bluuebunny/crossref_metadata_2025_split huggingface dataset:
Environmental Impact of Diets in 10 European countries
Authors: Alves R , Perelman J , Chang K , Millett C 
Published: October 2023

Abstract

Background
A growing consensus suggests that dietary changes have the potential to lessen the environmental impacts of food production. We performed a cross-country comparison of dietary patterns and their associated environmental impact in Europe, including by socio-demographic factors.

Methods
We analyzed pooled cross-sectional 24/48/72-hour dietary records collected during 2010-2018 from 10 European countries using the European Food Safety Authority (EFSA) Comprehensive European Food Database (16,508 adults; age 18-79 years). Each food consumed was mapped to the corresponding environmental impact data using the SHARP Indicators Database, which provides greenhouse gas emission (GHGE kgCO2-eq/day) and land use (LU m2*year/day) values for approximately 900 foods. Multivariable linear regression models were used to compare diet-associated GHGE and LU between population subgroups (gender, age, education, and diet type) with country-level fixed effects. We also analyzed the contributions of major food groups to the mean daily total of GHGE and LU for each country.

Results
The mean dietary GHGE and LU per capita ranged from 4.0 kgCO2eq and 5.0 m2*year in Spain to 6.5 kgCO2eq and 8.2 m2*year in France. Diet-related GHGE and LU (per Kg/food) were lower amongst females (2.6kgCO2eq, B=−0.08, P &lt; 0.01; 3.2m2*year, B=−0.11, P &lt; 0.01), people aged 66-79 (2.6kgCO2eq, B=−0.03, P &lt; 0.01; 3.4m2*year, B=−0.4, P &lt; 0.01), people following vegetarian diets (1.7kgCO2eq, B=−0.07, P &lt; 0.01; 2.0m2*year, B=−0.07, P &lt; 0.01), and higher amongst individuals with secondary education (2.7kgCO2eq, B = 0.04, P &lt; 0.01; 3.6m2*year, B = 0.05, P &lt; 0.01).

Conclusions
The impact of specific food groups on environmental footprints varies across countries and between different socio-demographic groups, signaling that cultural, literacy and generational factors possibly contribute to determine consumers’ environmental footprints.

Key messages
• The environmental impact varies across nations and socio-economic groups, highlighting the significant role played by cultural and generational factors in shaping consumers’ environmental footprints.
• The study findings are crucial for the development of country-specific food policies aimed at promoting environmentally friendly diets.
Vaccine hesitancy among migrants and refugees in Europe: from the local to global perspective
Authors: Gańczak M , Jansen D , Vervoort JPM , Filakovska-Bobakova D , Karnaki P 
Published: October 2023

Abstract

Background
Vaccine hesitancy (VH) in migrants and refugees (M/R) undermine the prevention of communicable diseases. Scientific research is valuable regarding its potential for producing analyses to better understand the phenomenon.

Objectives
To present findings of the 1st phase of the RIVER-EU project on vaccination among M/R populations. To provide a more comprehensive - from local to global - perspective by reviewing the evidence of the problem.

Methods
During the 4th quarter of 2022 qualitative studies were conducted which described barriers to vaccination among the Ukrainian M/R (Poland); M/R (Greece); Turkish/Moroccan adolescent females (Netherlands); the Roma community (Slovakia). VH exploration was an important ‘by-product’ of the project. This presentation will go beyond research results - a review of the existing evidence will help contextualize our findings.

Results
VH among M/R depended on a variety of factors, which differed between countries and selected communities and were deeply rooted in geographical, political but also cultural and social context. For example, drivers of HPV VH among the Ukrainian M/R in Poland were influenced by personal risk perception, such as self-perceived risks and severity of illnesses caused by the virus; these were fueled by low awareness, lack of credible information in Ukrainian language, and lack of satisfactory education. Lack of confidence in the quality, safety and effectiveness of the HPV vaccine distributed in Ukraine, powered by the loss of trust in medical staff/governmental institutions, due to the universal bribery and corruption in the health sector, also played an important role. Deprioritization of the HPV vaccine caused by misconceptions about non-mandatory vaccinations also influenced VH.

Conclusions
A better understanding of VH in M/R groups, with the help of the monitoring over longer periods of time is urgently needed. Monitoring M/R VH can inform needed interventions to support vaccine acceptance.
Excess mortality in low-and lower-middle-income countries: A systematic review and meta-analysis
Authors: Gmanyami J , Jarynowski A , Belik V , Lambert O , Amuasi J H , Quentin W 
Published: October 2023

Abstract

Background
The COVID-19 pandemic caused a massive death toll, but its effect on mortality remains uncertain in low- and lower-middle-income countries (LLMICs). This review summarized the available literature on excess mortality in LLMICs, including methods, data sources, and drivers of excess mortality.

Methods
A protocol was registered in PROSPERO (ID: CRD42022378267). We searched PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Scopus for studies conducted in LLMICs on excess mortality which included at least a one-year non-COVID-19 period as the comparator, and with publication date from 2019 to date. The meta-analysis included studies with extractable data on excess mortality, methods, population size, and observed and expected deaths. We used the Mantel-Haenszel method to estimate the pooled risk ratio with 95% confidence intervals.

Results
The review included 21 studies (5 from Africa), of which 11 were included in the meta-analysis (2 from Africa). Of 1,405,128,717 individuals, 2,161,846 deaths were expected, and 3,633,661 deaths were reported. The pooled excess mortality was 104.7 deaths per 100,000 population. The risk of excess mortality was 1.68 (95% CI: 1.67, 1.68 p &lt; 0.001). Data sources included public cemeteries, civil registration systems, obituary notifications, surveys, funeral counts, burial site imaging, and demographic surveillance systems. Techniques used to estimate excess mortality were mainly statistical modelling and geospatial analysis. Of the 21 studies, only one reported on drivers of excess mortality and found higher excess mortality in urban settings.

Conclusions
Our results show that excess mortality in LLMICs during the pandemic was substantial even if it was considerably lower than in high-income countries. There is uncertainty around excess mortality estimates given comparatively weak data. Further studies are needed to identify the drivers of excess mortality by exploring different methods and data sources.
Communicating evidence synthesis: co-designing summary formats with end users
Authors: Murray R , Lynch R , O'Neill M , Smith S M , Mahtani K R , Ryan M , Clyne B , Sharp M K 
Published: October 2023

Abstract

Background
Evidence syntheses are essential to the creation of evidence-based guidelines that guide health care. Findings from our recent mixed methods systematic review (MMSR) identified no gold standard format for communicating summaries of evidence syntheses to guideline development groups. This is important as these groups are comprised of patients, healthcare providers, policymakers, etc., who all have different expertise, perspectives and priorities. Our overall aim is to develop evidence-informed prototype summary formats for use in guideline development. To inform this process, we held online co-design focus group workshops shaped by findings from our MMSR.

Methods
We held six focus groups with 30 participants involved in developing guidelines and/or evidence synthesis (February - March 2023). The topic guide was informed by the MMSR -- focusing on recommendations with mixed methods support, ≥3 supporting studies, and those prioritised by an expert advisory group through a pragmatic prioritisation exercise using the MoSCoW method (Must, Should, Could, and Will not haves). Focus groups were recorded and transcripts were analysed using a directed content analysis.

Results
Participants suggested a “less-is-more” structured approach that minimises methodological steps and statistical data, promoting accessibility to all audiences by judicious use of links to the full technical report. They emphasized the importance of concise consistently-presented formats which emphasize key messages, flag readers to indicators of trust in the producers (i.e., logos, websites, and conflict of interest statements), and highlight the quality of evidence.

Conclusions
Project findings are informing the creation of accessible and actionable guidance on best-practices for creating summary formats. Next steps involve user-testing prototype formats through semi-structured interviews which will then be integrated into the National Clinical Guideline development process in Ireland.

Key messages
• Co-design workshops delineated key aspects of effective and acceptable evidence synthesis summary formats to help create reproducible format templates for use in clinical guideline development.
• Creating summary formats accessible to all guideline development group members will promote better communication and translation of research evidence into recommendations and practice.
Physical illness and changes in spousal depression: a register study on Finnish middle-aged couples
Authors: Metsä-Simola N , Volotinen L , Martikainen P 
Published: October 2023

Abstract

Background
Physical health decline may affect family members’ mental health by causing distress and, in case of functional impairments, need to provide care. We examined how diseases common in midlife but with different disease progression and level of impairment are associated with short-term and long-term changes in spousal depression.

Methods
We used Finnish total population register data from 2000-2019 to identify 91,849 men and 70,836 women aged 30-70 that experienced onset of severe diseases without cognitive impairment (myocardial infarction, prostate cancer, breast cancer), conditions with sudden onset and immediate impairment (stroke, traumatic brain injury) or progressive conditions with increasing impairment (Parkinson's disease, multiple sclerosis, dementia) while living with a spouse. We measured depression with antidepressant purchases and used fixed-effects linear probability models to examine spouses’ depression trajectories before and after onset of spousal disease

Results
Preliminary findings show that the onset of any type of spousal illness is associated with an increase in depression. Among men this increase is similar in magnitude irrespective of the type of spouse's illness, whereas among women the increase is smaller if the spouse is diagnosed with a disease without cognitive impairment. When the spouse is diagnosed with a progressive condition, female spouses’ depression increases more gradually, whereas a large immediate increase in depression follows sudden onset conditions. One year after diagnosis there are little changes in spousal depression.

Conclusions
Diseases common in midlife increase spouse's risk of depression around the time of diagnosis, and the effect appears persistent. Adequate support should thus be available to family members from the start of physical illness. When planning support to female spouses, the male spouse's cognitive impairment and associated care needs should be carefully evaluated.

Key messages
• Diseases common in midlife increase spouse's depression risk around the time of diagnosis, and the effect appears persistent. Support to spouses should be available from the start of illness.
• Cognitive impairment of the male spouse seems to increase female spouse's depression particularly strongly, suggesting that caregiving help could be especially beneficial for women.
Assessing national policies on labour migration and health: data from IOM's Migration Governance Index
Authors: Profili C 
Published: October 2023

Abstract
Much of the empirical research work on labour migration and health has been in low to middle income countries and labour sending countries, with little data from Europe. The IOM will explore current policy and practice, and evidence gaps, in Europe, and discuss their Migration Governance Index, which assess migration in relation to labour and health access https://www.migrationdataportal.org/overviews/mgi. The MGI helps governments, upon request, take stock of their migration policies and strategies to identify good practices and areas with potential for further development.
Policy developments on labelling for a more sustainable food system
Authors: Gokani N 
Published: October 2023

Abstract
Governments across Europe are developing policies which promote healthier, more sustainable food choices. This presentation explores these policies with a focus on the EU. In May 2020, the European Commission published its Farm to Fork Strategy which acknowledged the inextricable links between healthy people, healthy societies and a healthy planet. This committed to introduce legislative proposals to revise rules on food labelling for consumers. On the one hand, focusing on health, the Commission committed to introduce harmonised front-of-pack nutrition labelling, nutrient profiling criteria to restrict claims made on foods, extending mandatory origin or provenance information for certain products, and revise the rules on ‘use by’ and ‘best before’ dates by 2022. These commitments were reinforced by Europe's Beating Cancer Plan, which further committed to introduce mandatory ingredients list and nutrition declaration as well as warnings for alcoholic beverages by 2023. On the other hand, the Commission also committed to introduce a Sustainability Labelling Framework to empower consumers to make informed and sustainable food choices by the end of 2024. In synergy with other labelling initiatives - such as animal welfare labelling, ‘green claims’ organic labelling and those described above - it is meant to cover the provision of consumer information relating to the nutritional, climate, environmental and social aspects of food products. The Commission has already missed its 2022 deadlines and all suggestions point to it missing its 2023 and 2024 deadlines. This presentation will summarise the development so far, suggest how the EU should move forward and highlight barriers to implementation. Discussions on how to move forward will be held with the audience.
Effectiveness of antimicrobial interventions in animal production: systematic review & meta-analysis
Authors: Costa M M , Cardo M , Ruano Z , Alho A M , Dinis-Teixeira J , Aguiar P , Leite A 
Published: October 2023

Abstract

In animal production, the rational use of antimicrobials has been promoted to decrease antimicrobial resistance (AMR) in microorganisms. This systematic review evaluated the effectiveness of interventions to reduce/adequate antimicrobial use and decrease AMR. Articles were identified in PubMed, Scopus, The Cochrane Library, Web of Science, and grey literature in DANS EASY, WorldCat, RCAAP. Eligible studies included original studies, assessing broiler/pig populations, antimicrobial interventions, comparator with standard/no use of antimicrobials, outcomes related to AMR, farm level and analytical observational studies. Meta-analysis was conducted for combinations including type of intervention, bacterial species, production type, population. Interventions effectiveness was estimated using odds ratio of resistance to antimicrobial substances/classes by bacteria and populations with and without intervention. A total of 46 studies were eligible. For broilers, restrictions were all non-therapeutic use (46%), complete restriction (27%), prohibition on antimicrobials used for growth promotion (23%). For pigs, restrictions included: all non-therapeutic use (37%), complete restriction (37%), group treatments (22%). For meta-analysis (21 studies), combinations indicated a protective effect for most antimicrobial classes in E. coli, Campylobacter and Enterococcus and broilers, and Escherichia coli and Campylobacter and pigs, compared to conventional production or without intervention. An increased odds of resistance were observed for cephalosporins in E. coli and broilers raised without antimicrobials, and to fluoroquinolones/quinolones in Campylobacter and pigs raised without antimicrobials, compared to conventional production. Our study revealed that organic, antimicrobial-free farms and group treatment restrictions in conventional production were mostly associated with AMR reduction, providing information on available options that may support decision-making to tackle AMR.

Key messages
• Organic/antimicrobial-free farms indicated a protective effect on resistance to most antimicrobials.
• Fluoroquinolones resistant Campylobacter may persist in pigs raised without antimicrobials.
Has the COVID-19 pandemic changed non-COVID-19 healthcare utilisation patterns across Europe?
Authors: Aldridge S J , Schmidt A E , Owens R , Dolanski-Aghamanoukjan L , Mathis-Edenhofer S , Lyons R A 
Published: October 2023

Abstract

As SARS-COV-2, the virus responsible for the COVID-19 pandemic, spread across Europe in the first half of 2020, countries deployed a range of responses to mitigate its spread and reduce mortality. Most countries adopted some form of “social distancing”, restricting movement and contact between households in order to minimise the burden on healthcare systems. During this time a dramatic fall in non-COVID-19 related healthcare utilisation (HCU) has been observed universally. We aim to quantify this change in HCU across 7 European countries during and following the COVID-19 pandemic. Identifying to what extent different types of HCU have recovered, and the associations between these HCU and COVID-19 infection and hospitalisation rates. We gathered aggregated age standardised longitudinal health and administrative data from 7 European countries between 2017 and 2021 using standardised scripts held in the PHIRI Docker Application to examine the impact of COVID-19 on HCU. We deploy a meta-analysis using a combination of forecasting and generalised linear models to investigate the association between local COVID-19 metrics and three types of HCU: emergency cardiovascular incidents, elective surgeries, and severe trauma admissions. Results vary markedly by country and show an association both with general incidence rates and public health measures taken in the course of the pandemic, based on the OxCGRT index. We provide a first-time comprehensive cross-European analysis of the indirect effects of the COVID-19 pandemic with lessons for sustainable and resilient health systems in crisis times. More research is needed to understand the drivers at the national and subnational level within welfare state contexts.

Key messages
• Patterns of healthcare utilisation changed dramatically during the COVID-19 pandemic, but to varying degrees across Europe.
• The PHIRI framework allows coordination with a number of European groups enabling a much more substantial analysis on healthcare utilization.
Factors influencing engagement in advance care planning in the community: A mixed-research synthesis
Authors: Pilch M , Cooper Lunt V , Hickey A , Thomas S , Hayes C , Kaminiecki B , Korpak J , Mockler D , Doyle F 
Published: October 2023

Abstract

Background
The development of innovative Advance Care Planning (ACP) health behaviour change interventions for adults (≥50 years old) in the community should be informed by a findings synthesis. The objectives of this review were to (a) identify stakeholders' perspectives on facilitators and barriers to ACP behaviours and (b) map these factors across the Capability, Opportunity, and Motivation dimensions of behaviour (COM-B model).

Methods
This hybrid mixed-research synthesis followed a published protocol. Content analysis was applied to the results sections of the included studies. Data transformation and triangulation processes underpinned findings integration (4,5).

Results
The review included 117 records and studies recruited patients (62%), service providers (29%), and trusted others (9%). ACP behaviours were ACP as a general concept, (41%), communication (28.7%), documentation (22%), decision-making (5.3%), or surrogate appointment (3%). Ten categories of influencing factors were identified, ranked according to frequency of reporting. They included Connectedness, Psychological Factors, Metapreferences, Service Provision, Temporality, Sociodemographic Characteristics, Literacy, Resources, Experience, and Macro-Level Factors. Their sub-categories (52 in total) were mapped across the COM-B model. The most frequently reported Motivation sub-categories were Comfort and Readiness (n = 78), Actors and Roles Requirements (n = 56), and Perceptions and Beliefs (n = 45). The Opportunity dimension included Communication and Understanding (n = 43), Effect of the Other (n = 42), and Involvement and Collaboration (n = 41). The top Capability sub-category was ACP literacy (n = 43).

Discussion
The triangulation of stakeholders' perspectives facilitated identification a complex array of factors influencing ACP behaviours. Their mapping across the COM-B model informed future research, policy, and ACP intervention development.

Key messages
• Stakeholders’ engagement in ACP behaviours is influenced by a complex array of factors, with the majority of them falling into the categories of motivation and opportunity.
• Future ACP interventions design need to build on this learning and develop strategies and policies that support meaningful stakeholders’ engagement in ACP activities, including their collaboration.
Implementing an action plan for the WHO designated Cork Healthy City, Ireland 2020-2030
Authors: O'Mullane M , Cahill D , Cronin J , Harford K , Ní Chonchúir A , Young M , Syron M , Davoren M , Fitzgerald T 
Published: October 2023

Abstract

Issue
With current UN predictions that by 2050 two thirds of the planet's citizens will live in cities, a Healthy Cities approach promoting health equity and advancing the WHO One Health agenda is an important public health intersectoral process. This is the overarching mission of WHO designated Cork Healthy Cities, Ireland, which emphasizes a collaborative, community-led and inter-agency approach at the heart of its business.

Description
Cork Healthy Cities launched its ten-year action plan (2020-2030) to address the six themes (the 6 Ps) outlined for Phase VII of WHO European Healthy Cities Network: People, Places, Participation, Prosperity, Peace, and Planet. The Cork City Profile, which informs the action plan with an evidence-base, is an important interagency aspect to the work of Cork Healthy Cities.

Results
A range of actions for each of the 6 Ps have been planned within the Cork Healthy Cities Action Plan. Results from sample projects for each of the 6Ps will be presented, including Child Friendly City (People); Let's Play Cork (Places); Sexual Health Network (Participation); Deliver the PSYCHED (Positive Support You Can Have Every Day) Initiative (Prosperity); the development of the Trauma Informed City (Peace); and Green Spaces for Health initiative (Planet).

Lessons
The actions outlined above have been included in the Cork City Development Plan (2024-2028), providing evidence of the public health actions being integrated into local government strategic planning processes. The collaborative and intersectoral experience of Cork Health Cities provides important learning for other cities across Europe. Public health actions within the Cork Healthy Cities Action Plan were the first of their kind in an inter-agency partnership platform such as Healthy Cities in Cork.

Key messages
• Create meaningful working relationships across public health, city council, researchers, and community groups.
• Engage with city planning to develop an environment for positive health for all.