bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nitrites and nitrates from additives and natural sources and risk of cardiovascular outcomes
Authors: Srour B , Chazelas E , Debras C , Druesne-Pecollo N , Agaesse C , Szabo de Edelenyi F , Sellem L , Kesse-Guyot E , Deschasaux-Tanguy M , Touvier M 
Published: October 2022

Abstract

Nitrates and nitrites are used as food additives in processed meats. They are also commonly ingested from water and several foods. Evidence suggests a beneficial role of dietary nitrites and nitrates in lowering blood pressure. However, associations between exposure to nitrites and nitrates from natural sources and food additives, separately, and risks of hypertension and cardiovascular disease (CVD) have not been investigated. We aimed to study these associations in the French population based prospective cohort NutriNet-Santé. Overall, 104,817 adults were included. Associations between exposure to nitrites and nitrates (evaluated using repeated dietary records, linked to a food composition database accounting for commercial brands of industrial products) and risks of hypertension and cardiovascular disease were assessed using multivariable Cox proportional hazard models. During follow-up, 3810 incident cases of hypertension were ascertained, and 2075 cases of CVD, 1004 of cerebrovascular diseases and 1079 or coronary heart diseases were diagnosed. Participants with higher exposure to nitrites from food additives and specifically those highly exposed to sodium nitrite (e250) had a higher hypertension risk compared with those who are not exposed to nitrites from food additives (HR = 1.19 (95% CI 1.08-1.31), P = 0.002, and 1.19 (95% CI 1.07-1.31), P = 0.002, P &lt; 0.001), respectively). There was no evidence for an association between total nitrites or nitrites from natural sources, or dietary nitrates with hypertension risk (all P-values&gt;0.3). There was no evidence for associations between dietary nitrites, or nitrates with risks of cardiovascular, cerebrovascular or coronary heart diseases (all P-values&gt;0.2). In conclusion, we found that higher exposure to nitrites from food additives was associated with higher risk of hypertension. Our results do not support a potential protective association between dietary nitrites or nitrates and cardiovascular outcomes.

Key messages
• These results provide additional evidence in the context of current discussions about updating regulations on the use of nitrites as food additives.
• Our findings do not support any protective impact of nitrites and nitrates on cardiovascular health.
Modelling the impact of salt reduction policies on hypertension in Portugal
Authors: Lorenzo i Sunyer N , Severo M , Gregório MJ , Lopes C 
Published: October 2022

Abstract

Salt reduction policies are identified as effective; however, the assessment of their impact in European countries has been underexplored. The aim of this study is to assess the impact of salt reduction policies on hypertension in Portugal, to ultimately guide future policies. Based on national data, the top five foods contributing to salt intake, their salt content, and daily consumption were determined. Food reformulation included current policies and proposed targets for future agreements. Food availability trend from the main contributors was estimated from national food balance sheets. For this study, we considered five counterfactual scenarios (CF) to estimate salt intake variation: (1) reduction of salt content of foods targeted by current policies, while assuming stable consumption of the primary contributors; (2) proposal to extend CF 1 to other food categories; (3) change in the principal contributor's consumption based on the trend, assuming stable salt content; (4) combination of CF 2 and 3; (5) CF 4 and assuming a reduction of “1 pinch of salt”. Relative risk was estimated from regression coefficients to then calculate the potential impact fraction (PIF) and ultimately provide the hypertension cases prevented per year for each CF. The change in salt intake expected by each CF is -11.16%, -13.57%, +0.12%, -13.40% and 23,99%, respectively. For each CF, PIF and hypertension cases avoided per year was, as follows (mean (95%CI)): 9.46% and 46401 (44201;48925) for the first; 14.05% and 68921 (66149;72025) for the second; -1.24% and -6099 (-7636;-4763) for the third; 13.2% and 65125 (62286;67892) for the fourth; and, 15.58% and 76397 (73208;80021) for the last. This study suggests that if the salt content of main contributors was not reduced, its increasing food trend consumption might result in higher incidence of hypertension in Portugal. However, by combining current policies with targets on additional foods, more than 60,000 cases could be avoided annually.

Key messages
• Salt content reduction policies are necessary if we want to reduce the incidence of hypertension among the Portuguese population.
• Assessment of the impact of salt reduction policies is crucial if we want to choose those that have a stronger impact on the health of our population.
A Data Quality Framework for the European Health Data Space for secondary use
Authors: Bernal-Delgado E , Engsig-Karup T , Estupiñán-Romero F , Sahlertz Kristiansen N , Bredmose Simonsen J 
Published: October 2022

Abstract
A cornerstone in the development of the European Health Data Space for secondary use of data (EHDS2) is the design, implementation and assessment of a Data Quality Framework (DQF). Consistently, the Joint Action TEHDAS has a dedicated work program where, learning from others’ experiences across Europe and abroad, the work package is building the concepts and methods for such a DQF. The scope of this work program is to provide recommendation to the Member States and the European Commission on the concept of DQF to foster, where (institutions) the DQF should be implemented, when in data life cycle, how should be implemented and by whom. In terms of the concept, the DQF raises the importance of quality assurance procedures at data processor level and the level of quality of the data collections in terms of reliability, relevance, timeliness, coherence, coverage and completeness. When it comes to when along the data life cycle, DQF is expected operate when data needs harmonization at data processor level (ie, the effective application of interoperability standards), in the publication of the data sources (ie providing users knowledge on the provenance of data and the content of data source); or, when data sources have to be integrated and sensitive data pseudonymized (ie, the quality of the linkage and losses after pseudonymisation). Finally, when it comes to the methodology, TEHDAS suggests a three-fold approach - some quality measures in the DQF could be translated into legislation (eg, the requirement of regular auditing for a data processor to be a trusted party in the EDHS2); some could be kept as good-practices (eg, recommendation of archival procedures when a research project finalizes); and, under the assumption of continuous data quality improvement, an assessment, benchmarking and promotion methodology (eg, a grading system at data processor level).
Do Immigrants Use Less Health Care than Non-immigrants? A Population-based Study among People living with Multimorbidity in Canada
Authors: Talukder C , Wilk P , Ali S , Stranges S 
Published: October 2022

Abstract

Background
Immigrants face unique health care barriers, which can negatively impact their health service use and overall health. Those with multimorbidity may face a particular challenge given its association with increased need for health care. The purpose of this study was to compare health care utilization, as measured by the number of visits to family physicians and specialists, between immigrants and Canadian-born individuals living with multimorbidity.

Methods
A cross-sectional analysis was carried out using data from the 2015-2016 cycles of Canadian Community Health Survey (CCHS) on 9,014 study participants living with multimorbidity. The study utilized Andersen and Newman's behavioral model as a conceptual framework to identify quantifiable predictors associated with health service utilization. For the entire sample as well as for male and female subsamples, statistical models were fitted using negative binomial regressions to account for the count nature of the outcome variables.

Results
After adjusting for relevant confounders, no statistically significant differences were observed between immigrants and Canadian-born respondents in the number of visits to family physicians or specialists. However, subgroup analysis revealed that female immigrants with multimorbidity had considerably fewer visits to family physicians than Canadian-born females (Incident Rate Ratio [IRR]=0.86, 95% CI: 0.76-0.98), while for males these differences were not significant (IRR=1.03, 95% CI: 0.87-1.21).

Conclusions
Future research should focus on longitudinal studies to track the health status of immigrants over time, particularly those living with multimorbidity. Moreover, public health policies should be implemented to reduce cultural and social barriers to health care, with a special focus on female immigrants.
The influence of nutritional marketing on the preferences, attitudes and consumption of children from 6 to 10 years old
Authors: Lima J , Ferreira B , Figueiredo J 
Published: October 2022

Abstract

Introduction
Childhood obesity is a natural response to the modern food environment. A daily consumption of sugar that exceeds the WHO recommendation by 40.7% of Portuguese children influence this condition. It is recognized that children spend more time watching television and youtube, absorbing commercials about food, being susceptible to these messages and negative health literacy. Nutrition marketing is involved in these ads and most of them promote foods high in fat, sugar and salt through persuasive techniques.

Purpose
Assess implications of exposure to nutritional marketing through television and YouTube on preferences, attitudes and consumption of children from 6 to 10 years old and contribute to the increment of health literacy.

Materials and methods
Data collection through two online questionnaires about television and youtube habits and children's food preferences, developed by the research team. Statistical analysis was performed using IBM SPSS Statistics software.

Results
Forty-two students who were attending a private school, aged between 6 and 10 were evaluated. Access to youtube has led to less healthy choices for breakfast in 95% of students (p = 0.038). It was found that most children do not have TV in their room and have a more balanced breakfast (81%). Cereals, soft drinks and biscuits are foods groups that children see the most in the tv commercials (p = 0.001).

Conclusions
Exposure to nutritional marketing influences children's preferences, consumption and preferences. An active strategy should be encourage to increment health literacy levels at the family level influencing therefore children's healthier choices.
Video game addiction among Tunisian adolescents in Sousse: A cross-sectional study in high schools
Authors: Ouertani M , Ben Fredj S , Ghammem R , Zammit N , Maatouk A , Ben Belgacem W , Boujebha S , Guesmi N , Maatoug J , Ghannem H 
Published: October 2022

Abstract

Background
Addiction to video games is a theme regularly mentioned and associated with the risks that concern adolescents. This study aimed to determine the prevalence of video game addiction (VGA) among adolescents and identify its associated factors.

Methods
We conducted a cross-sectional study within public high schools, in Sousse, Tunisia in 2019. The target population was high school students. A structured self-administered questionnaire was used to collect data about sociodemographic characteristics, lifestyle behaviors, and mental health disorders, and we used the 21-item Game Addiction Scale to objectify video game addiction. Statistical analysis was carried out using the program SPSS v.20.

Results
A total of 1342 participants were recruited for the study,36.8% of whom were boys. The average age was 17.5 ±1.44 years. The analysis of mental health disorders showed that 67% were anxious, 66.8% were alexithymic, 65.4% were depressed and 39% had low self-esteem. The analysis of lifestyle behaviors showed that a lack of physical activity was reported by 57.6% of participants. Problematic use of the Internet (&gt;2 hours per day) was reported among 72.4% of the students. The prevalence of video game addiction was 13%. Boys were more prone to be addicted than girls (66.2% versus 33.8%, p &lt; 0.001). ≥17 years old students had a higher rate of VGA than those aged&lt;17 years old (57.3% vs 42.7%, p = 0.031). VGA was higher among students who follow the non-scientific study section (69.4%, p = 0.007). Students who had moderate depression had the highest percentages of VGA (35.7%, p = 0.005). Students who had problematic use of the internet were more addicted to video games (80.3%) than those not having problematic use (19.7%), p = 0.009.

Conclusions
This study allowed us to identify the students who are vulnerable to VGA. Also, a huge responsibility is accorded to school staff and parents to tackle this health problem by sensitizing their children and setting up some protective family rules.

Key messages
• Several factors were significantly associated with video game addiction, especially problematic internet use.
• Further research is needed to understand the underlying mechanisms of video game addiction and to explore effective preventive or interventional strategies.
Primary care management strategies and COVID-19 related hospitalization: a population-based study
Authors: Palandri L , Ferrari A , Serafini A , Riccomi S , Ugolini G , Kurotschka PP , Bellelli F , Morandi M , Padula MS , Righi E 
Published: October 2022

Abstract

Background
Due to SARS-CoV-2 rapid mutations, the ending of the pandemic is still proceeding at a slow pace and there is the need to strengthen and invest in health systems that avoid hospital overload and its consequences on patients’ health. Most symptomatic infections have mild to moderate respiratory symptoms and patients are managed in the context of primary care. In Italy, literature on COVID-19 outpatients management by general practitioners (GPs) is scarce. This study explores the effect of GP active care and monitoring on COVID-19-related hospitalization in patients in the province of Modena (Italy) and investigates the possible determinants of GP's management.

Methods
This is a retrospective cohort study of SARS-CoV-2 infected adult outpatients managed by their GPs from March 2020 to April 2021 in the province of Modena (Italy). Data on GPs’ characteristics, management strategies (visits and remote monitoring), patients’ socio-demographic characteristics, and hospitalization were extracted from the GP's electronic medical records and were analyzed using descriptive statistics and multiple logistic regression.

Results
46 GPs agreed to participate, and 5340 patients were included in the analyses. 3014 (56%) patients received active daily remote monitoring and 840 (16%) were visited at home. Remote monitoring and home visits were both associated with a reduction of the probability of hospitalization rate of approximately 50% (respectively OR:0.52, 95%CI:0.33, 0.80 and OR:0.50, 95%CI;0.33, 0.78). Preliminary analysis of determinants showed that GPs’ patient load, setting, age, and sex were significantly associated with management strategies.

Conclusions
Active monitoring performed by GPs was effective in reducing the probability of hospitalization. Primary and hospital care integration can be effective for COVID-19 management. Studies on GPs’ characteristics and patient load and their effect on their ability to care for patients are needed.

Key messages
• Active remote monitoring and visits performed by Italian general practitioners effectively reduced hospitalization for COVID-19.
• Primary and hospital care integration can be effective for COVID-19 management.
Sharp Increase in Eating Disorders among University Students since the COVID-19 Pandemic
Authors: Tavolacci M , Ladner J , Déchelotte P 
Published: October 2022

Abstract

Background
The COVID-19 pandemic has caused stress, required lockdowns, curfews and social restriction and thus may have altered physical activity and eating habits among university students. The objectives were to determine the impact of the COVID-19 pandemic on Eating Disorders (ED) among university students.

Methods
Between 2009 and 2021, five repeated on line cross-sectional studies were conducted among university students. ED were identified using the French version of the five-item “Sick, Control, One stone, Fat, Food” (SCOFF) questionnaire. The ExpaliTM-validated algorithmic tool, combining SCOFF and body mass index, was used to screen EDs into four diagnostic categories: bulimic, hyperphagic and restrictive ED.

Results
With the five studies, 8981 university students were included in total, 67.3% female with a mean age of 20.7 years. The prevalence of ED was stable between 2009 and 2018 and significantly increased from 31.8% in 2018 to 51.8% in 2021 for women (p trend &lt; 0.0001), and from 13.0% in 2009 to 31.3% in 2021 for men (p trend &lt; 0.0001). Lower food security scores were associated with a higher risk for all ED categories. Depression and academic stress due to COVID-19 were associated with ED regardless of category. Regarding health behaviors, a high adherence to the National nutrition recommendation was a protective factor for the risk of bulimic ED, hyperphagic ED and restrictive ED. A lower frequency of moderate and vigorous physical activity was associated with a higher risk of hyperphagic ED.

Discussion
Our study has shown a high screening of ED among the students of a French university fourteen months after the beginning of the COVID-19 pandemic. By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED. Initiatives to reinforce early screening of ED to implement targeted interventions in the student population are urgently needed.

Key messages
• This finding underlines the need to extensively screen for ED in students population and identify vulnerable individuals at risk of ED.
• By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED.
Smoking cessation at diagnosis and cancer survival: systematic review and meta-analysis
Authors: Del Riccio M , Bonaccorsi G , Lorini C , Vettori V , Gandini S , Caini S 
Published: October 2022

Abstract

Stopping smoking can considerably cut one's risk of developing cancer compared to continued smoking (i.e. up to 50% after 5 years for esophageal cancer and after 10 years for lung cancer). Much less is known about whether quitting smoking may bring a survival advantage to people who are active smokers at the time of cancer diagnosis. We conducted a systematic review and meta-analysis of the studies that examined the prognostic effect of quitting smoking at or around diagnosis among cancer patients. We searched MEDLINE and EMBASE for articles published until 30th March 2022 that reported the impact of quitting smoking at or around diagnosis on cancer patients’ survival (any type). Separately for each cancer site, study-specific data were pooled into summary relative risk (SRR) and corresponding 95% confidence intervals (CI) using random effect meta-analysis models, investigating sources of heterogeneity and bias. Forty-three articles were included, including 20 for lung cancer (LC), 16 for head and neck cancer (HNC), and less than 10 for bladder, breast, gastrointestinal tract, and other sites. Quitting smoking at or around diagnosis was associated with longer overall survival (SRR 0.71, 95% CI 0.64-0.80) in LC patients (consistently for non-small cell and small cell LC) as well as HNC patients (SRR 0.80, 95% CI 0.70-0.91). No significant publication bias was found. For the other body sites, the studies were limited in number, which prevented meta-analyses, but results were generally consistent with a beneficial effect of smoking cessation on survival. Quitting smoking at or around diagnosis is associated with a significantly improved overall survival of smokers diagnosed with LC and HNC and shows beneficial effects in patients with other cancers. Physicians should offer smoking cessation counselling to smokers who start diagnostic workup for suspected cancer, and smoking cessation strategies should arguably become part of standard multidisciplinary oncological care.

Key messages
• Smoking cessation at or around diagnosis is associated with a significantly improved overall survival of smokers diagnosed with different types of cancer.
• Smoking cessation strategies (and counselling) should become part of standard multidisciplinary oncological care.
Let's not forget those who forget! Participatory design in the context of dementia built environment
Authors: Chrysikou E , Savvopoulou E , Rehn J , Minetou L , Hernandez Garcia E , Lad H , Capolongo S , Cadar D , Orlu M 
Published: October 2022

Abstract

Dementia is a major cause of disability and dependency among older people worldwide. Eco-bio-psychosocially supportive design can significantly reduce agitation and depression while improving mobility and daily activities. For this we need to include dementia patients as experts while understanding the neurological changes and functional impairments associated with the progression of the disease over time. How can we support dementia patients to participate? What tools/processes can we use to involve them in the design process? The aim of this project was to map and evaluate co-design methods for dementia and neurodiversity, in order to create an eco-bio-psychosocially supportive environment. Mixed methods were used comprising a systematic literature review on co-design techniques for spaces for dementia, three workshops: a 3-day one with seven early career researchers translating patient involving methodologies to the dementia context, a round table Patient and Public Involvement and Engagement with six service providers and stakeholders cross three countries and a cross-sectoral international day conference with four academics, four early career researchers and eight stakeholders and a series of co-design workshops for dementia and neurodiversity, which were then classified according to applicability so as to generate co-production methods for living environments for dementia. This transdisciplinary project highlighted the challenges of participatory design in the context of dementia built environment. The importance of the topic was highlighted by clinicians and staff but there are still significant limitations in terms of research and methodologies. The workshops outcome was an inclusive code of conduct for participatory design and research for dementia patients, which will help to improve home and care environments for people with dementia. The framework involved aspects such as time, space, equipment in relation to people involved (carers, patients, proxies).

Key messages
• The project created a framework to support dementia patients’ involvement for built environment decision making that considers aspects such as time, space and equipment to foster communication.
• The framework described the phases and the tools/methods in order to build trust and enable fluidity to accommodate dementia patients’ needs.