bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying quantitative evidence-based parameters to monitor emerging resistance to new antibiotics
Authors: Arieti F , Garlasco J , Magrini E , Tebon M , Compri M , Babu Rajendran N , Pezzani M D , Tacconelli E 
Published: October 2023

Abstract

Background
Antimicrobial resistance (AMR) has a major public health burden, and newly-approved molecules have shown fast emerging of resistance. This study aims at assessing and developing an innovative framework to monitor and benchmark emerging resistance to new antibiotics in Europe.

Methods
Within the European ECRAID-Base project and the EPI-Net platform, data were extracted at two levels: reporting of emerging resistance to the 12 new antibiotics approved by EMA since 2012 and related outbreaks, and active resistance monitoring in national surveillance systems in 32 European countries. The burden of emerging resistance was measured through the following indicators: time lag between approval and first resistance report, average number of outbreaks, trend in the number of yearly publications standardised by the logarithm of the total number and weighted by the pooled resistance rate, and inclusion of new antibiotics in national surveillances.

Results
Overall, 956 articles reported resistance to new antibiotics since 2012. Resistance to ceftolozane-tazobactam (CLZ-TAZ) was the most reported, followed by ceftazidime-avibactam (CAZ-AVI); resistance to eravacycline and delafloxacin was less reported. For 6 antibiotics, resistance occurred within one year of approval. Out of 35 surveillance systems reviewed, only 13 (in 12 countries) included at least one new antibiotic; CLZ-TAZ and CAZ-AVI, monitored in 11 and 12 countries respectively, were the most surveyed. Resistance trends showed greater increase for imipenem-relebactam, CAZ-AVI, and meropenem-vaborbactam. Nine outbreaks were detected, including 136 patients: CAZ-AVI was responsible for the highest number of outbreaks (five).

Conclusions
Resistance was detected to new antibiotics, yet very few countries have active monitoring systems to detect it. Appropriate monitoring and benchmarking of emerging resistance to new antibiotics is pivotal to support careful antibiotic policies at country and global level.

Key messages
• Emerging resistance to new antibiotics was assessed through quantitative parameters: some drug combinations would deserve further attention, given the increased resistance reports and surveillance gap.
• Analysis of these parameters might suggest that combinations of existing agents are prone to developing resistance, and hence support focusing research on the development of novel-class drugs.
Individual exposure to multiple pollutions (air, noise, ELF-EMF) in daily-life microenvironments
Authors: Salmon A , Bouland C 
Published: October 2023

Abstract

Introduction
Environmental pollutions are numerous and ubiquitous. Urban citizens are continuously exposed to several kind of pollutions. To assess these exposures and identify they sources, data collection at an individual level gives a more detailed picture of the multiple exposure and the microenvironments to which it is attributable [1,2,3,4].

Protocol
The study combines individual measurements of exposures of 490 Brussels inhabitants, reporting on their localization and duration, and perception of health and quality of life. The protocol integrates 3 main tools:
1. Portable devices measure individual exposure during 24 hours of a normal weekday.
a. Airbeam 2® measures PM1, PM2.5 and PM10 every 1sec.
b. Smartphone measures noise levels every 1sec., registers GPS data and is equipped with the application Aircasting® to transfer data.
c. EMDEX II® measures 50Hz electromagnetic fields every 3sec.
2. A diary reports the environments in which the participant is staying every 15min.
3. A questionnaire (standardized and based on the literature questions) focuses on socio-economic aspects, lifestyle, perception of health, and perception and knowledge of exposure.

Preliminary Results
Means of exposure of noise levels by microenvironments: kitchen= 51,31 (6,13) dB, living room = 46,04 (6,71) dB, dining room = 48,39 (8,00) dB, sleeping room = 28,95 (5,24) dB.
Means of exposure to PM 2.5 by microenvironments: kitchen= 14,62 (49,47) µg/m3, living room= 14,68 (64,58) µg/m3, dining room = 19,51 (94,26) µg/m3.

Conclusions
With further analysis, the data collected will allow characterizing each type of environment reported (for ex.: living room, kitchen, park, car, biking in the city, ...) regarding their exposure to multiple pollutants combined(air, noise, low-frequency electromagnetic fields). Next to the study of the scientific literature, the results will enable target recommendations on exposure prevention, considering the potential synergies due to co-exposures.

Key messages
• A detailed knowledge of multiple exposures at an individual level and their sources is neccessary to tackle the issue.
• Exposure to different type of pollutions impact similar systems of the human organisms and studies on their combined effects and potential synergies are relevant.
Detection and management of tuberculosis in Tunisia: challenges and outcomes
Authors: Mansouri A , Bouguerra H , Belkahla M , Gzara A 
Published: October 2023

Abstract

Introduction
Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. In Tunisia, where TB remains endemic, the national control program ensures free vaccination, free outpatient TB treatment in addition to early detection of cases and directly observed treatment short course. However, available data on these activities and outcomes are limited. The objective of this study was to describe the evolution of TB detection and management indicators and outcomes from 2018 to 2021.

Methods
We analyzed data collected part of the epidemiological investigations of notified cases and active search for cases over a period of 4 years (2018-2021). In each governorate, dedicated teams collect samples from cases’ contacts for microscopic sputum examination for screening and ensure patients’ follow-up. All data related to contact tracing, treatment and outcomes were collected, entered and analyzed using SPSS-21.

Results
The number of screened cases decreased from 30337 in 2018 to 16045 in 2021. The number of investigations of reported cases also decreased; from 2408 in 2018 to 1295 in 2021 (proportion of 74.6% to 48.9% respectively). However, the percentage of positives increased from 1.4% to 2.1%. In 2021, therapeutic success was recorded among 81% of cases (compared to 86% in 2018). From 2018 to 2021, there was an increase in three indicators: fatality rate (1.55 to 2.53%), discontinuation of treatment (from 2.5% to 3.2%) and the proportion of multidrug-resistant TB cases (0.45 to 0.69%).

Conclusions
Despite free care and treatment, our study showed challenges in the prevention and management of TB. Several activities of the national tuberculosis program have decreased, probably due to the pandemic, as noted in general preventive and care activities worldwide. More education and awareness efforts should be made, not only for patients and their contacts, but also for health care professionals, to be more vigilant in early case detection and continued treatment.

Key messages
• Several activities of the national tuberculosis program have decreased from 2018 to 2021, probably due to the pandemic.
• From 2018 to 2021, there was an increase in the fatality rate, discontinuation of treatment and multidrug-resistant TB cases.
Unraveling COVID-19 investigation hurdles with viral genomics
Authors: Sá R , Isidro J , Borges V , Duarte S , Vieira L , Gomes J P , Tedim S , Matias J , Leite A 
Published: October 2023

Abstract

In the context of a COVID-19 outbreak, identifying transmission chains is crucial for effective public health response. However, relying solely on epidemiological investigation can lead to misidentification of links. This study aimed to assess the concordance between epidemiologically linked cases and viral genetic profiles in the Baixo Vouga Region of Portugal, from March to June 2020. We conducted a retrospective analysis of 1925 COVID-19 cases, of which 1143 were assigned to 154 epiclusters. Viral genomic data was available for 128 cases. We used this data to assess the accuracy of the initial transmission dynamics reconstruction, identify misidentified links, and resolve sporadic cases. Public health authorities identified two large epiclusters with a central role in disease spread, but the genomic data revealed that each epicluster included more than one transmission network. The increasing size of epiclusters and their extension to densely populated settings triggered the misidentification of links. Genomics also helped resolve some sporadic cases and misidentified directions of transmission. The epidemiological investigation had a sensitivity of 70%−86% in detecting transmission chains. Our findings demonstrate the challenges associated with the epidemiological investigation of hundreds of community cases in the context of a massive outbreak caused by a highly transmissible and new respiratory virus. We recommend incorporating viral genomics into outbreak investigations to improve the accuracy of transmission chain reconstructions. This could lead to the development of more effective public health actions such as prevention activities, policies, and surveillance systems. The innovative use of genomics in epidemiological investigations can have a significant impact on public health outcomes.

Key messages
• Large COVID-19 epiclusters and densely populated settings led to misidentified links. Epidemiological investigation had 70%−86% sensitivity to detect chains.
• Using viral genomics in outbreak investigations can improve accuracy of transmission chain reconstructions, helping to resolve misidentified links and sporadic cases.
Neighborhood deprivation and household socioeconomic status as risk factors for diabetes in Brussels
Authors: Van der Heyden J , Missine S , Charafeddine R , Demarest S 
Published: October 2023

Abstract

Background
Socioeconomic (SE) differences in diabetes prevalence have been shown both at the individual and neighborhood level. Disentangling the role of SE determinants of diabetes at different levels can help to identify more targeted strategies to reduce SE differences in diabetes prevalence. As contextual factors may differ it is important to explore this in different settings. In this study we investigated the association of diabetes with household socioeconomic status (SES) and neighborhood deprivation in Brussels taking into account individual risk factors.

Methods
The study sample included participants ≥ 15 years of the Belgian National Health Interview Survey (HIS) 2013 and 2018 residing in Brussels (n = 5045). Information on neighborhood deprivation, assessed through a composite indicator (income, employment, nationality,..), was linked to the HIS data. A multilevel analysis was conducted to assess the association of self-reported diabetes with household SES and neighborhood deprivation adjusting for age, sex, obesity, nationality and country of birth.

Results
The overall prevalence of diabetes in the study sample was 6.8%. Individual risk factors associated with a higher diabetes prevalence were older age, obesity and being born outside the EU. Belonging to a household with a low income (OR 2.3;95% CI 1.2-2.5 - ref. highest income group), low education at household level (OR 1.6;95% CI 1.0-2.5 - ref. highest education group) and living in a deprived neighborhood (OR 2.0, 95%CI 1.3-3.1 - ref. living in wealthy area) were all independently associated with a higher diabetes prevalence.

Conclusions
Neighborhood deprivation and low household SES are independent risk factors of diabetes. Actions to reduce SE differences in diabetes prevalence should take into account determinants at the individual, household and neighborhood level. Further research should explore the role of environmental risk factors to explain the higher diabetes prevalence in deprived areas.

Key messages
• Differences in diabetes prevalence between rich and poor neighborhoods remain when accounting for individual characteristics and household socioeconomic status.
• Environmental factors may explain the higher diabetes prevalence in deprived neighborhoods.
Vulnerability to heatwaves: a scoping review of prevention programs. Results from the ENBEL project
Authors: Mazzalai E , De’ Donato F , De Sario M , Michelozzi P 
Published: October 2023

Abstract

Background
This study, conducted as part of the European ENBEL project (Horizon 2020), aims at synthesising the scientific evidence on heat health preventive measures targeting vulnerable populations, considering other environmental co-exposures, such as air pollution, wildfires and droughts.

Methods
A scoping review was performed on Medline and Embase (Ovid) through search terms on clinical and social vulnerabilities, health outcomes (morbidity, mortality, hospitalisation), heatwaves, droughts, air pollution, wildfires, and preventive measures. Records in English published between 2000 and 2023 were included and screened according to PRISMA guidelines.

Results
8608 records were retrieved, 5895 of which screened after duplicate removal. 51 were included in the qualitative synthesis. The interventions, mainly targeting workers (from agriculture, healthcare, waste management, firefighting and military sectors) and school athletes, were the most evaluated preventive measures. The role of hydration, rest in the shade, cooling cloths and food, and acclimatisation procedures were highlighted for both groups. On the other hand, local prevention plans, mainly from high-income Countries, focused on the elderly, adults in poor health conditions, homeless and institutionalised people. The implemented measures concentrate on cooling interventions, provision of health care and social services, education and information campaigns. Regarding co-exposures, a study on prevention for firefighters and one on the implementation of Clean Air Centres in California for people vulnerable to heat and smoke were retrieved. A search of the grey literature will be performed to avoid publication bias.

Conclusions
There is still limited evidence on the effectiveness of preventive measures aimed at protecting vulnerable subgroups from heat-related health effects. The present findings can help orient the public health agenda and research priorities on climate changes adaptation measures.

Key messages
• Heatwaves are more frequent due to climate change, putting vulnerable population at risk. Developing plans and programs aimed at reducing negative health outcomes related to heat should be a priority.
• Hydration, rest, and acclimatization procedures reduce heat-related illnesses in workers and athletes. Local prevention plans for the elderly show the role of education and information.
The burden of ischemic stroke due to air pollution in ten European countries
Authors: Vojvodic K , Todorovic J , Terzic Supic Z , Stojisavljevic S , Devleesschauwer B 
Published: October 2023

Abstract

Background
Stroke is one of the leading causes of disability worldwide and there are many reports that the higher risk of ischemic stroke is associated with air pollution. It is noted that the adverse effects of air pollution on health are still invisible and not enough communicated to patients and health professionals.

Methods
Within the European Burden of Disease Network (COST Action CA18218), we analyzed Disability-Adjusted Life-Years (DALY) rates associated with ischemic stroke per 100,000 among all ages attributable to air pollution. Estimates were taken from the Global Burden of Disease Study 2019, for ten countries with the highest DALY rates per 100,000 ischemic strokes in 2019: Bulgaria, North Macedonia, Montenegro, Georgia, Serbia, Romania, Ukraine, Russian Federation, Bosnia and Herzegovina and Latvia.

Results
The highest DALY rate per 100,000 ischemic strokes was in Bulgaria (7016.81), followed by North Macedonia (5773.40), Montenegro (5119.61), and Georgia (4967.42). The highest DALY rate attributable to air pollution was in North Macedonia (1462.61), followed by Bulgaria (1240.13), Montenegro (1052.21), and Serbia (1037.41). The highest percentage of ischemic stroke attributable to air pollution was in Bosnia and Herzegovina (25.66%), North Macedonia (25.32%), Serbia (21.23%), and Montenegro (20.55%).

Conclusions
Air pollution is a significant contributable factor in the prevalence of ischemic stroke. In observed countries, more than 20% of the ischemic stroke burden is attributable to air pollution. The highest DALY rate attributable to air was in Balkan countries.

Key messages
• The highest DALY and the highest percentage of ischemic stroke attributable to air pollution were in Balkan countries.
• There is an emerging need for public health regulations and policies in order to reduce air pollution and stroke.
The role of health insurance literacy in the process and outcomes of choosing an insurance policy
Authors: Holst L , Brabers AEM , Rademakers JJDJM , de Jong J D 
Published: October 2023

Abstract

Background
Several countries have healthcare systems that require their citizens to make informed and thoughtful decisions about which health insurance policy fits their needs and preferences best. There are indications that citizens do not always have sufficient skills, so called health insurance literacy (HIL), to do this. This can lead to citizens being sub-optimally insured, suffering inadequate coverage and facing unexpected costs. This study aims to investigate whether the level of HIL among Dutch citizens is related to the way in which they experience the process of choosing a policy, and furthermore whether it is related to their health insurance choices.

Methods
A mixed-mode questionnaires was distributed to 1,500 participants of the Nivel Dutch Health Care Consumer Panel in February 2020. The response rate was 54% (n = 806). Regression analyses were performed to gain a better understanding of the association of HIL with the process and outcomes regarding the choice of a health insurance policy.

Results
Respondents with a low HIL, in comparison to those with a high HIL, find choosing a health insurance policy more often difficult, not interesting, and boring, and less often consider it important and worthwhile (p &lt; 0.01 for all). Also, they make less use of their opportunity to switch from one health insurer to another (p &lt; 0.05). However, they do opt for a supplementary insurance policy and a voluntary deductible to the same extent as respondents with a high HIL.

Conclusions
The level of HIL among Dutch citizens is related to the way they experience the process of choosing a health insurance policy, and to the extent to which they switch from one health insurer to another, but not to their health insurance choices. It is important to get a better understanding of the barriers citizens with a low HIL experience during this process, and of their needs and preferences.

Key messages
• The level of HIL is related to the way Dutch citizens experience the process of choosing a health insurance policy.
• Compared to those with a high HIL, Dutch citizens with a low HIL switch health insurers less often, but opt for a supplementary policy and a voluntary deductible to the same extent.
Skills4 Health Literacy– Nordic project promoting capacity building on health literacy and dementia
Authors: Wångdahl J , Sørensen K , Gramstad A , Hoffrén-Mikkola M , Korsbakke Emtekær Hæsum L ,   For the Skills4 Health literacy Consortium
Published: October 2023

Abstract

Background
An increasing proportion of the population is living with dementia and need health- and social care. People with limited health literacy have difficulties with accessing, understanding, appraising, and applying health information to promote and maintain health. Knowledge about how to promote health literacy is limited among health- and social care providers although such knowledge is important to be able to work person-centered and to reduce the risk of unequitable health and health care. As a response to this, the Erasmus+ project Skills 4 Health Literacy is conducted in the period 2022-2025. The project's overall aim is to meet the needs of higher education institutions in training future and current health and social care professionals, through digital education technologies, to promote health literacy capacity-building when supporting persons at risk of dementia to deliver relevant and personalized interventions.

Methods
A review of research, policies, and curriculums, and four focus group discussions and 14 individual interviews with experts from with a wide range of social and health care sites in Denmark, Finland, Norway, and Sweden.

Results
We developed a competence profile for health- and social care workers highlighting which knowledge, skills, and abilities they need to promote and take health literacy into account when working with people at risk of dementia and relatives to those. Thereafter, we developed, and pilot tested health literacy courses (1 classroom-based, 1 traditional online and 1 MOOC) based on this competence profile, in three of the Nordic countries.

Conclusions
There is a need for health literacy training among health- and social care workers in the Nordic countries. This project suggests a consensus-build competency profile to further develop the capacity building within health and social care and dementia with regards to health literacy training.

Key messages
• Health- and social care workers in the Nordics who meet elderly need training in health literacy.
• A competence profile and health literacy courses have been developed to meet those needs.