bluuebunny/crossref_metadata_2025_split huggingface dataset:
Designing comprehensive and politically feasible food environment policy: the promise of packaging
Authors: Wahnschafft S , Spiller A , Lemken D , von Philipsborn P 
Published: October 2023

Abstract

Policy packaging has been identified as a promising approach to increase public support for effective and comprehensive policymaking by bundling measures that are unpopular from a behavioral and/or fiscal perspective with those that are popular; however, this potential has yet to be examined for improving food environments to promote healthy diets. We examine public preferences for a policy packaging approach amongst eligible voters in Germany (N. 1,200), as well as which policy design and voter characteristics underpin said preferences, via a survey-embedded conjoint experiment. Policy package attributes are drawn from recommended measures for improving food environments in Germany based on the INFORMAS Food-EPI assessment. We examine three inclinations towards policy packaging: those who are (1) resistant, (2) inclined, but sensitive to the design, and (3) enthusiastic, irrespective of design. We use linear and logistic regression models to examine the effect of policy design attributes and voter characteristics on policy package support inclinations. Most voters (73%) were inclined towards policy packaging, but sensitive to package design. We found that ‘costly’ measures - I.e., those that restricted or disincentivized unhealthy behaviors - were generally less popular than ‘compensatory’ ones - I.e., those that enabled or incentivized healthy behaviors - in policy packages; however, most participants preferred some combination of both. Participant beliefs regarding the topic of food environment policymaking predicted packaging preferences more so than any socio-demographic, political, or health characteristic. Packaging policy measures together, particularly those with counteracting effects across behavioral and fiscal axes, allows for more comprehensive and politically feasible policymaking to improve food environments. Enhancing science communication on environmental drivers of food choices is vital to bolster support for food environment policy packages. .

Key messages
• There is an appetite amongst voters for improving food environments that extends beyond the adoption of single measures, and rather towards a policy packaging approach.
• Communication that fosters a paradigm shift towards acknowledging environmental influences on diet and health would be vital for fostering support for comprehensive food environment policy packages.
Precarious housing and health inequalities in Spain since the crisis
Authors: Caroz Armayones J M 
Published: October 2023

Abstract

Background
Housing is considered crucial to human existence and has been recognized as a key social determinant of health. However, the “housing question” has become a major issue in high-income countries. In this context, the concept of precarious housing has emerged to describe the increasing prevalence of insecure and unstable housing conditions. However, its research has been limited to very specific national and temporal contexts. To address this gap, the present paper aims to study the predictors of precarious housing and its impact on health inequalities in the Spanish context since the GFC.

Methods
The methodology will consist of a multilevel analysis of pooled cross-sectional data from the Spanish Survey of Living Conditions (ECV) 2007-2020 (N = 51882) to identify the predictors of housing precariousness. Then, we are going to examine the associations between precarious housing and health outcomes and inequalities through multivariate logistic regressions.

Results
Our descriptive results show that precarious housing has become a persistent problem in the Spanish context. Furthermore, we found that precarious housing levels are unevenly distributed across the population along axes of inequality. In this respect, tenure status emerges as a critical predictor. Compared to outright homeowners, mortgage homeowners, market rental tenants, social rental tenants, and free cession dwellers experience significantly higher levels of housing precariousness (RR: 6.53, CI: 5.97 - 7.15; RR:8.10, CI:7.37-8.91; RR:5.72, CI:5.06-6.48; and RR:1.41, CI:1.21-1.65 respectively). Finally, we show that precarious housing conditions are significant predictors of health outcomes and inequalities. The odds ratio (OR) of reporting lower self-reported health increases with the number of precarious housing levels: 1.68 (CI: 1.52-1.85) for one level, 2.43 (CI: 1.94-3.03) for two levels, and 3.55 (CI: 2.23-5.67) for three levels.

Key messages
• Precarious housing is influenced by axes of inequality such as age, gender or nationality.
• Health inequalities are strongly associated with precarious housing conditions.
Planning matters: a document analysis of 23 Portuguese national health programs
Authors: Lima D , Costa S , Pinheiro-Guedes L , Barbosa S , Salvador S , Carvalho A , Morais Vilaça I , Oliveira P , Teixeira M , Barbabela R , Vieira A , Caveiro D , Chaves A C , Leão T 
Published: October 2023

Abstract

Background
Health planning is crucial for effective public health interventions and optimal use of resources. Portugal has a long history of developing health plans and programs, with the General-Directorate of Health (GDH) publishing programs for communicable and noncommunicable diseases. Yet, these programs’ evaluation is rare, not only in terms of results but also in their design and content. This study aimed to analyze all available GDH programs to assess their structure and content.

Methods
We performed a document analysis of the 23 national health programs, analyzing the items well-established by the literature as fundamental to be present in these plans and programs. Each program was analyzed independently by two independent researchers, and discrepancies were resolved within the authors’ group. Besides assessing items as present or absent, comments were added.

Results
Programs largely varied: of the 23 programs, 17 were outdated, and four were dispersed among multiple documents. Sixteen complied with at least 75% of the predefined items, with priority programs having a higher compliance rate compared to non-priority ones (83% vs 33%). The definition of goals was the most commonly fulfilled criterion, present in 91.7% of the analyzed documents. Though, the time scope of the programs was updated only in 20.8% of the programs, accounting for the criterion least commonly met.

Discussion/Conclusions
Despite being published by the same institution, the programs analyzed were heterogeneous, and most were not updated. Establishing a standardized structure for the design of these health programs would ensure that fundamental items are present, accelerate the update of the programs, and facilitate communication and collaboration with partners and stakeholders in public health

Key messages
• This study analyzed 23 national health programs published by the Portuguese General-Directorate of Health (GDH) and found great heterogeneity in their structure and availability.
• Establishing a common standardized structure for health planning is essential to ensure all fundamental aspects are taken into consideration and improve communication and stakeholders partnership.
Perception of informal care for elderly by healthcare and social care workers in Kazakhstan
Authors: Zhylkybekova A , Koshmaganbetova G , Grjibovski A , Glushkova N 
Published: October 2023

Abstract

Background
The challenges of providing care for the elderly are often underestimated by the general public. Informal caregivers for the elderly frequently require support, and this issue is the subject of much attention in developed countries worldwide. However, it remains a blind spot in post-Soviet countries, particularly Central Asia. The purpose of this study was to investigate the perceptions of informal care for the elderly by healthcare and social care workers in Kazakhstan.

Methods
Ten key stakeholders were interviewed using a semi-structured interview. The sample included three managers, two general practitioners, one district nurse, two social workers, and two psychologists. The thematic qualitative study was conducted between October and November 2021. The data analysis was conducted using MAXQDA 2022 software.

Results
Most of the interviewed workers believe that caring for elderly parents is the duty and responsibility of their children, which is in line with the norms of law and the culture of society. While there is a general understanding that caring for the elderly presents challenges for informal caregivers, there is no consensus among workers on the necessary support to provide them. It is important to note that informal caregivers for the elderly are not identified or registered, and medical services are only provided in response to complaints, without regard for their specific needs. There is also no assessment of the caregiver's burden or quality of life. Additionally, necessary psychological assistance and counseling are not provided.

Conclusions
To address these issues, it is necessary not only to change the legislative framework, but also to improve communication between services, as well as to conduct ongoing informational work with healthcare and social care workers about the needs and requirements of those who provide care for the elderly.

Key messages
• Legislation is needed in Kazakhstan to support informal caregivers for the elderly, including their identification and registration, and their inclusion in medical and social assistance programs.
• Need train healthcare and social care workers to be attentive to the needs of both the elderly and their caregivers, including assessing their mental health and preventing psychological breakdowns.
Health and quality of life development plan: from theory to practice
Authors: Carmezim Pereira S , Godinho Simões D , Durão J , Martinho J , Alho M , Pita Ferreira P , Sequeira R , Sousa P , Campos Fernandes A 
Published: October 2023

Abstract

In 2019, a decentralization process in Portugal transferred health governance competencies and autonomy from central to municipal level. Despite empowering local authorities to shape health policies and strategic partnerships, municipalities turned to academia for public health planning expertise. This work depicts how the National School of Public Health devised a Health and Quality of Life Development Plan for one such municipality. A two-stage approach was used. Firstly, a comprehensive overview of population health status and determinants was produced. It involved analysing local and national legal frameworks and worldwide strategic literature; assessing sociodemographic, economic, environmental and health indicators; questioning residents and key stakeholders; and city council and local health authorities working sessions. Secondly, detailed strategies were laid out to address specific health needs and determinants. It involved analysing similar municipal plans; selecting priority health actions; and designing evidence-based interventions with target, timeline, estimated resources and outcomes measures. The authors built and applied a public health planning methodology, resulting in a profound health diagnosis. Public and stakeholder scrutiny ensured prioritization of key action areas and effective working pathways in strategic planning were introduced. Furthermore, evidence-based actions adapted to local capacity, budget and resources were presented. Outputs range from health literacy sessions in schools to contingency plans for public health emergencies. Health governance responsibilities’ redefinition evidenced a knowledge gap and drove the need to consult academia to develop evidence-based health policies. By creating this methodology, the authors defined strategic pillars and tailored operational recommendations for municipalities, which rely on ongoing indicator monitoring and, ultimately aim to improve population health through concerted efforts.

Key messages
• The decentralization of health competencies granted local autonomy in shaping health policies. To support decision and policy-making, a comprehensive tool for health diagnosis assessment was designed.
• The need for a concerted local action with definition of territorialized development strategies, highlights the value of a deep connection between decision-makers and academia as a consulting entity.
From genome inspection to clinical significance: source attribution of a foodborne botulism outbreak
Authors: Arnaboldi S , Magagna G , Monastero P , Todeschi S , Bornati L , Losio M N , Finazzi G 
Published: October 2023

Abstract

Background
Foodborne botulism is a neuro-paralytic disease caused by the ingestion of botulinum neurotoxins (BoNTs). Given its high fatality rates and economic consequences, prompt management of human cases requires collaboration among public health authorities, supporting hospitals in rapid diagnosis, food inspections, and formal analysis. This study aims to investigate the food source responsible for a botulism outbreak in Northern Italy, which resulted in the hospitalization of a person.

Methods
Faecal specimen from the patient, and suspected food were collected (industrial-made asparagus cream, both packages consumed and still closed). BoNT presence and identification was performed by mouse-test. After the enrichment in TPGY broth, samples were plated on CMM medium to observe the proteolysis, and on EYA medium for colonies isolation. DNA was extracted and genome was sequenced by Illumina MiSeq. Typing was performed by MLST. SNP-based phylogenetic analysis was conducted, including isolated strains from outbreaks occurred in the same year and geographic area.

Results
The strains were identified as group I proteolytic Clostridium botulinum, with BoNTB responsible for the outbreak. Faeces and the ingested food exhibited the same Sequence Type (ST178), differing by only one SNP. Notably, the closed package had a distinct ST (ST29), and a significant divergence from the outbreak strains (7282 SNPs). Conversely, the other strains displayed SNP differences ranging from 11116 to 46536.

Conclusions
Genome characterization enabled the identification of the outbreak source as the ingestion of BoNTB present in asparagus cream, suggesting also the circulation of several different strains of Cl. botulinum causing foodborne outbreaks. These findings highlight the ongoing public health concern of foodborne botulism, even in industrial-processed foods. Our study underscores the importance of source attribution and effective outbreak management in preventing hazardous botulism outbreaks.

Key messages
• Genome sequencing enabled the source identification of a foodborne outbreak caused by Cl. botulinum toxin B.
• Our study emphasizes the current significance of foodborne botulism as a public health issue.
Monitoring inequalities in cancer prevention and care in Europe
Authors: Stepien M , Rodriguez Rasero F , Ben E , Nicholl C 
Published: October 2023

Abstract

The European Cancer Inequalities Registry (ECIR), a flagship initiative of the Europe's Beating Cancer Plan, was launched by EC President Ursula Van der Leyen in February 2022. The aim of the registry is to identify, communicate and monitor inequalities in cancer prevention and care across Europe. The ECIR data tool presents cancer-related indicators on cancer burden, from prevention, screening and early detection, to diagnosis, treatment and quality of life of patients and survivors. Where possible, the indicators are presented along six inequality dimensions: country, sex, age, education, employment status and urbanisation. Furthermore, this data tool is complemented with regular reporting mechanisms, factsheets, and a roadmap that presents data quality criteria and future, planned enhancements of the data tool. Stakeholders can always submit suggestions for additional indicators. The data already reveals important socio-economic and demographic inequalities in cancer prevention and care. For example, in most EU countries obesity, low intake of fruits and vegetables or physical inactivity tend to be more prevalent for groups with lower education, income, or those living in rural areas. The same applies to participation in cancer screening. For example, the EU average for women eligible for breast cancer screening that reported not to have ever had a mammography is 11%. However, in some EU countries, this percentage is more than double. It is highly likely this contributes to the unacceptable differences in breast cancer 5-year survival. In conclusion, there are still striking geographical and socio-economic disparities observed for cancer prevention, screening or treatment indicators. By transparently communicating such observed inequalities in Europe, the ECIR data tool can help guide future financial EU investments, identify best practices to effectively tackle these inequalities and also monitor the effectiveness of the new cancer policies.

Key messages
• Inequalities in cancer prevention and care are observed among EU countries.
• ECIR helps to monitor cancer inequalities in Europe and guide financial investments.
The National Health Index shows regional differences in morbidity and workability loss in Finland
Authors: Koponen P , Lindell E , Sarnola K , Luoto R , Jousilahti P , Lumme S , Koskinen S 
Published: October 2023

Abstract

Background
The development of the National Health Index (NHI) aims to provide data on the need for social and healthcare services, and social security benefits, in relation to health problems with the greatest burden. It also aims to contribute to targeting preventive measures to promote wellbeing, health and workability.

Methods
Data from registers maintained by several national authorities were combined and compared to identify numbers of persons with diagnosis for care (ICD-codes), medication (ATC-codes) and/or received benefits in at least one of the data sources. To determine the burden caused by the different health problems, their prevalence was weighted based on the associated costs, effects on quality of life, mortality, and workability loss. Both age-standardised and non-standardised indexes were calculated for each region in relation to Finland's entire population (index 100).

Results
The subindexes show significant regional variation, index figures ranging from 28 to 148 for the disease groups: cancers, cardiovascular diseases, diabetes, memory disorders, musculoskeletal diseases, severe mental health problems, accidents, chronic respiratory diseases, and alcohol disorders, as well as for workability loss (sickness benefit, disability pension, vocational rehabilitation, index figures 27-242). The overall NHI was highest in northeastern regions, and lowest in the capital region and the western coast regions. Age standardization mitigated the regional differences.

Conclusions
The NHI and the subindexes provide information for evaluating and planning services and benefits. They can be used as key indicators in regional welfare reports. Regional differences in access to care and register data coverage may have an impact on the results. The next phase in our project will analyze socioeconomic differences and develop methods to forecast future trends, taking into account demographic changes and the potential for disease prevention.

Key messages
• The overall NHI results, covering ten disease groups, are in line with previous data on highest disease burden in northeastern regions.
• Differences in access to services and register data coverage need to be evaluated when interpreting the differences between regions, both in morbidity and in workability loss.
He who seeks finds: surveillance of Enteroviruses and Human Bocaviruses in Northern Italy wastewaters
Authors: Righi F , Mangeri L , Galuppini E , Tilola M , Bertasi B , Losio M-N 
Published: October 2023

Abstract

Background
Wastewaters surveillance has proven to be a valuable tool in detecting the spread of SARS-CoV-2 and other pathogens. Enterovirus (EV) and Human bocavirus (HBoV) are viruses that can infect humans, causing mild to severe pathologies transmitted also through the fecal-oral route. EVs are ssRNA viruses, grouped among four taxonomic species EV-A to D. HBoV is ssDNA virus mainly affects infants. Genus Bocavirus includes 4 genotypes: HBoV1 to 4, detected mainly in feces. EVs and HBoVs infections are often not notified, causing loss of data on the actual incidence. The aim of this study was to investigate the presence and diffusion of EVs and HBoVs in wastewaters.

Methods
200 wastewater samples were collected during 2022, at the inlet of wastewater treatment plants in three cities of the Lombardy Region (i.e.: Brescia, Bergamo, and Cremona). EVs and HBoVs were detected by RT Real-time PCR and Real-time PCR respectively using specific primers for target region of the viral genome. Positive samples were genotyped by Sanger sequencing. Prevalence was calculated with the Blaker's method.

Results
Overall EV and HBoV prevalences were 20.5% (CI95% 15.5-26.2%) and 37% (CI95%.30.6-43:9%), respectively. EV was mainly detected in the mild season with a prevalence of 68.3% (CI95% 53.0-80.4%). Sequence analysis reported that EV-B species was the most prevalent in this study (9 samples). HBoVs positive samples’ prevalence was higher in cold season (71.6% CI95% 60.5-80.6%), than mild season. HBoV2 showed higher prevalence (85.6% CI95% 75.6-92.0%) than HBoV3.

Conclusions
This study provided insight into the seasonal spread of EVs and HBoVs circulating and can contribute to understand the disease burden. Wastewaters surveillance provides a wide and more complete epidemiological data than the clinical one of a single person, rather providing information of a community of individuals making the data very valuable to the competent authorities.

Key messages
• Wastewaters surveillance is a useful tool for investigating the spread and circulation of viruses in population.
• EVs and HBoVS are widespread in Northen Italy population.