bluuebunny/crossref_metadata_2025_split huggingface dataset:
Built environmental characteristics, physical activity in neighbourhoods of Accra, Ghana
Authors: Effah E S , Nai A , Bardos H 
Published: October 2024

Abstract

There is increasing evidence that characteristics of the built environment can influence residents’ lifestyles, physical activity thereby influencing the development of obesity and non-communicable diseases even in low- and middle-income countries. The aim of this study is to describe the characteristics of the built and the social environment of neighbourhoods of Accra, Ghana, and to explore association between neighbourhood characteristics and the physical activity of the residents. A cross-sectional study was conducted in Accra, 12 neighbourhoods were randomly selected based on high and low values of residential density and socioeconomic status. Sociodemographic, household and neighbourhood information were collected with an adapted questionnaire of NEWS (Neighbourhood Environment Walkability Scale) for Africa. Physical activity was assessed by WHO Global Physical Activity Questionnaire and social cohesion by the Perceived Neighbourhood Social Cohesion Questionnaire. Differences between variables by neighbourhood types were analysed using Chi square test and Kruskal Wallis test. Generalized linear model was performed to determine the association between neighbourhood characteristics and residents’ physical activity. The built environmental characteristics of different neighbourhood types and the physical activity of the residents showed significant differences. The associations indicated that individuals living in high residential density neighbourhoods had increased levels of engaging in physical activities. Land use mix, street connectivity, safety, aesthetics and social cohesion of neighbourhoods showed correlation with physical activity of residents. The built environment and social characteristics of neighbourhoods can influence the lifestyle and physical activity of residents in Accra, Ghana.

Key messages
• High residential density neighbourhoods correlated with higher level of physical activity.
• Land use, street connectivity, safety and aesthetic of neighbourhoods and social cohesion showed correlation with physical activity.
The Impact of Poor Air Quality on Hospitalisation of Multi-morbid Patients: A Systematic Review
Authors: Hassan N , Mohamed L , Ahmed A , Baxter C , Wilson S , Tolley C , Namdeo A , Slight R , Slight S P 
Published: October 2024

Abstract

Background
Exposure to poor air quality worsen existing health conditions, particularly amongst vulnerable patients, leading to increased healthcare utilization. We conducted a systematic review to explore the impact of exposure to poor quality on healthcare requirements in multi-morbid patients.

Methods
We searched six major databases (Medline via Ovid, Embase via Ovid, Web of Science, CINAHL, Global Health, and Scopus) using search terms grouped into sets relating to ‘air pollution,’ ‘multimorbidity,’ “association” and ‘hospitalisation.’ We were interested in the impact of common air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) and articles were screened independently by two researchers. The review was registered with The International Prospective Register of Systematic Reviews (CRD42022369757) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results
A total of nineteen studies were included. All six air pollutants increased hospitalisation amongst multi-morbid patients, especially those with diabetes and cardiovascular comorbidity. Females and the elderly (&gt;65 years old) were the most vulnerable to the effects of air pollution, with an increase in hospitalisations of 9.23% and 6.35% when exposed to PM2.5 and PM10, respectively. Patients &gt;65 years had a higher likelihood of hospitalisation for ischemic and haemorrhagic stroke when exposed to PM2.5 or PM10 at warm season. Patients (≥70 years) who had cardiovascular and pulmonary comorbidity were 3.9% more likely to be hospitalised for a cardiopulmonary event with a rise in NO2 levels. We found an intersectional effect (referred to as “the CADC effect” - Climatic changes, Air pollutant, Demographics, Chronic conditions) that influenced the likelihood of hospitalisation.

Conclusions
Future research is required to further understand this CADC effect in other high-risk population.

Key messages
• Females, elderly, those with cardiovascular, and pulmonary comorbidity are at the highest risk of hospitalisation with poor air quality.
• The CADC effect explains the intersectional effect between hospitalisation in multimorbid patients, patients demographics and chronic conditions, and air pollution and temperature effects.
Environment, climate, socio-economics & restrictions impact on COVID-19 in Northen Italy
Authors: Palandri L , Rizzi C , Vandelli V , Filippini T , Carrozzi G , De Girolamo G , Russo M , Soldati M , Righi E , Lugli C 
Published: October 2024

Abstract

Up to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, and most of them focused on viral spread rather than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. Our population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (n.68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021. Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. Several significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. Our findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly.

Key messages
• Evaluating simultaneously four exposure domains on COVID-19 outcomes informs public health policy for future pandemic management.
• The comprehension of risk factors associated with severe outcomes, such as hospitalization and mortality, is pivotal for planning responses to similar health emergencies in the future.
An intervention on climate change anxiety and pro-environmental behaviours in Italian young people
Authors: Lombardi G S , Zjalic D , Di Russo M , Perilli A , Congedo G , Nachira L , Cadeddu C , Innocenti M , Bruno S , Fioravanti G 
Published: October 2024

Abstract

Background
The climate crisis greatly affects mental health, often leading to climate change anxiety. In Italy, there is a lack of research and school programs to help manage climate anxiety and other climate-related psychological consequences. The aim of the CAMBIO CLIMA project is to evaluate the levels of eco-anxiety and pro-environmental behaviours (PEBS) in a sample of Italian middle and high school students, before and after a tailored intervention on the climate crisis.

Methods
The intervention involves one hundred middle and high school classes from three Italian regions. The students will complete a set of surveys, including psychometric scales and questions on socio-demographic factors and climate change awareness. The students will then participate in a two-hour online workshop. A video will be shown at the beginning to raise awareness about climate change. The instructor will ask the students which solutions could be found to solve specific problems caused by climate change. The instructor will then propose and explain a list of PEBS that students can implement to fight against climate change. Finally, students will be invited to put into action these behaviours. A week after the intervention, students will be asked to take part in a post-intervention survey, completing the same set of questionnaires they completed at enrolment.

Results
Currently, the research team is in the preparatory stage, establishing contacts with schools and organizing materials for the online workshop. The intervention is scheduled for the upcoming school year.

Conclusions
The intervention, focused on enhancing the sense of self-efficacy, is expected to increase the resilience of adolescents, making them less vulnerable to the impact, both direct and indirect, of climate change on mental health. The project is funded by PRIN: PROGETTI DI RICERCA DI RILEVANTE INTERESSE NAZIONALE - Bando 2022 (Prot. 2022N22J5F).

Key messages
• Climate change has a disproportionate impact on young people.
• It is essential to plan adequate school programs that stimulate the sense of awareness and encourage PEBS simultaneously.
Sanitary Surveillance Program for pools in Matosinhos, Portugal
Authors: Barbabela R , Maia M A , Jesus A S , Abreu Gomes C , Silva J G , Balazeiro M , Sousa F , Duarte G , Fernandes A , Queiroz Almeida D , Penedos Oliveira D , Pinheiro V , Rodrigues N 
Published: October 2024

Abstract

The use of pools for sports, recreational, and therapeutic activities has increased over time. It is important to ensure and control the quality of the water and surrounding areas, as well as the hygienic-sanitary conditions of these spaces. The ‘2018 Pool Sanitary Surveillance Program’ of the Portuguese Northern Regional Health Administration proposes the surveillance of water quality, teaching accessories, and surfaces. The aim of this investigation is to conduct microbiological analysis of the teaching accessories and surfaces in public pools in the municipality of Matosinhos and assess if this program has improved the results for water quality, teaching accessories, and surfaces from 2018 to 2023. The environmental health team of our Public Health Unit performed swabs of the teaching accessories and surfaces of all seven public pools in Matosinhos for microbiological analysis. The swabs were performed in 2018 (21), 2019 (48) and 2023 (42). During each visit, three random points were selected for analysis. In 2019, 31 rugs (64,6%) were analysed, but in 2023 only 10 (23,8%) were rugs. It was found that rugs had the highest contamination by P. aeruginosa (94,4%), fungi (60,8%), and the only sample with coagulase-positive Staphylococci. There was a decrease in samples from twelve to six with P. aeruginosa and an increase from 22 (46.8%) to 29 (69.0%) with fungi from 2019 to 2023. Bacterial colonies grew in 20 samples (95.2%) in 2018, 44 (91,6%) in 2019, and 42 (100%) in 2023. All water samples collected for the evaluation of microbiological parameters outlined obtained compliant results. Fungal and P. aeruginosa detection indicate a potential risk to the health of pool users. A quality report with corrective measures was produce for each pool in each visit. Surveillance of pool water, teaching materials and surrounding surfaces, is crucial to ensure water quality and safety. By doing so, we may lower the risk of disease transmission and protect the population’s health.

Key messages
• To ensure the safety of pool users is a public health challenge. It would be relevant to have legislation that addresses this issue.
• To survey pools and its surroundings and accessories must be a continuous task, allied with literacy to management and users.
Exposure to microplastics via hemodialysis: differences between women and men
Authors: Fiore M , Bivona F , Palella M , Fatuzzo P M , Zanoli L M , Timperanza C , Longo V M , Lo Cicero L , Oliveri Conti G , Ferrante M 
Published: October 2024

Abstract

Background
Hemodialysis (HD) may contribute to microplastics (MPs) burden in dialysis patients. The aim of the study was to estimate any differences in exposure to MPs between cases (on dialysis patients) and controls (not on dialysis patients), investigating any sex differences.

Methods
We organized a case-control study. Both cases and controls were recruited at the Policlinic “G. Rodolico-San Marco” Hospital Nephrology Unit. Preparation and determination of MPs smaller than 10 µm in blood samples were carried out using a patented method (Italian Patent n. 102018000003337-07 March 2018, European Patent n.3788344 20 July 2022) and SEM-EDX electron microscopy analysis, respectively.

Results
A convenience sample was recruited including 15 dialysis (60.0% women) and 10 not on dialysis patients (60.0% women) with a median (IQR) age of 77.0 (59.0-83.0) in dialysis patients and 65.5 (49.3-79.0) in those not on dialysis. No significant differences were found between cases and controls on the consumption of bottled water (100% vs 80%, p = 0.07), bagged foods (93.3% vs 70%, p = 0.12) unlike the use of drugs (100% vs 70%, p = 0.02). Women in general declared a greater use of drugs than men (F 93.3%, M 80.0%, p = 0.32). Dialysis patients had higher MPs levels than non-dialysis patients [9132(4896-15847) vs 3554(1661-7340), p-value=0.06]. In particular, female dialysis patients had values comparable to males [9132 (4665-17205) p/d vs men: 10438 (3672-16699) p/d] while non-dialysis female patients had higher levels than males [3274 (1681- 7814) p/g vs 1661 (1661-3354) p/g]. No difference was detected about the diameter of the MPs (IQR) [dialysis patients 4.28 (3.72-4.66) µm vs non-dialysis patients [4.67 (4.15-5.08) µm].

Conclusions
Future studies must focus on studying the relationship between exposure to MPs and their levels in dialysis patients as well as investigating the differences between men and women and the possible consequences of dialysis as a further source of exposure.

Key messages
• On dialysis patients, both men and women, had higher MPs exposition compared to not on dialyzed ones.
• Not on dialysis women had higher MPs levels than not on dialysis men.
BMI Trajectories and the Influence of Missing Data
Authors: Gray L A 
Published: October 2024

Abstract

Introduction
Body Mass Index (BMI) trajectories have been estimated in various ways. These estimates are important to understand how BMI develops over time and for use in cost-effectiveness analysis. However, missing data is often stated as a limitation in studies that analyse BMI over time and there is little research into how missing data can influence these BMI trajectories. The aim of this study is to determine how much influence missing data can have when estimating BMI trajectories and to explore the effects this has on subsequent analysis.

Methods
This study uses data from the English Longitudinal Study of Aging. First, a growth mixture model is used to estimate distinct BMI trajectories in adults over the age of 50. Next, methods that assume data is missing at random (MAR) are used: complete case analysis and multiple imputation. Finally, Diggle Kenward and Roy methods that assume data is missing not at random (MNAR) are implemented. Estimated trajectories from each method are then used to predict the risk of developing type 2 diabetes (T2DM) using discrete-time survival analysis.

Results
Four distinct trajectories are identified using each of the methods to account for missing data: stable overweight, elevated BMI, increasing BMI, and decreasing BMI. However, the likelihoods of individuals following the different trajectories differs between the different methods.
Results show that the influence of BMI trajectory on T2DM is reduced after accounting for missing data. More work is needed to understand which methods for missing data are most appropriate and give the most reliable results.

Conclusions
Missing data can significantly influence estimations of BMI trajectories. When using BMI trajectories to inform cost-effectiveness analysis or policymaking, missing data should be considered. More research is needed to examine the extent to which accounting for missing data might influence the cost-effectiveness of policies, e.g. weight management interventions.

Key messages
• Missing data is important when modelling BMI trajectories.
• More research is needed to examine the extent to which accounting for missing data might influence the cost-effectiveness of policies, e.g. weight management interventions.
Neighbourhood immigrant density and COVID-19 infection and hospitalization among healthcare workers
Authors: Nwaru C , Bonander C , Li H , Santosa A , Löve J , Nyberg F 
Published: October 2024

Abstract

Background
Studies have shown inequalities in COVID-19 infection among healthcare workers (HCWs), with occupational exposure failing to fully explain the inequalities. Little is known about the role of other social determinants of health, such as neighborhood immigrant density. We examined if living in immigrant-dominated neighborhoods was associated with increased risk of COVID-19 infection and hospitalization among HCWs in Sweden, and if so, whether such exposure amplified the risk of COVID-19 among immigrant HCWs. Addressing this question would contribute to a better understanding of factors driving COVID-19 disparities among HCWs.

Methods
Data were from HCWs aged 20 to 62 years (N = 86187) resident in one of 14 Swedish municipalities (three of which are Sweden’s largest metropolitan cities) on 1 January 2020. Residential neighborhoods were categorised into Swedish-dominated, mixed, and immigrant-dominated. The study outcomes were the first occurrence of COVID-19 infection and hospitalization registered until 30 September 2022. Multilevel mixed-effects survival regression was used for the association analyses, with control for confounders (age, sex, income, comorbidities etc).

Results
After adjusting for confounders, living in immigrant-dominated neighborhoods was only associated with an increased risk of COVID-19 infection in the first pandemic wave (HR 1.17, 95%CI 1.07 - 1.29), but living in these areas was associated with an elevated risk of COVID-19 hospitalization throughout the entire period. Immigrant HCWs, regardless of where they lived, had around 2-fold higher risk of being hospitalised for COVID-19 than non-immigrant HCWs living in Swedish-dominated neighborhoods.

Conclusions
Neighborhood immigrant density was associated with COVID-19 hospitalization among HCWs in Sweden. However, immigrant HCWs had a high risk of the outcome regardless of where they lived. More research is needed to identify the root causes of the excess risk among immigrant HCWs.

Key messages
• HCWs living in immigrant-dominated neighborhoods had an elevated risk of COVID-19 hospitalization.
• This study sheds additional light on the drivers of COVID-19 inequalities among Swedish HCWs.
Measured obesity and overweight in adults: the Italian Health Examination Survey 2023-CUORE Project
Authors: Marcozzi B , Lo Noce C , Vannucchi S , Di Lonardo A , Damiano C , Galeone D , Bellisario P , Palmieri L , Donfrancesco C 
Published: October 2024

Abstract

Background
The WHO recommends to halt the rise of obesity by 2025, considering 2010 as baseline. This analysis aims to assess if Italy can meet the WHO target in the general adult population using data measured in the periodic health examination surveys (HESs) conducted within the CUORE Project.

Methods
In the HES started in 2023, mean level of BMI and prevalence of obesity (BMI &gt; =30 kg/m2) and overweight (25 &lt; =BMI&lt; 30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (727 men and 706 women), from 7 (of 20) Italian Regions, in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. Insufficient physical activity was defined as less than 150 minutes of moderate-intensity activity per week, or equivalent. The survey is funded by the Italian Ministry of Health-CCM.

Results
Prevalence of obesity was 23% (95% C.I. 16-29%) in men and 25% (19-31%) in women; prevalence of overweight was 47% (39-54%) in men and 30% (24-37%) in women. Mean level of BMI was 27.5 kg/m2 (27.2-27.8 kg/m2) in men and 26.9 kg/m2 (26.4-27.3 kg/m2) in women. Obesity resulted tendencially higher in persons with insufficient physical activity (27%, with 95% C.I. 17-36% in men; 28%, 19-37% in women) than among those without (19%, 11-27% in men; 21%, 12-30% in women), and in persons with primary or secondary school education (29%, 17-40% in men; 32%, 20-44% in women) than in those with higher educational level (20%, 12-27% in men; 21%, 14-28% in women).

Conclusions
Going in the direction of WHO target, preliminary data collected within 2023 showed a prevalence of obesity not statistically different in comparison to HES data of 15 and 5 years ago, both in men and women, however, 70% of men and 55% of women are in the overweight/obesity condition. Preventive actions at national and community level should be still massively implemented.

Key messages
• Prevalence of obesity and overweight resulted still at epidemic level in the Italian adult general population.
• In the Italian adult population stable obesity prevalence trend was observed in comparison to 15 and 5 years ago.
Long-term cardiovascular events in individuals hospitalised with COVID-19: a retrospective cohort
Authors: Soares P , Ruivinho C , Lobão M J , Paixão J , Simões I , Moça R , Costa A , Atanásio G , Brazão M L , Goes A R 
Published: October 2024

Abstract

Background
The post-COVID condition involves a range of persistent or new symptoms affecting various organs, including an increased risk of cardiovascular issues. As there are limited data on cardiovascular events in post-acute COVID-19 patients, we aimed to estimate their incidence and assess its association with patient and infection characteristics in Portugal.

Methods
We conducted a registry-based retrospective cohort study from seven hospitals across Portugal, including individuals hospitalised due to COVID-19 between March 2020 and March 2021. Our outcome of interest was cardiovascular events in the post-acute phase of COVID-19, occurring at least 30 days after the positive SARS-CoV-2 test. The variables of interest considered were the severity of the episode, existing cardiovascular risk and vaccination status before the SARS-CoV-2 test. Person-years and incidence rates were estimated. A Cox proportional hazard regression model was employed to assess risk factors.

Results
We included 1,803 patients in the analysis, of which 143 (7.9%) experienced at least one cardiovascular event following COVID-19 hospitalisation. The overall incidence rate of having at least one cardiovascular event was 34.65 per 1,000 person-years (95% confidence interval (CI): 29.20; 40.82). We found a higher risk of cardiovascular events for individuals with pre-existing cardiovascular risk (adjusted hazard ratio (aHR): 3.76, 95% CI: 1.53; 9.24) and lower risk for individuals with at least one vaccine dose before the SARS-CoV-2 test (partial - aHR: 0.44, 95%CI: 0.30; 0.64, complete - aHR: 0.46, 95%CI: 0.2; 0.80). We did not find a significant difference between the severity of the COVID-19 episode and the risk of having cardiovascular events post-COVID-19.

Conclusions
Our results indicate the presence of cardiovascular complications post-COVID-19, emphasising the need for healthcare systems to initiate screening and preventive strategies for individuals deemed at elevated risk.

Key messages
• COVID-19 vaccination decreases the risk of cardiovascular events post-COVID-19.
• Healthcare systems should start screening and preventive strategies for individuals with pre-existing risk of cardiovascular events.