bluuebunny/crossref_metadata_2025_split huggingface dataset:
The future of care in the Netherlands: application of foresight to explore challenges towards 2050
Authors: Dekker L H , Hilderink HBM 
Published: October 2023

Abstract

Background
Ageing populations have major impact on public health leading to more pressure on formal as well as informal health care. With rising health care expenditures, a sharp rise in geriatric diseases, multimorbidity, and a decrease in the available resources to manage complex health problems, it is of utmost importance to explore the impact of future public health challenges we are facing.

Methods
Foresight helps decision-makers anticipate future developments and inform current policies. It involves using the DESTEP methodology to analyze trends in formal and informal care and their impact on health. A participatory approach is used, including focus groups and interviews with stakeholders, to identify key drivers and challenges. Prioritized topics are then evaluated based on their potential impact on public health and healthcare, using both scientific and grey literature.

Results
Major future challenges such as the rising pressure on formal health care (shortage of personnel, limited financial resources) results in more people who will depended for the provision of informal care. At the same time many people have difficulties to be able to have sufficient control finding the right health care for of their own needs. Especially some vulnerable groups (lower educated, migrant background, elderly) will not be able to get proper care. At the same time digitalization is part of the solution (providing care more efficiently) and the problem (not all population groups are digitally literate, increased demand for care). Public health policy should target these challenges in order to achieve potential health gains in the future.

Conclusions
Long-term thinking could be stimulated by stronger involvement of policy-makers in the elaboration of options for action. Applying foresight aid understanding uncertainties and support policy makers focusing on challenges in the more distant future with the support of stakeholders.

Key messages
• The public health issues require an integrative approach with a focus on a more distant future and a comprehensive engagement of relevant stakeholders.
• Long-term thinking could be stimulated by stronger involvement of policy-makers in the elaboration of options for action.
Geographical inequality in health: results from a population-based health survey
Authors: Sørensen J B , Friis K , Jensen M M , Pedersen M H , Lasgaard M , Larsen F B 
Published: October 2023

Abstract

Background
The greatest public health concern is social inequality in health, which also includes a geographic dimension. Residents of less resourceful areas are often disproportionately exposed to health risks, and the negative health effects of both low social position and unhealthy surroundings can exacerbate each other. This study aims to explore the relationship between sociodemographic characteristics of local areas, health behavior and mental health.

Methods
The study used self-reported data from the ‘How are you? 2021’ health survey conducted in the Central Denmark Region (N = 33,925), and parish-level data from Statistics Denmark. Latent Profile Analysis was used to group parishes into five socio-geographic groups based on social composition, where deprived areas were characterized by low income, high unemployment, and low education. Health behavior and mental health were compared across socio-geographic groups using linear regression, contrasts and linear hypothesis tests.

Results
Citizens in less resourceful areas exhibit higher prevalence rates of daily smoking, physical inactivity, unhealthy diet, and obesity, alongside higher levels of perceived stress and depressive symptoms, as compared to citizens in more affluent areas. However, a higher proportion of individuals in affluent areas exceeded the Danish Health Authority's low-risk recommendations for alcohol consumption.

Conclusions
The health outcomes of citizens living in less resourceful areas are inferior to those of citizens in more affluent areas. Residents in less resourceful areas exhibit poorer health outcomes across health behaviors and mental health. Based on the study's findings, implementing health promotion initiatives at the local level and addressing the underlying social inequality through structural efforts are necessary. This could potentially help to reduce the disparities in health outcomes in citizens in less resourceful areas compared to those in more affluent areas.

Key messages
• Health outcomes of citizens in less resourceful areas are inferior to those living in affluent areas.
• Local health promotion initiatives and structural efforts addressing social inequality is needed.
A comparative study on the mandatory variation of COVID-19 vaccination policies
Authors: Batten N , Winter B , Grgic G , Wiley K 
Published: October 2023

Abstract

Background
Reflection on COVID-19 vaccine policies is critical to understand their effectiveness. Joint level vaccine mandates encouraged by the EU were not adopted by member states, leading to a multitude of vaccine policies that varied in their mandatory nature. We hypothesised that highly mandatory vaccine policies would result in high vaccine uptake & low mandatory polices would result in the opposite, & that differences between countries would impact policy implementation & effectiveness.

Methods
The mandatory vaccine framework was used to evaluate the mandatory nature of case study countries’ COVID-19 vaccine policies from 2020-23. France, Italy, Sweden, Poland, & Romania were chosen to represent a cross-section of economies, health systems, political histories, & COVID-19 experiences. Data was sourced from the ECDC's COVID-19 Data Tracker, government documents, media reports, & peer reviewed studies.

Results
Highly mandatory vaccine policies lead to higher overall vaccine uptake, as found in France 92.3% & Italy 89.8%. However, highly mandatory policies may cause social disruption & increase mistrust in vaccinations & governments, as seen in France. Moderate to low mandatory policies had mixed results. Romania & Poland had low vaccine uptake below the EU average. Additionally, low mandatory policies risk higher death & case rates & did not increase social acceptance of vaccination or avoid vaccine related social disruption, as seen in Poland. Sweden presents contrasting findings, reporting vaccine uptake of 86.2%, 13.1% above EU average despite their low mandatory policies, contradicting the hypothesis.

Conclusions
The research provides insights into vaccine policy decision making under the pressure of pandemic conditions, & the potential consequences of implementing various severity & enforcement levels within vaccine policies. The study demonstrates the need to develop pandemic vaccine framework to aid policymakers during disease crises.

Key messages
• The research highlights that it is essential that policy makers adopt cultural and health system appropriate vaccination policies for the populations they are targeting to vaccinate.
• The variation of vaccine uptake between member states also stresses the importance for the EU to take a more central role in health policy.
Organizational Vaccine Literacy (VL) can remove system barriers to Newly Arrived Migrants vaccination
Authors: Declich S 
Published: October 2023

Abstract
The strategic approach is to propose and support a pathway of organisational awareness that increases the capacity to recognise, value and resolve needs related to potential barriers to accessing information, adherence and use of the vaccination offer by dedicated services for Newly Arrived Migrants (NAMs). In this framework it will be presented the process and development of the VL tool (an exploratory survey, a Glossary of Essential Terms on Vaccination for non-health personnel) and of the training strategies for strengthening VL and cultural aware approach among “professional FOR health”.
Progress on drinking water, sanitation and hygiene in schools: global overview on the WASH programme
Authors: Baltag V 
Published: October 2023

Abstract

Context
Safe drinking-water, sanitation and hygiene are crucial to human health and well-being. Safe WASH is not only a prerequisite to health, but contributes to livelihoods, school attendance and dignity and helps to create resilient communities living in healthy environments. WHO and UNICEF, through the WHO/UNICEF Joint Monitoring Programme (JMP), produce internationally comparable estimates of progress on drinking water, sanitation and hygiene (WASH) and are responsible for monitoring the Sustainable Development Goal (SDG) targets related to WASH. Since the establishment of the SDGs, the JMP has published global baseline reports on WASH in households (2017), WASH in schools (2018) and WASH in health care facilities (2019), and a progress update on households (2019).

Objectives
To put the European findings in a global perspective regarding school toilets.

Results
Findings from the last report published under this JMP (2021) will be presented, updating national, regional and global estimates for WASH in schools up to the year 2019, with a special focus on the implications for ensuring the safety of students and school staff during and after the coronavirus disease 2019 (COVID-19) pandemic. Using service ladders to benchmark and compare progress across countries on WASH in schools by tracking progress towards a basic level of service, as the indicator used for global monitoring of SDG targets related to WASH in schools, we will see that situations are contrasted. Globally 63% of schools had a basic sanitation service in 2019, while it is the case of 99% of schools in Europe and Northern America. The differences are of the same level regarding basic drinking water service in schools (respectively 69% vs. 99%), as well as for basic hygiene (resp. 57% vs. 98%).

Conclusions
Those results illustrate the paradox that existence of a given facility, access and use are not equivalent and need to be explored further.
Social inclusion of people with mental illness: the widening gap in the adult population in Belgium
Authors: Smith P , Nicaise P , Lorant V 
Published: October 2023

Abstract

Background
Social inclusion is poor among people with mental illness (MI). In recent decades, many countries have developed policies to address this issue. It remains unclear, however, whether their social inclusion has improved over time. This study aimed to assess the evolution of the social inclusion of adults with moderate and severe MI compared to the general population without MI between 1997 and 2018 in Belgium.

Methods
Data on the general adult population were retrieved from the Belgian Health Interview Survey in six cross-sectional waves from 1997 to 2018. Three degrees of MI severity were compared using the 12-items General Health Questionnaire: no MI, moderate MI, and severe MI (score &lt; 4, 4-7, and &gt; 7). Social inclusion was measured using indicators relating to employment, income, social contacts, and partnership.

Results
Since 1997, the probability of being unemployed, having limited social contacts, and living on less than 60% of the median national income has been increasing among people with severe MI. Between 1997 and 2018, social inclusion increased among the general population without MI and among people with moderate MI, but decreased among people with severe MI.

Conclusions
The gap between the social inclusion of people with severe MI and people with moderate or no MI has widened over time, despite major reforms of mental health care and policies. Policymakers and clinical practitioners should pay more attention to supporting the social inclusion of people with more severe MI, particularly in relation to employability and social support.

Key messages
• In Belgium, the social inclusion of people with severe mental illness has decreased over the past two decades.
• The widespread social exclusion of people with severe mental illness is in conflict with international human rights conventions.
Front-to-package labels relevance for policy: the Nutri-Score as case study
Authors: Hercberg S , Julia C 
Published: October 2023

Abstract
Front-of-package nutrition labels provide simplified information on the nutritional composition of foods. They are considered efficient tools to help consumers make heathier food choices at the point of purchase and may thus contribute at preventing nutrition-related diseases (overweight and obesity, cardiovascular disease, cancer etc.). The Nutri-score is a summary graded front-of-pack label developed in France in 2014. Using a nutrient profiling system, it classifies products in five categories from A/green to E/red depending on their composition in energy, saturated fats, sugars, salt, fibers, proteins and fruit, vegetables, legumes, nuts and olive, canola and nut oils. The validation of the Nutri-Score investigated both the validation of the nutrient profiling system underlying it and its graphical format, comparing its performance to several other schemes currently in use in the world. Overall, the Nutri-Score is aligned with dietary guidelines, and the average nutrient profile of the foods consumed at the dietary level appeared to reflect the nutritional quality of the diet. At the diet level, the nutrient profile of the foods consumed has been found to be associated with higher risks of cancer, cardio-vascular diseases, weight gain or metabolic syndrome in multiple cohort studies. Finally, compared to other schemes the Nutri-Score was found to be the most effective at improving the capacity of consumers to compare products and help them make healthier food choices in purchasing situations.
Disease costs due to outdoor ambient particulate matter pollution in Germany, 2018
Authors: Plass D , Kienzler S , Tobollik M , Wintermeyer D 
Published: October 2023

Abstract

Introduction
In addition to the population health effects of outdoor ambient particulate matter pollution (PM2.5), estimates of the costs related to these health impacts are increasingly requested to inform policy decision-making processes. Within the UKAGEP-project the burden of disease due to PM2.5 in Germany was monetized.

Methods
First, the disease burden attributable to PM2.5 in Germany for the year 2018 was estimated using the Environmental Burden of Disease approach. To estimate the monetary impact of PM2.5, two approaches were followed. We applied the Value of Statistical Life (VSL) approach, using a monetary value of about 6.3 (2.4-7.2) million € attached to each death case. Further, we used the Value Of a statistical Life Year (VOLY) approach, attaching a monetary value of 58,623 (36.646-146.582) € to the loss of a life year. Statistical uncertainties in both the disease burden results and the VSL and VOLY values were considered, presenting a lower and upper estimate of the overall disease costs.

Results
In 2018, the overall burden of disease attributable to PM2.5 was 209,702 (194,265-391,112) Disability-Adjusted Life Years. Using the VOLY-approach, this corresponds to disease costs of about 17 (7-57) billion €. In contrast, when using the VSL-approach, the estimated 15,652 (10,390-21,466) deaths attributable to PM2.5 in this year result in disease costs of about 98 (25-124) billion €.

Conclusions
In comparison with other cost assessments, connecting EBD estimates with the VSL- and VOLY-approach allows to include indirect and intangible costs and not to simply focus on the disease treatment costs. The VSL-approach leads to remarkably higher costs because it does not take into account the age at the time of death and thus attaches the same monetary value to each death case. We recommend to use the VOLY-approach because it considers the remaining life expectancy.

Key messages
• Air pollution causes considerable disease costs in Germany.
• We recommend to use the VOLY-approach because it considers the remaining life expectancy.
Evaluation of antibiotic resistance in bacterial strains isolated from sewage of slaughterhouses
Authors: Laganà P , Gioffrè M E , Facciolà A , Coniglio M A 
Published: October 2023

Abstract

Background
The frequent and incorrect use of antibiotics in animal husbandry has led to the spread of antimicrobial resistance. The issue should be addressed in a One Health vision, since human and animal health, as well as the environment are interconnected. Wastewater from slaughterhouses can be contaminated with multidrug-resistant bacteria, representing a possible cross-contamination route. This study evaluated the presence of antibiotic-resistant bacteria in wastewater from slaughterhouses to highlight their role in the spread of antibiotic resistance.

Methods
In total, 18 out 35 slaughterhouses in Sicily (Italy) were considered. For each wastewater system the samples were collected before any treatment, and cultured within 24 h of sampling. The isolates were identified by API20NE, API20E profiles (bioMerieux, France). Using the Kirby Bauer test, the isolated strains were classified as resistant (R), intermediately resistant (I), or sensitive (S) to the tested antibiotics.

Results
Proteus mirabilis (85.7%) and Peudomonas aeruginosa (27.3%) were the most frequently isolated microorganisms, followed by Enterobacter cloacae, Aeromonas hydrophila, and Citrobacter freundii. The most resistant strains belonged to Enterobacter spp., which showed the highest resistance rate for macrolides, penicillins and cephalosporins. Aeromonas spp. was resistant to carbapenems while E. coli showed the highest resistance to colistine. Finally, Citrobacter spp. was completely resistant to macrolides, rifampicin, and tetracycline.

Conclusions
High resistance levels were detected for some antibiotics widely used in human medicine such as macrolides, penicillins, and cephalosporins. Resistance to carbapenems and colistine, which are now considered key drugs in human medicine for the treatment of severe multidrug-resistant infections, was also reported. Thus, continuous monitoring on the correct use of antibiotics in animal husbandry is necessary.

Key messages
• Wastewater from slaughterhouses may be a vehicle of antibiotic-resistant bacteria.
• The One Health approach should be used for the management of health security, food safety and antimicrobial resistance.
Polygenic Risk Scores for cancer mortality prediction
Authors: Sciurti A , De Blasiis M R , Bolli A , Busby G 
Published: October 2023

Abstract

Background
Polygenic risk scores (PRSs) have shown great accuracy in predicting cancer risk. In screening-based cancer prevention, it is important to be able to predict lethal cancer risk and PRSs have the potential to improve such prediction. This preliminary analysis, conducted on the UK BioBank, investigates the ability of 5 cancer PRSs to predict cancer incidence and mortality.

Methods
Five cohorts were derived from the UK BioBank for 5 common types of cancer (breast, colorectal, lung, pancreas and prostate). PRSs for cancer were constructed for each participant. The PRS hazard ratio per standard deviation (HR×SD) for cancer incidence and mortality was estimated using two proportional hazards Cox regression models for each type of cancer controlling for genotyping array, the first ten principal components of ancestry, family history, sex (where applicable), and age at enrolment.

Results
In the breast cancer cohort, PRS showed a HR×SD of 1.74 (95%CI:1.70-1.78) for cancer incidence and 1.66 (95%CI:1.52-1.81) for cancer mortality. In the prostate cancer cohort the PRS had a HRxSD of 1.78 (95%CI:1.74-1.81) for incidence and 1.73 (95%CI:1.61-1.86) for mortality. Similar results were found in the colorectal cancer cohort with a 1.27 (95%CI:1.24-1.31) PRS HR×SD for incidence and 1.30 (95%CI:1.24-1.37) for mortality, as well as in the pancreas cancer cohort with a 1.44 (95%CI:1.38-1.51) PRS HR×SD for incidence and 1.48 (95%CI:1.40-1.57) for mortality. In the lung cancer cohort a marginal PRS HR×SD was found for incidence and for mortality [1.07 (95%CI:1.04-1.10) and 1.07 (95%CI:1.03-1.12), respectively].

Conclusions
These results suggest that, for most types of cancer, PRSs can predict cancer mortality, as well as incidence, indicating their potential use as a tool to identify people at risk of lethal disease.

Key messages
• These results may contribute to outline clinical utility of PRSs in cancer prevention.
• PRSs may be a useful addition to screening-based cancer prevention, in order to prioritise patients at risk of lethal cancer.
A pandemic's impact on Mental Health
Authors: Grabenhofer-Eggerth A , Sagerschnig S , Gruber B 
Published: October 2023

Abstract

Background
A small topic-specific foresight exercise that shows how monitoring the current and country-specific state of people's mental health has been done in Austria. Since the consequences of the Covid-19 pandemic cannot be precisely quantified with just one or two indicators, a different approach is needed.

Methods
A comprehensive overview of different mental health indicators is a good approach to identify general trends in the psychosocial health of the population. In the absence of survey data, it was decided to focus on available routine data. A specific country context can be understood through comparisons between countries, as was done in use case D of the PHIRI project.

Results
Even though the pandemic (or other crises) affected practically everyone's life, some population groups are showing significant psychological suffering, e.g., young people (especially girls and young women), people with pre-existing mental health conditions, and elderly.

Conclusions
Hence, interventions need to be taken at various levels of a society-wide approach. This means that despite specialized psychosocial support, interventions on “lower levels” dealing with matters of social security, community support etc. are necessary. The Austrian example was used to describe insights to future developments that are applicable to the impact of the COVID-19 pandemic to mental health of the population in several European countries.
Implementation of precision medicine in (routine) cancer care in Belgium in a fair and equitable way
Authors: Schmitt T , Delnord M , Cauët E , Van Valckenborgh E , Van Den Bulcke M 
Published: October 2023

Abstract

Background
Personalized medicine has been found to be highly promising in the prevention or early detection of cancers. Despite the advantages, the scope and potential of personalized health care are under-appreciated and underrealized in health systems. Taking into account the advantages that personalized medicine can bring to cancer prevention and treatment, and acknowledging at the same time the trends happening outside of the field of oncology, Sciensano Cancer Centre conducted research on the use of personalized medicine in the Belgian healthcare system.

Methods
By applying foresight methodology, we first conducted desk research and sent a survey to experts; this was then followed by two stakeholder meetings where we discussed the importance and uncertainties of the factors that have an influence on the implementation of precision medicine in (routine) cancer care in Belgium in a fair and equitable way and developed future scenarios accordingly.

Results
The main influential factors are concerned with economic issues, such as the allocated budget in the healthcare system. Similarly, technological factors around precision medicine should not be neglected: especially issues concerning digitalization will be decisive to determine the future of precision medicine in Belgium.

Conclusions
With the increasing prevalence and incidence of cancer in Belgium, several factors should be considered to implement precision medicine for cancer prevention and treatment in a fair and equitable way. Strategic foresight on precision medicine can support decision-makers in these tasks and help them develop future-oriented policies.