bluuebunny/crossref_metadata_2025_split huggingface dataset:
5.O. Workshop: Climate change and energy issues in our life-course and our environment
Authors:   Organised by: EUPHA (ENV) Chair persons: Peter Van Den Hazel - EUPHA (ENV), Marija Jevtic - EUPHA (ENV)
Published: November 2019

Abstract

Globalization and economic trends bring enormous changes to civilization. Growth in demographic, economic and human activities alters the natural global environment beyond safe or sustainable borders. Energy domain is one of these borders we cross. These changes pose threats to human health and with the rise in temperature the visible symptoms are seen in the difficulty of securing sufficient and clean energy, as well as the appropriate supply of health-safe food and water.
Overall progress made through the use of renewable energy sources should reduce risks and allow for the improvement of basic living conditions. However, a significant shift in reducing inequalities and improving global quality of life and health indicators requires transformation of many sectors.
The calculated health impacts and health costs from Western Balkan coal plants are a case study that show 3,000 premature deaths, 8,000 cases of bronchitis in children, and other chronic illnesses; costing both health systems and economies a total of EUR 6.1-11.5 billion. Another example illustrates how schools can contribute to change. Results from behavioral change studies show the audience in which frame they fit in their possibilities to influence their behavior towards their living environment. Followed by a discussion on strategic choices on how to motivate people to protect their environment and climate.

Key messages
Energy issues are a main driver in reducing health risks. Knowledge about framing our values towards climate change might change our behavior.
Climate and energy issues as preconditions for health and well being
Authors: Jevtic M , Bouland C 
Published: November 2019

Abstract
Globalization and modern economic trends bring enormous changes to civilization. The human health pattern also changes and the overall system becomes more complex. Exponential growth in demographic, in economic and in human activities alters the natural global environment beyond safe or sustainable borders, which refers to energy for the future, as well as climate change in the broadest sense. These changes pose threats to human health and with the rise in temperature the most visible symptoms are seen in the difficulty of securing sufficient energy amount, as well as the appropriate supply of health-safe food and water. Global influences on the health of the population require changes in different sectors (economy, health, economy, etc).
Even though, World Meteorological Organization data show that the five-year average global temperature from 2013 to 2017 was at a record level, and that in 2017 it was one of the three hottest years. Today, about 3 billion people have no access to safe food and/or water and are also exposed to significant air pollution. Nearly one billion people have no electricity in the household, and 13% of the world’s population has no access to modern electricity. Air pollution indoors by using combustible fuels for domestic energy caused 4.3 million deaths in 2012 (women and girls accounted for 6 out of 10). Energy has a dominant contribution to climate changes and accounts for about 60% of overall global greenhouse gas emissions.
Overall progress made through the use of renewable energy sources should reduce risks and allow for the improvement of basic living conditions. However, a significant shift in reducing inequalities and improving global quality of life and health indicators requires transformation of many sectors. Energy, therefore, is crucial for almost every challenge the world is facing today (climate change, food production, health systems, etc.). SDG 7 is particularly important and is linked to other SDGs.
Impacts of transboundary coal air pollution from Balkan region to European public health
Authors: Matkovic Puljic V , Jones D , Myllyvirta L , Gierens R 
Published: November 2019

Abstract

Background
Western Balkan region holds coal power plants that are old, inefficient and substandard. In 2016, the region’s 16 plants emitted more SO2 than the entire 250 European coal power plants. In this study we modelled the transboundary nature of air pollution affecting this region and EU.

Methods
We calculated health impacts and costs from Western Balkan coal plants by the following steps: (1) Identify coal power plants in the Western Balkans in 2016; (2) Source 2016 coal power plant emissions data; (3) Model the pollutant exposure resulting from the emissions from Western Balkan coal power plants; (4) Calculate health impacts associated with modelled pollutant exposures; (5) Attribute the health impacts to individual coal power plants; (6) Calculate the cost of the health impacts.

Results
The modeling shows that every year Western Balkans’ plants cause 3,000 premature deaths, 8,000 cases of bronchitis in children, and other chronic illnesses costing both health systems and economies a total of € 6.1-11.5 billion. The EU bears the majority of health cost, more than half of these health costs relate to the EU (€ 3.1 to 5.8 billion), a third (32%) to Western Balkan countries (€ 1.9 to 3.6 billion) and around 17% in other countries. Moreover, Bulgaria and Croatia’s health budgets are the most heavily impacted. Costs needed to cover the health impacts of Western Balkan coal pollution amount to € 0.3-0.7 billion. For Bulgaria this is the same as 10%-18% of the country’s total health expenditure in 2016. For Croatia (costs of € 0.2-0.4 billion), it amounts to 8%-14% of total health expenditure in 2016.

Discussion
These results imply an coal phase out to protect public health. Strong enforcement of the existing pollution control measures are needed. Political processes such as EU accession of Balkan countries may be a door to prioritise pollution control and air quality, in particular by excluding companies planning new coal power capacity from EU financing.
Rabies vaccination strategies in a western country: a cost evaluation
Authors: Suijkerbuijk A W M , Mangen M J J , Haverkate M R , Bantjes S E , Ruijs W L M , Swaan C M , Visser L G , Over E A B , Luppino F S , de Wit G A 
Published: November 2019

Abstract

Introduction
Rabies is a fatal but preventable infectious disease with a large disease burden in endemic countries. The risk of contracting rabies for travellers from a Western country is low. However, an increasing number of Dutch travellers, potentially exposed to rabies abroad, consult a clinician for post-exposure prophylaxis. In this study, several interventions were examined on how they might influence costs involved in rabies treatment and prevention, including the most recent vaccination guidelines and the use of intradermal vaccination.

Methods
A decision tree based economic model was constructed. Costs of new versus old guidelines, intramuscular versus intradermal vaccination, and post-exposure treatment subsequent to increased vaccination coverage in several risk groups were calculated and compared to each other. Statistical uncertainty with respect to numbers of travellers and vaccination coverage was assessed.

Results
Costs were highest using the old guidelines, estimated at €15.1 million (€405 per vaccinated person). Intradermal vaccinations in combination with the new guidelines led to the lowest costs, estimated at €10.1 million (€270 per vaccinated person). A higher vaccination uptake resulted in higher overall costs. The ratio between the additional vaccinated persons and additional costs in all risk groups was similar, around €104 per person.

Conclusions
The new rabies vaccination guidelines reduced total costs. Strategies with increased vaccination uptake led to fewer rabies immunoglobulin administrations and fewer vaccinations after exposure but at higher total costs. Although intradermal administration of rabies vaccination on a large scale can reduce total costs of pre-exposure prophylaxis and can positively influence vaccination uptake, it remains a costly intervention.

Key messages
The new vaccination guidelines reduce total costs of rabies prevention. Intradermal administration of rabies vaccination on a large scale can further reduce total costs of pre-exposure prophylaxis. Strategies with increased vaccination uptake lead to fewer rabies immunoglobulin administrations and fewer vaccinations after exposure but at higher total costs.
Nutritional quality of food consumed (graded by the FSAm-NPS / Nutri-Score) and mortality in Europe
Authors: Deschasaux M , Huybrechts I , Murphy N , Julia C , Hercberg S , Srour B , Ferrari P , Riboli E , Gunter M , Touvier M 
Published: November 2019

Abstract

Background
Unhealthy diets are major contributors for non-communicable diseases (NCDs) and related deaths. To help consumers make healthier food choices, political authorities are considering implementing a simple label to reflect the nutritional quality of food products. The Nutri-Score, based on the nutrient profiling system of the Food Standards Agency (FSAm-NPS), was chosen by several countries in Europe (France, Belgium, Spain). Yet, its implementation is only voluntary per EU regulation. Scientific evidence is therefore needed regarding the relevance of the FSAm-NPS at the European level. Hence, our objective is to study how the nutritional quality of foods consumed graded by the FSAm-NPS relates to NCDs-related mortality in European populations.

Methods
Our prospective analyses included 501,594 adults from the EPIC cohort (1992-2015, median follow-up: 17.2y). Usual food intakes were assessed with standardized country-specific methods. The FSAm-NPS was calculated using the 100g content of each food in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. Multi-adjusted Cox proportional hazards models were computed.

Results
The consumption of foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of mortality overall (n = 50,743 events: HRQ5vs.Q1=1.06 [95%CI: 1.02-1.09], P-trend&lt;0.001) and by cancer (n = 21,971 events: HRQ5vs.Q1=1.06 [1.01-1.11], P-trend=0.003), respiratory diseases (n = 2,796 events: HRQ5vs.Q1=1.33 [1.16-1.52], P-trend&lt;0.001) and cardiovascular diseases, although more weakly (n = 12,407 events: HRQ5vs.Q1=1.05 [0.98,1.11], P-trend=0.04).

Conclusions
In this large multinational European cohort, consuming foods with a higher FSAm-NPS score was associated with higher mortality, supporting the relevance of the FSAm-NPS to grade the nutritional quality of food products for public health applications (e.g, Nutri-Score) to guide the consumers towards healthier food choices.

Key messages
The consumption of food products with a lower nutritional quality as graded by the FSAm-NPS score was associated with higher mortality in the large multinational European EPIC cohort. This adds support to the relevance of the FSAm-NPS to grade the nutritional quality of foodstuffs for public health applications (e.g. Nutri-Score label) to help consumers make healthier food choices.
Consumption of ultra-processed foods and the risk of overweight, obesity, and weight trajectories
Authors: Srour B , Beslay M , Allès B , Chazelas E , Deschasaux M , Hercberg S , Monteiro C A , Kesse-Guyot E , Touvier M , Julia C 
Published: November 2019

Abstract

Previous epidemiological studies found associations between the consumption of ultra-processed foods (UPF) and the risk of obesity-related outcomes. The aim of this study is to investigate the associations between UPF consumption and the risk of overweight and obesity, and weight trajectories, in in the French large scale NutriNet-Santé cohort.

Methods
Overall, 110260 participants aged at least 18 years from the French NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected using repeated 24h dietary records, merged with a food composition database of 3300 different products, categorized according to their degree of processing by the NOVA classification. Associations between UPF intake and risks of overweight and obesity were assessed using Cox proportional hazard models. Associations between UPF intake and weight trajectories were assessed using linear mixed models for repeated measures with random slope and intercept.

Results
UPF intake was associated with a higher risk of overweight (n = 7063 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.11 (1.08-1.14); P &lt; 0.0001) and obesity (n = 3066 incident cases; HR = 1.09 (1.05-1.13); P &lt; 0.0001). Higher consumers of UPF (4th quartile) were more likely to present an increase in body mass index over time (β = 0.04, P &lt; 0.0001). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (fruits and vegetables and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns) and after a large range of sensitivity analyses.

Conclusions
In this large observational prospective study, higher consumption of UPF was associated with a higher risk of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption.

Key messages
The consumption of ultra-processed food is associated with an increased risk of overweight and obesity. As the French Public Helath agency recommends, their consumption should be limited. Nutritional composition, food additives, contact materials, or neoformed contaminants might play a role in these associations and further studies are needed to understand their relative contribution.
Explaining healthcare among unaccompanied minor refugees: a realist review
Authors: Ulrich H , Mlinarić M , Kohler E 
Published: November 2019

Abstract

Introduction
Existing research on psychosocial care of unaccompanied minor refugees (UMRs) mainly focusses on socio-epidemiological accounts and qualitative evidence from the perspective of experts in the field of psychosocial care. In contrast, knowledge concerning differing context factors as well as underlying mechanisms of current healthcare barriers, which could inform policy recommendations, are rather scant.

Methods
To synthesize scientific evidence and gray literature dealing with the field of psychosocial healthcare of UMRs, a realist review (RR) was conducted following six methodological steps of RAMESES publication standards for realist synthesis. Based on a iterative search of keywords “UMR”, “UMF”, “UMA” and “mental health care” in electronic databases PubMed, GBV and Web of Science we gained access to 974 texts from 2005 to 2019. Screend studies and reports were systematically reviewed according rigor and relevance, which included n = 53 documents for realist synthesis with theory-informed context-mechanism-outcome configurations (CMOs).

Results
UMRs have a high prevalence risk for posttraumatic stress disorders and they face manifold institutional, cultural, ethical, juridical, and language-based barriers of care. A dominant and multiple CMO highlight residence status (C1), which limits access of UMRs to healthcare (M1) and produces psychosocially related mental health outcomes (O1). Residence status (C1) may also trigger mechanisms of structural or at least perceived discrimination (M2), which mediates undersupply of UMRs (O2).

Conclusions
The inclusion of lay perspectives and an intersectional approach could inform health services research and practitioners. The reflection of UMR’s social positions between categorical constructs of resilience and vulnerability, discriminatory discourses of othering, and restrictive health policies may guide policy recommendations to potentially reduce persistent disadvantages.

Key messages
The inclusion of lay perspectives and an intersectional approach could inform UMR related health services research and practitioners. The reflection of UMR’s social positions (between categories, discourses, and health policies) may guide policy recommendations to potentially reduce persistent disadvantages.
Contraceptive use among undocumented migrant women seen by Médecins du Monde in the Humanitarian Hub
Authors: Déom V , Ben Abdelhafidh L , Rojas Lopez F , Vanden Bussche I , Glorie C , De Bethune X 
Published: November 2019

Abstract

In order to address the growing needs of the undocumented migrant population living in the Maximilian Park in Brussels, Médecins du Monde and 8 other organisations created The Humanitarian Hub in January 2018 where migrants can access medical care among other services. From January to February 2018, only 5 women out of 1483 patients visited The Humanitarian Hub regarding sexual & reproductive health and none asked about contraception. In response, a voluntary demedicalized midwifery clinic was implemented to build trust with the women and offer them contraception.
At our field teams’ request, operational research was conducted. We used a mixed methodology, including retrospective quantitative analysis of patient files and field observations made during participant observation sessions. These observations helped us better understand the barriers women face in accessing contraception and how migration complicates its usage.
By implementing gender-sensitive consultations, the number of women patients rose from 5,4% to 10,6% in 2018. Between March 2018 and March 2019, 144 women consulted midwives regarding their sexual & reproductive health. Quantitative analysis on pre-exposure contraception on 52 files showed that 4 used a contraception, 25 women requested one, 4 refused it, 19 discussed it with the midwife, and among them, 8 agreed to try it. The most common reasons for the 80 consultations analysed were requesting contraception (62,5%), including morning-after pills (12,5%) and fear of pregnancy (32,5%). The most common contraceptive method was the pill (63,6%) followed by injections (30,3%).
Our medical team saw 29 women with unwanted pregnancies, which confirms the importance of focusing on contraception options for migrant women, although addressing this may be difficult in medical consultations. It also supports the need to implement demedicalized midwifery consultations to facilitate sensitive discussions with migrant women.

Key messages
Our research shows that contraceptive use is a particularly sensitive challenge in the irregular migrant women population due to the particularities of their lives. The development of demedicalized midwifery consultations helps professionals give irregular migrant women feasible advice on contraception in regard to their unique situations.
Chronic pain and migration-related factors among Syrian refugees: a cross-sectional study
Authors: Strømme E M , Haj-Younes J , Hasha W , Fadnes L T , Kumar B , Diaz E 
Published: November 2019

Abstract

Background
Refugees display high rates of chronic pain. However, the relationship between refugee-related exposures introduced along their migration trajectories and the development of chronic pain remains unclear. The aim of this study was to assess the impact of stressors induced at various migration stages on chronic pain in Syrian refugees.

Methods
This is a cross-sectional survey among adult Syrian refugees in Lebanon and in Norway. We conducted logistic regression to study the associations between chronic pain and migration-related factors experienced prior to or during flight (trauma exposure, migrating alone and detainment) and after arrival in a new country (legal status, social relationships, living conditions and access to health care).

Results
Altogether 827 Syrians participated (response rate 85%). The mean age was 33 years and 41% were women. The overall prevalence of chronic pain was 30%. The mean WHO Quality of Life (WHOQOL) domain scores for both social relationships (13.4) and environment (10.2) were significantly lower among those reporting chronic pain, with low scores indicating less satisfaction. Regression analyses revealed an association between chronic pain and exposure to trauma (adjusted odds ratio (AOR) 2.5 (1.8; 3.4)), but no clear association between chronic pain and migrating alone or history of detention. Poor social relationships (AOR 1.9 (1.2; 3.1)), poor support from friends (AOR 1.5 (1.0; 2.1)) and poor living place (AOR 1.4 (1.0; 2.0)) were associated with reporting chronic pain, although associations reduced when adjusting for traumatic experiences. The associations between chronic pain and poor economy (AOR 1.6 (1.1; 2.5)) and poor access to health care (AOR 1.5 (1.0; 2.1)) persisted after trauma exposure adjustment.

Conclusions
We found a strong relationship between trauma exposure and chronic pain. Further, perceived poor economy and poor access to health care were associated with chronic pain regardless of trauma history.

Key messages
Trauma exposure, perceived poor economy and poor access to health care are associated with chronic pain among Syrian refugees. Public health care interventions should consider the combined impact of risk factors throughout the migration trajectory.
Health and web for women: preliminary results of “SEI Donna” survey
Authors: Covolo L , Guana M , Bonaccorsi G , Brunelli L , Castaldi S , De Donno A , Mereu A , Verani M , Zaniboni D , Gelatti U 
Published: November 2019

Abstract

Background
In 2018, 52% of the European population use the Web to seek health information and 77% consider it a useful tool to improve their knowledge about health. The Italian survey “SEI Donna” aims to investigate knowledge, perceptions and use of the web tools in women regarding health issues.

Methods
We used an online questionnaire to collect data including the type of online research and the degree of trust towards different sources. We also assessed health literacy (HL) and eHealth literacy scale (eHEALS) using validated tests.

Results
Of 7291 women who completed the questionnaire, 96% (n = 7022) seeks health information online. The 33% of women follows social media groups on health. One third of sample (31%) purchased a health product online, particularly cosmetics (75%) and supplements (41%). More than one third of sample thinks that information retrieved by web improve their health (35%) and influence their habits (34%). Half of sample (52%) searched online for a second opinion after medical examination. The reason was the need of a deepening in the 67% of cases. Overall, the HL is functional in 34% of cases, marginal in 56% and low in the rest (10%). Women with low HL trust less health information reported by institutional websites than women with functional HL, respectively 73% vs 86% (p &lt; 0.001) and the eHEALS score of women less trusting is lower than those trusting, 23±7 vs 28±7 (p &lt; 0.001).
One third of women declares not to be able to evaluate the reliability of a website particularly women with low HL (36%) compared to those with functional HL (20%), p &lt; 0.001. Women reporting not to be able to evaluate the reliability of a website have eHEALS score lower than women who indicated an institutional website, respectively 24±7 vs 28±7 (p &lt; 0.001).

Conclusions
The results confirm the large use of the web as a tool to seek health information, have a second opinion and buy health products. A good level of HL and eHEALS seem to make women more skilled in surfing the web.

Key messages
The results confirm the importance to put effort on strategies aiming to improve health literacy and eHealth literacy in the population. In the public health communication perspective, the fact that one third of women thinks that information retrieved by web improve their health and influence their habits, must be considered.