bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers and levers to vaccination of the elderly: results of a qualitative study
Authors: Addario A , Pardo M , Dorier S , Barth N , Gavazzi G , Botelho-Nevers E
Published: October 2023

Although vaccination is an essential element in the prevention of infections in the elderly, vaccination coverage in this population is low. In this population, there is less data concerning the levers and obstacles to vaccination than in the general population. The aim here is to identify the levers and obstacles to recommended vaccinations in the 65 years and over group, but also to shed light on the possible arguments that could play a role in the commitment to new vaccination behaviour. A qualitative survey based on 14 semi-structured interviews was conducted with people aged 65 and over, living at home in the Auvergne Rhône-Alpes region (France) from March to May 2022. The interviews were recorded, transcribed in their entirety and then subjected to a thematic content analysis by two independent persons. The participants interviewed were generally in favour of vaccination. The fears and motivations for vaccination reported by the participants are similar to those of the general population. We find the following obstacles: the low effectiveness of certain vaccines, potential side effects, lack of confidence in the government and health authorities and in pharmaceutical laboratories. As far as levers are concerned, free health care, limits on health expenditure, prevention of infections or even their eradication, and collective action are elements that are found in the discourse of the seniors. The general practitioner is at the centre of their vaccination decision, he is a person of trust and knowledge with a paternalistic vision and yet sometimes he is the one who does not recommend a vaccine. Moreover, the past experience of polio epidemics has left its mark on the seniors because of its impact on their autonomy and their bodies. The analysis of a common experience of the patient-doctor relationship and of poliomyelitis made it possible to support the hypothesis of a ‘generation effect’ in the relationship to vaccination among seniors.

Key messages

• The general practitioner has a central role in the vaccination of the elderly.

• the past experience of polio epidemics has left its mark on the seniors because of its impact on their autonomy and their bodies.
The COVID-19 pandemic and the regional orthopedic anesthesia guidelines
Authors: Macarico A , Bacelar-Nicolau L
Published: October 2023

Background

The infection of humans with virus SARS-Cov-2 was first reported in December 2019, in Wuhan, China and in 11th March 2020, COVID-19 was declared a pandemic by the World Health Organization. Since transmission was mainly through inhalation of droplets, general anesthesia was considered a high-risk transmission procedure. In this context, to choose regional anesthesia whenever possible, was recommended. Our main aim was to analyze if COVID-19 lead to an increased use of regional anesthesia in orthopedic surgeries.

Methods

Based on the orthopedic anesthetic activity of Hospital de Cascais (Portugal), two six months periods were compared: one following the resume of surgical activity after the first pandemic wave (“after COVID period”) and the homologous period of the previous year (“before COVID period”). Both periods were assessed for homogeneity for: age, sex, ASA status, contraindications for regional anesthesia, type of surgery, duration, priority and outpatient/inpatient care. Chi-square or Fisher tests were applied, as well as a binary logistic regression.

Results

Periods were significantly different for care (p = 0,0028), with more outpatient surgery in the after COVID period (43% versus 37,2%). No bivariate association was identified between periods and anesthesia. However, the binary logistic regression showed higher odds of being submitted to regional anesthesia in the after COVID period (p = 0,002 OR = 1,507 CI95%[1,156-1,964]).

Conclusions

Possible explanations for absent bivariate association between period and anesthesia, are that all patients were tested for COVID-19, and the higher number of outpatient surgery (for which general anesthesia is preferred) in the after COVID period. When all predictors were controlled with the binary logistic regression, the guidelines seemed to have been followed. However, the lower limit of CI95% is near 1. This may indicate that in the future, further efforts to implement regional anesthesia guidelines, may be needed.

Key messages

• COVID-19 Guidelines for regional anesthesia were followed but additional efforts are needed, as new pandemics are expected.

• As a preventive measure for future pandemics, training programs of regional anesthesia should be mandatory.
Post-Covid syndrome in the workplace
Authors: Magnavita N , Arnesano G , Di Prinzio R R , Meraglia I , Merella M , Vacca M E
Published: October 2023

A high percentage of those who develop SARS-CoV-2 infection have post-Covid syndrome. Health surveillance in the workplace must identify workers who develop this syndrome to prepare the appropriate support measures. All workers who developed Covid in a sample of 1378 workers exposed to biohazards were asked to report post-Covid symptoms and to complete questionnaires to measure occupational stress, sleep quality, fatigue, work ability, and mental health. 164 workers had Covid and 115 of these (70%) had symptoms one month after the acute phase. The frequency of the post-Covid syndrome was higher in workers with more severe or longer-lasting acute forms and in females than in males. In 80% of cases, the pattern of symptoms included the association of anosmia and dysgeusia or of weakness, fatigability, and tiredness. In 20% of cases these symptoms were associated with dyspnea, tachycardia, headache, sleep disturbances, anxiety, and muscle aches. In 80% of cases, the pattern of symptoms included the association of anosmia and dysgeusia or of weakness, fatigability, and tiredness. In 20% of cases these symptoms were associated with dyspnea, tachycardia, headache, sleep disturbances, anxiety, and muscle aches. 11% of those who contracted the infection reported worsening of the morbid conditions from which they had previously suffered; these symptoms were still present six months after the acute phase. Workers with post-Covid were found to have poorer quality sleep, increased fatigue, anxiety, depression, and decreased work ability compared with workers whose symptoms had rapidly disappeared. A large percentage of workers, after an infection that might also be mild or modest, developed persistent symptoms that compromise their working capacity and quality of life. Considering the number of Covid cases in the world, it can be estimated that between 42 and 69 million people suffer from post-Covid syndrome.

Key messages

• A large percentage of workers suffer from post-Covid syndrome and require support in the workplace.

• We can estimate that 42-69 million people worldwide suffer from post-Covid syndrome.
A systematic review of real-world contact tracing strategies at the onset of the COVID-19 pandemic
Authors: Rosso A , Amicosante AMV , Mattioli I , Bernardini F , Guglielmi E , Eugeni E , Baglio G
Published: October 2023

Background

Contact tracing (CT) represented one of the core activities for the prevention and control of COVID-19 in the early phase of the pandemic, before the availability of effective vaccines. Poor evidence is available on the real-world implementation of CT strategies and adoption of CT digital tools during the initial phase of the emergency.

Methods

We aimed to provide a comprehensive picture of the organizational aspects of CT activities during the first wave of the pandemic, through the identification and description of CT strategies used in different settings during the period March-June 2020 and of digital tools adopted in the early phase. A systematic review of published studies describing organizational models of COVID-19 CT strategies and digital tools used in real-world settings was conducted. PubMed, Embase and Cochrane Library were searched.

Results

We retrieved a total of 1,637 studies, 30 of which met all our inclusion criteria. Seven studies target the general population, 10 studies described CT activities carried out in specific population subgroups, 13 described the use of CT apps in real world settings. Main activities implemented to rapidly scale-up CT activities included decentralization of CT, involvement of trained non-public health resources (e.g. University students, civil servants), use of digital tools for CT management, inter-agency collaboration, community engagement. Digital apps proved to be a useful supplementary component in CT strategies, however their acceptability was hampered by privacy, equity and effectiveness's concerns.

Conclusions

Despite the lack of data on CT effectiveness, available evidence provides indication on coordination mechanisms and use of human and technical resources needed for the rapid scale up of CT activities. Further research on real world implementation of CT strategies during the COVID-19 pandemic would be needed to contribute to a more robust evidence-making process.

Key messages

• Decentralization of CT activities, involvement of trained non public health professionals, intersectoral collaboration were the key components of early COVID-19 CT strategies.

• The use of smartphone apps and other digital tools proved to be a substantial support for CT activities. However, privacy, ethics and equity issues must be clearly addressed.
COVID-19 vaccine booster dose effectiveness among health workers: systematic review & meta-analysis
Authors: Bartolucci L , Damiani G , Pascucci D , Pires Marafon D , Laurenti P
Published: October 2023

Background

The COVID-19 pandemic still being a major public health issue. New vaccine products have been developed, approved, distributed and given primarily to Healthcare Workers (HCWs). The aim of this systematic review is to define the term of protection offered by the administration of EMA (European Medicines Agency)-approved COVID-19 vaccine booster dose for healthcare professionals, considering the Vaccine Effectiveness (VE) against SARS-CoV-2 infections.

Methods

A systematic research of the literature was carried out using PICO (Population, Intervention, Comparison, Outcomes) model and following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Then, a meta-analysis was carried out.

Results

Starting from 1241 obtained, 5 studies met the inclusion criteria. All studies dealt with only first booster dose. VE against infection was estimated, with Comirnaty booster dose, between 50% (95% C.I. 42-56%) and 86% (95% C.I. 79-90%) and, with Spikevax booster dose, between 56% (95% C.I. 45-65%) and 96% (95% C.I. 82-99%). The meta-analysis showed an overall VE of 73% (95% C.I. 70-76%).

Conclusions

High VE levels among HCWs in the prevention of SARS-CoV-2 infections, which rapidly decline, were reported. Hence, the periodic administration of additional booster vaccine doses would be indicated.

Key messages

• EMA-approved COVID-19 vaccine booster doses are effective among healthcare workers, one of the categories most at risk: they can protect them from infections, keeping them able to work.

• Due to the effectiveness short duration, periodic administration of additional booster doses would be indicated among healthcare workers.
Actions for the protection and prevention of sustainable healthy complementary feeding in nurseries
Authors: Barocco G , Croci E , Bucci F G , Longo T , Marsi A , Guzzo G , Calabretti A , Bogoni P
Published: October 2023

Background

The WHO and UNICEF in the Global Strategy for infant and young children feeding (GS), indicate that the principle actors of society play significant roles in protecting, promoting and supporting safe and adequate complementary feeding for infants and young children. The WHO and FAO in The Sustainable Healthy Diet, guiding principles (SHD) moreover underline synergies among foods, nutrients present in dietary patterns and their bioavailability, degree of food processing, and subsequent health impact. COVID-19's (C) social economic impact has changed food supply costs. The UNICEF Baby-Friendly Community Initiative, involving 41 nurseries with 1600 enrolled children and a coverage rate of 38% (EU objective 35%) has operated in the municipality of Trieste, since 2015. Beginning August 2022 the project aims were to verify the application of food safety regulations (FSR), recommendation of the GS, SHD and regional nutritional guidelines (RNG) in nursery catering services.

Methods

13 nurseries have been verified. 78 food samples (FS) of oven-cooked vegetables (V), meat and fish (MF) were taken from 10 nursery kitchens, with a total production of 1150 meals per day. The University of Trieste has performed over 400 analyses. The outcomes were compared with FSR, literature references and pre C research results carried out in 2015.

Results

Relevant and systemic corrective actions indicated by FSR, GS and RNG have been implemented to overcome non-compliance. The analyses performed on FS have shown that the protective compounds have remained similar, and in some cases improved, in V foods. However, in the MF-based oven-cooked preparations, a significant content of Maillard products was highlighted and only some of them showed values above the acceptable limit.

Conclusions

The evidence of the project will be able to orient public actors for future integrated actions of protection, promotion and support of a healthy and sustainable complementary diet after C.

Key messages

• After the social economic impact of the Covid-19 pandemic it is determinant to support public actors in continuing to protect, promote and support safe and adequate complementary feeding in nurseries.

• It is crucial to program systemic and coordinated actions to ensure adequate resilient food systems in nursery catering services in adherence with the WHO, FAO and UNICEF recommendations.
WHO Support tool to strengthen health information systems
Authors: Novillo-Ortiz D
Published: October 2023

In the first presentation, a representative of the WHO Europe team who took part to the development of the “Support tool to strengthen health information systems: guidance for health information system assessment and strategy development” as part of the European Health Information Initiative (EHII), will introduce the tool and the relevance of performing health information system assessments to support Member States in strengthening their HIS. The 4 main guiding steps of the HIS tool (1. Perform an HIS assessment; 2. Develop an HIS vision; 3. Develop an HIS improvement plan; 4. Monitor progress and perform regular evaluations) will be outlined as well as the HIS assessment item sheet that guides the performing of an assessment, which consists of a core module and several add-on modules. The aim of the core module is to provide an overview of the functioning of the entire national HIS. The aim of the add-on modules is to shed more light on specific parts or functions of the national HIS. As the tool is in continuous development, the plans for the future will be outlined, including a short introduction to the new add-on modules that will be included in the tool.
A cost-consequence analysis of a menu intervention in early childhood education and care
Authors: Kurkela O , Virtanen S M , Erkkola M , Saarinen M , Niinistö S , Raulio S , Ahokas I , Meinilä J , Forma L ,   The FoodStep study group
Published: October 2023

Achieving a more climate-friendly, healthy, and sustainable food system that follows the principles of the green economy requires a revision of the current practices in Finland. The early childhood education and care (ECEC) provides a potentially fruitful platform for a systemic change. This study assessed the costs and consequences of a menu intervention as part of the FoodStep-project that aims to develop a novel food system model in ECEC. A randomized controlled study was carried out in 23 ECEC centers to investigate the health, climate, and economic impacts of a novel food system model that was co-created together with the municipality decision makers and professionals in food catering and ECEC. A menu-level cost-consequence analysis was performed to summarize information on the costs and the several essential consequences. Bottom-up micro-costing using data from municipal food services was applied to assess the costs. Differences in nutritional supply in relation to national ECEC meal recommendations and climate impact between existing and new diets were assessed. According to preliminary results, the moderate menu modifications resulted in a slight decrease in mean daily meal costs (breakfast, lunch, snack). A substantial increase in the supply of vegetables, legumes, and poultry was observed, while the servings of red meat decreased notably. New diets did not remove the observed imbalances in energy supply from different sources at the baseline nor the excess supply of salt, however, the overall energy supply was found to be sufficient within both menus. Menu changes resulted in a notable decrease in the unfavorable climate impacts compared with the baseline menus. The implemented changes improved the dietary quality of the menus and decreased the negative climate impact with a modest decrease in costs. Despite the promising results, further analysis of the intervention's cost-effectiveness is required to assess the potential of the novel food system model.

Key messages

• The implemented changes improved the dietary quality of the menus and decreased the negative climate impact with a modest decrease in costs.

• The intervention shows potential for a wider application with the aim of achieving a more climate-friendly, healthy, and sustainable food system.
Food system definitions and narratives in Irish agri-food strategies
Authors: Stanley I , Murrin C
Published: October 2023

Public health challenges, including malnutrition, chronic diseases and climate change, are interrelated and encompass several policy areas. Food policymaking that recognises interlinkages between agriculture, health, trade and the environment can create public policies that create for better livelihoods and planetary health. To date there has been limited research undertaken to document the food policymaking process in Ireland and to assess policy coherence. Though there has been increased emphasis on sustainability in agri-food policymaking, national level strategies have so far neglected to fully consider public health and environmental impacts, creating a barrier to more sustainable and resilient systems. This could be due to differing definitions of ‘sustainable food systems’ between sectors, creating incoherence in policy aims and goals. The aim of this study is to examine food system definitions in Irish agri-food strategies and to compare them to narratives and approaches set out in academic literature and international reports. Food Vision 2030 is the latest Irish Agri-food strategy and the first to propose a food systems approach to transform the agri-food sector. A content analysis of the strategy report was conducted and strategy missions and actions were compared to food system definitions and strategies employed at the United Nations Food System Summit 2021 (UNFS). The definition of food systems used in the strategy matched the UN definition and two of five Food Vision Missions were considered ‘well aligned’ with the UNFS Action Tracks. These related to ‘nature-positive’ food production and equitable livelihoods. Overarching missions relating to food supply and consumption were less aligned. Actions were targeted at production (29%). 12.4% of actions related to natural resources and 3.5% to consumption. While the overarching message in agri-food strategies aligns with UN definitions a disconnect in the the development of policy actions remains.

Key messages

• Understanding definitions of ‘sustainable food systems’ across sectors is important for aligning policy goals and objectives.

• Food Vision 203 is a step in the right direction for Irish agri-food strategies. However, it is evident at ‘action level’ that the primary focus remains in the productivism approach to agriculture.
Health equity implementation expectations and challenges in a multi-level system reform initiative
Authors: Bouckley T , Peiris D , Nambiar D , Schierhout G
Published: October 2023

Background

Within Australia, a system reforming place-based initiative across an area the size of Spain is being implemented. The aim is to expand community-based care models and reduce hospital demand. As COVID-19 demonstrated, sustainability of healthy societies requires a health equity focus across all stages of health reform. Despite central equity principles, pressures risk diminishing this goal as policy is translated into practice across system levels. This initiative is a perfect case study opportunity to inform policy implementation through understanding operationalisation challenges and protections across a multi-level system.

Methods

18 semi-structured interviews were conducted in 2022 and 2023 with a purposive sample of senior policy executives, program managers and clinicians across partner organisations and the NSW Ministry of Health. An iterative interview process captured perspectives across system levels as the program was progressively implemented. Interviews were analysed using an inductive constant comparative approach.

Results

Preliminary findings indicate tensions that impact on realising equity goals. Key tension points exist between levels of operationalisation. These can manifest as perceived trade-offs between health equity and efficiency; place-based reforms that put downward pressure on resource challenged local services to manage equity; and funding models that discourage access. Tension mitigation is partially achieved through leadership commitment, community building, and ring-fenced equity funds. The shared equity understanding in rural areas is also a protective factor.

Conclusions

While local mitigation factors can protect equity goal preservation, we recommend consideration towards building alignments across system levels. This can include aligning leadership goals and designated funding streams across levels. Further opportunities not often captured in the interviews exist, including aligning accountability and monitoring processes.

Key messages

• Mitigation strategies exist to overcome inherent system tensions that impact on reforms achieving equity goals. While these can be partially achieved at one level, multi-level alignment is critical.

• Shared leadership goals and designated funding streams can support overcome health equity tensions during implementation of reform initiatives, and would be supported by multi-level system alignment.
Promotion of Health Literacy in a Colorectal Cancer Screening
Authors: Costa A , Torres J , Vieira A , Henriques A
Published: October 2023

Background and objectives

Colorectal cancer is the 4th deadliest cancer in the world. Colorectal Cancer Screening (CRCS) allows to an increase in the associated overall survival. Biannual fecal immunochemical screening has been shown to be more cost-effective than colonoscopy. Health Literacy (HL), as a mediator in decision-making, can be fundamental in adhering to this screening. The objective is to map the interventions that promote Health Literacy within the scope of CCR screening.

Methods

Scoping review, following the methodology recommended by the Joanna Briggs Institute. Using the Participants, Concept and Context (PCC) strategy, participants were defined as people aged between 50-75 years; as context, the community, and as concepts of Health Literacy and CRCS. Five studies were included in the scoping review.

Results

In the studies included in the review, educational activities aimed at screening were carried out. It was also found increasing the use of digital media promotes Health Literacy. These activities can result in an increase in adherence to this screening. The study by Temucin & Nahcivan (2020) highlights the decisive role of nurses in education and counseling on CRCS. These interventions result in greater empowerment of populations and consequent decision-making related to the CRCS.

Conclusions

It was found that there are still few studies that relate the levels of Health Literacy and adherence to CRCS. However, interventions considering HL levels can result in more knowledge, awareness, and adherence to CRCS.

Key messages

• Health Literacy interventions that empower populations in the decision-making related to the Colorectal Cancer Screening.

• Health Literacy interventions through digital media increase adherence to Colorectal Cancer Screening.
The Global Impact of Edentulism: A Systematic Review
Authors: Hunter E , Congdon N , de Moura Brito L , McKenna G , Petrauskiene E , Rodrigues Leles C , Tsakos G , Woodside J , Virgili G , Piyasena P
Published: October 2023

Background

The evidence to describe the consequences of edentulism has been limited. This systematic review aimed to identify, appraise and summarise the evidence available to describe the broad health and socio-economic impacts of edentulism experienced by individuals living in low-, middle- and high-income countries.

Methods

Searches were carried out on five databases: Scopus, Web of Science, CENTRAL, EMBASE and MEDLINE. Grey literature was searched, in addition to professional recommendations and reference cross-checks. The search was completed on 15th June 2022 and updated on 21st March 2023. Searches were restricted to human studies of community dwelling adults aged ≥18 years. No restrictions were placed on publication date, language, gender or country. Data was independently extracted by two researchers and risk of bias assessment was conducted using the QualSyst Tool. The study was registered on PROSPERO (CRD42022320049).

Results

402 articles were identified from database searches, reference cross-checks and professional recommendations. Title, abstract and full text screening resulted in 32 articles for narrative review. A diverse range of outcomes were identified, including frailty, nutrition, health behaviours, quality of life, mental health and general health conditions. Due to heterogeneity between studies, Synthesis Without Meta-Analysis (SWiM) Guidelines will be used to synthesis the study results. Results from the synthesis using SWiM Guidelines are pending. Despite the inclusion of broad search terms, no relevant studies to explore the impact of edentulism on socio-economic outcomes such as productivity were identified.

Conclusions

There was a lack of high quality interventional evidence to support robust conclusions within this review. Further research to understand the impact of edentulism and establish causal relationships is needed to inform future preventative and treatment strategies.

Key messages

• Global disease burden of edentulism is high. The World Health Organisation (WHO) has estimated that global prevalence of edentulous adults aged ≥60 is 23% (WHO, Oral Health Factsheet, March 2023).

• Many of the factors that contribute to edentulism are preventable and distributed inequitably. Understanding the impact of edentulism remains an area of global public health importance.
The processes and practices of intermediaries in connecting individuals to local physical activity
Authors: O'Grady M , Barrett E , Connolly D
Published: October 2023

Background

Community-based health-related staff, acting as intermediaries, connect individuals to non-medical community services, such as physical activity and exercise. This study explored the practices of intermediaries in different health-related sectors in Ireland, in connecting individuals to local physical activity [PA], as part of a larger project investigating the role of intermediaries in promotion of physical activity.

Methods

A qualitative descriptive design was used for this study. Semi-structured interviews were carried out with three categories of intermediaries: Health Promotion and Improvement Officers [HPIO] (n = 10), Local Sports Partnership Officers [LSPO] (n = 8) and Social Prescribing Link Workers [SPLW] (n = 11). Interviews were audio recorded and transcribed verbatim. Data were analysed using qualitative content analysis.

Preliminary findings

The practices of each intermediary were varied. HPIO focus on providing individuals with smoking cessation services, rather than connecting to PA. LSPO provide ‘light touch interventions': one-off contacts, followed by connection or signposting to PA groups delivered by the partnership. SPLW provide a continuum of support from ‘light touch’ to more intensive interventions, with as much practical or instrumental support needed by the person to connect to local PA. Referrals from healthcare professionals to intermediaries specifically to increase PA were low. However, many individuals who are referred for other reasons such as loneliness and mental health issues are connected to local PA.

Conclusions

Each category of intermediary reported different processes for connecting individuals to PA and provided differing levels of support, but received low numbers of referrals from healthcare professionals specifically for physical activity. Future studies are needed to investigate the impact of interventions provided by these intermediaries on PA levels of individuals attending their services.

Key messages

• Local sports partnership officers and social prescribing link workers facilitate connections to local, community-based physical activity, by providing different levels of support.

• Intermediaries may be an under-utilized resource by healthcare professionals to increase physical activity, and future cohort studies are needed to investigate the impact of the intermediary role.
Effectiveness of dietary intervention among people with diabetes mellitus: A quasi-experimental study
Authors: Kumar Gupta S , Lakshmi P , Malhotra S , Rastogi A , Kaur M
Published: October 2023

Background

This study was aimed to evaluate the impact of intervention based on the behaviour change theory on dietary practices among patients with T2DM living in rural areas.

Methods

A quasi-experimental study was carried out in a rural area of district Fatehgarh Sahib of Punjab, North India. A total of 700 people with T2DM was screened for the eligibility from the randomly selected rural health centeres. The baseline survey included a total of 584 eligible T2DM patients (283 in the intervention and 291 in the control arms), whereas the endline survey included a total of 479 participants (242 in the intervention and 237 in the control arms). A prevalidated and structured food frequency questionnaire at baseline and at the end of 6 months of follow-up. The outcomes of study were mean changes in the total calorie intake from carbohydrate and fat, salt intake, fiber intake and biochemical measurements namely fasting plasma blood glucose, and proportion of population having HbA1c ≤ 7%. Difference in difference analysis (DiD) using Generalized Estimating Equation (GEE) model was applied to adjust for confounders. Statistical significance was considered p < 0.05.

Results

DiD suggested a significant decrease in mean: total calorie intake (-857 kcal/day; 95% CI -1115 - -599, p < 0.001), calorie intake from carbohydrates (-569 kcal/day; 95% CI -729 - -410, p < 0.001), calories intake from fat (-329 kcal/day; 95% CI -438 - -220, p < 0.001) and dietary salt intake (-5 gm/day; 95% CI -7 - -3, p < 0.001). There was also a significant increase in the mean dietary fiber intake (4 gm/day; 95% CI 0.82 - 7, p = 0.01), a decrease in the mean FPBG (-42 mg/dl; 95%CI: -55 - -29, p < 0.001) and a significant increase in proportion of participants having HbA1c within range (≤7%), (8%; 95%CI:1% - 14%, p = 0.01).

Conclusions

Study suggested dietary interventions based on the behaviour change theory helped to achieve optimal dietary habits and glycemic stability among patients with T2DM living in rural areas.

Key messages

• This study emphasised the advantage of behaviour change interventions implementation based on behaviour change theories among patients with T2DM.

• T2DM patients can be encouraged to follow healthy dietary habits by using tailored instructions.
Exploring spatial patterns of cardiovascular disease among women in India
Authors: Patil T , Jana A , Gaurav S
Published: October 2023

Cardiovascular disease (CVD) has become a leading cause of mortality and morbidity in India, surpassing the global rate. While CVD is influenced by gender due to sex-specific risk factors in women, it remains underdiagnosed, and undertreated in women. WHO provides a list of ‘best buys’ which does not consider sex-specific risk factors. Hence, we assessed prevalence, unawareness and spatial variations of CVDs in women (15-49 years). We used NFHS (2019-20) WHO causal links between underlying drivers, behavioral risk factors, metabolic/physiological risk factors, and CVDs. We used ordinary kriging interpolation techniques to measure the spatial heterogeneity of CVD prevalence and spatial autocorrelation techniques using global Moran I statistic. Furthermore, ordinary least square were used to examine spatial predictors and geographically weighted regression and multiscale geographically weighted regression model were used to map the local spatial variations. CVDs prevalence in women is 11.7% [95%, CI: 0.117-0.118], its unawareness is 12% [95%, CI: 0.116-0.117] among women. Spatial regression analysis suggests observed geographical variation of CVDs significantly correlated with risk factors- metabolic (BMI), behavioral (tobacco consumption), and underlying (sex-specific - women's education as a proxy for autonomy and socioeconomic depriviation- household wealth). India has a high burden of CVDs in women, with state-level disparities and a lack of awareness about the disease. Women are not a target population for CVDs in SDG 3.4 and India's National Health policy, 2017; however, its rising epidemic burden on women demands a need for policy choices targeted at women. The study provides evidence to inform the policy choices in reducing CVDs burden in women. It suggests a need to develop gender-specific guidelines for CVD prevention and management in India.

Key messages

• The study provides evidence to inform the policy choices in reducing CVDs burden in women and suggests a need to develop gender-specific guidelines for CVD prevention and management in India.

• India has high burden & unawareness of CVDs in women with risk factors- BMI, tobacco consumption, sex-specific - women's education as a proxy for autonomy; socioeconomic deprivation- household wealth.
Fixing food together: transitioning Ireland to a healthy sustainable food system – CHA position paper
Authors: O'Brien O , Owens S , Stanton A , Allman J , Browne S , Cox J , Fitzgerald R , Harrington J , Morrissey J , Tierney A
Published: October 2023

Problem

The Climate & Health Alliance (CHA) is a coalition of medical, health and advocacy organisations that seeks to highlight the significant health co-benefits of addressing the climate crisis. Our global food system contributes to diet-related chronic disease and has resulted in climate change, pollution, biodiversity collapse and nature loss. A healthy sustainable food system is needed to minimise interrelated obesity, climate change and malnutrition pandemics.

Description of the problem

The CHA conducted an extensive literature review to: 1. Demonstrate the need for a food system transition ; 2. Identify Ireland's challenge areas ; 3. Make recommendations for a healthy sustainable diet in the Irish context; 4. Recommend policy-level actions for Ireland.

The CHA launched ‘Fixing Food Together’ in May 2023. We identified six challenge areas for Ireland: 1. Ending the junk food cycle; 2. Promoting transition to a more plant-based diet; 3. Harnessing the power of international and national guidelines; 4. Reducing food waste; 5. Improving agricultural practices and land use; 6. Using policy to affect behaviour change.

Results

The CHA presented individual-level recommendations for future Irish dietary guidelines, including breastfeeding, ultra-processed foods, protein foods and food waste. Seven policy recommendations were made: 1. National guidelines; 2. Regulations/laws; 3. Research, processing and technology actions; 4. Financial actions ; 5. Agricultural actions; 6. Public institution actions; 7. Public awareness actions

Lessons

‘Fixing Food Together’ represents the first time a healthy sustainable diet and food system has been defined for an Irish context. The cross-sectional nature of the alliance provides a valuable consensus from its member organisations. It brings an often missing public health perspective to the climate and food systems dialogue.

Key messages

• Our current food system is harming human and planetary health.

• ‘Fixing Food Together’ identifies Ireland’s challenge areas and makes recommendations to transition to a healthy sustainable food system.
Patients’ satisfaction with the current access to and the quality of WASH services in rural hospitals
Authors: Omarova A
Published: October 2023

Background

Problems with access to safe WASH entail a deterioration in both the social and economic situation in the country and health and well-being of the people. The current study attempted to determine the patients’ satisfaction with the current access to and quality of WASH.

Methods

The survey was carried out in the hospital of the Shet district, located in the central part of Kazakhstan. Overall, 188 patients were interviewed. The obtained data was analysed aided with Epi Info 7.

Results

Almost all patients (99.47% [95% CI: 97.07-99.99%]) used the water, but 48.4% [95% CI: 35.49-66.62%] of them used it for drinking needs. Of all the respondents, 53.19% [95% CI: 45.79-60.49%] rated the color of water as “good”, smell - 57.45% [95% CI: 50.04-64.61%], taste - 45.21% [95% CI: 37.96-52.62%] and 69.15% [95% CI: 62.02-75.67%] indicated the absence of turbidity. However, 35.11% [95% CI: 28.3-42.39%] of respondents considered that the water supply source is not reliable and only 17.02% [95% CI: 11.94-23.17%] of them gave for the water quality the maximum 10 points on a 10-point scale. The type of water supply source used in the hospital statistically significantly affected the patients’ assessment of the taste of water (χ2=6.55, p = 0.04) and the reliability of the source (χ2=6.88, p = 0.03). Overall, 43.09% [95% CI: 35.9-50.49%] of respondents indicated that the available services of WASH were not adapted for them. There are also no gender-segregated toilets and conditions for hygiene during menstruation for female patients (89.89% [95% CI: 84.67-93.8%]).

Conclusions

Thus, in rural regions, the separation of toilets by gender, conditions for women during menstruation and the adaptation of the WASH for people with disabilities have been missed. There is also no proper understanding of the WASH services among patients.

Acknowledgement

The research is funded by the Science Committee of the Ministry of Science and Higher Education of the Republic of Kazakhstan (Grant No. AP09058465).

Key messages

• WASH management in rural hospitals needs to adhere to the principle of “leave no one behind” and pay more attention to building the capacity of patients in the field of WASH.

• Rural regions represent the biggest challenge in achieving SDG 6 in Kazakhstan.
Intervention Research In Health Promotion: The Challenges of Transferability of a Youth Nutrition Project
Authors: Guillemin A-F
Published: October 2023

Recent evidence reports the efficacy of theory-based interventions to promote physical activity (PA) among population (Gourlan et al., 2015). However, despite those encouraging results reported in the scientific literature, few documents currently exists to help professionals in the health and educational domains to implement theory-based interventions (Marcus & Forsyth, 2009). The “Great Live and Move Challenge” (GLMC) is an intervention based on the tenets of the theory of planned behavior (TPB, Ajzen, 1991) which aim to promote PA among 7-11 years old French school-aged children and their parents (Cousson-Gélie et al., 2019). Throughout the GLMC, children are asked to quantify their daily PA level by illustrating each 15 minutes of PA achieved with an “energy cube”. The cluster randomised controlled trial showed the effectiveness of GLMC in 3121 children by significantly increasing the proportion of children doing one hour of physical activity per day. During a two-year follow-up, children answered each year a questionnaire measuring TPB constructs and weekly physical activity practice both at pre- and post-intervention. A subsample of 157 children also wore an accelerometer (i.e., Actigraph GT3X+). Results notably show that the intervention had a positive impact on the proportion of children who comply with physical activity guidelines during the two years of follow-up, with an increase each year. The GLMC is now implemented in 7 French departments and reaches over 24,000 children. Based on these results, we would like to propose an adaptation of the GLMC for adults, by adapting this intervention in the professional environment, in order to maintain the community aspect of the project. After the presentation of the project and its transferability in different spaces, an interactive debate will be organised on the challenges of transferability.
Air pollution, self-reported health, and ethnicity in the UK: A spatial-temporal analysis
Authors: Abed Al Ahad M , Urška Demšar U , Frank Sullivan F , Hill Kulu H
Published: October 2023

Background

Air pollution is associated with poor health; though it is unclear whether this association is stronger for ethnic minorities compared to the population majority. In this study, we assessed the spatial-temporal association between air pollution and self-reported health and its variation by ethnicity in the UK.

Methods

Individual-level data from Understanding Society: the UK Household Longitudinal Study including 67,982 adult individuals over 11 years (2009-2019) were linked to yearly concentrations of NO2, SO2, PM10, and PM2.5 pollutants using the census Lower Super Output Area (LSOA) of residence. The association between air pollution and self-reported health (Likert scale: 1-5, excellent to poor) and its variation by ethnicity was assessed using three-level mixed-effects ordered logistic models. Analysis distinguished between spatial (between areas) and temporal (across time within each area) effects of air pollution.

Results

Higher concentrations of NO2, SO2, PM10, and PM2.5 pollution were associated with poorer health. Decomposing air pollution into between (spatial: across LSOAs) and within (temporal: across years within each LSOA) effects showed a significant between effect for NO2, SO2, PM10, and PM2.5 pollutants, while within effects were absent for all pollutants. People from Indian and Pakistani/Bangladeshi origins and non-UK-born individuals reported poorer health with increasing concentrations of SO2, PM10, and PM2.5 pollutants in comparison to British-white and UK-born individuals.

Conclusions

This study supports the presence of a spatial-temporal association between air pollution and poor self-reported health, which is stronger for ethnic minorities and foreign-born individuals in the UK. Air pollution mitigation is necessary to improve individuals’ health, especially for ethnic minorities who are affected the most.

Key messages

• Exposure to air pollution is linked to poor self-reported health and this association is stronger for ethnic minorities compared to the UK majority population.

• Local measures to reduce air pollution, especially in ethnic concentration neighbourhoods are necessary to improve people’s health.
Improvement in medical consultation by using an AI-powered symptom assessment application (SAA)
Authors: Kini N , Schmude M , Gilbert S , Cotte F , Millen E , Coman M A , Nemes D , Bode P , Ungureanu M I
Published: October 2023

Introduction

The shortage of healthcare workers affects countries worldwide and primarily affects people in rural areas. Although Romania trains a high number of physicians, the absence of effective retention and motivation policies leads many of them to opt for higher-paying jobs in other countries. As a result, patients experience long travel and wait times. Our study assessed if using an AI-powered SAA, Ada, in a waiting room is feasible for patients, can improve consultation efficiency, and enhance patient-physician communication.

Methods

This study was conducted in the waiting room of a GP in Cluj-Napoca, Romania, from May to July 2022. Consenting patients completed a symptom assessment while waiting for their consultation. A survey was administered to patients, the study nurse, and physician to gather feedback on their experience.

Results

The study enrolled 49 patients (29 women, 20 men). Most of the patients found the questions in Ada to be of appropriate length (94%), understandable (90%), and engaging (86%). Patients using Ada felt that they could express all their health issues (79%) and explain their symptoms better to the doctor (84%). They also felt more confident to discuss symptoms that their doctor may have missed (86%) and would use Ada again (84%). Most patients completed the assessment independently (65%). The study physician reported that 70% of patients who used Ada answered questions quickly and asked more questions related to their symptoms.

Discussion

By providing personalized health information, Ada prepared patients for their consultation, resulting in improved patient engagement and facilitation of clinical conversation. Incorporating a SAA into routine patient care has the potential to enhance the quality of medical care and reduce consultation time, thus, compensating for physician shortages. Further studies to determine the efficacy of integrating SAA with telemedicine can further help tackle the issue of uneven health workforce distribution.

Key messages

• Patients found Ada, a mobile AI-powered symptom assessment application, easy to use, understandable, and would use it again. The app helped prepare patients for their doctor’s consultation.

• Doctors reported increased patient engagement in consultation among users of Ada. These apps can help save time when used by patients in the waiting room and the results are shared with the doctors.