bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaccine-preventable diseases: evaluating immune response in a sample of Italian healthcare students
Authors: Paladini A , Amantea C , Rossi M F , Fortunato C , Cadeddu C , Gualano M R , Laurenti P , Borrelli I , Santoro P E , Moscato U
Published: October 2023

Background

Healthcare university students are exposed to a range of risk factors during their hospital practical training, particularly in relation to biological hazards. Despite being students, they must be paid the same attention as health professionals in relation to the same possibility of transmitting infections to fellow colleagues, patients, and the wider community.The primary aim of this study is to investigate the seroprevalence characteristics of IgG antibodies against main infectious diseases in students enrolled in medical and health-related degree programs in an Italian university.

Methods

We conducted a retrospective epidemiological study of health professions students of a university hospital in Rome, collecting sociodemographic information and serology of antibody titers under study (hepatitis B, measles, mumps, rubella and varicella) from 2013 to 2023. After initial description of the study population, bivariate and multivariate analyses were performed to study the association between presence of antibodies with relevant variables.

Results

Our study sample included 2523 students (68.5% females; mean age 22.2, SD 3.8), of which 44.4% were protected against HBV, 87.3% against measles, 85.5% against mumps, 94.6% rubella and 95.2% against varicella. Differences in antibody coverage between age groups were statistically significant (p < 0.001), with the exception of mumps. Surprisingly, the prevalence of HBV antibody titer below the seropositivity cut-off appeared to have an inverse correlation with older age (1998-99 OR 0.75 CI 0.61-0.93, 2000-01 OR 0.50 CI 0.41-0.62, 2002-04 OR 0.40 CI 0.31-0.52).

Conclusions

Despite several recommendations and campaigns to promote vaccinations, the goal of achieving high immunization rates among healthcare workers still represents a challenge. Public health policies should focus on improving prevention strategies, including serological screening and workplace vaccination for non-immune individuals, especially for Hepatitis B.

Key messages

• Improving prevention strategies, including serological screening and vaccination, is crucial to achieve high immunization rates among healthcare students, especially for Hepatitis B.

• Health profession students are at risk of exposure to infectious diseases during hospital practical training, and the prevalence of immunity varies among different age groups.
EPASCORE: A new indicator for prescriptive appropriateness of antimicrobials: our
experience
Authors: D'Avino A , Grande D , Schiattarella A , Dionisi P , Dolce M , Miraglia B A , Brandimarte G , Carnali M , Nasi G
Published: October 2023

Background

Antibiotic resistance is being a crucial issue in hospitals, and its control, passes through an appropriate use of antibiotics. To evaluate the prescriptive appropriateness, we introduced a new indicator which takes into account the rate of infections together with antimicrobial consumption and the median time of treatment of each event.

Methods

The “Estimated Prescriptive Appropriateness Rate” (EPA-SCORE) “has been calculated for each group of bacteria, as the rate between the observed consumption of an antibiotic (DDD/1000days of hospitalization) and the expected one as if the same antibiotic had been used for 10 days exclusively for the observed infections for which it was indicated, according to the following formula: EPASCORE = (DDD observed/expected)*1/(N.of infections). Data from January 2020 and June 2022 were collected while restrictive and persuasive strategies of Antimicrobial Stewardship were implemented. Changes in EPA-SCORE were evaluated through the years.

Results

In our hospital, in the first semester of 2022 prevalence of ESBL+ Gram negative-infections was 0.90 cases/1000 doh/year. The observed consumption of drugs indicated for those infections was 86.9 DDD/1000 dof, whilst the expected one for the registered number of infections was 9.01 DDD/1000doh, with an EPASCORE of 10.37%. Regarding multi-drug-resistant gram negative-infections, prevalence was 1.48/1000doh/year; observed antibiotic consumption for them (whose prescription was restricted to ID specialists) was 43DDD/1000doh, whilts the expected DDD was 29.6 DDD/1000doh (EPASCORE 67.7%). Comparing data between 2022 and the same period of 2020, a significant increase in EPASCORE was detected (+4.2% and +7.1% for ESBL+ and MDR Gram- infections in 2022 respectively)

Conclusions

Our date demonstrate that the EPASCORE represents a feasible indicator of appropriateness of antimicrobial prescription, and restrictive strategies of antimicrobial stewardship can help to improve its outcome.

Key messages

• Antimicrobial Stewardship has a leading role to face antimicrobial resistance.

• EPA-SCORE is a feasible indicator to measure appropriateness of antimicrobial prescription.
Barriers and enablers to vaccine uptake in the Ultra-Orthodox Jewish population: a systematic review
Authors: Jacobson A , Spitzer S , Gorelik Y , Edelstein M
Published: October 2023

Background

The Jewish Ultra-Orthodox (UO) population is an undervaccinated minority group that has been disproportionally affected by outbreaks of vaccine-preventable diseases (VPD) such as measles and polio. Underlying reasons remain poorly characterized. We aimed to identify vaccination barriers and enablers in this population.

Methods

We systematically reviewed the literature, searching Pub-med, Web of science, Medline, PsychNet and Scopus from 1995 to 2021 for quantitative and qualitative primary research in English. We assessed included publications for quality and extracted relevant data based on the 5As taxonomy: access, awareness, affordability, acceptance and activation.

Results

We included 9 qualitative and 7 quantitative studies from the 125 studies identified. Access barriers included scheduling difficulties, inconvenient opening hours, and logistical difficulties related to having multiple young children. Acceptance barriers included safety concerns. Insufficient knowledge about the importance of vaccines and timely vaccination and the perception of being shielded from infections because of seclusion from wider society were key awareness barriers. Competing priorities, such as work and housework, were the main affordability barriers. Mainstream religious leadership's support for vaccination was an enabler, although recent studies suggest their influence on vaccination behavior is decreasing and the influence of anti-vaccination messages is growing.

Conclusions

Barriers to vaccination among the UO were mainly logistical, with little religious framing. Safety and efficacy concerns were similar to those reported in the wider community. Decreasing influence of the traditionally pro-vaccine mainstream religious leadership and growing influence of anti-vaccination movements targeting the UO community are new phenomena that require close monitoring. Tailored interventions are required to protect the community and wider society against future VPD outbreaks.

Key messages

• Vaccination barriers in Ultra-Orthodox Jewish communities are due mainly to logistical challenges, such as competing priorities in large families with young children.

• Religious leadership is the main enabler of vaccination in Ultra-Orthodox Jewish communities, but their declining authority and exposure to antivaxx materials is causing a shift in attitudes.
Aligning Environmental Sustainability, Health and Affordability in Diet Quality: A Systematic Review
Authors: Leydon C , Leonard U M , McCarthy S N , Harrington J M
Published: October 2023

Background

Improving population health while simultaneously respecting planetary boundaries is of critical interest globally. Despite this shared motivation, research on the dietary changes required continues to operate in silos, focusing on certain pairings (diet-climate), rather than examining sustainable diets in their totality. This review aimed to summarise the literature on adherence to a priori defined dietary patterns in consideration of diet quality, environmental impacts, metabolic risk factors for non-communicable diseases (NCDs), and affordability.

Methods

Following the PRISMA guidelines, the review protocol was registered prospectively with PROSPERO. Seven electronic databases were searched as of October 2022. Two reviewers independently screened abstracts for inclusion, followed by full-text. One reviewer conducted data extraction and a quality assessment of eligible articles.

Results

Twenty-four studies were included with the majority from European countries (n = 22), and two from Australia. Thirteen distinct diet quality scores were identified, with those measuring adherence to national dietary guidelines the most reported. Thirteen distinct environmental impact indicators were identified, with greenhouse gas emissions (GHGE) (n = 23) assessed most. Indicators to assess impact on biodiversity were reported least. All studies reported on Body Mass Index (BMI) and seven on the daily cost of dietary adherence. Higher quality diets assist with maintaining a healthy weight and reducing environmental impacts, however, incongruities between population and planetary health can occur, especially between plant food consumption and water footprint. Further, sustainable diets can increase financial cost.

Conclusions

Higher diet quality can reduce planetary pressures, however lower impact diets are not inherently nutritionally optimal. Higher quality, low environmental impact diets may provide a protective role against risk of obesity, but have affordability implications.

Key messages

• Diets providing synergies between health and multiple environmental concerns requires continued research, with specific focus on the socio-cultural and economic dimensions of sustainable diets.

• Public health strategies to confront the Global Syndemic should greater emphasise the win-win outcomes for population and planetary health through dietary change in higher-income countries.
Evaluation of metabolic parameters among health workers in terms of adherence to Mediterranean diet
Authors: Uğraş Dikmen A , Medeni V , Özkan S , Tonbuloğlu Altıner Ö , Demirbaş O B , İlhan M N
Published: October 2023

Background

The certain occupational risk factors, such as physical and mental stress from working conditions and poor diet, make healthcare workers(HCWs) a vulnerable group for obesity and non-communicable diseases(diabetes, dyslipidemia, etc.). Adopting a healthy and sustainable diet is very important in terms of both health and environmental impacts. The aim of this study was to evaluate metabolic parameters among HCWs in terms of adherence to the Mediterranean diet, which is shown to be a healthy and sustainable dietary model.

Methods

This cross-sectional study included 372 HCWs. The data collection tool consisted of the sociodemographic information of the participants, Mediterranean Diet Adherence Scale(MEDAS) questions, body mass index(BMI) and metabolic parameter information obtained retrospectively from hospital data. BMI≥30 kg/m2 and 25-29.9 kg/m2 were considered obese and overweight, respectively. Descriptive and inferential statistics were performed.

Results

71% of the participants stated that they had not heard of the concept of ‘sustainable nutrition’ before. Of the HCWs who participated in the study, 65.3% were overweight or obese. It was found that 59.7% of the HCWs showed low adherence to the Mediterranean diet and 39.5% showed moderate adherence. Men(p < 0.001), those with high school education or less (p = 0.030) and those who did not think that they ate healthy(p = 0.001) had significantly lower compliance with the Mediterranean diet. BMI(p = 0.022) and HbA1c(p = 0.049) parameters were significantly lower and HDL parameter(p = 0.015) was higher in HCWs with moderate and high adherence to the Mediterranean diet.

Conclusions

It was observed that the frequency of hearing the concept of ‘sustainable nutrition’ and compliance with the Mediterranean diet was low among healthcare professionals. Also, it was found that the frequency of obesity, dyslipidemia, and high diabetes-related parameters were increased in those with low adherence to the Mediterranean diet.

Key messages

• National, EU and global policies should be developed to increase compliance with healthy and sustainable diets among health workers who play a key role in the provision of quality healthcare services.

• Plans and programs to increase adherence to Mediterranean-type dietary patterns will bring significant increased health benefits related to non-communicable diseases and its risk factors.
How are Norwegian municipalities working to promote a healthy and sustainable diet?
Authors: Torheim L E , Totland T H , Lyshol H , Ljøsne I , Helleve A
Published: October 2023

Background

Diet and nutrition are crucial factors for public health. The importance of diet in promoting sustainability is increasingly understood, and there is a large overlap between healthy and sustainable diet. In Norway, municipalities play a key role in public health work including promoting a healthy diet in the population. The aim of this study was to describe Norwegian municipalities’ efforts to improve the diet of the population, and examine whether this was linked to sustainability.

Methods

All 356 municipalities in Norway were invited to answer a digital questionnaire which was filled in by 170 municipalities (48%). The data are presented as proportions.

Results

Most of the municipalities participating in the survey (91%) reported implementing at least one intervention to promote a healthy diet, however, these were mainly limited to a few nationwide activities such as the school milk or school fruit schemes. Only 7-8% were working to promote a sustainable diet through nudging or reducing meat consumption. Reduction of food waste was reported by 38% of the municipalities. In only a third of the municipalities, did employees who work with public health or sustainability have nutrition competencies.

The municipalities that did not answer the questionnaire were to a greater extent small municipalities and municipalities located in northern Norway than the municipalities that participated in the survey.

Conclusions

The work to promote a healthy diet was fragmented and not an integrated part of the public health effort in most municipalities. Very few municipalities worked to promote a more sustainable diet.

Key messages

• Efforts to promote a healthy diet in Norwegian municipalities are fragmented and inadequate.

• Norwegian municipalities’ promotion of a healthy diet is to a limited extent linked to promoting sustainability.
Mitigating and preventing food insecurity: a scoping review of the current EU policies
Authors: Capriolo A , Specchia M L , Zace D , Carini E , La Gatta E , Messina R , Petrella L , Di Pietro M L
Published: October 2023

Background

Food insecurity (FI) is a major public health concern, due to its association with a variety of adverse health outcomes. The aim of this study is to provide a picture of the EU policy response and adherence to the international recommendations in terms of FI mitigation and prevention.

Methods

A scoping review was carried out based on PRISMA Extension for scoping reviews method. By using specific queries/keywords, Pubmed and Scopus were searched and also institutional databases: EUR-Lex, WHO Global Database on the Implementation of Nutrition. The search was supplemented by a review of a list of organizations’ official websites, including Cordis, Food and Agriculture Organization of the United Nations, United Nations International Children's Emergency Fund and World Food Programme.

Results

The search on PubMed and Scopus produced a list of 8 articles, 3 concerning agriculture policies in EU, 4 related to intervention on the school lunch and 1 focused on the introduction of a tax on unhealthy drinks. Based on the search on EUR-Lex and WHO Global Database on the Implementation of Nutrition, 4 EU-wide statutory policies were collected covering school meals, food loss reduction, food waste prevention and food crisis and humanitarian aid operations.

The institutional website's review returned 18 documents in the form of ‘soft law’ measures, including action plans, action tools and projects.

Conclusions

Preliminary findings suggest that currently, at EU level, a coherent specific policy framework on FI is lacking. The policy fragmentation is mainly due to the multidimensional nature of FI, which has interconnections with multiple and different areas of food system-food availability, food accessibility, food safety and food quality and healthiness. The outputs also show that to date EU has failed to adhere to the international recommendations (above all, WHO recommendations) on FI mitigation and prevention. This has significant implications in terms of public health.

Key messages

• Policies design and implementation have the potential to create living environments conducive to good health and to lead to concrete health gains.

• Health gains resulting from strategies and policies implementation against FI reduce healthcare costs associated with the treatment of the FI-related diseases.
Inequalities in availability and compliance of school food programs in Canadian elementary schools
Authors: Maximova K , Tran T , Marshall K , Veugelers P J
Published: October 2023

Background

School food programs (SFP) are essential to promoting healthy eating in children. Canada lacks a federally funded and standardized SFP, resulting in a patchwork of SFP offerings. We examined SFP availability and compliance with Alberta Nutrition Guidelines for Children and Youth (ANGCY) in elementary schools from different socioeconomic settings.

Methods

Data were collected from 2 repeat cross-sectional surveys between 2008-2021: (1) REAL Kids Alberta (Raising healthy Eating and Active Living Kids in Alberta), a provincially representative population-based survey; and (2) APPLE Schools (A Project Promoting healthy Living for Everyone in Schools), a health promotion intervention targeting elementary schools in socioeconomically disadvantaged settings. School principals reported on availability and compliance of breakfast/snack and lunch programs with ANGCY. School-level socioeconomic characteristics included: Pampalon index (from Census data) and rural/small vs. large population centre (PC).

Results

Provincially, less than 50% schools offered breakfast/snack program. Lunch program was offered in over 85% schools. Over half of SFP complied with ANGCY by including 3-4 food groups (breakfast/snack: 62%, lunch: 52%). SFP availability in more vs. less deprived schools increased over time (2008: 25% vs. 26%, 2014: 58% vs. 40%). More schools located in rural/small vs. large PC offered SFP and availability increased over time (2008: 29 % vs. 18%, 2014: 56% vs. 46%). There were no consistent trends in compliance of SFP by socioeconomic characteristics. SPF availability and compliance in APPLE Schools improved from 68% to 73% and 53% to 68%, respectively. SPF availability was higher in more vs. less deprived APPLE schools (Y1: 85% vs. 54%, Y6+: 78% vs. 69%).

Conclusions

Higher availability and compliance of SFPs with nutrition guidelines in deprived and rural settings emphasize the critical role of SFPs in mitigating socioeconomic inequalities in healthy eating.

Key messages

• School food programs are essential to promoting healthy eating in children.

• School food programs may play a critical role in mitigating socioeconomic inequalities in healthy eating.
Development of a food frequency questionnaire to monitor protein intake in Flanders, Belgium
Authors: Moyersoen I , Berger N
Published: October 2023

Background

To improve planetary and dietary health, the Flemish government adopted the ‘Green Deal Protein Shift on our plate’ policy which aims to reverse the ratio between animal-based and plant-based protein-rich products in our diet to 40/60 by 2030. The Green Deal provides a platform for actions that unites players from across the food system. To guide the development of actions and assess their effectiveness it is crucial to closely monitor the protein consumption of the population.

Methods

We developed a semi-quantitative Food Frequency Questionnaire (FFQ) to be self-completed annually (2023-2030) by a representative sample of 1000 adults (18-65 years). The food list of the FFQ was developed using a stepwise approach based on the Belgian food consumption survey 2014, selecting the 90% most contributing foods to protein intake. New foods retrieved from a market research and expected innovations were added. Similar foods were combined into survey items, and portion size questions added. Protein intake was estimated using the weighted mean protein intake of the 90% most consumed foods represented in each item. A content validation study was performed to assess question comprehension, food identification and quantification. Results will allow to estimate average protein intake and evolution of protein sources over time.

Results

The FFQ includes 60 food items. The average completion time was 16 minutes. The content validation let to re-ordering of food items and reformulation of portion descriptions.

Conclusions

The newly developed FFQ will strengthen the Flemish public health surveillance system: monitoring protein intake and the ratio of animal-based versus plant-based and alternative protein will allow to guide actions and track progress towards policy objectives of the ‘Green Deal Protein Shift on our plate'.

Key messages

• This study highlights the role of public health surveillance systems in monitoring new policy actions and progress towards policy objectives.

• This study highlights the development of rapid screening tools using a database approach and market research data.
Men's Views on Gender Equality: Attitudes and Behaviors at Male-Friendly Clinics in Malawi
Authors: Triulzi I , Orlando S , Palla I , Mthiko B , Thole D , Ciccacci F , Turchetti G
Published: October 2023

Background

Malawi ranks 173 out of 188 on the UN's Gender Inequality Index (GII) and Malawi has the eighth highest child marriage rate in the world. While previous research has mostly focused on understanding gender roles and norms from women's viewpoints, there has been limited exploration of men's attitudes and behaviors towards gender equality. This study seeks to address this gap by examining the social determinants that shape gender-equitable attitudes and investigating the relationship between behaviors and attitudes in Southern Malawi.

Methods

Between August 2022 and November 2022, we conducted an observational study in four healthcare facilities located in Balaka, Phalula, Namandanje, and Kapire. The study focused on men who participated in a health education program specifically designed for them, known as male-friendly clinics. We interviewed these men using a structured questionnaire based on the International Men and Gender Equality Survey (IMAGES), which includes the Gender-Equitable Men (GEM) scale. To identify the factors influencing gender-equitable attitudes and explore the associated behaviors, we employed both univariate and multivariable analyses.

Results

We included a total of 422 men in this study, with a median age of 46 years (IQR= 34, 55). Men reported a median score of 0.53 on the Gender Equality Attitudes (GEM) scale, where 1 represents the higher GEM scores and indicates more equitable attitudes. Higher gender-equitable attitudes were associated with higher education, urban areas and with various behaviours, such as joint decision-making in couples in women's (0.55 vs 0.49; p= 0.008) and children's health (0.54 vs 0.48; p=0.012), and in spending on food and clothing (0.56 vs 0.49; p<0.001).

Conclusions

This study showed that education and location are the two leading social determinants that affect attitudes toward gender in Southern Malawi. This study confirmed that more gender-equitable attitudes reflect less power imbalance in couples.

Key messages

• Higer education grade and urban areas affect attitudes toward gender equality in Southern Malawi.

• Gender-equitable attitudes reflect equal distritution of power in couples.
Project Hep-ØN: A comprehensive approach to reduce chronic viral hepatitis in Portugal
Authors: Pita Ferreira P , Martins R , Filipe A R , Lopes C , Costa C , Moreira A R , Oliveira P , Perna C , Louro D , Pecante A C
Published: October 2023

Issue

The World Health Organization considers viral hepatitis a public health problem and aims to eliminate it as a threat by 2030, reducing incidence by 90% and mortality by 65%. To achieve these goals, the National Program for Viral Hepatitis recommends the screening of viral hepatitis at least once in a lifetime. However, this is not a widespread practice.

Description of the problem

Micro-elimination is an effective, efficient, and cost-effective intervention in addressing chronic hepatitis in specific geographic areas. The ‘Hep-ØN’ project aims to reduce the incidence, mortality, and morbidity of viral hepatitis in the area of influence of Oeste Norte. The project has three strategic axes: screening, patient follow-up, and liver disease literacy, with the support of several partners.

Results

The goal is to implement viral hepatitis screening at least once in a lifetime for all adult users, improve referral networks, ensure treatment and post-treatment surveillance of viral hepatitis, and empower healthcare professionals. The project aims to cover the 180,000 users registered in Oeste Norte (municipalities of Alcobaça, Bombarral, Caldas da Rainha, Óbidos, Peniche, Nazaré), of which more than 150,000 are over 18 years old. The pilot project is taking place in Peniche until September 2023, and covers more than 27,000 users, of which more than 22,000 are adults. The project's strategies can be applied to other areas, allowing for the rapid identification and treatment of viral hepatitis.

Lessons

The success of the pilot project in Peniche will demonstrate the importance of integrated and localized interventions in preventing and eliminating chronic viral hepatitis, first in ACES ON and then in other regions of the country. Replication should be adapted to local characteristics, leveraging synergies with local and national partners. Integrated care models are an effective strategy to address the challenges of preventing, treating, and controlling chronic viral hepatitis.

Key messages

• ‘Hep-ØN’ project aims to screen all adults, treat viral hepatitis, and empower healthcare professionals in Oeste Norte to eliminate chronic hepatitis.

• Success of the pilot project in Peniche will show localized interventions’ importance in identifying and treating viral hepatitis rapidly and how integrated care models are an effective strategy.
Worry about unmet medical care as a sensitive proxy indicator for medically vulnerable area
Authors: Cho J H , Jo J Y , Choi E H , Kwon K J , Yuk H S , Park J E , Yeob K E , Kim S Y , Park J H
Published: October 2023

Background

Unmet medical care needs affect health outcomes and measure medical care inequality. However, understanding demand in vulnerable areas solely based on experience might be insufficient. This study aims to explore whether a ‘worry about unmet medical care’ indicator could be a sensitive item to identify medically vulnerable areas along with ‘unmet medical experience'.

Methods

We surveyed 1,916 in a region of Korea after allocating them proportionally by age and gender. The same participants were surveyed on unmet medical care experience & worry. Chi-square & t-tests confirmed differences. Logistic regression was used to identify factors influencing on unmet needs.

Results

While the experience of unmet medical care was 3.4%, the worry about unmet medical care was 79.9%, The rate of worry about unmet medical care increased with age (19-39, 40-69, 70+ years old, 71.0%, 82.3%, 86.8%, respectively), and it was high among all age groups in medically vulnerable areas (19 -39, 40-69, 70+ years old, 92.3%, 94.3%, 98.2%, respectively, p<.0001). Unmet medical care experiences were high in medically vulnerable area ‘level 2’ (aOR=4.37; 95% [CI] 2.13-8.98), and worry about unmet medical care was high in lower education level (middle or elementary school) (aOR=1.81; [CI] 1.02-3.20), interest in health ‘yes’ (aOR=2.58; [CI] 1.89-3.51), medically vulnerable area ‘level 2'(aOR=2.67; [CI] 1.91-3.73). ‘level3’ area (aOR=11.81; [CI] 7.74-18.03) was found to be more likely to have worry about unmet medical care.

Conclusions

Significant differences were observed between the experience of unmet medical care and worry about unmet medical care in the participants living in medically vulnerable area. To better predict actual vulnerable areas and establish approaches to address them, both unmet medical care experiences and worries need to be monitored.

Key messages

• Significant differences were observed between the experience of unmet medical care and worry about unmet medical care in the participants living in medically vulnerable area.

• To better predict actual vulnerable areas and establish approaches to address them, both unmet medical care experiences and worries need to be monitored.
2.I. Workshop: Planetary and One health policy and governance: evidence, tools and management
Authors:   Organised by: EUPHA-PHPP, EUPHA-ENV,   Chair persons: Marleen Bekker (EUPHA-PHPP), Marija Jevtic (EUPHA-ENV)
Published: October 2023

In the past few years, a broad perspective on the relationships between human health, animal health and environmental health has developed under different conceptual labels of EcoHealth, One Health and Planetary health. Regardless of particular frames, what they have in common is the recognition that human health is not superior to other components of the ecosystem, and therefore these are complementary approaches. In this workshop we aim to increase awareness and knowledge of the fundamental interdependencies of human health, animal health, ecology and economy. The purpose is to enhance policy actions and health management with regard to the cumulative impacts across environmental, animal and human health, and the many potential trade-offs that should be taken into account when prioritizing one action over another. Also, there are specific requirements for integrative and cross-sectoral as well as multilevel governance with respect to cross-disciplinary capacity, stakeholder acceptance and other implementation conditions. In order to set the agenda, build coalitions and advocate for One health policies and management, a first and foremost condition is the development of interconnections between existing networks and platforms to speak with one voice. This workshop presents research evidence into One Health management needs, the European Hub for Planetary Health; and a recently developed One Health policy screening tool for rapid decision-making on which potential impacts and trade-offs policy impact assessment and action should focus. After three presentations from renowned speakers in the field, we will open the floor for interactive dialogue with the audience on the categorization, prioritization, and planning of follow up activities for One Health agenda-setting, advocacy and platform expansion. We intend this workshop as a recurring workshop in the next two conferences ensuring follow up actions throughout the years, using among others the EUPHA and its PHPP and ENV sections networks and media channels to spur awareness and action.

Key messages

• Prevention of emerging One Health threats require a public health community mind shift creating collective action with animal, environmental as well as economic and agricultural policy sectors.

• Our platforms, tools and evidence support agenda-setting, advocacy and policy screening to reduce health impacts and inequalities.
Development of a country specific flow chart to the effective vaccination of migrants in Italy
Authors: Scarso S , Russo M L , Marchetti G , Mancini G , Bellini A , Sabato M , Ferrari C , Marceca M , Declich S
Published: October 2023

Background

Achieving universal health coverage (UHC) is a key priority for promoting health equity. However, migrants face significant barriers to accessing health services, including vaccination. Within the “Access To Vaccination for Newly Arrived Migrants”(AcToVax4NAM) project (Grant No. 101018349, 3° EU Health Programme), this study aims to develop Italian country-specific action-oriented flow chart to overcome system barriers to the effective vaccination of newly arrived migrants (NAM).

Methods

Taking advances from AcToVax4NAM's prior research on vaccination barriers and solutions related to NAM immunization, Italian Professionals for Health (PfH) were engaged in participatory activities to ensure context-specific and relevant flow charts. The stakeholders invited were professionals working in Local Health Authorities (LHA), Non-Governmental Organizations and Universities. Two Focus Groups (FGs) were organized in order to validate and finalize the flow chart.

Results

A total of 29 PfH participated in the two FGs. The Italian country-specific flow chart resulted in a comprehensive approach to addressing barriers to effective vaccination of NAM in LHA. The flow chart includes steps such as entitlement, reachability, adherence, achievement and evaluation which are critical to ensuring vaccination coverage among migrants. A total of 58 tools also provides practical resources to support PfH in implementing the flow chart and addressing system barriers. Further evaluation of the impact of this flow chart on vaccination coverage and health outcomes is needed to assess their effectiveness and inform future efforts to improve health equity.

Conclusions

The development of Italian country-specific flow charts represents an important step towards achieving UHC and reducing health inequity among migrants. This flow chart and the tools identified to address the barriers have the potential to be a powerful support resources for equitable and guaranteed vaccination for NAM.

Key messages

• The Italian country-specific flow chart by addressing barriers to effective vaccination of NAM have the potential to significantly improve the health of migrants by reducing health inequity.

• The AcToVax4NAM’s approach to creating context-specific flow charts ensures health equity for newly arrived migrants and their access to necessary vaccinations, promoting optimal health outcomes.
Time to act! A review exploring the impact of climate change on respiratory diseases
Authors: Scerri K , Cuschieri S
Published: October 2023

Background

Climate change is a growing global epidemic, with negative repercussions on various determinants including an impact on non-communicable diseases. Respiratory diseases contribute to a substantial global burden. Therefore, exploring the relationships and impact between the growing climate change epidemic and respiratory diseases are of utmost clinical importance. The aim of this review was to provide a comprehensive summary on the pathophysiological effects of climate change on respiratory diseases.

Methods

A PubMed literature search (2000-2022) was performed using the following keywords, “climate change'', “air pollution'', “asthma”, “allergic rhinitis'', “thunderstorms” and “pollen”. The article selection followed the PRISMA 2020 guideline.

Results

Extreme temperature events, both heat and cold temperatures, air pollution, extreme weather events including wildfires, droughts, thunderstorms and dust storms as well as allergens were found to have a positive association between climate change and respiratory diseases. Climate change lead to an increase in these events, making respiratory diseases more susceptible.

Conclusions

The effects of climate change on respiratory diseases is detrimental. Urgent adaptive strategies to reduce the impact of climate change is eminent. Failure to reduce/halt these climatic effects will result in higher respiratory burden among the population, healthcare systems, with potential economic downfall, and an uninhabitable world.

Key messages

• Climate change is dominating the global ecosystems with detrimental effect on respiratory diseases.

• Urgent action to halt climate change is a requisite to safeguard the future generation.
Piloting patient-reported outcome measures for evaluation of the Irish Chronic Disease Programme
Authors: Cosgrave E , O'Brien S , O'Brien M , Hurley L , Drummond L , Gleeson M , O'Keeffe D , O'Reilly O
Published: October 2023

Background

The Irish National Integrated Care Programme for Chronic Disease (ICPCD) aims to deliver end-to-end, patient-centred care across three clinical programmes; Heart, Respiratory and Diabetes. Patient-reported outcome measures (PROMs) are a means of objectively measuring changes in patients’ subjectively-perceived health status over time in response to services. As such, PROMs facilitate service monitoring and evaluation and are an important tool for the ICPCD to ensure optimal, patient-centred, value-based healthcare delivery.

Methods

To select the most appropriate PROMs instrument for use across ICPCD, comprehensive literature review was undertaken followed by key stakeholder consultation in winter 2022. Following consideration against a set of pre-determined criteria the EQ-5D-5L, a well-validated, reliable PROMs instrument, was selected as the most appropriate PROMs instrument for use. Study design involved pilot implementation of EQ-5D-5L in one ICPCD ambulatory care hub service followed by mixed methods evaluation of staff experience of the pilot.

Results

The pilot was conducted from April to June 2023 among a socio-demographically diverse sample of patients attending their first and last episode of care with the ICPCD diabetic patient education service in Galway. Following service attendance there was a significant aggregate improvement in self-reported overall health rating but no significant change in self-reported mobility, self-care, usual activities, pain/discomfort or anxiety/depression. Predominant staff concerns included staff and patient burden and the need for adequate staff resourcing and information technology support.

Conclusions

In conjunction with key national stakeholders findings from the pilot will be used to support the development of a PROMs implementation plan at scale for adoption across all ICPCD services. Ultimately national implementation will support the ongoing delivery of high quality patient-centred care within ICPCD services.

Key messages

• PROMs facilitate service evaluation and are an important tool for the Irish National Integrated Care Programme for Chronic Disease (ICPCD) to ensure optimal patient-centred healthcare delivery.

• This pilot will support PROMs implementation at scale across ICPCD services and ultimately reinforce the ongoing delivery of high-quality, value-based, integrated healthcare.
Lessons learned from COVID-19: improving breast cancer services from the patient perspective
Authors: Myers C , Bennett K , Cahir C
Published: October 2023

Globally, health services for breast cancer (BC) were significantly disrupted due to the coronavirus disease (COVID-19) pandemic (1)and the recovery and adaptation of health services is widely unknown(2). The purpose of this study is to reflect on the health service experiences of women with a diagnosis of BC in Ireland during the pandemic and to propose patient-centered priorities and recommendations to improve BC services moving forward from COVID-19. The study included semi-structured qualitative interviews (n = 28) with women who participated in a related mixed-methods cohort study. Women with a diagnosis of BC within 5 years in Ireland were initially enrolled and women were selected for interviews through stratified purposive sampling to ensure data was available on diverse cases. Interviews took place in early 2023 to reflect on perspectives from the COVID-19 government lockdown. Thematic analysis was conducted using NVivo software. Thematic analysis highlighted three main themes: unmet needs; patient priorities; and recommendations. Women discussed unmet needs such as routine care fall-out, mental well-being, and financial difficulties. Patient priorities included cohesion among multidisciplinary BC care, proper communication with BC health professionals, and self-empowerment in BC care. Lastly, women recommended improvements for the transition from active treatment, support services, and adaptation of telemedicine. “I do think that any patient going through cancer treatments, it's not just breast cancer, any patient ... there needs to be a little bit more support for the aftercare.” The pandemic has impacted BC services considerably, and this impact has accentuated unmet needs for women with BC in Ireland. Considering these unmet needs from varying backgrounds, patient- centred priorities and recommendations were proposed. To conclude, the patient voice should be prioritized when implementing changes for improvement to health services.

Key messages

• Health systems must learn from the pandemic to improve services and to avoid detrimental impact of future disasters.

• The patient voice should be a key stakeholder when implementating health policies.
Secondary risk reduction service acceptability amongst Irish breast cancer survivors and clinicians
Authors: Steele C , Harrington J M , O'Reilly S
Published: October 2023

Background

Many patients (>75%) diagnosed with breast cancer in Ireland today will be cured and are at risk of dying from other cancers and non-communicable diseases. Breast cancer diagnosis provides a pivotal time point for education on modifiable risk factors and engagement with secondary risk reduction services. Our study set out to establish the level of awareness and acceptability of these areas, respectively.

Methods

A survey was developed for breast cancer survivors and oncology clinicians using previously validated questionnaires; the ‘Mitchelstown Cohort Survey’ and the ‘International Physical Activity Questionnaire'. IBM SPSS software (Version 28.0) was used for data analysis.

Results

Between September and December 2021, 322 patients and 29 clinicians attending the South Infirmary Victoria and Cork University Hospitals, completed the survey. Over 80% of patients and clinicians were aware of modifiable cancer risk factors. Only 1 in 5 clinicians had training in secondary risk reduction however 90% were willing to refer to services. Education had an impact on the likelihood of patient engagement with weight management, dietary, and exercise education (Pearson chi-squared test; p = 0.009, 0.039, 0.139 respectively). Patients who smoked, had increased alcohol intake, or gained weight since diagnosis were more likely to engage with services (p = <0.001, p = <0.001, p = 0.015 respectively). Patients who made changes to activity levels since diagnosis were more likely to engage with exercise education (p = 0.015).

Conclusions

This study identified that over 4 in 5 breast cancer survivors and oncology clinicians were aware of the importance of modifiable lifestyle risk factors. While 9 in 10 clinicians were willing to refer to secondary prevention services if available, the likelihood of patient engagement was associated with their at-risk behaviours and education level. Our study highlights the challenges of implementing health promotion programs in this cohort.

Key messages

• High level of intended engagement with secondary risk reduction services amongst breast cancer survivors and oncology clinicians.

• Likelihood of patient engagement was associated with their at-risk behaviours and education level.
Marine pollution and human health in Small Island Developing States (SIDS): A systematic review
Authors: Scarsi N , Morsella A , Castagna C , Messina R , Cadeddu C , Ricciardi W
Published: October 2023

The link between ocean and human health is increasingly gaining interest among researchers. There is a rapidly growing - yet still fragmented - body of evidence on marine pollution being a major threat to human health. Small Island Developing States (SIDS) are more vulnerable and their health systems risk carrying the heaviest burden. From here, this systematic review aims to retrieve all known impacts of marine pollution on human health in SIDS. PubMed, Web of Science and Scopus were consulted from inception to 2022, to identify risk factors (pollutants), sources, human exposure channels and relative health issues, in SIDS. Out of 17,264 records, 258 were eligible for full-text screening. From preliminary results, intoxications (especially Ciguatera Fish Poisoning - CFP), neurological effects and mental health issues are the most frequently cited health outcomes whereas ocean warming, metals, harmful algal blooms, and plastic are the most frequent risk factors. Findings confirm that the relationship between marine and human health in SIDS is as strong as its body of literature's growth. Some health-threatening factors are weakening SIDS’ socio-economic dimensions too. Geographically, the Caribbean and Pacific regions attract most interest. With CFP being predominant in the list of diseases, a relatively low amount of plastic-related articles was unexpectedly found, thus further searches will ensure no pertinent articles are missed.

Key messages

• The health threat posed by marine pollution to SIDS needs more monitoring and evidence.

• Targeted agendas and successful pollution policies require interdisciplinary and cross-border collaboration.
PHONIC: Public Health OperatioNs for clImate aCtion-Development of a framework to identify priorities
Authors: Geffert K , Rehfuess E , Schneider A , von Polenz I , von der Haar A , Voss M , Matthies-Wiesler F
Published: October 2023

Background

Following decades of improving health and well-being, climate change constitutes the biggest threat to human health in the 21st century. Given the urgency of this topic, it is relevant to identify ways to prioritize those public health operations that will result in the greatest benefit for the population health in a changing climate, considering the vulnerabilities of different groups. The project's aim is to assess climate change mitigation and adaptation measures related to public health functions, thereby making them resilient to current and future challenges.

Methods

This will be done by i. identifying linkages between public health functions and climate change mitigation and adaptation measures; ii. developing an umbrella framework that allows overall classification of public health operations addressing climate change mitigation and adaptation based on a review; iii. developing a sub-framework for selected operations based on international good practice with indicators that allows for structured assessment and evaluation of the current state of practice; iv. piloting of the sub-framework in Germany and Kenya by comparing national actions from public health services against international good practices. All steps will be carried out in close cooperation with experts across multiple disciplines, institutions, and countries.

Results

Preliminary results of the project show that there are already frameworks existing that have merged environmental determinants and public health operations, such as the Essential Public Health Functions for Health, Environment and Climate from PAHO. These will be complemented by the outcomes of a scoping review on indicators and international good practice examples. The next phase will include the piloting of these tools in real life settings.

Conclusions

The PHONIC project aims to develop a practical guidance for decision makers in the context of public health to identify priorities for climate change action.

Key messages

• There is potential in combining public health operations and climate change action for identifying priority actions for decision makers and practitioners.

• Practical guidance needs to be developed and implemented to link public health operations with climate action.