bluuebunny/crossref_metadata_2025_split huggingface dataset:
Working on new applications: Use of economic evaluation in burden of disease estimates
Authors: Cecchini M , Lerouge A 
Published: October 2024

Abstract
Burden of disease (BoD) analyses provide policy-makers with useful evidence to prioritise policy responses to major public health threats. Increasingly, however, epidemiological data alone is not considered as sufficient to inform decisions, particularly when funding is allocated within a single government approach and different sectors compete for a larger share of the overall budget. Similarly, other funders, such as charities and foundations, may want to prioritise budget allocation between health and non-health objectives. In all these cases, traditional BoD analyses need to be complemented by economic evaluations. In its simplest form, the economic component may mean adding an assessment of the healthcare costs caused by the diseases in the study. A more comprehensive, though still with limitations, approach is to use monetary values to measure the extent to which individuals are willing to exchange their income - which can be spent on other things - for the health outcomes they experience. Finally, in its most advanced and comprehensive form, analyses can include assessments of a number of relevant dimensions, such as those in the OECD’s Better Life Index. The latter approach is also consistent with, and its results support the implementation of, a health in all policies approach. This presentation will look at traditional and innovative approaches that can be used to add an economic dimension to BoD analyses. After introducing the rationale and key methodological issues of each approach, the presentation will discuss the advantages and disadvantages of each methodology and will identify areas where their use can be beneficial in guiding the decision-making process. Examples of the use of these methodologies in real-world analyses will also be presented to support the theoretical part of the discussion.
Barriers to Personalised Prevention: Perspectives from a Multi-Stakeholder Consultation
Authors: Costa A , Cardoso M L , Carvalho A , Osti T , Farina S , Flodkvist E , Gyllenberg A , Boccia S , Vicente A M 
Published: October 2024

Abstract

Background
The high and increasing burden of Non-Communicable Diseases (NCDs) demands a healthcare shift towards prevention. Personalised preventive interventions (PPIs) that consider biological, sociocultural, environmental, and behavioural characteristics of individuals, are not as widely adopted as other personalised medicine approaches. To identify the main barriers and gaps that are hindering the adoption of PPIs in healthcare systems, we consulted a wide range of European stakeholders, including health professionals, policy makers, citizens and patients, and researchers.

Methods
The consultation process included experts’ interviews and an online survey, taking place over 10 months in 2023/2024. Interviews were analysed using qualitative Thematic Analysis. The online survey development was based on the barriers identified by the interviewed experts, complemented with findings from the literature. Respondents scored their level of agreement/disagreement using a 6-point Likert scale. Descriptive statistical analysis was performed.

Results
A total of 26 semi-structured interviews and 270 complete surveys were obtained. Overall, the main barriers highlighted were: 1) Health systems strategies are geared towards curative care and not prevention. 2) Awareness and understanding of the concept of PPIs is low. 3) There is a lack of basic and life-long training for health professionals on PPIs; 4) There is insufficient evidence for PPIs to raise the necessary policymakers’ interest. 5) Health literacy of citizens and patients is low. 6) There is insufficient prevention research, evidence of cost-efficiency and regulation procedures for translation into health practice.

Conclusions
Identified barriers are interconnected and the challenges extend beyond prevention to personalized medicine interventions. Collaborative efforts are needed to elevate visibility and engage stakeholders, facilitating integration of PPIs into healthcare systems for widespread adoption.

Key messages
• This consultation offers valuable insights on challenges that need to be addressed to enable the integration of PPIs into healthcare and reduce the burden of NCDs.
• Investments in disease prevention and PPIs should stand as a global key priority.
Public perceptions of the health impacts of climate change: a survey study in Greece
Authors: Lamnisos D , Michalopoulos G , Andrianaki M 
Published: October 2024

Abstract

Background
Climate change is the biggest global health threat of the 21st century. Despite the tremendous challenges, many people remain unaware of the human health implications of climate change. People perceptions about the health harms of climate change can increase public support for the action needed to reduce climate change. The aim of this study was to examine the public perception of climate change as a human health issue in Greece.

Methods
A population survey study was conducted from October to December 2023 in the municipalities of Messini and Alexandroupoli, Greece, following proportional quota sampling. A questionnaire was developed and included measures about the socio-demographic background of participants, their understanding of key facts about climate change and their views about climate change thread to human health.

Results
406 individuals with a mean age 37.7 (sd = 14.8) participated in the study. Participants understood that climate change is happening (93.6%) and 54% of them think climate change is mostly or entirely caused by human activities, whereas 38% think it is caused equally by human activities and natural causes, and about 8% think climate change is mostly or entirely caused by natural causes. A majority of participants reported that climate change has adversely affected the health of people in various way, either a moderate amount or a great deal, including physical or mental harm from forest fires (90%), physical or mental harm from storms and floods (87%), heat-related illnesses (82%), illness due to reduced outdoor air quality (70%) and loss of housing for residents displaced by extreme weather events (70%).

Conclusions
Participants viewed climate change as an important cause of health harm, however they partially understood that climate change is caused by humans. Public health authorities should educate the public and policymakers about the climate change and advocate for policies to address the human health challenges of climate change.

Key messages
• Public health authorities should educate the public and policymakers about the climate change problem and its impact to human health.
• Providing people with information about the health harms of climate change can increase public support for the actions needed to reduce emissions.
A questionnaire to assess ecoanxiety and its sociodemographic determinants among Italian adolescents
Authors: Nachira L , Innocenti M , Di Russo M , Congedo G , Campo E , Zjalic D , Lombardi G , Perilli A , Bruno S , Fioravanti G 
Published: October 2024

Abstract

Background
Climate change poses serious challenges to Public Health, including mental health impacts. In Italy, few studies investigated the rise of eco-anxiety, especially among adolescents, who are the main group affected by this feeling. Specific measurement tools for this population are needed to fill this gap. The aim is to adapt the Italian version of the Climate Change Anxiety Scale (CCAS) to adolescents, and pair it with a socioeconomic and demographic questionnaire (SDQ) to assess determinants.

Methods
The Italian CCAS was modified for adolescents through a process involving a literature review, expert discussions, and a pretest. This adapted version (a-CCAS) was tested with individuals aged 14-18 years old, maintaining an ideal ratio of 10 respondents per item. Extant psychometric scales were utilized to assess its validity. The SDQ was developed from results of a systematic review of known associations between socioeconomic and demographic factors and eco-anxiety in youth, and expert discussions, and validated by piloting the SDQ with another sample of adolescents. Internal consistency of the a-CCAS and SDQ was assessed by Cronbach’s alpha (Cα).

Results
The a-CCAS kept most of its original content, comprising 13 items and 2 subscales: cognitive and functional impairment. Pilot respondents were 162; Cα coefficient was &gt;0.7 for both subscales. Convergent and concurrent validity showed positive correlations with the extant scales. The SDQ comprised 12 items in 3 domains: family, social and political-environmental determinants. Respondents were 47 and Cα coefficient was &gt;0.7.

Conclusions
The a-CCAS and SDQ are valid tools for assessing baseline eco-anxiety and its determinants in Italian adolescents and can contribute to Public Health efforts to reduce the climate-related mental health burden, by measuring the impact of specific educational interventions about climate change targeted at the young. This questionnaire was created as part of the PRIN P2022JJ3LB project.

Key messages
• These results contribute to filling an evidence gap on eco-anxiety and its socioeconomic and demographic determinants among Italian adolescents by providing researchers with a valid measurement tool.
• This tool holds promise for assessing the impact of psychologically-informed educational interventions about climate change and adaptive coping strategies on adolescents’ eco-anxiety levels.
From Pandemic to Heatwave: Digital Strategies for Health Resilience
Authors: Loureiro M , Vasconcelos H , Neves A L 
Published: October 2024

Abstract

Heatwaves threaten public health in the EU, as evidenced by the high heat-related mortality in the summer of 2022. Despite their frequency, European heat-health action plans (HHAPs) largely exclude digital solutions. The COVID-19 pandemic shifted perceptions and use of digital health tools, demonstrating their effectiveness in responding to health crises and providing insights for heatwave management. This work explores the potential of further including digital health interventions into European HHAPs. The objective is to identify adaptable digital strategies to mitigate heatwave health impacts. We started by analyzing WHO’s guidance on the creation of HHAPs, as well as the European Observatory on Health Systems and Policies’ assessment of the four main areas supported by digital health tools during the pandemic. Later, we proposed four main areas where digital health solutions could be efficiently integrated. Each area underwent a rapid literature review to identify digital solutions used during COVID-19, followed by a critical analysis for applicability in heat-health action planning. We identified four areas where the implementation of digital tools should be explored: Communication and Information Dissemination (focusing on raising awareness among vulnerable groups, caregivers, and organizations); Modeling and Forecasting (developing precise forecasts for proactive planning); Health services coordination (among services delivering immediate care during heatwaves); Monitoring and Population Surveillance (implementing strategies to identify and mitigate heat-related risks e.g. among vulnerable populations). Results indicate that digital health solutions from COVID-19 can enhance national HHAPs. Tools for pandemic prevention and response are applicable to extreme weather events. The pandemic’s increased digital usage resulted from policy changes and infrastructure investment - leveraging these advancements could prepare Europe for extreme heat threats.

Key messages
• Results indicate that digital health solutions from COVID-19 can enhance national HHAPs. Tools for pandemic prevention and response are applicable to extreme weather events.
• The pandemic’s increased digital usage resulted from policy changes and infrastructure investment - leveraging these advancements could prepare Europe for extreme heat threats.
The role of class stigma in socioeconomic inequalities in type 2 diabetes: The Maastricht Study
Authors: Sezer B , Albers J , Meisters R , Schram M T , Galan B E , Kallen CJH , Greevenbroek MMJ , Dagnelie P C , Koster A , Bosma H 
Published: October 2024

Abstract

Background
Low socioeconomic position (SEP) is a risk factor for type 2 diabetes mellitus (T2DM). An underlying mechanism behind socioeconomic health inequalities can be stigma, particularly classism. Studying the influence of class stigma in the context of (pre)diabetes and socioeconomic inequalities may shed light on the societal factors influencing diabetes.

Methods
Data from 1947 participants aged 49-88 who participated in the second phase of The Maastricht Study starting between November 2020 and April 2023 were used. SEP (education, income, occupation) and 6-item classism scale were measured through self-reported questionnaires. (Pre)diabetes was measured through an oral glucose tolerance test. We conducted multinomial logistic regression analyses to investigate the associations between SEP, classism, and diabetes status.

Results
20.9% (N = 406) of the study sample had T2DM (Mage=69.8(±6.8) years; 31.3% women). People with low SEP had more often T2DM (e.g., income OR = 2.13, 95%CI:1.54-2.82) and reported perceived classism (e.g., education OR = 2.07, 95%CI:1.33-3.21) than people with high SEP. Classism was not statistically significantly associated with T2DM (OR = 0.78, 95%CI:0.48-1.29).

Conclusions
Social health inequalities are apparent in T2DM; however, our results suggest that class stigma might not be a major factor in underlying processes. Further research can investigate the role of chronic stress and intersection of multiple stigmas.

Key messages
• The underlying factors behind socioeconomic health disparities are complex. Social and psychological environment in low SEP should be investigated carefully.
• Although low SEP is strongly associated with T2DM and perceived classism, class stigma might not be a major target in explaining socioeconomic pathways in diabetes.
Benefits of hypothetical air pollution reduction interventions on NCDs in Belgium
Authors: Pelgrims I , Devleesschauwer B , Van der Heyden J , De Clercq E 
Published: October 2024

Abstract

Background
The adverse health impact of air pollution on non-communicable diseases (NCDs) is well documented, yet methodological tools for assessing the potential health benefits of interventions are lacking. This study uses a parametric g-computation approach to evaluate the impact of hypothetical interventions targeting long-term air pollution exposure on reducing NCDs prevalence in Belgium, using data from three national Health Interview Surveys (BHIS 2008-2013-2018).

Methods
BHIS data (n = 27,536) were linked to environmental data at participants’ residential addresses. A g-computation approach was used to calculate the potential impact fractions of air quality interventions on several NCDs. Regression models were adjusted for socio-economic, environmental and lifestyle factors. The scenarios involved reducing individual long-term air pollution exposure to WHO air quality guideline levels, followed by investigating dose-response functions through various percentage reductions in air pollution exposure.

Results
Significant associations were found between air pollution and asthma, stroke, and multimorbidity. Adhering to WHO air quality guidelines would substantially reduce stroke risk in Belgium by 0.87% (95% CI:0.38; 1.35) for PM2.5 and 0.32% (95% CI:-0.05; 0.70) for NO2, preventing 63% and 22% of cases, respectively. For asthma, risk reduction was 1.43% (95% CI:-0.53; 3.4) for PM2.5 and 0.83% (95% CI: 0.01; 1.63) for NO2, preventing 27% and 16% of cases, respectively. For multimorbidity, risk reduction was 3.20 % (95% CI: -1.75; 8.16) for PM2.5 and 0.43% (95% CI:-2.03; 2.90) for NO2, preventing 7% and 0.4% of cases, respectively. Results revealed a clear dose-response association between air pollution reduction and the prevalence of stroke, asthma, and multimorbidity in Belgium.

Conclusions
This study demonstrates that air pollution reduction interventions could effectively decrease the prevalence of asthma, stroke, and multimorbidity in Belgium.

Key messages
• Air pollution reduction interventions could effectively decrease the prevalence of asthma, stroke, and multimorbidity in Belgium.
• The g-computation approach to assess PIF of interventions represents a straightforward approach for drawing causal inferences from observational data.
Thermal indices for evaluating the impact of thermal conditions on human health: a systematic review
Authors: Pantavou K , Fillon A , Li L , Maniadis Z , Nikolopoulos G 
Published: October 2024

Abstract

Background
Thermal indices assess individuals’ perception of their ambient thermal surroundings (thermal comfort and heat/cold stress) considering several meteorological factors, such as temperature, humidity, wind, and radiation. As climate change progresses, there is an increased demand for accurately monitoring the association between thermal environment and human health. This study summarizes the available evidence on the association between thermal indices and health outcomes.

Methods
We conducted a systematic search in PubMed, Scopus, and Web of Science until December 31st, 2023, to identify all relevant studies examining the association between thermal indices and health outcomes in outdoor environments.

Results
A total of 5,034 electronic records were screened. Of these, 310 were considered eligible, examining 1,143 associations. Seventeen indices were identified, with 32 (10.3%) articles using more than one index. The most commonly employed index was Apparent Temperature (articles: n = 141, 38.2%; associations: n = 634, 55.5%). The specific-cause health outcomes examined spanned 18 categories of the International Classification of Diseases. Most associations (n = 304, 26.6%) pertained to mortality/morbidity related to diseases of the circulatory system, followed by all-cause morbidity/mortality (n = 288, 25.2%). The 48.6% (n = 556) of the associations suggested an increased risk of adverse health outcomes when indices increased while 32.5% (n = 372) of the associations were non-significant. The 14.2% (n = 162) of the associations suggested an increased risk of adverse outcomes when indices decreased while 16% (n = 183) of the associations were non-significant.

Conclusions
The relevant literature revealed associations between thermal indices and health outcomes. Therefore, thermal indices, considering several meteorological variables, could be a useful tool for public health planning. However, there is diversity in their methodologies and reporting.

Key messages
• Summarizing the published evidence regarding thermal indices is expected to attract the interest of public health professionals and policy makers, and enhance their use.
• Implementing integrated methods to monitor the association between thermal conditions and health, including using thermal indices, could be valuable for developing and evaluating policies.
Picking a bone with fluoride – dose-response meta-analysis on exposure to fluoride and bone density
Authors: Mazzoli R , Iamandii I , De Pasquale L , Filippini T , Vinceti M 
Published: October 2024

Abstract

There are still uncertainties around the effects, beneficial and adverse, of water fluoride exposure on bone density and strength. We selected bone mineral density (BMD) for investigation as it is recognized as the major non-invasive indicator of bone strength, representing its clinical assessment standard. The aim of this systematic review and meta-analysis was to characterize for the first time the relation between fluoride exposure and BMD through a dose-response approach, using a one-stage dose-response meta-analysis based on a cubic spline random-effects model. Out of 1201 potentially relevant literature records retrieved, after removing duplicates, title/abstract screening, and full-text evaluation, 16 studies were eligible for this review, 12 of which were also suitable for the dose-response meta-analysis. We observed an almost linear association between fluoride and BMD, yielding a mean difference of 2.60 (95% CI 0.17 to 0.40) at 4 mg/L of fluoride exposure. This pattern was also confirmed for hip BMD (MD = 2.83; 95% CI 0.11 to 0.40 at 4 mg/L). However, sex-specific analyses showed different patterns of association. In males, the relation between fluoride exposure and BMD was almost linear until 0.75 mg/L (MD = 0.24; 95% CI -0.22to 0.37), after which it plateaued. Females showed a slight increased BMD at 1 mg/L (MD = 0.05; 95% CI -0.02 to 0.16) but decreasing values above 2.5 mg/L (MD=-0.22; 95% CI -2.72 to 2.38 at 4 mg/L), with an indication of an inverted U-shaped association. This pattern was clearer when we restricted our analysis to hip BMD (MD=-0.56; 95% CI -2.98 to 1.85 at 4 mg/L). Sensitivity analyses examining both bone-specific BMD and conducting risk of bias assessments are currently underway. Moreover, imprecision of the estimates, especially in stratified analyses, and potential for residual confounding, underscore the need for further prospective studies, to more adequately assess the relation between fluoride exposure and bone density and strength.

Key messages
• At fluoride exposure below 1 mg/L, we observed a linear correlation between fluoride exposure and increase bone density in the overall pooled dose-response analysis of eligible studies.
• Sex-specific patterns: males show positive response until certain exposure threshold; while females demonstrate an increase only at low doses of exposure and a downward trend at higher exposures.
The effect of outdoor air pollution on Alzheimer’s disease: a systematic review
Authors: Wilson S , Dhillon G , Hassan N , McArdle R , Su L , Slight S 
Published: October 2024

Abstract

Air pollution is one of the largest global environmental risks to public health. Over recent years, neuroimaging techniques have started to uncover the detrimental impact air pollution has had on brain health, including the development of Alzheimer’s Diseases (AD). We systematically reviewed the literature to evaluate the effects of long-term exposure (months to years) to outdoor air pollutants on the development of AD-like neurology. This review was registered on PROSPERO (CRD42023482979) and followed PRISMA guidelines. Four large databases (MEDLINE, Embase, Scopus, and CINAHL) were searched in November 2023 using terms associated with air pollution, neuroimaging, and AD. Only peer-reviewed primary research articles using neuroimaging data to examine AD-like pathology after long-term exposure to air pollutants (Particulate Matter (PM2.5, PM10), SO2, NO2, O3, and/or CO) were included. Titles, abstracts and full-texts were screened, and included articles were quality assessed using the Newcastle Ottawa Scale. A narrative synthesis was conducted to analyse the studies. Our search yielded 397 results, of which eight articles met our inclusion criteria. Articles focused on changes to white matter (n = 5), cortical thickness (n = 6), and grey matter (n = 2). Exposure to PM2.5 was commonly associated with white matter reductions, and PM10 and NO2 exposure was associated with reduced cortical thickness. The effect of exposure to different outdoor pollution on grey matter was inconclusive, with both increases and decreases in grey matter volume observed. This review highlighted how PM2.5, PM10 and NO2 exposure was associated with neurological changes commonly seen in AD. These findings can be used by policymakers and researchers to identify specific pollutants that need greater restrictions and regulations to improve population health.

Key messages
• PM2.5, PM10 and NO2 exposure are associated with neurological changes commonly seen in AD.
• Greater restrictions and regulations are needed on specific pollutants to improve population health.