bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal and postnatal care in a frozen conflict zone: results from a household survey
Authors: Musheghyan L , Sargsyan Z , Agopian A , Aprahamian D , Lazaryan Z , Dorian A 
Published: October 2023

Abstract

Introduction
Maternal and child health are crucial for the well-being of a society. Armed conflicts negatively affect health systems including maternal and child health services. We explored access and utilization of prenatal and postnatal care services in Nagorno-Karabakh: a frozen conflict zone.

Methods
We applied cluster sampling to draw a sample of 1023 households in Nagorno-Karabakh in 2022. Interviewer-administered surveys were conducted among women of reproductive age (18-49) from the selected households. The instrument captured key reproductive health, and maternal and child health indicators, for the youngest 0-5 y.o. child.

Results
Out of 1023 women, 299 (29.5%) had at least one 0-5 y.o. child: 54.5% males and 45.5% females. Almost all the respondents received prenatal care (97.7%), the majority of them (95%) starting in the first trimester with frequency of more than 4 visits (90.7%). The visits included blood pressure measurement (99.3%), urine test (99.7%), blood test (99.7%), checking baby's heartbeat (99.3%), ultrasound (98.3%), nutrition education (82.9%) and breastfeeding counseling (79.8%), and asking about vaginal bleeding episodes (58.2%). Less than half of the respondents reported folic acid (49.5%) and iron (46.5%) supplementation during the pregnancy. While in the healthcare facility, mostly doctors checked mothers’ and babies’ health, 78.6% and 90.3%, respectively. Once discharged, less than 50% of the mothers and more than 80% of the babies received follow-up health checks.

Conclusions
Despite operating in a frozen-conflict zone, the health system of Nagorno-Karabakh was able to provide prenatal care in line with global evidence-based recommendations. Our findings indicate some gaps in breastfeeding counseling, folic-acid supplementation, and utilization of postnatal services. Capacity-building and community-based educational programs have the potential to improve overall prenatal and postnatal care and build sustainable health systems.

Key messages
• This unique study showed that despite operating in a frozen-conflict zone, the health system of Nagorno-Karabakh was able to provide prenatal care in line with global evidence-based recommendations.
• Capacity building, as well as patient-provider and community-based educational programs have the potential to improve overall prenatal and postnatal care in Nagorno-Karabakh.
Factors that influence the uptake and delivery of HPV vaccines in migrants: a systematic review
Authors: Mansour R , Razai M , Hargreaves S 
Published: October 2023

Abstract

Background
Migrants are known to be an under-immunised group for many routine vaccinations. We did a global systematic review to explore and assess factors that influence uptake of vaccines for human papillomavirus (HPV) infection, using the WHO-endorsed Behavioural and Social Driver of Vaccination Framework (BeSD).

Methods
Using PRISMA guidelines, 3,075 records were found from 7 databases (2006-2023), with no exclusions based on country or language. After title/abstract screening and full-text review, data were extracted for thematic analysis using BeSD (4 domains for vaccine behavioural change) and qualitative synthesis.

Results
We included 104 studies from 16 countries: two thirds from the US, 25% from Europe, and only 2% from LMICs. The majority focused on vaccine eligibility and/or parents; 10% looked at providers’ views; 2% involved wider stakeholders, and most research focused on females. Migrant sub-groups reported diverse views and experiences about HPV vaccines. Many examined vaccine initiation and identified low awareness/knowledge of HPV/HPV vaccine. “What people think/feel” domain: barriers such as concerns on vaccine safety, cultural belief, lack of information, vaccine unnecessary; mixed view on vaccine benefit. “Social process”: doctor recommendation and information via providers/peers was influential but depended on framing and migrant characteristics. “Motivation” domain was understudied. “Practical issues” that impact uptake included cost, mobility, accessibility, and language.

Conclusions
Culturally sensitive education to address misconception and enhance importance of HPV vaccines were considered important, alaongside practical efforts to address mobility (mHealth), proactive vaccine behaviour and strong provider recommendation. A comprehensive strategy along the BeSD pathway, using a multipronged approach, would be valuable, and may be further enhanced by exploring wider macro-level factors.

Key messages
• Special efforts will be needed to engage mobile groups in HPV vaccination, with further research needed in LMICs.
• Culturally sensitive education to address misconception and enhance importance of HPV vaccines were considered important.
Alarming issue of suicides and their indirect costs in Slovenia
Authors: Sedlak S , Jelenc M , Sambt J 
Published: October 2023

Abstract

Background
Suicides represent a major public health problem and a heavy burden on healthcare systems. Suicide is not a disease, but it can be the final result of various diseases and conditions, including various mental illnesses (depression, psychosis, etc.) as well as alcohol and drug addiction. High premature mortality due to suicide has social and economic consequences for society. The purpose of the present study was to analyze for the first time in Slovenia the partial indirect costs of suicide, on average, for the period from 2008 to 2019.

Methods
At the Slovenian National Institute of Public Health we analyzed the lost income from work due to suicide based on routine health data of the deceased, for the period from 2008 to 2019. The study was conducted in collaboration with the Faculty of Economics of the University of Ljubljana. The National Transfer Accounts (NTA) methodology was used. The estimated economic costs of suicide were based on the calculation of indirect costs, which are related to lost productivity due to death.

Results
Partial indirect costs due to suicide amounted to EUR 8.2 million on average or around 0.2% of all healthcare expenditures, which amounts to 0.02% of gross domestic product in the studied period. Lost income from work due to death amounted to EUR 4.8 million, and unpaid household work lost due to death amounted to EUR 3.4 million, as an annual average for the period 2008-2019.

Conclusions
The range of indirect and direct costs, also from the point of view of various mental illnesses should be included in the calculation in the future, a list of selected illnesses prepared and the available resources and their limitations showed. By including additional economic costs, the burden of suicide would certainly be higher.

Key messages
• Suicide prevention must be the national priority in Slovenia.
• By treating the diseases that can lead to suicide, the number of suicides and the direct and indirect costs could be partially lowered.
Prevalence and Shifts in Antibiotic Use in an Italian Hospital: A Comparison of 2016 and 2022 Data
Authors: Fortunato C , Mengarelli detto Rinaldini D , Dolcini J , Barbadoro P 
Published: October 2023

Abstract

Background
Antibiotics are among the most commonly prescribed drugs, but inappropriate prescription rates (molecule, duration or dosage) remain high, leading to the selection of multidrug-resistant microorganisms. This study aims to describe the most commonly used antibiotics in our hospital and compare them to 2016 data.

Methods
Conducted in November 2022 at the Azienda Ospedaliera Universitaria delle Marche of Ancona (Italy), the study followed the protocol proposed by the European Center for Disease Prevention and Control (ECDC). Patients admitted to wards before 8 a.m. and not discharged at the time of the survey were included. Data from 2022 were compared to the 2016 study.

Results
In 2022, 41.7% (N = 284) of the 681 patients were taking at least one antibiotic, with 400 antibiotic therapies administered, of which 90.5% were given parenterally. Among the patients on antimicrobial therapy, 40% were being treated for a community infection, 27% for a hospital acquired infection and 19% for surgical prophylaxis. Among all the antimicrobial prescriptions used, the most used class of antibiotics in 2022 was penicillin / beta lactamase inhibitor (21.6%, N = 86), followed by third-generation cephalosporins (11.8%, N = 47), carbapenems (11.6%, N = 46), glycopeptides (8.8%, N = 35), first-generation cephalosporins (8.8%, N = 35) and fluoroquinolones (7.0%, N = 28). Data from 2016 registered a 21.2% prevalence of penicillin / beta lactamase inhibitor, 15.7% of fluoroquinolones, 14.7% of third-generation cephalosporins, 10.5% first-generation cephalosporins, 7.6% of carbapenems and 4.1% of glycopeptides.

Conclusions
The prevalence of antibiotics used in our hospital has changed after six years. This shift may be due to new patterns of bacterial resistance and new antimicrobial drugs (e.g. cefiderocol).

Key messages
• Our study found a shift in prevalence of antibiotic use in our hospital after six years.
• Penicillin/beta lactamase inhibitors are still the most commonly used antibiotics in our hospital.
Blood pressure measurement device change in the Healthy Finland health examination survey
Authors: Lehtoranta L , Palosaari T , Tolonen H , Lundqvist A 
Published: October 2023

Abstract

Background
Blood pressure (BP) measurements in health examination surveys (HESs) are needed for public health monitoring. In Finland, population-based HESs with BP measurements have been performed with mercury sphygmomanometers since the 1960's. The use of oscillometric devices has rendered sphygmomanometers impractical for health surveys. This study describes the change in BP measurement method and mean BP values in Finnish HESs.

Methods
66 000 randomly selected adults living in Finland were invited to the Healthy Finland questionnaire-based health survey in 2022-2023. Of those, 10 000 were asked to participate in a HES including BP, anthropometric, and functional capacity measurements as well as collection of biological samples. Prior to the selection of the new oscillometric BP device, validation studies for devices were evaluated, and the availability was checked. BP measurements were performed using WatchBP Office Vascular (TWIN200 VSR) device.

Results
Two consecutive BP measurements were obtained from 3424 participants aged 30 years or older (ongoing until 6/2023). The mean (95% CI) systolic blood pressures (SBP) for men and women were 137.1 (136.2-140.0) and 134.7 mmHg (133.7-135.6), respectively. The corresponding values for diastolic blood pressure (DBP) were 82.3 (81.8-82.8) and 79.3 mmHg (78.9-79.8). The mean difference (95% CI) between the 1st and the 2nd SBP measurements were -2.4 (-2.7- -2.0) and -1.8 (-2.1- -1.4) in men and women, while the corresponding values for DBP were -1.1 (-1.4- -0.9) and -1.2 (-1.5- -1.0). Distribution of measurements was Gaussian apat from some values, that were unlikely to be obtained (SBP: 155, 156, 157; DBP: 96, 99).

Conclusions
Oscillometric BP provide reliable data in HESs. Finnish BP levels may be on the rise. Further reseach is needed to estimate the effects of gaps in the measurement algorithm of TWIN200 VSR and the differences in consecutive measurements.

Key messages
• In a health examination survey, oscillometric blood pressure measurements led to similar results as with a sphygmomanometer.
• Algorithm gaps and smaller difference on successive measurements were seen.
Impact of the tobacco law on hospitalizations for tobacco-related diseases in adults in Portugal
Authors: Santos M , Perleman J , Díonisio J , Vasconcelos R , Peralta-Santos A 
Published: October 2023

Abstract

Introduction
Tobacco contributes to about 8 million deaths per year worldwide, of which 1.2 million are due to passive exposure to tobacco smoke, according to WHO data. Ambitious anti-tobacco policies have been implemented in European countries, but few have been evaluated. The present research measures the impact of the anti-tobacco laws implemented in Portugal in 2007, and reinforced in 2015, in the adult population residing in Portugal, between January 1, 2002 and December 31, 2018.

Methods
We used data for all in-patient stays at all public hospitals over the 2002-2018 period. A quasi-experimental interrupted time series study was applied, considering the years 2008 and 2016 as exogenous shocks. The dependent variables under study are the incidence of hospitalizations by municipality of residence and year for tobacco-related diseases, namely: AMS, stroke, lower respiratory tract infections, COPD and asthma. We adjusted the analysis by the percentage of women, percentage of people aged &gt;65, and purchasing power. We produced time trend graphs for each variable, with subsequent adjustment to the Poisson regression model to predict its evolution. A comparison was made between the values observed after the implementation of the law and its reformulation and the values projected based on the regression model selected, to identify the percentage difference between the two.

Expected Results
In line with the international literature, a generalized decrease in the incidence of hospitalizations for tobacco-related diseases was observed after the implementation of the tobacco law. Likewise, after the changes added in its reformulation, the reduction in incidence was stronger, although not as sharply, compared to 2007.

Conclusions
Anti-tobacco laws in Portugal have been effective in reducing tobacco-related hospitalizations, with expected gains in life expectancy and reduced burden for the health system.

Key messages
• Tobacco contributes to about 8 million deaths per year worldwide, of which 1.2 million are due to passive exposure to tobacco smoke.
• Generalized decrease in the incidence of hospitalizations for tobacco-related diseases was observed after the implementation of the tobacco law.
From Geroscience Discoveries to Public Health Practice: Shifting the Paradigm towards Healthy Ageing
Authors: Csiszar A , Adany R , Tarantini S , Ungvari Z 
Published: October 2023

Abstract
The global population is ageing rapidly, and the paradigm towards healthy ageing is shifting from a challenge to an opportunity. Advances in geroscience have shown promise in delaying/preventing age-related diseases. However, public health research targeting healthy ageing needs to consider these advances and develop interventions that target fundamental ageing processes. This presentation highlights the need for a paradigm shift towards healthy ageing and the incorporation of geroscience discoveries into public health practice. Traditional behavioral and biological risk factors have been the mainstay of public health interventions targeting age-related diseases. However, epidemiological studies need to consider mechanistic links between lifestyle risk factors and ageing processes and include newly developed transcriptomic, epigenetic, proteomic, and metabolomic biomarkers of ageing to identify groups of people who are ageing faster. Public health interventions should be designed with cellular/molecular mechanisms of ageing kept in mind. In addition to established interventions addressing traditional risk factors, emerging dietary modifications such as intermittent fasting paradigms, and diets enriched in NAD+ precursors show promise. These emerging concepts can be incorporated into a complex anti-ageing paradigm that also includes physical activity and cognitive trainings to interrupt the bridge between ageing and physical/intellectual decline. Finally, interdisciplinary Healthy Ageing programs are needed to address the growing socio-demographic challenges associated with rapid population ageing. These programs bring together expertise in public health, geroscience, nutritional sciences, and preventive medication against non-communicable diseases. By shifting the paradigm towards healthy ageing and incorporating geroscience discoveries into public health practice, we can promote healthy ageing and reduce the burden of age-related diseases.
Using popular culture to fill in the gaps in public health knowledge – the case of school toilets
Authors: Molcho M 
Published: October 2023

Abstract

Background
Avoiding going to the toilets during the school day has serious implications on children's health and education. Concerns about using the toilets may also lead to reduce intake of fluid, resulting in dehydration and associated dizziness, fatigue and poor concentration, compromising children's education as well as their overall well-being. Yet, there is limited evidence on the reasons behind children's tendency to avoid using the school's toilets. To address this paper presents the representation of school in popular culture, as a way to understand how children perceive school toilets.

Methods
Popular culture play a significant role in shaping perceptions of places and people, serving as the primary way in which they learn about people's experiences. Thus, the way the toilets are represented in popular culture such as books or films may influence adolescents’ use of public toilets, even if they are not aware of that. This paper explores some films, young adults books and children books to identify the narratives around school toilets as portrayed in popular culture/

Results
The narrative of school toilets in popular media can be divided to three main themes, toilets as a place that provides safety and privacy from the prying eyes of both peers and the authorities; toilets as a space for illegitimate activities, aggression and bullying; spaces where sub-cultures and anti-establishment activities emerge. While these themes are not mutually exclusive, each has its unique aspect in the perception and representation of the role that school toilets play in children's lives.

Discussion
This presentation will help shaping the conversation about a public health problem that is rarely discussed. It will shed a light on the perceived role of public toilets and will help finding way to address and alleviate concerns about using toilets in school.
Nutritional and non-nutritional content in food: targets for front-to-package labels
Authors: Grosso G , Bonaccio M 
Published: October 2023

Abstract
A global shift from traditional to “Westernized” dietary patterns is being considered responsible for the substantial worsening of global diets and the consequent impact on human health. The need for easily accessible, palatable, and affordable food has driven an industry-led globalization of the markets with products easily available worldwide often at cost of nutritional quality, with evidence of substantial substitution of local food production/consumption. A growingly large share of commercial food products are dangerously high in added sugar, starch and/or fat and poor in vitamins and fiber. Additional concerns also rely on the poorly investigated role of food chemical additives on human health, with substantial documented effects on human gut microbiota and potential threats for long term exposure. Given the poor nutritional profile, the unknown effects of industrial additives, and the “substitution effect” for healthy foods, the consumption of industrially processed foods is of great interest for public health experts because the massive market invasion and the potential global impact on the general population. More importantly, foods quality and level of processing is currently not of concern for nutritional guidelines while it started being questioned for its role on general public health.
The estimated health impact of sustainable diets in the Danish population: a risk-benefit assessment
Authors: Jacob A E , Pires S M , Jakobsen M U , Jolliet O , Davydova A , Poulsen M , Jakobsen L S 
Published: October 2023

Abstract

Background
To mitigate the climate emergency and support a growing world population, sustainable diets have become a popular topic. These plant-forward diets are promising in terms of health effects, but estimated population health impacts linked to changes in nutrition and exposure to food contaminants have yet to be quantified. We used a risk-benefit assessment (RBA) to quantify the net health impact of theoretical dietary changes.

Methods
We collected dietary consumption data from the Danish National Survey of Diet and Physical Activity, exposure data for selected chemical contaminants (cadmium, methyl mercury, lead, and inorganic arsenic) from Danish food monitoring, and dose-response data for various health outcomes from published epidemiological data. The average Danish diet was compared to multiple dietary scenarios: a Danish-adjusted EAT-Lancet diet and other alternative scenarios that looked at proportional decreases in animal-based foods with plant-based substitutions.

Results
Shifting to a Danish-adjusted EAT-Lancet diet would require increased consumption of legumes by 6,352%, nuts by 1,036%, bread and cereals by 100%, fruits and berries by 40%, and fish and shellfish by 39%. Red meat and dairy consumption would need decreases of 83% and 25%, respectively. With these changes, we estimated that a net of 22,900 DALYs would be averted in one year in the Danish population. The food groups contributing most to positive health impacts were nuts (-7,721 DALYs), bread and cereals (-6,244), decreased red meat (-5,681), legumes (-2,509), and fruits and berries (-1,396). These results are preliminary; all scenarios will be compared.

Conclusions
Our results support a beneficial impact on the health of the Danish population due to sustainable dietary transitions. Similar benefits are expected for other populations across Europe. We argue that RBAs are a powerful decision-support tool and can provide quantitative evidence for sustainable diets and future interventions.

Key messages
• Our comprehensive risk-benefit assessment concluded that transitioning towards a more sustainable diet leads to positive health impacts.
• Our conclusions support policy and decision makers in implementing plant-forward dietary recommendations and agendas in the Danish population.