bluuebunny/crossref_metadata_2025_split huggingface dataset:
Building a roadmap for the evaluation of a National Health Plan: the experience of Portugal
Authors: Costa L , Costa A , Mexia R , Rosa A , Santos J , Dias C , Caldas de Almeida T 
Published: October 2021

Abstract

Issue
The National Health Plan (PNS) 2012-2016 (extended until 2020) is the Portuguese strategic health document that presents the direction of intervention within the Health System. A final evaluation of PNS was foreseen, with National Institute of Health Dr Ricardo Jorge (INSA) being responsible for carrying out this task. The experience gained by INSA in defining a roadmap to be used in this process can be important in steering other actors to policy evaluation.

Description of the problem
In order to analyze the impact of policies, it is necessary to collect evidence that can evaluate the results achieved, and more importantly, identify gaps in implementation and evaluation issues. Herein, we aim to present the methodological approach developed to pave the way to the final assessment of PNS.

Results
As part of the Biennial Collaborative Agreement 2016-2017, WHO sponsored a high-level technical consultative process with relevant experts to address the condition for defining the work plan. It was devised to undertake: i) A scoping review based upon data collected from PNS implementation evidence mapping; ii) A qualitative analysis of the perception from main stakeholders on PNS impact and their expectations. Thus, a matrix of evidence was built to analyze the alignment of PNS at national and local levels, and with the main health framework targets and indicators. Also, online surveys and face-to-face interviews were done with key stakeholders in order to identify evidence gaps and critical factors for the successful PNS implementation, among others.

Lessons
To characterize its implementation and impact on citizens' health, a sound PNS evaluation should be guided by clear assessment questions, supported by validated tools and complemented by international guidance. In addition, a long-term consultative process with key stakeholder support is required to properly identify opportunities, priorities, and outcomes.

Key messages
Institutionalization of an evaluation process as part of public policies life cycle is a powerfull tool to foster learning and crucial to achievement of proposed goals. A clear structure to support the policy evaluation approach is mandatory to guarantee impartiality, independence and transparency on the overall process.
Undergraduates' perception of health risk of body arts: results of an Italian multicentre study
Authors: Marotta D , Gallè F , Valeriani F , Liguori G , Romano Spica V , Vitali M , Protano C 
Published: October 2021

Abstract

Background
In the last decades, body art practices such as tattooing and piercing have known an increasing popularity, mainly in young people. These procedures are associated with infectious and non-infectious health risks. The aim of this multicenter study was to evaluate the knowledge of health risks related to body art procedures among undergraduate students from ten Italian universities.

Methods
A cross-sectional study was performed on undergraduate students attending universities in northern, central and southern Italy. An anonymous questionnaire was administered to the participants for collecting their socio-demographic characteristics and for assessing their knowledge about health risks associated with tattoos and piercing.

Results
A total of 2985 students (mean age 23.15 ± 3.99, 73.9% females) completed the questionnaire. 775 (25.9%) of them were from northern Italy, 906 (30.3%) from the Centre and 1324 (44.4%) from the South. More than 90% of the sample were aware that tattoo/piercing procedures can cause health problems. However, the mean values of correct answers about the health risks associated to body art practices were low (5.38 ± 2.39 on a total of 11 correct answers for tattooing and 5.93 ± 3.12 on a total of 14 for piercing). Higher knowledge of the health risks related to tattooing was found among those attending university since more than four years (p &lt; 0.001), life science courses (p &lt; 0.001) and residing/living in the university area (p = 0.023). Those attending North/Centre universities (p &lt; 0.001), since more than 4 years (p &lt; 0.001), life science courses (p &lt; 0.001), and those with graduated father (p = 0.013) had better knowledge of the health risks related to piercing.

Conclusions
These results show a lack of knowledge about health risks related to body art practices in the sample. Educational interventions on this issue targeted to youth are needed in Italy.

Key messages
Undergraduates do not show a good knowledge of health risks related to tattooing and piercing. Educational interventions are needed to raise youth awareness and knowledge of health risks of body art.
1.Q. Workshop: Novel digital tools and approaches to improve migrant health in European primary care services
Authors:   Organised by: St George's University of London (UK), ESGITM,   Chair persons: Sally Hargreaves (UK), Teymur Noori (Sweden)
Published: October 2021

Abstract

Some migrant populations in European countries face a disproportionate burden of infections (tuberculosis, latent tuberculosis, HIV, hepatitis, parasitic infection) and be under-immunised. Reducing the burden of infection is a key regional priority, yet there are major shortfalls in current practice, and a need for novel approaches. The ECDC has recently called for innovative implementation strategies within primary care, to look beyond single disease programmes, and to encompass a wider group of at-risk migrants. In this workshop we will explore some recent developments, including the use of novel digital tools to guide clinical decision making in primary care, and new approaches to latent TB screening. New approaches are urgently needed to strengthen screening and vaccination programmes and support routine data collection. We will seek audience participation in sharing models of best practice from across Europe and better defining innovative implementation approaches to improve screening and vaccine coverage in migrant populations, and review successes and challenges.
The workshop will start with 15 minute presentations by each of the 3 speakers (to include a short Q&A after each talk). This will then move into a 15 minute audience discussion centred around seeking specific feedback on examples of innovation, good practice, and lessons learned across EU/EEA countries in approaches to strengthening uptake of screening and catch-up vaccination in migrant populations.

Key messages
There is a need to better define more effective strategies in primary care to strengthen screening for infection and improve vaccine coverage in migrant populations Digital tools and other approaches have been developed that can facilitate timely identification of key infections, that could contribute to improving health outcomes
How democracy alters our view of inequality and what this means for wellbeing
Authors: Gugushvili A , Reeves A 
Published: October 2021

Abstract

Income inequality is associated with poor health when economic disparities are especially salient. However, political institutions may alter this relationship because democracies (as opposed to autocracies) may be more inclined to frame inequalities in negative rather than positive ways. Living in a particular political system potentially alters the messages individuals receive about whether inequality is large or small, good or bad, and this, in turn, might affect whether beliefs about inequality influence health. Further, media coverage of economic inequality may negatively affect health if it contributes toward the general perception that the gap between rich and poor has gone up, even if there has been no change in income differentials. In this study, we explore the relationship between democracy, perceptions of inequality, and self-rated health across 28 post-communist countries using survey and macro-level data, multilevel regression models, and inverse probability weighting to estimate the average treatment effect on the treated. We find that self-rated health is higher in more democratic countries and lower among people who believe that inequality has risen in the last few years. Moreover, we observe that people in democracies are more likely to learn about rising inequality through watching television and that when they do it has a more harmful effect on their health than when people in autocracies learn about rising inequality through the same channel, suggesting that in countries where there is less trust in the television media learning about rising inequality is not as harmful for health. Our results indicate that while democracies are generally good for well-being, they may not be unambiguously positive for health. This does not mean, of course, that inequality is good for health nor that, on average, autocracies have better health than democracies; but rather that being more aware of inequality can negatively affect wellbeing

Key messages
While democracies are generally good for well-being, they may not be unambiguously positive for health. Being more aware of inequality can negatively affect wellbeing.
Risk factors for severe and fatal COVID-19 among patients admitted to an Italian hospital
Authors: Agodi A , Montineri A , Manuele R , Noto P , Castiglione G , Grassi P , Mattaliano AR , Maugeri A , Barchitta M ,   EPIRADIOCLINF group
Published: October 2021

Abstract

Background
The epidemic of COVID-19 has spread dramatically affecting more than 140 million people and leading to more than 3 million deaths. We aimed to investigate what factors pose a risk for disease severity and death.

Methods
We prospectively included patients with laboratory-confirmed COVID-19 from San Marco Hospital (Catania, Italy), who had been admitted by Dec 31, 2020. Demographic, clinical, treatment, and laboratory data, were collected and compared between severe and non-severe patients, as well as between survivors and non-survivors. We used univariable and multivariable methods to explore the risk factors associated with disease severity and death.

Results
Overall, 463 patients were included, of whom 33.7% had severe disease and 14.0% died in hospital. Patients with severe disease were older (p &lt; 0.001) and more likely to have had heart failure (p = 0.038). With respect to the risk of death, increasing age, hypertension, diabetes, ischemic heart disease, atrial fibrillation, heart failure, chronic obstructive pulmonary disease, cancer, and chronic renal failure were more common among non-survivors than survivors (p-values&lt;0.05). In particular, a logistic regression model confirmed age (OR = 1.14; 95%CI=1.10-1.20; p &lt; 0.001) and heart failure (OR = 14.8; 95%CI=2.7-80.8; p = 0.002) as the main risk factors for death. The comparison between the first and the second waves of the epidemic did not reveal differences in demographic and clinical characteristics, however, the treatment approach has changed significantly.

Conclusions
The risk of severe and/or fatal COVID-19 was higher among older patients with comorbidities. These findings lay the foundation for prediction models that could inform shielding policies and vaccine prioritisation strategies.

Key messages
The risk of severe and fatal COVID-19 is substantially elevated among older patients with previous comorbidities. These findings are important to inform shielding policies and vaccine prioritisation strategies.
Prospective analysis of gender-related characteristics in relation to cardiovascular disease
Authors: Bolijn R , Kunst AE , Appelman Y , Galenkamp H , Moll van Charante EP , Stronks K , Tan HL , Van Valkengoed IGM 
Published: October 2021

Abstract

Background
Cardiovascular diseases (CVD) are a major public health problem in men and women worldwide. Differences in CVD incidence between men and women have been widely reported, although explanations for these differences remain unclear. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly explain how these differences arise. We aimed to establish the associations between selected gender-related characteristics and CVD incidence.

Methods
We linked baseline data of 18,058 participants without CVD from the population-based, multi-ethnic HELIUS study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands in 2013-2018. Using Cox regression analyses, we studied associations of time spent on household work, doing home repairs, primary earner status, type of employment, performing a male-dominated or female-dominated occupation, and desire for emotional support with CVD incidence, overall (with or without adjustment for sex) and stratified by sex. Analyses were adjusted for age, ethnicity, and socioeconomic status.

Results
In the fully adjusted analyses, most gender-related characteristics were not associated with higher CVD incidence, overall and among men. In women, homemakers had a higher hazard for CVD compared to fulltime workers (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.35-4.04), whereas those spending a moderate amount of time on household work had a lower hazard for CVD than those spending little time (HR 0.56, 95% CI 0.34-0.95).

Conclusions
Although most gender-related characteristics were not associated with CVD incidence in men, being the homemaker and time spent on household work were associated with CVD incidence in women. Thus, attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies.

Key messages
Some gender-related characteristics are relevant for cardiovascular disease risk, particularly in women. Attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies.
Health-related QoL and fatality in CHD patients: findings from a national cohort study, Turkey
Authors: Emli Alpay E , Dinc G , Sakarya S , Ergor G , Sozmen K , Ekinci B , Unal B 
Published: October 2021

Abstract

Background
Although strong association between self-reported health and coronary heart disease (CHD) exists, health related quality of life (HRQOL) has not been conceptualized as a predictor for fatality in CHD patients. We investigated whether HRQOL may predict the risk of death in six years in CHD patients.

Methods
There were overall, 614 of CHD cases in the national representative Chronic Diseases and Risk Factors Survey in Turkey, 2011. Baseline self-reported health data on EuroQol- 5 Dimension (EQ-5D) and a Visual Analog Scale (VAS) were used from the same survey. The cases were followed-up for all-cause and CHD specific fatality (ICD-10 diagnostic codes: I20- I25) through electronic health records by 2017. Kaplan Meier and Cox regression models were used for data analysis. Age and sex adjusted HRs [aHR 95% CIs] were estimated for having some or extreme problems in EQ5D domains and VAS.

Results
Median follow-up years (IQR) was 6.46 (6.39-6.47). The number of deaths from all causes and CHD were 103 and 26, respectively. Age and sex adjusted HRs for all causes fatality were statistically significant for some or extreme problems in usual activities [2.48 (95%CI 1.60-3.83)], in pain/comfort [2.28 (95% CI 1.44-3.62)], in self-care [2.25 (95% CI 1.46-3.46)] and in mobility [1.85 (95% CI 1.16-2.96)]. Age and sex adjusted HRs for CHD specific fatality were statistically significant for some or extreme problems in self-care [3.45 (95% CI 1.48-8.07)] and pain/comfort [3.07(95% CI 1.19-7.93)]. VAS was negatively associated with overall fatality.

Conclusions
In CHD cases, poor self reported health might be a good indicator for overall and CHD specific fatality in 6 years. Especially having some or extreme problems in selfcare and pain/comfort are closely related with overall fatality as well as CHD specific fatality.

Key messages
There are strong relationships between HRQOL and all causes fatality as well as CHD specific fatality. Poor self- reported health might be a predictor for overall and CHD specific fatality in CHD cases.
Impact of air pollution on health in South-East Europe
Authors: Belis C , Van Dingenen R , Klimont Z , Dentener F 
Published: October 2021

Abstract
The Western Balkans (WB; Albania, Bosnia and Herzegovina, Kosovo*, Montenegro, North Macedonia and Serbia) is a region next to the European Union where the levels of air pollution are among the highest of Europe and transboundary pollution with neighbouring countries is frequent. The estimated PM2.5 average exposure index in the WB is above the exposure concentration obligation (20 µg/m3) of Directive EU/2008/50. In this study, the TM5-FAst Scenario Screening Tool (TM5-FASST) was used to estimate the trends of air quality impacts on health, from 2000 to 2050 in the WB. To that end, five ECLIPSE 6b emission scenarios with different assumptions on population growth, deployment of technologies and policies were compared. Mortality from PM2.5 and ozone were calculated using the integrated exposure-response model (IER) and a log-linear exposure-response function, respectively, in line with the Global Burden of Disease assessment for 2017. The implementation of the maximum feasible reduction (MFR) scenarios in the WB would lead to a decrease in the mortality associated with PM2.5 of 49% - 65% in 2050 compared to the current legislation baseline (CLE). On the contrary, no further control (NFC) scenarios would cause an increase in PM2.5 mortality of 16% - 21% in 2050 compared to the CLE. Furthermore, compared to the CLE baseline in 2050, lack of action would lead to an 11% - 21% increase in mortality in neighbouring countries, due to transboundary pollution originating in the WB region. As a whole, the study confirms that implementing the adopted policies would lead to a reduction of the air pollution impacts in the coming decades and provides estimates of the maximum benefits expected from ambitious policies and the impact of not implementing the currently adopted ones.
(* This designation is without prejudice to position on status and is in line with the UNSCR 1244/99 and the ICJ Opinion on the Kosovo declaration of independence.)
Delivering on the Green Deal’s zero pollution ambition for health
Authors: Stauffer A , Perroud S , Matkovic V 
Published: October 2021

Abstract
As part of an integrated approach, the EU Green Deal also includes a zero pollution ambition for a toxic-free environment. This is a much needed and overdue commitment to address the significant environmental health burden from pollution in Europe. Air pollution alone leads to 400,000 premature deaths annually, and the extent of the health harm from chemicals pollution, or effects from combined exposures are still under investigation. The next months will show if the EU Commission can deliver on their ambition, with the launch of a zero pollution action plan for air, water and soil, and the speed of the process to revise the EU's ambient air quality standards. In addition, the World Health Organization (WHO) is expected to launch updated air quality guidelines, following a scientific review which showed greater health harm from poor air quality. The presentation will provide an overview of the policy opportunities for public health professionals to be engaged in, to make the health case for zero harm from pollution, and zero delay in stopping pollution. A particular emphasis will be placed on showcasing the need for zero financing of pollution, as major investments for transformation under Just Transition and green recovery schemes are underway.
Health care disruption inequalities during Covid-19: Evidence from eleven longitudinal studies
Authors: Parsons S , Maddock J , Di Gessa G , Green MJ , Thompson EJ , Stevenson AJ , Kwong ASF , McElroy E , Silverwood RJ , Katikireddi SV 
Published: October 2021

Abstract
Like other health systems worldwide, the UK, the National Health Service (NHS) has faced major disruptions due to high Covid-19 burden and repeated lockdown measures. These disruptions can have both short and long-term health impacts. The NHS provides free healthcare and prioritises equity of delivery, but despite this, inequalities in access to health care remain and it is plausible that pandemic-related disruptions affect different groups disproportionally, thus widening health inequalities. This paper investigates associations between well-established axes of health inequality (sex, age, social class, education and ethnicity) and self-reported health care disruptions (medication access, procedures, or appointments) in over 65,000 participants across eleven longitudinal studies in the UK. Participants reported disruptions from March 2020 through to as late as January 2021. We obtained study-specific estimates using logistic regression models and combined them in a random-effects meta-analysis. Analyses were adjusted for sex, age and ethnicity where relevant. Between 10.1% (Millennium Cohort Study) and 31.8 % (Understanding Society) of study participants reported experiencing health care disruptions. Results show that females (OR: 1.27 [95%CI: 1.15,1.4]; I2=56%), older participants (e.g. OR: 1.39 [1.13,1.72]; I2=77% for 65-75y vs 45-54y), and non-white ethnic minorities (OR: 1.17 [1.02,1.34]; I2=0% vs white) were more likely to report healthcare disruptions. Those in a more disadvantaged social class (e.g. OR: 1.18 [1.08, 1.21]; I2=0% for manual/routine vs managerial/professional) were also more likely to report healthcare disruptions, but no clear differences were observed for education. Our findings highlight inequities in healthcare disruptions, which, if unaddressed, could contribute to the maintenance or widening of existing health inequalities.
Diet, physical activity, and sleep in relation to furlough during the COVID-19 pandemic in the UK: evidence from eight longitudinal studies
Authors: Maddock J , Wielgoszewska B , Green MJ , Gessa G Di , Parsons S , Griffith GJ , Croft J , Stevenson AJ , Booth C , Ploubidis GB 
Published: October 2021

Abstract
The recent Covid-19 pandemic, and its mitigations, are expected to have long-term consequences on the health and health behaviours. In an effort to reduce the effect of lockdown on the economy, the UK government launched their Coronavirus Job Retention Scheme (commonly known as furlough) in March 2020, which entitled employees who were unable to work to 80% of their monthly pay up to a cap of £2,500. We investigated the association between changes in economic activity and health behaviours of the working-age participants of eight longitudinal studies, during the early stages of the pandemic. Specifically, we investigate the post-pandemic levels, and the pre-to-post pandemic change, in fruit and vegetable consumption, physical activity, and sleeping patterns. We obtained study-specific estimates using modified Poisson regression, adjusting for a comparable set of potential confounders, and combined results in a random-effects meta-analyses. Compared to those who continually worked, furloughed workers were more likely to report an increase in their fruit and vegetable consumption (1.22 [1.04-1.43]; I2 = 52%), and an increase in their physical activity (1.19 [1.04-1.35]; I2 = 73%). However, furlough appears to have a polarizing effect on sleeping patterns (change from 6 - 9 h to outside this range: 1.46 [1.03, 2.08]; I2 = 75%; change from outside of the 6 -9 h to within this range: 1.78 [1.03, 3.07]; I2 = 75%), especially amongst women and those with no higher education degree. This polarization is partially explained by the age of the survey participants, indicating that sleeping patterns of the younger cohorts were more adversely affected. Furlough schemes may be associated with better diet and more physical activity, while inconsistent effects on sleeping patterns may place younger generations at particular risk of atypical sleep.