bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standardizing Primary Health Care in Italy: Operational Guidelines for Community Health Houses
Authors: Scotellaro M , Cornio A R , Borghini A , Carini E , Iodice M , Cosentino M , Sposato C V , Rinaldi M , Verrengia M , Mantoan D 
Published: October 2024

Abstract

Background
In response to Italy’s demographic changes and increasing chronic disease burden, there has been a need to standardize Primary Health Care (PHC) through Community Health Houses (CHHs). This study addresses the gap in a unified approach by developing operational guidelines using a consensus-based method among a national Experts Panel, aiming to enhance the effectiveness and integration of healthcare services across the country.

Methods
A multidisciplinary and multiprofessional workgroup was formed, including stakeholders from various health professions and Italian regions, to develop these guidelines that could integrate different health professional skills. The consensus process involved a series of online and face-to-face meetings, utilizing a modified Delphi method. This approach ensured that diverse expert opinions were harmonized and that the guidelines were relevant to different geographic contexts and healthcare settings.

Results
Through iterative rounds of consultation and revision, the workgroup reached a consensus on key aspects of PHC delivery. These included procedures, digital health tools integration and definition of various roles within the CHHs. Preliminary feedback from pilot implementations has shown improvements in accessibility, care continuity, and patient satisfaction, indicating effective adaptation of the guidelines to local contexts in line with the territorial healthcare Italian reform ratified by Ministerial Decree n. 77/2022.

Conclusions
The consensus-driven development of CHHs guidelines represents a significant advancement in Italy’s health policy, promoting a more integrated and efficient healthcare system. These guidelines are anticipated to form the cornerstone of Italy’s strategy to cope with its public health challenges, particularly in managing chronic diseases and aging populations. Future work will focus on national rollout and continuous improvement of these guidelines based on ongoing evaluation and feedback.

Key messages
• Consensus-based guidelines for Italy’s CHHs enhance PHC delivery, improving accessibility and patient satisfaction across the Country.
• Italy’s new PHC guidelines, developed through expert consensus, set a foundation for a unified, efficient healthcare system to address chronic disease and aging.
Governance and health system reform: a case study of new health regions in Ireland, 2018-2023
Authors: Schulmann K , Bruen C , Parker S , Siersbaek R , Mac Conghail L , Burke S 
Published: October 2024

Abstract

Background
While the significance of good governance is recognised within health systems research, its role in health system reform is underexplored. This research focuses on the establishment of new decentralised regional health structures in Ireland in the period 2018-2023, examining how aspects of governance impacted the decentralisation reform process, from policy design through to implementation.

Methods
The research applied a qualitative, multi-method approach involving analysis of official documents relevant to the regional decentralisation process, and 12 semi-structured interviews with key informants from across the health sector. The research applies the TAPIC framework for health governance as its analytic framework and the data is analysed using thematic analysis.

Results
Deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders, and a lack of clarity of roles and responsibilities for various process and key decisions related to the reform were identified as undermining progress at various stages of Ireland’s decentralisation reform process. An underlying distrust between key institutional actors was identified. These findings are grounded in complex social, cultural, and political and institutional developments in Ireland’s history. Also of note is the interwovenness of the five TAPIC domains and the importance of engaging with the complexity and relationality intrinsic to health system reform processes to achieve the aim(s) of the reform in question.

Conclusions
Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and address these, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed.

Key messages
• Governance plays a crucial if overlooked role in health systems reform. Effective governance arrangements are central to the successful design and implementation of reform initiatives.
• Ensuring a strong link between policy design and implementation processes is crucial to the success of health systems reform.
Predicting Obesity via Deep Learning: The Role of Chrononutrition
Authors: Di Traglia L , Vestri A , Palla L 
Published: October 2024

Abstract

Background
Obesity is a significant public health challenge, prompting the need for assessing effective tools for its monitoring and prevention. Chrononutrition investigates the role of timing, regularity and frequency of food intake on body metabolism and health. Here we aim to check if data on the distribution of calorie intake in the day may improve BMI prediction as compared to using only data on total day intake.

Methods
We apply deep learning on chrononutritional data on calorie intake over 6 daily timeslots from a nationally representative cross-sectional survey sample of the Italian population (INRAN-SCAI 2005/2006) comprising 2313 Italian adults 18-64 ys old with 3 day diet diaries. In particular, we implemented three deep neural network models, varying network configurations and feature selection. The 1st includes 18 (6 for each day diary) chrononutritional variables and the 3 day total intakes, beside age and sex; the 2nd includes age, sex and the 18 chrononutritional variables only; the 3rd uses age, sex and the 3 day totals only. We applied Early Stopping to limit overfitting. Optimization was conducted using the Adam algorithm, minimizing the mean squared error (RMSE), while mean absolute error (MAE) was the primary performance indicator.

Results
The results highlight that Model 3 outperformed the other models with MAE=2.514 and RMSE=3.476, indicating that for the purpose of predicting obesity, information on the time-of-day distribution of calorie intake is not increasing predictive ability of BMI on top of age, sex and total calorie intake in the day.

Conclusions
Additional use of day-time intake information worsened prediction of BMI via deep learning using this cross sectional Italian survey. However the error made is still sizeable and warrants the inclusion of other variables; our results don’t rule out the role of chrononutrition on metabolic health which may act through other biological mechanisms related to specific nutrients.

Key messages
• Chrononutrition data don’t improve BMI prediction over total calorie intake data in a cross-setional representative sample of the Italian population.
• Deep learning approach to BMI prediction shows the importance of targeted selection of features in public health nutrition.
Potential reformulation of food products two years after implementation of Nutri-Score in Belgium
Authors: Vasquez M S , Vandevijvere S 
Published: October 2024

Abstract

Background
Nutri-score is a front of pack labeling system that provides consumers with simplified information of the nutritional quality of food products. It is based on a five color (green to red) or letter (A to E) scheme that grades the quality of the product using an algorithm that takes into account the energy, sugar, saturated fats, salt, fiber, protein content, and percent of fruits and vegetables. In Belgium, Nutri-score was implemented on a voluntary basis in April 2019. This study aims to explore reformulation of products with Nutri-score by comparing their nutrient content and Nutri-score distribution in 2019 and 2021.

Methods
Product data from one of the major retailers was used in the analysis. Similar products in 2019 and 2021 with matched barcodes were used. Descriptive statistics were computed and statistical analyses such as the signed rank test and the McNemars test were performed to respectively evaluate the changes in the nutrient content and Nutri-score. The tests were conducted at 5% level of significance.

Results
From the matched sample of 668 products, about 55% had a Nutri-score of A and B in both 2019 and 2021. The proportion of food products with Nutri-Score of A/B and of D/E was not significantly different after two years of Nutri-Score implementation. Results showed a significant decrease in the median energy content of dairy, sauces, and meat products and in the median sugar content of dairy and fruit and vegetable products. There was a significant increase in the median fiber content of the dairy, meat products, and non-alcoholic beverages. For all food groups, the salt content of the products in 2019 and 2021 was not significantly different.

Conclusions
This two-year interval analysis described the changes in the classification and reformulation of the products with Nutri-score. Favorable changes in the nutrient quality of the product profiles reveals improvement in their reformulation.

Key messages
• In this analysis, changes has been observed in the nutrient content of food products between 2019 and 2021.
• Producers or manufacturers should continue working on commitments to enhance the nutritional quality of the products delivered to consumers.
Air Pollution Reduces the Individuals’ Life Satisfaction Through Health Impairment
Authors: Abed Al Ahad M 
Published: October 2024

Abstract

Background
The impact of air pollution on individuals’ happiness and life satisfaction (LS), and its relationship to other factors became the focus of recent research. Though, the underlying mechanism of how air pollution impacts LS remains unclear. In this study, we examined the direct and indirect effect of air pollution on individuals’ LS through health mediation.

Methods
We used longitudinal individual-level data from “Understanding-Society: the UK Household-Longitudinal Study” on 59,492 individuals with 347,377 repeated responses across 11 years (2009-2019) that was linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution. Generalized structural equation models with multilevel ordered-logistic regression were used to examine the direct effect of air pollution on LS and the indirect effect from health impairment.

Results
Higher concentrations of NO2 (coefficient = 0.009, 95%CI = 0.007,0.012, p &lt; 0.001), SO2 (coefficient = 0.025, 95%CI = 0.017,0.034, p &lt; 0.001), PM10 (coefficient = 0.019, 95%CI = 0.013, 0.025, p &lt; 0.001), and PM2.5 (coefficient = 0.025, 95%CI = 0.017,0.033, p &lt; 0.001) pollutants were associated with poorer health, while poorer health was associated with reduced LS (coefficient = -0.605, 95%CI = -0.614,-0.595, p &lt; 0.001). Mediation path analysis showed that air pollution impacted individuals’ LS directly and indirectly. The percent of total effect mediated through health was 44.03% for NO2, 73.95% for SO2, 49.88% for PM10, and 45.42% for PM2.5 and the ratio of indirect to direct effect was 0.79 for NO2, 2.84 for SO2, 0.99 for PM10, and 0.83 for PM2.5.

Conclusions
Health plays a major mediating role in the relationship between air pollution and LS. To alleviate the impact of air pollution on LS, future strategies should focus on health promotion besides reducing air pollution emissions.

Key messages
• Air pollution is related to lower life satisfaction directly and indirectly through health impairment.
• Strategies and policies aiming at reducing air pollution emissions and better health would improve the individual’s life satisfaction and lower the mental health burden.
Co-creation of migrant health interventions in Portugal: Insights from the VO(I)CES project
Authors: Marques M J , Seyfulayeva A , Hamwi S , Machado A S , Gama A , Osbourne R , Dias S 
Published: October 2024

Abstract

Background
International migration is increasing both globally and in Europe, highlighting the need for responsive interventions that cater to the diverse needs and strengths of migrants. Although genuine involvement of stakeholders in the design and implementation of interventions is vital to enhance their relevance, responsiveness, and ownership, co-created migrant health interventions remain limited. This study aims to address this gap by collaboratively developing health literacy interventions with meaningful involvement from migrants and professionals from both the social and health sectors.

Methods
As part of the VO(I)CES project, twelve idea-generation workshops were conducted in Portugal, applying the Ophelia (Optimising Health Literacy and Access) process, engaging over 70 stakeholders (migrants, social and healthcare professionals). To guide discussions, these workshops used case vignettes developed from 16 health literacy profiles that were identified in a previous study among 1,126 migrants. The discussions aimed at eliciting detailed insights into the potential actions that are responsive to migrants’ challenges.

Results
Several key interventions were identified by the stakeholders, including the enhancement of cultural and linguistic training for healthcare providers, the use of community health agents/mediators to improve service delivery and community engagement, and the creation and dissemination of multilingual, multi-format health information materials. Specific interventions for groups experiencing increased vulnerabilities such as pregnant women were also proposed, alongside suggestions for creating citizen spaces and improving digital skills among healthcare staff.

Conclusions
The co-creation approach facilitated the development of tailored context-specific interventions that are anticipated to enhance health literacy, improve healthcare accessibility, and promote health equity for migrants.

Key messages
• Ideas Generation Workshops provide a platform for a wide range of groups to have their say and know their voice is being heard.
• Co-creation tailors interventions to diverse needs, avoiding a one-size-fits-all approach.
Correlates of using behavioural sciences to design health promotion interventions and programs
Authors: Belanger-Gravel A , Lavoie K L , Desroches S , Barnett T , Paquette M C , Therrien F , Gauvin L 
Published: October 2024

Abstract

Background
The World Health Organization highlighted the need to better integrate behavioural science in the field of public health. Based on the theoretical domains framework, this study examined correlates of public health practitioners’ use of behavioural science principles to plan public health actions aim at promoting physical activity and healthy eating.

Methods
This study adopted a cross-sectional design. A convenience sample of 160 public health practitioners were recruited from different public health agencies (non-profit organizations, governmental and para-governmental agencies). They were asked to complete a survey questionnaire online and self-reported their use of behavioural science to plan health promotion interventions. Regression analyses were conducted to examine correlates of behaviour and behavioural intentions. All analyses were controlled for sex, number of years of experience in public health and the type of organization they work for.

Results
Skills (OR = 4.1, 95%CI: 1.3, 13.5) and intentions/goals (OR = 9.2, 95%CI: 2.3, 36.1) were the two domains significantly associated with the use of behavioural science. Perceived capacity to overcome the fact that none of their colleagues rely on behavioural sciences in their organization (OR = 7.2, 95%CI: 1.7, 30.3) was also associated with behaviour. Knowledge (OR = 8.6, 95%CI: 1.9, 39.1) and beliefs about consequences (OR = 4.0, 95%CI: 1.1, 14.7) were in turn associated with intentions/goals.

Conclusions
This unique study provides important insights for the development of future knowledge transfer activities aim at supporting positive attitudes and motivations toward the use of behavioural science as well as developing competencies and a normative use of behavioural science. The development of a strong knowledge basis would also need to be a core component of trainings to support the integration of behavioural science in public health to design physical active lifestyles and healthy eating interventions.

Key messages
• Increasing knowledge and skills in behavioural sciences is a key for a better integration in public health practices.
• Changes in norms and attitudes toward the use of behavioural sciences will also support a better uptake.
Geographical variation in prostate cancer testing explained by socio-economic position in Stockholm
Authors: Rai B , Clements M 
Published: October 2024

Abstract

Background
Prostate cancer screening using prostate-specific antigen (PSA) testing is controversial but remains prevalent in many countries. Despite its prevalence there is little information in Sweden or globally on the spatial heterogeneity in PSA testing. This study aims to describe the spatio-temporal variation in PSA testing in the Stockholm region specifically at the municipality and small area level. Additionally, it aims to quantify the extent to which socio-economic position (SEP) indicators such as education, income, and country of birth explain the observed variation in PSA testing.

Methods
A retrospective population-based register study was conducted, encompassing men aged 40 years and older residing in the Stockholm region from 2007 to 2016. Utilizing spatial smoothing techniques, we calculated the age-standardised proportion of men undergoing PSA testing prior to any prostate cancer diagnosis within each area for every calendar year. Furthermore, we used Bayesian logistic regression models with spatial random effects to estimate the individual-level association between PSA testing and socio-economic position. The proportion of variance in PSA testing explained by various measures of SEP was also estimated at both the municipality and small area levels.

Results
Significant geographical disparities in PSA testing were observed across small areas within Stockholm. The proportion of variance explained in PSA testing at the small area level was highest for income (32.6%), followed by education (9.7%) and country of birth (7.4%). Incorporating all SEP measures led to a higher proportion of explained variance at the small area level (41.6%) compared to the municipality level (24.8%).

Conclusions
PSA testing was significantly associated with various socio-economic indicators and some of the spatial variation could be explained by SEP. It would be useful to ascertain whether similar patterns are observed in other regions or countries.

Key messages
• The findings suggested widespread and consistent opportunistic prostate cancer screening practices within the Stockholm region, raising concerns regarding potential overdiagnosis and overtreatment.
• The socio-economic differences in prostate cancer screening could partially explain the differences in cancer incidence and mortality.
Cultural filters in processing information on COVID vaccines among minoritized groups in London, UK
Authors: Chaudhry T , Zenner D , Tum P , Morrow F , Kielmann K 
Published: October 2024

Abstract

Introduction
Vaccination coverage among minoritized groups, including migrants, is low in the United Kingdom. Cultural factors are often cited as barriers, yet the broader impact of minoritization on vaccine acceptance remains understudied. We explored the intersection of culture with individual, familial, and systemic factors in shaping trust and perceptions of COVID-19 vaccines in East London, UK.

Methods
We conducted focus group discussions (n = 6) and interviews (n = 19) with individuals from minoritized backgrounds in East London to elicit their perceptions and experiences of COVID-19 and the vaccination programme. Thematic analysis was used to identify individual, social, and systemic factors influencing the processing of perceived value of information on COVID vaccines.

Findings
Culture was rarely cited as an explicit barrier to vaccine uptake. Instead, participants’ linked their perceived vulnerability and immunity to COVID-19 with age, sex and health status. Information about COVID vaccines was processed and acted upon in the context of gendered family dynamics and support. Community identity, gatekeepers and social networks further influenced the perceived legitimacy of information received. Some participants voiced how their minoritized status shaped trust/mistrust in the national health system’s and government’s delivery of the COVID-19 information and vaccination campaigns

Conclusions
Unpacking cultural filters is crucial for addressing vaccine-related information barriers in minoritized groups. Going beyond mere language translation, tailored communication materials should address social enablers and systemic barriers. Further, closer collaboration between community gatekeepers and healthcare professionals to facilitate optimal use of these materials is needed to improve vaccine uptake.

Key messages
• Culture should not be assumed to be the main factor contributing to non-adherence and non-uptake of public health vaccine.
• Vaccine uptake can be improved by healthcare workers and key community gate-keepers working collaboratively with minoritized groups.
Factors influencing protective gear use in crisis-affected Afghanistan during COVID-19
Authors: Lee J W , Kim Y J , Kim K B , Noh J W 
Published: October 2024

Abstract

Background
Afghanistan has faced considerable challenges in healthcare delivery during the COVID-19 pandemic. These challenges were compounded by limited health literacy, shortages of skilled health workers, and fragile health infrastructure, which increased the country’s double burden of disease. The World Health Organization (WHO) recommended the use of masks as part of a comprehensive strategy to mitigate the spread of SARS-CoV-2. Nevertheless, research on mask-wearing practices in Afghanistan is limited. This study aims to investigate the factors influencing the wearing of protective gear, including masks, during the COVID-19 pandemic in Afghanistan.

Methods
This study analyzed 16,058 households from the 2020 Afghanistan Multi-Sector Needs Assessment (MSNA) survey data. This survey was conducted between August and September 2020 by the Racial and Ethnic Approaches to Community Health (REACH) Initiative. Sampling weighted multivariable binary logistic regression analysis was performed.

Results
Recent internally displaced persons (IDPs) and returnees in Afghanistan were more likely to wear protective gear to prevent COVID-19 compared to non-recent IDPs. Factors such as household sizes, household income, knowledge of humanitarian support, and the distance to healthcare facilities were significantly associated with the likelihood of wearing protective gear.

Conclusions
The study suggests that certain factors place crisis-affected populations in Afghanistan at high risk in COVID-19 preventive behaviors, especially in wearing protective gear. The findings in this study indicate that public health interventions should focus on improving healthcare accessibility and enhancing information dissemination while considering socioeconomic factors. Additionally, this study highlights the need for access to personal protective gear during outbreaks of infectious disease, such as the COVID-19 pandemic.

Key messages
• Socioeconomic factors and accessibility on health services and information can affect COVID-19 preventive behaviors in crisis-affected populations.
• This study can inform public health professionals to develop adequate interventions during infectious disease outbreaks.