Modeling ciliopathies in patient-derived primary cells

Ciliopathies comprise a group of inherited diseases caused by mutations in genes encoding proteins that localize to cilia or centrosomes. They afflict multiple organs and are one of the most frequent monogenic causes of kidney failure in adults, adolescents and children. Primary cilia play diverse roles in cell signaling, cell cycle regulation, planar cell polarity and mechanosensing. The use of patient-derived cells possessing endogenous disease causing mutations enables the study of these processes and their dysregulation in disease. Here we describe methods to cultivate patient-derived dermal fibroblast and renal epithelial cells isolated from urine. Fibroblasts are highly robust, long-lived, and easy to culture cells in which ciliary assembly can be easily induced. Similarly, the ability to acquire and culture ciliated renal epithelial cells without patient-invasive-intervention holds great potential to further our understanding of ciliopathies. In addition to monolayer cultures, we also detail the formation of three-dimensional renal-epithelial organoids-so-called tubuloids-that demonstrate epithelial-polarization and transepithelial transport activities like those seen in vivo renal-tubules. These in vitro models are powerful tools to investigate the underlying disease mechanisms of human ciliopathies that can be employed without the need for heavy-handed genetic or molecular manipulations.

The city of proximity (accessible, inclusive, sustainable, healthy & salutogenic): the case of Brussels Bourse, Grand-Place station

The ecological dimension is expressed, among other things, in the matter of movement and the process of appropriation of local spaces. The creation of public space is oriented towards centralising and bringing exchanges closer together. It is a recognition of the ways of life of the individual who has become aware of the other essentials for human well-being. How does the proximity of multimodality and culture strengthen the urbanity? And how does it influence urban intensity, livability, health & the salutogenic approach of public space? The study investigates the quality of public mobility spaces through design, multimodality and sustainable planning by surveying the case of Bourse-Grand-Place station in Brussels. This transformation project is the subject of an empirical method using the material of recent research on urban design and professional practice. Falling within the scope of the “Cities for People” vision of the future, the design of this project integrates socio-cultural activities around the idea of “Station for People”. A concept based on universal accessibility ensures that all individuals can access it. Thereafter, an evolving social economy programme promoted cycling through equipment, maintenance, recycling, training, innovation and the encouragement of cycling culture. The breakthrough of the innovative multimodal design process based on multidisciplinarity could become a helpful urban strategy, oriented toward making proximate neighbourhoods both residentially and practically attractive. The present article carries out an enquiry of how design and urban activities take part in strategies to improve the quality of the public spaces. It reveals some hints that could help urban practitioners when making decisions regarding the quality of an urban place and ‘living together’ oriented developments. With a contribution to climate change issues, this article demonstrates how urban design can contribute to the quality of life of users and citizens.

Urban places and Mental Health challenges (lessons learned from Covid-19 crisis)

Nature deprivation under COVID-19 lead to reduced well-being. Urban design interventions were also identified as an important contributor to the restoration of community confidence, choice, and safety. Factors related to sociodemographic, housing and lockdown were linked to changes in exposure to nature during the pandemic lockdown. Changes in exposure to nature and mental health outcomes during the COVID-19 lockdown were strongly linked. Especially young people had an increased number of mental health problems. Children and youth were more bored and worried in comparison with the pre-pandemic period. The educational institutions worldwide were closed or changed to online education during the pandemic, leading to great disturbance in students’ education and outdoor events. All “green infrastructure” (GI) resources (including parks, gardens etc.) received great attention as “essential infrastructure” supporting well-being. But, the quality, functionality and position of GI in urban areas showed inequality in distribution. Frequently, societies with greater ethnic diversity, lower income and larger health inequality suffered from unsatisfactory or lack of access. GI is important in decision-making to address inequality. This work will also present an open-air activity for all generations: A reflective walk through the oldest part of Novi Sad (EU Capital of Culture 2022), as a part of Project Reflective citizens in Novi Sad. This walking tour was led by pupils from primary school - where all generations spend useful time in open space and a safe atmosphere walking tour, learning and listening about the cultural history of the oldest part of the city. It is vital to enhance urban planning and design practices in making healthier and more resilient communities. It is necessary to underline the importance of planning green spaces that need time to form in urban areas, and which have proven to be very important for mental health in the midst of the pandemic crisis.

Planetary health education: a cornerstone for international sustainable public health deals

As stated in The Lancet Public Health editorial, “No public health without planetary health”, the future health of the planet and human health are inextricably linked. For this reason, global citizens, practitioners, and professionals, especially those involved in Public Health, must be equipped to address and understand the field of Planetary Health (PH), which looks at the complex connections associated with disruptions to natural systems and resulting impacts on human health. Strategies aimed at incorporating PH education into high schools and academic curricula are required to build capacity for future national and local PH leadership. One of the most relevant tools used to achieve these goals is the PH Education Framework, designed by the Planetary Health Alliance (PHA). This framework considers five foundational domains as essential for PH knowledge, values, and practice, and has been currently applied by different institutions involved in PH. The Italian Institute for PH (IIPH) applied this framework to a school-based project for education in urban health, which will be better described in the workshop presentation. The PH Education Framework domains were used for the development of four interactive sessions oriented to raise students’ interest on the topic and stimulate active participation during and after the intervention, also with simple pro-environmental behaviours. The experience was shown to be fruitful for Public Health residents as well, who were deeply involved in and led the interactive sessions held in the high school. By means of a qualitative assessment, residents demonstrated to have increased their self-confidence, knowledge and leadership skills in PH. Further research and applications of the PH Education Framework are needed in order to increase evidence and awareness in PH and strengthen PH collaboration in Europe and beyond.

Food Production as a challenge for One Health Approach and Public Health

A sustainable food production is essential for human sustainability. According to available data, the world's diets and food habits must evolve and change intensely. Nowadays, more than 800 million people suffer from deficient food. On the other hand, more consumers have an unhealthy diet contributing to premature death, obesity, food related non-communicable diseases. Diets must provide an appropriate calorie intake, different of plant-based food, low amounts of animal-based food, unsaturated fats, vitamins and minerals (rather than saturated, refined grains, highly processed foods, and added sugars). It is needed adjustment to various agro-systems, cultural traditions, and individual dietary preferences. However, production must also be sustainably adjusted to meet the global population's growing food demands, as well as using the doughnut economy principle. A sustainable food production requires a One Health approach, and also evolving towards a decarbonized agricultural production by eliminating the use of fossil fuels and land use change losses of CO2 in agriculture. Policies to encourage people to choose healthy diets are needed. Those should include the improvement of the availability and accessibility to healthy food through improved logistics and storage, increased food security, policies that promote buying from sustainable sources, as well as reducing food waste. The mindset change regarding to the agro-system, food production and food usage in a healthy way at individual level, community level, national level and global level are essential for sustainable human population. Healthy eating should be the highest priority of food consumers, as well as its mindset shift from ‘live to eat’ to ‘eat to live’. Consumers should feel safe and healthy, but also think about future generations, respecting agriculture and food production. Sustainable, equitable, healthier, and more inclusive food systems have the power to catalyze the achievement of all 17 SDGs by 2030.

Costs of air pollution impact on health in the Western Balkans: preliminary results

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.

Introducing walkable cities as a Public Health intervention

COVID-19 pandemic yet again showed that health crises and epidemics are introducing urban planning as a public health response. Globally, we saw a renewed interest in urban environment and healthy living and the changes in urban environments which can make for a healthier living. Even before the pandemic, various urban concepts and models that take as basis a health-oriented, holistic approach are being implemented in many cities. To name a few: car-free centres or neighbourhoods, the so-called ‘Superblocks’, neighbourhoods with low-speed traffic, walkable and cyclable cities aiming at all amenities being easy reach so-called ‘15 Minutes city’. COVID-19 crisis only accelerated many of these initiatives and brought them to global level need and attention. Such interventions are being introduced to demotivate the use of polluting cars, to ease up and to promote healthy and active transportation such as walking and cycling. As a consequence, those interventions not only are hoped to lead to an increase in physical activity, but also better air quality, reduction of noise. Cities have accelerated urban transformations of the space for active transportation such as the introduction of more cycling lanes in their networks, transforming ‘car’ streets to mix use streets, etc. Particularly during the pandemic, the streets that were previously dominated by car use, parking lots, parking spaces, and car lanes have shifted their focus to the pedestrians, healthy and active mobility. Though, not so optimistic continuation of the speed of the changes in urban planning are seen at the end of the pandemic. It is still clear that spaces for people, spaces promoting mental health such as green spaces, green islands, green pedestrian streets and healthy mobility, are missing. Lockdown measures of reducing the car traffic and increasing the walkable spaces for citizens were primarily imposed to save public health but had one important co-benefit - improved air quality in many areas.

Health Experts’ voice for Healthier Choice – a call for Zero Air Pollution in the Western Balkans

In 2019, the European Environment Agency has shown that the fine particulate matter PM2.5 caused more than 25 000 premature deaths in six Western Balkans countries alone, namely Albania 4 000, Bosnia and Herzegovina 5 900, Kosovo* 2 800, Montenegro 900, North Macedonia 3 400 and Serbia 11 400. In the same year, more than 2 200 lives were lost due to nitrogen dioxide (NO2) and ozone (O3) pollution. Air pollution and climate change are major health problems in the region. Health experts in the Western Balkans region have joined forces to highlight the importance of air quality actions and achieving zero air pollution as a prevention intervention for public health. We brought together a call for the Western Balkans policy-makers to invite them to commit to full alignment of all national air quality standards with the World Health Organization guidelines, to establish regional intersectoral cooperation to accelerate the moving to zero pollution, to including health authorities, public health institutes, and medical societies, patient representative and all health care experts and providers; to end direct or indirect public subsidies of polluting processes, especially fossil fuel activities such as coal power plants; to finalise the process of the ratification of the Convention on Long-range Transboundary Air Pollution and its protocols; to support modelling to establish economy-wide emission reduction commitments for the five main pollutants; to develop and implement Air Quality Strategies; to increase the uptake of Best Available Technologies (BAT) in accordance with the Industrial Emissions Directive; to establish an adequate air quality monitoring system, and to including through accreditation of air quality monitoring networks. Public health experts from the WB, united in the regional call, highlight the urgent need for improvements in air quality in the region together with a zero air pollution objective and a timeline to reach it.

Mental Health Forums for young healthcare professionals (lessons learned from Serbia)

Issue/problem

Mental health is an important subject for all healthcare professionals. Challenges of the current pandemic have affected the teaching process at the universities, especially on the faculties of healthcare professions.

Description of the problem

Taking care of the patients' mental health does not diminish the need to care about the healthcare workers. The pandemic crisis posed new questions and brought out existing obstacles that future healthcare workers face.

Results

The Mental Health Forum (MHF) was organized within the course “Principles of Public Health Issues” for Ph.D. students of Public health to commemorate the European week of public health 2020. The activity kept going due to students showed interest in using the practice of free associations to discuss subjects important for mental health in the community, working with patients and interpersonal relationships. MHF were hosted by a professor who facilitated the meetings while the undergraduate and PhD students of different programs deliberated on subjects of importance for mental health, both for patients and the healthcare workers. The pandemic crisis, which is still going and demands constant adjustments to be made, raised a number of questions related to individual and professional aspects of life.

Lessons

Student focus groups formed on the MHF ponder upon substantial issues related to mental health and mental hygiene. The importance that the education process and acquiring skills have on self-confidence and mental health is emphasized, as well as challenges that the pandemic created in finding a way for a young healthcare worker (doctor, dentist, nurse, pharmacist) to get the necessary skillset for dealing with patients in an assuring manner. MHF raised questions about the positions of the elderly and of the children, mental health of the patients, the link between mental health in the community and opinions about vaccination, preventive measures and evidence-based research.

Key messages

MHF represents a place to discuss the obstacles in mental health, both in the community and between students. MHF offers support and empowers students to pursue their goals in these troubling times.

Improving Health through Green Deal and Climate Pact (motivation for WB Region)

The WB Green Agenda (WB GA) aims to implement the GD principles in this region and has defined five priority areas: climate, energy, mobility; circular economy, pollution reduction, sustainable agricultural and food production, and biodiversity. Some of the WB GA goals are strongly related to health: e.g. the continent's carbon neutrality by 2050, the ambitious climate policy, the reform of energy and transport sectors. The launch of the EU CP is an important opportunity for the WB to promote action in this area. For instance, promoting energy efficiency and supporting building renovation are directly related to the quality of life and hygiene of housing. Reduction or cancellation of coal subsidies as well as the region's withdrawal from the use of coal is of great importance for reducing externalities. In the WB, citizens are concerned about their health due to air, water and soil pollution and their reduction is in the common interest. To that end, it is necessary, inter alia, to: ratify the Convention on Long-range Transboundary Air Pollution and its protocols in each of the WB economies; to implement air quality strategies; and to strengthen air quality monitoring systems (and network accreditation). Appropriate processes are needed to reduce water and soil pollution, as well as to ensure the transformation of the agricultural sector. It is also necessary to harmonize the agricultural and food sector with EU standards for food safety, plant and animal health and environmental protection. To achieve the WB GA goals it is important to develop policy strategies based on the most up-to-date scientific studies for this region (JRC, 2020). On the basis of the analysis presented in this study we conclude that the processes associated with the GD and the CP will be of benefit for both individual and public health in the EU and in the WB.

One Health in Urban environment- public health challenge for the future

Urban environment is a specific one in which are citizens and also their pets and other animals looking for a mutual place for a qualitative life. Humans are trying to make their life as good as possible, bringing the “nature” inside urban environment, but not always thinking through if urban environment will have effect on that “nature” - pets and plants in houses. The availability of data on number of pets in urban environments is being studied. It is estimated that in a city of 500.000 inhabitants, there are around 17.000 dogs, but number of cats is even more challenging to find. Which towns are the highlighted ones with developed culture of cohabitation? The ones with equally developed conditions for the life “of all. WHO (1990) suggests that dog ecology and related anthropological aspects can serve to establish background information for the planning and implementation of dog population management schemes and for the control of zoonotic diseases. Dog population density is related to different habitats, cultures, and social conditions of human populations (Fielding and Plumridge 2005). For example, Albert and Bulcroft (2015) in their study underline the important social and emotional roles that pets play in the urban household. People in cities demonstrate high levels of attachment, caring, and intimacy towards their pets. Pets are viewed as important members of households and owners are willing to spend high budget of money on needed medical or preventive care for their pets. One health concept in an urban environment has a specific significance from overcoming common risks for humans and animals point of view. The risk of infectious diseases is probably the most common one, including zoonotic diseases. This risk can even be a life threating one. There is also the risk of non-infectious diseases and influence of the mental health of owners to pet's life. Also, the influence of owner's life style to the life of pets - eating, walking and other habits.

Artificial Intelligence and Urban health: a step forward to the achievement of SDGs

The Sustainable Development Goals (SDGs) recognized the transformative power of urbanization with a dedicated goal (SDG11) focused on cities. This represents a pivotal first step to empower cities, also technologically, enabling new levels of intelligence and showing the need to become smarter. Artificial Intelligence (AI) and smart cities bring a multidisciplinary, integrated approach, examining how the digital and physical worlds are converging. The AI-based algorithms are overcoming the provision of urban services entering the realms of urban governance, planning, health, and safety. The aim of this study is to review how digital technologies and AI-based algorithms can influence and transform urban health. A scoping review of the literature was conducted using the Population, Concept, Context (PCC) framework to formulate the research question. A comprehensive search strategy will be implemented according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Major electronic databases were queried combining specific keywords. In addition, the search was completed by a snowball-search to identify missing articles. Out of a total of 1150 publications, 8 were identified as relevant to the research question. Among these articles, 43% and 35% reported findings from Europe and North America respectively. Evidence from the literature primarily focuses on the integration of smart city networks (sensor, people, business), based on AI, and urban health with different impacts on the health conditions of urban population over time. Public health plays major roles in urban planning sharing jointly common missions and perspectives. The advent of smart cities supported by AI can have an impact on public health, transforming urban life, with important consequences for physical, mental, and social well-being. AI applications in urban health could support public health activities of prevention and surveillance, and decision-making process, ushering a new era of public health.

Presence of resistance in building resilience of Health workforce in the COVID-19 crisis

 

In the extraordinary circumstances of the Covid pandemic, Group Analytic Society Belgrade (DGAB) devised and organized online support groups for health workers, health associates and student volunteers. Participation is devised to be voluntary, while respecting confidentiality and non-disclosure of content outside the group. Support groups for health workers aim to share experiences, feelings and mutual support that they invest in daily work. We assume that the groups as a space of integration understanding and common thinking, could impact the building of resilience of health workers in the given conditions of a pandemic crisis. Groups are organized two times a week - 1 h and 15' each. One may apply by filling out an online form, and choosing one of the offered dates, that provides access to the group once a week. Group leaders are experienced analysts, DGAB members and analysts in their final years of education. In the initial phase, they are open - it is enough to choose a day that suits the participant when filling out the application, and in the selected term to join via the link for the zoom meeting (the link is sent to the e-mail given in the application). The aim is to present challenges we encountered in forming the groups, from strong resistance in accepting the help offered, negating the need for support to the helplessness and hopelessness that any help is possible. Exploring ways to overcome noticed resistance and presenting experience in providing support to health professionals is vital to strengthen the capacity of human resources and health systems in general. The pandemic crisis has not only affected the conditions and needs of patients, but has created a need for complex approach and care for health workers (human resources), so health systems could achieve sustainability and overcome the crisis that has befallen them.

Key messages

The pandemic crisis has not only affected the conditions and needs of patients, but has created a need for complex approach and care for health professionals. Management of healthcare organizations should ensure to all health professionals support to overcome the crisis that has befallen them.

Poverty and energy issues as environmental and health challenges in SDGs

In 2019, 21.1 % of the EU-27 population were at risk of poverty or social exclusion. Energy poverty is one of many poverty forms and it is a widespread problem across Europe, as between 50 and 125 million people are unable to afford proper indoor thermal comfort. Energy poverty is linked to low household income, high energy costs and energy inefficient homes. These challenges are deeply connected with SDG7 and SDG1, and also produce environmental pollution. The roots of energy poverty are in polluting fuels that are the cheapest and at hand to the population in (risk of) poverty. Biomass heating is the inefficient use in old stoves and the lack of wood drying before use (the loss of up to 50% of the energy and higher energy costs of heating). Biomass and coal is also a major contributor to poor air quality in many European regions, especially in eastern part of the EU and Western Balkans. Biomass smoke contains health-damaging substances (particulate matter, PAHs etc). Studies on indoor air pollution show concentrations of PM10 may extremely exceed standards for ambient air pollution levels and put the people (mostly women and children), at increased risk of health impacts. Biomass burning also leads to the release of black carbon, which is not only a concern for health, but also as short-lived climate change forcer (SDG 13). A conservative estimate of the current contribution of biomass smoke to premature mortality in Europe amounts to at least 40,000 deaths per year. The inefficient use of the biomass means higher costs for already ‘disadvantaged' citizens and those in risk of (energy) poverty. Energy poverty is a distinct form of poverty associated with a range of adverse consequences for people's health and wellbeing (respiratory diseases, CVD, mental health, and stress associated with unaffordable energy bills). Poverty and energy issues as environmental and health challenges should seen through SDG 1 and SDG 7, but also through SDG 8, SDG1 1 and SD G3.

Household pharmaceutical waste (example from Serbia)

Background

Proper disposal of household pharmaceutical waste can reduce the negative influence of medicines on the environment. Environmental awareness do not necessarily equate with proper behavior, as other issues, such as the availability of an organized disposal system, play an important role. The aim was to examine the current disposal methods of unused medicines from households, and the willingness of Serbian residents to participate and bear the costs of an organized collection program. Also, we wanted to define factors contributing to an individual's willingness to participate and pay for a disposal program.

Methods

The survey included randomly selected patients older than 18 years visiting private pharmacies in the four largest Serbian cities. The questionnaire included information on the presence of unwanted medicines in the household, general medicine disposal practices, the likelihood to participate in a medicine takeback program, willingness to pay for a disposal program, importance to the environment, and demographic variables.

Results

The majority of Serbian people dispose unused medicines into household garbage. 80% of respondents are likely to participate, however less than half are willing to pay for the collection of unused medicines. The factors that influenced willingness to participate are environmental awareness and income, while the factors affecting willingness to pay, are previously received advice about proper disposal, education level, number of unwanted medicines in the household and gender.

Conclusions

Awareness campaigns advising the general public on proper medicine disposal and well-organized and easily accessible collection programs are essential in order to enable the general public to return unused medicines for proper disposal.

Key messages

Household pharmaceutical waste is a major public health issue in Serbia. Residents in Serbia are willing to participate in collection programs, thus building legislative into practice is urgent.

European Green deal and Climate Pact: A roadmap for digital public health

The Covid-19 pandemic crisis caused a serious ‘tectonic' disturbance in all sectors, especially pointed out weaknesses of the healthcare systems. The recently adopted European Green Deal (EGD). It should take into account the Covid-19 pandemic challenge and maintain its primary objectives. The pandemic crisis has shown not only individual health risks, but also global health threats (direct and indirect). The SARS-CoV-2 virus causes an insufficiently known infectious disease. The subsidiary health effects are still countless: mental health, health-economic costs, deadlock in the other diseases treatment, etc. One of the main messages regarding environment, is that society should find new economic models less damaging to the environment and to biodiversity, implying circular economy, a less consumerist and active society: e.g. a 4 days-working week. Covid-19 took us to the extreme of being confined at home, either working or taking care of our families. However, the Covid-19 global quarantine and confinement (and huge reduction of travelling, mainly flights) had a great impact on decrease of CO2 levels, on the quality of air and on biodiversity. Vulnerability and lack of efficient action in many countries, is a strong warning for Europe (and globally) to insist in strengthening public health and convert lessons learned into action. The Coronavirus, originating from destruction of wildlife and intensive animal farming, will bring more pandemics in the future. We need more public health consideration towards effects of climate change on public health. It is possible to keep economy functioning by promoting remote work supported by digital platforms and innovation for international networks. Strategically, the European recovery plan should be aligned with the EGD.

These challenges open the way to digital health, and as such, can be defined a roadmap to tackle climate change.

Validation of the oral health impact profile - 14 in patients with head and neck cancer

Background

The Oral Health Impact Profile-14 (OHIP-14) was designed to assess patients’ perception of the impact of oral disorders on their quality of life (QoL). Although the OHIP-14 is now frequently used in patients with head and neck cancer, data related to its measurement properties in this population are scarce. The aim of the present study was to evaluate the reliability and validity of the OHIP-14 in a sample of Serbian patients with head and neck cancer.

Material and Methods

Data were available for 345 patients (257 [74.5%] males; aged 30-92 years), with head and neck cancer. All patients completed the OHIP-14 and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-H&N35. Factor analyses, internal consistency reliability (i.e., Cronbach’s α coefficient), and construct validity were analyzed.

Results

The factor analyses confirmed that 14 OHIP items were measuring a single underlying factor. Cronbach’s α coefficient was 0.98 and corrected item-total correlations ranged 0.77-0.93. Lower OHIP-14 scores (i.e., lower impacts on oral health) were more frequently present among patients who had only surgery as a therapeutic procedure compared to those who had surgery accompanied with radio- and chemotherapy (p< 0.01). Patients with a tumor stage 0-II also had lower OHIP-14 scores compared to those who had a tumor stage III-IV (p< 0.01). The OHIP-14 correlated significantly with the QLQ-C30 and QLQ-H&N35 scales.

Conclusions

As a unidimensional instrument, the OHIP-14 provides oral QoL assessments with sound internal consistency reliability and construct validity among patients with head and neck cancer.

Key words:Quality of life, oral health, psychometrics, reliability, validity.

Green Deal as a Climate Changes Dam on the Road to Health

Public health professionals (PHP) have a dual task in climate change. They should persuade their colleagues in clinical medicine of the importance of all the issues covered by the GD. The fact that the health sector contributes to the overall emissions of 4.4% speaks to the lack of awareness within the health sector itself. The issue of providing adequate infrastructure for the health sector is essential. Strengthening the opportunities and development of the circular economy within healthcare is more than just a current issue. The second task of PHP is targeting the broader population. The public health mission is being implemented, inter alia, through numerous activities related to environmental monitoring and assessment of the impact on health. GD should be a roadmap for priorities and actions in public health, bearing in mind: an ambitious goal of climate neutrality, an insistence on clean, affordable and safe energy, a strategy for a clean and circular economy. GD provides a framework for the development of sustainable and smart transport, the development of green agriculture and policies from field to table. It also insists on biodiversity conservation and protection actions. The pursuit of zero pollution and an environment free of toxic chemicals, as well as incorporating sustainability into all policies, is also an indispensable part of GD. GD represents a leadership step in the global framework towards a healthier future and comprises all the non-EU members as well. The public health sector should consider the GD as an argument for achieving goals at national levels, and align national public health policies with the goals of this document. There is a need for stronger advocacy of health and public-health interests along with incorporating sustainability into all policies. Achieving goals requires the education process for healthcare professionals covering all of topics of climate change, energy and air pollution to a much greater extent than before.

Building capacity for public urban mental health – example of Reflecting Citizens workshops

Novi Sad is a shelter of six languages, and the place of encounter of different cultures, of nurturing diversity through jokes, recipes, literature, music, works of art. Diversity and colourful customs in Novi Sad are not just the reflection of positive movements, but also serious events, wars, big migrations, internal and external migrations. Today Novi Sad (and our region) are home of 21 ethnicities, with six official languages, complicated administration, and wish to live in peace.

Having in mind the contents and matrix which are developing in the Reflective citizens (RC) workshops, the idea was born that RC could become part of all activities of the city of Novi Sad, as tool to develop the dialogue of citizens in cultural spaces of Novi Sad, the European capital of culture in 2021.

The idea that Reflective Citizens migrate (move) through different cultural spaces and that thus (in contact with cultural contents) hypotheses, ideas and actions are born, which will in positive communication make contributions to the significance of all cultural values, is justifiable and in time gives a visible, positive result.

Reflecting citizens workshop could be seen as a method for building capacity concerning developing innovative concepts for public urban mental health.

Reflective Citizens workshops contribute in improving health in community through fostering dialogue and mutual reflection. Also, Reflective Citizens workshops are open space for all citizens who want to contribute to dialog, multiculturalism, tolerance, thus contributing quality of life, social environment and mental health also.

Environment and health as a driver of transformation

As technology progresses, social inequality grows, the gap widens, and the environment continues to suffer. Furthermore, the social environment in societies is “ruffled” and does not appear to be constructive toward well-being. New inequalities are emerging in the availability of technology, climate change, education. The achievement reports on the Sustainable Development Goals (SDGs), also point out to the need of reviewing individual indicators.

The UN Human Development Report estimates that children in highly developed countries have a 55% chance of obtaining high education, as opposed to children born in underdeveloped countries where only 3% of them have a chance of high education. In underdeveloped countries, according to the UN data, 17% of them die by the age of 20, while in developed countries this is 1%. The gap in the opportunities of young people in different living environments is quite pronounced nowadays. If this process does not get stopped, it can be irreversible.

The directions of transformation necessary to achieve the SDGs, while respecting the principles of equality, quality of life preservation and improvement, are divided into six groups. Transformations should aim at: an educated workforce, an innovative economy, gender equality and social protection, health and wellbeing for all, universal health care and support for healthy lifestyles. Transformation is also a prerequisite for: climate neutrality, circular economy, decarbonisation, renewable energy and industrial development. Sustainable agriculture and food production, conservation and restoration of natural resources, as well as sustainable, green urban environments and support for small communities also require radical changes. An indispensable factor for transformation is that both digital and modern technologies align with sustainable development, respecting human rights privacy and social inclusion.

Environmental Challenges as Mental Health risks and oppotunities in the light of SDGs

Background

Environmental risk factors such as air pollution, contaminated water, climate change, soil pollution, chemical exposures, ultraviolet radiation, noise pollution and others potentially contribute to diseases and mental disorders, such as depressive and anxiety disorders. Taken together mental, behavioral and neurological disorders accounted for 10% of the global disease burden in 2015 and is expected to increase to 15% by the year 2020.

Methods

We will identify health promoting factors on the background of the changing disorders spectrum. Based on a narrative review we identified as potentially environmental mental health promoting factors quality green areas, e urban planning, sanitation and public transportation, and decrease in noise pollution.

Results

Using the sustainable development goals (SDGs) as a benchmarking tool in national, regional and local development plans, citizens are empowered to improve their mental health through improved environment. Discussion: Mental health is an underresearched area in the field of environmental health. Intersectoral and interdsiciplinary collaboration can contribute to overcome boudnaries of specific disciplines and build bridges to support the overall goal of promoting and supporting mnetal health and reducing the burden of mental and neurological disorders.

Children self-reports and Parent proxy reports of physical activity and sedentary behaviour

Background

Aim of this study was to determine agreement between parent proxy reports and children self-reports of physical activities and sedentary behaviour.

Methods

The sample included 7-10 year-old children and their parents (n = 188) in a local community in Northern Serbia. Data were collected by questionnaires designed to assess context-specific measures of children’s physical activity (outside play, organized sports) and sedentary behavior (TV viewing, using computer, playing electronic games). Children and their parents completed questionnaires separately. Agreement between children’s and parent`s responses was calculated with Cohen’s kappa. Differences in parent`s and children`s responses in relation to gender, grade and BMI were analyzed using χ2 test. Values p &lt; 0.05 were considered statistically significant.

Results

Level of agreement between parents’ and children’s reports ranged from poor for variable TV viewing before going to school (κ = 0.21; p = 0.04) to substantial for variable physical activity before going to school (κ = 0.74; p = 0.00). Girls were more likely than boys to agree with parents about time spent playing on the computer after school (χ2=11.23;p=0.01). Overweight and obese children tended to report more time in TV viewing than their parents (χ2=26.4;p=0.01).

Conclusions

There are differences in reports of physical activities and sedentary behaviour between 7 to 10 year-old children and their parents The lowest level of agreement found for variable TV viewing indicates low awareness and control of this screen-based sedentary behaviour.

Key messages

Differences in parents’ and children’s reports of children’s physical activities and sedentary behaviour are confirmed. It should be taken into consideration in studies which use self-reports or proxy reports for assessing children’s physical activities and sedentary behaviour.

Mathematical modeling of medical equipment needs for public health purposes

Issue

A public health challenge facing many developing countries is the lack of medical equipment, such as mammograms and CT scanners, as well as the unequal access to available equipment. In order to rationalize costs and provide patients with more equal access to preventive and diagnostic services, optimized distribution based on actual needs, considering factors such as population structure and private sector capacities is necessary. The suggested optimization was made in cooperation between students of public health, applied mathematics, and information technology.

Description of the problem

Based on Open data released by the institutions of Republic of Serbia, pertaining to radiological equipment operated by state healthcare facilities over a period of three years (2015, 2016 and 2017) and projected population, by sex, age, and region, a mathematical model has been made, aimed at optimizing equipment distribution across the 4 regions. With the goal of finding an adequate model, region and year specific data were used for calculating the Gini coefficient. Multiple alternatives were tested over a period of a few months, with the results displayed graphically, using a web application presenting the equipment distribution.

Results

In maximizing the territory covered, the availability of the equipment to the patients was increased, and with it, the equipment’s utility. The results indicate savings can be achieved, taking into consideration the capacities of the private sector.

Lessons

An adequate mathematical model can contribute to a better distribution of equipment, as well as cost saving. Taking into consideration that inadequate funding is one of the major challenges faced by state healthcare services worldwide, with appropriate data, the model would find use in other countries as well.

Key messages

Open medical data opens up new space for action by the interested parties. Inter-professional cooperation holds great potential in solving public health problems.

Healthier breath for all and everywhere – Urban air quality monitoring experience

Issue/problem

Increasing attention is being paid to air pollution as one of the greatest threats to public and urban health. The WHO’s Urban Health Initiative points out the importance of collecting data and mapping the present state of air quality in urban areas. For citizens, such engagement is enabled by the appearance of personal air quality measurement devices that use crowd-sourcing to make measurement results publicly accessible in real time.

Description of the problem

As a way of contributing to air pollution monitoring in their town, three PhD Public health students conducted over 40 measurements between the start of June and end of August 2018 on various locations in the city of Novi Sad, Serbia. Measurements were performed using AirBeam personal air quality monitoring devices and their results presented as μg/m3 of Particulate Matter 2.5 (PM2.5) and automatically uploaded to the internet using the Air-casting app.

Results

Measurements conducted in public transportation vehicles returned the rather high average value of 40 μg/m3, where coffee shops and restaurants scored an even higher value of 48,67 μg/m3. The lowest average air pollution levels were registered near the Danube river bank (5.67) and in the parks (6), while the sites near crossroads or in the street showed average air pollution of 8.33 μg/m3.

Residential areas where smoking is present during the day reported 2.5 times higher PM2.5 values than those without smokers (33.8 and 12.78 μg/m3).

Lessons

Bearing in mind that the air quality is considered as a serious health risk in urban areas, results of this pilot investigation suggest potential health risk for citizens living in urban areas.

The negative effects of combustion and smoking on air quality are strongly highlighted, as well as the positive impact of green areas and parks near residential areas.

Key messages

Air pollution exposure as a serious health risk in urban areas. Crowdsourcing as a way of air quality monitoring has great potential for contributing to public health.

Environmental noise levels and noise annoyance in Novi Sad, 2012-2016

Objective

Increased noise level represents a significant public health problem in urban environments. The aim of this paper is to examine the annoyance of the population by road traffic noise in the City of Novi Sad.

Methods

The results of 161 24-hour noise measurements in Novi Sad were analyzed. Measurements were done by Public Health Institute of Vojvodina, according to accredited and standardized national methodology during 2012 - 2016.

Results

Total noise indicator (Lden) / night noise indicator (Lnight) ranged from 61,1 dB / 50,7 dB in residential, up to 66,3 dB / 58,1 dB in recreation / hospital areas, 68,0 dB / 60,3 dB in city traffic areas and 70,2 dB / 62,7 dB in business and residential areas. Taking into account the results and using methodology prescribed by national regulations, the percentage of highly annoyed population (% HA) was found to be in the range 11-25% during the day, and 6-13% during the night. Using ISO 1996-1:2016, prevalence of a population highly annoyed (PHA) was established to be in the range 9,2-33,9% in residential; 18,4-45,7% in recreation / hospital areas 22,9-50,6 in city traffic; 27,7-55,4% in business and residential areas.

Conclusions

The results confirm that urban noise seriously disturbs people. It was established that about a half of the population was highly annoyed which poses a serious challenge for public health. The results have social, health and economic importance for the population. Activities to reduce the noise level could also stimulate economic, health, social and community programs for sustainable development aiming to preserve and improve human health.

Acknowledgment: Supported by the Ministry of Education and Science of the Republic of

Serbia - Project “Biosensing Technologies and Global System for Continuous Research and

Integrated Management”, No.43002

Key messages

Continous noise monitoring is important for understanding the impact of noise on human health. About a half of the population was highly annoyed by noise, which poses a big challenge for public health in urban areas.

Importance of Health literacy in magnesium supplementation - Case study Novi Sad, Serbia

Background

Currently the market offers wide range of magnesium dietary supplements that vary either in their pharmaceutical dosage form (capsules, tablets, direct form, effervescences etc.), magnesium compound present (magnesium oxide, - chloride, -citrate,- bisglycinate, -acetyltaurinate etc.) their dosage (ranging from 150 to 400mg) or other vitamins and minerals present (vitamin B complex, vitamin C, zinc, manganese etc). Since the public can now choose to buy dietary supplements not only from pharmacies and specialized stores but from places such as supermarkets, cosmetic shops or even markets it is important to educate the public and help them make healthier choices.

Objectives

While providing primary health care services in public pharmacy, overall choices and reasons for buying magnesium supplements were noted during the first four months of 2019 (January to April). The goal was to investigate the most important factors patients consider when opting to take magnesium supplements as well as their health literacy regarding the topic.

Results

The results indicate that the currently most popular choices are mouth dissolving forms of magnesium (more than 50% units sold), and predominantly forms the magnesium oxide form (around 75%). It is suggested that the most important factors when choosing magnesium dietary supplements are its price, media presence, friends advice, general familiarity or even product design as very few the patients asked about the present form of the magnesium.

Conclusions

Magnesium dietary supplements belong to highly desirable supplements on the free market. It is observed that patients choice mostly doesn’t coincide with health authorities recommendations.

Key messages

Importance of health literacy and understanding the dietary supplement labels. Higher impact of sources of information other than healthcare authorities.

Reflective citizens as a tool for well-being and public health achievement (Novi Sad, Serbia)

Issue/Description

Reflective Citizens (RC) as ’psycho-social transitional spaces’ - were established in 2005, when Serbia joined the International Listening Posts (LP) Network of OPUS (Organization for Promoting Understanding of Society). Recognizing the need for more reflective citizens’ spaces, for continuously ongoing work through social trauma, Psycho-Social section (PSS - GAS Belgrade) began organizing them more often and in different cities. Serbian RC developed specific conceptualization and methodology, carefully integrating aspects of LP, group analysis, group’s relations, and social dreaming, which are still in the process of evaluation and improvement.

Results

RC in Novi Sad have started in 2014, with a huge enthusiasm, as a team work of PSS. It is recognized that Novi Sad, as a multinational and specific multicultural environment could develop Applied Reflective Citizens - Citizens’ dialogue in cultural spaces in Novi Sad, as supportive and open space for all citizens who wish to develop themselves, multiculturalism, tolerance and better social environment. At the seven workshops organized by now, the beginning was marked by a session of social dreaming. Free psychosocial associations in thinkrooms have defined the topics: loneliness, helplessness, walls and borders, migrations, diversity, mental malnutrition, the presence of evil and the need for goodness, lack of communication... and on the basis of them, the corresponding hypotheses.

Lessons

Applied Reflective Citizens have become the support and open space for all citizens who want to contribute to multiculturalism, tolerance, a better social environment, understanding the environment and building incentive bridges in communication through dialogue and also to contribute to a positive cultural climate, building cultural capacities and fostering cultural dialogue through mutual reflection, thus contributing the quality of life, which is of public health significance.

Key messages

Reflective Citizens can be a contribution for improving health in community through fostering dialogue and mutual reflection. Reflective Citizens give an open space for all citizens who want to contribute to multiculturalism, tolerance, better social environment, thus contributing quality of life, and to public health, also.

Motivation for change, cornerstone of diabetes self-management in patients with type 2 diabetes

Background

Personal motivation for change plays a fundamental role in creation of sustainable changes regarding diabetes self-management. The aim of this study is to assess the motivation as well as the relation between the level of patient`s motivation in relation to disease characteristics, metabolic control, behavioral determinants and the barriers patients encounter in diabetes self-management.

Methods

The data for this cross-sectional study were obtained by combining anthropometric measurements (body mass index-BMI), biochemical parameters (glycosylated hemoglobin-HbA1c) and by interviewing respondents using certain sub-scale of a structured Personal Diabetes Questionnaire (PDQ).

Results

The sample consisted of 117 respondents with T2DM. The majority (61.06%) was not motivated to make self-management changes. Non-motivated respondents were older than 65 years of age (X^2=8,046; p = 0.005) and had: a lower level of education (X^2=35.320; p = 0.000), diabetes for more than 10 years, poor glyco-regulation (90,14%) and were overweight / obese (81,7%). Motivated respondent were more physically active (X^2=6.439; p = 0.000), more adherent to anti-hyperglucemic therapy (OHAs) (X^2=9.673; p = 0,002), and more adherent to dietary regime. Average barrier scores: in the following healthy diet [t=-7.960; p = 0.000], in therapeutic adherence [t=-4.318; p = 0.000] and physical activity [t=-6.439; p = 0.000] were also statistically significantly different with the high impact in relation to respondents’ motivation.

Conclusions

Assessment of the motivation for changes in diabetes self-management should become an integral part of monitoring patients with T2DM in Primary Health Care (PHC). In this way, individual advisory strategies could be developed, because motivated and not motivated persons have different needs for counseling.

Key messages

Motivated and not motivated persons with T2DM have different needs for counseling. Assessment of the motivation for changes in diabetes self-management should become an integral part of monitoring patients with T2DM.

Climate and energy issues as preconditions for health and well being

Globalization and modern economic trends bring enormous changes to civilization. The human health pattern also changes and the overall system becomes more complex. Exponential growth in demographic, in economic and in human activities alters the natural global environment beyond safe or sustainable borders, which refers to energy for the future, as well as climate change in the broadest sense. These changes pose threats to human health and with the rise in temperature the most visible symptoms are seen in the difficulty of securing sufficient energy amount, as well as the appropriate supply of health-safe food and water. Global influences on the health of the population require changes in different sectors (economy, health, economy, etc).

Even though, World Meteorological Organization data show that the five-year average global temperature from 2013 to 2017 was at a record level, and that in 2017 it was one of the three hottest years. Today, about 3 billion people have no access to safe food and/or water and are also exposed to significant air pollution. Nearly one billion people have no electricity in the household, and 13% of the world’s population has no access to modern electricity. Air pollution indoors by using combustible fuels for domestic energy caused 4.3 million deaths in 2012 (women and girls accounted for 6 out of 10). Energy has a dominant contribution to climate changes and accounts for about 60% of overall global greenhouse gas emissions.

Overall progress made through the use of renewable energy sources should reduce risks and allow for the improvement of basic living conditions. However, a significant shift in reducing inequalities and improving global quality of life and health indicators requires transformation of many sectors. Energy, therefore, is crucial for almost every challenge the world is facing today (climate change, food production, health systems, etc.). SDG 7 is particularly important and is linked to other SDGs.

The role of micro-insurance in the field of public health

Issue/problem

It is recognized that is very important to have an instrument to mitigate risks and reduce the vulnerability of poor and low-income households, especially in disasters. Health risks are often identified by the poor people as the greatest and costliest risks they face. Millions of people worldwide fall into poverty as a result of excessive healthcare costs because the state doesn’t provide them health insurance. Health problems not only impact household budget, but also reduce the productivity and reduce the opportunity for growth. Therefore the reform of social systems poses a considerable challenge.

Description

In order to remedy the situation, global actors like World Health Organization (WHO, International Labour Organization (ILO), the World Bank (WB) advocate for a special category of insurance, health micro-insurance (HMI), as a medium term solution for health care financing, that tends to access equitable and quality health care. HMI was created to promote insurance coverage among economically vulnerable sections of society. It is one of the potential ways that might provides the protection of low-income people against specific perils in exchange for regular premium payment proportionate to the likelihood and cost of the risks involved.

Results

As a health care financing mechanism, HMI has a short history, but offers the following benefits: it can improve the access of certain vulnerable populations to healthcare, develop more suitable services, facilitate the participation of civil society and limit fraud, educate populations about social security.

Lessons

This instrument has not been conceptualized to compete or replace public social protection. Rather, it is most effective when embedded into a comprehensive social protection framework which includes informal, private and other risk management strategies of preventive measures, mitigation and suitable coping strategies.

Key messages

HMI can mitigate the risks of population and groups, ill health and provides hope that the poor will receive reliable and adequate access to affordable health care. HMI can be seen as a tool for better public health in vulnerable and poor communities.

Breastfeeding knowledge and attitudes of young people

Background

One of the World Health Organizations (WHO) global nutrition goals by 2025 is to increase the rate of exclusive breastfeeding of infants under six months to at least 50%, which can be achieved only through educating future parents on the importance of breastfeeding. The goal of this research was to establish the current effects of the public health campaigns in raising awareness on breastfeeding by analyzing the opinions of young people towards maternal milk.

Methods

The study was conducted as a prospective study for six months in 2018. and in 2019. 281 people participated (158 female, 123 male) of whom 127 psychology students.The participants had no children, and were aged between 18 and 26.. The survey consisted of socio-demographic questions and the Iowa Infant Feeding Attitude Scale (IIFAS) with 17 questions. Data processing included methods of descriptive and inferential statistics using the MedCalc program. Values of p &lt; 0,05 were considered statistically significant.

Results

More than one out of two female and almost two out of five male participants recognized milk as a diet optimal for their infant (53% female, 38% male). Over twice as many participants considered maternal milk to be extremely positive in comparison to baby formulas as positive. Only 12% of respondents acknowledged that infants had beneficial effects from breastfeeding throughout their lives.

Since only 12.8% of infants in Serbia are exclusively breastfed (according to the available data), the public health authorities need to take more drastic measures in order to complete the WHO set goal by 2025.

Key messages

Current public health campaigns aren’t showing sufficient effects. Both sexes need to be included in education process about the importance of breastfeeding.

Dietary influence on breast cancer

Certain lifestyle and environmental factors play an important role on breast cancer (BC) risk, but data on the influence of nutritional factors are still conflicting. Migrational data have pointed to nutrition as one of the more relevant external factors involved. So far, the only well established nutrition-related risk factors for BC are obesity and alcohol consumption. The evidence that body fatness is a cause of postmenopausal breast cancer is convincing as is the evidence that alcoholic drinks are a cause of BC in all ages. On the other hand, body fatness probably protects against BC diagnosed premenopause. It is more likely that the BC risk is related to life-long dietary habits. The general preventive recommendation often includes a reduction of alcohol, red meat and total dietary fat, and increase in vegetable and fruit consumption. The purpose of this work was to summarize and present current opinions on the influence of diet and nutrition on BC etiology and to suggest possible preventive measures.

Blast injury from explosive munitions

OBJECTIVE

To evaluate the effect of blast in common war injuries.

METHODS

One thousand three hundred and three patients injured by explosive munitions and demonstrating extremity wounds without other penetrating injuries were admitted to the Military Medical Academy in Belgrade between 1991 and 1994. Of these, 665 patients (51%) had symptoms and physical signs that were compatible with the clinical diagnosis of primary blast injury, whereas the remaining 658 patients did not.

RESULTS

Random sampling of 65 patients in the blast group during the early posttraumatic period showed statistically significant elevations in blood thromboxane A2 (TxA2), prostacyclin (PGI2), and sulfidopeptide leukotrienes compared with the random sample of 62 patients in the nonblast group. This difference could not be accounted for by differing injury severity between the groups, because the severity of wounds as measured by both the Injury Severity Score and the Red Cross Wound Classification was similar in both groups. Amongst blast patients, 200 patients (30%) had long-term (1 year) symptoms and signs reflecting central nervous system disorders. These symptoms and signs were only sporadically found in 4% of the nonblast patients. These findings indicate that primary blast injury is more common in war injuries than previously thought and that of those affected by blast, a surprisingly high proportion retain long-term neurologic disability. The elevation in eicosanoids could be used to confirm and monitor blast injury.

CONCLUSION

In relation to the immediate management of patients injured by explosive weapons, it follows that particular attention should be paid to the presence and/or development of blast injury. Our findings indicate that blast is more common in war injuries than previously thought. Eicosanoid changes after blast injury suggest that blast injury causes a major physiologic stress. A variety of effects on the central nervous system suggest that blast injury could be responsible for some aspects of what is now considered to be the posttraumatic stress disorder.

Colon and rectal war injuries

The results of retrospective analysis in the treatment of 189 wounded with colorectal lesions treated at the Military Medical Academy from July 1991 to December 1993 were presented. Primary surgical management was performed in 33 (17.5%) wounded. The others were transported into this hospital for further treatment after primary surgical management in war hospitals in the combat zone. Colorectal lesions (46.0%) were primarily inflicted by bullets of various calibers and high kinetic energy. The time interval between wounding and surgery was less than 6 hours for 39.6% of the wounded, whereas 80.1% were operated on within 12 hours. Multiple or combined colonic and rectal injuries were found in 91.5% of the wounded. Different surgical procedures were performed in accordance with the surgical war doctrine. Postoperative complications (colorectal cause) were found in 40 (21.2%) wounded. Reoperation was performed in 35 (18.5%) wounded. Total mortality rate was 10.1% (19 wounded).