bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comprehensive sexuality education: indicators to evaluate interventions in Italian schools
Authors: Paparatto G , Martinelli D , Suligoi B , Nardone P , Silvestri C , Bonaldo L , di Nino M G , Ubbiali M , Chinelli A , Tavoschi L 
Published: October 2024

Abstract

Background
Comprehensive sexuality education (CSE) is globally acknowledged as the most effective approach to promoting sexual health and preventing Sexually Transmitted Infections (STIs). However, in Italy, CSE is not consistently part of the school curriculum. The EduForIST project, funded by the Ministry of Health, introduced and tested a unique CSE model in a sample of secondary schools across six Italian regions, aiming to develop an evaluation model for potential nationwide implementation.

Methods
The EduForIST partnership, comprising experts from various institutions, devised a framework for monitoring and evaluating CSE interventions. Through monthly focus group discussions from April 2023 to February 2024, they established indicators for short-, medium-, and long-term evaluation of clinical and behavioral outcomes, as well as process indicators to assess intervention implementation.

Results
A total of 35 indicators were developed, including clinical and behavioral ones for medium and long-term outcomes, short-term behavioral outcomes, and process indicators. Data for clinical and behavioral indicators can be obtained from administrative sources like the Ministry of Health and Regional Health Authorities. The National Institute of Health provides data from relevant surveillance programs. However, many process indicators require specific data collection and calculations. Challenges such as under-reporting and underestimation persist, especially in regions with limited CSE implementation.

Conclusions
Creating an effective monitoring system for CSE interventions necessitates integrating diverse data sources, including health records, administrative data, and behavioral assessments. The proposed model’s effectiveness will be fully assessed by comparing pre- and post-intervention after widespread implementation in secondary schools. Meanwhile, the selected indicators serve as a foundation for evaluating baseline status of STIs and behaviors in Italy.

Key messages
• The EduForIST project establishes a robust framework for evaluating Comprehensive Sexuality Education (CSE) interventions in secondary schools, addressing gaps in nationwide implementation.
• By devising indicators encompassing several measures, the project lays the groundwork for a comprehensive monitoring system, vital for assessing the effectiveness of CSE interventions in Italy.
Radiation exposure of patients undergoing multiple-slice CT scans in Romania
Authors: Prejbeanu I , Assani M Z , Niculescu F , Prunariu L A , Prejbeanu R G 
Published: October 2024

Abstract

Ionizing radiation is largely used in medicine due to its role in the diagnosis and treatment of patients. In the past 50 years computed tomography (CT) has become indispensable for medical practice because it offers sub-millimeter cross-sectional imaging of any region of the body. New CT scanners use thinner slices, providing more accurate results, but also an increased radiation exposure with possible long-term harmful effects for the patients. The parameter used as an indicator of radiation dose in CT is the dose-length product (DLP). The study included 4507 patients who were CT scanned using a 16, 32, 64 or 128-slice CT machine. DLP was measured for head, sinuses, thorax, abdomen, pelvis, abdomen+pelvis, and trunk scans - regions for which the health authorities have established national diagnostic reference levels (DRL - the expected radiation dose received by a patient in CT). One-way ANOVA was used to analyse data considering the use of contrast agents, the gender, age, and weight of patients. Average DLP values were higher (up to 80%) than national DRL for all regions in 64 and 128-slice scans. The highest DLP values were registered in contrast CT for all scanners (p &lt; 0.01); the maximum average (a threefold increase compared to DRL) was measured in the 32-slice sinuses contrast CT. Average DLP correlated with patients’ gender and weight (p &lt; 0.01), but the influence was lower compared to the use of contrast agents. In conclusion, CT scans acquired using thinner slices lead to more accurate results and high-quality images, but the study suggests an increased radiation exposure. CT has an uncontestable contribution to a precise and rapid diagnosis, but more attention must be given to the stochastic effects risks associated with the radiation dose received during a CT scan. Are all scans necessary? Do all patients really need to receive high doses? The role of the practitioner is decisive, and the justifiable process is “a must” in all radiodiagnosis practices.

Key messages
• CT doses must be kept “as low as reasonably achievable” while maintaining diagnostic image quality.
• Justification, dose limitation, and optimisation are fundamental principles of radioprotection.
Integrating environmental sustainability within national food-based dietary guidelines: a qualitative analysis from five case study countries
Authors: Hadida G , Turner G , Alae-Carew C , Ann Brown K , Nájera Espinosa S , Curtin E , Picetti R , Scheelbeek P , Green R 
Published: October 2024

Abstract

Background
The incorporation of environmental sustainability principles into national food-based dietary guidelines (FBDGs) has gained prominence as a strategy to address both human health and environmental concerns. This study aims to identify and explore the processes and considerations to integrate environmental sustainability in food-based dietary guidelines.

Methods
Countries that have integrated environmental sustainability in FBDGs since 2016 were identified from the UN FAO website. Background documents and interviews with key stakeholders involved in the development of FBDGs from case study countries (The Netherlands, Denmark, Chile, France and Belgium (Flanders)) were thematically analysed using the Framework Method. A coding framework explored the rationale for integration, data sources and analysis methods, stakeholder and expert engagement, synergies and trade-offs, translation into public messaging, and key learnings.

Results
Eight background documents and six interviews were analysed. Approaches to integrating environmental sustainability varied, from inclusion in dietary modelling optimisation to changes to consumer messaging. Nearly all countries adjusted guidelines to reduce red and processed meat and emphasise the role of plants in diets. However, issues of cultural significance, affordability, and access limited ambitions to reduce overall meat intake. Novel plant-based alternatives remain contentious due to concerns about their ultra-processed nature and potential nutrient inadequacies as substitution foods. Key barriers to integrating environmental sustainability into FBDGs include consumer acceptance, data quality and availability, stakeholder involvement and conflict, timelines, and resource constraints.

Conclusions
Several countries have successfully integrated environmental sustainability into their dietary guidelines, but there is still variation in the integration and acceptance of FBDGs including environmental sustainability.
Maximising the potential of National Cancer Mission Hub-like structures: A SWOT analysis approach
Authors: Ghattas J , Delnord M , Abboud L ,   ECHoS WP 2.3 KEP participants
Published: October 2024

Abstract

Cancer is a significant and urgent concern in public health, particularly in the context of an aging population like in Europe. It is estimated that new cancer cases will increase by 21% by 2040 in Europe. With the ambition of improving the lives of 3 million people by 2030, the European Commission launched 2 major initiatives: Europe’s Beating Cancer Plan (EBCP) and the Mission on Cancer (MoC). The EBCP is a policy-driven initiative aimed at supporting Member States in addressing the whole cancer continuum. It is supported by the MoC, a research driven initiative. Member States are implementing the EBCP and MoC in a way that fits their national contexts. This can take different forms, such as ‘cancer hub,’ ‘mirror group,’ or other similar structures. The role of these entities can vary, ranging from purely coordinating activities to involving more technical work. We performed a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis with different national mission-hub-like (NCMH-like) structures to explore their strategic positioning. We collected results from 6 countries (Belgium, Italy, the Netherlands, Portugal, Poland, and Sweden) as part of the EU project ECHoS on setting NCMHs. Participants perceived that formal government endorsement, existing stakeholder mapping, and good stakeholder engagement as strengths for the structure. Whilst, they identified overlap with other ongoing initiatives and low stakeholder engagement as weaknesses that need to be addressed, the future of existing structures could be threatened by financial and human resources as well changing political landscape. National, regional alignment and the leverage of EU funding were recurrent opportunities to build on. Ultimately, NCMH-like structures can be leveraged to achieve national and European alignment on cancer initiatives, if they succeed in building a sustainable financial and governance structure.

Key messages
• National Cancer Mission Hub-like structures can build on existing initiatives to support the implementation of EU cancer initiatives if they achieve sustainable financial and governance structures.
• SWOT framework is a good tool for a comprehensive overview of the strategic positioning of National Cancer Mission Hub-like structures in different European countries.
A comparative analysis of national dementia plans: preventive strategies in five European countries
Authors: Blandi L , Clemens T , Brand H , Odone A 
Published: October 2024

Abstract

Background
About 8.5% of people aged +65 live with dementia in Europe. Preventive measures can avert up to 40% of cases. The aim of the study is to analyse National Dementia Plans (NDP) in Europe, to elicit how much dementia prevention is considered a priority and whether policies are evidence-based.

Methods
A qualitative comparative analysis was performed between NDPs of countries with the best healthy life expectancy in the elderly in Europe. The NDPs of France, Ireland, Italy, Spain, and Sweden were included. The consensus on actions and elements of prevention policies was evaluated, according to the WHO recommendations and to Cheung’s framework designed for evaluating chronic diseases policies.

Results
All the NDPs prioritised early diagnosis, public awareness, and community engagement for dementia risk reduction. They fostered the development of information system for data collection and established committees for progress monitoring. However, not all NDPs defined timelines for policy implementation and most of them expired years ago. NDPs included prevention research agenda, but their preventive actions did not address alcohol consumption, traumatic brain injury, and air pollution, representing 3 well-known risk factors attributable for the 15% of preventable cases. Neither integration of dementia with other chronic disease preventive strategies was present and a clear allocation of funds for NDPs always missed.

Conclusions
NDPs partially address risk factors of preventable cases. All countries need to update their NDPs, integrating new scientific evidence and allocating clear financial funds. This can potentially prevent millions of new cases, decreasing the burden of disease and improving the sustainability of health systems.

Key messages
• NDPs do not target adequately dementia in Europe.
• New evidence-based preventive policies, including most recent identified risk factors, would have a clear impact on burden of disease and health systems’ sustainability.
Exploration of research projects on personalised prevention supported by the European Commission
Authors: Maio A , Farina S , Di Grande S , Osti T , Pastorino R , Boccia S 
Published: October 2024

Abstract

The interaction between environmental exposures, lifestyle factors, and genetic predisposition affect individual susceptibility to chronic diseases. Personalised Prevention (PP) has emerged in the recent years as potential approach to integrate traditional public health approaches in prevention. The implementation of PP into national health systems so far has not realized its full potential due to a number of obstacles including scanty evidence from research. Within the project “PROPHET: A Map for Personalised Prevention in the Future of Healthcare”, we conducted an extensive mapping of currently active research projects in the field of PP. We carried out a scoping review according to Arksey and O’Malley methodology, followed by consultations with experts in personalised medicine and prevention. We included 45 ongoing research projects on PP, of which 57.8% were funded by Horizon Europe, 35.5% by Horizon 2020, and 6.7% by Eu4Health. Regarding disease types, 40% of the projects were about cancer, 20% on cardiovascular and 20% on neurological and psychiatric diseases, followed by metabolic diseases and other chronic conditions. Overall, the EC allocated approximately €160 million to cancer personalised prevention projects, roughly double of the funding dedicated to cardiovascular, neurological and psychiatric diseases. The emphasis on cancer projects is noteworthy, with Horizon Europe emerging as the main funding programme aligned with the ongoing Cancer Mission. Regardless of the disease, most of the projects addressed primary and secondary personalised prevention research. This is in line with the limited approaches in PP in the setting of primary and secondary personalised prevention (e.g., genetic testing to identify high risk subjects for breast cancer) compared to tertiary prevention (e.g., pharmacogenomics). This comprehensive mapping underlines the EU’s continued commitment to promoting PP, which is fundamental to the future of healthcare.

Key messages
• The EC prioritises significant financial resources towards cancer personalised prevention research projects, highlighting Cancer Mission as a focal initiative in the personalised prevention field.
• European-funded projects focus on primary and secondary personalised prevention strategies. This suggest that we currently miss evidence in these areas.
Alcohol-related premature mortality in Northern Dimension partnership countries 2003-2021
Authors: Jousilahti P , Harald K , Vienonen M , Laatikainen T 
Published: October 2024

Abstract

Background
Potential Years Life Lost (PYLL) is an established method to measure, follow trends and compare disease burden within and between countries. Northern Dimension Partnership in Health and Social wellbeing (NDPHS) network was established in 2003 and includes the following countries: Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Poland, Russia, and Sweden. Due to the Russian invasion to Ukraine, Russia is now excluded from the collaboration. Iceland is not included in the analyses due to too small number of events.

Methods
Premature mortality was defined as a death before the age of 70 years. Alcohol-related deaths included the following ICD-codes: E24.4, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, Q86.0, R78.0, X45, X65, Y15, K73, K74.0-K74.2, K74.6, O354, P043 and G4051. PYLL-rates per 100,000 population are presented separately for men and women in four time points: 2003, 2013, 2017 and 2021. Data were obtained from Eurostat and analyses are standardized to EU standard population.

Results
In the whole NDPHS area, alcohol related PYLL-rates declined between 2003 and 2017: from 527 to 458 in men, and from 159 to 134 in women. However, between 2017 and 2021 the rates increased: to 509 in men and to 154 in women. In 2021, the highest alcohol-related PYLL-rates were in Latvia (1696 in men and 530 in women) and the lowest in Norway (94 in men and 43 in women). Thus, the differences between countries in alcohol-related PYLL-rates were 20-fold in meles and 10-fold in females. In all countries the rates were 2-3 times higher in men compared to women.

Conclusions
Alcohol use is an important cause of premature mortality and disease burden in NDPHS area. There are marked differences in alcohol-related PYLL-rates between sexes and countries. The increase in alcohol-related PYLL-rates between 2017 and 2021 may be related to the Covid-pandemic.

Key messages
• Alcohol use is an important cause of premature mortality and disease burden in NDPHS countries, and there are marked differences in alcohol-related mortality between sexes and countries.
• Reduction of total alcohol consumption is an evidence-based most effective public health measure to reduce alcohol-related health harms.
Everyday household costs of raising a child with cerebral palsy
Authors: Roos G , Alecu A I , Austgulen M H 
Published: October 2024

Abstract

Background
Caring for a child with a disability can be costly in terms of time and energy, and it is also associated with lower incomes and higher direct costs, such as costs for assistive technologies, transport, food, clothing and leisure activities. However, few studies that have focused on households’ everyday costs associated with raising a child with disability. This study is based on the capability approach. The economic costs of a child with cerebral palsy are defined as the economic costs associated with achieving the same capabilities, or functionings, as a child without cerebral palsy. The purpose of this study is to explore the needs and economic costs in households raising a child with cerebral palsy. The results are important to inform, plan and justify targeted policies and interventions.

Methods
Digital in-depth interviews with caregivers from 15 Norwegian households raising children with cerebral palsy (aged 4-17 years, GMFCS levels 1-5). 12 women, 2 men and a couple were interviewed two times (1-2 hours each).

Results
The caregivers who took part in the interviews described their demanding role and that they spend a lot of time organizing daily routines, activities, health services, assistive technologies and assistants. Many of them initially reported that they do not have many daily extra costs, but when discussing the different areas of consumption, it emerged that households have extra housing costs because they need to make adaptations, remodeling and maintenance to their homes. An adapted car, which requires service, insurance and fuel, is often used for transport. The washing machine runs regularly and towels, sheets and clothes need to be frequently changed. Sometimes they also end up buying food, clothes or toys that are not used.

Conclusions
Households caring for children with cerebral palsy have additional costs for several types of expenses, including especially high costs for housing and transportation.

Key messages
• Households raising a child with cerebral palsy have needs that generate additional costs.
• The costs vary and it is important to cover a broad range of cost areas.
Positive effects from the introduction of fully subsidised nicotine replacement therapy in Ireland
Authors: Naughton P , Sheridan A , Murphy E , Blake M , Kavanagh P 
Published: October 2024

Abstract

Smoking remains a leading cause of preventable death in the Europe. Despite recent declines in prevalence, the adverse health and economic effects of smoking are felt disproportionately by disadvantaged groups. Nicotine replacement therapy (NRT) is well established as an effective smoking cessation aid; however, its financial cost may act as a barrier to uptake. In February 2023, eligibly for fully subsidised NRT was expanded to all users of smoking cessation services in Ireland. This study evaluated the impact of universal access to NRT on smoking cessation. This study utilised secondary analysis of routinely collected data from service users attending Irish smoking cessation services. Individuals were followed for twelve weeks. Changes in self-reported quit status and NRT use were analysed before (January 2021 - February 2023) and after (March 2023 - December 2023) the introduction of fully subsidised NRT. Logistic regression modelling identified factors associated with smoking cessation. The total number of participants was 19,717. There was higher uptake of NRT among service users who were eligible for free NRT (59% vs 40%, p &lt; 0.001) and higher quit rates at four (41% vs 29%, p &lt; 0.001) and twelve (29% vs 20%, p &lt; 0.001) weeks. Logistic regression models demonstrated that NRT use was significantly associated with smoking cessation at four (aOR 1.88, 95%CI 1.47 - 2.41) and twelve (aOR 1.76, 95%CI 1.37 - 2.28) weeks. This study confirms the effectiveness of NRT in an Irish context and illustrates the benefits of universal access to this life saving medicine. Targeted interventions are required to intensify services offered to disadvantages groups if the ambitious objectives of Tobacco Endgame are to be achieved. These findings represent an urgent call to action for European policy makers to deliver equitable access to NRT across the continent. Such action can transform the public health landscape and help bring us closer to achieving a tobacco free Europe.

Key messages
• This study confirms the real-world effectiveness of NRT use as a smoking cessation aid.
• The removal of financial barriers is associated with increased NRT use and successful smoking cessation.
Impact of COVID-19 measures on psychosocial outcomes in Austria – a qualitative vignette study
Authors: Vorstandlechner M , Harlfinger J , Kien C , Ritschl V , Chapman A , Schneckenreither G , Zauner G , Gartlehner G , Popper N , Stamm T 
Published: October 2024

Abstract

During the COVID-19 pandemic, Austria implemented frequent and restrictive containment measures. We aimed to explore the perspectives of individuals affected by political and epidemiological decisions in Austria, particularly in Vienna and Lower Austria. A qualitative vignette-based study conducted from July to Oct 2023 utilized two hypothetical future pandemic scenarios to prompt in-depth discussions in semi-structured interviews with Austrian residents about their perspectives, either private or from the fields of healthcare, education, citizen representation, business, research, public health and politics. Interview data was analysed using a thematic analysis approach. To ensure results’ rigor and accuracy, we followed the COREQ guideline and included two citizen research partners. This project is funded by WWTF (Grant ID: LS22071). Preliminary thematic analysis from 28 interviewees (53.6% female) aged 19-77 (mean 53.0 years) shows that the negative effects of school closures was a major concern among participants. Despite diverging points of view on other topics, there was a broad consensus that school closures would have negative consequences, such as unstable educational modalities impairing young people’s individual development, decreasing psychosocial support in their peer groups, leading to long-term educational losses, not only for individuals but also for society as a whole, and having a negative impact on economic growth, social justice and innovation. The participants also described a lack of evidence for the necessity of the frequent school closures during the pandemic as had happened in Austria and suggested a different approach in a future pandemic. Further topics were the deterioration of mental health, incentives instead of mandatory measures, more transparent communication by authorities, agreement between experts and researchers, reducing uncertainties regarding pandemic management, compliance by the general public and democratic social cohesion.

Key messages
• Addressing the multi-faceted impact of a pandemic requires a comprehensive approach that considers mental health, social justice, communication and social cohesion alongside containment measures.
• This work represents a learning from the COVID-19 pandemic. From the conclusions of this study, recommendations can be derived to be better equipped in future pandemics.