bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unintended consequences of pandemic measures for refugees in camp-like settings
Authors: Sarma N , Biallas R , Biddle L , Hintermeier M , Gottlieb N , Mohsenpour A , Bozorgmehr K 
Published: October 2023

Abstract
We present the results of a review that focused on refugees, asylum-seekers and internally displaced persons living in camps or accommodation centres, given their often closed character and crowded living arrangements. We systematically review the evidence on unintended consequences of public health and social measures (PHSMs) implemented in such settings. Relevant articles were identified in major academic databases from 12/2019 to 02/2023. Empirical studies reporting the results of PHSMs implemented to curb Covid-19 infections in camp-like settings were included. Following abstract and full-text screening, the described effects of PHSMs were extracted, distinguishing intended from unintended policy outcomes by their knowability (anticipated/unanticipated), value (positive/negative/neutral), distribution (subgroups/equity), and temporality. The “unintended outcomes evaluation approach” proved useful to identify unintended consequences of pandemic measures and examine the nature of their effects. Yet, few studies aimed at unintended outcomes, with these often being chance findings. The evidence reported thus often required some interpretation to capture and construct potential causal pathways from PHSMs to unintended outcomes. Preliminary results suggest that strict lockdown measures had negative effects on the mental health of individuals in camp settings, who already face a high burden of mental illness. Moreover, reduced economic and bureaucratic activities threatened the livelihood of individuals in camp settings through suspending asylum procedures, withdrawal of social and medical support, and the absence of legal economic opportunities. PHSMs thus drove individuals further into precarity, while the benefit of lockdown measures in this setting remains uncertain. Our review highlights the lack of research on unintended outcomes of public health measures, while demonstrating the importance of considering such outcomes for an equitable pandemic response.
A EU-Africa partnership to co-design a training intervention to scale-up access to surgery in Africa
Authors: Pittalis C , Drury G , Mwapasa G , Borgstein E , Cheelo M , Kachimba J , Chilonga K , Brugha R , Lavy C , Gajewski J 
Published: October 2023

Abstract

Background
The EU Global Health Strategy recognises that a skilled workforce is critical to advance universal health coverage. In response, our consortium brought together researchers, academics and clinicians from Ireland, the UK, the Netherlands, Malawi, Zambia and Tanzania to co-design a surgical workforce training and supervision intervention for district hospital teams aimed at scaling-up access to essential surgery in rural East Africa. Participatory action research (PAR) informed intervention design, incorporating the needs of frontline surgical providers and tailoring the training to meet identified gaps. This is the first study of this type in global surgery.

Methods
PAR workshops were held in Malawi, Zambia and Tanzania in 2017-2019 with key stakeholder groups: local authorities, professional associations, hospital managers and multi-disciplinary representatives of surgical teams from 67 district and referral hospitals. Through semi-structured discussions, qualitative data were collected on participants’ perceptions and experiences of barriers to safe and timely surgical and anaesthesia care, challenges in referral systems, and district surgical teams’ training and supervision needs. Data were compared for themes across sites and cadres.

Results
District surgical providers reported: a lack of in-service training, lack of access to mentoring and a demand for feedback on referrals. Participants prioritised training needs that could be addressed through regular in-service training and supervision visits from referrals to district hospitals to be delivered over the intervention period. Participants used findings in an action-planning cycle to develop country- and site-specific training plans for each research site.

Conclusions
Our approach to surgical capacity building, utilising both European and African expertise, has resulted in a demand-driven in-service training and supervision programme, now included in the participating countries’ national health strategies.

Key messages
• The inclusive, participatory approach to surgical system strengthening employed by our study enabled the co-design of a locally relevant, contextualised intervention.
• Our study generated lessons on how to rebalance power dynamics in European-African health partnerships.
Childhood obesity
Authors: Scazzina F 
Published: October 2023

Abstract
Obesity is one of the world's most challenging public health problems. The phenomenon of childhood obesity is increasing in industrialized and emerging countries, with the major impact of the onset of diseases in adolescence and adulthood. The high prevalence of youth obesity is associated with increasing rates of diabetes, hypercholesterolaemia, non-alcoholic fatty liver disease and hypertension, which are risk factors for the development of cardiovascular disease in adulthood, the leading cause of chronic non-communicable disease deaths according to the World Health Organization. A healthy diet associated with an active lifestyle is a valuable tool for the prevention, management and treatment of many diseases, including obesity. In this sense, it is most effective to intervene in the paediatric population in order to establish correct eating habits from the earliest years of life that support current and future nutritional well-being. Among the various nutritional strategies to combat obesity and associated comorbidities, the Mediterranean Diet (DM) has been identified as the most effective. Educational actions to improve dietary behaviour and increase awareness of the health benefits associated with a traditional MD must be designed at school, home and clinic level. Better policies that create a new environment for children and grown-ups to choose better diets and lead active and healthy lives in every country of the WHO European Region are needed.
Health inequalities in type 2 diabetes: contributions of exposures in the residential environment
Authors: Albers J D , Koster A , Sezer B , Meisters R , Schram M T , Eussen SJPM , Dukers NHTM , Stehouwer CDA , Lakerveld J , Bosma H 
Published: October 2023

Abstract

Background
People with lower socioeconomic position (SEP) have higher risk of type 2 diabetes (T2D). Besides genetic predisposition, the exposome shapes this risk. This includes exposures in the residential environment. We explored the relationships between SEP, the residential food environment, walkability, greenspace, and T2D.

Methods
Cross-sectional and longitudinal data from 9188 participants were analyzed. Prevalent T2D was measured by an oral glucose tolerance test. Incident T2D was self-reported in annual follow-up questionnaires. Education, income, and occupation were measured as indicators of SEP. The residential environment was operationalized by address level Food Environment Healthiness Index (FEHI), number of fast-food outlets (FF), walkability index (WI), and proportion of greenspace (GS). Logistic regression and survival analyses were used to model the associations between SEP, the environment and T2D. The proportion of mediation of the association between SEP and T2D was estimated in a causal mediation analysis using a simulation approach.

Results
Over a median follow-up of 6.2 years, 207 incident cases were identified. Lower SEP was associated with higher risk of T2D. Hazard ratios (HR) were 2.0 (95%CI 1.6-2.6), 1.8 (1.4-2.3) and 1.8 (1.2-2.6) for an interquartile range decrease (IQR) of education, income, and occupation, respectively. HRs for IQR changes of the environmental factors were: FEHI 1.2 (1.0-1.4), FF 0.9 (0.8-1.0), WI 1.2 (1.0-1.6) and GS 1.2 (1.0-1.4). Regression on prevalent T2D yielded similar results. Lower SEP was associated with a less healthy environment (e.g., FEHI -0.08 (-0.10--0.06) for education). Environmental exposures mediated between 0.3% (-8.6-8.6) and 8.5% (2.3-27.4) of the longitudinal associations.

Conclusions
Lower SEP was associated with prevalent and incident T2D. People with lower SEP lived in a slightly less healthy residential environment. Some of the SEP-T2D association could be mediated by the environment.

Key messages
• A less healthy residential food environment, lower walkability and less green space might mediate some of the association between SEP and T2D.
• More research is needed to clarify the extent to which environmental pathways contribute to health inequalities.
The environmental pollution role in increasing the incidence of thyroid cancer in Tuscany (Italy)
Authors: Cartocci A , Bosco R , Cevenini G , Golinelli D , Messina G , Nante N , Capezzone M 
Published: October 2023

Abstract

Background
The incidence of thyroid cancer (TC) in Italy is one of the highest in Europe; the reason for this is unclear. Some studies investigated the potential role of toxic elements related to geological and/or anthropogenic sources in increasing the incidence of TC. The aim of our study is to further investigate the connection between higher TC incidence and environmental pollution; that is fundamental to implement prevention practices and to increase awareness of environmental issues.

Methods
The Tuscany Cancer Registry provided us the number of cases of TC patients for all the provinces of Tuscany during the period from 2013 to 2017. Provinces were grouped in exposed/unexposed to several environmental pollutants. In particular, they were stratified based on the presence of mines, on the presence of geothermal plants and on the ministerial classification in “contaminated sites” and no “contaminated sites”, i.e. areas in which an alteration of the characteristics of the environmental soil matrix, subsoil and groundwater has been ascertained such as to represent a risk to human health. Rate ratios (RR) and their 95% confidence interval (CI) were estimated.

Results
Contaminated sites have significantly higher incidence then uncontaminated ones (male RR: 1.2, CI: 1.05-1.364, p = 0.008; female RR of 1.12, CI: 1.03-1.21, p = 0.009). Similar results were obtained stratifying for the presence of mines (male RR: 1.25 CI: 1.12-1.40, p &lt; 0.001; female RR: 1.35, CI: 1.26-1.45, p &lt; 0.001) and then of geothermal plants (male RR: 1.22 CI: 1.06-1.40, p &lt; 0.001; female RR: 1.40, CI: 1.29-1.52, p &lt; 0.001).

Conclusions
Further laboratory experiments are needed to confirm the connection between specific pollutants and TC. If these findings will be confirmed a stringent legislation and environmental polices have to be taken to reduce the TC incidence. In this way, also the cost of healthcare management of patients with TC can be reduced.

Key messages
• Pollutants could affect both the environment and people health.
• The prolonged exposure to pollutions could increase thyroid cancer incidence.
Health impact assessment of the chemical exposome in European children
Authors: Rocabois A , Philippat C , Crépet A , Vrijheid M , Slama R 
Published: October 2023

Abstract

Background
We aimed to assess the impact of the chemical exposome on the health of European children since previous health impact assessments (HIA) were limited to a few chemicals.

Methods
74 out of 484 substance-outcome associations had an overall level of evidence at least likely and were therefore considered for HIA. For 51 of the 74 associations, dose-response relationships were identified from systematically searched meta-analyses or epidemiological studies. For 41 of these, exposure levels were compatible for HIA. Exposure levels were based on biomarker concentrations assessed in 1301 pregnant women and children of the HELIX cohorts in 6 European countries. The baseline burden of disease were from national estimates of the World Health Organisation for 8 outcomes. The attributable burden of disease was estimated by combining exposures and dose-response relationships and expressed in terms of population attributable fraction, disability-adjusted life years (DALYs) or variations in mean level for quantitative health outcomes. Associated uncertainty was taken into account using Monte-Carlo simulations.

Results
Each substance harmful for cognition or birth weight entailed an average estimated decrease in Intellectual Quotient by 1.7 points (95% confidence interval (CI) 0, 4.3) and in birth weight by 57 g (95%CI 0, 138). The chemical exposome entailed 1.65 (95%CI 0.63; 2.90) DALYs for 1,000 children per year. The main contributors to the impact were perfluoroalkyl substances, other persistent organic pollutants and tobacco. The impact was mainly due to neurodevelopment (0.4 DALY), congenital heart defects (0.6 DALY), respiratory health (0.4 DALY) and sudden infant death syndrome (0.3 DALY).

Conclusions
Our study is one of the largest HIA in terms of number of chemicals considered. The results exclude urban exposures such as air pollution and are probably largely underestimated because of a lack of data on dose-response relationships and baseline burden of disease.

Key messages
• Chemical exposures (mainly perfluoroalkyl substances, persistent organic pollutants, metals and tobacco) contribute to the burden of disease in European children.
• Chemical exposures have an impact on fetal and infant death, neurodevelopment, cardiometabolism, respiratory and reproductive health of children.
Development and validation of a photograph-based instrument to assess nutrition literacy: the NUTLY
Authors: Sousa S , Albuquerque G , Severo M , Costa A R , Moreira P , Lunet N , Padrão P 
Published: October 2023

Abstract

Background
Most instruments measuring nutrition literacy are difficult to apply to less educated people, or assess theoretical knowledge, not necessarily evaluating the ability to make healthy food choices. We aimed to develop and validate a photograph-based instrument to assess nutrition literacy (NUTLY) among adults in Portugal.

Methods
NUTLY assesses the ability to identify the food with the highest energy/sodium content from sets of three photos (two foods with similar content and one with higher content). A version of 79 sets was obtained after a stepwise process involving expert and lay panels. It was applied to a sample representing different age, gender and education level groups (n = 329). We assessed internal consistency (Cronbach's α) and associations between each test item (set of three photos) and the overall score, defined as the sum of correct answers (latent trait models); sets performing worse were excluded. Reproducibility was assessed after one month (n = 158). To assess construct validity, NUTLY was compared to the Medical Term Recognition Test (METER) and the Newest Vital Sign (NVS), and across groups with varying education and training in nutrition/health. Latent class and Receiver Operating Characteristic (ROC) analyses were used to define the cut-off point.

Results
The final NUTLY includes 48 sets (energy: 33; sodium: 15; α = 0.74). Mean scores were highest in nutritionists (39.9), health professionals (38.5) and decreased with decreasing education (p &lt; 0.001). Those with adequate nutrition literacy (based on NVS) showed higher NUTLY scores (37.9 vs. 33.9, p &lt; 0.001). For METER, the differences were not significant. Reproducibility was high (ICC=0.77). The Area Under the ROC Curve was 0.97. Adequate nutrition literacy was defined as a NUTLY score≥35 (sensitivity: 89.3%; specificity: 93.7%).

Conclusions
NUTLY is a valid and reliable tool for assessment of nutrition literacy, with the potential to be adapted to other cultures and specific population groups.

Key messages
• A new photograph-based nutrition literacy measuring tool was developed and validated in Portugal, overcoming some limitations of previous instruments.
• In the future, this instrument could be used as part of a public health surveillance system, and as a tool to assess the success of nutrition education interventions.
Quantifying Metabolic Food Waste in Ireland from Excess Food Intake
Authors: Krah C , Bahramian M , Burke D , Hynds P , Priyadarshini A 
Published: October 2023

Abstract

Background
The Republic of Ireland (ROI) currently reports the second highest prevalence of adult obesity in Europe, with &gt;25% of the adult population classified as obese. Concurrently, a concomitant increase has been reported for the risk of cardiovascular diseases and several cancers. While there has been extensive research on the health impacts of excess food intake, of the resulting food waste, also known as metabolic food waste (MFW) and its associated environmental impact has received little attention. Accordingly, the current study sought to estimate quantities of MFW from excess food intake among the Irish adult population and resulting global warming potential. Body weight and diet information were collected in a survey of 920 people across ROI. The excess fat of overweight (OW) and obese (OB) individuals was calculated and converted to excess calories using the Composition of Foods Integrated Dataset (CoFID 2021). The energy content (calories) of the food items was used to estimate the quantities (kg) of food consumed to gain the excess fat. Having derived the kg of food/MFW, the associated Global Warming Potential (GWP) was calculated.

Results
Calculated MFW were 50.84 kg/cap/yr and 122.2 kg/cap/yr for the OW and OB populations, respectively. Dairy produce accounted for the highest annual MFW in both groups (12.0 kg/cap (OW), 28.6 kg/cap (OB)), followed by cereals/grains (9.0 kg/cap, 21.5 kg/cap) and potatoes (7.1 kg/cap, 17.0 kg/cap). Calculated annual GWP of food items highlight dairy produce as having the highest GWP v (66.8 CO2 eq/kg for OW and 160.5 CO2 eq/kg for OB), followed by red meat (36.2 CO2 eq/kg for OW and 87.1 CO2 eq/kg for OB) and white meat (24.1 CO2 eq/kg for OW and 57.8 CO2 eq/kg for OB).

Conclusions
The Irish adult diet is characterized by high consumption of cereals/grains and dairy produce, with the annual volume of MFW generated by obese individuals more than twice the annual volume of food (52kg/cap) disposed of by individuals at home

Key messages
• Managing the consumption of dairy and meat products could accomplish two important goals: the promotion of environmental sustainability and the enhancement of public health.
• In addition, managing obesity from the dietary stand point will encourage sustainable consumption and food security.
Conceptualizing the Supersetting approach and presenting Tingbjerg Changing Diabetes
Authors: Stougaard M , Termansen T , Stjernqvist N W , Tetens A , Tørslev M K , Bloch P 
Published: October 2023

Abstract

Background
Health and ill health are created in the settings where people live. Thus, health inequity is strongly linked to the social, cultural, and environmental contexts of people's everyday lives. In disadvantaged neighbourhoods, residents generally have poorer health than the general population, especially when it comes to type 2 diabetes (T2D) and mental illnesses. Meanwhile, studies show positive health outcomes of multilevel, multicomponent participatory community interventions pointing towards the need for increased health promotion and prevention of T2D in local communities.

Conceptualisation
This session presents the Supersetting, an intervention strategy for multilevel, multicomponent community interventions. The Supersetting strives to attain synergistic effects from coordinated actions carried out across multiple settings. Stakeholder participation is a core element of a Supersetting. Consequently, a Supersetting initiative must work with a comprehensive organisation structure for dialogue, decision-making, coordination and action between citizens, civil society organisations, public authorities and their institutions, private sector corporations, and researchers.
Instead of predefined and meticulously planned actions, the Supersetting approach builds on five overarching principles guiding the development and implementation of interventions. These are 1) integration, 2) participation, 3) empowerment, 4) context-sensitivity and 5) knowledge.

Case
The Supersetting has mainly been implemented in the long-term strategic health promotion imitative Tingbjerg Changing Diabetes (TCD), which aims to create well-being and promote good, healthy lives while preventing T2D in the disadvantaged neighbourhood of Tingbjerg, Denmark. Data on T2D from national health registers will be presented.

Conclusions
The Supersetting approach is a relevant, context sensitive conceptual framework for developing initiatives for sustainable impact in community health promotion.
Exploring fluoride-free content on Twitter: A topic modeling analysis
Authors: Lotto M , Zakir Hussain I , Kaur J , Butt Z A , Cruvinel T , Morita P P 
Published: October 2023

Abstract

Social media discussions about the hypothetical side effects of fluoride-containing products have contributed to forming and strengthening health beliefs underpinning the anti-fluoridation movement. Given the importance of content analysis in mitigating online misinformation, this study aimed to investigate fluoride-free content on Twitter. Firstly, 21,169 tweets published in English between May 2016 and May 2022 concerning the keyword ‘fluoride-free’ were collected using the Twitter API. After the data preprocessing, Latent Dirichlet Allocation (LDA) topic modeling was conducted to identify the salient terms and topics inside the collected tweets. Then, the similarity between topics was calculated by an intertopic distance map. Furthermore, an investigator manually reviewed a sample of tweets that featured the most representative word groups associated with particular topics to determine the main issues. Finally, additional data visualization was performed using Elastic Stack software to analyze the total count and relevance of each topic related to fluoride-free records over time. The topic modeling analysis demonstrated a significant distance between the topics from a coherence score of 0.542, confirming the identification of three different issues: ‘healthy lifestyle’ (topic 1), ‘consumption of natural/organic oral care products’ (topic 2), and ‘recommendations for using fluoride-free products/measures’ (topic 3). Moreover, the number of fluoride-free publications decreased between 2016 and 2019 but increased again in 2020. Thus, recent increases in fluoride-free tweets appear driven by public concerns about adopting a healthy lifestyle, including the consumption of natural and organic products. Therefore, public health authorities, health professionals, and legislators must acknowledge the dissemination of fluoride-free content on social media to implement effective strategies to counteract its potential harm to the population's oral health.

Key messages
• People are concerned about the hypothetical side effects of fluoride-containing measures and products.
• The consumption of fluoride-free content on social media is associated with adopting a healthy lifestyle.