bluuebunny/crossref_metadata_2025 huggingface dataset:
UbiSeCEF: Ubilab's Secure Cloud Environment Framework for Public Health Research
Authors: Miranda P , Kaur J , Morita P
Published: October 2023

Issue/Problem

The adoption of cloud-based public health research over personal health data in an academic setting in Canada is still in its early stages and lacks the necessary maturity to handle such technologies. This can be attributed to the fact that many public health researchers lack the required IT knowledge to set up and use these environments securely and effectively.

Description of Problem

The lack of expertise among public health researchers in Canada has led to a slow adoption of cloud-based public health research. This has resulted in a significant gap between the potential benefits of cloud-based research and the current state of practice. To address this challenge, we propose Ubilab's Secure Cloud Environment Framework (UbiSeCEF) as guidelines for those interested in conducting similar public research.

Results

UbiSeCEF's components were developed with consideration given to requirements from stakeholders, Ubilab's operations and data objectives, state-of-the-art technologies, and laws and standards that regulate public health research and personal health data sharing. The framework utilizes Azure's data governance framework, virtual private networks (VPN), role-based authentication, and policy-based access to control access to resources and research data. The implementation of UbiSeCEF provides a secure, flexible, and efficient environment for cloud-based public health research.

Lessons

The lack of IT expertise among public health researchers can hinder the adoption of cloud-based public health research. To address this challenge, the development of frameworks like UbiSeCEF can provide guidance for secure and effective implementation. The use of state-of-the-art technologies and compliance with laws and standards that regulate public health research and personal health data sharing can greatly enhance the quality and reliability of research outcomes while ensuring the protection of personal health data.

Key messages

• Framework developed to enhance secure & effective adoption of cloud-based public health research by addressing lack of IT expertise among researchers.

• The research aims to assist other researchers and institutions in navigating the complexities of cloud-based public health research while maintaining the privacy and security of public heath data.
Sexual health communication in public service media: The case of Finland and Sweden
Authors: Abrams R , Nordmyr J , Backholm K , Forsman A K
Published: October 2023

Background

Adolescents spend more time online than ever before and refer to media as their primary source for information on sexual health. Furthermore, studies show that health communication through media is an effective health promotion method, reaching a large scale of the population. Therefore, sexual health promotion through media is a promising public health action. Hence, this study aimed to analyze how and to what extent sexuality and sexual health-related content targeting adolescents is communicated in public service media in Finland and Sweden.

Methods

A critical content analysis will be performed focusing on public service media content highlighting sexuality and sexual health-related topics. Public service media content that has been published in Finnish or Swedish during the last 10 years (2013-2022) and targeting adolescents aged 10-19 years old is included in the study.

Results

The preliminary results shed a light on sexuality and sexual health content in public service media, presenting an overview of what content (themes) is communicated to adolescents, how the communication takes place (channels and formats) and to what extent the theme is prevalent and promoted in Finland and Sweden. The results furthermore highlight the evidence-base informing the production of media content and also illustrate eventual differences in sexuality and sexual health content between the countries.

Conclusions

The findings contribute to the limited knowledge about the media image that is communicated to young people with regard to sexuality and sexual health in Finland and Sweden with regards to both structural and content-related issues, as well as underscoring the opportunities for developing sexual health promotion through public service media.

Key messages

• The findings highlight similarities and differences in sexuality and sexual health content targeting adolescents in public service media in Finland and Sweden.

• The findings highlight how sexuality and sexual health content is prevalent and structured in public service media as well as how it is connected to health promotion.
Improving health outcomes of patients with myocardial infarction with value based methodology
Authors: Vasiljev V , Juraga D , Rukavina T , Bilajac L , Marinović Glavić M , Raat H
Published: October 2023

Digital technologies have the potential to support the implementation of value-based healthcare by enabling personalised patient care and improving health outcomes. The ValueCare project (H2020, No. 875215) aims to deliver personalised integrated (health and social) care services, better outcomes for older people and an improved care experience and is being tested in 7 pilot sites across Europe. The Rijeka pilot site focuses on older patients who have suffered a myocardial infarction (MI), which is a leading cause of morbidity and mortality worldwide. The study will assess the impact of the ValueCare approach on improving health outcomes for older people who have suffered a MI. A total of 240 older people (120 intervention and 120 control subjects) will take part in the study. The intervention group will receive the ValueCare approach, which includes: Consultation between the patient and care provider to discuss the results of the self-reported ICHOM questionnaires; a personalised care plan co-created by the patient and care provider; a digital solution to support the patient's personalised care plan; and monitoring of the personalised care plan by caregivers. ValueCare's digital solution enhances the assessment and monitoring of the personalised care plan through: a mobile application for older people, a wearable, and a web application for caregivers. The mobile application uses a motivation and goal-setting approach, including a Virtual coach who acts as a conversation partner to help participants achieve their personal goals. The impact of the intervention will be evaluated using a self-reported ICHOM Standard Set for Older Persons at three time points: Baseline T0, Follow-up T1 (after 12 months) and T2 (after 18 months). Our results will shed light on the potential of digital technologies to transform the prevention and treatment of MI and ultimately improve patient outcomes and reduce healthcare costs.

Key messages

• Digital health has emerged as a promising approach to transforming healthcare and improving patient's outcomes.

• Value-based healthcare improves outcomes and reduces costs for myocardial infarction treatment, putting patients at the center of care.
The association between self-perceived stuttering and social participation among older adults
Authors: Lindström E , Öhlund Wistbacka G , Eggers K , Lindström M , Lyberg-Åhlander V
Published: October 2023

Aims

Social participation is important for general health and quality of life among older adults. Currently, research concerning the association between stuttering and social participation among older adults with larger data sets is scarce. The aim of this population-based cross-sectional study was to investigate the association between stuttering and social participation among older adults in southern Sweden in 2012.

Methods

Participants were 8518 inhabitants of the Region Skåne in 2012, aged between 55 and 80 years. They were recruited from a larger survey study in which 28029 participated (51.7% average participation rate). The association between stuttering and social participation were conducted with multiple logistic regressions, and adjusted for independent variables (age, gender, country of birth, socioeconomic status, language spoken at home, hearing and self-rated health).

Results

The frequency of self-perceived stuttering was 1.9% among women and 3.3% among men. The statistical analyses showed an association between self-perceived stuttering and low social participation. The associations remained even after multiple adjustments, both among women and men. Each independent variable was significantly associated with low social participation.

Conclusions

In this population-based study, the association between stuttering and low social participation is significant among older adults. Stuttering may thus contribute to low social participation in the age group 55-80 years.

Key messages

• The association of stuttering and social participation in older adults was explored.

• Self-perceived stuttering was associated with lower social participation.
Aging well? Exploring self-reported quality of life in the older Austrian population
Authors: Felsinger R , Mayer S , Haidinger G , Simon J
Published: October 2023

Background

The increase of life expectancy around the world sets an ageing society with all its challenges on the global Public Health agenda. In Austria, the additional years of life gained are not spent in good health, as the healthy life expectation is far below the European average. This study aimed to examine the change in self-reported quality of life (QoL) over time in the Austrian older-aged population and explore associated factors.

Methods

Repeated cross-sectional data was retrieved from three waves of the Austrian Health Interview Survey conducted in 2006, 2014 and 2019, including a total of 10 056 participants aged 65 years and above. To estimate QoL in this age group, domain scores of the WHOQOL-BREF were used. Trends in QoL were descriptively analysed across different age groups, sex and survey years. Adjusted Wald tests were conducted to compare means of older women and men. Linear regression models were estimated to explore the impact of age, sex, family status, education, income, residence and survey year on QoL domains.

Results

While WHOQOL-BREF domain scores increased over time, a steady decrease with age was observable in all survey waves. Mean scores were significantly higher in men than in women in all QoL domains and in each survey year except for the social domain. In the regression analyses, sex differences disappeared in most domains after adjusting for income and education. Factors associated with significantly higher QoL scores in all domains included younger age, higher education, higher income and living in Western Austria.

Conclusions

Observed sex differences in QoL seem to be driven mainly by income and education differences in the older-aged Austrian population. Following the WHO's and UN's 10-year global plan of action - The United Nations Decade of Healthy Ageing 2021-2030 - further efforts towards developing sustainable strategies and policies to reduce socioeconomic inequalities also with attention to sex/gender gap are strongly needed.

Key messages

• This study provides a first in-depth analysis of quality of life in Austrian senior citizens.

• Younger age, higher education, higher income and living in Western Austria are associated with better quality of life.
Care trajectory differences in women and men with end-stage renal disease after dialysis initiation
Authors: Piveteau J , Raffray M , Couchoud C , Chatelet V , Vigneau C , Bayat S
Published: October 2023

Introduction

End-Stage Kidney Disease (ESKD) is a major public health issue with an important burden for patients. Some sex and gender differences related to ESKD are well documented. For example, more men initiate dialysis. However, less is known about the differences in the care that follows dialysis start. The objective of this study was to describe the differences in healthcare utilization in the year following dialysis initiation between men and women.

Methods

Data from the French National Renal Epidemiology and Information Network (REIN) registry linked with the French National Health Data System (SNDS) were used. All adults patients with ESKD who initiated dialysis in France in 2015 were included. Characteristics at dialysis start, including co-morbidities, were compared between men and women. The healthcare utilization, outpatient and inpatient, in the year following dialysis start was examined as frequencies and compared by sex using Chi-2 and Student or Welch test.

Results

We included 8856 patients (36% of women). Women had fewer hospital stays <24 hours than men (53% with > =1 hospitalization <24 hours vs 57% among men, p-value=0.02) and fewer hospital stays for other problems than renal (44% had >2 hospital stays vs 46% in men, p-value=0.04). Hospital stays for vascular access preparation or maintenance were longer in women than men (median duration: 2 days vs 1 day, p-value<0.001). No significant difference was observed between women and men about hospital stays for kidney problems and consultations with a general practitioner.

Conclusions

Taking advantage of the linkage of national clinical and healthcare utilization databases, this study shed light on the care trajectory that follows dialysis initiation between men and women. Similarities were observed, including outpatient follow-up with a GP. Some specific differences, such as longer hospital stays for vascular access preparation or maintenance, calls for further studies to improve the care of women with ESKD.

Key messages

• Few differences exist between men and women in their care trajectory notably an outpatient follow-up with a GP.

• Some differences have been highlighted, especially in some hospital stay duration that could be a subject of futures studies.
Age-period-cohort analysis of mortality and its association with deprivation in Hungary, 2007-2021
Authors: Juhász A , Nagy C , Ádány R , Pikó P , Burkali B , Oroszi B
Published: October 2023

Background

Severe spatial inequalities in health and its determinants are a well-known and long-standing phenomenon in Central-Eastern European countries, including Hungary. The aim of our study was to perform an age-period-cohort (APC) analysis to provide information on mortality trends and their association with deprivation in Hungary using the latest available data for the period 2007-2021.

Methods

The extended APC model, allowing estimation of mortality risk considering deprivation, time, age, and cohort effects and their interactions, was used to analyse the trajectories of several outcome variables along complex dimensions. Model fitting and inference were carried out by using Bayesian computation with INLA methodology.

Results

Mortality risk was the lowest in the 5-9 year age group and increased with age. Between 2007-19, the mortality risk showed a decreasing trend, which returned to the 2007 level by 2020-21 due to the COVID-19 pandemic. Considering the birth cohort effect, the mortality risk peaked in the 1953-57 cohort, then decreased until the 1972-76 cohort, followed by a steady state, and then decreased from the 1988-92 cohort onwards. Deprivation was positively associated with higher mortality risk. The interaction of deprivation and period effect on mortality risk showed a steeper increasing trend for deprived groups for 2020-21. In terms of the interaction of deprivation and cohort effect, the risk of mortality in the most deprived group was higher than the national risk for all birth cohorts. The risk increased until the 1967-71 cohort, then decreased until the 1992-96 cohort, and then again showed an increasing trend. The risk of mortality for the least deprived population was lower than the national average risk, while the opposite difference could be observed for the most deprived group.

Conclusions

Deprivation was associated with higher mortality risk, COVID-related mortality and cohort effect during the study period.

Key messages

• The COVID epidemic-associated increase in mortality affected groups of different deprivation status to varying degree.

• Different cohort effects were found behind the mortality risk in different deprivation groups.
Colonizations and infections due to 3GCR Enterobacteriaceae in a University hospital in Italy
Authors: Stevanin G , Tocco Tussardi I , Palladini F , Montesarchio L , Aprili I , Zandonà E , Tardivo S
Published: October 2023

Background

The spread of third-generation cephalosporin-resistant Enterobacteriaceae (3GCREB) is an increasing issue in terms of antimicrobial resistance and infection prevention and control (IPC), especially in the hospital setting. We aimed to investigate the burden of colonizations and infections caused by 3GCREB in an Italian teaching hospital.

Methods

We performed a retrospective study on cases of 3GCREB isolation from microbiological specimens (from gastrointestinal, urinary, blood, respiratory and cutaneous systems) which were detected over a year period (January-December 2022) at the University Hospital of Verona, Italy. We reviewed the corresponding patients’ charts to retrieve clinical information and classify cases as colonizations vs. infections. Infections counted as hospital-acquired (HAI) when the 3GCREB was detected after the third day following admission, otherwise as community-acquired infection (CAI).

Results

Of 2,451 3GCREB isolates retrieved, 1,815 (74.1%) were from rectal swabs. The monthly detection trend was consistent throughout the year with a minimum in February (n = 159) and a maximum in August (n = 238); monthly average was 204 isolates. The majority of 3GCREB isolates (n = 1,887; 77%) were classified as colonizations. Of the 564 3GCREB isolates which were classified as infections (23% of total isolates), 305 (54.1%) were HAIs and 259 (45.9%) were CAIs. The highest proportion of HAIs (n = 121; 39.7%) was detected in medical units, followed by intensive care areas (n = 100; 32.8%) and surgical units (n = 84; 27.5%).

Conclusions

Comparing the percentages of patients with 3GCREB colonization and infection, we conclude the presence of 3GCREB in our hospital to be about 3 times higher than when only patients with 3GCREB infections are considered. This highlights the importance of surveillance to protect fragile patients. IPC training of staff is essential to counter the intra-hospital spread of these pathogens.

Key messages

• Prevalence of 3GCREB is an increasing healthcare issue in the hospital setting and medical directions should focus on staff IPC training to counter the spread of these pathogens.

• Detection of 3GCREB colonizations is crucial to track the spread of multidrug-resistant organisms, identify cases and protect fragile patients.
Associations between exposure to organochlorine pesticides and diabetes risk: a systematic review
Authors: Vu U , Méjean C
Published: October 2023

Background

The prevalence of diabetes is on the rise worldwide, and recent studies have suggested that exposure to organochlorine pesticides (OCPs) may contribute to this development. However, the evidence remains inconclusive. Our study aimed to consolidate the existing evidence to understand better the association between OCP exposure and the risk of gestational diabetes mellitus (GDM) and type 2 diabetes (T2D).

Methods

We searched for longitudinal and cross-sectional studies in PubMed, Web of Science, and Google Scholar until April 1st, 2023. We included peer-reviewed, English-language studies focused on the general population with clearly stated exposure and outcome measures related to OCP, GDM, and T2D. We collected data on study type, sample size, covariates, and effect measures. The National Toxicology Program's Office of Health Assessment and Translation approach was used to ensure the study quality.

Results

We identified 33 studies, including 8 cohorts, 7 nested case-control, and 18 cross-sectional studies. The focus was mainly on p,p'-DDE, and p,p'-DDT exposures. Findings on the association between OCPs and GDM or T2D risks were mixed, with no conclusive evidence across the studies. For p,p'-DDT, and p,p'-DDE, GDM studies found no significant associations, while T2D studies showed non-significant and positive associations. Other OCP exposures showed mixed results for GDM and T2D. The majority of studies had a probably low risk of bias.

Conclusions

The association between OCP exposure and diabetes risk is inconclusive. Differences in study design, exposure assessment methods, and statistical approaches may contribute to inconsistent findings. Further research, including well-designed prospective studies and meta-analyses, is required. We must prioritize alternative pest control, raise awareness of OCP dangers, enforce regulations, and screen at-risk populations. OCP levels monitoring and healthcare guidance for high-exposure populations are also crucial.

Key messages

• Inconclusive evidence on the association between OCP exposure and the risk of GDM and T2D calls for further research, including prospective studies and meta-analyses.

• Prioritizing OCP risk reduction, raising awareness, and at-risk populations are critical to protect public health.
The impact of the COVID-19 pandemic on delayed care of CVD in Europe: a systematic review
Authors: Khan Y , Verhaghe N , Devleeschauwer B , Cavillot L , Gadeyne S , Pauwels N , Van den Borre L , De Smedt D
Published: October 2023

Aim

Cardiovascular diseases are the leading cause of death worldwide and the COVID-19 pandemic has disrupted healthcare systems, causing delays in essential medical services, including cardiovascular (CV) care. This study aims to estimate the impact of the COVID-19 pandemic on delayed cardiovascular (CV) care in Europe by providing a systematic overview of the available evidence.

Methods and Results

PubMed, Embase, and Web of Science were searched until mid-September 2022. This review included 132 studies. Outcomes of interest were changes in hospital admission, mortality, delays in seeking medical help, delays in treatment initiation, and changes in the number of treatment procedures. Results were presented in five disease groups: Ischemic Heart Disease (IHD), cerebrovascular diseases, Cardiac Arrests (CA), Heart Failure (HF), and others. There was a significant decrease in hospital admissions for IHD, cerebrovascular diseases, and HF, and a significant increase in CA. Mortality rates were higher for IHD and cerebrovascular diseases. Urgent and elective cardiac procedures’ rates also decreased during the pandemic.

Conclusions

The review's limitations include its exclusive focus on European countries, which may not generalize to other regions due to differences in containment and tracing measures. The reviewed studies did not always report consistent outcomes and were primarily conducted during or just after the first wave of the pandemic, limiting our understanding of the long-term impact. Policymakers and healthcare systems should allocate adequate resources, provide clear guidelines for accessing medical care, reduce delays in seeking medical attention, and promote healthy lifestyles to prepare for future pandemics. Future reviews should consider the longer-term impact of pandemics on delayed CV care and evaluate the long-term health and health-economic impact of the COVID-19 pandemic on delayed CV care.

Key messages

• The pandemic has reduced hospital admissions and caused delays in seeking medical attention, while increasing mortality rates for some cardiovascular diseases in Europe.

• Prepare for pandemics: allocate resources, set guidelines for care, reduce delays, promote health, and evaluate impacts on cardiovascular care.
Machine learning algorithms for prediction of double burden of malnutrition among Tunisian adults
Authors: Zribi M , Zaier F , Zoghlami N , Elati J , Traissac P , Aounallah-Skhiri H
Published: October 2023

Background

Malnutrition, referring to both nutritional deficits and excess adiposity (EA), currently affects one third of the world population. In Tunisia, nutritional deficits are still major challenges in a context of epidemiological and nutritional transition. The objectives of our study were to identify the potential risk factors of DBM and propose a better machine learning (ML) based model for predicting DBM among Tunisian adults.

Methods

About 7963 respondents aged 20 years and over were taken from Tunisian Health Examination Survey (THES), a cross-sectional national household survey undertaken in 2016. DBM was defined as the association of EA and anemia. EA was defined as a waist-to-height ratio ≥0.6 and /or overweight: BMI ≥25kg/m2. Anemia was defined as hemoglobin (Hb)<13g/L in men and Hb < 12g/L in women. The potential risk factors for malnutrition were extracted using logistic regression (LR). Five ML algorithms including Naïve Bayes, support vector machine (SVM), artificial neural network (ANN), AdaBoost and random forest (RF) were employed for predicting DBM and their performance was evaluated using accuracy, precision, recall, and area under the curve (AUC).

Results

LR illustrated that age, sex, region, wealth index, educational level and marital status were identified as potential risk factors for DBM. AdaBoost had the highest accuracy (89.8%), followed by SVM (89.6%). Naïve Bayes had the highest Recall (98.1%) and the most performant AUC (91.4%), while RF had the highest Precision (70.8%). The ANN had an accuracy of 89%, a precision of 70.4%, a recall of 78.7% and an AUC of 0.851.

Conclusions

The study demonstrated the efficacy of ML algorithms in predicting DBM in Tunisian adults. AdaBoost and SVM showed the highest accuracy, and could be utilized as an early detection tool to manage DBM and alleviate the burden on the healthcare system. However, larger and more diverse datasets are needed for further validation.

Key messages

• Double burden of malnutrition, defined as the coexistence of undernutrition and overnutrition, is a significant issue globally and a major challenge in Tunisia.

• Machine learning algorithms, particularly AdaBoost and SVM, can be effective tools for predicting and managing double burden of malnutrition in Tunisian adults.
HIA as a standard tool for effective decision-making on NCD policies
Authors: Pekarcikova J
Published: October 2023

Background

Increasing rates of NCD are observed within EU countries. This paper aims to highlight the potential of Health Impact Assessment (HIA) in informing projects, plans, and programs related to health improvement, thus enhancing its role in the decision-making process.

Methods

The preliminary analysis focuses on HIA's involvement in the decision-making process regarding NCD in the EU, particularly in CEE countries over the past decade. The study examines various aspects of the identified HIAs, including their general information, the time frame of the HIA, proposed preventive measures, methods used, the description of the determinants of health affected by the decision, the type of document assessed, the affected population, the impact of the HIA on subsequent decisions, the source and cost of funding, the limitations of the study, HIA as a part of EIA or not, the use of artificial intelligence algorithms in the possibility of HIA implementation, etc. The impact of each HIA on subsequent decisions was categorized using an adaptation of a classification system developed by Wismar et al. for use in evaluating European HIAs (Wismar et al. 2007).

Results

The findings suggest that HIA is crucial in addressing the public and providing transparent information to entities with decision-making authority. It is recommended that the HIA process be a standard tool used to clarify information on health risk factors, implement new health policies, and monitor their effectiveness. The study also indicates that a completely digital approach to HIA is an open question that requires further research. AI algorithms can potentially aid in improving HIA's efficiency and processing complex information and data.

Conclusions

HIA has excellent potential to improve the decision-making process related to non-communicable diseases, and its incorporation as a standard tool is essential. The use of AI algorithms in HIA implementation is a promising area for future research.

Key messages

• HIA is a crucial tool in addressing the public and providing transparent information to entities with decision-making authority.

• The use of AI algorithms in HIA implementation is a promising area for future research.
Time from sickness absence due to cancer until return to work by locations and sex, Catalonia, Spain
Authors: Ayala A , Benavides F G , Serra L
Published: October 2023

Background

Number of people diagnosed with cancer in the workplace are expected to increase steadily. Sickness absence is a tool of social protection system through which workers with a health problem can get absence from work, while receive economic and medical support until they are able to return to their workplace.

Methods

Cohort study of 426 affiliates to Social Security (57.5% women), residents in Catalonia who suffered an sickness absence due to a cancer between 2012-2015. Individuals were followed up from the beginning of the sickness absence episode until return to work. Kaplan Meier survival estimates were applied, stratified by sex, to compare time until return to work distinguishing between different cancer locations.

Results

Median age among workers who returned to work after an sickness absence was 49.3 years (sd 9.2). Among men, most frequent locations were male genital organs (28.7%), digestive (23.2%) and urinary organs (22.7%), and among women, breast and female genital organs (61.2%) and skin neoplasm (21.6%). Maximum time until return to work was 11.2 months. The median time until return to work was 1 month in both sexes. In men, we found the longest median time in male genital organs with 38 days and the lowest in skin cancer with 10 days. In women, we found the longest median time in digestive and the lowest in skin neoplasms with 14 days. Kaplan Meier curves showed bigger differences in time to return to work between locations among women than among men. Differences between both sexes were found statistically significant (p < 0.0001).

Conclusions

Most of the people who survive a cancer go back to employment. Time until return to work vary between cancer locations and sexes. Studying return to work of people who suffer a cancer allows us to determine how the disease affects survivors and society to better understand specific needs of survivors and detecting vulnerable groups.

Key messages

• Time from sickness absence due to cancer until return to work vary between cancer locations and sexes.

• Research on sickness absence in important to better understand specific needs of survivors and detecting vulnerable groups.
The association of depressive symptoms with perceived occupational noise exposure in young adults
Authors: Heinonen-Guzejev M , Whipp A M , Wang Z , Anu Ranjit A , Palviainen T , van Kamp I , Kaprio J
Published: October 2023

Background

Previous studies show that occupational noise annoyance is associated with depressive symptoms. This study aimed to investigate the association of perceived occupational noise exposure and depressive symptoms in young adulthood and to evaluate whether noise sensitivity mediates or moderates this association. This study was part of Equal-Life program, grant No 874724.

Methods

The study was based on FinnTwin12, an ongoing longitudinal twin study. We included those participants who were working daily (n = 521) or weekly (n = 245) during the past 12 months. Mean age was 22.4, SD 0.7, 53% were female. The main analysis was to examine the association between perceived occupational noise exposure and depressive symptoms in young adulthood, at age 22. We studied depressive symptoms using the General Behavior Inventory (GBI). We also studied whether depressive symptoms assessed at age 17 were associated with perceived noise exposure at work at age 22. Linear regression analyses were used. Noise sensitivity and other covariates were included in linear regression models.

Results

Perceived daily occupational noise exposure was associated with depressive symptoms at age 22 (beta 1.19; 95% CI 0.09, 2.29) in all participants, and separately in females (beta 2.22; 95% CI 0.34, 4.09) but not males (beta 0.22; 95% CI -1.08, 1.52). Noise sensitivity was independently associated with depressive symptoms in all (beta 1.35; 95% CI 0.54, 2.17), and separately in males (beta 1.96; 95% CI 0.68, 3.24) but not females (beta 1.05; 95 % CI -0.04, 2.13). Pre-existing depressive symptoms at age 17 were predictive of perceived occupational noise exposure at age 22. Noise sensitivity was independent of perceived occupational noise exposure.

Conclusions

Perceived occupational noise exposure was associated with depressive symptoms in young adults, females in particular. Noise sensitivity was independently associated with depressive symptoms in all, males in particular.

Key messages

• In young adults and females in particular, perceived daily noise exposure at work was associated with depressive symptoms.

• Noise sensitivity was independently associated with depressive symptoms among all participants, males in particular.
Association between bed supply and pneumonia hospitalization according to hospital types in Korea
Authors: Kweon S S , Yang J H , Lee E Y , Kim J H , Kim H Y , Shin M H , Jang Y L
Published: October 2023

Background

An ecological study was conducted to determine the causes of regional differences in hospitalized pneumonia incidence in Korea. We evaluated the association between regional bed capacity and pneumonia hospitalization rates, and the interaction of hospital type.

Methods

Variables of hospitalized pneumonia patients (n = 2,226,243) aged 19 years from 2015 to 2020, prior to the COVID-19 pandemic, were extracted from the Korean National Insurance database. Age-standardized pneumonia hospitalization rates per 10,000 population by region and year were calculated. Multilevel linear regression was conducted to assess the association between the regional number of beds by hospital type and pneumonia hospitalization rates. The multilevel analysis was stratified by length of stay (LOS) and whether recommended clinical practices for pneumonia treatment were performed during hospitalization.

Results

Pneumonia hospitalization rates were highest in the Gwangju metropolitan city. The excessive pneumonia hospitalization rate in Gwangju occurred mainly in primary care (PC) and nursing care (NC) hospitals. A significant positive association between regional number of bed supply and pneumonia hospitalization rates (p-value=0.0157) was found. Interaction effect of hospital type and regional bed number supply was statistically significant (p-value<0.001). Positive association between regional bed supply and hospitalization rates was prominent in low grade hospitals, such as PC or NC hospital, and with the poor adequacy of pneumonia care, including long LOS and without recommended clinical practices.

Conclusions

The results suggest that while public health benefits can be expected from increased regional bed availability, there may be unexpected harms associated with supplier-induced demand for hospitalization, mostly in inferior hospitals. Therefore, hospital type and quality of medical care also should be considered in the process of expanding bed capacity in a region.

Key messages

• Regional difference of pneumonia hospitalization rates was associated with hospital bed capacity.

• Supplier induced hospitalization of pneumonia occurred mainly in inferior type of hospital.
Evaluation of family physicians’ attitude towards primary healthcare consultations
Authors: Jasiukaitiene V , Venckute I
Published: October 2023

Background

The quality of services in the health care system is very important for both patients’ health and health care providers. In the past decade, good service ratings from the patient's perspective have become crucial in evaluating the work of medical professionals and health care institutions. However, it is also important to consider the opinions of health care specialists, especially when it comes to medical consultation, which is one of the most important components of primary health care (PHC) chain.

Aim

To evaluate the attitude of family physicians (FP) towards consultations provided in PHC.

Methods

The study was conducted in 2022. December - 2023 in February. The research contingent is FP of Lithuania. Research method - quantitative momentary research, anonymous questionnaire survey, 206 subjects were interviewed. Calculated chi-square (χ2) and z-criterion.

Results

The majority of FP indicated that they involve the patient in the decision-making process (68.0%), those working in private institutions said so more often than those working in public institutions (p < 0.05). 89.3% of the subjects stated that the consultation time with the patient is not enough, and 70.4% respondents receive many unregistered patient visits per day. E-health makes it difficult for 81.1%, 86.4% of the respondents indicated that there is too much of a workload and this was mostly said by respondents working in public institutions (p < 0.05). Remote consultations facilitate the workflow (76.2%). The older age of the respondents and greater work experience lead to lower self-confidence during remote consultation, longer consultation time and less belief in the benefits of remote consultation (p < 0.05).

Conclusions

Most FP positively evaluate the consultation they provide, but they also said that the consultation time is insufficient, they must consult a number of unregistered patients, e-health complicates the work. Remote consultations facilitate the workflow.

Key messages

• The consultation time is insufficient.

• Remote consultations facilitate the workflow.
Prejudices towards the Romas in Hungarian healthcare: taboos and areas to tackle inequalities
Authors: Marek E , Katz Z , Szilard I , Orsos Z , Nemeth T
Published: October 2023

Background

The Roma or Gipsy population is the largest ethnic minority both in Europe and Hungary with 10-15 years lower life expectancy and worse health indicators than majority populations. The aim of our study was to investigate a sensitive and controversial issue: the perspectives of Hungarian health professionals about the presence and impacts of prejudice towards Roma patients.

Methods

Semi-structured interviews were conducted between June 2017 and May 2018 involving 19 healthcare professionals. Qualitative methods were applied to analyse the transcripts.

Results

The presence and occasional manifestation of prejudices against the Romas were confirmed by the interviewees, most commonly in the form of longer waiting time, comments or other meta-communicative tools. Prejudicial attitudes and discriminatory behaviour are less common in wards where the prevalence of disadvantaged patients (HIV-positive, homeless) is higher (e.g. infectology). Prejudice is not specifically directed at the Roma ethnic minority, but also extends to populations living in poor socio-economic conditions, or with underlying self-destructive behaviour (alcoholism, drug use). In the opinion of our interviewees, occasional prejudicial behaviour does not lead directly to sub-standard care and poorer health, but it cannot be ruled out that it may indirectly contribute to it, in case the patient does not seek medical attention due to a former negative experience within healthcare. In terms of prevention, the education of both parties and the prevention of burnout of health providers are essential tasks for the future as this latter may also enhance the manifestation of prejudices.

Conclusions

Our study includes the investigation of a highly sensitive and understudied area of research. Our findings may provide a better understanding of Hungarian health professionals’ views on the effects of prejudice towards the Roma patients in healthcare, as well as about the need and strategies of prevention.

Key messages

• Direct relationship between healthcare providers’ prejudices and the lower quality of healthcare services or the worse health status of Roma patients may be excluded.

• Indirect negative effects of prejudices may occur in cases where a patient refrains from seeking care due to previous perceived or experienced discrimination.
Determinants of implementing the ID ROLL OUT study's interventions: qualitative results
Authors: Wimmesberger N , Allen R , Först G , Fink G , Giesen R , Kern W V , Rieg S , Farin-Glattacker E
Published: October 2023

Issue

Antimicrobial stewardship programmes (ASP) and infectious disease (ID) specialists aim to ensure the rational use of antimicrobials and to improve patient outcomes. Whilst ASPs are established to varying degrees, ID specialists are rarely available in secondary and tertiary care hospitals in Germany.

Description of the problem

With the ID ROLL OUT study, we implemented and evaluated an intervention, which comprises ASP with and without ID specialists’ consultation in ten hospitals (excl. university hospitals) in south-west Germany. Little has been reported on the medical and pharmaceutical staff's perspectives on the implementations. This study describes barriers, facilitators, and suggestions for improvement to successfully establish a large-scale multicentre intervention. The participants responsible for implementing the intervention were interviewed using semi-structured, guided interviews at two time-points (t1: n = 17; t2: n = 18). The recorded interviews were analysed for content, following Kuckartz.

Results

A high level of acceptance and a positive attitude towards the intervention are conducive to the intervention's successful implementation. The teams find extra time for the study and a close staff collaboration at a local team level to be helpful. The main barriers identified are a high workload, lack of acceptance by colleagues in key roles, and the Covid-19 pandemic. Lack of digitalisation and entrenched internal structures were identified as major barriers. To further improve implementation, more infectious disease training should be provided, along with support from superiors and extension of the intervention phase. Moreover, government-mandated ASP guidelines and quality management by the German Medical Association are desired and expected to contribute in the future.

Lessons

The identified determinants provide much-needed key information, which is important for the efficient, targeted and successful implementation of future similar interventions.

Key messages

• Acceptance, positive attitude and staff collaboration help to implement the intervention.

• Heavy workloads and lack of support from key colleagues hinder the intervention’s implementation.
Hospital management of an epidemic in intensive care: a predictive tool for saturation
Authors: Capitanio L , Josseran L , Dumas L , Gautier S
Published: October 2023

The COVID-19 epidemic has highlighted the importance of hospital resource management in exceptional health contexts. The hospital capacity of intensive care units has emerged as a determining factor in overall hospital management. The objective of this study is to create a tool for predicting the saturation status of an intensive care unit. The predictive model was developed based on a SIR compartmental model. The model was trained using hospitalization data (admissions, discharges, and capacity) from the Raymond Poincaré Hospital, AP-HP. The model parameters (transmission and recovery rates) were estimated using the least squares method. A web application, OHASiS® (Outil Hospitalier d'Analyse de Situations de Saturations), was developed using Shiny and embeds the model. The model provides a reliable prediction over 7 days of the evolution of the number of admissions and discharges in COVID-19 intensive care units. Information on capacity makes it possible to predict a possible saturation of the service. A sensitivity analysis of the model revealed no significant difference between predicted and observed attendance data. The OHASiS® tool allows for the visualization of epidemiological data and helps with medical decision-making as the epidemic evolves. It would be desirable to integrate this application into future hospital management plans. This tool could also be used during simulation exercises. Validation of the predictive model in the context of seasonal epidemics still needs to be conducted.

Key messages

• A SIR compartmental model was used to develop a tool for predicting the saturation status of ICU.

• The web application OHASiS® can help with medical decision-making and should be integrated into future hospital management plans, though further validation is needed for use during seasonal epidemics.
Organisational and Structural Drivers of Childhood Immunisation in the European Region
Authors: Valdecantos R L , Palladino R , Lo Vecchio A , Montella E , Triassi M , Nardone A
Published: October 2023

Background

Evaluating the immunisation program is vital to identify the inherent factors that impact the achievement of the intended countrywide vaccine coverage rates (VCRs). However, despite the implementation of widespread vaccination programs, the European Health Systems continue to experience care challenges attributable to organizational and structural issues. This study aimed to review the available data on aspects within the organizational and structural domains that might impact vaccination coverage.

Results

This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched a comprehensive range of databases from 1 January 2007 to 6 July 2021 for studies that reported quantitative or qualitative research on interventions to raise childhood vaccine coverage. Outcome assessments comprised organizational and structural factors that contribute to vaccine concerns among pediatric parents, as well as data reported influencing the willingness to vaccinate. To analyze the risk of bias, the Ottawa, JBI's (Joanna Briggs Institute) critical appraisal tool, and Amstar quality assessment were used accordingly. The inclusion criteria were met by 205 studies across 21 articles. The majority of the studies were conducted in the United Kingdom (6), the European Union (3), and Italy (3).

Conclusions

A range of interventions studied in primary health care settings have been revealed to improve vaccination coverage rates including parental engagement and personalization, mandatory vaccination policies, vaccine program redesign, vaccine supply chain design, administering multiple/combination vaccines, improved vaccination timing and intervals, parental education and reminders, surveillance tool and Supplemental Immunisation Activity (SIA), and child health information model.

Key messages

• Maintaining high vaccine uptake rates is critical to the success of any vaccination program and the improvement of children’s health.

• Parents and the general public must be actively engaged by health planners and specialists, and process mechanisms must be implemented to guarantee that children receive primary prevention.