bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecting Unrecognized Dementia Using Deep Learning Methods with Korean National Claims Data
Authors: Yoo K B , Nam J W , Lee K M , Kang T H , Yoon J H
Published: October 2024

Background

Dementia is one of the leading causes of death in elderly people. In Korea, the government supports dementia screening for people aged 60 and older, but it is not a population-based organized screening program. It is difficult to achieve early diagnosis and early treatment. The objective of this study is to detect unrecognized dementia using Korean National Claims Data for early diagnosis.

Methods

This study used the National Health Insurance Claims data in Korea. The case group is the new dementia visit as an unrecognized group, while the control group was randomly selected from the general population without dementia. The predictors included health utilization, socioeconomic and demographic, procedure codes, diagnostic codes and health screenings data. The health utilization variables included length of stay, the number of outpatient visits, health expenditures and other encounter information. All medical utilization data was aggregated monthly. In the case group, 12 months of data from 6-month or 2-years before the onset of dementia were used. In the control group, 12 months of data from randomly selected time point were included. Transformer, embedding methods, and Time2Vec were used as the deep learning methods. This study included 453,306 incidents of dementia, representing almost all cases reported from 2010 to 2019 in Korea. The control group consisted of 669,873.

Results

After training the deep learning prediction model, the AUC for 6-month dementia prediction on the test dataset was 0.87, and for 2-year dementia prediction, it was 0.76. The most important variables were health utilization variables, especially health expenditures. The health utilization trajectories of the case group were significantly different from those of the control group.

Conclusions

Based on the claims data, we could detect unrecognized dementia case. We can extend the model to other chronic disease such as cancer and stroke, which are significant burden of disease.

Key messages

• Screening in healthcare facilities or using lab test results would be more accurate, but it would be difficult to apply to a large population due to the cost-effectiveness and timeliness constraints.

• On the other hand, the detection model using the existing claims data would be helpful to to develop cost-effective mass screening program. It can cover the weakness of current screening program.
Preventing type 2 diabetes in Portugal: a novel person-centered digital intervention
Authors: Alves J , Félix I B , Balsa J , Marques M M , Pimenta N , Guerreiro M P
Published: October 2024

Introduction

Diabetes, particularly type 2 diabetes (T2D), stands as one of the leading noncommunicable diseases worldwide. In Portugal, the prevalence of diabetes has surged, with T2D affecting 14% of adults in 2021. Its repercussions extend beyond individual health, deeply impacting familial, social, and community dynamics, presenting a significant public health challenge globally.

Objectives

The VA|PREVENTION project (https://doi.org/10.54499/2022.02969.PTDC) aims to assess the (cost-) effectiveness and implementation of an innovative person-centered digital intervention to prevent T2D among high-risk adults.

Methodology

A comprehensive approach encompasses the Behavior Change Wheel for intervention design, scalability principles, the WHO guidelines for digital health interventions, co-design, and the ISO framework for usability assessment. Evaluation will be pursued through a type 1 hybrid effectiveness-implementation study (randomized controlled trial), supplemented by qualitative and economic studies.

Results

The web application prototype features Ema, an automated virtual human coach (VHC), educational menus and a dashboard (version 1.0). Co-design included 2 workshops with 11 representatives of end-users and health professionals. Ema uses standardized techniques from an ontology to support behavior change, based on an initial assessment of low-level target behaviors (e.g. walking, fruit consumption, and reducing red meat intake), and barriers to performing these behaviors. Ema communicates in a helpful-cooperative style using a synthetic voice in European Portuguese, with its speech also appearing as subtitles on the interface. Users interact with Ema by pressing buttons or entering data, such as the daily number of steps. Ethics approval was granted for usability assessment with end-users.

Conclusions

The project is expected to yield health, scientific, technological, and policy impacts, powered by an exploitation and sustainability roadmap.

Key messages

• Innovative type 2 diabetes prevention through a scalable web app with a virtual human coach.

• Comprehensive and robust approach for developing and evaluating the digital behavior change intervention.
Greenwashing by the fossil fuel industry: impediments to SDGs
Authors: Makhoul J , Talhouk N , Loutfi J , Al-Madhwahi A
Published: October 2024

The fossil fuel industry, a major commercial determinant of public and environmental health, constitutes a central challenge to the achievement of the SDGs. Motivated by profit, the industry has contributed to establishing the current global reliance on fossil fuel as the primary energy source and essential raw material in global production. Major oil companies have purposefully hindered the research and transition towards renewable energy. This was achieved through an intricate web of interference and mechanisms that fall under the corporate playbook, such as political interference through lobbying to stagnate carbon emission reduction, influences on carbon pricing policies, and hinderances to environmental protection legislation. These practices known as ‘greenwashing’ have resulted in misinformation, interfered with climate action in an aim to increase demand for their products, to decrease the pressure from society on the industry, and portray a green image to consumers. Using the commercial determinants of health framework and focusing on the Middle East, this presentation will illustrate how fossil fuel companies falsely advertise their products as environmentally friendly, resulting in environmental degradation, and impede the achievement of most SDGs, especially SDG 3 (good health and wellbeing), SDG 7 (affordable and clean energy), and SDG 13 (climate action).
How Big Tobacco exploits the UN SDGs to advance its own goals
Authors: Nakkash R
Published: October 2024

Globally, the tobacco industry poses a major barrier to the advancement of the Sustainable Development Goals through its influence on SDG 3 (health and well-being), 8 (decent work and economic growth), 13 (climate action), and 17 (partnerships for the goals). Soon after the launch of the SDGs report, Big Tobacco immediately used it to promote its own agenda for development in LMICs such as Lebanon. Using the commercial determinants of health model, this presentation will highlight global and local tobacco monopoly practices, specifically the Lebanese Regie, as a commercial actor and their practices linked to the SDGs to illustrate how the tobacco industry compromises SDG advancement. The presentation will also address some of the system level attributes that serve to perpetuate such practices in Lebanon, allowing for tobacco industry free reign in the country. The presentation will end with suggestions on how LMICs, such as Lebanon, can address the growing industry influence on advances in SDGs and discuss potential measures to curb harmful commercial actor practices.
Digital health divide in Indonesia: evidence from national-level data
Authors: Nababan H
Published: October 2024

Indonesia is a country in south-east Asia with a diverse population and context underlined by its geographical condition as an archipelagic country. Due to closer proximity to the capital, the Western regions (e.g., provinces in Sumatra and Java islands) are relatively more developed than the central and eastern parts of Indonesia (e.g., Nusa Tenggara, Sulawesi, and Papua). In the last few years, the country started to embrace digital transformation for public services including the health sector. Accelerated by the COVID-19 pandemic, a proliferation of digital health services through for example the use of telehealth and health apps is now considered important to improve access and availability of health services, especially among marginalized and hard-to-reach populations. Nonetheless, the difference in access to information and technology infrastructure and services as well as in the level of digital literacy across different regions in Indonesia may perpetuate the existing inequity in access to health services. In 2022, data from the Indonesian Central Bureau of Statistics showed that the level of internet access in Indonesia’s capital Jakarta has reached 85%, while the level in the eastern part of Indonesia (i.e., Papua) is only 26%. Similarly, the level of internet access in the Western provinces tend to be higher than their Eastern counterparts. Additionally, a survey performed by the Ministry of Communication and Informatics to assess the level of digital literacy in Indonesia shows that 85% out of 10,000 respondents accessed the internet through smartphones. However, almost all respondents encounter problems when accessing the internet, especially regarding network quality which causes unstable and frequent connections disconnected. In addition, the level of digital literacy varies across different regions, with the Western region performing better than other regions (e.g., digital literacy index of 3.64 in Yogyakarta vs 3.55 in Papua in 2022).
Radon Exposure Is Associated with Breast Cancer Risk: A Long-Term Population-Based Study from Finland
Authors: Li P , Lin C , Martikainen P , Myrskylä M
Published: October 2024

Background

Radon is a common environmental carcinogen. It is not known whether radon exposure and breast cancer risk are associated at the population level.

Methods

Women continuously living in Finland during the 1987-2016 period were linked to municipality-level indoor radon data annually to estimate their cumulative radon exposure over 30 years. Breast cancer incidence was observed over five years from 2017 onwards. Association between radon exposure and breast cancer incidence was assessed using conditional Cox models adjusted for family history of breast cancer, reproductive history, and socio-demographic covariates. Population attributable fractions (PAF) of breast cancer due to radon exposure were estimated. Robustness analyses were conducted in the population who lived only in houses.

Results

Among 1,335,947 women, 20,067 breast cancer cases were observed during a median follow-up period of 4.9 years. Among women who were exposed to high levels of radon (>100 Bq/m3), overall breast cancer incidence was 10% higher (Hazard ratio 1·10 [95% CI 1·05-1·16]), duct carcinoma incidence was 6% higher (1·06 [1·00-1·13]), lobular carcinoma incidence was 8% higher (1·08 [0·94-1·23]), and the incidence of other morphological sub-types was 34% higher (1·34 [1·17-1·53]) than among other women. Robust associations with overall breast cancer incidence (1·12 [1·05-1·20]) and the incidence of morphological sub-types in the house sample. Correspondingly, suggestive dose-response associations were observed.

Conclusions

High radon exposure is associated with elevated breast cancer risk at the population level, and this relationship is independent of well-established risk factors.

Key messages

• This study investigates the association between long-term radon exposure and breast cancer incidence based on national register data.

• High radon exposure is robustly associated with breast cancer risk in general Finnish population.
Population ageing and health financing: A method for forecasting two sides of the same coin
Authors: Williams G
Published: October 2024

There is a perception that population ageing will have deleterious effects on future health financing sustainability. Given the positive association between health care utilization and increasing calendar age, many analysts assume population ageing will result in considerable growth in health spending. Since this expenditure tends to be sourced primarily from public funds, there is great policy interest to quantify how population ageing is likely to affect health expenditure trends. We propose a new method-the Population Ageing financial Sustainability gap for Health systems (or alternatively, the PASH)-to explore how changes in the population age mix will affect health expenditures and revenues. Using a set of six countries in Europe and the Western Pacific representing a diverse range of health financing systems (Australia, Bulgaria, Japan, Slovenia, United Kingdom, Vietnam), we forecast the size of the ageing-attributable gap between health revenues and expenditures from 2020 to 2100 under current health financing arrangements. The largest gap by 2100 is expected to be in Vietnam, where the gap between revenues and expenditure is expected to increase by around $170 per person in 2018 PPPs or 2.3% of GDP; 87.1% of this increase is due to expected growth in expenditures. In Slovenia, where the gap is forecast in line with the forecast for Japan (the oldest country in the world), nearly half of the gap (44.2%) is due to reductions in revenue generation. All countries face some health financing gap due to ageing under current financing arrangements. The PASH analysis highlights the wide range of policy options available to manage health financing as the population ages, such as changing sources for health revenues and reducing expenditure by promoting healthy ageing.
The value of healthy ageing: Estimating the economic value of health at older ages using time use data
Authors: Santos J V , Cylus J
Published: October 2024

While health naturally has intrinsic value and maintaining health as people age seems to make good economic sense, making the case for investing in health at older ages can be challenging. Much economic growth is historically attributed to the working-age population; however, maintaining good health as people age also enables older people to contribute meaningfully to the economy. Investing in health at older ages, therefore, can be strategic economic policy. We develop a novel method to quantify the economic value of health through time use data. Using data from the United Kingdom Time Use Survey (UKTUS) 2014-15 for individuals aged 65 years-old and older, we apply survey-weighted generalized linear models to predict the time spent in non-market productive activities based on age and self-perceived health. We then quantify the monetary value of time spent engaging in these activities and simulate the monetary impact of health gains at older ages. Both age and self-perceived health status were associated with minutes spent in many non-market productive activities. Being in ‘very good’ instead of ‘very bad’ self-perceived health is associated with an additional production of 439£, 629£, and 598£ per month for an average individual aged 65 to 74 years-old, 75 to 84 years-old, and 85 years-old and older, respectively. Our simulation model indicates that improving the health of 10% of older people in ‘very bad’ health could lead to an economic increase of up to 278£ million through non-market activities. Health at older ages creates considerable economic value which is not captured using standard national accounting measures. Our work highlights the importance of health for functional capacity as people age, allowing them to engage more in non-market activities. Our method to quantify the monetary value of health can be adapted to other settings to make the economic case for investing in healthy ageing.
Ban on mobile phones in the classroom: first (positive) effects
Authors: Boode Karin
Published: October 2024

Karin Boode MBA is Strategic Youth Policy Advisor and working at the National Association of Regional Public Health Services Netherlands. Leading on from the presentation on the harms of social media and smartphones, Karin will present examples of policies that have been successful in reducing the health impacts on youngsters. She will focus on the role of schools in addressing this problem, and how public health organisations can effectively disseminate guidance to teachers and parents in limiting screen time and improving self-regulating behaviours of children and adolescents to minimise screen and smartphone addiction. Karin will also explore controversial legislation such as smartphone bans.
DYNAMO-HIA: A health impact assessment tool fit for quantifying tobacco control policy
Authors: Lhachimi S
Published: October 2024

DYNAMO-HIA is a generic, publicly-available and easy to use software tool for health impact assessments of changes in health risk-factors such as obesity, air pollution, processed meat consumption, physical activity, alcohol taxation, or smoking. The tool uses a graphic use interface, does not require programming skills, and has comparatively modest data requirements. Health outcomes that can be investigated are mortality, life expectancy, healthy-life expectancy, disability and prevalence of various chronic disease such as chronic obstructive pulmonary disease (COPD), cancer, or coronary heart diseases. DYNAMO-HIA can in principle be used for any tobacco control policy or ordinance-e.g. price increases or pictorial health warning labels-that target changes in smoking prevalence or smoking initiation/quitting rates. Past applications of DYNAMO-HIA for tobacco control policy included country studies for Belgium, Mongolia, or Korea and several comparative country studies. In this presentation we will give a general overview into the use of DYNAMO-HIA and show-case a recently published study. This study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices.
Populating HIA of tobacco policies with empirical evidence on behavioral response to price increases
Authors: De Wit A , Rotteveel A , Lambooij M
Published: October 2024

Performing Health Impact Assessment of tobacco policies requires to have insights into how smokers will react to policy measures such as price increases. In the Netherlands, a series of 3 substantial price increases has been implemented in 2020 (10% increase), 2023 (10% increase) and 2024 (24% increase). We performed three consecutive studies comparing the ex-ante stated preferences about behavioural response to actual and hypothetical future price increases, and compared these stated preferences with actual behaviour changes 6 months after the increase in excise tax. Two of these possible behavioural reactions actually will impact smoking prevalence or smoking intensity, e.g. stopping altogether and decreasing the number of cigarettes smoked. Other behavioural responses are less favourable and will not impact health, such as buying more and cheaper tobacco abroad and smoking less expensive brands or transferring from cigarettes to roll-your-own or e-cigarettes. For the price increases of 2020 and 2023, we have observed a substantial number of about 10% of smokers quitting successfully and about one third attempting to quit smoking. (Attempting to) quit smoking was much more prevalent among those with a more pronounced intention to stop smoking at the ex-ante measurements. At the same time, cross-border shopping increased significantly as well, with a 10 percent-point growth in the absolute amount of all tobacco consumed originating from abroad following the 10 percent price increase of April 2023. This big increase in cross-border shopping appeared to be independent of distance to the border. We conclude that every significant price increase stimulates smokers to consider to stop smoking. However, unilateral price increases in one country will eventually also stimulate smokers to buy cross-border. Behavioural data as presented should inform HIA to make them more realistic with regard to actual behaviour changes and health impacts of smoking policies.
Improving implementation of health interventions among ECEC organisations: a social network analysis
Authors: Leurs-Stijnen M , Kremers S , Gubbels J
Published: October 2024

The environment wherein a child grows up determines many health and life outcomes of the child. The early childhood education and care (ECEC) is an important setting for children which offers possibilities for health promotion activities. A learning network with professionals from ECEC organisations in South-Limburg, the Netherlands is established, aimed at sharing health promotion ‘best practices’. This study examined the network structure of the learning network and of ECEC locations regarding health topics such as nutrition, physical activity and sun protection. A mixed-methods design was adopted. An online-questionnaire was used to examine the relationships of the members of the learning network (N = 6) and ECEC locations (N = 59) between these organisations and with organisations related to the health topics. Data was analysed and visualised using a social network analysis (SNA) in UCINET. Thereafter, semi-structured interviews were held with the members of the learning network (N = 6), to discuss the network structure and possible improvements of the network. The SNA showed a weak network structure for the learning network and ECEC locations. Connections were mostly related to organisations in the field of nutrition and physical activity. This implied that health interventions related to sun protection and green environments were not implemented to the same extent as nutrition and physical activity. The interviews provided insight into the underlying reasons for (the lack of) certain connections. Overall, the members were satisfied with the quality and quantity of their current collaborations. The SNA and interviews indicated that the collaboration between ECEC organisations and organisations related to other health topics like green environment or sun protection could be improved. Therefore, it is recommended that ECEC organisations should engage in collaborations with organisations in these domains.
Involving stakeholders in planning the scale-up of a health promotion intervention: a practical example
Authors: Harms L , Gubbels J , Gerards S
Published: October 2024

Scaling up health promotion interventions is complex. Despite the potential effects and impact on society, factors related to the intervention itself, potential adopters or implementers, and contextual factors can hinder or promote widespread scale-up. Frameworks such as the PRACTIS (PRACTical planning for Implementation and Scale-up) guide and approaches such as Design Thinking offer practical guidance for researchers to increase the likelihood for successful scale up. SuperFIT is an integrated intervention approach aiming to promote healthy energy balance-related behaviours in children aged 2-4 years. To date, SuperFIT has been implemented in over one hundred childcare locations, reaching at least 1800 children per day. A local PA-providing organisation is responsible for the implementation of SuperFIT. The aim of this project was twofold: to identify the needs of future adopters and implementers of SuperFIT (i.e. What information and materials do you need?) and to develop the relevant tools and implementation strategies. We used a co-creation approach, combining stakeholder interviews (n = 6) based on the PRACTIS guide to identify gaps and needs, with creative sessions (participants n = 8) and multiple thinking-out-loud sessions (participants n = 6) to generate solutions that would be relevant to implementers. Stakeholders included researchers with experience in SuperFIT and implementation science, implementers and managers of the current and new PA-providing organisations. Gaps were identified and summarised under three main themes: 1) a lack of clarity what SuperFIT entails, 2) SuperFIT adaptations to new implementation contexts, 3) the skills and implementation capacity required to ‘train the trainer’. Creative sessions assisted the generation of prototype tools. We have learnt the value of patience and perseverance, as some obstacles need time to be overcome.
WHO/Europe tools for strengthening health information systems
Authors: Adib K , Davtyan K , Verschuuren M , Novillo Ortiz D
Published: October 2024

WHO/Europe offers different tools and capacity building activities to support Member States (MS) in strengthening their health information systems (HIS). These range from assessment methodologies and guidance documents to situation reports and workshops and trainings. The HIS assessment method of WHO/Europe provides an overview of the performance of the entire HIS in an MS. As such, this is often applied as a starting point for HIS strengthening activities in a country, and ideally repeated every few years to measure progress. Next to an assessment of the overall HIS, WHO/Europe also has methods for assessing specific HIS aspects, such as cybersecurity preparedness and GIS capacity. There are also several tools and capacity building activities that specifically focus on strengthening HIS digitalisation (d-HIS). For example, there is a modular d-HIS training, the programme of which can be adapted to meet specific MS needs. This also applies to the population health monitoring training that is available for interested MS. In addition, WHO/Europe has published a range of guidance documents, ranging from a comprehensive d-HIS strengthening manual to guidance on how to write an impactful health report, and guidance on how to apply data protection principles in public health. Finally, WHO/Europe supports HIS strengthening by making Regional and country-level situation reports, and by writing and contributing to scientific papers. In this presentation, first a general overview of available types of HIS strengthening tools and activities will be provided, after which the available tools and capacity building related to data protection and cybersecurity will be presented in more detail, because of the high interest WHO/Europe encounters for these topics in the Region currently.
Climate change adaptation measures in the context of health promotion using participatory foresight
Authors: Spagl S , Horváth I , Durstmüller F , Brugger K , Schmidt A E
Published: October 2024

Issue/problem

Climate change is regarded as a big threat to human health (WHO 2023), requiring action to prepare our health systems. Using participatory foresight approach has the potential to increase capacities of communities and to sustain future health. The process is easily transferable to other regions or countries across Europe. The work is part of the Austrian “Climate-Resilience-Check Health for regions and municipalities”.

Description of the problem

We present an innovative qualitative method to contribute to a climate change and health vulnerability and adaptation assessment following WHO’s guidelines. Questions answered by the project were: • What measures can be taken to shape the regions’ potential for a health-promoting lifestyle and to increase climate resilience? • Does participatory foresight represent a well-suited method to develop climate adaptation measures which address local needs? Taking place between 10/23 to 12/23, the participatory foresight process consisted of (1) a foresight-workshop facilitating development of adaptation measures through the creation of personas and (2) intervention boards, which gave the broader population the opportunity to vote for measures developed in the workshop. The aim of the approach was to identify measures that receive approval within the population.

Results

The participatory foresight process highlighted the local populations’ wish of revitalizing village centers to strengthen social cohesion. Particular emphasis was placed on the establishment of a community center and the expansion of daycare services.

Lessons

The process will be conducted in further regions as part of the Climate-Resilience-Check Health for Austrian regions and provides lessons of good practice for roll-out across European countries aiming to bridge efforts for climate adaptation and health promotion at regional levels.
Driving policy changes: RISE-Vac lessons learnt and recommendations
Authors: Tavoschi L , Thanasi E , Di Nino M G , Tramonti Fantozzi M P , Moazen B
Published: October 2024

The RISE-Vac project consortium applied evidence-based public health methods to collate, assess, and analyze all the evidence generated through project activities, including literature review and prospective data collection on quantitative and qualitative aspects of vaccine services implementation in prison settings. A multi-sectorial and inter-disciplinary group of experts was set-up including health professionals, statisticians, social scientists and people with lived experience from civil society organisations, health services, prison administrations, academia and international agencies. A set of recommendations, advice, and policy options on how to increase vaccine uptake, targeted to people in prison and using a citizen-centred approach, were developed and tailored to specific needs profiles of different prison population subgroups. Vaccinations to be considered in prison settings were grouped according to target population and/or public health objective into: Seasonal vaccinations and vaccination during outbreak; Childhood life-course vaccinations (booster doses); Vaccinations for cancer prevention; Vaccination for older population groups and people with chronic conditions. In consideration of the diversity of the countries participating in the project, their epidemiological context and available resources and infrastructures, a multi-tiered approach for the development and implementation of models for vaccination services implementation in prison settings was devised, encompassing core vaccinations, such as HBV, Flu, COVID-19 and tetanus, as well as expanded vaccination offer to respond to enhanced health needs and to promote equity of health outcomes, including e.g. HPV vaccination.
Measuring the economic impact of environmental stressors on health
Authors: Barbosa A , Orujova L , Feldens T , Soprani J , Martins F , Pinheiro V , Freitas A , Santos J V
Published: October 2024

Environmental stressors are an important source of burden of disease worldwide. The accurate economic evaluation of health hazards caused by environmental stressors guide the design of more effective and comprehensive public policies. However, guidelines on cost assessment, monetisation and discounting methodologies are scarce. Therefore, several different methodologies are applied in multiple contexts, making comparability difficult. Within BEST-COST, methods for monetising health hazards caused by environmental stressors are identified and described based on a systematic review approach. An electronic search was performed in Medline, Scopus, Web of Science and Econlit, alongside with grey literature and citation and reference tracking identifying all relevant studies. Different methods are identified, such as value of a statistical life (VSL) and value of a life year (VOLY), as well as specificities from data collection to modelling for the economic evaluation. These methods may be categorised based on their approach (market-based or non-market based), perspective of analysis (payer, patient or societal) and health measures. In this presentation, the various key methodologies to assess the economic impact of environmental stressors on health will be introduced and demonstrated. Through these insights, workshop participants will be supported in performing health impact assessments and cost-benefit analyses, which play a pivotal role in informing public policies that impact environment and subsequently health.
Sex differences in cardiovascular disease in relation to socioeconomic position in the NAKO study
Authors: Moreno Velasquez I , Peters SAE , Dragano N , Greiser K , Dörr M , Fischer B , Berger K , Hannemann A , Peters A , Pischon T
Published: October 2024

Background

Low socioeconomic position (SEP) is associated with cardiovascular disease (CVD) risk; yet, the underlying pathways are not fully clear and may affect sexes differently. We investigated sex differences in the relationship of SEP with prevalent CVD, cardiovascular risk factors (CRF) and estimated cardiovascular risk in a contemporaneous German population.

Methods

Data derived from the baseline examination of 204,780 participants in population-based German National Cohort (NAKO). Logistic, multinomial, and linear regression models were used to estimate sex-specific odds ratios (OR) and beta-coefficients with 95% confidence intervals (CI) of CVD, CRF and very high-risk score (SCORE2 ≥7.5% (age 40-49 years) or ≥ 10% (age 50-69 years)) associated with educational attainment and relative income. Women-to-men ratios of ORs (RORs) with 95%-CI were estimated.

Results

In women compared to men, low vs. high SEP was more strongly associated with obesity, overweight, self-reported myocardial infarction and hypertension, elevated blood pressure values, antihypertensive medication, and alcohol consumption, but less strongly related to smoking. In women with the lowest vs. highest educational level, the OR for a very high 10-year CVD risk was 3.61 (95%-CI 2.88; 4.53), compared to 1.72 (95%-CI 1.51; 1.96) in men. The women-to-men-ROR was 2.33 (95%-CI 1.78; 3.05), attenuated after age-adjustments. For the comparison of low vs. high relative income, the odds of having a very high 10-year CVD risk was 2.55 (95%-CI 2.04; 3.18) in women, and 2.25 (95%-CI 2.08; 2.42) in men (women-to-men ROR, 1.31 (95%-CI 1.05; 1.63).

Conclusions

In both sexes, there was an inverse graded relationship between SEP and the likelihood of prevalent CVD and CRF, with stronger associations in women than in men. Although women had a lower estimated 10-year CVD risk compared to men, the likelihood of having a very high CVD risk conferred by low SEP vs. a high one was higher in women than in men.
Changes in physical activity and sedentary behavior during COVID-19 pandemic restrictions in Germany
Authors: Herbolsheimer F , Brummer J , Stein M , Krist L , Steindorf K
Published: October 2024

Background

During the COVID-19 pandemic’s first wave, mobility restrictions and protective measures have impacted both public and private life. In Germany, the population was advised to stay home except for work, outdoor sport activities, and essential shopping. This study aims to evaluate how these measures affected physical activity and sedentary behavior, focusing on identifying the groups most affected.

Methods

In April and May 2020, we distributed a COVID-19-specific questionnaire to participants of the German National Cohort (NAKO). The questionnaire was specifically designed to assess changes in physical activity and sedentary behavior compared to pre-restriction levels, along with data on anxiety and depressive symptoms.

Results

Around 26 % of the 152,421 respondents reported increased sedentary time, and about 38 % reported reduced participation in sport activities compared to pre-restriction levels. Over one-third of those who previously met the WHO’s physical activity recommendation could not maintain it during the restrictions. There was also a notable decline in active transportation (M = - 0.12; 95% CI: -.126; -.117), whereas participants spent more time on recreational physical activities (M = 0.12; 95% CI: .117; .126). Based on multivariable linear and log-binomial regression models, we found that younger people were more affected by the restrictions than older adults. Factors such as transitioning to remote work, self-rated health, and depressive symptoms strongly correlated with changes in all physical activity domains, including sedentary behavior and adherence to physical activity guidelines.

Conclusions

The shift towards inactivity or low-intensity activities during the nationwide restrictions poses potential long-term health risks, highlighting the urgent need for public health policies to address the negative impact of COVID-19 restrictions on physical activity and sedentary behavior.
The Network of Expertise on Long COVID as a means to synthesise intelligence and improve our response to long COVID at EU level
Authors: Van Der Heide I
Published: October 2024

To promote international collaboration and strengthen EU and national-level responses to Long COVID, the Commission set up the Network of Expertise on Long COVID (NELC) in 2023. It brings together national institutions involved in Long COVID work, nominated by the Public Health Expert Group (PHEG) representatives of each Member State. The network provides a platform for exchanges of national experiences on diagnosis, treatment, and management of long COVID. The Commission and the NELC agreed on eight specific actions to be implemented to manage Long COVID. The development of a Long COVID definition is complex due to the diverse range of symptoms experienced by patients, and so working towards a unified EU case definition is the first action proposal. This will allow the development and implementation of a surveillance system on national and EU level to foster the knowledge on the actual scale and the symptomatology of Long COVID across the EU leading to a better comparability of health data at Union level. The proposal to develop and implement a training programme for healthcare professionals at EU level will allow for the exchange of expertise/training on Long COVID across Member States. The provision of clinical guidelines based on evidence to Member States will help manage Long COVID, and international collaboration will allow for the sharing of valuable information and data with third countries that have experience with Long COVID. The Commission will use the EU Health Policy Platform to create an open stakeholder group. This group will allow stakeholders and patient groups to express their point of view, and to share experiences. Assessing the far-reaching social and economic consequences of Long COVID across the EU will allow for more targeted social and economic policy responses from Member States. It is important that priority is given to research responding to the most urgent needs of health care systems, which is why the Commission aims to identify research needs.
Assessment of the impact of Long COVID on labour market participation and potential economic effects in the EU
Authors: De Leon Edo A
Published: October 2024

This paper estimates the economic cost of long COVID through its direct impacts on the labour market. The direct implications of long COVID for affected individuals concern their capacity to work, and their productivity at work. Some individuals might continue to work, but at a lower productivity level, some might reduce their hours worked, including as a result of temporary absences, and some might stop working at all. To the best of our knowledge, so far, no study has explicitly addressed the impact of long COVID on the EU labour market. The present paper provides a tentative assessment using available estimates from surveys, clinical follow-up studies and model simulations of the prevalence of long COVID. This tentative approach yields an estimated negative impact on labour supply of 0.2-0.3% in 2021 and 0.3-0.5% in 2022. In person-equivalents, this means long COVID would have reduced labour supply by 364,000-663,000 in 2021 and by 621,000-1,112,000 in 2022, combining the effect of lower productivity, higher sick leaves, lower hours, and increased unemployment or inactivity. The lower bound of this range is close to a recent estimate put forward for the US (Abraham & Rendell, 2023). Available labour market data suggest a mixed picture when it comes to the impact of long COVID. Overall, the possible role of long COVID in the rising trend in sick leave, disability and activity-limiting health factors, warrants careful monitoring going forward, due to its potential impact on labour supply and labour productivity, and on public finances through increased social benefits, pensions, health care and long-term care expenditure.
Community Healthcare-Associated Infections: Enhancing Control with Software and Tailored Protocols
Authors: Morais Vilaça I , Monteiro H , Pereira C , Silva R , Cabral I , Silva F , Sousa R , Pratas Valente C , Tavares F
Published: October 2024

Issue/Problem

Healthcare-associated infections are major global public health challenges. In Portugal, the prevalence of resistant Enterobacteriaceae is particularly alarming. Studies typically focus on hospitals and long-term care facilities, neglecting community settings where patients, particularly the elderly with multiple comorbidities, often transition between hospital and home.

Description of the problem

Effective control measures are vital across all healthcare environments. In home care, sporadic implementation of Contact Precautions, due to the lack of specific guidelines and challenges in accessing colonization information, has been a major gap. This project aimed to close this gap by integrating a software, previously used only in hospitals, to enhance infection control in domiciliary care. The intervention adapted contact transmission-based precautions for home settings and used data from the previous year’s infections and colonization to tailor recommendations for each patient, preventing transmission between homes and enhancing caregiver education.

Results

Preliminary data from a two-month monitoring period involved 40 patients under the care of three domiciliary teams. Eleven had records of infections involving 19 microorganisms, including 7 Enterobacteriaceae, five of which were carbapenemase producers. This led to five customized recommendations for improved precautions. The intervention also heightened nurses’ awareness of patients’ microbiological histories, evidenced by increased inquiries to the infection control team.

Lessons

Adapting measures to the unique dynamics of home care, distinct from hospital settings, is critical. Involvement of care teams in decision-making ensures practical adherence and enhances measure effectiveness. Regular monitoring is crucial for compliance, making this approach a model for other settings.

Key messages

• Adapting hospital protocols to community settings and offering close support to caregiving teams increases compliance.

• Implementing software that facilitates communication about infection and colonization enhances infection control effectiveness in community settings.
Characterising Long COVID in an Irish cohort: a study of symptom type, severity and determinants
Authors: McGuire F , Fallon U , Kavanagh P , Carney P
Published: October 2024

Long COVID (LC) is a multisystem disorder impacting 65 million people globally. This secondary analysis of data from the Follow-up After Disease Acquisition (FADA) retrospective cohort study of COVID-19 recovery, aimed to characterise the nature and severity of LC in an Irish sample. The Modified COVID-19 Yorkshire Rehabilitation Scale categorised symptoms. Data analysis employed descriptive statistics and logistic regression. Of 4,671 respondents, 2,338 (50.1%) self-reported LC. LC participants were predominantly female (1,543, 66%), White Irish (1,512, 84.9%), and highly-educated (1,174, 65.8%). 907 (51.5%), had ≥one baseline co-morbidity. Most (1,076, 59.1%) had never smoked. Only 6.9% (162) of LC cases were ever hospitalised with acute COVID-19. Recovery was reported by 979 (41.9%). Of those with persistent symptoms 306 (31.6%) were classified as “moderate/severe.” Fatigue was predominant, (1,021, 75.1%) accompanied by cognitive dysfunction (932, 68.5%) and breathlessness (870, 64.0%). Functional impairment, assessed by the EQ-5D-5L score, was evident. Factors associated with LC persistence and severity included baseline co-morbidities (aOR persistent LC 1.44 [95% CI 1.12-1.85], p = 0.005; aOR moderate/severe LC 2.90 [1.92-4.37] p < 0.001)), smoking (aOR persistent LC 1.59 [1.11-2.28] p = 0.01, aOR moderate/severe=1.65 [1.0-2.71] p = 0.05), and meeting/exceeding WHO’s physical activity guidelines (aOR persistent LC 1.49 [1.16-1.92], p = 0.002, aOR moderate/severe=1.69 [1.12-2.54], p = 0.01). LC’s diverse symptomatology and functional impairment serve as a call to action to the health service to equip itself to address this complexity. This study offers insights into LC symptom type, duration, and determinants, emphasising the need for Public Health to traverse domains, to improve all facets of population health. These findings add to the current understanding of LC, providing a foundation for the development of tailored LC services.

Key messages

• Long COVID causes a constellation of diverse symptoms.

• The Irish Health service needs to be equipped to manage the diverse symptomatologu.
MedDietMenus4Campus: Integrating Views from Nutrition, Marketing and Psychology to Improve Diets
Authors: Viegas C , Rocha A
Published: October 2024

Food service is an important setting for public health interventions, educating consumers and modulating behaviours through the meals provided. Social Marketing is one of the strategies designed to promote behaviour change, which contributions to health and well-being of consumers are widely recognised. This project aims to identify the compliance of food service menus with the Mediterranean Diet (MD) in public high education institutes (HEI) canteens, pinpointing opportunities to intervene, namely: 1) promoting changes in the food offer addressing proximity to the MD, creating, and offering plant-based meals, with seasonable and local food products and 2) developing tailored social marketing strategies to engage stakeholders to encourage healthier and sustainable food habits. It gathers a team comprised of nutrition experts on public health and food service, food technologists, gastronomy experts, psychologists, and marketers. To achieve the objectives researchers will: 1) develop an index to evaluate compliance of menus with the MD; 2) define priority stakeholders and define a methodology for engagement; 3) evaluate perceptions, barriers and facilitators; 4) develop a meal plan framework; 5) develop a new food concept “student bag” (meal on the go) and test it for industry scale-up; 6) use previous diagnosis to develop social marketing strategies directed to stakeholders and consumers to achieve food behaviour change and 7) measure the impacts of the implemented strategies. This research intends to create and implement a new healthy and sustainable food service concept, expecting to define the standpoint to inspire other food service settings to achieve an effective and sustainable food offer change and positively influence food service consumers’ food pattern towards Mediterranean recommendations, while addressing the Sustainable Development Goals (3 - good health and 12 - responsible consumption and production; 17 - partnerships for the goals).