bluuebunny/crossref_metadata_2025_split huggingface dataset:
The importance of mental health literacy in times of crisis: Adolescent mental health during the COVID-19 pandemic
Authors: Tullius J , Beukema L 
Published: October 2021

Abstract
Many adolescents do not seek appropriate help when they experience mental health problems (MHP). Especially during the COVID-19 pandemic, this has become an increasingly pressing public health problem as more adolescents experience MHP due to social isolation, problematic home environments, and lack of future outlooks. Strengthening adolescents' competencies to cope with MHP (so called mental health literacy (MHL)) has the potential to prevent worsening of problems and delayed help-seeking. However, the implementation of MHL interventions remains absent or short-lived. To stimulate its implementation, this study explored attitudes of adolescents regarding mental health, help-seeking, and MHL interventions. We used a mixed-methods design including online focus group discussions and interviews, and surveys. Data collection took place since April ‘20. Participants were recruited online, through social media. So far, 58 adolescents (ages 13 and 19) attending secondary school in the Netherlands participated in this study. The data collected includes mental health status pre-, during, and post-lockdown as well as attitudes on mental health support and education. Our qualitative data analysis follows the principles of thematic analysis. We found that adolescents experience a lack of attention for mental health in secondary education as well as stigma and negative attitudes towards mental health treatment and help-sources, in general and during COVID-19. The participants voiced that they would like to know more about mental health and illness, help-sources and normalize the conversation of mental health. The attitudes of adolescents aided in shaping ideas for the implementation of mental health education. Our preliminary findings suggest that MHL and its related competencies are necessary to be able to (self-)manage one's own and others mental health especially in situations of crisis (e.g. COVID). This may decrease the disadvantageous characteristics of long-term MHP.
Climate change and the effects on environment and exposure to chemicals
Authors: Vicente JL 
Published: October 2021

Abstract
European citizens are exposed to a variety of potentially hazardous chemicals through the environment, consumer products, food, drinking water and at work in their daily lives. Human Biomonitoring (HBM) detects traces of chemicals in our bodies, aiming to improve public health. This is why human exposure is the focus of the HBM4EU initiative, a 5-year European programme funded by Horizon 2020 involving 30 European countries aimed at coordinating and advancing human biomonitoring in Europe while providing evidence that supports policymaking. Climate change can influence the persistence, mobility and other aspects of chemicals/toxins in the environment and with this influence human exposure and health effects related. HBM is the tool we use to measure the internal burden of exposure. Some papers have been published that recognize that climate change can influence human exposure to chemicals/toxins by different means. But more research is necessary to assess the impact on contaminant behaviour and toxicity due to the altered patterns of distribution that results in differences in human exposure and, consequently, in the associated health effects. Changes in the population's exposure pattern (type and intensity) to mycotoxins (a food contaminant fungi) could be a good indicator of climate change since crops infection by fungi and their own metabolism are very much dependent of climatic parameters.
Climate change and health impact: is food missing in the equation?
Authors: Assunção R 
Published: October 2021

Abstract
It has been generally recognized by researchers and regulators that climate change constitutes an important driver affecting the food sector, representing a public health issue that deserves particular attention. Climate change is associated with increasing temperatures and more extreme rainfall; it alters relationships among crops, pests, pathogens, and weeds; and it exacerbates several trends including declines in pollinating insects, increasing water scarcity, increasing ground-level ozone concentrations, and fishery declines. In one hand, climate change threatens our ability to ensure global food security, eradicate poverty and achieve sustainable development. Agricultural productivity is affected by changing rainfall patterns, drought, flooding and the geographical redistribution of pests and diseases, with consequent implications in food availability, a key requirement for food security. On the other hand, despite less debated, climate change could also affect food safety, namely through the occurrence of food safety hazards at various stages of the food chain, from “farm to fork”. The tendency to increase the use of agrochemicals to balance the effects of more frequent extreme weather events and water scarcity in some regions could become more frequent. In addition to pesticide residues, both chemical and microbiological risks are expected to impair food and feed safety as a consequence of climate change: in particular mycotoxins, marine biotoxins (phycotoxins), trace metals, among others. Here, all these concepts will be discussed and integrated, to highlight the potential impact of climate change in food systems, focusing particularly on the contribution to human health especially in what concerns food safety.
Burden of disease of dietary exposure to aflatoxins in European countries
Authors: Martins C , Viegas S , Assunção R 
Published: October 2021

Abstract
Aflatoxins (AFTs) are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In 2015, WHO estimated the burden of disease associated with exposure to AFTs and concluded that this exposure corresponds to 636,869 Disability-adjusted Life Years (DALYs) at global level. Particularly for Portugal and recently, there were estimated 0.08-0.30 DALYs/100,000 considering consumption and occurrence in food data, and 1.7 DALYs/100,000 based on human biomonitoring data. The present study considered the exposure data presented in the EFSA scientific opinion “Risk assessment of aflatoxins in food” where data from occurrence of AFTs in food and from food consumption were gathered to estimate the exposure to AFTs in 19 European countries. A deterministic and a bottom-up approach was developed to estimate the health impact of the exposure to AFTs for adult population through the calculation of DALYs associated to the number of estimated extra-cases of hepatocellular carcinoma (HCC). Results showed similar values for all the 19 European countries considered. For adult population and considering the data provided by EFSA using the upper-bound approach (worst-case scenario), the estimated number of DALYs ranged from 0.32 (Spain) to 1.10 (United Kingdom) DALYs/100,000. A total of 11.76 DALYs/100,000 was globally estimated for the considered European countries. The highest burden was estimated for the United Kingdom, that together with The Netherlands, Ireland, Czech Republic, and Austria were the highest contributors to the global estimated European burden associated to the exposure to AFTs. The present study generated reliable and crucial data to characterize the burden associated to exposure to AFTs in the European population. The obtained results constitute an important contribution to define priorities and support the need for further policy actions to protect European citizen's health.
Digital health literacy and COVID-19 pandemic: Results of a nationwide survey in Germany
Authors: De Santis KK , Jahnel T , Sina E , Wienert J , Zeeb H 
Published: October 2021

Abstract

Background
Digital health literacy is important for interpreting information and making health decisions in an increasingly digitised world. We investigated the perceived digital health literacy and the attitudes towards digital information on the COVID-19 pandemic using a nationwide survey.

Methods
We conducted a cross-sectional, computer-assisted telephone survey in October 2020 using a panel sample of Internet users selected from the general population living in Germany. Responses on items regarding the COVID-19 pandemic and the eHealth Literacy Scale (eHEALS; total sum score of 8=minimum to 40=maximum perceived digital health literacy) were analysed using descriptive statistics and a linear regression analysis.

Results
Of the 1014 Internet users, 928 (92%) completed the eHEALS. The respondents were 52% female, aged 14-93 years (mean±SD of 55±17 years), 66% with up to secondary education and 45% with up to average household income. The responses on eHEALS were consistent (Cronbach's α=.88). While the perceived digital health literacy was high (mean±SD eHEALS score of 31±6), less than half of respondents (43%) were confident in using digital information for health decisions. Higher digital health literacy was associated with younger age (β=-.22, p&lt;.001), higher household income (β=.21, p&lt;.001) and more education (β=.14, p&lt;.001). About half of respondents (52%) reported that they sometimes or often come across inaccurate digital information on the COVID-19 pandemic. The majority (78%) were confident in their ability to recognise inaccurate digital information on the COVID-19 pandemic and 43% installed the contact-tracing app.

Discussion
Internet users in Germany report high perceived digital health literacy but low confidence in making health decisions and low trust in digital information on the COVID-19 pandemic. Factors contributing to such low confidence in the general population need to be investigated.

Key messages
Despite high digital health literacy, the confidence in making health decisions is low in the general public. The trust in digital information on the COVID-19 pandemic is low.
Infographics in support of decision-making of well-being and health promotion
Authors: Hätönen H , Tolonen H 
Published: October 2021

Abstract
The promotion of population well-being and health is a complex phenomenon. Extensive information is needed for the related decision-making in order to understand the current state, to determine objectives, to agree measures and to assess the impact of decisions. Evidence-based and informed decision-making has been discussed for a long time. The rapid growth in the availability and quantity of information has challenged the perception of knowledge and expertise. Increasing the amount of information in decision-making is no longer the solution to solve various societal phenomena. A new kind of thinking and new practices are needed to ensure that the information used in decision-making continues to be reliable and understandable. In Finland, the knowledge base and use of it in the decision-making of the promotion of well-being and health, have been identified as an important development area. In the Government resolution “Promotion of well-being, health and safety - 2030” one priority is to improve the effectiveness of decision-making. The goal is that, policymakers promote well-being, health and safety and reduce inequality. In order to achieve this, actions will be directed towards decision-making tools as well to ensuring information is up-to date, reliable and understandable. Infographics have become more common and are able to respond in many ways to the development needs of the information used in decision-making. The greatest benefit of infographics is in situations where there is a need to raise a complex phenomenon to the discussion or to present it to the decision-maker closely and quickly. Dialogue is also needed in order to build a common understanding and utilization of information. For that infographics provide an excellent tool. The presentation describes practical examples of use of infographics in supporting decision-making. However, it is also recognized that traditional text-based memoirs, reports and similar documents are still needed.
Early cognitive ability and emotional-behavioural development in childhood
Authors: Bowe A , Staines A , Murray D 
Published: October 2021

Abstract

Background
Children with below average cognitive ability represent a substantial yet under-researched population for whom cognitive and social demands, which increase in complexity year by year, may pose significant challenge. This study compares trajectories in emotional-behavioural development for children with and without below average cognitive ability and examines the independent association between cognitive ability and clinically significant emotional-behavioural difficulty (EBD) in childhood.

Methods
Participants consist of 7,000 children and caregivers from the Growing Up in Ireland survey. Cognitive ability was measured at age 3 using the Picture Similarities Scale. A t-score 1-2 standard deviations below the mean was categorised as below average cognitive ability (n = 767), and scores above this as average/above (n = 6418). EBD was measured using the Strengths and Difficulties Questionnaire (SDQ) at age 3,5 and 9 years. A generalised linear mixed model with repeated measures was used to examine the relationship between cognitive ability and SDQ. Logistic regression examined the independent association between cognitive ability and clinically significant EBDs between age 3-9 years.

Results
The change in mean total SDQ score over time differed significantly between the cognitive ability groups (F(2)=8·817, p &lt; 0·001). Between 5-9 years, there was no change in SDQ for those with average/above cognitive ability. For those with below average ability there was a significant increase of 0·48 points (95% CI 0·34 - 0·62, p &lt; 0·001). After adjustment, the odds of a clinically significant EBD between age 3-9 were 1.4 times higher for those with below average cognitive ability (AOR 1.39, 95% CI 1.17-1.66, p &lt; 0.001).

Conclusions
Children with below average cognitive ability are at higher risk of EBD in childhood. A scalable method of early identification should be a research priority for public health, enabling early intervention for cognitive and adaptive outcomes.

Key messages
Children with below average cognitive ability experience higher mean emotional-behavioural difficulty scores throughout childhood compared to those with average or above cognitive ability. Early life is a critical period for cognitive development. Public health research must focus on the early identification of at risk children to enable cognitive and adaptive functioning interventions.
Good perception of own lifestyle associated with poor attendance at Diabetic RetinaScreen Programme
Authors: Syed S , Fitzpatrick P 
Published: October 2021

Abstract

Background
Untreated diabetic retinopathy is the most common cause of sight loss in people of working age. The Diabetic RetinaScreen programme (DRS) is the national diabetic retinopathy screening programme in Ireland which commenced in 2013 with aim to prevent diabetic retinopathy and subsequent blindness, through free screening and ophthalmology services. High uptake is crucial for the effectiveness of the programme. This study aimed to determine the sociodemographic, lifestyle and healthcare factors associated with attendance at the DRS programme in Ireland, using data from a national cohort study, the Irish Longitudinal Study on Ageing (TILDA).

Methods
The TILDA wave-4 dataset (anonymised) was utilised for the current study. Questions on DRS invitation and attendance formed part of the wave 4 study questionnaire. Multivariate logistic regression was used to examine independent factors associated with attendance. SPSS was used for analysis.

Results
418 respondents (7.3%) were invited to DRS and 373 (89.2%) attended. Among all those who were invited to DRS, 244 (58.4%) were male and 174 (41.6%) were female. The mean age was 69.8 years (53-84 years). Following multivariate logistic regression, following a good diet/taking exercise (OR = 0.29, 95% CI 0.10-0.82) was negatively associated with attendance, after adjustment for age, male gender, higher education and medical card.

Conclusions
Recognising factors linked with uptake is important to develop goal directed strategies. Interestingly those who stated they followed a good diet & took exercise and were compliant with DM prevention were less likely to attend DRS. Previous research has also indicated that a higher physical activity level is associated with higher self-perceived health status

Key messages
Persons with DM with good compliance to diet and exercise were found to have poor attendance at the DRS programme. Targeted advertising is required to raise awareness of diabetic retinopathy.
Sex differences in the associations of socioeconomic status with stroke in the Turkish Population
Authors: Turunc O , Zwas DR , Calderon-Margalit R , Unal B 
Published: October 2021

Abstract

Background
Low SES status is associated with the risk of stroke, with sex differences in the risk profiles. Recent evidence suggests that this association may differ in middle-income countries. We explored this association in the Turkish population.

Methods
The database of the Chronic Diseases and Risk Factors Survey in Turkey from 2013 and 2019 was used. The education level and employment status of the participants were chosen as a proxy indicator for SES. Cox regression analyses were conducted to assess the effect of SES on incident stroke controlled by age, settlement, behavioral and biological risk factors. Interaction terms were introduced to the Cox models to assess the multiplicative interaction between sex and SES on the risk of stroke.

Results
The study included 13 975 participants; 7 450 females (53.3%) and 6525 males (46.7%). During 74.2±9.87 months of follow-up, 108 strokes occurred among females (2.34 cases per 1000 person-years) and 81 stroke cases occurred among males (2.01 cases per 1000 person-years). Completion of primary school education was associated with decreased risk of stroke (HR = 0.46, 95%Cl: 0.25-0.84) among males. Education level had a linear protective effect against stroke among females after adjustment for behavioral and biological risk factors (HR = 0.50, 95%Cl: 0.30-0.81; HR = 0.30, 95%Cl: 0.12-0.71; respectively for primary education and secondary or higher education). Employment status did not predict the incident stroke for both sexes. There was no evidence of an interaction between sex and education (p = 0.68).

Conclusions
In this Turkish population, stroke risk was greater in women than in men. Increasing education was associated with a reduced risk of stroke in Turkish women, whereas the only completion of primary education was protective for men, with no further protection at increased educational levels. Further exploration of sex and gender risk differences in moderate-income countries may lead to improved efforts at risk reduction.

Key messages
Education level as a social determinant of health in middle-income countries may affect men and women differently with regards to the risk of stroke Understanding sex differences in the associations of socioeconomic status with stroke may lead to improved efforts at risk reduction of stroke in MICs.
Vaccine Hesitancy and Cognitive Biases: A tailored approach for a better communication
Authors: Casigliani V , Menicagli D , Fornili M , Lippi V , Chinelli A , Stacchini L , Baglietto L , Lopalco PL , Tavoschi L 
Published: October 2021

Abstract

Background
Vaccine hesitancy (VH) remains worldwide a reason of concern. Most of the vaccination education strategies followed a ‘fact-based' approach, based on the assumption that decision making is a rational process, without considering the influence of cognitive biases and heuristics. Our study aimed at identifying factors involved in the parents' vaccination choice to inform and shape communication interventions.

Methods
We conducted an online national survey among parents between November 2020 and April 2021. The questionnaire consisted of 59 items organised in 5 parts: personal information, cognitive biases, risk aversion, conspiracy mentality, and VH. Exploratory factor analysis was conducted to identify latent variables underlying the 19 items related to the 6 cognitive biases. Factors were categorised in quintiles and the corresponding pseudo-continuous variables used as predictors of the VH. Logistic regression model was applied to assess the association of the VH with factors, conspiracy mentality and risk propension. We adjusted for age, gender, economic status, and education levels.

Results
The study included 939 parents, 764 women (81.4%), 69.8% had a degree or higher level of education. Considering cognitive biases, four factors explaining 54% of the total variance were identified and characterised as: fear of the side effects of vaccines (scepticism factor); carelessness of the risk and consequences of infections (denial factor); optimistic attitude (optimistic bias factor); preference for natural products (naturalness bias factor). All factors were positively associated with VH (p &lt; 0.001) as were conspiracy mentality (p = 0.007) and risk propension (p = 0.002).

Conclusions
This study confirmed the need to amplify the model used to analyse the VH considering cognitive biases as an important factor affecting the parents' decision making. These results may be useful to design personalised communication interventions regarding vaccines and vaccination.

Key messages
The model used to analyse the vaccine hesitancy needs to be extended including the evaluation of cognitive biases and heuristics. Communication interventions to promote vaccine acceptance should be tailored and personalized on the basis of the drivers of choice of the parents.
Physical Activity Determinants in Older People: An Analysis of the UK Understanding Society Wave 2
Authors: Ikpeme M , Pang D 
Published: October 2021

Abstract

Background
Ageing leads to inactivity and conditions like heart disease, type II diabetes, and risk of falls. Regular physical activity (PA) helps with a renewed feeling of ability, efficient blood circulation, balance, and coordination. In the UK, physical inactivity is the fourth largest killer of the elderly. This study examines some physical activity determinants in older people.

Methods
A cross-sectional analysis of the UKUS cohort study Wave 2 (2010-12) with participants aged 65 and above was done. The descriptive analyses involved crosstabulations and pictorials in SPSS and Microsoft Office. Data was dichotomised for 2x2 tables in OpenEpi for the univariate analyses. Multivariate analysis was via ordinal logistic regression in SPSS. As Wave 2 had no variable describing PA, a ‘total physical activity' (TPA) score was created. TPA is composed of the addition of the total walking score (TWS), total hobbies/sports score (THSS), ‘total physicality score' (TPS), and total sport frequency (TSF). All five variants were created by indexing available proxy variables unique to each category. Results were reported with odds ratios and 95% confidence intervals.

Results
Univariate analysis with TPA showed an association with some variables like income, OR = 15.25 (8.57-27.12), social interaction, OR = 2.11 (1.46-3.05), family interaction, OR = 2.69(1.45-4.98), wellbeing, OR = 312(157.5-617.9), physical health, OR = 2.84(1.39-5.81) and emotional health, OR = 2.42(1.21-5.07). Multivariable analysis after adjusting for age and sex yielded no significant associations between most PA and predictors. Some significant associations include TWS and social class, AOR= 2.59 (P = 0.013), green food consumption, and TPS, AOR= 1.47 (P &lt; 0.05).

Conclusions
In general, higher income, gross personal income, social class, wellbeing, and green food consumption seemed to produce greater odds of participating in all physical activities.

Key messages
These findings suggest the need for other social determinants to be thoroughly investigated. There is also a need for older adults to be well provided for so these determinants of health can improve their quality of life.