross-sectional 24/48/72-hour dietary records collected during 2010-2018 from 10 European countries using the European Food Safety Authority (EFSA) Comprehensive European Food Database (16,508 adults; age 18-79 years). Each food consumed was mapped to the corresponding environmental impact data using the SHARP Indicators Database, which provides greenhouse gas emission (GHGE kgCO2-eq/day) and land use (LU m2*year/day) values for approximately 900 foods. Multivariable linear regression models were used to compare diet-associated GHGE and LU between population subgroups (gender, age, education, and diet type) with country-level fixed effects. We also analyzed the contributions of major food groups to the mean daily total of GHGE and LU for each country.

Results

The mean dietary GHGE and LU per capita ranged from 4.0 kgCO2eq and 5.0 m2*year in Spain to 6.5 kgCO2eq and 8.2 m2*year in France. Diet-related GHGE and LU (per Kg/food) were lower amongst females (2.6kgCO2eq, B=−0.08, P < 0.01; 3.2m2*year, B=−0.11, P < 0.01), people aged 66-79 (2.6kgCO2eq, B=−0.03, P < 0.01; 3.4m2*year, B=−0.4, P < 0.01), people following vegetarian diets (1.7kgCO2eq, B=−0.07, P < 0.01; 2.0m2*year, B=−0.07, P < 0.01), and higher amongst individuals with secondary education (2.7kgCO2eq, B = 0.04, P < 0.01; 3.6m2*year, B = 0.05, P < 0.01).

Conclusions

The impact of specific food groups on environmental footprints varies across countries and between different socio-demographic groups, signaling that cultural, literacy and generational factors possibly contribute to determine consumers’ environmental footprints.

Key messages

• The environmental impact varies across nations and socio-economic groups, highlighting the significant role played by cultural and generational factors in shaping consumers’ environmental footprints.

• The study findings are crucial for the development of country-specific food policies aimed at promoting environmentally friendly diets.
Vaccine hesitancy among migrants and refugees in Europe: from the local to global perspective
Authors: Gańczak M , Jansen D , Vervoort JPM , Filakovska-Bobakova D , Karnaki P
Published: October 2023

Background

Vaccine hesitancy (VH) in migrants and refugees (M/R) undermine the prevention of communicable diseases. Scientific research is valuable regarding its potential for producing analyses to better understand the phenomenon.

Objectives

To present findings of the 1st phase of the RIVER-EU project on vaccination among M/R populations. To provide a more comprehensive - from local to global - perspective by reviewing the evidence of the problem.

Methods

During the 4th quarter of 2022 qualitative studies were conducted which described barriers to vaccination among the Ukrainian M/R (Poland); M/R (Greece); Turkish/Moroccan adolescent females (Netherlands); the Roma community (Slovakia). VH exploration was an important ‘by-product’ of the project. This presentation will go beyond research results - a review of the existing evidence will help contextualize our findings.

Results

VH among M/R depended on a variety of factors, which differed between countries and selected communities and were deeply rooted in geographical, political but also cultural and social context. For example, drivers of HPV VH among the Ukrainian M/R in Poland were influenced by personal risk perception, such as self-perceived risks and severity of illnesses caused by the virus; these were fueled by low awareness, lack of credible information in Ukrainian language, and lack of satisfactory education. Lack of confidence in the quality, safety and effectiveness of the HPV vaccine distributed in Ukraine, powered by the loss of trust in medical staff/governmental institutions, due to the universal bribery and corruption in the health sector, also played an important role. Deprioritization of the HPV vaccine caused by misconceptions about non-mandatory vaccinations also influenced VH.

Conclusions

A better understanding of VH in M/R groups, with the help of the monitoring over longer periods of time is urgently needed. Monitoring M/R VH can inform needed interventions to support vaccine acceptance.
Excess mortality in low-and lower-middle-income countries: A systematic review and meta-analysis
Authors: Gmanyami J , Jarynowski A , Belik V , Lambert O , Amuasi J H , Quentin W
Published: October 2023

Background

The COVID-19 pandemic caused a massive death toll, but its effect on mortality remains uncertain in low- and lower-middle-income countries (LLMICs). This review summarized the available literature on excess mortality in LLMICs, including methods, data sources, and drivers of excess mortality.

Methods

A protocol was registered in PROSPERO (ID: CRD42022378267). We searched PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Scopus for studies conducted in LLMICs on excess mortality which included at least a one-year non-COVID-19 period as the comparator, and with publication date from 2019 to date. The meta-analysis included studies with extractable data on excess mortality, methods, population size, and observed and expected deaths. We used the Mantel-Haenszel method to estimate the pooled risk ratio with 95% confidence intervals.

Results

The review included 21 studies (5 from Africa), of which 11 were included in the meta-analysis (2 from Africa). Of 1,405,128,717 individuals, 2,161,846 deaths were expected, and 3,633,661 deaths were reported. The pooled excess mortality was 104.7 deaths per 100,000 population. The risk of excess mortality was 1.68 (95% CI: 1.67, 1.68 p < 0.001). Data sources included public cemeteries, civil registration systems, obituary notifications, surveys, funeral counts, burial site imaging, and demographic surveillance systems. Techniques used to estimate excess mortality were mainly statistical modelling and geospatial analysis. Of the 21 studies, only one reported on drivers of excess mortality and found higher excess mortality in urban settings.

Conclusions

Our results show that excess mortality in LLMICs during the pandemic was substantial even if it was considerably lower than in high-income countries. There is uncertainty around excess mortality estimates given comparatively weak data. Further studies are needed to identify the drivers of excess mortality by exploring different methods and data sources.
Communicating evidence synthesis: co-designing summary formats with end users
Authors: Murray R , Lynch R , O'Neill M , Smith S M , Mahtani K R , Ryan M , Clyne B , Sharp M K
Published: October 2023

Background

Evidence syntheses are essential to the creation of evidence-based guidelines that guide health care. Findings from our recent mixed methods systematic review (MMSR) identified no gold standard format for communicating summaries of evidence syntheses to guideline development groups. This is important as these groups are comprised of patients, healthcare providers, policymakers, etc., who all have different expertise, perspectives and priorities. Our overall aim is to develop evidence-informed prototype summary formats for use in guideline development. To inform this process, we held online co-design focus group workshops shaped by findings from our MMSR.

Methods

We held six focus groups with 30 participants involved in developing guidelines and/or evidence synthesis (February - March 2023). The topic guide was informed by the MMSR -- focusing on recommendations with mixed methods support, ≥3 supporting studies, and those prioritised by an expert advisory group through a pragmatic prioritisation exercise using the MoSCoW method (Must, Should, Could, and Will not haves). Focus groups were recorded and transcripts were analysed using a directed content analysis.

Results

Participants suggested a “less-is-more” structured approach that minimises methodological steps and statistical data, promoting accessibility to all audiences by judicious use of links to the full technical report. They emphasized the importance of concise consistently-presented formats which emphasize key messages, flag readers to indicators of trust in the producers (i.e., logos, websites, and conflict of interest statements), and highlight the quality of evidence.

Conclusions

Project findings are informing the creation of accessible and actionable guidance on best-practices for creating summary formats. Next steps involve user-testing prototype formats through semi-structured interviews which will then be integrated into the National Clinical Guideline development process in Ireland.

Key messages

• Co-design workshops delineated key aspects of effective and acceptable evidence synthesis summary formats to help create reproducible format templates for use in clinical guideline development.

• Creating summary formats accessible to all guideline development group members will promote better communication and translation of research evidence into recommendations and practice.
Physical illness and changes in spousal depression: a register study on Finnish middle-aged couples
Authors: Metsä-Simola N , Volotinen L , Martikainen P
Published: October 2023

Background

Physical health decline may affect family members’ mental health by causing distress and, in case of functional impairments, need to provide care. We examined how diseases common in midlife but with different disease progression and level of impairment are associated with short-term and long-term changes in spousal depression.

Methods

We used Finnish total population register data from 2000-2019 to identify 91,849 men and 70,836 women aged 30-70 that experienced onset of severe diseases without cognitive impairment (myocardial infarction, prostate cancer, breast cancer), conditions with sudden onset and immediate impairment (stroke, traumatic brain injury) or progressive conditions with increasing impairment (Parkinson's disease, multiple sclerosis, dementia) while living with a spouse. We measured depression with antidepressant purchases and used fixed-effects linear probability models to examine spouses’ depression trajectories before and after onset of spousal disease

Results

Preliminary findings show that the onset of any type of spousal illness is associated with an increase in depression. Among men this increase is similar in magnitude irrespective of the type of spouse's illness, whereas among women the increase is smaller if the spouse is diagnosed with a disease without cognitive impairment. When the spouse is diagnosed with a progressive condition, female spouses’ depression increases more gradually, whereas a large immediate increase in depression follows sudden onset conditions. One year after diagnosis there are little changes in spousal depression.

Conclusions

Diseases common in midlife increase spouse's risk of depression around the time of diagnosis, and the effect appears persistent. Adequate support should thus be available to family members from the start of physical illness. When planning support to female spouses, the male spouse's cognitive impairment and associated care needs should be carefully evaluated.

Key messages

• Diseases common in midlife increase spouse's depression risk around the time of diagnosis, and the effect appears persistent. Support to spouses should be available from the start of illness.

• Cognitive impairment of the male spouse seems to increase female spouse's depression particularly strongly, suggesting that caregiving help could be especially beneficial for women.
Assessing national policies on labour migration and health: data from IOM's Migration Governance Index
Authors: Profili C
Published: October 2023

Much of the empirical research work on labour migration and health has been in low to middle income countries and labour sending countries, with little data from Europe. The IOM will explore current policy and practice, and evidence gaps, in Europe, and discuss their Migration Governance Index, which assess migration in relation to labour and health access https://www.migrationdataportal.org/overviews/mgi. The MGI helps governments, upon request, take stock of their migration policies and strategies to identify good practices and areas with potential for further development.
Policy developments on labelling for a more sustainable food system
Authors: Gokani N
Published: October 2023

Governments across Europe are developing policies which promote healthier, more sustainable food choices. This presentation explores these policies with a focus on the EU. In May 2020, the European Commission published its Farm to Fork Strategy which acknowledged the inextricable links between healthy people, healthy societies and a healthy planet. This committed to introduce legislative proposals to revise rules on food labelling for consumers. On the one hand, focusing on health, the Commission committed to introduce harmonised front-of-pack nutrition labelling, nutrient profiling criteria to restrict claims made on foods, extending mandatory origin or provenance information for certain products, and revise the rules on ‘use by’ and ‘best before’ dates by 2022. These commitments were reinforced by Europe's Beating Cancer Plan, which further committed to introduce mandatory ingredients list and nutrition declaration as well as warnings for alcoholic beverages by 2023. On the other hand, the Commission also committed to introduce a Sustainability Labelling Framework to empower consumers to make informed and sustainable food choices by the end of 2024. In synergy with other labelling initiatives - such as animal welfare labelling, ‘green claims’ organic labelling and those described above - it is meant to cover the provision of consumer information relating to the nutritional, climate, environmental and social aspects of food products. The Commission has already missed its 2022 deadlines and all suggestions point to it missing its 2023 and 2024 deadlines. This presentation will summarise the development so far, suggest how the EU should move forward and highlight barriers to implementation. Discussions on how to move forward will be held with the audience.
Effectiveness of antimicrobial interventions in animal production: systematic review & meta-analysis
Authors: Costa M M , Cardo M , Ruano Z , Alho A M , Dinis-Teixeira J , Aguiar P , Leite A
Published: October 2023

In animal production, the rational use of antimicrobials has been promoted to decrease antimicrobial resistance (AMR) in microorganisms. This systematic review evaluated the effectiveness of interventions to reduce/adequate antimicrobial use and decrease AMR. Articles were identified in PubMed, Scopus, The Cochrane Library, Web of Science, and grey literature in DANS EASY, WorldCat, RCAAP. Eligible studies included original studies, assessing broiler/pig populations, antimicrobial interventions, comparator with standard/no use of antimicrobials, outcomes related to AMR, farm level and analytical observational studies. Meta-analysis was conducted for combinations including type of intervention, bacterial species, production type, population. Interventions effectiveness was estimated using odds ratio of resistance to antimicrobial substances/classes by bacteria and populations with and without intervention. A total of 46 studies were eligible. For broilers, restrictions were all non-therapeutic use (46%), complete restriction (27%), prohibition on antimicrobials used for growth promotion (23%). For pigs, restrictions included: all non-therapeutic use (37%), complete restriction (37%), group treatments (22%). For meta-analysis (21 studies), combinations indicated a protective effect for most antimicrobial classes in E. coli, Campylobacter and Enterococcus and broilers, and Escherichia coli and Campylobacter and pigs, compared to conventional production or without intervention. An increased odds of resistance were observed for cephalosporins in E. coli and broilers raised without antimicrobials, and to fluoroquinolones/quinolones in Campylobacter and pigs raised without antimicrobials, compared to conventional production. Our study revealed that organic, antimicrobial-free farms and group treatment restrictions in conventional production were mostly associated with AMR reduction, providing information on available options that may support decision-making to tackle AMR.

Key messages

• Organic/antimicrobial-free farms indicated a protective effect on resistance to most antimicrobials.

• Fluoroquinolones resistant Campylobacter may persist in pigs raised without antimicrobials.
Has the COVID-19 pandemic changed non-COVID-19 healthcare utilisation patterns across Europe?
Authors: Aldridge S J , Schmidt A E , Owens R , Dolanski-Aghamanoukjan L , Mathis-Edenhofer S , Lyons R A
Published: October 2023

As SARS-COV-2, the virus responsible for the COVID-19 pandemic, spread across Europe in the first half of 2020, countries deployed a range of responses to mitigate its spread and reduce mortality. Most countries adopted some form of “social distancing”, restricting movement and contact between households in order to minimise the burden on healthcare systems. During this time a dramatic fall in non-COVID-19 related healthcare utilisation (HCU) has been observed universally. We aim to quantify this change in HCU across 7 European countries during and following the COVID-19 pandemic. Identifying to what extent different types of HCU have recovered, and the associations between these HCU and COVID-19 infection and hospitalisation rates. We gathered aggregated age standardised longitudinal health and administrative data from 7 European countries between 2017 and 2021 using standardised scripts held in the PHIRI Docker Application to examine the impact of COVID-19 on HCU. We deploy a meta-analysis using a combination of forecasting and generalised linear models to investigate the association between local COVID-19 metrics and three types of HCU: emergency cardiovascular incidents, elective surgeries, and severe trauma admissions. Results vary markedly by country and show an association both with general incidence rates and public health measures taken in the course of the pandemic, based on the OxCGRT index. We provide a first-time comprehensive cross-European analysis of the indirect effects of the COVID-19 pandemic with lessons for sustainable and resilient health systems in crisis times. More research is needed to understand the drivers at the national and subnational level within welfare state contexts.

Key messages

• Patterns of healthcare utilisation changed dramatically during the COVID-19 pandemic, but to varying degrees across Europe.

• The PHIRI framework allows coordination with a number of European groups enabling a much more substantial analysis on healthcare utilization.
Factors influencing engagement in advance care planning in the community: A mixed-research synthesis
Authors: Pilch M , Cooper Lunt V , Hickey A , Thomas S , Hayes C , Kaminiecki B , Korpak J , Mockler D , Doyle F
Published: October 2023

Background

The development of innovative Advance Care Planning (ACP) health behaviour change interventions for adults (≥50 years old) in the community should be informed by a findings synthesis. The objectives of this review were to (a) identify stakeholders' perspectives on facilitators and barriers to ACP behaviours and (b) map these factors across the Capability, Opportunity, and Motivation dimensions of behaviour (COM-B model).

Methods

This hybrid mixed-research synthesis followed a published protocol. Content analysis was applied to the results sections of the included studies. Data transformation and triangulation processes underpinned findings integration (4,5).

Results

The review included 117 records and studies recruited patients (62%), service providers (29%), and trusted others (9%). ACP behaviours were ACP as a general concept, (41%), communication (28.7%), documentation (22%), decision-making (5.3%), or surrogate appointment (3%). Ten categories of influencing factors were identified, ranked according to frequency of reporting. They included Connectedness, Psychological Factors, Metapreferences, Service Provision, Temporality, Sociodemographic Characteristics, Literacy, Resources, Experience, and Macro-Level Factors. Their sub-categories (52 in total) were mapped across the COM-B model. The most frequently reported Motivation sub-categories were Comfort and Readiness (n = 78), Actors and Roles Requirements (n = 56), and Perceptions and Beliefs (n = 45). The Opportunity dimension included Communication and Understanding (n = 43), Effect of the Other (n = 42), and Involvement and Collaboration (n = 41). The top Capability sub-category was ACP literacy (n = 43).

Discussion

The triangulation of stakeholders' perspectives facilitated identification a complex array of factors influencing ACP behaviours. Their mapping across the COM-B model informed future research, policy, and ACP intervention development.

Key messages

• Stakeholders’ engagement in ACP behaviours is influenced by a complex array of factors, with the majority of them falling into the categories of motivation and opportunity.

• Future ACP interventions design need to build on this learning and develop strategies and policies that support meaningful stakeholders’ engagement in ACP activities, including their collaboration.
Implementing an action plan for the WHO designated Cork Healthy City, Ireland 2020-2030
Authors: O'Mullane M , Cahill D , Cronin J , Harford K , Ní Chonchúir A , Young M , Syron M , Davoren M , Fitzgerald T
Published: October 2023

Issue

With current UN predictions that by 2050 two thirds of the planet's citizens will live in cities, a Healthy Cities approach promoting health equity and advancing the WHO One Health agenda is an important public health intersectoral process. This is the overarching mission of WHO designated Cork Healthy Cities, Ireland, which emphasizes a collaborative, community-led and inter-agency approach at the heart of its business.

Description

Cork Healthy Cities launched its ten-year action plan (2020-2030) to address the six themes (the 6 Ps) outlined for Phase VII of WHO European Healthy Cities Network: People, Places, Participation, Prosperity, Peace, and Planet. The Cork City Profile, which informs the action plan with an evidence-base, is an important interagency aspect to the work of Cork Healthy Cities.

Results

A range of actions for each of the 6 Ps have been planned within the Cork Healthy Cities Action Plan. Results from sample projects for each of the 6Ps will be presented, including Child Friendly City (People); Let's Play Cork (Places); Sexual Health Network (Participation); Deliver the PSYCHED (Positive Support You Can Have Every Day) Initiative (Prosperity); the development of the Trauma Informed City (Peace); and Green Spaces for Health initiative (Planet).

Lessons

The actions outlined above have been included in the Cork City Development Plan (2024-2028), providing evidence of the public health actions being integrated into local government strategic planning processes. The collaborative and intersectoral experience of Cork Health Cities provides important learning for other cities across Europe. Public health actions within the Cork Healthy Cities Action Plan were the first of their kind in an inter-agency partnership platform such as Healthy Cities in Cork.

Key messages

• Create meaningful working relationships across public health, city council, researchers, and community groups.

• Engage with city planning to develop an environment for positive health for all.
eHealth for chronic diseases management: challenges and opportunities
Authors: Chiolero A
Published: October 2023

Digital health technology, also known as eHealth, could help improve the management of chronic diseases such as diabetes by facilitating data exchange between patients and health professionals. Further, the use of digital health technology and mobile devices could improve disease monitoring and strengthen patient empowerment. However, not all healthcare professionals are comfortable with digital health technology, and several barriers limit their use, including patients’ socio-demographic factors. Based on the results of a study assessing the eHealth profile of patients with diabetes, we will discuss challenges and opportunities in the use of digital health technology for chronic disease management.