bluuebunny/crossref_metadata_2025 huggingface dataset:
Individual differences in sustainable working life: genetic and environmental contributions
Authors: Svedberg P , Narusyte J , Ropponen A
Published: October 2022

Background

Previous research of aetiology of interruptions in working life have shown that both genetic and environmental factors contribute to individual differences in sickness absence (SA) and disability pension (DP). However, we still lack knowledge about etiological factors contributing to sustainable working life. The aim was to study the importance of genetics, shared (mainly childhood) environmental factors, and individual (unique) environmental factors for remaining in the work force over the life-course, i.e., having a sustainable working life.

Methods

The study population include 108,275 twin individuals born 1930-1990 (53% women) with comprehensive national register data on social security, health, and demographic factors. We utilized two measures of sustainable working life: 1) employed at least two consecutive years (n = 21,348), without interruptions due to SA (>14 days), DP, or unemployment; 2) 22-years of sustainable working life, i.e., those who were employed all years from 1994 to 2016 (n = 12,931) without SA (>14 days), DP, or unemployment. Old-age pension, emigration, or death were censored. The final sample included same-sexed twin pairs of known zygosity; monozygotic pairs n = 11,403 and dizygotic pairs n = 13,354. Classical twin modelling was applied to estimate the relative contributions of genetic and environmental factors to individual differences in sustainable working life.

Results

Individual differences for two consecutive years of sustainable working life were explained by genetics 36%, shared environment 8%, and unique environmental factors 56%. For 22-years of sustainable working life genetics accounted for 18%, shared environment 46%, and unique environmental factors for 37% of individual differences.

Conclusions

Individual variation in sustainable working life is due to both genetic and environmental factors. Environmental experiences that twin siblings share while growing up is of importance, especially for long-term sustainable working life.

Key messages

• Childhood environmental circumstances as well as environmental exposures later in life seem to outweigh genetic influences on long-term sustainable working life.

• From a public health perspective, the importance of family and surrounding environment on sustainable working life implies a potential for workplace or societal interventions, or individual support.
Overview of innovative skill-mix changes in nursing across Europe
Authors: Maier C , Winkelmann J , Wismar M
Published: October 2022

Background

Many countries in Europe and worldwide have implemented new professional for nurses or are in the process of implementation, yet, an overview of the evidence on skill-mix changes has been missing. This study has analysed skill-mix innovations in nursing, evidence on outcomes and lessons for implementation.

Methods

An overview of systematic reviews, following a protocol plus country case studies, as part of an international study. The literature search was performed in six databases, with search terms covering skill-mix whereby the nursing profession played a key role. Screening was performed by three researchers after high interrater reliability rates were achieved. Analyses were performed for the nursing professions, a typology of skill-mix changes (task-shifting and role expansion) and evidence on outcomes.

Results

A total of 42 systematic reviews were identified on nurses working in new roles. The roles varied considerably, ranging from nurse prescribing to advanced practice nursing and nurse-led clinics. Nurse-led chronic care programmes were frequently identified, with overall positive outcomes on several health outcomes, e.g., for patients with diabetes or cardiovascular diseases. Nurses were also working in advanced roles in health promotion and prevention, e.g., performing screening programmes, showing equivalent quality of care compared with doctors if adequately trained. Several skill-mix models to enhance care coordination and integration were identified, suggesting that when tailored to the needs of specific population groups, particularly for vulnerable groups, may improve health outcomes or access to services.

Conclusions

The roles of nurses are increasingly diversifying and expanding internationally. Sharing country experiences on how to effectively educate the workforce to be prepared for these new roles and ensure smooth integration is critical.
The income-mortality paradox among first- and second-generation immigrants in Sweden
Authors: Miething A , Juarez SP
Published: October 2022

Background

This study investigates mortality differences by income among first- and second-generation immigrants and the native ancestral population in Sweden. Despite immigrants’ various vulnerabilities and the exhaustive evidence for a persistent inverse relationship between income and mortality in general Western populations, previous studies from outside Sweden demonstrated surprisingly weak income gradients in mortality among first-generation immigrants. Examining these associations among second-generation immigrants may help to understand this paradox.

Methods

Swedish register data from 2002 to 2016 were used to study the association between individual income rank positions and all-cause mortality. The study population was restricted to ages 25-64 years. Based on ‘relative indices of inequality’ (RII) derived from Poisson regressions, we measured mortality differentials between the least and most deprived income rank positions stratified by nativity group and sex. Correspondingly, we assessed absolute differences in mortality between the most and least deprived by using ‘slope indices of inequality’ (SII).

Results

Largest inequalities in mortality by relative income rank positions (based on RII) were found for the Swedish native ancestral population that showed on average a nearly doubled mortality risk for least compared to most deprived rank position. Immigrants disclosed weak or even nullified associations between relative income rank and all-cause mortality. Mortality inequalities by income among second-generation immigrants were substantially higher relative to first-generation immigrants but somewhat lower compared to the native ancestral population. These patterns were consistent between males and females, and confirmed by the use of SII.

Conclusions

Distinct exposures to inequality structures but also first-generation immigrants’ ‘mortality advantage’ likely contribute to the considerable mortality differences by income between the studied nativity groups.

Key messages

• Despite their social and economic vulnerabilities, first-generation immigrants in Sweden disclose weak associations between relative income rank and all-cause mortality.

• Second-generation immigrants in Sweden show notably higher magnitudes in income-related mortality compared with first-generation immigrants.
Association between institutional affiliations of academic editors and authors in medical journals
Authors: Palladino R , Alfano R , Moccia M , Barone-Adesi F , Majeed A , Triassi M , Millett C
Published: October 2022

Background

Most of the literature on conflict of interest (COI) has not focused on the role of academic editors and their possible COIs, although academic editors often hold senior faculty positions at universities, which might be considered a COI if this influences towards a more favourable processing to articles submitted by institutional colleagues. The current study aims to assess whether academic editor affiliation, a potential COI, can influence academic institution ranking as top contributor in the biomedical field.

Methods

We conducted a cross-sectional analysis extracting publicly available data from the 2019 Clarivate InCites Journal Citation Reports for journals in the “Medicine, General & Internal” category and from each journal website. We constructed the following study outcomes: i) being a top 5 academic contributor for the peer-review journal of interest (yes/no), ii) being a top 10 academic contributor for the peer-review journal of interest (yes/no), and iii) ranking position as top 50 academic contributor for the peer-review journal of interest. Mixed-effect linear and logistic regression models were employed, as appropriate.

Results

We included 114 journals in our analysis, 49% were open-access only. Sharing same affiliation of any of the editorial board members was associated with a 6.7 and 5.6 greater likelihood of being top 5 and top 10 contributors, respectively (95%CI 5.07-8.73 and 4.34-7.22). Similarly, sharing same affiliation was associated with being 12.1 places higher as top contributor (95%CI 10.35-13.81). When considering the editor in chief affiliation solely, association was even stronger.

Conclusions

We found that academic editors sharing the same institutional affiliation with authors was strongly associated with the likelihood of that institution of being a top contributor. Shared institutional affiliations between editors and authors should be clearly stated as part of an open and transparent peer-review process.

Key messages

• Editors sharing same affiliation with authors was strongly associated with the likelihood for the institution the editor was affiliated with of being top contributor for academic medical journals.

• Shared institutional affiliations between editors and authors should be clearly stated as part of an open and transparent peer-review process.
Improving PHIRI performance and scalability: working within EGI-ACE
Authors: Sipos G
Published: October 2022

EGI-ACE is a 30-month H2020 project (Jan 2021 - June 2023) with a mission to empower researchers from all disciplines to collaborate in data- and compute-intensive Open Science, enabled by free-at-point-of-use services that are delivered through the European Open Science Cloud (EOSC). EGI-ACE delivers the EOSC Compute Platform (ECP), a federated system of compute and storage infrastructure extended with platform services to support diverse types of data processing and data analytics cases. The ECP currently includes High Throughput Compute (HTC) and Cloud Compute facilities, and will broaden its scope with High Performance Compute services later in 2022. The platform layer of the ECP provides assistance for single sign-on, transfer and federation of distributed data, interactive computing, management of large numbers of jobs, orchestration of compute clusters, AI and machine learning tasks. There are over 25 thematic services in EOSC that build on the ECP, and deliver scalable data analysis for different domains, from astrophysics, through life sciences, environmental sciences, to humanities. PHIRI participates in EGI-ACE as one of the ‘Early Adopters’ of the ECP. Under the EGI-ACE workplan PHIRI will explore reproducible population health workflows with the use of cloud computing, single-sign-on, Jupyter Notebooks and Binder services of the ECP. The tests will enable PHIRI to scale out existing data analysis notebooks to big capacity machines, to reproduce simulations and models across users, and to overall validate the technological and sustainability approaches of EGI-ACE. PHIRI will also advise the project on best ways to introduce secure processing capabilities within the ECP services.
euPrevent
Authors: Van Der Zanden B
Published: October 2022

euPrevent is a non-profit organisation and a Euroregional network that wants to promote the quality of life of citizens in the border regions of the Netherlands, Germany and Belgium. Policy in the field of care and well-being is mainly organised at national level. This has a major impact on citizens in the border region who regularly cross the border for work or family reasons. We therefore focus on the establishment of sustainable, cross-border network connections between health organisations in the border region. Our cross-border cooperation is based on the following three frameworks, within we work: (1) Positive Health, (2) Health in All Policies (HiAP), and (3) Sustainable Development Goals. The network will be represented by Brigitte van der Zanden, the Director of euPrevent and a long standing expert in cross-border health issues.
Nitrites and nitrates from additives and natural sources and risk of cardiovascular outcomes
Authors: Srour B , Chazelas E , Debras C , Druesne-Pecollo N , Agaesse C , Szabo de Edelenyi F , Sellem L , Kesse-Guyot E , Deschasaux-Tanguy M , Touvier M
Published: October 2022

Nitrates and nitrites are used as food additives in processed meats. They are also commonly ingested from water and several foods. Evidence suggests a beneficial role of dietary nitrites and nitrates in lowering blood pressure. However, associations between exposure to nitrites and nitrates from natural sources and food additives, separately, and risks of hypertension and cardiovascular disease (CVD) have not been investigated. We aimed to study these associations in the French population based prospective cohort NutriNet-Santé. Overall, 104,817 adults were included. Associations between exposure to nitrites and nitrates (evaluated using repeated dietary records, linked to a food composition database accounting for commercial brands of industrial products) and risks of hypertension and cardiovascular disease were assessed using multivariable Cox proportional hazard models. During follow-up, 3810 incident cases of hypertension were ascertained, and 2075 cases of CVD, 1004 of cerebrovascular diseases and 1079 or coronary heart diseases were diagnosed. Participants with higher exposure to nitrites from food additives and specifically those highly exposed to sodium nitrite (e250) had a higher hypertension risk compared with those who are not exposed to nitrites from food additives (HR = 1.19 (95% CI 1.08-1.31), P = 0.002, and 1.19 (95% CI 1.07-1.31), P = 0.002, P < 0.001), respectively). There was no evidence for an association between total nitrites or nitrites from natural sources, or dietary nitrates with hypertension risk (all P-values>0.3). There was no evidence for associations between dietary nitrites, or nitrates with risks of cardiovascular, cerebrovascular or coronary heart diseases (all P-values>0.2). In conclusion, we found that higher exposure to nitrites from food additives was associated with higher risk of hypertension. Our results do not support a potential protective association between dietary nitrites or nitrates and cardiovascular outcomes.

Key messages

• These results provide additional evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.

• Our findings do not support any protective impact of nitrites and nitrates on cardiovascular health.
Modelling the impact of salt reduction policies on hypertension in Portugal
Authors: Lorenzo i Sunyer N , Severo M , Gregório MJ , Lopes C
Published: October 2022

Salt reduction policies are identified as effective; however, the assessment of their impact in European countries has been underexplored. The aim of this study is to assess the impact of salt reduction policies on hypertension in Portugal, to ultimately guide future policies. Based on national data, the top five foods contributing to salt intake, their salt content, and daily consumption were determined. Food reformulation included current policies and proposed targets for future agreements. Food availability trend from the main contributors was estimated from national food balance sheets. For this study, we considered five counterfactual scenarios (CF) to estimate salt intake variation: (1) reduction of salt content of foods targeted by current policies, while assuming stable consumption of the primary contributors; (2) proposal to extend CF 1 to other food categories; (3) change in the principal contributor's consumption based on the trend, assuming stable salt content; (4) combination of CF 2 and 3; (5) CF 4 and assuming a reduction of “1 pinch of salt”. Relative risk was estimated from regression coefficients to then calculate the potential impact fraction (PIF) and ultimately provide the hypertension cases prevented per year for each CF. The change in salt intake expected by each CF is -11.16%, -13.57%, +0.12%, -13.40% and 23,99%, respectively. For each CF, PIF and hypertension cases avoided per year was, as follows (mean (95%CI)): 9.46% and 46401 (44201;48925) for the first; 14.05% and 68921 (66149;72025) for the second; -1.24% and -6099 (-7636;-4763) for the third; 13.2% and 65125 (62286;67892) for the fourth; and, 15.58% and 76397 (73208;80021) for the last. This study suggests that if the salt content of main contributors was not reduced, its increasing food trend consumption might result in higher incidence of hypertension in Portugal. However, by combining current policies with targets on additional foods, more than 60,000 cases could be avoided annually.

Key messages

• Salt content reduction policies are necessary if we want to reduce the incidence of hypertension among the Portuguese population.

• Assessment of the impact of salt reduction policies is crucial if we want to choose those that have a stronger impact on the health of our population.
A Data Quality Framework for the European Health Data Space for secondary use
Authors: Bernal-Delgado E , Engsig-Karup T , Estupiñán-Romero F , Sahlertz Kristiansen N , Bredmose Simonsen J
Published: October 2022

A cornerstone in the development of the European Health Data Space for secondary use of data (EHDS2) is the design, implementation and assessment of a Data Quality Framework (DQF). Consistently, the Joint Action TEHDAS has a dedicated work program where, learning from others’ experiences across Europe and abroad, the work package is building the concepts and methods for such a DQF. The scope of this work program is to provide recommendation to the Member States and the European Commission on the concept of DQF to foster, where (institutions) the DQF should be implemented, when in data life cycle, how should be implemented and by whom. In terms of the concept, the DQF raises the importance of quality assurance procedures at data processor level and the level of quality of the data collections in terms of reliability, relevance, timeliness, coherence, coverage and completeness. When it comes to when along the data life cycle, DQF is expected operate when data needs harmonization at data processor level (ie, the effective application of interoperability standards), in the publication of the data sources (ie providing users knowledge on the provenance of data and the content of data source); or, when data sources have to be integrated and sensitive data pseudonymized (ie, the quality of the linkage and losses after pseudonymisation). Finally, when it comes to the methodology, TEHDAS suggests a three-fold approach - some quality measures in the DQF could be translated into legislation (eg, the requirement of regular auditing for a data processor to be a trusted party in the EDHS2); some could be kept as good-practices (eg, recommendation of archival procedures when a research project finalizes); and, under the assumption of continuous data quality improvement, an assessment, benchmarking and promotion methodology (eg, a grading system at data processor level).
Do Immigrants Use Less Health Care than Non-immigrants? A Population-based Study among People living with Multimorbidity in Canada
Authors: Talukder C , Wilk P , Ali S , Stranges S
Published: October 2022

Background

Immigrants face unique health care barriers, which can negatively impact their health service use and overall health. Those with multimorbidity may face a particular challenge given its association with increased need for health care. The purpose of this study was to compare health care utilization, as measured by the number of visits to family physicians and specialists, between immigrants and Canadian-born individuals living with multimorbidity.

Methods

A cross-sectional analysis was carried out using data from the 2015-2016 cycles of Canadian Community Health Survey (CCHS) on 9,014 study participants living with multimorbidity. The study utilized Andersen and Newman's behavioral model as a conceptual framework to identify quantifiable predictors associated with health service utilization. For the entire sample as well as for male and female subsamples, statistical models were fitted using negative binomial regressions to account for the count nature of the outcome variables.

Results

After adjusting for relevant confounders, no statistically significant differences were observed between immigrants and Canadian-born respondents in the number of visits to family physicians or specialists. However, subgroup analysis revealed that female immigrants with multimorbidity had considerably fewer visits to family physicians than Canadian-born females (Incident Rate Ratio [IRR]=0.86, 95% CI: 0.76-0.98), while for males these differences were not significant (IRR=1.03, 95% CI: 0.87-1.21).

Conclusions

Future research should focus on longitudinal studies to track the health status of immigrants over time, particularly those living with multimorbidity. Moreover, public health policies should be implemented to reduce cultural and social barriers to health care, with a special focus on female immigrants.
The influence of nutritional marketing on the preferences, attitudes and consumption of children from 6 to 10 years old
Authors: Lima J , Ferreira B , Figueiredo J
Published: October 2022

Introduction

Childhood obesity is a natural response to the modern food environment. A daily consumption of sugar that exceeds the WHO recommendation by 40.7% of Portuguese children influence this condition. It is recognized that children spend more time watching television and youtube, absorbing commercials about food, being susceptible to these messages and negative health literacy. Nutrition marketing is involved in these ads and most of them promote foods high in fat, sugar and salt through persuasive techniques.

Purpose

Assess implications of exposure to nutritional marketing through television and YouTube on preferences, attitudes and consumption of children from 6 to 10 years old and contribute to the increment of health literacy.

Materials and methods

Data collection through two online questionnaires about television and youtube habits and children's food preferences, developed by the research team. Statistical analysis was performed using IBM SPSS Statistics software.

Results

Forty-two students who were attending a private school, aged between 6 and 10 were evaluated. Access to youtube has led to less healthy choices for breakfast in 95% of students (p = 0.038). It was found that most children do not have TV in their room and have a more balanced breakfast (81%). Cereals, soft drinks and biscuits are foods groups that children see the most in the tv commercials (p = 0.001).

Conclusions

Exposure to nutritional marketing influences children's preferences, consumption and preferences. An active strategy should be encourage to increment health literacy levels at the family level influencing therefore children's healthier choices.
Video game addiction among Tunisian adolescents in Sousse: A cross-sectional study in high schools
Authors: Ouertani M , Ben Fredj S , Ghammem R , Zammit N , Maatouk A , Ben Belgacem W , Boujebha S , Guesmi N , Maatoug J , Ghannem H
Published: October 2022

Background

Addiction to video games is a theme regularly mentioned and associated with the risks that concern adolescents. This study aimed to determine the prevalence of video game addiction (VGA) among adolescents and identify its associated factors.

Methods

We conducted a cross-sectional study within public high schools, in Sousse, Tunisia in 2019. The target population was high school students. A structured self-administered questionnaire was used to collect data about sociodemographic characteristics, lifestyle behaviors, and mental health disorders, and we used the 21-item Game Addiction Scale to objectify video game addiction. Statistical analysis was carried out using the program SPSS v.20.

Results

A total of 1342 participants were recruited for the study,36.8% of whom were boys. The average age was 17.5 ±1.44 years. The analysis of mental health disorders showed that 67% were anxious, 66.8% were alexithymic, 65.4% were depressed and 39% had low self-esteem. The analysis of lifestyle behaviors showed that a lack of physical activity was reported by 57.6% of participants. Problematic use of the Internet (>2 hours per day) was reported among 72.4% of the students. The prevalence of video game addiction was 13%. Boys were more prone to be addicted than girls (66.2% versus 33.8%, p < 0.001). ≥17 years old students had a higher rate of VGA than those aged<17 years old (57.3% vs 42.7%, p = 0.031). VGA was higher among students who follow the non-scientific study section (69.4%, p = 0.007). Students who had moderate depression had the highest percentages of VGA (35.7%, p = 0.005). Students who had problematic use of the internet were more addicted to video games (80.3%) than those not having problematic use (19.7%), p = 0.009.

Conclusions

This study allowed us to identify the students who are vulnerable to VGA. Also, a huge responsibility is accorded to school staff and parents to tackle this health problem by sensitizing their children and setting up some protective family rules.

Key messages

• Several factors were significantly associated with video game addiction, especially problematic internet use.

• Further research is needed to understand the underlying mechanisms of video game addiction and to explore effective preventive or interventional strategies.
Primary care management strategies and COVID-19 related hospitalization: a population-based study
Authors: Palandri L , Ferrari A , Serafini A , Riccomi S , Ugolini G , Kurotschka PP , Bellelli F , Morandi M , Padula MS , Righi E
Published: October 2022

Background

Due to SARS-CoV-2 rapid mutations, the ending of the pandemic is still proceeding at a slow pace and there is the need to strengthen and invest in health systems that avoid hospital overload and its consequences on patients’ health. Most symptomatic infections have mild to moderate respiratory symptoms and patients are managed in the context of primary care. In Italy, literature on COVID-19 outpatients management by general practitioners (GPs) is scarce. This study explores the effect of GP active care and monitoring on COVID-19-related hospitalization in patients in the province of Modena (Italy) and investigates the possible determinants of GP's management.

Methods

This is a retrospective cohort study of SARS-CoV-2 infected adult outpatients managed by their GPs from March 2020 to April 2021 in the province of Modena (Italy). Data on GPs’ characteristics, management strategies (visits and remote monitoring), patients’ socio-demographic characteristics, and hospitalization were extracted from the GP's electronic medical records and were analyzed using descriptive statistics and multiple logistic regression.

Results

46 GPs agreed to participate, and 5340 patients were included in the analyses. 3014 (56%) patients received active daily remote monitoring and 840 (16%) were visited at home. Remote monitoring and home visits were both associated with a reduction of the probability of hospitalization rate of approximately 50% (respectively OR:0.52, 95%CI:0.33, 0.80 and OR:0.50, 95%CI;0.33, 0.78). Preliminary analysis of determinants showed that GPs’ patient load, setting, age, and sex were significantly associated with management strategies.

Conclusions

Active monitoring performed by GPs was effective in reducing the probability of hospitalization. Primary and hospital care integration can be effective for COVID-19 management. Studies on GPs’ characteristics and patient load and their effect on their ability to care for patients are needed.

Key messages

• Active remote monitoring and visits performed by Italian general practitioners effectively reduced hospitalization for COVID-19.

• Primary and hospital care integration can be effective for COVID-19 management.
Sharp Increase in Eating Disorders among University Students since the COVID-19 Pandemic
Authors: Tavolacci M , Ladner J , Déchelotte P
Published: October 2022

Background

The COVID-19 pandemic has caused stress, required lockdowns, curfews and social restriction and thus may have altered physical activity and eating habits among university students. The objectives were to determine the impact of the COVID-19 pandemic on Eating Disorders (ED) among university students.

Methods

Between 2009 and 2021, five repeated on line cross-sectional studies were conducted among university students. ED were identified using the French version of the five-item “Sick, Control, One stone, Fat, Food” (SCOFF) questionnaire. The ExpaliTM-validated algorithmic tool, combining SCOFF and body mass index, was used to screen EDs into four diagnostic categories: bulimic, hyperphagic and restrictive ED.

Results

With the five studies, 8981 university students were included in total, 67.3% female with a mean age of 20.7 years. The prevalence of ED was stable between 2009 and 2018 and significantly increased from 31.8% in 2018 to 51.8% in 2021 for women (p trend < 0.0001), and from 13.0% in 2009 to 31.3% in 2021 for men (p trend < 0.0001). Lower food security scores were associated with a higher risk for all ED categories. Depression and academic stress due to COVID-19 were associated with ED regardless of category. Regarding health behaviors, a high adherence to the National nutrition recommendation was a protective factor for the risk of bulimic ED, hyperphagic ED and restrictive ED. A lower frequency of moderate and vigorous physical activity was associated with a higher risk of hyperphagic ED.

Discussion

Our study has shown a high screening of ED among the students of a French university fourteen months after the beginning of the COVID-19 pandemic. By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED. Initiatives to reinforce early screening of ED to implement targeted interventions in the student population are urgently needed.

Key messages

• This finding underlines the need to extensively screen for ED in students population and identify vulnerable individuals at risk of ED.

• By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED.
Smoking cessation at diagnosis and cancer survival: systematic review and meta-analysis
Authors: Del Riccio M , Bonaccorsi G , Lorini C , Vettori V , Gandini S , Caini S
Published: October 2022

Stopping smoking can considerably cut one's risk of developing cancer compared to continued smoking (i.e. up to 50% after 5 years for esophageal cancer and after 10 years for lung cancer). Much less is known about whether quitting smoking may bring a survival advantage to people who are active smokers at the time of cancer diagnosis. We conducted a systematic review and meta-analysis of the studies that examined the prognostic effect of quitting smoking at or around diagnosis among cancer patients. We searched MEDLINE and EMBASE for articles published until 30th March 2022 that reported the impact of quitting smoking at or around diagnosis on cancer patients’ survival (any type). Separately for each cancer site, study-specific data were pooled into summary relative risk (SRR) and corresponding 95% confidence intervals (CI) using random effect meta-analysis models, investigating sources of heterogeneity and bias. Forty-three articles were included, including 20 for lung cancer (LC), 16 for head and neck cancer (HNC), and less than 10 for bladder, breast, gastrointestinal tract, and other sites. Quitting smoking at or around diagnosis was associated with longer overall survival (SRR 0.71, 95% CI 0.64-0.80) in LC patients (consistently for non-small cell and small cell LC) as well as HNC patients (SRR 0.80, 95% CI 0.70-0.91). No significant publication bias was found. For the other body sites, the studies were limited in number, which prevented meta-analyses, but results were generally consistent with a beneficial effect of smoking cessation on survival. Quitting smoking at or around diagnosis is associated with a significantly improved overall survival of smokers diagnosed with LC and HNC and shows beneficial effects in patients with other cancers. Physicians should offer smoking cessation counselling to smokers who start diagnostic workup for suspected cancer, and smoking cessation strategies should arguably become part of standard multidisciplinary oncological care.

Key messages

• Smoking cessation at or around diagnosis is associated with a significantly improved overall survival of smokers diagnosed with different types of cancer.

• Smoking cessation strategies (and counselling) should become part of standard multidisciplinary oncological care.
Let's not forget those who forget! Participatory design in the context of dementia built environment
Authors: Chrysikou E , Savvopoulou E , Rehn J , Minetou L , Hernandez Garcia E , Lad H , Capolongo S , Cadar D , Orlu M
Published: October 2022

Dementia is a major cause of disability and dependency among older people worldwide. Eco-bio-psychosocially supportive design can significantly reduce agitation and depression while improving mobility and daily activities. For this we need to include dementia patients as experts while understanding the neurological changes and functional impairments associated with the progression of the disease over time. How can we support dementia patients to participate? What tools/processes can we use to involve them in the design process? The aim of this project was to map and evaluate co-design methods for dementia and neurodiversity, in order to create an eco-bio-psychosocially supportive environment. Mixed methods were used comprising a systematic literature review on co-design techniques for spaces for dementia, three workshops: a 3-day one with seven early career researchers translating patient involving methodologies to the dementia context, a round table Patient and Public Involvement and Engagement with six service providers and stakeholders cross three countries and a cross-sectoral international day conference with four academics, four early career researchers and eight stakeholders and a series of co-design workshops for dementia and neurodiversity, which were then classified according to applicability so as to generate co-production methods for living environments for dementia. This transdisciplinary project highlighted the challenges of participatory design in the context of dementia built environment. The importance of the topic was highlighted by clinicians and staff but there are still significant limitations in terms of research and methodologies. The workshops outcome was an inclusive code of conduct for participatory design and research for dementia patients, which will help to improve home and care environments for people with dementia. The framework involved aspects such as time, space, equipment in relation to people involved (carers, patients, proxies).

Key messages

• The project created a framework to support dementia patients’ involvement for built environment decision making that considers aspects such as time, space and equipment to foster communication.

• The framework described the phases and the tools/methods in order to build trust and enable fluidity to accommodate dementia patients’ needs.
Effect of a mobile app on breastfeeding among cesarean deliveries: A randomized controlled trial
Authors: Duong Doan TT , Binns C , Lee A , Minh Pham N , Phuong Hoa Dinh T , Zhao Y , Ha Bui TT
Published: October 2022

Aim

Cesarean section has negative impacts on breastfeeding rates. This study is to evaluate the effect of a mobile application on breastfeeding outcomes among mothers who had cesarean section using a randomized control trial in Vietnam in 2020 - 2022.

Methods

A triple-blinded randomized trial of a mobile application was conducted. The mobile application was tailored to Vietnamese culture with two separate versions for the intervention and the control group. The intervention version auto-generated three messages per week and linked the information in the library content to improve breastfeeding while the control version sent messages on maternal and child health care. Pregnant mothers were recruited during their antenatal visits and randomly assigned to two groups. Outcomes of interest included early initiation of breastfeeding and exclusive breastfeeding rates.

Results

A total of 275 mothers in the control and 293 in the intervention group who had undergone a cesarean section were included in the analyses. Significant increases were observed for early initiated breastfeeding within two hours (aOR= 1.51, 95%CI: 1.01 to 2.27) and exclusive breastfeeding during hospital stay (aOR=1.59, 95%CI: 1.02 to 2.49).

Conclusions

Our results support the use of a theory-based design mobile phone application as a part of a promising intervention to improve breastfeeding outcomes.

Key messages

• A mobile phone application could be a widely accessible, acceptable, and effective intervention to improve breastfeeding outcomes.

• To improve exclusive breastfeeding rates, comprehensive interventions at different levels of sociocultural and market contexts, settings, and individuals are needed.
Assisted Reproductive Technology: Gaps in young adults’ perceptions and information from clinics
Authors: López-Toribio M , Melovska J , Dimitrievska V , Dostálová A , Novotná M , Rozée V , Hens K , March S , Güell F , Carrasco JM
Published: October 2022

Background

Around 186 million individuals are facing infertility worldwide, with a huge impact on their wellbeing. Fertility care is considered a key element to promote reproductive health. This study aims to explore young adults’ knowledge, perceptions and concerns about infertility and Assisted Reproductive Technology (ART), and to contrast it with the information provided by ART clinics.

Methods

A multi-country qualitative study was conducted in Albania, Belgium, Slovenia, Spain, Italy, Kosovo, North Macedonia and Switzerland within the H2020 B2-INF project (Grant Agreement 872706). In 2021, 10-15 semi-structured interviews were conducted in each country with participants aged 18-30, childless and non-ART users. Additionally, 3-5 clinics’ websites in each country were explored. Data was collected in native languages and translated into English. A thematic analysis was carried out.

Results

In total, 98 interviews were conducted and 38 clinics’ websites were explored. Three themes emerged from the analysis of the interviews: 1. Parenthood and (in)fertility; 2. Young people's perception on ART; 3. Information and publicity of ART. Parenthood was described as a relationship beyond biological ties and infertility as a social taboo. Most participants perceived ART positively and would use it if needed, although knowledge on ART was low. Participants considered information on ART as scarce and suggested that government-led information campaigns should be launched to raise awareness on it. Concerning clinics, the websites provided information on infertility and exhaustive technical descriptions of ART techniques, although it may be difficult for the general population to understand. Data offered on success rates were unclear and heterogeneous.

Conclusions

Gaps in citizens’ expectations and needs and the information provided by ART clinics were identified. Awareness campaigns are needed to diminish social taboo on infertility and ART and to promote reproductive health.

Key messages

• Assisted Reproductive Technology is positively perceived by young adults, though their knowledge of it and infertility is low. Information campaigns are thus needed to raise awareness among the young.

• ART clinics have room for improvement in aligning the information provided on their websites with young people's perceptions and needs, and to show it in a more accessible and understandable way.
Stressful life events as predictors of refugee adolescents’ subjective mental health need
Authors: Namer Y , Fretian A , Podar D , Razum O
Published: October 2022

Background

Asylum seeking and refugee (ASR) adolescents fleeing armed conflict have lived through stressful events. Although not all stressful life events are experienced as post-traumatic stress, they may still lead to subjective need for mental health support. In this study, we assessed which stressful events predicted subjective need.

Methods

We collected and analysed cross-sectional data (February 2019-November 2020) from ASR adolescents aged 11-18, coming from Syria, Afghanistan and Iraq (n = 216). Subjective mental health need was measured with the question “Do you think you have emotional difficulties that you need help with?” and stressful life events (SLE) by the SLE Checklist, a self-report screening tool that asks if participants experienced stressful events in three categories: separation from family, witnessing armed conflict, experiencing violence. Binary logistic regression was run to assess the relative contribution of stressful life events to subjective need.

Results

30.1% of participants reported subjective need for mental health support. Most commonly encountered events were witnessing armed conflict (53.2%) and experiencing the death of a loved one (51.9%). Only one stressful event significantly predicted subjective need for mental health support: separation from family or relatives against one's will (e.g., by police or military) [OR = 6.32, 95%CI(1.79,22.31)].

Conclusions

ASR adolescents who have been separated from their family by force report subjective need for mental health support. It is important to supplement diagnostic tools with subjective report of needing mental health care. ASR adolescents who have experienced separation from famil by force should be given spaces to talk about their need for mental health support. Public health interventions could focus on creating or utilising such spaces where mental health support is available. Crucially, bureaucratic and legal burdens that impede speedy family reunification should be reduced.

Key messages

• ASR adolescents who have been separated from their families by force are more likely to report subjective need for mental health support.

• The higher reported need highlights the importance of reducing bureaucratic and legal burdens that impede fast family reunification.
Reform of the mental health care system in the Republic of Croatia
Authors: Stimac Grbic D
Published: October 2022

Issue/problem

The pandemic and earthquakes that hit Croatia have increased the need to develop an effective community based mental health care system.

Description of the problem

In Croatia, the hospitalization rate for depression has doubled in the last 20 years, and the growing needs are mainly related to the mental health of children and young people. The average length of hospital stay due to mental disorders is higher than the EU average, as is the suicide rate. Due to insufficient recognition at the primary level of health care, inadequate treatment and stigma, people with mental disorders rarely seek help.

Results

Croatia is in the process of adopting the Strategic Framework for Mental Health 2022-2030. The Action Plan for community based mental health service and the Action Plan for mental health promotion, the early detection and treatment of mental disorders are being developed. Emphasis is on intersectoral cooperation, reorientation of the mental health system to community-based care, empowerment, especially of young people, through social emotional learning in school programs, peer support and involvement of young people in decision-making processes. Increasing the mental health literacy, destigmatization, empowering people with mental health disorders to participate in designing interventions, establishing multidisciplinary mobile teams to provide community services and the cooperation of all sectors in mental health care are emphasized. The national program for improvement mental health literacy of educational staff was launched. Telemedicine services have been developed, and the pilot project Providing psychosocial services by mobile multidisciplinary teams have been implemented.

Lessons

Comprehensive, multidisciplinary and multisectoral action is needed to effectively address the problems in the mental health care system.

Key messages

• Community based mental health care is client oriented care.

• People with experience of mental disorder and their families must be involved in the decision-making process.
Mental health problems, low economic capability, and social marginalization among 28,047 adults
Authors: Haugland SH , Topor A , Friesinger JG
Published: October 2022

Background

Mental health problems and low economic capability increase the risk of social marginalization. However, few larger studies with a broad age group have investigated how the cumulative effect of having both these difficulties may affect social life. The purpose of this study was to examine the associations between having mental health problems or having low economic capability or reporting both, and social marginalization.

Methods

The study is based on responses from 28 047 adults (> 18 years old) from the general population participating in The Norwegian Counties Public Health Survey 2019. The study had a cross-sectional design and included respondents’ evaluation of own economic capability, mental health problems (HSCL-5) and social marginalization measured as lack of social support, low participation in organized social activities, low participation in other activities, missing someone to be with, feeling excluded and feeling isolated. Multivariable logistic regression was adjusted for sex and age.

Results

Findings showed that having mental health problems or low economic capability were both associated with various measures of social marginalization with odds ratio [OR] 95% confidence interval [CI] ranging from OR 1.33; CI 1.23-1.43 to OR 12.63; CI 10.90-14.64. However, the odds of social marginalization strongly increased for respondents having both mental health problems and low economic capability compared to respondents without both these difficulties, with OR ranging from OR 2.08; CI 1.90-2.27 to OR 29.46; CI 25.32-34.27. Findings are preliminary.

Conclusions

Having both mental health problems and low economic capability strongly increases the risk of social marginalization, far beyond the effect of each factor alone.

Key messages

• Having both mental health problems and low economic capability strongly increases the risk of social marginalization, far beyond the effect of each factor alone.

• Services should aim to develop multi-faceted approaches to meet multiple life-challenges to prevent social marginalization.