Health Policy Formulation Research Articles

Growing global public health challenges

Global public health is currently undergoing unprecedented and complex changes. The COVID-19 pandemic has exposed vulnerabilities and weaknesses of the global health system, urging nations globally to prioritize pandemic prevention and response strategies. Simultaneously, emerging infectious diseases such as mpox and avian influenza, as well as re-emerging infectious diseases including tuberculosis, AIDS, and viral hepatitis, continue to pose threats to global public health security. Moreover, the prevalence of chronic diseases remains significant, while concerns pertaining to environmental health and the well-being of children and adolescents are growing increasingly prominent. Addressing these challenges requires the formulation of effective public health policies, strengthened international cooperation, enhanced health education, improved public health literacy, and the establishment of a more resilient global public health system.

Impact of arsenic exposure on the hepatic metabolic molecular network in obese pregnant mice using metabolomics and proteomics

Arsenic is a ubiquitous environmental toxin that can affect normal physiological processes. Although the health impacts of arsenic have been investigated, its influence on hepatic metabolism in obese pregnant women and the underlying mechanisms remain unclear. Multi-omics analysis, including metabolomics and proteomics, can improve the understanding of arsenic-induced hepatotoxicity in obese pregnant women. This study aimed to investigate the adverse effects of gestational arsenic exposure on hepatic metabolism in high-fat-diet-induced obese pregnant mice. Following arsenic exposure during pregnancy, the liver tissue was evaluated comprehensively using metabolomics and proteomics techniques combined with pathological and biochemical analyses. Arsenic exposure not only significantly increased lipid accumulation in the livers of obese pregnant mice but also elevated inflammatory factors and oxidative stress markers. Specifically, histopathological examination revealed more steatosis, inflammatory cell infiltration, and hepatocyte ballooning in the livers of arsenic-exposed mice than in those of controls. These changes indicate that arsenic exposure exacerbates hepatic lipid accumulation and induces liver damage in the context of obesity. Metabolomic analysis provided further insight into the metabolic-level disruption caused by arsenic exposure. Significant changes were observed in lipid metabolism pathways, particularly the arachidonic acid metabolism pathway. As arachidonic acid and its metabolites play important roles in inflammation and oxidative stress, this pathway may be critical in arsenic-induced hepatotoxicity. Additionally, proteomic analysis showed differences in the expression levels of several key proteins involved in lipid synthesis, oxidative stress, and inflammatory response. Notably, oxidative-stress-related proteins, including glutathione peroxidase 4 (GPX4), were upregulated, suggesting an increased oxidative burden. In summary, there are complex interaction mechanisms among arsenic exposure, inflammatory response, and related lipid metabolism. The integration of metabolomics and proteomics aided in clarifying the molecular alterations induced by arsenic. The results show that arsenic exposure significantly affects hepatic lipid metabolism in obese pregnant mice through multiple metabolic pathways and protein regulatory mechanisms. In addition to providing new insights into the relationship between arsenic exposure and obesity as well as related metabolic diseases, this study can act as a reference for environmental health risk assessment and the formulation of public health policies. This enhanced understanding of the adverse effects of arsenic on hepatic metabolism will contribute to the development of strategies for mitigating the health risks associated with environmental toxins, particularly for vulnerable groups such as obese pregnant women.

Intersecting dimensions: advanced analytical approach to school climate and injury prevention in health policy

BackgroundChild safety in schools is paramount for decision-makers globally, with a focus on ensuring children return home safely. However, the prevalent issue of injuries across educational systems demands a comprehensive investigation into their causes, incorporating interdisciplinary perspectives and social dynamics, to develop effective prevention strategies. The objective of this study is to comprehensively analyze the factors contributing to school-related injuries and examine the impact of school climate on student safety. By employing advanced data analysis techniques, the research aims to develop targeted, effective strategies to enhance child safety in educational settings. This research aims to develop a multidimensional taxonomy to understand child injuries in elementary schools better, enhancing precision in decision-making.MethodsData from 363 Israeli primary schools and 10,855 school injuries attended to by MDA, the principal EMS provider, were analyzed. The study utilized a two-level taxonomy, employing clustering methodology to classify schools into distinct climate "patterns," with each pattern further delineating school injury characteristics into sub-patterns. The chosen method proved effective in revealing nuanced relationships between school injuries and climate characteristics.ResultsAnalysis revealed five school climate clusters, ranging from "good" to "bad," each exhibiting two homogeneous sub-clusters of school injuries. Schools with a "positive" climate witnessed boys predominantly experiencing head injuries during breaks, while girls often sustained limb injuries from playing in corridors. Conversely, within the "negative" climate cluster, subgroups emerged based on injury nature, whether linked to playing or falling from a height.ConclusionThe research delineates a nuanced association between school climate and injury rates, emphasizing the necessity for sophisticated analytical techniques beyond conventional methodologies. Utilizing a diverse dataset from various disciplines, the study highlights the multidimensional aspects of school health. The developed taxonomy reveals the complex dynamics within school environments, advocating for customized health policies to mitigate injuries. Critical findings prompt a reevaluation of established assumptions about the school climate-injury relationship, informing strategic policymaking. For example, it suggests collaboration to enhance school safety through targeted, gender-sensitive interventions and improvements. Integrating different data sources offers a holistic understanding crucial for effective health policy formulation in educational contexts.

PD221 Health Regulation And Health Technology Assessment: Brazilian Experience In Developing Actions For Health Regulation

IntroductionIn 2017, the Brazilian Health Regulatory Agency (Anvisa) and the Oswaldo Cruz Foundation (Fiocruz) in Brazil entered into a collaboration that enabled the production of evidence and dissemination of technical scientific information in the regulatory field, with aim of supporting the decision-making process on regulatory issues.MethodsThis qualitative and descriptive study was designed to report on the technical cooperation between Anvisa and Fiocruz in Brazil during from 2017 to 2020.ResultsThe studies developed by the Decentralized Execution Term assisted in the formulation of health policies at the macro, meso, and micro political levels, supporting the strengthening of institutional regulatory policy. The medicines agenda was the most recurrent in cooperation outputs, followed by the food and smoking agendas. The postmarket surveillance agenda played a leading role in actions carried out with the updating of the Technovigilance Manual and the creation of pharmacovigilance bulletins, both of which were available to health professionals and citizens. Finally, 27 courses were offered, and 1,276 certificates were issued (606 to workers linked to health regulation).ConclusionsThe Brazilian experience enabled to capacity building and critical analysis of evidence in regulatory scope. It has facilitated the preparation of productions that align with the regulatory agenda. Health technology assessment and health regulation need to converge in monitoring processes to reduce uncertainties and increase user safety.

The immune health assessment technique of the elderly population and its application and promotion in the prevention and treatment of common aged diseases

Immunosenescence refers to the phenomenon in which the human immune system gradually degrades in structure and function with the increase of age. The mechanism of human immunosenescence is complex, involving the systematic changes of multiple immune cell populations and molecular markers. At present, there is a significant lack of data on the characteristics of immunosenescence in the whole population in China, which limits the comprehensive understanding of the law of immunosenescence in the elderly population and the formulation of effective coping strategies. To accurately assess the immune health status of the elderly population, the integrated application of multiomics technology and informatics technology can help scientists to understand the changes of the immune system with age in detail and depict the characteristic map of immunosenescence, which not only helps to understand the molecular mechanism of aging but also provides potential targets for the development of intervention measures for age-related diseases. Moreover, it can provide a scientific basis for the health management of the elderly population, help formulate more effective prevention and treatment strategies, and provide a solid scientific basis for the formulation of public health policies in our country in the future.

Intrinsic Capacity and Instrumental Activity of Daily Living Among Community Dwelling Elderly in China: The Mediating Effect of Two‐Way Social Support and Sense of Coherence

ABSTRACTObjectivesTo explore the influence of intrinsic capacity (IC) on instrumental activities of daily living (IADL) among community‐dwelling elderly and to analyze the chain‐mediated effects of two‐way social support, and sense of coherence (SOC).DesignThis study was a cross‐sectional research design. Participants were recruited from September 2023 to December 2023 from Hangzhou City, Zhejiang Province, China, using a multistage sampling method.SampleParticipants in this study were at least 60 years old and had been currently living in the community for at least 1 year (n = 458).MeasurementsThe Integrated Care for Older People screening tool, the Brief Two‐Way Social Support Scale, the Sense of Coherence Scale‐13, and the Functional Activities Questionnaire were used to collect relevant data, which were statistically tested using structural equation modeling and multiple mediation effects.ResultsThere were correlations between IC, two‐way social support, SOC and IADL in community‐dwelling elderly (all p < 0.01). IC predicted two‐way social support (β = 0.570, p < 0.001), SOC (β = 0.544, p < 0.001) and IADL (β = −0.492, p < 0.001); two‐way social support had a positive predictive effect on SOC (β = 0.363, p < 0.001) but a negative predictive effect on IADL (β = −0.193, p < 0.001); SOC negatively predicted IADL (β = −0.150, p < 0.05).ConclusionsTo mitigate the impact of declining IC on IADL among community‐dwelling elderly, to sustain independent living, and to reduce the risk of progression to illness and disability, this study proposes two‐way social support and SOC as potential effective intervention targets. This conclusion holds implications for the assessment and intervention of elderly health, as well as the formulation of public health policies.

A qualitative study to explain the determinants of naswār consumption from the point of view of its consumers.

One of the health problems related to tobacco that is increasing in society is the consumption of naswār. This study aimed to investigate the determinants of naswār consumption from the point of view of its consumers. In this qualitative study, 47 men with an age range of 23- 54 years who consumed naswār from the southern cities of Fars province in Iran were selected and interviewed. These participants were selected using purposive and snowball sampling methods, and data was collected using semi-structured interviews. Data analysis was done using the conventional approach of qualitative content analysis. Three main categories were extracted: (1) Individual factors and beliefs related to naswār consumption (Non-addictive, similar and replacement with smoking, Not causing confusion, Being relaxing and enjoyable, increasing the effect of using other substances, reducing fatigue, causing body aches due to lack of use, having long effect, not causing physical problems, not causing weakness, having fast effect, increasing energy to work), (2) Environmental factors (being available, Having the low price, being consumed anywhere, being easy to store and carry, Not understanding others), and (3) Social factors (as a hobby, lack of entertainment, relatives and friends of the consumer, lack of ban on the consumption of naswār, lack of family opposition). As the results showed, there are many reasons for consuming naswār based on individual, environmental, and social factors. Formulation of laws, health policies, and education can be effective in adopting strategies to prevent and control the consumption of naswār.

HPR214 Use of Multicriteria Decision Analysis (MCDA) for Includes Innovation in Public Health Policy Formulation: A Scoping Review

HPR214 Use of Multicriteria Decision Analysis (MCDA) for Includes Innovation in Public Health Policy Formulation: A Scoping Review

Perceptions of healthcare workers on implementing the 2022 WHO verbal autopsy instrument in rural India through the existing public health system.

Cause-of-death (CoD) information is crucial for health policy formulation, planning, and program implementation. Verbal Autopsy (VA) is an approach employed for the collection and analysis of CoD estimates at the population level where medical certification of cause of death is low and, secondly, for integrating it with the existing public health system by utilizing the grassroots level workforce. The study aims to understand the field perspectives on implementing the 2022 WHO VA instrument in rural India through the existing public health system. This article is derived from a qualitative arm of study that was conducted in one of the blocks of Kanpur district, Uttar Pradesh. Frontline health workers (FHWs), as well as Medical Officers (MOs) serving in the Community Health Centre (CHC) area, were selected as study participants. A 5-day training and orientation workshop was conducted to train the FHWs to conduct computer-assisted personal interview VA using the 2022 WHO VA instrument. MOs have been trained to assign the CoD via Physician-Certified VA (PCVA). In-depth interviews (IDIs) were conducted with FHWs involved in conducting VA and physicians involved in conducting PCVA within the field practice area. A total of 13 IDIs were conducted, consisting of 10 FHWs and 3 MOs, within the selected CHC area of Ghatampur. Based on the responses received, five major themes were identified. Although VA is being used to collect CoD information from the community in India through a Sample Registration Survey (SRS), the key findings suggest that this activity could be scaled up by utilizing the existing public health system. However, additional manpower may be required for constant monitoring and evaluation of the program. Incentivization of FHWs would aid in the timely completion of VAs and coordination with local and higher health authorities. The perception of healthcare workers about the feasibility and acceptability of VA in this study highlighted some of the challenges and possible solutions that could aid in developing a comprehensive model to improve CoD information at the population level through the existing public health system.

Analysis of the Predictors of Mortality from Ischemic Heart Diseases in the Southern Region of Brazil: A Geographic Machine-Learning-Based Study.

Mortality due to ischemic heart disease (IHD) is heterogeneously distributed globally, and identifying the sites most affected by it is essential in developing strategies to mitigate the impact of the disease, despite the complexity resulting from the great diversity of variables involved. To analyze the predictability of IHD mortality using machine learning (ML) techniques in combination with geospatial analysis in southern Brazil. Ecological study using secondary and retrospective data on mortality due to ischemic heart disease (IHD) obtained from the Mortality Information Systems (SIM-DATASUS) de 2018 a 2022, covering 1,191 municipalities in the states of Paraná (399), Santa Catarina (295), and Rio Grande do Sul (497). Ordinary Least Squares Regression (OLS), Geographically Weighted Regression (GWR), Random Forest (RF), and Geographically Weighted Random Forest (GWRF) analyses were performed to verify the model with the best performance capable of identifying the most affected sites by the disease based on a set of predictors composed by variables of procedures and access to health. In the analyzed period, there were 59,093 deaths, 65% of which were men, 82.7% were white, and 72.8% occurred between 60 and 70 years of age. Ischemic heart disease presented the highest mortality rates in the northwest and north regions of the state of Paraná, and in the central-east, southwest and southeast regions of Rio Grande do Sul, the latter state accounting for 41% of total deaths. The GWRF presented the best performance with R2 = 0.983 and AICc = 2298.4, RMSE: 3.494 and the most important variables of the model in descending order were electrocardiograph rate, cardiac catheterization rate, access index to hemodynamics, access index of pre-hospital mobile units, cardiologists rate, myocardial scintigraphy rate, stress test rate, and stress echocardiogram rate. The GWRF identified spatial heterogeneity in the variation of geographic predictors, contrasting the limitation of linear regression models. The findings showed patterns of vulnerability in southern Brazil, suggesting the formulation of health policies to improve access to diagnostic and therapeutic resources, with the potential to reduce IHD mortality.

ANÁLISE EPIDEMIOLÓGICA DO TRAUMA GENITOURINÁRIO NO ESTADO DO ACRE: PREENCHENDO LACUNAS DE CONHECIMENTO NA REGIÃO NORTE DO BRASIL, 2013-2023

Genitourinary traumas include injuries to the kidneys, ureters, bladder, urethra, and genital organs, often resulting in severe complications and requiring complex medical interventions. This study aims to characterize the epidemiological profile of patients with genitourinary trauma treated at a referral center in Acre, Brazil, from 2013 to 2023, highlighting demographic characteristics, types of injuries, treatments applied, and clinical outcomes. The research adopted a cross-sectional, descriptive, and retrospective approach, using secondary data from the SUS information system. A total of 102 cases were analyzed, with a predominance of male patients (85.3%) and an average age of 31.64 years. Renal traumas were the most common (59.8%), followed by urethral (20.6%) and bladder injuries (8.8%). Most patients required surgical interventions (83.3%), and the mortality rate was low (2.9%). This study fills a knowledge gap regarding the epidemiology of genitourinary traumas in Acre, providing essential data for the formulation of public health policies and prevention strategies.

The role of obesity in increasing the risk of hypertension in the elderly

Introduction: Obesity has been identified as one of the main risk factors contributing to the increase in hypertension cases, particularly among the elderly. This study aims to analyze the role of obesity in increasing the risk of hypertension in the elderly by examining the relationship between body mass index (BMI) and blood pressure. Methods: This research uses a cross-sectional design, an analytical study that studies the causes of incidents or incidents. Data collection uses a questionnaire. The sample in this study was 64 elderly hypertensive patients in the working data analysis using the chi-square test. Results: This study's results indicate a relationship between obesity (p=0.000) and the incidence of hypertension in the elderly working. The results showed that the elderly with obese status had a significantly higher risk of hypertension compared to the elderly with average weight. Conclusions: These findings underscore the importance of preventing and treating obesity in the elderly to reduce the risk of hypertension and other health complications. This research is expected to contribute to formulating health policies and hypertension prevention programs among the elderly through a practical weight management approach

Industry influence on public health policy formulation in the UK: a complex systems approach.

Unhealthy commodity industries (UCIs) such as tobacco, alcohol, gambling, ultra-processed food and beverage producers are known to influence policy-making to advance their interests, often to the detriment of public health goals. This study mapped the complex system underpinning UCI's influence on public health policy formulation in the UK and identified potential interventions to shift the system towards being able to better attain public health goals. We conducted a participatory systems mapping workshop with ten experts to build a causal loop diagram (CLD) and identify potential interventions to address UCI's influence on public health policy development. The resulting CLD depicts a highly interconnected and reinforcing system driving UCI's involvement in public health policy formulation across five thematic areas. Among the most connected elements were the 'dominance of market mechanisms', 'perception of partnership as good governance principle', 'industry involvement lending perceived legitimacy to the policy formulation process', 'industry is seen as part of the solution' and 'industry ties to policy-makers'. Participants identified a total of 22 interventions within this system. Analysis of the CLD and interventions identified the potential for two key paradigmatic changes in this complex system: de-normalizing the perception of unhealthy commodity industry actors as legitimate stakeholders in policy formulation; and prioritizing public health and wellbeing objectives over profit and economic gain. In order to shift the system towards better attaining public health goals, interventions should reinforce each other and be supportive of these two key paradigmatic shifts.

Quantifying the Strain: A Global Burden of Disease (GBD) Perspective on Musculoskeletal Disorders in the United States Over Three Decades: 1990-2019.

Background: Musculoskeletal (MSK) disorders significantly contribute to global disability, especially in high-income countries. Yet, comprehensive studies on their epidemiological burden in the United States (US) are limited. Our study aims to fill this gap by characterizing the MSK disease burden in the US using Global Burden of Disease (GBD) data from 1990 to 2019. Methods: We conducted an ecological study using descriptive statistical analyses to examine age-standardized prevalence and disability-adjusted life years (DALY) rates of MSK disorders across different demographics and states. The study also assessed the impact of risk factors segmented by age and sex. Results: From 1990 to 2019, the burden of MSK disorders in the US increased significantly. Low back pain was the most prevalent condition. Age-standardized prevalence and DALY rates increased by 6.7% and 17.6%, respectively. Gout and other MSK disorders saw the most significant rise in DALY rates. Females experienced higher rates than males, and there were notable geographic disparities, with the District of Columbia having the lowest and North Dakota and Iowa the highest DALY rates. Smoking, high BMI, and occupational risks emerged as primary risk factors. Conclusions: Our study highlights the escalating burden of MSK disorders in the US, revealing significant geographic and sex disparities. These findings highlight the urgent need for targeted health interventions, policy formulation, and public health initiatives focusing on lifestyle and workplace modifications. Region- and sex-specific strategies are crucial in effectively managing MSK conditions, considering the influence of various risk factors.

Unravelling the Dynamics of Macroeconomic Variables and Infant Mortality in India Based on ARDL Model Analysis

The well-being of mothers and children serves as a vital indicator of a nation’s prosperity and is influenced by a range of factors, including macroeconomic variables such as Gross Domestic Product (GDP), unemployment, inflation, income, education, and healthcare expenditure. Escalating inflation precipitates higher food prices, amplifies household living costs, and diminishes purchasing power, consequently exerting a substantial impact on individuals’ nutritional and physical health. This study aims to examine the correlation between macroeconomic variables, specifically GDP per capita, Consumer Price Index (CPI), unemployment, and infant mortality in the Indian context. Despite the significance of this relationship, there exists a dearth of research on the association between macroeconomic variables and maternal and child mortality, particularly within the Indian context. Prior studies consistently underscore the indispensability of macroeconomic stability in achieving improved outcomes in maternal and child health. The analysis draws upon secondary data procured from reputable sources such as the World Bank and Reserve Bank of India (RBI), encompassing time series data about both the dependent variable, namely the infant mortality rate, and the explanatory variables. To investigate the impact of macroeconomic variables on infant mortality, the study employs the Autoregressive Distributed Lag (ARDL) Error Correction Model, which accounts for the interplay between the variables over time. Empirical findings establish the existence of long-term cointegration between macroeconomic variables and the infant mortality rate. However, in the short run, some variability in cointegration arises due to a multitude of factors, including policy interventions, demographic characteristics, and socio-cultural determinants. This study substantiates the proposition that sustaining macroeconomic stability and fostering economic growth play pivotal roles in attaining health sector objectives, particularly in emerging economies like India. Consequently, while formulating health policies, equal emphasis must be placed on measures aimed at stabilizing the economy to ensure favourable outcomes of such policies.

The data layer: the importance of sources critical appraisal

Abstract One of the main purposes of public health institute is to tracking the health status of its citizens and understanding its evolution over time. Given the absence of a singular, comprehensive data source, we developed a framework to select databases specific to each disease and outcome of interest. This process includes a thorough evaluation of the operational case definitions, as well as the strengths and weaknesses of each database, with a particular focus on their sensitivity and specificity. These qualities are appraised following a dedicated scoring form into different categories (i.e., high, medium, low). The selection criteria for data sources hinge on several key questions: Is the database exhaustive or merely a sample? Does the case definition rely on direct medical diagnoses or proxies? Does the source capture all cases? Is the data collected at regional or national level? Are there mechanisms for yearly or periodic updates? To establish the most accurate national prevalence estimates for each outcome, we often need to adjust for data misclassification-applying corrections for biases such as self-reported data and interpolating for missing entries. In some instances, a pooled estimate from multiple data sources is developed. A specific case will be presented to illustrate our approach in practice. This critical evaluation is pivotal, as the quality of data underpins the entire health information pyramid. The integrity of our data directly influences our ability to convert data into actionable health wisdom, ultimately affecting public health decision-making and policy formulation.

1.L. Scientific session: Public Health data in support of healthy ageing policies

Abstract As Europe grapples with an ageing population, the imperative of health policies that promote healthy ageing is increasingly critical. This workshop aims to explore the significant role of public health data in shaping and supporting such policies. By integrating insights from administrative records to sophisticated research infrastructures, we will highlight the multifaceted uses of data in public health, particularly in the realms of non-communicable diseases and health-related behaviours in older populations. The session will open by examining how administrative records have been utilised within Lombardy’s regional health system to understand the epidemiology and access to care for people living with dementia. The discussion will then cover the advantages and challenges associated with integrating health data from diverse sources, emphasising the importance of quality, privacy, and the potential for real-time surveillance and response systems in healthcare. Following this, the focus will shift to the determinants of good health among older adults, presenting findings from a comprehensive cross-sectional study that identifies key factors contributing to what can be termed as “superhero” health status: seniors who maintain excellent physical and mental health. This analysis will delve into socioeconomic, behavioural, and environmental factors that influence health outcomes in the elderly, providing evidence-based recommendations for public health interventions and highlighting the potentialities of ad hoc surveys in examining health outcomes during emergencies. Thirdly, the workshop will also address the impact of significant life transitions on health behaviours, specifically the transition to retirement and its effects on alcohol consumption. Leveraging longitudinal data from a pan-European multidisciplinary research infrastructure, it will be demonstrated how retirement affects daily habits and lifestyles, including changes in alcohol consumption patterns. This segment will explore the implications of these findings for public health planning and policy formulation. In conclusion, there will be a discussion about healthcare system policies that support healthy ageing and the global impact of ageing on economics and health economics. These discussions will draw from the presented data sources and studies to suggest ways in which public health policies can be designed to reduce disparities and improve overall health outcomes among the elderly. This workshop is designed to provide a comprehensive overview of how data-driven insights can inform effective public health strategies and interventions to support an ageing society. By exploring various aspects of health data application, from individual behaviour to systemic policy adjustments, the session aims to highlight the critical role of data in promoting sustainable health and well-being in older adults, especially in the context of increasing life expectancy and prolonged retirement periods. Key messages • Harnessing data from diverse sources is crucial for understanding and enhancing healthy ageing processes. • Utilising longitudinal studies and robust data to design informed public health policies is essential for effective ageing interventions.

Association of anthropogenic heat with asthma and related symptoms among children in China: A novel index reflecting climate change

BackgroundAnthropogenic heat (AH) is defined as the significant release of waste heat into the environment due to human activities, serving as a controllable heat source contributing to global climate change. However, epidemiological evidence establishing a clear association between AH and childhood asthma is currently lacking. ObjectivesTo explore the relationship between children's exposure to AH and asthma, as well as its related symptoms. MethodsThis population-based cross-sectional study, part of the National Chinese Children Health Study from 2012 to 2018, involved 188,145 children aged 6 to 18 years. We used multisource remote sensing images and ancillary data to estimate AH exposure. Data on asthma symptoms were collected through validated self-reported questionnaires. A generalized linear mixed model was applied to determine the associations. ResultsOur findings indicate a positive correlation between AH exposure and asthma risk in children. An interquartile range (IQR) increase in total AH was linked to higher odds of current asthma (OR: 1.15, 95 % CI: 1.10, 1.20) after adjusting for covariates. Categorizing AH by source, industrial AH exhibited the strongest effect, with an increased risk of current asthma (OR: 1.16, 95 % CI: 1.11, 1.22). Notably, younger children exhibited stronger associations between AH exposure and asthma-related symptoms, with boys showing heightened susceptibility, particularly for persistent cough. ConclusionThis study suggests that exposure to AH may elevate the risk of asthma and related symptoms, particularly in boys and younger children. Providing a foundation for developing practical strategies to mitigate the adverse impacts of global warming on respiratory health, while also guiding the formulation and evaluation of climate action and public health policies, and supporting sustainable urban development.

Area-Level Factors of Dental Caries in Children and Adolescents in European Neighborhoods - a Systematic Review.

The WHO emphasizes the importance of taking area-level factors into account when formulating public health interventions. The aim of this systematic review was to identify which area-level factors are associated with children's dental caries in Europe and might therefore be a suitable starting point for public health interventions. We conducted a systematic review based on a search in PubMed, Web of Science, and Cochrane Library including all European studies on caries in children and their area-level factors published since the year 2000 in English or German. We included 39 studies and identified 13 area-level factors investigated in the literature: degree of urbanization, deprivation, mean housing price, gross-national product, mean level of education, unemployment proportion and income, density of supermarkets, snack bars and dental offices, health, diet, and crime. Rural residency and higher unemployment were weakly associated with poorer oral health regarding dental caries. Deprivation showed a stronger (inverse) association. For income, findings were ambiguous; studies showed associations in both directions. For the other determinants, the included studies found no association. Many studies reported associations between place of residence and children's dental caries, but the mediators on this causal path are still not clearly established. The area-level factors analyzed in this review seem to play a role, but more studies with designs that allow causal interpretation of findings are needed to establish solid robust evidence that can be used in the formulation of future health policies.

Application of MICMAC and Regnier’s Abacus Techniques to Assess the Association between High Sugar Diet and the Prevalence of Dental Caries in Young Adults

This study aimed to identify and assess the association between a high-sugar diet and the prevalence of dental caries in young adults. In addition, these variables were prioritized based on their relevance and dependence using the complementary methodologies MICMAC and Regnier’s abacus. A literature review was conducted to identify the related variables. A group of 10 dentistry and nutrition experts assesses the importance of these variables using a structured questionnaire. As a result, both methodologies agreed on the importance of dental hygiene and the frequency of sugar consumption in the prevalence of dental caries. Access to dental health services was also identified as a significant factor. These findings are relevant because they have implications for the formulation of public health policies and the design of strategies that can reduce the impact of dental caries to improve the dental health of the population.