bluuebunny/crossref_metadata_2025_split huggingface dataset:
The health literacy toolbox for schools: An intervention to promote (digital) health literacy
Authors: Schulenkorf T , Okan O 
Published: October 2023

Abstract

Background
Children and youth increasingly seek for health information on the Internet and Social Media, requiring to link media, digital and health literacy to equip them with the skills to distinguish reliable and trustworthy information from disinformation. Preferably, health literacy learning is addressed in schools, but to date there are no programs to address this subject in German schools. This study sought out to develop a classroom-based toolbox to promote health literacy in, e.g., media and digital education classes or subjects such as biology, physical activity, social sciences.

Method
A review on curricular, school requirements, and health literacy interventions was conducted. Findings informed the participatory development of a health literacy toolbox with teaching and learning units for students (7-8th grade) and teachers. The toolbox was tested in three schools, comments were received by teachers and students, supporting the adjustment of the toolbox.

Results
The toolbox is based on the school curriculum for media and digital education of secondary schools, addressing adolescent students in grades 7 and 8 in German secondary schools. It includes learning units to increase competencies regarding health information seeking, understanding of information, and critically analysing health claims and messages. Alongside exercises on critical thinking while navigating online Internet and media sources, the toolbox provides topical learning units, linking health literacy with, e.g., COVID-19, vaccination, healthy eating, substance use, media use, commercial determinants, and mis- and disinformation.

Conclusions
This is the first health literacy toolbox of its kind. Embedding it into the mandatory media and digital education curriculum, and addressing both students and teachers, will ensure the uptake of the programme in schools. Both the toolbox and the methodology of its development can serve as a blueprint for other countries to develop their own interventions.
Investigation of an unusual cluster of illness among staff at a wildlife rescue centre
Authors: Purcell B , Harvey Vince L , McManus O , Crook P , Letts A , Murphy A , Kane U , Sheehan S 
Published: October 2023

Abstract

When two previously fit and well staff from a wildlife rescue centre were hospitalised in early September 2018 with severe pneumonia and meningitis symptoms, the Health Protection Team began an investigation. Possible diagnoses included influenza and legionella, although it was not flu season, and initial testing proved negative. There were reports of other staff illness over the preceding weeks. The centre had accepted a wide range species over the Summer, including high numbers of gulls and pigeons, and an outbreak of psittacosis was suspected; the patients responded rapidly to doxycycline. An incident management team was rapidly convened to investigate and determine control measures. A testing algorithm was developed: including for Influenza A&B, Urine legionella & pneumococcal antigen; reference laboratory serology testing and real-time PCR for Chlamydia.psittaci; and pan-corona viruses. Case finding was conducted by telephone interviews and a select-survey of all 55 staff gained 46 responses. A series of site visits examined working practices at the site. Avian and environmental sampling was undertaken. A total of 22 staff met the agreed case definition for psittacosis, five of whom were later confirmed. Clinical features ranged from mild to severe. The onset dates of illness ranged from July to September. There was no evidence of person-to-person transmission. Analysis did not show a clear correlation between PPE use and illness. Clinical, microbiological, environmental, veterinary, and epidemiological evidence indicated zoonotic transmission of psittacosis. Variable compliance with PPE, hygiene when handling birds, and disinfection had likely contributed via aerosolization of dust. This was likely exacerbated by very high bird stocks and unusually warm weather conditions. Comprehensive recommendations were made to reduce the chances of future outbreaks, which are generalisable to other countries.

Key messages
• This was one of the largest clusters of human psittacosis described in a workplace in England.
• Biosecurity in animal rescue centres is crucial to limit the chance of psittacosis and other zoonoses.
Living Arrangements and the Speed of Chronic Disease Accumulation among Older Migrants and Natives
Authors: Jang S Y , Myrskylä M , van Lenthe F J , Loi S , Oksuzyan A 
Published: October 2023

Abstract

Background
Immigrants may experience a faster health decline than natives due to the deleterious impact of migration-related experiences on healthy ageing. Support from living arrangements where family members reside together is known to provide a buffering effect for such health deterioration. This study examines the role of living arrangements in the health of immigrants versus natives, focusing on the rate of chronic disease accumulation to portray the healthy ageing processes.

Methods
We use data from the Survey of Health, Ageing and Retirement in Europe (SHARE). First, we employ ordinary least square regression models with clustered standard errors in the pooled sample to determine the average number of chronic diseases by migration background. Then, we run immigrant status- and living arrangement-stratified analyses to illustrate the age-related profiles of chronic disease accumulation in immigrants versus natives.

Results
According to our results, living with a spouse or family has a buffering effect on chronic health deterioration for natives, which disappears among immigrants. This beneficial effect is especially prevalent for native men, explaining the immigrant-native gap in the average number of chronic diseases - observed only in a couple or family households among men. Further, chronic diseases accumulate at different rates with age between immigrants and natives based on their living arrangements. Immigrant men living with a family have a slower chronic disease accumulation than native men, while among women, the accumulation speed is faster in immigrants than in natives.

Conclusions
Our results indicate that living with a spouse or a family member provides a different amount of protection by the migration background, leading to different healthy ageing processes between immigrants and natives. Therefore, public policies should monitor the health of the ageing migrant population not only as a whole but also by living arrangements.

Key messages
• Types of living arrangements are associated with age-related profiles of chronic disease accumulation.
• Living with a spouse or a family member provides a different amount of protection by the immigration background, leading to different healthy ageing processes between immigrants and natives.
Health and sustainability impacts of scenarios of replacement of beef by pulses in two EU countries
Authors: Monteiro Pires S , Fieis de Melo J , Vieira ACL , Gomez Redondo H , Assunção R , Cozzi E , Biasini B , Menozzi D 
Published: October 2023

Abstract

Background
High consumption of red meat is an important cause of burden of disease and environmental degradation globally. To motivate changes in food consumption and production, policymakers need evidence on the overall impact of such changes on the health of citizens, and on all aspects of sustainability: environment, socioeconomics, and culture.

Methods
Using three different approaches, we compared the impact of four scenarios of replacement of beef consumption with pulses (a well-established plant protein source) in two EU countries, Portugal and Denmark. First, health impacts were quantified in disability-adjusted life years (DALY); second, sustainability impact was measured using various social, economic and environmental indicators. Finally, we used MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique), an interactive, iterative, multicriteria decision analysis approach, to create a quantitative value model.

Results
We estimated positive health impacts for all substitution scenarios in the two populations. Positive impacts were larger for Denmark and ranged from 5,9 DALYs (25% substitution of beef by pulses in Portugal) to 39,7 DALYs averted/100,000 people (100% substitution, Denmark). The two countries had positive economic impacts, but beef production was more resilient than pulses. Environmental and social impacts of beef production were consistently higher than pulses. The MCDA model included a set of 15 criteria within the four dimensions of analysis to assess the overall value of implementing each scenario.

Conclusions
Individually, each approach allowed us to compare health, sustainability and integrated impacts of different options for food substitutions relevant to the sustainability agenda. Together, they allowed us to create a platform for discussing the co-benefits of dietary changes in different contexts. Expanding this work to other dietary changes and countries will support further development of public health policies.

Key messages
• Different possible scenarios of substitution of beef consumption by pulses, an alternative plant-based protein source, will lead to overall positive health and sustainability impacts.
• Quantitative measurements of the integrated health, environmental and socioeconomic impacts of dietary transitions will support development of public health policies towards sustainable diets.
Non-adherence to COVID-19 containment behaviours: results from an all-Ireland telephone survey
Authors: Darker C , O'Connell N , Graham C , O'Connor C , Zgaga L , Burke E , Mather L , Nicolson G , Barry J , Scally G 
Published: October 2023

Abstract

Background
COVID-19 public health measures like handwashing and social distancing can help stem the spread of the virus. Adherence to guidelines varies between individuals. This study aims to identify predictors of non-adherence to social distancing and handwashing guidelines.

Methods
A cross-sectional weekly telephone survey was conducted over eight weeks (11/06/2020-05/08/2020). The sample included adults resident on the island of Ireland (75:25 split between ROI and NI). Data were collected on demographics, threat perceptions, fear of COVID-19, response efficacy and self-efficacy, response cost and social norms, COVID-19 behaviours, mood, loneliness, and self-reported health.

Results
3011 participants were surveyed. Handwashing non-adherers were more likely to be male (OR: 5.2, 95% CI: 2.4 - 11.3), to have higher levels of loneliness (OR: 1.86, 95% CI: 1.1 - 3.1), and higher perceptions of handwashing costs (OR: 3.4, 95% CI: 2.2 - 5.2). Those reporting rarely engaging in social distancing were more likely to be members of lower socioeconomic groups, to be younger (OR: 0.97, 95% CI: 0.96 - 0.98), male (OR: 1.67, 95% CI: 1.1 - 2.5), healthcare workers (OR: 1.98, 95% CI: 1.1 - 3.4), to report lower mood (OR: 1.72, 95% CI: 1.3 - 2.2), were less likely to live in households with people aged under-18 (OR: 0.75, 95% CI: 0.6 - 0.9), and to have lower fear of COVID-19 (OR: 0.79, 95% CI: 0.6 - 0.9).

Conclusions
Non-adherers to handwashing differ to social distancing non-adherers. Public health messages should target specific demographic groups and different messages are necessary to improve adherence to each behaviour.

Key messages
• non-adherers have different demographic/psychological covariates public health messages should be tailored to the specific behaviour/populations of interest, rather than generic messaging.
• both behaviours (hand washing & social distancing) share some predictive variables, including male gender, perceptions of response cost, social norms and self-efficacy.
Experiences of elderly people living alone during the COVID-19 pandemic: Phenomenological research
Authors: Ilgaz A , Sert E , Gozum S , Oncel S 
Published: October 2023

Abstract

Background
One of the groups most affected by the COVID-19 pandemic, with a high mortality and morbidity rate, is the elderly. Among these, one of the most affected groups is the elderly living alone. No study has been found in the literature that questions the experiences of the elderly living alone in this process in detail. It is aimed to explore the experiences of elderly individuals living alone during the COVID-19 pandemic, and to address this process and the problems they experience with all aspects in terms of health.

Methods
In qualitative research, a phenomenological approach was adopted, and this study was conducted with 14 elderly people living alone. Individual in-depth face-to-face interviews were conducted. A semi-structured interview form was used in the interviews. Content analysis was used in the analysis of the data. Kappa analysis was performed to determine the internal consistency of the responses from the experts. Cohen's kappa coefficient was 0.95, which means a perfect fit.

Results
The mean age of the individuals was 76.14±7.04 and 71.4% of the participants were women. The main themes identified were a) the effects of pandemic restrictions, b) the view of the elderly on pandemic rules, c) physical, d) mental and e) social health problems, f) coping strategies of the elderly, g) support received in problem solving, h) and solution suggestions from the elderly.

Conclusions
Pandemic restrictions in elderly individuals living alone have caused disruption of health checks and changes in daily life. The elderly experienced physical, mental and social health problems during the pandemic and developed coping strategies to combat the process. The experiences of the elderly and their suggestions should be taken into account in being prepared for any crisis that may affect the whole society, especially the elderly living alone.

Key messages
• The elderly living alone experienced physical, mental and social health problems during the pandemic period.
• During the pandemic period, the elderly are affected in many ways such as economically, socially, etc. In this process, they developed coping strategies and gave suggestions for the next crises.
Integration of prison health care into national disease surveillance and health informatic systems: opportunities and challenges for Europe and beyond
Authors: O'Moore E 
Published: October 2023

Abstract
Approximately six million people are incarcerated annually in the WHO EURO region. The majority of these people spend only a minority of their lives in prison. Many people living in prison (PLP) experience significant health & social care inequalities/inequities and have higher levels of health & care needs than their peers in the community. Imprisonment can represent a public health opportunity to identify and address such needs. Programmes delivered in prisons targeting infectious diseases like HBV, HCV, HIV and tuberculosis (TB) can improve active case finding specifically in prison settings but can also impact on elimination and control targets for whole populations by addressing high risk transmission networks centred in and around prison associated populations. But too often prisons represent a ‘black hole’ for health & care data flows, neither receiving health information from community-based health systems nor providing, in an accessible way, details of health interventions delivered in prisons. The result is discontinuity of care and inefficiencies (economic&clinical) in treatment and care programmes. For example, people being screened multiple times for an infection (e.g. HCV) but not receiving treatment, or starting and stopping multiple courses of treatment in a chaotic way which could add to public health risks, e.g. multi-drug resistant TB. National disease surveillance systems missing data on prison populations also risk health security given the ability of prisons to amplify infectious diseases which could pose health threats to wider communities. Significant efforts are required to ensure that national disease surveillance and health information systems routinely include PLP to improve health intelligence, health security and continuity of care. This can support delivery of screening, diagnostic and therapeutic services. But can also enable health service evaluation, health & care needs assessment, and quality improvement programmes.
Sociodemographic disparities in burden of osteoporosis among Swedish adult and elderly population
Authors: Gao M , Scott K , Falkstedt D , Mishra G , Grünberger I 
Published: October 2023

Abstract

Background
Osteoporosis is a common skeletal disease. Previous research has been primarily based on non-prospective designs, and rarely included male and/or migrant populations. We investigated the associations of sociodemographic characteristics with risk of osteoporosis in a Swedish nationwide cohort.

Methods
This register-based prospective study included 1,900,279 males and 1,961,619 females born in 1920-1960, followed for osteoporosis from age 50 until December 31, 2012. Multivariable Cox regression was used to estimate the associations with sociodemographic characteristics and was stratified by gender and co-occurrence of fractures.

Results
12,906 males and 84,621 females aged 50-92 years received a diagnosis of osteoporosis. Incidence rates increased sharply from age 70. At all ages, women on average had 5 times higher rates of receiving first osteoporosis diagnosis than men. Region of birth and education were associated with incidence of osteoporosis in a gender-specific pattern. Compared to Swedish-born women, incidence of osteoporosis without fracture was elevated among female migrants from the former Soviet states (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.51-1.73) and the Middle East (HR, 1.62; 95% CI, 1.48-1.78), but lower among those from other Nordic countries (HR, 0.94; 95% CI, 0.91-0.97). Compared to Swedish-born men, a higher incidence was observed for male migrants from North America (HR, 2.03; 95% CI, 1.47-2.81). When fracture was accounted for, Swedish-born individuals showed higher incidence compared to migrants from other European countries except Nordic. For all osteoporosis subtypes, higher education was associated with increased incidence in women but not in men.

Conclusions
Incidence of osteoporosis varies with age, sex, country of origin, length of stay, and educational level. Sociodemographic disparities in osteoporosis need to be considered by healthcare sectors for targeted interventions to reduce future fracture rate.

Key messages
• This study demonstrates a large burden of osteoporosis in the Swedish adult and elderly population.
• Sizeable sociodemographic disparities in osteoporosis exist even within a country with universal healthcare.
Digital public health in Germany
Authors: Maass L 
Published: October 2023

Abstract
The German healthcare system is complex, with different levels of government and stakeholders involved. Therefore, implementing a consistent and cohesive digitalisation strategy nationwide is challenging. Unsurprisingly the system seems to operate according to the mantra: “From the cradle to the grave: forms, forms”. It is still one of the most paper-based healthcare systems in Europe. Until 2021, there were no electronic health records. Electronic prescriptions are delayed until 2024. The systems structures appear stuck and inflexible. The COVID-19 pandemic displayed the weaknesses of the German healthcare system: A lack of digital infrastructure, limited access to teleconsultations and telemedicine, healthcare professionals lacking training in digital health tools, etc. However, instead of giving up, there was a push from the industry and legislators toward applying more digital tools in the healthcare routine. Germany was among the first countries to develop one of the safest contract tracing apps worldwide (Corona-Warn-App). It further lifted its restrictions on telemedical consultations and was the first country to introduce medical and care apps on prescription (DiGA and DiPA). Additionally, the first national health portal was introduced in 2020 to provide the general population with information on health- and disease-related topics and an overview of currently implemented and planned digital health services. Now, it is discussed setting up a national Health Data Lab to empower public health research through secondary data based on health insurance claims data. Nevertheless, the question remains where the German legislative sees the role of health promotion and primary prevention. While public health associations push for recognising these crucial aspects of public health, all national projects currently focus on diagnostics and treatment. The question remains if and when Germany will realise the potential of digital public health in primary health promotion.
Prenatal counseling and maternal health behavior: The case of Ramadan fasting during pregnancy
Authors: Witte P , Van Ewijk R , Pradella F 
Published: October 2023

Abstract

Background
Ramadan during pregnancy has been found to be associated with various adverse health effects in the offspring, which are largely attributed to maternal intermittent fasting. At the same time, many pregnant Muslims decide to fast during Ramadan. With a growing Muslim population in Europe, Ramadan fasting during pregnancy may become an even more prominent issue in the future. Since pregnant women regularly exchange with healthcare professionals, it is pivotal to evaluate the role of prenatal consultation on Ramadan for the maternal fasting decision.

Methods
This study uses survey data on pregnant Muslims from Mainz, Germany (N = 326). Data on fasting during pregnancy, consultation with healthcare professionals on fasting during pregnancy, as well as a rich set of socio-economic background characteristics were collected. We estimate the effect of prenatal consultation on the number of days fasted using a log-normal hurdle model. To test whether our controlled estimates might be biased by unobservable confounders, we use the Oster (2019) method.

Results
The share of women who fasted at least one day was 36.5% (mean: 17 fasted days). Among these women, receiving prenatal consultation on fasting during pregnancy reduced the number of fasted days by 10.8 days (95% CI: -19.03, -2.56). Results from the Oster method show that this result is not biased by unobservable confounders.

Conclusions
This study shows that prenatal consultation on Ramadan fasting reduces the number of fasted days among pregnant Muslims who intend to fast during pregnancy. These findings imply that prenatal caregivers should be encouraged to discuss Ramadan fasting with their Muslim patients. Further research is needed to develop guidelines for prenatal advice on Ramadan during pregnancy in a framework of shared decision-making.

Key messages
• Controlled effect estimates show that potentially harmful maternal Ramadan fasting behavior during pregnancy can be mitigated by prenatal caregivers.
• This study demonstrates a novel way to exploit real-world data in the absence of randomization by quantitatively assessing the impact of unobservable confounders.