bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a food frequency questionnaire to monitor protein intake in Flanders, Belgium
Authors: Moyersoen I , Berger N 
Published: October 2023

Abstract

Background
To improve planetary and dietary health, the Flemish government adopted the ‘Green Deal Protein Shift on our plate’ policy which aims to reverse the ratio between animal-based and plant-based protein-rich products in our diet to 40/60 by 2030. The Green Deal provides a platform for actions that unites players from across the food system. To guide the development of actions and assess their effectiveness it is crucial to closely monitor the protein consumption of the population.

Methods
We developed a semi-quantitative Food Frequency Questionnaire (FFQ) to be self-completed annually (2023-2030) by a representative sample of 1000 adults (18-65 years). The food list of the FFQ was developed using a stepwise approach based on the Belgian food consumption survey 2014, selecting the 90% most contributing foods to protein intake. New foods retrieved from a market research and expected innovations were added. Similar foods were combined into survey items, and portion size questions added. Protein intake was estimated using the weighted mean protein intake of the 90% most consumed foods represented in each item. A content validation study was performed to assess question comprehension, food identification and quantification. Results will allow to estimate average protein intake and evolution of protein sources over time.

Results
The FFQ includes 60 food items. The average completion time was 16 minutes. The content validation let to re-ordering of food items and reformulation of portion descriptions.

Conclusions
The newly developed FFQ will strengthen the Flemish public health surveillance system: monitoring protein intake and the ratio of animal-based versus plant-based and alternative protein will allow to guide actions and track progress towards policy objectives of the ‘Green Deal Protein Shift on our plate'.

Key messages
• This study highlights the role of public health surveillance systems in monitoring new policy actions and progress towards policy objectives.
• This study highlights the development of rapid screening tools using a database approach and market research data.
Men's Views on Gender Equality: Attitudes and Behaviors at Male-Friendly Clinics in Malawi
Authors: Triulzi I , Orlando S , Palla I , Mthiko B , Thole D , Ciccacci F , Turchetti G 
Published: October 2023

Abstract

Background
Malawi ranks 173 out of 188 on the UN's Gender Inequality Index (GII) and Malawi has the eighth highest child marriage rate in the world. While previous research has mostly focused on understanding gender roles and norms from women's viewpoints, there has been limited exploration of men's attitudes and behaviors towards gender equality. This study seeks to address this gap by examining the social determinants that shape gender-equitable attitudes and investigating the relationship between behaviors and attitudes in Southern Malawi.

Methods
Between August 2022 and November 2022, we conducted an observational study in four healthcare facilities located in Balaka, Phalula, Namandanje, and Kapire. The study focused on men who participated in a health education program specifically designed for them, known as male-friendly clinics. We interviewed these men using a structured questionnaire based on the International Men and Gender Equality Survey (IMAGES), which includes the Gender-Equitable Men (GEM) scale. To identify the factors influencing gender-equitable attitudes and explore the associated behaviors, we employed both univariate and multivariable analyses.

Results
We included a total of 422 men in this study, with a median age of 46 years (IQR= 34, 55). Men reported a median score of 0.53 on the Gender Equality Attitudes (GEM) scale, where 1 represents the higher GEM scores and indicates more equitable attitudes. Higher gender-equitable attitudes were associated with higher education, urban areas and with various behaviours, such as joint decision-making in couples in women's (0.55 vs 0.49; p= 0.008) and children's health (0.54 vs 0.48; p=0.012), and in spending on food and clothing (0.56 vs 0.49; p&lt;0.001).

Conclusions
This study showed that education and location are the two leading social determinants that affect attitudes toward gender in Southern Malawi. This study confirmed that more gender-equitable attitudes reflect less power imbalance in couples.

Key messages
• Higer education grade and urban areas affect attitudes toward gender equality in Southern Malawi.
• Gender-equitable attitudes reflect equal distritution of power in couples.
Project Hep-ØN: A comprehensive approach to reduce chronic viral hepatitis in Portugal
Authors: Pita Ferreira P , Martins R , Filipe A R , Lopes C , Costa C , Moreira A R , Oliveira P , Perna C , Louro D , Pecante A C 
Published: October 2023

Abstract

Issue
The World Health Organization considers viral hepatitis a public health problem and aims to eliminate it as a threat by 2030, reducing incidence by 90% and mortality by 65%. To achieve these goals, the National Program for Viral Hepatitis recommends the screening of viral hepatitis at least once in a lifetime. However, this is not a widespread practice.

Description of the problem
Micro-elimination is an effective, efficient, and cost-effective intervention in addressing chronic hepatitis in specific geographic areas. The ‘Hep-ØN’ project aims to reduce the incidence, mortality, and morbidity of viral hepatitis in the area of influence of Oeste Norte. The project has three strategic axes: screening, patient follow-up, and liver disease literacy, with the support of several partners.

Results
The goal is to implement viral hepatitis screening at least once in a lifetime for all adult users, improve referral networks, ensure treatment and post-treatment surveillance of viral hepatitis, and empower healthcare professionals. The project aims to cover the 180,000 users registered in Oeste Norte (municipalities of Alcobaça, Bombarral, Caldas da Rainha, Óbidos, Peniche, Nazaré), of which more than 150,000 are over 18 years old. The pilot project is taking place in Peniche until September 2023, and covers more than 27,000 users, of which more than 22,000 are adults. The project's strategies can be applied to other areas, allowing for the rapid identification and treatment of viral hepatitis.

Lessons
The success of the pilot project in Peniche will demonstrate the importance of integrated and localized interventions in preventing and eliminating chronic viral hepatitis, first in ACES ON and then in other regions of the country. Replication should be adapted to local characteristics, leveraging synergies with local and national partners. Integrated care models are an effective strategy to address the challenges of preventing, treating, and controlling chronic viral hepatitis.

Key messages
• ‘Hep-ØN’ project aims to screen all adults, treat viral hepatitis, and empower healthcare professionals in Oeste Norte to eliminate chronic hepatitis.
• Success of the pilot project in Peniche will show localized interventions’ importance in identifying and treating viral hepatitis rapidly and how integrated care models are an effective strategy.
Worry about unmet medical care as a sensitive proxy indicator for medically vulnerable area
Authors: Cho J H , Jo J Y , Choi E H , Kwon K J , Yuk H S , Park J E , Yeob K E , Kim S Y , Park J H 
Published: October 2023

Abstract

Background
Unmet medical care needs affect health outcomes and measure medical care inequality. However, understanding demand in vulnerable areas solely based on experience might be insufficient. This study aims to explore whether a ‘worry about unmet medical care’ indicator could be a sensitive item to identify medically vulnerable areas along with ‘unmet medical experience'.

Methods
We surveyed 1,916 in a region of Korea after allocating them proportionally by age and gender. The same participants were surveyed on unmet medical care experience & worry. Chi-square & t-tests confirmed differences. Logistic regression was used to identify factors influencing on unmet needs.

Results
While the experience of unmet medical care was 3.4%, the worry about unmet medical care was 79.9%, The rate of worry about unmet medical care increased with age (19-39, 40-69, 70+ years old, 71.0%, 82.3%, 86.8%, respectively), and it was high among all age groups in medically vulnerable areas (19 -39, 40-69, 70+ years old, 92.3%, 94.3%, 98.2%, respectively, p&lt;.0001). Unmet medical care experiences were high in medically vulnerable area ‘level 2’ (aOR=4.37; 95% [CI] 2.13-8.98), and worry about unmet medical care was high in lower education level (middle or elementary school) (aOR=1.81; [CI] 1.02-3.20), interest in health ‘yes’ (aOR=2.58; [CI] 1.89-3.51), medically vulnerable area ‘level 2'(aOR=2.67; [CI] 1.91-3.73). ‘level3’ area (aOR=11.81; [CI] 7.74-18.03) was found to be more likely to have worry about unmet medical care.

Conclusions
Significant differences were observed between the experience of unmet medical care and worry about unmet medical care in the participants living in medically vulnerable area. To better predict actual vulnerable areas and establish approaches to address them, both unmet medical care experiences and worries need to be monitored.

Key messages
• Significant differences were observed between the experience of unmet medical care and worry about unmet medical care in the participants living in medically vulnerable area.
• To better predict actual vulnerable areas and establish approaches to address them, both unmet medical care experiences and worries need to be monitored.
2.I. Workshop: Planetary and One health policy and governance: evidence, tools and management
Authors:   Organised by: EUPHA-PHPP, EUPHA-ENV,   Chair persons: Marleen Bekker (EUPHA-PHPP), Marija Jevtic (EUPHA-ENV)
Published: October 2023

Abstract

In the past few years, a broad perspective on the relationships between human health, animal health and environmental health has developed under different conceptual labels of EcoHealth, One Health and Planetary health. Regardless of particular frames, what they have in common is the recognition that human health is not superior to other components of the ecosystem, and therefore these are complementary approaches. In this workshop we aim to increase awareness and knowledge of the fundamental interdependencies of human health, animal health, ecology and economy. The purpose is to enhance policy actions and health management with regard to the cumulative impacts across environmental, animal and human health, and the many potential trade-offs that should be taken into account when prioritizing one action over another. Also, there are specific requirements for integrative and cross-sectoral as well as multilevel governance with respect to cross-disciplinary capacity, stakeholder acceptance and other implementation conditions. In order to set the agenda, build coalitions and advocate for One health policies and management, a first and foremost condition is the development of interconnections between existing networks and platforms to speak with one voice. This workshop presents research evidence into One Health management needs, the European Hub for Planetary Health; and a recently developed One Health policy screening tool for rapid decision-making on which potential impacts and trade-offs policy impact assessment and action should focus. After three presentations from renowned speakers in the field, we will open the floor for interactive dialogue with the audience on the categorization, prioritization, and planning of follow up activities for One Health agenda-setting, advocacy and platform expansion. We intend this workshop as a recurring workshop in the next two conferences ensuring follow up actions throughout the years, using among others the EUPHA and its PHPP and ENV sections networks and media channels to spur awareness and action.

Key messages
• Prevention of emerging One Health threats require a public health community mind shift creating collective action with animal, environmental as well as economic and agricultural policy sectors.
• Our platforms, tools and evidence support agenda-setting, advocacy and policy screening to reduce health impacts and inequalities.
Development of a country specific flow chart to the effective vaccination of migrants in Italy
Authors: Scarso S , Russo M L , Marchetti G , Mancini G , Bellini A , Sabato M , Ferrari C , Marceca M , Declich S 
Published: October 2023

Abstract

Background
Achieving universal health coverage (UHC) is a key priority for promoting health equity. However, migrants face significant barriers to accessing health services, including vaccination. Within the “Access To Vaccination for Newly Arrived Migrants”(AcToVax4NAM) project (Grant No. 101018349, 3° EU Health Programme), this study aims to develop Italian country-specific action-oriented flow chart to overcome system barriers to the effective vaccination of newly arrived migrants (NAM).

Methods
Taking advances from AcToVax4NAM's prior research on vaccination barriers and solutions related to NAM immunization, Italian Professionals for Health (PfH) were engaged in participatory activities to ensure context-specific and relevant flow charts. The stakeholders invited were professionals working in Local Health Authorities (LHA), Non-Governmental Organizations and Universities. Two Focus Groups (FGs) were organized in order to validate and finalize the flow chart.

Results
A total of 29 PfH participated in the two FGs. The Italian country-specific flow chart resulted in a comprehensive approach to addressing barriers to effective vaccination of NAM in LHA. The flow chart includes steps such as entitlement, reachability, adherence, achievement and evaluation which are critical to ensuring vaccination coverage among migrants. A total of 58 tools also provides practical resources to support PfH in implementing the flow chart and addressing system barriers. Further evaluation of the impact of this flow chart on vaccination coverage and health outcomes is needed to assess their effectiveness and inform future efforts to improve health equity.

Conclusions
The development of Italian country-specific flow charts represents an important step towards achieving UHC and reducing health inequity among migrants. This flow chart and the tools identified to address the barriers have the potential to be a powerful support resources for equitable and guaranteed vaccination for NAM.

Key messages
• The Italian country-specific flow chart by addressing barriers to effective vaccination of NAM have the potential to significantly improve the health of migrants by reducing health inequity.
• The AcToVax4NAM’s approach to creating context-specific flow charts ensures health equity for newly arrived migrants and their access to necessary vaccinations, promoting optimal health outcomes.
Time to act! A review exploring the impact of climate change on respiratory diseases
Authors: Scerri K , Cuschieri S 
Published: October 2023

Abstract

Background
Climate change is a growing global epidemic, with negative repercussions on various determinants including an impact on non-communicable diseases. Respiratory diseases contribute to a substantial global burden. Therefore, exploring the relationships and impact between the growing climate change epidemic and respiratory diseases are of utmost clinical importance. The aim of this review was to provide a comprehensive summary on the pathophysiological effects of climate change on respiratory diseases.

Methods
A PubMed literature search (2000-2022) was performed using the following keywords, “climate change'', “air pollution'', “asthma”, “allergic rhinitis'', “thunderstorms” and “pollen”. The article selection followed the PRISMA 2020 guideline.

Results
Extreme temperature events, both heat and cold temperatures, air pollution, extreme weather events including wildfires, droughts, thunderstorms and dust storms as well as allergens were found to have a positive association between climate change and respiratory diseases. Climate change lead to an increase in these events, making respiratory diseases more susceptible.

Conclusions
The effects of climate change on respiratory diseases is detrimental. Urgent adaptive strategies to reduce the impact of climate change is eminent. Failure to reduce/halt these climatic effects will result in higher respiratory burden among the population, healthcare systems, with potential economic downfall, and an uninhabitable world.

Key messages
• Climate change is dominating the global ecosystems with detrimental effect on respiratory diseases.
• Urgent action to halt climate change is a requisite to safeguard the future generation.
Piloting patient-reported outcome measures for evaluation of the Irish Chronic Disease Programme
Authors: Cosgrave E , O'Brien S , O'Brien M , Hurley L , Drummond L , Gleeson M , O'Keeffe D , O'Reilly O 
Published: October 2023

Abstract

Background
The Irish National Integrated Care Programme for Chronic Disease (ICPCD) aims to deliver end-to-end, patient-centred care across three clinical programmes; Heart, Respiratory and Diabetes. Patient-reported outcome measures (PROMs) are a means of objectively measuring changes in patients’ subjectively-perceived health status over time in response to services. As such, PROMs facilitate service monitoring and evaluation and are an important tool for the ICPCD to ensure optimal, patient-centred, value-based healthcare delivery.

Methods
To select the most appropriate PROMs instrument for use across ICPCD, comprehensive literature review was undertaken followed by key stakeholder consultation in winter 2022. Following consideration against a set of pre-determined criteria the EQ-5D-5L, a well-validated, reliable PROMs instrument, was selected as the most appropriate PROMs instrument for use. Study design involved pilot implementation of EQ-5D-5L in one ICPCD ambulatory care hub service followed by mixed methods evaluation of staff experience of the pilot.

Results
The pilot was conducted from April to June 2023 among a socio-demographically diverse sample of patients attending their first and last episode of care with the ICPCD diabetic patient education service in Galway. Following service attendance there was a significant aggregate improvement in self-reported overall health rating but no significant change in self-reported mobility, self-care, usual activities, pain/discomfort or anxiety/depression. Predominant staff concerns included staff and patient burden and the need for adequate staff resourcing and information technology support.

Conclusions
In conjunction with key national stakeholders findings from the pilot will be used to support the development of a PROMs implementation plan at scale for adoption across all ICPCD services. Ultimately national implementation will support the ongoing delivery of high quality patient-centred care within ICPCD services.

Key messages
• PROMs facilitate service evaluation and are an important tool for the Irish National Integrated Care Programme for Chronic Disease (ICPCD) to ensure optimal patient-centred healthcare delivery.
• This pilot will support PROMs implementation at scale across ICPCD services and ultimately reinforce the ongoing delivery of high-quality, value-based, integrated healthcare.
Lessons learned from COVID-19: improving breast cancer services from the patient perspective
Authors: Myers C , Bennett K , Cahir C 
Published: October 2023

Abstract

Globally, health services for breast cancer (BC) were significantly disrupted due to the coronavirus disease (COVID-19) pandemic (1)and the recovery and adaptation of health services is widely unknown(2). The purpose of this study is to reflect on the health service experiences of women with a diagnosis of BC in Ireland during the pandemic and to propose patient-centered priorities and recommendations to improve BC services moving forward from COVID-19. The study included semi-structured qualitative interviews (n = 28) with women who participated in a related mixed-methods cohort study. Women with a diagnosis of BC within 5 years in Ireland were initially enrolled and women were selected for interviews through stratified purposive sampling to ensure data was available on diverse cases. Interviews took place in early 2023 to reflect on perspectives from the COVID-19 government lockdown. Thematic analysis was conducted using NVivo software. Thematic analysis highlighted three main themes: unmet needs; patient priorities; and recommendations. Women discussed unmet needs such as routine care fall-out, mental well-being, and financial difficulties. Patient priorities included cohesion among multidisciplinary BC care, proper communication with BC health professionals, and self-empowerment in BC care. Lastly, women recommended improvements for the transition from active treatment, support services, and adaptation of telemedicine. “I do think that any patient going through cancer treatments, it's not just breast cancer, any patient ... there needs to be a little bit more support for the aftercare.” The pandemic has impacted BC services considerably, and this impact has accentuated unmet needs for women with BC in Ireland. Considering these unmet needs from varying backgrounds, patient- centred priorities and recommendations were proposed. To conclude, the patient voice should be prioritized when implementing changes for improvement to health services.

Key messages
• Health systems must learn from the pandemic to improve services and to avoid detrimental impact of future disasters.
• The patient voice should be a key stakeholder when implementating health policies.
Secondary risk reduction service acceptability amongst Irish breast cancer survivors and clinicians
Authors: Steele C , Harrington J M , O'Reilly S 
Published: October 2023

Abstract

Background
Many patients (&gt;75%) diagnosed with breast cancer in Ireland today will be cured and are at risk of dying from other cancers and non-communicable diseases. Breast cancer diagnosis provides a pivotal time point for education on modifiable risk factors and engagement with secondary risk reduction services. Our study set out to establish the level of awareness and acceptability of these areas, respectively.

Methods
A survey was developed for breast cancer survivors and oncology clinicians using previously validated questionnaires; the ‘Mitchelstown Cohort Survey’ and the ‘International Physical Activity Questionnaire'. IBM SPSS software (Version 28.0) was used for data analysis.

Results
Between September and December 2021, 322 patients and 29 clinicians attending the South Infirmary Victoria and Cork University Hospitals, completed the survey. Over 80% of patients and clinicians were aware of modifiable cancer risk factors. Only 1 in 5 clinicians had training in secondary risk reduction however 90% were willing to refer to services. Education had an impact on the likelihood of patient engagement with weight management, dietary, and exercise education (Pearson chi-squared test; p = 0.009, 0.039, 0.139 respectively). Patients who smoked, had increased alcohol intake, or gained weight since diagnosis were more likely to engage with services (p = &lt;0.001, p = &lt;0.001, p = 0.015 respectively). Patients who made changes to activity levels since diagnosis were more likely to engage with exercise education (p = 0.015).

Conclusions
This study identified that over 4 in 5 breast cancer survivors and oncology clinicians were aware of the importance of modifiable lifestyle risk factors. While 9 in 10 clinicians were willing to refer to secondary prevention services if available, the likelihood of patient engagement was associated with their at-risk behaviours and education level. Our study highlights the challenges of implementing health promotion programs in this cohort.

Key messages
• High level of intended engagement with secondary risk reduction services amongst breast cancer survivors and oncology clinicians.
• Likelihood of patient engagement was associated with their at-risk behaviours and education level.