bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress Resilience And Resilience Factors Across 9 European Samples During The COVID-19 Pandemic
Authors: Petri-Romão P , Kalisch R
Published: October 2024

While many describe changes in mental health over the pandemic, we investigate change in resilience over time during the pandemic. Stress resilience can be operationalised as stressor reactivity, that is, how much a person’s mental health is affected by the stressors that they experience. Utilising the individual participant data (IPD) meta-analyses megadataset available we first define and quantify how many stressors individuals. We then regress this stressor exposure on mental health within each sample to compute each sample’s normative stressor reactivity. Each person’s individual stressor reactivity is then calculated as the residual to this line at each time points. Resilient outcomes can be understood as lower reactivity as this indicates lower susceptibility to stressors. Stressor reactivity (SR) scores control for individual stressor exposure, therefore allowing us to investigate resilience factors during a time in which exposure to macro and micro stressors varied greatly between individuals. Further, SR scores are a harmonised outcome that can easily compared across different samples in the IPD dataset. Using this outcome, we present findings on resilience trajectories and identify factors that are associated with resilient outcomes. We also disentangle the role of current stressor exposure and prior stressors, showing that prior exposure to stressors increases vulnerability in subsequent exposures. Our findings show that stressor reactivity over time was more stable than mental health symptoms during the pandemic, therefore indicating that SR as an outcome offers new insights into the impact of the pandemic.
Stressors and symptoms explaining sexual orientation inequalities in mental health services usage: A longitudinal study with young adults
Authors: Pachankis J , Bränström R , Roxo L
Published: October 2024

Background

Sexual minority (i.e., lesbian, gay, and bisexual [LGB], and other non-heterosexual) individuals are more likely to use mental health services than heterosexuals; however, evidence is scarce about factors contributing to this difference.

Methods

This study uses longitudinal data from a population-based sample of young adults (aged 18- 36) in Sweden (N = 1,137). We use mediation analysis to examine whether common mental health symptoms (i.e., depressive, anxiety and social anxiety symptoms, suicidality, and alcohol use) mediate sexual orientation differences in mental health services use; and to understand whether adding general stressors (i.e., low social support, loneliness, and perceived stress) to these models increases the total effect explained. Afterwards, we use logistic regression models to understand how minority-specific stressors (e.g., family reaction and dimensions of sexual minority identity) predict mental health service use among sexual minority individuals (N = 498), adjusting for common mental health symptoms.

Results

Common mental health symptoms only partially mediate the associations and the direct effect for sexual orientation remain significant (β = 0.11, p < 0.01). Adding general stressors to these models only slightly increase the total effect explained and the direct effect remained significant (β = 0.11, p < 0.01). Among sexual minority individuals, after adjusting for common mental health symptoms, a difficult process of coming out (β = 0.12, p < 0.05) and negative family reaction towards one’s sexual orientation (β = 0.15, p < 0.05) predicted use of mental health services.

Conclusions

Overall, these results show that minority-specific stressors contribute to help-seeking behaviours among sexual minority individuals, regardless of psychiatric morbidity, highlighting the potential role of mental health services empowering sexual minority individuals to cope with minority stress.
Patients’ and professionals’ experiences with remote care during COVID-19: a qualitative study
Authors: Kollmann J , Sana S , Merkelbach I , Kocken P L , Denktas S
Published: October 2024

Background

There are concerns about access to remote care for patients from low-income neighborhoods, as their first point of contact in Dutch health care is the general practitioner (GP). Now that general practice professionals have returned to the pre-pandemic ways of health care delivery, this paper looks back at experiences with remote care during COVID-19. It investigates experiences of both patients and general practice professionals with the approachability and appropriateness of remote care, and their satisfaction.

Methods

In this qualitative study, interviews were conducted with 78 patients and 18 GPs, 7 nurse practitioners and 6 mental health professionals from general practices in low-income neighborhoods. Interviews took place by phone or in person in the native language of participants.

Results

Patients from low-income neighborhoods generally found remote care to be approachable, especially telephone consultation. In contrast, video calling was rarely used. Most patients thought remote care was possible for minor ailments but still wanted to see the doctor face-to-face regularly. Patients were generally satisfied with remote care at the time, but this did not necessarily reflect their willingness to continue using it in the future. Moreover, there was lack in consensus among general practice professionals on the appropriateness of remote care for certain physical and mental complaints. Nurse practitioners and mental health professionals had a negative attitude toward remote care.

Conclusions

Integrating remote care in general practices in low-income neighborhoods is not only important in times of crisis, but also for the future where care is becoming increasingly digitalized. To achieve full integration of remote care in general practices, it is important to take opinions and barriers of patients and providers into account. It is also recommended to create guidelines for reaching consensus on the cases in which remote care can be appropriately used.

Key messages

• Take opinions and barriers regarding remote care of GP patients and providers into account.

• Create guidelines to reach consensus on the appropriate use of remote care for GP patients’ health problems.
The firearms industry challenges progress on SDGs in the Middle East
Authors: Makhoul J , Saad M , Nehme R
Published: October 2024

Firearms violence is a grave public health issue globally. Relevant public health outcomes include in addition to death, long term disability, and mental health harms. Further adverse effects on public health in armed conflicts include forced displacement, destruction of life supporting infrastructure and natural resources, in addition to adverse outcomes on civilian populations caught up in wars and protracted crises, who bear the burden more if located in low- and middle-income countries (LMICs) of the world. Firearms violence is understudied beyond recent research which focuses on gun violence at an individual level in the context of the Global North, such as in the US, and which rarely addresses the marketing and lobbying strategies of the firearms industry globally to increase sales and consumption of its products. This focus on civilian level gun ownership and violence obscures the influence of the underlying commercial determinant, the firearms industry. Armed conflicts globally are fueled to a great extent by the weapons produced by the firearms industry and their trade, the majority of which are manufactured in industrialized countries, such as the US, UK and China. Based on the above and through the commercial determinants of health framework, this presentation will illustrate using the Middle East as a case, how the firearms industry gravely undermines and threatens the majority of SGDs, 3 (health and well-being), 10 (inequality reduction) and 16 (peace and justice) directly, and several of the others indirectly. Implications for research are also discussed.
Digital health divide and digital technologies for treating substance-related disorders in Argentina
Authors: Badino M
Published: October 2024

Argentina is a country located in the South American region with more than 45 million inhabitants. According to the National Institute of Statistics and Censuses, over 92% of the population lives in urban areas. Additionally, 47% households do not have access to computers, and 12% lack availability of the internet. The present case study demonstrates the effects of the digital divide regarding the use and access to digital technologies in patients who underwent virtual treatment for substance-related disorders in a mental health service in the city of Córdoba, Argentina. This treatment modality included virtual consultation with a psychologist and WhatsApp groups for mutual support. The data obtained is part of a larger research project aimed at evaluating access to digital healthcare treatment, quality of life and patient satisfaction with the use of digital tools for treating substance-related disorders. Participants were adults between 25 and 60 years. The majority of the patients who were surveyed presented cognitive impairment and unemployment status. Those who completed secondary school (79%), stated that virtual consultation was easy to conduct (83%) and WhatsApp group texting information for mutual support was very difficult to comprehend for participating actively (63%). On the other hand, participants who only reached primary school (21%) declared that virtual consultation was easy to do (71%) and WhatsApp group texting information for mutual support was very difficult to comprehend for participating actively (87%). Concerning access, 78% of participants answered that they have difficulties with the availability of digital devices (i.e., smartphones, computers, or tablets), internet connectivity and privacy at home or work for undergoing digital treatment.
Joining forces to accelerate cancer and NCD prevention in Europe
Authors: Klepp K I
Published: October 2024

JA PreventNCD, a Joint Action to prevent cancer and other non-communicable diseases (NCDs) aims to assist authorities in prioritizing the most effective prevention strategies and policies to reduce the burden of cancer and NCDs, focusing on both personal and societal risk factors. A key objective is to tackle social inequalities by addressing the root causes of NCD risk factors and adopting a life-course approach. Recognizing that health is created by policies in several sectors is key when addressing health determinants, including social and commercial determinants of health. Consolidated efforts across countries will be required to tackle some of these determinants. To achieve the project’s objectives, the JA PreventNCD will build a comprehensive European infrastructure for monitoring risk factors, disease burden, and the impact of policies and interventions. Rigorous evaluation will ensure that the project’s deliverables will have an impact at local, national and EU levels. Three technical work packages address common risk factors for NCDs through actions ranging from policies and structural measures at societal level to interventions targeting individuals. Another set of cross-cutting work packages address monitoring, social inequalities, and health in all policies. More than 100 partners across 25 countries are involved, with almost 100 pilots to be conducted over the course of the project’s four years. One way of ensuring sustainability of the project’s outcomes is the building of a sustainable governance structure through the establishment of an EU Consortium on Cancer Prevention. Furthermore, as a mechanism to ensure high policy relevance of this JA, a Policy Decision Maker’s Forum will be established to engage policymakers and ensure feasibility of the project’s recommended actions.

Speakers/Panelists

Claudia Habl

Austrian National Public Health Institute, Vienna, Austria

Ane Fullaondo

Biosistemak, Bilbao, Spain

Arnfinn Helleve

Norwegian Institute of Public Health, Oslo, Norway
7.H. Round table: Advancing societal goals through health systems: Insights from the Renewed HSPA Framework
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Rachel Greenley (UK), Dheepa Rajan (Belgium)
Published: October 2024

The purpose of this workshop, entitled ‘Advancing societal goals through health systems: Insights from the renewed HSPA framework,’ is to take a deeper look at the intricate relationships between health systems and broader societal objectives. We will dissect the contributions of health systems to societal well-being, a concept that stretches beyond mere economic growth to include social cohesion, environmental sustainability, and economic development. The session will examine the renewed global Health System Performance Assessment Framework, which serves as a tool for policymakers to better understand how health systems fit together and explains how they perform. This framework allows for a clearer interpretation of health data and provides a pathway to pinpoint health system issues and design that are most likely to enhance performance and resilience. The workshop will delve into the three dimensions of societal well-being-social cohesion, economic development, and environmental sustainability-nested within the HSPA framework. We will explore the health system’s role in advancing these dimensions, such as fostering community bonds, supporting economic growth through a healthy workforce, and contributing to the sustainable management of environmental resources. Integrating health system performance into societal goals is a practical obligation to create a resilient, cohesive, and economically robust society. This workshop will engage stakeholders in a discourse to translate this integration into multisectoral and actionable policies, aligning health system goals with societal aspirations for a sustainable future. This workshop will focus on: How health system assessments can capture contributions to societal goals, underpinning sustainable economic and environmental practices. Real-world case studies showcasing health systems’ role in fostering societal well-being and advancing public health policies. Interactive discussions will shed light on how health systems can be pivotal in achieving the Sustainable Development Goals, particularly in the face of modern challenges such as climate change, demographic shifts, and economic pressures.

Key messages

• Health systems play a pivotal role in advancing societal well-being beyond traditional health outcomes.

• The renewed HSPA framework is a robust tool for policymakers to align health system performance with broader societal goals.

Speakers/Panelists

Scott Greer

University of Michigan, European Observatory on Health Systems and Policies, Ann Arbor, USA

Andrea Schmidt

Austrian Public Health Institute, Vienna, Austria
7.M. Round table: A new lens on loneliness: leveraging the built environment for social health
Authors:   Organised by: Manchester Institute of Education (UK), DEFACTUM (Denmark),   Chair persons: Nina Goldman (UK)
Published: October 2024

Loneliness is a global issue impacting a third of all adults, with young adults (15-25 years) disproportionately affected. Prolonged loneliness has serious consequences for mental and physical health and should be addressed as a matter of urgency. The built environment, where we live, work, and socialise, is increasingly recognised as a significant factor influencing loneliness. However, existing interventions often focus on older adults and neglect the role of the built environments in promoting connectedness across the life course. To bridge this gap, we need interdisciplinary collaboration to understand how our environments and communities can mitigate loneliness. This workshop will explore the critical intersection of place and loneliness interventions. The three panellists bring unique interdisciplinary expertise on loneliness ranging from policy to intervention implementation. These three talks (10min each) will set the stage for a dynamic discussion (30min):

1. Nina Goldman, commissioned by the World Health Organization to undertake a global overview of national loneliness policies, will present findings on how national strategies integrate place-based strategies across sectors such as housing, transportation, and urban planning.

2. Mathias Lasgaard, leading researcher on loneliness interventions, will present the innovative ‘More Together’ (MoTo) project - a multifaceted intervention addressing loneliness in both young and older adults within the Silkeborg Municipality, Denmark. This presentation will contextualize MoTo within the broader landscape of targeted loneliness interventions.

3. Eric Schoenmakers, advisor of the national loneliness action program in the Netherlands, will introduce the “I BELONG” project, an international network dedicated to understanding the relationship between public spaces, loneliness, and effective interventions for young adults in the Netherlands.

Key messages

• We aim to stimulate a paradigm shift in the way we address loneliness by moving beyond individual-centred solutions to develop a more holistic and community-based approach.

• We need more interdisciplinary collaboration to understand how our environments and communities can mitigate loneliness.

Speakers/Panelists

Nina Goldman

University of Manchester, Manchester, UK

Mathias Lasgaard

Defactum, Central Denmark Region, Aarhus, Denmark

Eric Schoenmakers

Fontys University of Applied Sciences, Eindhoven, Netherlands
Introduction to round table panel discussion and audience quiz
Authors: Gannon John
Published: October 2024

Dr. John Gannon is a Public Health Specialist Registrar with HSE Ireland. He has a background working in clinical paediatrics in Ireland, Australia and Zambia. John will introduce the workshop and begin by quizzing the audience using an interactive online tool, to evaluate their perceptions and understanding of the current landscape of screen usage and social media among children and adolescents. In this presentation, he will relay statistics on these metrics and the dramatic upsurge in recent years. He will also touch on the financial implications of these trends for global tech giants.
Impacts of long-term climate change on human health: a global scoping review
Authors: Limaheluw J , Hall L , de Kraker J , Serafim F , Roda Husman A
Published: October 2024

Introduction

Research output on climate change and human health is growing rapidly. This can make it difficult to find and use relevant information to develop public health action.

Methods

We present a global scoping review of the rapidly growing quantitative research output on long-term climate change and human health. We searched Scopus, Embase, and PubMed for quantitative, English language literature published between January 2000 and June 2021 that referenced climate change and human health in titles, abstracts, or keywords.

Results

From 36,956 publications we identified 754 relevant studies. Europe, the Americas, and the Western Pacific were studied much more often than other WHO regions. Research on temperature and vectors accounted for 70% of all included publications. Malaria, diarrheal diseases, and cardiovascular diseases were the most studied specific health outcomes. We found very few studies on non-communicable diseases in low- and middle-income countries. Retrospective publications (153) showed effects of climate change are already occurring worldwide. Most studies on tick-borne encephalitis, malaria, and lower respiratory infections associated with air pollution found impacts caused by climate change have increased. The strongest attribution of climate change was found for heat-related impacts. In prospective publications (626) diarrheal diseases, and impacts associated with heat and chemical air pollution were most consistently projected to increase. Future vector-borne disease impacts were projected to be highly location specific. Some studies demonstrated adaptation can effectively reduce impacts, while noting that capacity to adapt differs greatly between population groups.

Conclusions

Our findings underline climate change impacts are diverse and complex. Future research should prioritize the relatively understudied regions most vulnerable to climate change, such as Africa, and impacts beyond those related to temperature and vector-borne diseases.
Assessing vaccine hesitancy and vaccine literacy in the European prison population: a multicenter repeated cross-sectional study
Authors: Baglietto L , De Vita E , Mavrou J , Yiasemi I , Bardelli A
Published: October 2024

The study aimed to quantify vaccine hesitancy and vaccine literacy in prison populations and assess their correlation prior and after the implementation of training and information activities targeting PLP. A repeated cross-sectional observational study was conducted in 13 prisons of 4 European countries prior and after the implementation of a co-developed training package. The study sample included 847 people living in prison in the baseline round. The second round is currently ongoing. Through a structured questionnaire vaccine hesitancy, vaccine literacy, general health literacy, previous vaccine refusal history and socio-demographic characteristics of participants were assessed. Exploratory factor analysis was used to extract three independent components of vaccine hesitancy. Logistic regression was applied to assess the association between previous vaccine refusal and vaccine hesitancy; multiple linear regression was applied to assess the association between vaccine hesitancy and vaccine literacy and general health literacy. All analyses were adjusted for socio-demographic variables. In the baseline round, we identified three independent components of vaccine hesitancy explaining 49% of the total variance: Mistrust (proportion of the variance explained, 27%), Concern (14%) and Conspiracy (8%). All the components were associated with previous vaccine refusal (p-value <0.001) and presented very good internal consistency. Young participants presented the highest levels of vaccine hesitancy; migrants had the lower levels of Mistrust and the higher level of Concern; all three factors were lower among participants with the highest degree of academic education. Mistrust and Concern were inversely associated with vaccine literacy while all three subscales were associated with general health literacy (all p-values <0.001).
Quantifying the health burden of environmental stressors
Authors: Haagsma J A
Published: October 2024

The Burden of Disease (BoD) concept has gained increasing importance for health risk assessments, driven by the World Health Organization (WHO) and the Global Burden of Disease (GBD) studies. BoD utilizes the disability-adjusted life year (DALY) to express the population health impact of a disease, injury or risk factor. This information is essential for priority-setting in health, monitoring and evaluation of preventive interventions. However, calculating DALYs, particularly DALYs attributable to risk factors, requires a range of choices with regards to input data and methodological aspects. In this presentation we will focus on comparative risk assessment (CRA), a frequently used method to calculate the attribution of DALYs to risk factors. CRA consists of determining outcomes that are associated with a certain risk factor and relative risks of the identified outcomes as a function of exposure. This information is usually derived from systematic literature review(s). Next, information on the level of exposure in a population is required, usually by age, sex, location and/or year, and usually using a range of data sources on level of exposure. Additionally, the level of exposure associated with a minimum risk is assessed. Population attributable fractions (PAFs) are then multiplied by the relevant outcome quantity for each population subgroup to calculate the number of DALYs attributable to risk factors. Finally, mediation of risk factors through other risk factors can be taken into account. Knowledge of and uniformity in methods used to perform CRAs will facilitate the coherence and usability of estimates of the health impacts of risk factors and strengthen evidence-based decision-making in health policy. In this presentation, we will introduce the CRA approach and outline a number of innovations that are being driven by the BEST-COST project, including new methods for correlated outdoor exposures and for outdoor exposures penetrating to indoor environments.
Healthy air for healthy minds
Authors: Lindert J , Chihai J
Published: October 2024

Background

The adverse health effects from exposure to air pollution is increasingly known. A recent report shows that at least 95% of the world’s population breathe air containing dangerous levels of pollutants. According to estimates from the World Health Organization (WHO), ambient air pollution is related to 4.2 million deaths every year. Less is known about the association between indoor air (especially particulate matter 2.5 and volatile organic compounds (VOC) pollution and mental health conditions. Many sources of indoor air pollution exist, such as pressed wood products, pesticides, secondhand smoke, stoves, heaters, overcrowding and fireplaces.

Aims

We aim to synthesize knowledge on the effects of particulate matter 2.5 in indoor air and mental health conditions.

Methods

We systematically reviewed the association of indoor air pollution with mental health conditions using the databases Pubmed and EMBASE.

Results

Exposure to indoor air pollutants is associated with increased anxiety and depression and less cognitive performance. These results are robust; however, the impact of PM2.5 is larger for less-educated and female respondents. Females cook with solid fuels and biomass more often. Physical exposure and gender factors overlap in the exposure to indoor air pollutants.

Discussion

Poor indoor air quality should be part of a comprehensive assessment of factors influencing mental health and cognition. Neuroinflammation might explain the effects of poor air on mental health and cognition. Further research is needed to combine research on the social determinants of mental health and the effects of indoor air. Studies in different settings such as home, work, and hospitals are needed to better understand the specific exposures of indoor air pollution and mental health conditions in different population groups.
Novi Sad cultural stations as healthy buildings for wellbeing concept
Authors: Jevtic M , Polić D
Published: October 2024

Creating spaces for all citizens through the cultural stations project within the Novi Sad - European Capital of Culture 2022 has set an example of applying the concept of well-being which involves integrating various elements that support physical, mental, and social health. Cultural stations project in the city of Novi Sad is a concept supporting cultural programming, healthy food options, mental health support, accessibility and inclusivity, as well as community engagement. Social interaction in urban areas is vital for mental and emotional well-being, fostering a sense of belonging and community, diverse cultural programming that appeals to different groups, cultural activities such as art exhibitions, performances, workshops, and community events provide opportunities for creativity, learning, and social engagement, enhancing overall well-being. Access to cultural stations, spending time there has been linked to reduced stress, improved mood, and increased feelings of well-being within 7 neighborhoods of Novi Sad. This includes providing barrier-free access, accommodations for individuals with disabilities, and programming that is inclusive and welcoming to everyone. Participation of the local community in the design, programming, and management of cultural stations is also important. By integrating these principles into the design, programming, and management of cultural stations, Novi Sad creates vibrant, inclusive, and healthy spaces that contribute to the overall well-being of its residents and visitors. Cultural stations are located in different parts of the city in order to provide accessibility to all citizens. Their arrangement is in accordance with the recommendations of green construction and restoration, and the interior and surroundings foster respect for nature and nature-based solutions. Also, they are developing different content in line with culture, but also science, health and smart solutions as a tool for well-being.
Low income, being without employment, and living alone: How they are associated with cognitive functioning - Results from the German National Cohort (NAKO)
Authors: Rodriguez F-S , Röhr S , Wagner M , Berger K , Dragano N , Schmidt B , Becher H , Pabst A , Riedel-Heller S G
Published: October 2024

Background

While people with low socioeconomic status tend to have worse cognitive functioning, little is known about the impact of specific socioeconomic conditions. Aim of the present analysis was to investigate to what extent cognitive functioning differs by three socioeconomic conditions: low income, being without employment, and living alone.

Methods

A total of N = 158,144 participants (age 19-75 years) of the population-based German National Cohort (NAKO) provided data on socioeconomic conditions and completed cognitive testing. Multivariable regression model including the three socioeconomic conditions, age, sex, education, occupational status, having diabetes, hypertension, myocardial infarction, stroke, and depressive symptoms was used for analysis.

Results

Results from fully adjusted analysis indicated that cognitive functioning (z-score) was lower among those with low income (b=-0.53, CI95%=-0.57; -0.49) compared to not having low income, living alone (b=-0.10, CI95%=-0.14; -0.07) compared to not living alone, and being without employment (b=-0.22, CI95%=-0.27; -0.17) compared to being employed. The difference in cognitive functioning between those exposed compared to not exposed to the condition was changing slightly with older age among those with low income (interaction with age b=-2.39, CI95%=-3.24; -1.55) and, to a smaller extent, among those living alone (interaction with age b=-0.76, CI95%=-1.34; -0.19).

Conclusions

Low income, being without employment, and living alone were independently associated with poorer cognitive functioning after adjusting for confounders. As those with low income had the poorest cognitive functioning in old age, it is important to explore pathways of how cognitive health in this population group can be improved.
Evaluating XGBoost’s predictive accuracy on surgical site Infections in cardiac surgery
Authors: Baglivo F , Baratta S , Perrotta T , Tongiani M , De Angelis L , Petrillo M , Rizzo C , Baroni M
Published: October 2024

Background

Surgical site infections (SSIs) pose a significant threat in cardiac surgery (CS), profoundly impacting patient prognosis. SSI incidence varies widely, reported between 3.5% and 26.8%. The study used a decade-long dataset from SSI surveillance in a specialized hospital in Italy, applying machine learning (ML) techniques to predict the SSI incidence among CS patients.

Methods

Data collected from 2013-2023 through the surveillance system of SSI in patients undergoing CS were used to train a predictive ML algorithm (XGBoost). Data included information on demographics, risk factors, surgery variables (incision site, prophylaxis, etc.), and the infection outcome derived from follow-up interviews at 30 days post-surgery, or 90 days for patients with prosthetic materials, according to the ECDC case definition of SSI. We used the R libraries “caret”, “smotefamily” and “xgboost” to train the algorithm. A train-test split of 70-30 was applied. Both downsampling of the majority class (no SSI) and oversampling of SSI cases with SMOTE were used in the training set to address class imbalance.

Results

A total of 10,534 subjects (65.9% males, mean age 68.3 years) who underwent CS (64.3% with prosthetic materials) were included, among which 533 SSIs were identified (mean incidence of 5.06%), with 430 cases (80.7%) occurring after discharge (38.7% deep SSI) and 103 (19.3%) before discharge (55.5% deep SSI). The trained XGBoost algorithm achieved an AUC of 0.62, sensitivity of 69%, and specificity of 50% in the prediction of SSI on the test dataset.

Conclusions

These findings suggest that while the XGBoost model provides a fair predictive capability, there is significant room for improvement in sensitivity and specificity. The use of artificial intelligence offers a promising opportunity to identify patients at risk of SSI. However, further research and comprehensive data are needed to refine the predictive model and effectively improve prevention measures.

Key messages

• Predominantly occurring post-discharge, SSIs in cardiac surgery necessitate enhanced prevention strategies, highlighting the critical phase after hospital discharge where surveillance is paramount.

• Artificial intelligence may enhance post-discharge SSI surveillance, promising to identify patients at increased risk. Further research is needed to refine these AI tools for optimal sensitivity.
Water footprint and Med-Diet adherence: preliminary results from MedDietMenus4Campus
Authors: Dikmen D , Altınsoy C , Dikmen B , Balci T N , Viegas C , Rocha A
Published: October 2024

Background

The Mediterranean Diet (MedD) is widely recognized as a health-promoting and sustainable dietary pattern. This study evaluated the environmental impacts of higher education institutes (HEI) menus via water footprint and the compliance with MedD in Croatia, Portugal and Turkey.

Methods

Water footprint calculation followed the methodology of Mekonnen and Hoekstra (2012). Adherence to the Med-Diet was evaluated using the Med-Diet Compliance Index (MeDCIn). All available options were considered, except for restrictions such as vegetarian, considering a 5-day/week and 1-meal/day menu. Menus spanning a two-week period were analyzed from two distinct HEI in each country.

Results

Mean water footprints varied across three countries (1213.9-2297.4 L/person). Turkish HEI 1 (2297.4 L/person) and 2 (1934.2 L/person) exhibited the highest water footprints, while Croatian HEI 2 (1213.9 L/person) and Portugal HEI 2 (1308.6 L/person) had the lowest. MedDiet index scores ranged from 0.50 to 5.50. Portugal University 1 (5.5) and 2 (4.5) scored the highest, whereas Croatia University 1 (0.5) scored the lowest.

Conclusions

In the preliminary results, Portugal presented a lower water footprint and higher MedD adherence, possibly due to the higher use of seafood. The higher water footprint in Turkey might be due to more balanced servings of vegetables and fruits and significant portions of red meat. The low MedD compliance scores in Croatia can be attributed to insufficient fresh fruits, whole grains and pulses, and the low water footprint related to the use of ready-made desserts and soup powders not included in the water footprint database.
Stakeholders engagement model- Social Marketing strategies to improve students’ eating behaviour
Authors: Ferreira L , Monteiro B , Nogueira M , Gomes S
Published: October 2024

Previous studies have adopted the social marketing framework to investigate change behaviours towards healthier eating habits. However, despite the unequivocal link between Mediterranean Diet and healthy eating, the adoption of social marketing strategies to foster the adherence to such food pattern, remains unexplored, particularly in the context of HEIs. One research goal was to develop a stakeholder engagement model, in order to better craft social marketing strategies aligned with stakeholders’ needs. Hence, as different stakeholders call for different engagement designs, we consider that crossing the Social Marketing Framework with the Stakeholder Engagement Model, provides a solid basis to understand how to engage key stakeholders in the implementation of a program aimed at changing and influencing healthier eating habits aligned with the Mediterranean Diet within public HEIs canteens. Behavioural change in such contexts, demands a systemic and holistic approach, able to engage a diverse range of stakeholders, beyond those whose behaviour is expected to change. Social Marketing provides a strategic framework to promote behavioural change towards collective welfare. In the specific context of public health interventions towards healthier eating habits, this framework has been particularly useful. Hence, in-depth understanding on which stakeholders need to be involved in the social marketing process and at what stages, may yield insights into why some interventions change behaviour and why others do not. Findings revealed that it is not enough to create a single stakeholder engagement model throughout the social marketing plan in a more global perspective, as if one solution fits all. This study highlights the importance of designing glocal social marketing strategies, embedding glocal models of stakeholder engagement: standardizing the tools and practices that are possible and adapting what is necessary so that it has success in different national realities
Comorbidity of substance use and mental disorders in Europe
Authors: Montanari L
Published: October 2024

‘Comorbidity of substance use and mental disorders’ refers to the co-occurrence of a substance use disorder (SUD) and another mental disorder (MHD) in the same individual: mental disorders can be a risk factor for SUD and SUD may affect the occurrence of MHD. The relevance of the mental health disorders among people who use substances is related not only to its high prevalence, but also to its difficult assessment, diagnosis, and management. The EUDA is the European Drug Agency (EUDA), a decentralised agency of the European Commission with the purpose to support the European member States to monitor, respond and be prepared to the challenges posed by the drug phenomenon, including the link between SUD and MHD. In 2015 the agency has published an overview on comorbidity of SUD and MHD where it discusses several issues regarding dual disorders, including: theoretical concepts and mechanisms of actions, tools for screening and clinical diagnosis, epidemiology and interventions available to address comorbidity in the European countries (EMCDDA, 2015). The European strategic policy documents in the drug area stress the importance of considering mental health in monitoring, evidence-based responses and training for professionals in the drug field (EC, 2021). During the COVID19 pandemic, due to the overall increased concern on mental health in the population, the EUDA conducted an ad-hoc study to its the impact on substance use and mental health, especially in people who use illicit drugs. Recent work has been done to improve the available epidemiological data on comorbidity in the current European drug monitoring tools and to describe models of care for the treatment of dual disorders in Europe. Further steps are being taken with the development of the recent new agency’s mandate.

References: EMCDDA (2015), Comorbidity of substance use and mental disorders in Europe; Council of the European Union (2020), EU Drugs Strategy 2021-2025
HIV-1 transmission clusters and drug resistance in men who have sex with men in Portugal
Authors: Abrantes R , Pimentel V , Miranda M , Cruz S , Best-Hope S G , Seabra S , Martins MRO , Gomes P , Pingarilho M , Abecasis A B
Published: October 2024

Introduction

In 2022, 45.8% of diagnoses in the EU/EEA with known route of transmission were in Men who have Sex with Men (MSM). We aim to characterise HIV transmission clusters and transmission of drug resistance (TDR), as well as its determinants, using integrated sociodemographic, behavioural, clinical, and viral genomic data of MSMs newly diagnosed in Portugal between 2014 and 2019.

Methods

This study included data from 340 MSM who were diagnosed with HIV-1 infection. These individuals were newly diagnosed at 17 hospitals in Portugal between September 2014 and December 2019. Phylogenies were constructed and transmission clusters were identified with branch support ≥ 90% and 1.5% genetic distance. Logistic regression models were computed to examine the factors associated with clusters of transmission and with the presence of TDR.

Results

We identified 38 transmission clusters with 104 MSM, which included 26.6% of the total 305 MSM from our database used for cluster analysis. The overall prevalence of TDR was 8.2%. Only subtype C was significantly associated with TDR. 10.5% of the clusters had at least 1 drug resistance mutation (K103N, L90M or N88S). There was no significant difference in the prevalence of TDR between MSM inside and outside clusters. 50% of the clusters were composed of portuguese native MSM only, whereas 16% had exclusively migrant MSMs. No significant difference was found in the proportion of portuguese and migrant MSM inside and outside clusters. Factors associated with HIV-1 transmission clusters were age at diagnosis, district of residence, unprotected anal or vaginal sex with a woman, HIV testing frequency, presenter status and subtype. 87% of men engaged in sexual activity only with other men, while 13% with both men and women.

Conclusions

Specific subgroups of MSM are contributing to HIV dissemination in Portugal. Direct and precise prevention measures based on molecular epidemiology should be developed.

Key messages

• Specific subgroups of MSM are contributing to HIV dissemination in Portugal.

• Direct and precise prevention measures based on molecular epidemiology should be developed.
Assessing Health Gains: A Cost-Utility Analysis
Authors: Guarducci G , Siragusa C , Gurnari J , Gentile A M , Nante N
Published: October 2024

Background

With the increase in life expectancy and the consequent shift in the epidemiology of chronic diseases, the need to enhance and measure the population’s health status is even more imperative. The aim of this study is to assess health gains and their associated costs provided by an Italian clinic.

Methods

A retrospective study was conducted on 129 patients admitted for short-term planned hospitalization from June 2020 to August 2023. At both admission and discharge, these patients completed the EQ-5D-5L questionnaire. Quality-Adjusted Life Years (QALYs) were calculated from the difference in EQ-5D-5L scores between discharge and admission, assuming that health gains (discounted at a rate of 3.5%) accumulate up to two years after discharge. Cost-utility analysis was performed using QALYs and invoices issued by the clinic (cost of hospital stay: 250 Euro/day). Patients were stratified by gender, age (geriatric and non-geriatric), and length of stay (LoS). Descriptive statistics (median and interquartile range) and statistical analysis (Mann-Whitney test) were conducted using STATA software.

Results

The sample comprised 129 patients (55% female) with a median age of 81 [11] years and a median LoS of 16 [16] days. The median QALY gained was 0.33 [0.38], higher for males (0.35 [0.34]) than females (0.29 [0.45]). Patients younger than 65 years old experienced a greater gain in QALY (0.41 [0.42]) than geriatric patients (0.32 [0.38]) (p > 0.05). Patients with a longer LoS had a greater gain in QALY (0.35 [0.42]) than those with a shorter LoS (0.23 [0.29]) (p < 0.05). The median cost per QALY gained was 14,337 Euro, lower for males (13,803 Euro), non-geriatric patients (13,743 Euro), and those with a shorter LoS (10,670 Euro) (p > 0.05).

Conclusions

Despite disparities in QALY gains between groups, the median cost per QALY gained remained relatively constant. These findings underscore the importance of tailored interventions for effective resource allocation.

Key messages

• Differences in QALYs indicate the need for personalized healthcare strategies to optimize patient outcomes.

• The constant cost per QALY underlines the importance of effective and efficient allocation of resources.
Having paid work 1 year after disability claim in different types of mental and behavioural disorders
Authors: Ziech MLW , Hoekstra T , Boersema H J , Brouwer S
Published: October 2024

Background

The majority of claimants diagnosed with a mental and/or behavioral disorder have residual work capacity, however, the chance of actual (return to) work after a disability claim assessment may differ within this diagnosis group depending on the specific type of disease. The aim of this study is to examine the associations of different mental and behavioural diseases with having paid employment one year after the claim assessment.

Methods

This longitudinal register based cohort study included all work disability applicants with mental and behavioural disorders assessed with residual work capacity in the Netherlands in 2016. Data were derived from the Dutch Social Security Institute (UWV) and were linked to register data on paid employment. ICD codes were used to categorize 11 disease groups (mental retardation, autism spectrum disorders, ADHD, somatoform disorders, adjustment disorders, PTSS, anxiety, personality disorders, mood affective disorders, addictions and delusional disorders. Multivariable logistic regression analyses were conducted separately for applicants who work and not work at time of the claim assessment.

Results

A total of 8544 claimants (mean age 45, 56% female; n = 1915 work at baseline) were included. In the working group being diagnosed with ADHD (OR 3.05, CI 1.08-8.61) or PTSS (OR 1.45, CI 1.04-2.02) was associated with paid work, and adjustment disorder was negatively associated (OR 0.74, CI 0.56-0.97). In the not-working group, autism spectrum disorder (OR 1.51, CI 1.02-2.22), personality disorder (OR 1.36, CI 1.02-1.81) and addiction (OR 1.94, CI 1.32-2.86) was associated with return to work, and somatoform (OR 0.51, CI 0.31-0.84) disorders and mood affective disorders (OR 0.83, CI 0.70-0.99) were negatively associated.

Conclusions

The findings of this study show different associations between type of mental and behavioural disease groups and paid employment one year after the claim assessment.

Key messages

• The association of either remaining at work or return to work is different among mental and behavioural diagnosis groups, therefore a different approach is indicated.

• Active interventions to facilitate return to or remain at work might be indicated in specific diagnosis groups.