bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolically healthy obesity and cardiovascular outcomes
Authors: Tabara Y 
Published: October 2024

Abstract

Obesity increases cardiovascular risk through a deterioration of the metabolic profile. However, obesity is not always accompanied by a worsening metabolic profile. This longitudinal study aimed to determine whether obesity with a normal metabolic profile, i.e. metabolically healthy obesity, increases the risk of cardiovascular disease. We analyzed a health insurance data of Shizuoka prefecture resident. This data includes data from annual health check-ups performed for insured persons. This study analyzed data from 168,699 individuals aged &lt;65 years. Obesity was defined as ≥ 25 kg/m2 body mass index. Metabolically healthy was defined as ≤ 1 metabolic risk factors (high blood pressure, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, or high hemoglobin A1c). Incidence rate of cardiovascular diseases (stroke and myocardial infarction), and all-cause mortality identified from the insurance data were compared between clinical profile-matched metabolically healthy obesity and non-obesity groups (n = 8,644 each). Clinical parameters, namely systolic blood pressure (standard mean difference = 0.03), HDL cholesterol (0.01), LDL cholesterol (0.01), and hemoglobin A1c (0.01) did not differ among the metabolically healthy obesity and non-obesity groups. The incident rate of stroke (obesity: 9.2 per 10,000 person-years; non-obesity: 10.5; log-rank test P = 0.595), myocardial infarction (obesity: 3.7; non-obesity: 3.1; P = 0.613), and all-cause mortality (obesity: 26.6; nonobesity: 23.2; P = 0.304) also did not differ significantly among the groups even when abdominal obesity was considered in the analysis, though the population with metabolically healthy obesity reported negligibly worse metabolic profiles than the population with nonobese at the 5.6-year follow-up. Obesity, when accompanied by a healthy metabolic profile, did not increase the risk of cardiovascular outcomes and all-cause mortality.

Key messages
• Metabolically healthy obesity did not increase cardiovascular disease risks.
• Metabolically healthy obesity was associated with worse metabolic profiles after a few years later.
Investigation of a Norovirus GII.4Sydney[P16] outbreak in a care facility in Portugal, 2022
Authors: Ourique M , Minetti C , Manageiro V , Vicente A , Roque C , Coelho A , Oleastro M , Martins Correia D , de Sousa R , Rodrigues N 
Published: October 2024

Abstract

Background
On the 29th of April 2022 the local Public Health unit was notified of 12 cases of acute gastroenteritis in residents of a long-term care facility (LTCF). A joint epidemiological investigation team was established and initiated an outbreak investigation to characterize the outbreak and implement infection control measures.

Methods
Epidemiological questionnaires were administered to staff (n = 44) and residents (n = 60). Case definition was LTCF residents or staff members with at least one of the following symptoms: diarrhoea, vomiting, nausea, between April 25th and May 14th, 2022. Stool or vomit samples were collected for 11 individuals. To assess environmental contamination fifteen food samples from previous meals and six surface samples from toilet faucets, wash tubs, and cutting boards were collected. Spatial distribution of cases within the LTCF was performed to guide infection control implementation.

Results
A total of 43 people met the case definition. Attack rates in residents and staff were 37% (23/63) and 42% (20/48), respectively. Of the total tested specimens, six (6/8) from residents and two (2/3) from staff were positive for the Norovirus (NoV) GII.4 Sydney [P16] variant by genotyping. Two (2/6) samples from surface swabs from the toilet faucet in the resident’s living room were also positive for NoV GII. Food samples were negative for major bacterial agents implicated in gastrointestinal outbreaks. Cases were distributed throughout the LTCF wards with no clear clustering. Four residents required hospital admission.

Conclusions
Results suggest person-to-person as well as environmental transmission of NoV. Identification of behavioural and spatial patterns of residents and staff and subsequent enactment of infection control strategies mitigated the outbreak. These findings reinforce the need for public health to maintain continuous technical support to LTCF on the implementation of infection control best practices.

Key messages
• Outbreak investigation in LTCF confirms Norovirus transmission, emphasizing the importance of infection control measures in long-term care facilities.
• Study reveals Norovirus outbreak in LTCF, underscores the role of person-to-person and environmental transmission, highlighting the need for robust infection control protocols.
Musculoskeletal disorders and risk factors in the modern era: results from the Specchio cohort
Authors: Bouhet A , Baysson H , Uppal A , Lamour J , Zaballa M-E , Stringhini S , Nehme M , Guessous I 
Published: October 2024

Abstract

Background
Musculoskeletal disorders (MSDs) represent a major challenge for occupational and public health, but data are scarce in Switzerland or concentrated on a few sectors of activities. The aim of this study is to provide results on the prevalence and risk and protective factors of MSDs in the general working-age population of the Geneva canton, Switzerland.

Methods
A cross-sectional analysis was conducted as part of Specchio population-based cohort study. Prevalence and associations between MSDs and sociodemographic variables, individual behaviour (smoking, physical activity, sleep), health conditions (BMI, chronic diseases), physical and psychological risks at work were examined using regression models. The impact of teleworking was also evaluated.

Results
2’733 participants took part in the survey, of which 38% were men, and mean age was 50. Overall prevalence of MSDs was 74% among men and 84% among women. 80% of the individuals experience back pain and 56% shoulder pain. Among individuals who experienced MSDs, 55.2% consulted a healthcare professional. The risk factors for MSDs were female sex (OR = 1.95; 95% IC = 1.55-2.28), body mass index (obese) (2.2; 1.51-3.32), lower education (1.77; 0.84-4.37), smoking (1.65; 1.19-2.35), exposure to physical risks (3.54; 2.78-4.51), stress at work (effort-reward imbalance) (3.23; 2.45-4.29) and a poor work-life balance (2.36; 1.88-2.97). The prevalence of MSDs remained high among workers who telework (78% versus 84% in working population).

Conclusions
This study, carried out in a large population-based cohort, confirmed several risk factors for MSDs. These results will contribute to the implementation of prevention strategies, especially as teleworking has gained in importance in recent years, which may have aggravated workers’ isolation and stress, sedentariness, and poor body posture. Main message: These data confirm the weight of musculoskeletal disorders and will help implementation of prevention health strategies.

Key messages
• The relationship between psychosocial risks at work and the occurrence of Musculoskeletal Disorders (MSDs) persists even following adjustment for exposure to physical risks and individual risk factors.
• The prevalence of musculoskeletal (MSDs) disorders remained high among workers who telework.
Innovative tools from WHO Europe to protect children from digital marketing of unhealthy products
Authors: Zhiteneva O , Hetz K 
Published: October 2024

Abstract
Children in the WHO European Region are extensively exposed to marketing of unhealthy products, including tobacco, alcohol, HFSS foods, and gambling, which negatively influences their dietary choices, behaviors, and perceptions of a norm, threatening their health rights. Recognizing the urgency to protect children’s developmental potential and rights, WHO has actively addressed this issue both within Europe and globally. In 2010, WHO issued recommendations for Member States on marketing foods and beverages to children. Building on these efforts, the CLICK framework for monitoring digital marketing to children was introduced in 2018. In 2023, WHO released guidelines urging countries to adopt comprehensive, mandatory policies to protect children from HFSS food marketing. Despite political commitments and policies, children and adolescents continue to be exposed to unhealthy product marketing, increasing their risk of NCDs as online activity rises. At the same time, while efforts have focused on restricting specific products, rapid changes in digital marketing strategies necessitate broader measures. Emerging trends include promoting brand loyalty among young children through brand characters and logos. Tools and support are urgently needed to monitor and implement WHO recommendations in online settings, including brand marketing. Despite WHO recommendations, few countries have implemented mandatory policies. Reliable monitoring mechanisms are essential. To address this gap, the WHO Regional Office for Europe developed the KidAd platform to monitor children’s exposure to digital advertising.
Evaluating perinatal health in Europe: a comparison of routine population birth data sources
Authors: Philibert M , Gissler M , Zurriaga O , Donati S , Drausnik Z , Heller G , Velebil P , Mohangoo A , Sakkeus L , Zeitlin J 
Published: October 2024

Abstract

Background
International comparisons provide essential benchmarks for evaluating perinatal health policies, but these rely on the availability of routine national birth data. This study aimed to describe population birth data sources in Europe by their ability to provide core perinatal health indicators.

Methods
The Euro-Peristat Network collected routine national data on a recommended set of core indicators from 2015 to 2021 using a federated protocol based on a common data model with 17 data items. Data providers filled in an on-line questionnaire to describe the sources used in each country. We classified countries by the number of data items they provided (all 16, 15-14, &lt;14).

Results
28 out of the 31 countries that provided data responded to the survey. Routine data sources included birth certificates (14 countries), electronic medical records (EMR) from delivery hospitalizations (14 countries), direct entry by health providers (9 countries), EMR from other care providers (6 countries) and Hospital Discharge Summaries (7 countries). Completeness of population coverage was at least 98%, with 15 countries reporting 100%. These databases most often included mothers giving birth on the national territory, regardless of nationality or place of residence (19 countries). In 20 countries, routine sources were linked, including linkage between birth and death certificates (15 countries). Countries providing all 16 items (N = 8) were more likely to use EMRs from delivery hospitalizations, 88%, compared to 50% and 13% in countries with 15-14 items (N = 13) and &lt;14 items (N = 8). Linkage was also more common in these countries, 100%, versus 75% and 50% respectively. Other data source characteristics did not differ by the ability to provide data for the common data model.

Conclusions
There is high diversity in the data sources used to construct perinatal health indicators in Europe. Countries using EMR with linkage to other sources had the best data availability.

Key messages
• There is high diversity in the data sources used to construct perinatal health indicators in Europe.
• Countries using Electronic Medical Records with linkage to other sources had the best data availability.
Linking health-related behaviours to quality of life in older adults: A latent class analysis
Authors: Felsinger R , Simon J , Haidinger G , Weber M , Mayer S 
Published: October 2024

Abstract

Background
Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population.

Methods
Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions.

Results
In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics.

Conclusions
To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class.

Key messages
• This study explores the relationship between health behaviour and QoL in older Austrians.
• Findings support the development of differentiated interventions targeting different types of behaviour.
Incidence of type 2 diabetes by occupation – 10-year follow-up of the Gutenberg Health Study
Authors: Bauer J , Hegewald J , Rossnagel K , Prigge M , Jankowiak S , Chalabi J , Riechmann-Wolf M , Nübling M , Wild P , Seidler A 
Published: October 2024

Abstract

Background
In order to implement targeted type 2 diabetes (T2D) prevention measures for the workplace, it is important to identify high-risk occupations. Most previous studies examine the association between T2D and occupation cross-sectionally, but longitudinal studies are missing. This study aims to investigate the 10-year incidence of T2D in the working population of a German cohort and identify occupations with an increased risk.

Methods
Data from the population-based Gutenberg Health Study (GHS) were used to examine occupation at baseline (2007-2012) and T2D incidence at the 10-year follow-up. Occupational phases were coded into categories according to the KldB 2010. T2D was defined as either a physician-diagnosed T2D, HbA1c-level ≥6.5% or use of antidiabetic drugs. Age- and sex-standardised incidence and 95% confidence intervals (CI) were calculated for occupational groups based on the age- and sex-distribution of the German population. Standardised incidence ratios (SIR) and 95% CI were calculated using the incidence in the total GHS working population as the reference.

Results
Of 8130 workers at baseline, 45.2% were female, the mean age was 48.4 years and 4.5% had prevalent T2D. 388 cases occurred between baseline and the 10-year follow-up within the subgroup of persons without prevalent T2D at baseline and with follow-up data (n = 5954). The standardised incidence was 6.9%. “Food production and processing” (20.7%), “cleaners” (16.5%) and “drivers and mobile plant operators” (14.8%) had the highest standardised incidences. Compared to the total working population, we observed a threefold increased SIR for employees in “food production and processing” (3.0, 95% CI 1.8-4.7) and a two times higher SIR for “cleaners” (2.2, 95% CI 1.0-4.7) and “drivers and mobile plant operators” (2.2, 95% CI 1.3-3.3).

Conclusions
We identified occupations with an increased risk of T2D. Preventive measures and etiological research on work-related risks should focus on these occupations.

Key messages
• The highest standardised incidence was observed in the occupational groups “food production and processing”, “cleaners” and “drivers and mobile plant operators”.
• Targeted prevention measures for type 2 diabetes in the workplace should focus on these occupational groups with increased incidence.
Measles cluster in Northern Portugal: enhancing surveillance strengths
Authors: Mendes A , Vieira M , Vidal-Castro J , Duarte L , Areias R , Cruz-Alves G 
Published: October 2024

Abstract

Although measles was declared eliminated in Portugal in 2015, outbreaks persist, despite high vaccination coverage. The last outbreak in the northern region was in 2017. Portugal has a Surveillance System implemented for mandatory communicable diseases (SINAVE) integrating clinical, epidemiological and laboratory data. In 2021, WHO expressed concern about the low sensitivity of measles surveillance and urged Portugal to strengthen its surveillance practices. Our study aims to describe a measles cluster in northern Portugal during the first trimester of 2024. Data from measles cases from the first trimester of 2024 were collected from SINAVE. Contact tracing and Public Health (PH) intervention data was sent by Local Public Health Authorities through a survey designed for that purpose. A total of 70 suspected cases were reported and investigated: 6 cases were laboratory confirmed and 64 were discarded. The confirmed cases had a mean age of 28 years (all adults), with 50% female. The mean notification time was 0,3 days. The index case was imported (Mauritania) and unvaccinated, leading to 2 secondary cases. Five cases had 2 doses of a measles vaccine, with 1 case being a health professional. Additionally, 1 case was imported from France. For 2 cases the source of infection could not be unequivocally identified and no travel history during incubation period. A total of 851 contacts of confirmed cases were identified. Although sustainable transmission is not evident in our region, measles is being introduced through migration and tourism. Despite clinical awareness, strengthening early case detection is essential to enforce effective control measures. PH teams have been working tirelessly to trace clusters origins, gathering large number of contacts and adapting strategies for sustained control. In a globalized world, ensuring surveillance sensitivity is paramount. Integrating other data sources in surveillance routine is crucial for upholding Measles-Free Status compliance.

Key messages
• Measles must take centre stage on our agenda.
• Reinforcing surveillance, integrating additional data sources, is crucial for heightened sensitivity and prompt response.
The process of developing a framework for code of ethics
Authors: Athanasopoulos P , Tahzib F 
Published: October 2024

Abstract

Issue/Problem
The World Health Organisation (WHO) and Association of Schools of Public Health in the European Region (ASPHER) roadmap for the professionalisation of the public health workforce has noted ethics as a pillar for professionalisation. It also highlights the need for code of ethics and professional conduct for all public health professionals and institutions. The Global Network for Academic Public Health (GNAPH), in collaboration with EUPHA, ASPHER, and the UK Faculty of Public Health has been working together for a code of ethics.

Description of the problem
The WHO/ASPHER group asked for a framework to be developed by the expert group as part of the rollout of the professionalisation agenda. The objective of this work was to develop a guide that is applicable to different countries within Europe to develop their own of code of ethics and conduct. A modified Delphi approach to building consensus amongst professionals in ethics included law, academia, and public health professionals. The questions sought to be answered were what and how to develop a framework and what should be included in the guide for creating a public health code of ethics.

Results
Throughout this method we developed five values, and twelve principles that are essential for the development of a code of ethics through a consensus building exercise. This framework was the first of its kind as part of the professionalisation agenda for different regions. There will be ongoing work piloting this framework in practice with various professional groups and institutions.

Lessons
Throughout this process, the need and demand across the public health community for ethical education and development of code of ethics was made evident. Collaboration between academics, ethicist, lawyers, and public health professionals and policy makers were key in developing a public health code of ethics. Identifying the challenges with monitoring and evaluating of its implementation a public health code of ethics.

Key messages
• Ethics, and a code of ethics are an essential component of the professionalisation agenda of the public health workforce.
• There is need for continued collaboration and partnership with public health professionals and institutions in enacting its implementation and evaluation.
Effect of plastic-free diet, education and Bisphenol A exposure feedback on urine BPA in adolescent
Authors: Ulusoy F , Gozum S , Parlak M 
Published: October 2024

Abstract

Background
BPA is an endocrine disrupting chemical and is mostly taken orally. Adolescence is the critical sensitivity to these chemicals is maximum. This study was conducted to compare the effects of a plastic-free diet program, plastic-free diet education program and BPA exposure feedback on urine BPA levels in adolescents with high use of packaged products.

Methods
The first phase of the two-phase study is descriptive, the second phase is a single-centre, single-blind, three-arm non-randomized experimental design. The study was conducted at Antalya/Türkiye in the 2022-2023 academic year, and in the first stage, adolescents with high use of plastic packaged products and low attitudes towards healthy nutrition were identified. In the second stage, participants were assigned to the group-1 (n = 36), group-2 (n = 36) and group-3 (n = 36) by simple random sampling method. An eight-week plastic-free diet program was applied to the group 1, plastic-free diet education program and BPA exposure feedback was given to the group-2, and only BPA exposure feedback was given to the group-3. Plastic Packaged Product Usage Survey, Attitude Scale towards Healthy Nutrition, and spot urine samples were used to collect data.

Results
It was found that 2% of adolescents used low plastic packaging, 34% medium, 57% high, and 7% very high. Pre-posttest urine BPA levels ng/ml (µg/g creatinine) were 1.98 (2.54), 1.43 (1.51) in the intervention1 group, respectively; 1.91 (2.35), 1.43 (1.47) in the intervention2 group; It was found to be 1.97 (2.49) and 1.49 (1.66) in the intervention3 group. The effect sizes of pre-posttest BPA/creatinine values were calculated as 1.38, 1.13 and 1.09 in intervention1-2-3 groups, respectively.

Conclusions
All three interventions (plastic-free diet program, plastic-free diet education program and BPA exposure feedback) were effective in reducing urinary BPA levels, reducing plastic-packaged product use levels, and increasing attitudes towards healthy eating.

Key messages
• Since all three interventions are effective in reducing adolescents’ urinary BPA levels, it may be recommended to use the intervention appropriate to the field conditions.
• In the post-tests, the use of plastic packaged products by adolescents in all three groups decreased and their attitudes towards healthy nutrition increased.