bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of health literacy in adherence to the Mediterranean diet
Authors: Duarte A , Martins J , Martins S , Augusto C , Silva M J , Magalhaes F , Lopes C , Rosario R 
Published: October 2024

Abstract

Background
Health literacy has emerged as a crucial concept in public health. It is considered a modifiable determinant influencing health-related decision. One such decision is the adoption of specific dietary patterns. The Mediterranean diet has garnered recognition as one of the healthiest diets. This study aims to explore the association between health literacy levels among adults in socially vulnerable contexts and their adherence to the Mediterranean diet.

Methods
This study is part of a cluster-randomized trial conducted in primary schools from socially vulnerable contexts. A total of 469 parents of school-aged children agreed to participate. Health literacy was assessed using the Health Literacy Survey Questionnaire. Adherence to the Mediterranean diet was evaluated using the MEDAS questionnaire. Anthropometric and sociodemographic variables were self-reported via questionnaire. Parental BMI was calculated using weight/height^2. Education level was categorized into two groups (less than higher education and higher education), while professional status was classified based on the occupational categories of collar color. Generalized linear models were utilized for the analysis.

Results
Individuals with higher levels of health literacy present a greater odd to adhere to the Mediterranean diet (B = 0.022, 95% CI 0.010-0.035), even after adjusting for potential confounders (B = 0.019, 95% CI 0.006-0.032).

Conclusions
Health literacy emerges as a crucial factor influencing individuals’ dietary choices, as evidenced by its association with higher adherence to the Mediterranean diet. These findings underscore the importance of implementing policies and initiatives aimed at promoting health literacy, particularly among individuals from socially vulnerable contexts. Enhancing public health interventions to bolster health literacy should be prioritized to foster better dietary decision-making.

Key messages
• Health literacy plays an important role in the adoption of Mediterranean diet among adults from socially vulnerable contexts.
• Implementing policies to aim the promotion of health literacy, particularly among individuals from socially vulnerable contexts are necessary.
Development of a risk-stratified shared decision-making tool for colorectal cancer screening
Authors: Herrera D J , van de Veerdonk W , Talboom S , Van Bos L , Veressen A , Seibert D M , Feyen K , Haesaert L , Van Hal G 
Published: October 2024

Abstract

European guidelines stress the importance of informed decision-making in colorectal cancer (CRC) screening. However, tailored tools that facilitate decision-making for underserved people and general practitioners (GPs) in Flanders are lacking. This study aimed to develop a tailored shared decision-making (SDM) tool for CRC screening, specifically a video decision aid, using a co-creative process. The development involved two rounds of focus group discussions with underserved people and five local quality group meetings with GPs in various parts of Flanders, Belgium. Qualitative data were analyzed using a Modified-Grounded Theory Analytical (M-GTA) approach to identify key themes. Findings revealed four core themes. The first theme, ‘Recognizing the Barriers to Screening’, identifies challenges such as a lack of time, staff, and tools for GPs, as well as language and literacy barriers for underserved people. The second theme, ‘Learning from Existing Tools’, highlights successful elements like visuals and simple language and limitations such as low accessibility and poor navigation. The third theme, ‘Determining the Content and Design,’ reveals that GPs seek user-friendly tools for at-home viewing, while underserved people value personalized and clear information about CRC risk factors and screening costs. The final theme, ‘Identifying Strategies for Integration,’ stresses the importance of a structured, collaborative care approach for the successful integration of the tool. The proposed modifications for the SDM tool include enhancing its accessibility with multiple language options, using simple and relatable visuals, and providing personalized risk discussions for underserved people and GPs. Nonetheless, further testing is needed to confirm the effectiveness of the SDM tool in supporting preventive talks and informed decision-making in CRC screening among these target groups.

Key messages
• A structured, collaborative care approach is needed for successful SDM tool integration during preventive talks with underserved people.
•  Further testing is needed to confirm the tool’s effectiveness in supporting informed decision-making in CRC screening for underserved people.
Scoping Review of Health Literacy Interventions among Migrant Communities in Europe
Authors: Seyfulayeva A , Dias S , Peruhype R , Marques M J 
Published: October 2024

Abstract

Background
The increase in migration trends in Europe has brought attention to the significant health disparities between migrant and native populations, which are largely rooted in social determinants of health such as economic difficulties, language barriers, and limited access to services. Tailored health literacy (HL) interventions can serve as an intermediate factor between social determinants of health and health outcome, thereby holding great potential for addressing these disparities. Despite a growing body of research on migrant health, there remains a gap in our understanding of effective HL interventions for this population.

Methods
A scoping review was conducted following the Joanna Briggs Institute (JBI) updated guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Electronic searches were carried out across five databases (PubMed, SCOPUS, Web of Science, PsychINFO, and CINHAL) and supplemented by a manual search. We included European studies on migrant HL interventions, conducted between 2011 and 2023, and published in English or Portuguese language.

Results
Out of 1018 records, 7 studies met eligibility criteria. Predominantly situated in Northern and Western Europe (85.5%), interventions primarily targeted female migrants (71.4%) through in-person courses (42.9%). Identified intervention strengths included culturally adapted content, migrant engagement, and access to written materials. Gaps included mental health interventions and community outreach.

Conclusions
This scoping review provides a comprehensive overview of HL interventions targeting migrant populations, highlighting their characteristics, strengths, and gaps. These findings serve as a foundational step towards developing guidelines for effective HL interventions within migrant communities.

Key messages
• Most European health literacy interventions for migrants target women and are conducted in North or West Europe.
• Cultural adaptation and community engagement are key strengths of migrant health literacy interventions, yet gaps remain in mental health support and community outreach efforts.
The economics of mental ill-health in the EU/EEA
Authors: Cecchini Michele 
Published: October 2024

Abstract
This presentation will provide an overview of the challenges and costs of mental ill health in 29 EU/EEA countries and an economic assessment of options to address current policy gaps. Nearly 20% of people in the EU/EEA experience mental ill health, with a particularly high prevalence among vulnerable groups such as people on low incomes or young people. However, in the majority of cases, and particularly for those with milder forms, these conditions go undiagnosed. Even when diagnosed, access to quality health services is sub-optimal, mainly due to financial issues or waiting times. The European Union and its Member States have identified mental ill health as a major public health threat, but there are still significant policy gaps and a lack of evidence on the most effective and cost-effective interventions to implementation. Building on its methodology for identifying and evaluating better public health policies for better lives, the OECD has recently extended the scope of its economic work to mental health. This presentation will start by providing an estimate of the health and economic burden of mental ill health in EU/EEA countries and will present evaluations of best practices in this field recently introduced by EU Member States. The talk will not only present the results of the analyses but will also use the identified case studies to discuss the approach used and some of the methodological issues involved in carrying out economic analysis for a set of diseases with high burden but relatively low mortality.
Is genomic testing properly evaluated? A systematic review of health technology assessment reports
Authors: Migliara G , Sciurti A , Baccolini V , Mussetto I , Kaminska A E , Pistollato A , Anniballo A , Leone I , Marzuillo C , Villari P 
Published: October 2024

Abstract

Background
The last decade has witnessed a steady embrace of Personalized Medicine. However, the evaluation of genetic/genomic tests is not straightforward. The purpose of this systematic review is to identify health technology assessment (HTA) reports assessing genetic and genomic tests, to summarize the methodologies used, the maturity level of the evidence included in it and the highlighted gaps in research.

Methods
PubMed, Scopus, and Web of Science were searched. Additionally, a desk research was performed on the main HTA reports repositories. HTA reports expressly created to assess genetic/genomic technologies including at least three core evaluation components (analytic validity, clinical validity, clinical utility, economic evaluation, organizational aspects, ethical, legal, and social implications) were included. This study was supported by the EC and MUR under PNRR - M4C2-I1.3 Project PE_00000019 ‘HEAL ITALIA’.

Results
Overall, 27331 unique records were retrieved, 55 of which were included in the systematic review. The reports were mainly from Australia (29%), Canada (27%) and UK (25%), regarded pharmacogenomics (36%) and oncology (35%), and analysed test use for treatment choice (29%) and diagnosis (13%). The most reported evaluation components were economic evaluation (87%), clinical utility (76%), and clinical validity (67%). Personal utility (7%), ethical (15%), legal (11%) and social (24%) implications and the patient’s perspective (27%) were poorly represented. Analytical validity, safety, and organizational aspects were included in about half of the reports.

Discussion
Although these are only preliminary results, the substantial lack of a shared standard in the evaluation of genetic/genomic applications appears clear, given the heterogeneity of the dimensions addressed between reports, as well as the need to strengthen the evaluation of the neglected dimensions, often of primary importance in the definition of the value and risks of personalized medicine.

Key messages
• The findings highlight the lack of a standard in evaluating genetic/genomic applications.
• A common methodology should be developed to comprehensively evaluate genetic/genomic applications.
Estimating the economic burden of mental and substance use disorders in Belgium
Authors: Schmidt Masja 
Published: October 2024

Abstract
Mental and substance use disorders are the leading cause of disease burden (disability-adjusted life years, DALYs) in Belgium. Strong mental health policies are needed to reduce the burden, taking into account effectiveness and cost-effectiveness of possible interventions. Next to providing an overview of the economic burden of mental health conditions (what is), routine cost-of-illness studies also serve as a source of information for modelling the cost-effectiveness of policies and interventions to improve the mental health of populations (what could be). In the context of an extension of the Belgian Health Status Report and the Belgian National Burden of Disease Study, we calculated the direct medical costs of a range of health conditions, including mental health conditions such as depression. We used self-reported diagnostic data from the Belgian health Interview Survey linked with claims data to calculate the incremental costs attributable to mental health disorders with g-computation. We correct for confounders such as age and sex, and also look at uncertainty brought about by the data source and modelling. This presentation aims to share the experience of calculating the economic burden of mental ill-health in the context of a routine cost-of-illness study. We will present the results of the study and discuss alternative ways in which the costs of common mental health conditions such as depression could be estimated, for example based entirely on claims data using pharmaceutical cost groups.
Environmentally sustainable health and social care – A proposal for goals and steering for Finland
Authors: Wulff P , Alanko L , Iivonen S , Nissinen A , Setälä L , Meriläinen P , Savolainen H , Alhola K , Suomalainen E , Pulkki J 
Published: October 2024

Abstract

Issue
Health and social services cause significant environmental impacts. In Finland, national steering towards environmentally sustainable health and social care has been lacking.

Description of the problem
A multidisciplinary research project (EKO SOTE 2022-2023) was designed to investigate aims and steering mechanisms for environmentally sustainable social and health care in Finland. The project aimed to propose national steering and monitoring mechanisms for stronger environmental sustainability within the sector. Data for the proposal was collected from literature, review of national legislation, interviews, surveys, and co-development events. The project also aimed to calculate the carbon footprint of Finnish health and social care with the EEIO model ENVIMAT.

Results
It was estimated that health and social care contributed to 6.5% of Finland’s national carbon footprint in 2019, of which the share of health care was 4.2%. The new goal ‘Social and health care is carbon neutral and minimizes the environmental burden by 2035’ was proposed to be incorporated in the national strategic steering. Wellbeing service counties (WSC) as public care providers were suggested to be included as responsible actors in the Finnish Climate Act. National networks and targeted project funding for WSCs were found important. Three sets of indicators were designed for monitoring environmental sustainability: minimum indicators for all WSCs for national monitoring, voluntary indicators for regional monitoring, and indicators for advanced regions to pioneer best practices.

Lessons
According to the informants, national steering for environmentally sustainable health and social care is urgently needed. The national goal should be ambitious, wide-ranging, and feasible, and cover environmental aspects broadly. The steering requires multiple mechanisms: normative, strategic, informational, and economic. WSCs should be empowered to develop suitable means to achieve the national goal.

Key messages
• The project provided an ambitious, feasible, and comprehensive national goal and steering model for reducing the environmental impact of health and social care in Finland.
• Collaborative efforts and joint steering model could advance environmental sustainability in health and social care.
Consumption of low-calorie sweetened products and intakes of free sugar and energy among UK adults
Authors: Seesen M , Chang K , Parnham J , Laverty A , Millett C , Rauber F , Levy R , Gregg E , Vamos E 
Published: October 2024

Abstract

Background
Policies to reduce free sugar intake in the population often suggest alternative low or no sugar products that may contain low-calorie sweeteners (LCS). However, the health effects of LCS are controversial and little is known about whether free sugar and energy intake differ between people with varying levels of LCS product consumption. This study examines the associations between LCS product consumption and free sugar and energy intake in UK adults from 2008 to 2019.

Methods
Repeat cross-sectional data from the UK’s National Diet and Nutrition Survey (2008/09 to 2018/19) involve 8304 adults aged ≥18 years (mean 48.7, SD 18.3) with 58.4% being women. Consumption of LCS products (grams/day) were obtained from 4-day diet diaries and participants were categorized into four groups (No-LCS, Low-LCS, Mid-LCS, High-LCS) based on LCS consumption tertiles in 2008/09. Linear regression analysed associations with LCS group, year, their interaction, and adjusted for sociodemographic factors.

Results
All four groups consumed free sugar (relative to total energy intake) above recommended levels (5% kcal/day) throughout the study period. In 2008/09, the mean free sugar intake for the No-LCS group was 58.1 grams/day, and the mean total energy intake was 1855.7 kcal/day, which were not significantly different from the High-LCS group. Over time, free sugar intake declined by -1.0 g/year (95%CI: -1.4, -0.6) whereas total energy intake declined by -6.0 kcal/year (95%CI: -11.4, -2.1) in the No-LCS group. The High-LCS group showed similar declines leading to no significant difference in mean free sugar and total energy intake between the No-LCS and High-LCS groups in 2018/19.

Conclusions
In this representative study of UK adults, similar levels of free sugars and total energy intake were observed among those with no LCS and those with the highest LCS product consumption from 2008 to 2019. Absence of LCS product consumption in diets were not associated with higher free sugar intake.

Key messages
• The high level of LCS product consumption was not associated with lower free sugar intake among UK adults. These finding challenges policies promoting LCS to reduce UK adults’ free sugar intake.
• The finding that UK adults consistently consumed free sugar above recommended levels highlights the ongoing need for policy interventions.
Supply of Alcohol in Early Childhood Leads to Higher Rates of Drinking in Adolescence
Authors: Ksinan A , Ksinanova G , Pikhart H , Bobak M 
Published: October 2024

Abstract

Background
Adolescents often experience their first encounter with alcohol at home, provided by parents who perceive it as a means of safeguarding their children against later alcohol-related issues. However, research shows that parental supply of alcohol is a risk factor for adolescent drinking. Notably, existing studies solely focused on parental supply during adolescence, neglecting the prospective evaluation of parental alcohol provision during early childhood on later alcohol use.

Methods
The data came from the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC), a longitudinal birth cohort study (N = 5,777). Mothers reported on the frequency of offering alcohol to children when children were 3, 5, 7, and 11 years old. The outcome was adolescent alcohol use at ages 15 and 18, reported by adolescents, mothers, and pediatricians. Control variables included sex, maternal education, family structure, and parental alcohol consumption.

Results
Three classes of children were identified based on parental alcohol supply: abstainers (75.5% of sample), infrequent sippers (16.2%), and frequent sippers (8.3%). Parental drinking increased the risk of both infrequent and frequent sipping. These classes were entered into two structural models (age 15 and age 18 alcohol use modeled as latent factors), alongside covariates. Compared to abstainer class, infrequent and frequent childhood sippers exhibited significantly higher alcohol consumption at age 15 (β = .21, p &lt; .001; β = .25, p &lt; .001, respectively) and age 18 (β = .11, p &lt; .05; β = .24, p &lt; .001, respectively).

Conclusions
This study represents the first prospective investigation quantifying early childhood alcohol exposure and its subsequent association with adolescent alcohol consumption. Findings emphasize the influence of family dynamics on alcohol behaviors, underscoring the necessity for targeted preventive measures, particularly within families with higher parental alcohol consumption.

Key messages
• Offering alcohol to children at ages 3-11, even infrequently, significantly increases the risk of more frequent drinking at ages 15 and 18, compared to those with no early exposure.
• Parents who drink are more likely to have children who sip alcohol early, leading to higher alcohol consumption in adolescence. Prevention efforts should focus on family habits and early education.
Maternal education and antenatal attendance in Georgia: A cohort study
Authors: Saad W , John M M , Adeboye E S , Haj M , Manjavidze T 
Published: October 2024

Abstract

Background
Antenatal care (ANC) and maternal education are important determinants for maternal and newborn health outcomes. Understanding the impact of maternal education on ANC is crucial.

Purpose
To examine the association between maternal education and ANC attendance.

Methods
A retrospective cohort study utilized nationwide electronic medical birth registry data (2020-2022) in Georgia. the study includes pregnant women and their newborns. A randomized sample was selected, and extracted variables included maternal age, parity, body mass index, education, year of delivery, gestational age, infant sex, Apgar score, birth weight, delivery type, and newborn status. Statistical analysis via IBM SPSS v23 involved chi-square, t-tests, and logistic regression.

Results
The sample size contains 4976 mothers after excluding cases with missing data (n = 25). The mean maternal age was 30.5 years (SD = 5.4), with a mean BMI of 28.0(SD = 4.8), and the mean gestational week was 38.4(SD = 2.0), with a mean birth weight of 3263.0 (SD = 568.0) grams. Highly educated women had more than 3 times higher odds (OR = 3.636,95%CI:2.575-5.134) of having at least one ANC visit compared to those with Unknown education. primiparous women had significantly higher odds of having at least one ANC visit compared to Multiparous women, OR = 1.519, (95%CI:1.081-2.135). The chi-square test showed significant difference between ANC visits and the number of liveborn/stillborn (χ² = 53.026, p &lt; .001). Moreover, there was a significant association between birth weight categories and ANC visits (χ² = 167.095, p &lt; .001).

Conclusions
Our study emphasizes the role of education in improving access to ANC among women with low education levels. We can increase ANC visits and improve maternal and newborn health outcomes by focusing educational efforts on pregnant women. Additionally, focusing on high-risk populations, and using tailored interventions can further improve ANC attendance along with maternal and neonatal health.

Key messages
• Boosting ANC access and improving maternal and neonatal health by tailored community programs.
• Conservative communities and underrepresented communities require additional resources to promote tailored healthcare. and extra effort in education about ANC.