bluuebunny/crossref_metadata_2025_split huggingface dataset:
Classification and risk factors of Post COVID-19 condition: a longitudinal study in the Belgian population
Authors: Smith P 
Published: October 2022

Abstract

Background
Since the onset of the COVID-19 pandemic, most research has focused on the pathophysiology and management of the acute symptoms of COVID-19, yet some people tend to experience symptoms beyond the acute phase of infection, that is, Post COVID-19 condition (PCC). However, evidence on the prevalence of PCC, its symptoms, and mechanisms are still scarce. This study aimed to assess the distribution, patterns of symptoms, and associated factors of PCC in adult with confirmed COVID-19 infection in Belgium.

Methods
This is a longitudinal cohort study of Belgian adult population with recent COVID-19 infection confirmed via a molecular test and systematically recruited via national tracing call centers. A total of 5181 people were followed-up using online questionnaires at the time of their infection and 3 months later (from April 2021 to February 2022). Their physical, social and mental health was evaluated as well as their acute COVID-19 symptoms and persistent PCC symptoms. These different variables were self-reported.

Results
Half of the participants reported PCC (49.6%). The most frequent persistent symptoms 3 months after infection were fatigue (28%), headache (18%), and memory problems (12%). Women (OR = 1.67,CI95%=1.40-1.99), people with a lower level of education (OR = 1.23,CI95%=1.02-1.48), obese people (OR = 1.23,CI95%=1.02-1.48), people with chronic disease (OR = 1.97,CI95%=1.40-2.77), and people with a higher number of acute COVID-19 symptoms (OR = 2.56, CI95%=1.83-3.58) or hospitalised (OR = 2.19,CI95%=1.25-3.82) were more likely to report PCC. Finally, a latent class analysis on the 29 PCC symptoms highlighted 3 different classes of symptoms.

Conclusions
With the growing number of people infected with COVID-19, PCC is becoming an important public health issue. To allow people with PCC to recover, it is essential to have a multidisciplinary approach and to provide early post-acute physical and psychological rehabilitation interventions according to symptom patterns.
Perspectives of long COVID patients on their (unmet) needs: a national quantitative and qualitative study
Authors: Dauvrin M , Kohn L , Detollenaere J , Primus-de Jong C , Maertens de Noordhout C , Castanares-Zapatero D , Cleemput I , Van den Heede K 
Published: October 2022

Abstract

Introduction
After COVID-19, many people continue to experience various symptoms for several weeks, even after a mild acute phase, and encounter difficulties when confronted with the healthcare system. Patient associations asked the Belgian Health Care Knowledge Centre to investigate the needs of these patients to improve their management.

Purpose of research
An online quantitative survey was conducted in 2021 among Belgian patients with history of COVID-19; having/had persisting symptoms for at least 4 weeks. Alongside questions on symptoms, treatment and impact on employment, Health-Related Quality of Life (HRQoL) before and after COVID-19 was measured through the EQ-5D-5L. A regression analysis identified the factors associated with the impact of long COVID on HRQoL. The qualitative approach consisted in 33 interviews and forum discussions among 101 patients.

Results
1320 patients completed the online survey, most were symptomatic for more than 3 months. The average EQ-5D-5L index score was 0.85(95%CI:0.83-0.86) before and 0.65(95%CI:0.63-0.66) after infection. Duration, number and type of symptoms of long COVID significantly impacted HRQoL. More than half of the patients were unable to work. Qualitative part identified lack of empathy of health professionals, of systematic diagnostic approach, of interdisciplinary coordination. Patients felt misunderstood and developed their own diagnostic or treatment strategies. They questioned the value of medicine and resorted to non-reimbursed alternative therapies.

Conclusions
Long COVID has a significant impact on HRQoL and employment. Because of long COVID, patients were confronted, sometimes for the first time, with the imperfections of the health system. Better informing the health professionals on Long COVID patterns and management options, including reimbursement possibilities, and a comprehensive interdisciplinary assessment would give them the tools to respond to the needs of these patients.
Long COVID: health symptoms, impact on health-related quality of life and mapping to disability weights
Authors: Haagsma J 
Published: October 2022

Abstract

Introduction
Previous studies indicated that a significant share of COVID-19 patients experiences long lasting health complaints; a condition also referred to as “long COVID”. In order to assess the long term burden of disease of COVID-19, including long COVID, information is needed on health symptoms, health-related quality of life and duration of symptoms of long COVID patients. Therefore, the aim of this study was to assess health symptoms and health-related quality of life of long COVID in the general population of the Netherlands.

Methods
A total of 33,903 COVID-19 patients from the region South-Holland South (the Netherlands) whom tested positive between June 2020 and May 2021 at the municipal health services were invited to complete a web-based questionnaire on the presence, nature and consequences of long COVID and health-related quality of life, measured with the EQ-5D-5L.

Results
In total, 3,768 participants who completed the questionnaire experienced long COVID. Most commonly reporting symptoms were reduced physical condition (65.5%), fatigue (59.6%), problems concentrating (49.6%), loss of smell (41.2%) and shortness of breath (37.8%). 648 participants indicated that they experienced long COVID symptoms for 5 months or longer. Preliminary analysis showed that increasing number of symptoms was associated with a decrease in health-related quality of life.

Discussion and conclusions
Long COVID covers a range of health symptoms of varying severity and duration. This complicates the calculation of the non-fatal burden of disease of COVID-19, particularly because mapping of long COVID to existing disability weights is hampered.
Costs of air pollution impact on health in the Western Balkans: preliminary results
Authors: Belis C , Ballocci M , Matkovic V , Millo G , Jevtic M , Van Dingenen R 
Published: October 2022

Abstract
Air pollution is the main environmental driver associated with health. It is well documented that poor air quality is responsible for increased risk of mortality and morbidity. The social cost of mortality in 2015 was estimated in 3 trillion (OECD, 2016). The Western Balkans (WB) comprise Albania, Bosnia and Herzegovina, Kosovo*, North Macedonia, Montenegro and Serbia covering area of 218 750 km2 and a population of 19.9 million with total GDP of €94.2 billion (Banja et al., 2020). The WB was selected for this study because it is one of the air pollution hotspots in Europe where the levels of PM2.5, PM10, NO2 and O3 are frequently above the EU Air Quality Directive guidelines. This situation has been associated with a higher proportion of premature deaths attributable to air pollution exposure (4-19% of total deaths) in this region compared to EU member states (EEA, 2021). The health impacts including mortality and morbidity were estimated for particulate matter PM2.5, ozone (O3) and nitrogen dioxide (NO2) at country and city level on the basis of exposure in 2019 derived from monitoring stations and model estimations. Mortality impacts were parameterised using the number of premature deaths. Morbidity costs included: chronic bronchitis, hospital admissions due to respiratory diseases, hospital admissions due to cardiovascular diseases, bronchitis in children, asthma in children, reduced activity days and work lost days. The costs of mortality attributable to air pollution were estimated on the basis of non-market welfare based methods (WTP approach) while morbidity costs were estimated mainly with market based methods combining both direct and indirect costs. The 2019 health costs, both per capita and as share of the GDP, associated with air pollution in the WB were considerably higher than those in EU27.
Adapting and testing a tool to map digital health resources use by older adults in Israel and Taiwan
Authors: Levin-Zamir D , Baron-Epel O , Chang P , Neter E , Eliahu E , Duong T 
Published: October 2022

Abstract

Background
Despite the potential of digital health tools for improving health outcomes, older adults are known to use digital health tools differently than younger adults. Focusing on needs of older populations is critical, as their numbers and proportions are projected to increase dramatically in the coming decades, both in Israel and in Taiwan. A bi-national collaboration was developed to map existing digital health resources available to older adults, as part of a larger study on digital health services use among older adults.

Methods
A mapping tool was adapted from the WHO classification of digital health interventions, based on the experience in the Taiwanese and Israeli health systems. The areas included public health, prevention, self- monitoring and self-care information and services in primary and tertiary care. The mapping documented digital resources offered by governmental/Ministry of Health, public primary care (HMOs), hospitals, and non-governmental organizations. Sources of information were institutional websites, evaluated by two specially trained reviewers for each organization who assigned a dichotomous value (yes/no) for each category. Interrater reliability was computed using a Kappa coefficient.

Results
The instrument included 17 categories and 44 sub-categories of digital resources, ranging from public health information for emergency situations to specific health service characteristics. To date, the Kappa coefficients range from 0.59-0.68 for NGO, MOH and hospital resources, considered substantial; for 3 HMOs, the values ranged from 0.41-0.49, considered moderate.

Conclusions
The mapping tool adapted to the countries’ digital resources allowed for bi-national research to compare/contrast the countries’ experience. The next stage of the study will validate the results through expert interviews, followed by an end user survey with older adults to assess both reported use of services and enabling digital health literacy skills.

Key messages
• To meet the needs of aging populations, attention needs to be given to their engagement with digital health services and resources.
• Mapping digital health resources is essential for estimating how health needs are met nationally.
School tobacco policies and social inequalities in adolescent smoking
Authors: Mélard N , Lorant V 
Published: October 2022

Abstract

Background
Adolescents of lower socio-economic status initiate smoking earlier and smoke more frequently than those of higher socio-economic status. Tobacco control policies, such as school tobacco policies, aim to reduce adolescent smoking, but their implementation has been found to vary greatly from one school to another. Such differences in the implementation might therefore contribute to social inequalities in smoking. This study examines whether school tobacco policies are implemented where they are most needed, and how this implementation according to needs has changed over time.

Methods
Student (n = 18,805) and staff surveys (n = 438) were conducted in 2013 and 2016 in 38 schools from six European cities in six countries. School tobacco policies were measured as a 10-point score taking into account their multidimensionality, and the perceptions of both students and staff. We used concentration curves and indices to measure the inequality in the implementation of these policies depending on the smoking prevalence and on adolescents’ socio-economic status.

Results
A concentration curve below the perfect equity line indicated a concentration of school tobacco policies where smoking prevalence was lower. Moreover, this inequality was larger in 2016 compared to 2013 (concentration indices of .038 in 2013 and .041 in 2016). On the contrary, a concentration curve overlaying the perfect equity line indicated no inequality in the implementation of these policies depending on adolescents’ socio-economic status (concentration indices of .016 in 2013 and -.013 in 2016).

Conclusions
School tobacco policies have been developed to reduce adolescent smoking. They, however, seem to be less implemented in schools where they are most needed. This confirms that smoking prevention is still driven by the inverse prevention law. Next to evaluating the impact of such policies on smoking outcomes, research should also focus on their contribution to social inequalities in adolescent smoking.

Key messages
• School tobacco policies, developed to reduce adolescent smoking, might contribute to social inequalities in smoking.
• School tobacco policies are less implemented where they are most needed.
The role of gender equity in healthy life expectancy in 27 European countries
Authors: Leão T 
Published: October 2022

Abstract

Background
The number of years - and healthy years - a person is expected to live differs according to gender: women tend to live longer than men, but with a shorter healthy life expectancy (HLE). Power imbalance, such as income, prestige, or autonomy gaps, may lead to an unequal health distribution across gender in the older ages. The association between gender equality and longer life expectancies has been described, but little is known about its association with HLE. We aimed to study the association between gender equality, and its components, and HLE in Europe, in the last decade.

Methods
We combined HLE estimates from Eurostat with the Gender Equality Index (and its components) for 27 European countries, from 2013 to 2019. The associations between gender equality and HLE, and its gender gap, were assessed using regression analyses adjusted for Gross Domestic Product, number of medical doctors per 1000 inhabitants (as proxies of economic wellbeing and access to healthcare), and year.

Results
Higher gender equality was associated with longer HLE in men (β = 0.22 p &lt; 0.01), but not in women. Yet, higher equality in education was associated with longer HLE in both genders (βmen=0.49, βwomen=0.40, p &lt; 0.001), as was access to financial resources (βmen=0.27, βwomen=0.20, p &lt; 0.005), and social power (βmen=0.09, βwomen=0.07, p &lt; 0.05). Differently, equality in participation in full-time work was associated with shorter HLE in both genders (βmen=-0.33, βwomen=-0.30, p &lt; 0.001) and a higher HLE gender gap (β = 0.05, p &lt; 0.05). The HLE gender gap was smaller in contexts with higher equality in access to financial resources (β=-0.06, p &lt; 0.001) and education (β=-0.04, p &lt; 0.01).

Conclusions
These results point to a country-level relation between gender equality and HLE. Beyond the social issue, gender inequalities in education, income and social power seem to play a role in the health of women and men through their aging course.

Key messages
• Higher gender equality in education, income and social power are associated with longer healthy life expectancies in 27 European countries.
• Gender equality benefits not only women’s healthy life expectancies but also men’s, and is reflected in smaller gender gaps.
The fish paradox: people with low socio-economic status are not consuming the right type of fish
Authors: Zhu Y , Mierau JO , Riphagen IJ , Dekker LH , Navis GJ , Bakker SJL 
Published: October 2022

Abstract

Background
Fish intake is included in several national food-based dietary guidelines as a component of healthy diet because of its rich source of beneficial omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, heterogeneity among types of fish intake is rarely studied. We investigated the associations of socio-economic status (SES) with total and types of fish intake and validated whether types of fish intake was associated with plasma EPA and DHA.

Methods
From the Lifelines cohort study, 94 246 participants aged 44 ± 13 years old were included to test the association of two SES indicators, i.e., education level and income level, with dietary intakes of total, fatty, lean, fried, and other types of fish. Plasma EPA and DHA were measured in a minor subset of 575 participants (mean age: 50 ± 13 years old). Total and types of fish intake was assessed using Food Frequency Questionnaire. Linear regressions were applied, adjusted for relevant covariates.

Results
After adjusting for covariates, middle and low education were negatively associated with total, fatty, lean, and other fish intake (p &lt; 0.001 for all), and positively associated with fried fish intake (β (SE): 0.04 (0.04), p &lt; 0.001 for middle education; 0.07 (0.04), p &lt; 0.001 for high education), with high education as the reference group. Similar results were observed for income level. In the subset population, total and fatty fish were positively associated with plasma EPA and DHA (p &lt; 0.02 for all). Lean and other fish intake were positively associated with only DHA (p &lt; 0.008 for all), but not EPA, while fried fish was not associated with either EPA or DHA in plasma (p &gt; 0.1 for all).

Conclusions
Lower SES was associated with higher intake of fried fish, which did not seem to be associated with the fish-based EPA and DHA in plasma. Both nutrition education and food price policy could be implemented to increase the awareness and shape people's choice on types of fish.

Key messages
• People with low socio-economic status are consuming the type of fish that is not associated with fish-based omega-3 fatty acids, so nutrition education focusing on avoidance of fried fish is needed.
• Food subsidy programs promoting intake and increasing affordability of healthier fish are needed to improve the nutritional awareness and status of our population.
Not all plant-based diets are associated with benefits on mortality: the Moli-sani Study
Authors: Bonaccio M , Di Castelnuovo A , Costanzo S , Ruggiero E , Esposito S , Persichillo M , Cerletti C , Donati MB , de Gaetano G , Iacoviello L 
Published: October 2022

Abstract

Background
Vegetarians diets are characterized by the absence of some animal foods (e.g. red and processed meats), and a high consumption of plant-based foods. However, plant-based foods can include foods with varying nutritional value and health effects. We examined the association of three different pro-vegetarian (PVG) food patterns defined as general (gPVG), healthful (hPVG) and unhealthful (uPVG), with the risk of all-cause and cardiovascular disease (CVD) mortality in Italians.

Methods
Longitudinal analysis on 22,912 men and women (mean age 55±12 y) from the Moli-sani Study (2005-2010) followed up for 11.2 y (median). Food intake was assessed by a 188-item FFQ. A provegetarian food pattern (FP) was constructed by assigning positive scores to plant foods and reverse scores to animal foods. A healthful and an unhealthful pro-vegetarian FP, which distinguished between healthy (e.g. fruits, vegetables, legumes) and less-healthy plant foods (e.g. fruit juices, potatoes, sugary beverages), were also built up.

Results
In multivariable-adjusted analyses controlled for known risk factors, higher adherence to a gPVG was associated with lower all-cause (HR = 0.83; 95%CI 0.73-0.94) but not CVD mortality (HR = 0.90; 0.72-1.12). Increasing adherence to a hPVG was associated with reduced all-cause mortality risk (HR = 0.82; 0.72-0.95) as well as lower risk of CVD mortality (HR = 0.75; 0.59-0.95). Finally, the uPVG was directly associated with both all-cause (HR = 1.17; 1.03-1.33) and CVD mortality risks (HR = 1.23; 0.99-1.53).

Conclusions
A general pro-vegetarian food pattern was associated with longer survival in Italians. Preferring healthful vegetarian foods provided protection against CVD mortality too. Consistently, a large dietary share of unhealthful vegetarian foods, mostly highly processed, was associated with increased risk mortality. Thus the quality of the plant food consumed is paramount to achieve diet-related benefits on mortality.

Key messages
• A pro-vegetarian food pattern was associated with longer survival but preferring healthful vegetarian foods provided protection against CVD mortality too.
• The quality of the plant food consumed is paramount to achieve diet-related benefits on mortality.
An exploration of reformulation efforts by the food industry in Ireland
Authors: McMenemy D , Sweeney MR 
Published: October 2022

Abstract

Background
Previous research conducted in 2020 by our team examined the progress made by food manufacturers in reformulation between 2014 and 2017 (i.e., improving the nutrition profile of food staples by reducing salt, sugar, saturated fat and overall energy contribution). Our previous study showed improvements in salt and sugars levels across many food staples, but we found rising energy levels, total fat, and saturated fat in many food categories.

Methods
This study aimed to explore the ongoing progress in reformulation between 2017 to 2021. We photographed the labels of food staples in supermarkets with the leading market share in the Republic of Ireland (Tesco's, Dunnes, SuperValu, Lidl, Centra, Aldi, and M&S). We extracted the data, collated it in an excel spreadsheet, and analysed it to examine the nutrients of interest to the study (i.e., salt, sugar, fat, saturated fat, energy, carbohydrates, protein, fibre, and micronutrients). We compared the levels captured at this time point with those previously recorded in 2017.

Results
Eight hundred and seventy-two products were directly compared, including 80 spreads, 34 cereal snacks, 87 fruit juices, 193 cereals, 210 breads, 88 milks, and 169 yoghourts. This study shows that previously reported improvements in salt and sugar levels now appear to be going in the wrong direction.

Conclusions
Fat and saturated fat levels that were once on the increase now appear to be reducing, possibly implying that as salt and sugar go up, fat levels go down and vice versa. This may relate to product taste and palatability.

Key messages
• This study shows that previously reported improvements in salt and sugar levels now appear to be going in the wrong direction.
• Fat and saturated fat levels that were once on the increase now appear to be reducing, as salt and sugar go up, fat levels go down.