bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender bias in cardiovascular practice guidelines: the example of ischemic heart diseases
Authors: Bastian K , Rohmann JL , Piccininni M , Kelly Irving M , Bajos N
Published: October 2022

Background

Despite declines in cardiovascular disease mortality, evidence suggests women have a higher mortality and worse prognosis after ischemic events compared with men. This work investigates to what extent clinical recommendations made by cardiovascular guidelines might include sex and gender biases.

Methods

We reviewed the primary literature base underlying the 2019 European Society of Cardiology guidelines’ recommendations on chronic coronary syndromes focusing on sex and gender sensitivity aspects pertaining to ischemic heart diseases. We applied an adapted Cochrane Collaboration appraisal checklist and only included recommendations with direct citation to literature evidence. We used beta regression to model the association between the proportion of female participants within the study population and the year of publication (modeled as cubic polynomial), impact factor, and sex of the first/last author.

Results

In the 20 recommendations that quoted the literature, gender-sensitive propositions were fully absent, while 4 included sex-sensitive statements. Sex- or gender- specific study design or a priori statistical considerations were largely absent in the included publications. The term “gender” was used exclusively to denote biological sex. The included studies published between 1991 and 2019 comprised of more than 2.1 million individuals (29% female). Representation of women as study participants undulated over time. Female sex of first (OR = 1.84, 95%CI= 1.30-2.60) or last (OR = 2.27, 95%CI=1.31-3.92) author were statistically significantly associated with the probability of having more female study participants.

Conclusions

Methodological sex- and gender-sensitive considerations are largely missing in the evidence base used to guide cardiovascular care decision-making in Europe. Women remain underrepresented in the studies from which the guidelines are derived. Studies with female first or last authors were more likely to have better representation of women.

Key messages

• Though differences in morbidity are well-described, current European cardiovascular recommendations lack sex and gender sensitivity, and women remain underrepresented in the underlying evidence base.

• To what extent the clinical cardiovascular recommendations may or may not be valid for groups not well-represented in the underlying evidence base remains unknown.
Characterizing population-based health care needs at the departement level in France
Authors: Rodts U , Ngo T , Ros E , Millet L , Malâtre-Lansac A
Published: October 2022

Aligning health care spending with population needs is a goal shared by many public health and health care systems. However, most modelling approaches have proven deceptive and ineffective. We propose a novel data-driven, population-based approach to help policymakers explore the discrepancies between spending and needs in France. We leveraged several national open data sources covering demographics, social deprivation, epidemiology, environment, health-related behaviors, and all-payer health care spending (hospital inpatient, prescription medicines, ambulatory events, and dental care). We classified the French “departements” (hereafter counties) into clusters that are homogeneous in terms of health care needs, based on a multidimensional framework. Then, we calculated all-payer per capita health care spending to analyze its within- and between-cluster variation. Based on these findings, we designed a web-based, interactive mapping tool dedicated to French policymakers and payers. The analysis shows 7 clusters of French counties differing in terms of health care needs and spending. The higher-needs/lower-spending and lower-needs/higher spending clusters suggest considerable room for improvement through a regional distribution of spending at least partially based on needs. Most interestingly, the data we used is publicly available, but policymakers lack expertise and time to undergo such analyses themselves. We plan to develop a dynamic and more granular version of the tool to allow policymakers to accurately design and evaluate health care policies.
An update on national recommendations for the use of the adjuvanted recombinant zoster vaccine
Authors: Parikh R , Widenmaier R , Weller R , Lecrenier N
Published: October 2022

Background

The adjuvanted recombinant zoster vaccine (RZV), first approved in 2017, has high, long-lasting efficacy against herpes zoster (HZ) and a clinically acceptable safety profile. In addition to the prevention of HZ in adults aged ≥50 years, the non-live RZV can be used from age 18 years in individuals with immunocompromised (IC) conditions. We reviewed the evolving landscape of national recommendations for RZV use.

Methods

National health authority and vaccination committee websites of countries where RZV is approved were searched in March 2022.

Results

Of 41 countries where RZV is licensed, 14 (Australia, Austria, Canada, Czech Republic, Germany, Ireland, Italy, Netherlands, New Zealand, Saudi Arabia, Spain, Switzerland, UK, US) provide national recommendations related to RZV; the majority are preferential to RZV or only recommend RZV. Overall, seven and seven countries recommend immunisation from age 50 years or 60/65 years, respectively. Of the seven countries that recommend immunisation from age 60/65 years, five recommend immunisation in individuals from age 50 years with comorbidities/IC conditions. Five countries recommend immunisation from age 18/19 years in individuals at increased risk of HZ due to immunosuppressive disease/treatment. In addition, six national recommendations refer to RZV safety and nine address prior HZ vaccination and/or infection. All recommendations outlined the RZV administration schedule.

Conclusions

Although national recommendations can inform decision making in clinical practice, RZV recommendations are not available in all licensed countries. The recommendations highlight a trend in favour of the use of RZV for the prevention of HZ in older individuals and those with IC conditions.

Main messages: An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in older individuals and those with IC conditions.

Key messages

• An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in older individuals.

• An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in IC conditions.
HPV self-sampling as an additional option in cervical cancer screening: a pilot study in Estonia
Authors: Hallik R , Innos K , Jänes J , Veerus P
Published: October 2022

Background

Cervical cancer incidence and mortality rates remain high in Estonia and participation in organized cervical cancer screening program is low. The aim of this pilot study was to estimate the impact of offering an HPV self-sampling option on screening uptake.

Methods

A randomized intervention study was conducted within Estonian organized cervical cancer screening program in 2021. Among target group women who had not participated in screening by August 2021, 26,000 women were randomly selected and allocated to two equally sized intervention arms offering a choice between attending a clinic or taking a self-sample. The opt-out group received a Qvintip sampler by regular mail to home address, the opt-in group received by e-mail a link to order the sampler from a web-site. A control group of 32,000 women received the usual reminder to attend screening at a clinic. Participation rates were calculated and data on user experience were collected with a questionnaire.

Results

Significant difference in participation rates was observed between opt-out (41%) (among them 20% chose self-sampling, 21% chose clinic attendance), opt-in (34%) (8% self-sampling, 26% clinic) and control group (28%). Intervention arms showed higher screening uptake in all age-groups and regions, but the largest effect was seen at ages 60 and 65 years and in regions showing the lowest screening participation rates. Among self-sampling users, 99% agreed that self-sampling was easy and only 3% prefer testing at a clinic.

Conclusions

Offering women a choice between HPV self-sampling or attending a clinic significantly increased cervical cancer screening uptake. Sending an HPV self-sampling kit to home address was the most effective approach. Majority of women who chose HPV self-sampling want to use this option in the future. HPV self-sampling should be integrated in the cervical cancer screening program in Estonia.

Key messages
Older German adults’ health-related quality of life and associated social factors
Authors: Geigl C , Spagert L , Loss J , Leitzmann M , Janssen C
Published: October 2022

Background

A differentiated analysis of the structural relationships between social factors and health-related quality of life (HRQOL) in older German adults has not yet been conducted. In this analysis, we aimed to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental HRQOL in older German adults.

Methods

A community-based postal survey was used to collect cross-sectional data from German adults aged 65 and older (n = 1687, 33% response proportion, 52% female). Physical and mental dimensions of HRQOL were assessed using Short Form 36, version 2. Multiple linear regression models were used to analyse the associations between social factors and both physical and mental HRQOL.

Results

Health locus of control, physical activity, and income were positively associated with both physical HRQOL (Adj. R2 = 0.34, p < 0.001) and mental HRQOL (Adj. R2 = 0.22, p < 0.001), whereas age was negatively associated with both. Alcohol use was positively associated with physical HRQOL, and social support was positively associated with mental HRQOL.

Conclusions

A differentiated understanding of the relationships between social factors and HRQOL assists in group-specific targeting of health interventions. Demand-oriented interventions should consider underlying social factors to reduce socially determined inequities in HRQOL among older German adults. Depending on the focus of the intervention, it may be helpful to take specific social conditions into account. The results may be transferable to municipalities in high-income European countries.

Key messages
Regulation and financing of prenatal screening and diagnostic tests for fetal anomalies in Europe
Authors: Reinsperger I , Zechmeister-Koss I
Published: October 2022

Background

Pregnant women frequently use prenatal screening and diagnostic tests to detect fetal structural and chromosomal anomalies; however, the regulation and financing of these examinations differ substantially across countries. In this paper we focus on the provision, financing and setting of the following tests in selected European countries: First Trimester Screening (FTS)/Combined Test (CT), Non-invasive Prenatal Test (NIPT), second-trimester ultrasound screening for fetal anomalies, amniocentesis/chorionic villus sampling.

Methods

We chose 6 European countries that differ in various criteria (e.g., health/insurance system, geographical location) to illustrate the range of possible regulations and forms of funding: Germany, Switzerland, Netherlands, United Kingdom, Norway, Italy. We conducted a comprehensive hand search and consulted experts from the 6 countries using a questionnaire.

Results

The results are based on 11 completed expert questionnaires and 22 published sources. The heterogeneity of the provision, regulation and financing of the tests concerns in particular the choice of the first-line screening test for fetal trisomies (FTS/CT, NIPT or the identification of risk factors), the implementation of the NIPT, the reimbursement of the tests, the uptake of the examinations, but also the professional groups responsible for antenatal care (midwives, gynaecologists). There are some similarities between countries, e.g., concerning the provision and financing of invasive tests and of the ultrasound screening for fetal anomalies in the second trimester.

Conclusions

The results highlight the significant heterogeneity between European countries regarding prenatal screening and diagnostic testing for fetal anomalies. Due to the many ethical aspects of the topic, a broad societal discourse with the relevant interest groups and stakeholders seems to be necessary. Decision-makers should pay particular attention to high-quality and non-directive counselling.

Key messages
Evaluation of Telemedicine awareness, knowledge, attitude, skill levels of physicians and students
Authors: Mutlu A , Kilinc A , Ozcan L , Tepetas M , Metintas S , Onsuz MF
Published: October 2022

Background

The increase in the use of information and communication technologies around the world brings about developments and changes in the provision of health services. It is accepted that telemedicine applications will facilitate health services for patients and health personnel. This study aimed to evaluate the telemedicine awareness, knowledge, attitude and skill levels of physicians and medical school students.

Methods

This cross-sectional study was conducted between July and August 2021. A questionnaire form was prepared using the relevant literature then filled online by the participants. Telemedicine Awareness, Knowledge, Attitudes and Skills Questionnaire was used in the research. The universe of the research consisted of medical faculty students and physicians across Turkey. In the study, 933 people were reached by using the purposeful snowball sampling method, one of the non-probability sampling methods. Mann Whitney-U test, Kruskal Wallis test, Spearman correlation analysis and Multiple Linear Regression analysis were used.

Results

Of the participants, 442 (47.4%) were female, 497 (53.3%) were medical students, and 436 (46.7%) were physicians. Their ages ranged from 18 to 59, with a mean of 28.0±8.8 years. The median (min-max) scores obtained from the Telemedicine Awareness (TA) sub-section were 18(0-24), 51.3% of them had scores above the median score. TA sub-section had a moderate positive correlation (r = 0.559, p < 0.001) with knowledge sub-section and a weak positive correlation (r = 0.208, p < 0.001) with skill level sub-section. TA scores were higher among men, physicians and those who want to participate in a telemedicine training program. TA increased as the level of computer and internet knowledge increased (F = 29.171, R2=0.197, p < 0.001).

Conclusions

It can be said that TA is at a moderate level among medical students and physicians in Turkey. TA increased as the level of computer and internet knowledge, telemedicine knowledge and skills increased.

Key messages
Remote patient monitoring at home using ambient sensors: a systematic review
Authors: Alboksmaty A , Solomons N , Gul S , Neves AL , Aylin P
Published: October 2022

Background

The world population is ageing, and their health needs imply substantial demands on health systems. Remote Patient Monitoring (RPM) may help elderly patients live independently in their homes for longer. The essence of RPM is the continuity of use, which is challenging for wearable devices and patient-led technologies. Unobtrusive (ambient) sensors could be an innovative solution, such as motion detectors and similar technologies. This study aims to review the evidence on the effect of ambient sensors on healthcare use by the elderly.

Methods

This is a systematic review for narrative synthesis, searching five databases, Medline, Embase, CINHAL, Scopus and Web of Science, on 21 Feb 2022 without setting a lower time limit. No restrictions on the design of studies were applied. A meta-analysis was not feasible due to the heterogenicity of the studies.

Results

Out of 5,653 search results, 180 studies were subjected to full-text review, of which 6 studies were included in the final synthesis. All the included studies were conducted in the USA. Four studies assessed the technology's cost-efficiency, while only one reported significant cost savings. One study reported a significant reduction in hospital days and visits to a physician among the users. Using ambient sensors was associated with an increased length of stay in facilities where the elderly can live independently, including at home. The impact on the number of hospitalisations or emergency room visits was unclear.

Conclusions

Our review identified limited evidence on the effect of ambient sensors on healthcare use by the elderly. The potential has been demonstrated for ambient sensor technologies to result in cost savings; however, further research is needed to assess the impact on health outcomes.

Key messages
Scientific clues on global food (in)security and climate change relationship as drivers of health
Authors: Aslan D
Published: October 2022

Issue

Food insecurity is in close relationship with the determinants of health. Global crisis including climate change (CC), natural disasters, poverty can deepen the burden, and all are linked with the economic, social, commercial, structural determinants of health. Defining such connections may help in proposing practical solutions.

Description of the problem

COVID-19 pandemic made the food security (FS) problem more visible. Food security considers basically the affordability, availability, and the quality of food. Food insecurity (FiS), violation of the right to healthy food, influences disease patterns and causes communicable and non-communicable diseases (NCDs). Globally, 71% of deaths are attributed to NCDs. Analyzing the relationship between FiS and other determinants of health like CC may be helpful for sustainable solutions in such a world where we are talking on “our planet, our health” motto. Example given in this study is the relationship between the country values/rankings of the “Global Food Security Index (GFSI)” and the “Climate Change Performance Index (CCPI)”. GFSI defines the FS situation and CCPI defines countries’ response to CC.

Results

Countries’ CCPI and GFSI values do not show a linear relationship. For example, Norway, as a country at the top of the Human Development Index (HDI) ranking list has both high CCPI and GFSI values. On the other hand, although USA and Canada have low CCPI, both have good GFSI values. Sub dimensions of the indicators may also vary across countries. Crisis like COVID-19, conflicts, poverty emphasize the need on improving the indicators in a transdisciplinary approach.

Lessons

Investigating indicators taking the determinants of health into account is helpful. However, different characteristics of the countries make it difficult to propose a standard approach to overcome the problems. Developing “new” indicators with transdisciplinary work might be useful in this sense.

Key messages
Dietary exposure to acrylamide and breast cancer risk: results from the NutriNet-Santé cohort
Authors: Bellicha A , Wendeu-Foyet G , Coumoul X , Koual M , Pierre F , Debras C , Srour B , Kesse-Guyot E , Deschasaux-Tanguy M , Touvier M
Published: October 2022

Background

Acrylamide is classified as a probable human carcinogen by the IARC but epidemiological evidence on the carcinogenicity of acrylamide from dietary sources is limited. This study aimed to investigate the associations between dietary acrylamide and breast cancer risk in the NutriNet-Santé cohort.

Methods

This prospective cohort study included 80,597 French women (mean [SD] age at baseline: 40.8 [14] years) during a mean (SD) follow-up of 8.8 (2.3) years. Acrylamide intake was evaluated using repeated 24h dietary records (n = 5.5 [SD 3.0]), linked to a comprehensive food composition database. Associations between acrylamide intake and breast cancer risk (overall, premenopausal and post-menopausal) were assessed by Cox hazard models adjusted for known risk factors.

Results

The mean (SD) dietary acrylamide intake was 30.1 (21.9) µg/d (main contributors: coffee, potato fries and chips, pastries and cakes, and bread). During follow-up, 1016 first incident breast cancer cases were diagnosed (431 premenopausal, 585 postmenopausal). A borderline significant positive association was observed between acrylamide intake and breast cancer risk overall (HRQ4 vs Q1= 1.21 [95% CI: 1.00-1.47]) and a positive association was observed with premenopausal cancer (HRQ4 vs Q1= 1.40 [95% CI: 1.04-1.88]). Restricted cubic spline analyses suggested evidence for non-linearity of these associations, with higher HR for intermediate (Q2) and high (Q4) exposures. Receptor-specific analyses revealed a positive association with estrogen receptor-positive breast cancer, which represented 86% of total cancer cases. Acrylamide intake was not associated with post-menopausal breast cancer.

Conclusions

Results from this large prospective cohort study suggest the potential deleterious role of dietary acrylamide in breast cancer etiology, especially in premenopausal women, and provide new insights that should encourage further mitigation strategies to reduce the content of acrylamide in food.

Key messages
The economic value of informal long-term care
Authors: Huis in ‘t Veld T , Korver D , Orhan R , Berenschot L
Published: October 2022

Informal care makes up a significant share of long-term care (LTC) and is likely to become even more important in the near future because of the ageing population, rising numbers of chronic patients and shortages of formal carers. At the same time, informal care is under pressure because of societal developments (shrinking family sizes, increased participation of women on the labour market, rising retirement age and geographical dispersion of families). These developments may further enhance the effect of informal care in terms of individuals’ quality of life and opportunity costs caused by work absence and productivity losses. Against this background, Ecorys has performed studies, to empirically estimate the social value of informal LTC and increase the awareness on its importance. The results of the study, commissioned by the European Commission, demonstrate that informal caregivers represent about 80% of all caregivers (measured in FTE). If paid for, these hours would cost between 2.4 and 2.7% of EU GDP. Currently, these costs are not paid and the actual costs of informal care are estimated at 1.05% of EU GDP, mostly in lost tax revenues. European countries vary greatly in the extent to which informal carers are supported by public policies. Only some countries have cash benefit schemes to compensate for the loss of income from employment. Specific benefits and leave entitlements to support informal caregivers are often insufficient or lacking. In several studies in the Netherlands, Ecorys found that total social costs of informal care are estimated at 2.54% of NL GDP (€22 billion/year) and informal caregivers perceive increasing economic and psychological burden and are at higher risk of depression and burn out. Government policies are developed to better support informal caregivers.

Key messages
Psychometric Properties of the Turkish Version of the Coronavirus-Related Health Literacy Scale
Authors: Soylar P , Öztürk F , Sönmez S
Published: October 2022

Background

This study aims to assess the validity and reliability of the Coronavirus-Related Health Literacy Questionnaire adapted to Turkey and examine the levels of coronavirus-related health literacy among the adults.

Methods

This cross-sectional study was carried out in Turkey. The tools were applied to a total sample population of 452 people. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were calculated to determine the construct validity of the questionnaire with the IBM SPSS Amos program version 24.0.

Results

The validity and reliability analyses of the Coronavirus-Related Health Literacy (HLS-COVID-Q22) questionnaire were adapted to Turkish. Internal consistency was very high (α = 0,963) and construct validity suggests a sufficient model fit, making HLS-COVID-Q19 a feasible tool for assessing coronavirus-related health literacy in population surveys. The findings show that the questionnaire is a valid and reliable tool consisting of 19 items and 3 subdivisions. The mean coronavirus-related health literacy score of the participants was found to be 2.92 (±0.51), meaning that it was on average. The coronavirus-related health literacy level of 18.8% of the participants was found to be ‘inadequate’ while 37.8% had ‘problematic’ and 43.4% ‘sufficient’ health literacy. The HLS-COVID-Q19-TR scores of those in the young age group (18-29 years old), married, employed, university graduates, and vaccinated against COVID-19 were found to be higher, and a statistically significant difference was found (p = 0.049, p = 0.009, p = 0.029, p = 0.012 and p = 0.051, respectively).

Conclusions

The results of the research reveal that the HLS-COVID-Q19-TR is a valid and reliable tool. In this study, more than half of the participants were found to have “inadequate” or “problematic” coronavirus-related health literacy levels. For this reason, studies aimed at improving society's coronavirus-related health literacy should be conducted.

Key messages
Multi-method analysis of gender differences in psychological distress among the elderly during COVID
Authors: Queen C , Pasupathy R , Reine I
Published: October 2022

As COVID swept through Europe, and the world, with high rates of illness and death, so did symptoms of anxiety, depression, post-traumatic stress disorder, stress, and psychological distress. This study examines the relationship between gender and psychological distress among Latvians over 50 years old within the first 6 months of the COVID-19 pandemic. Data from Wave 8 COVID-19 data of the Survey of Health, Aging, and Retirement in Europe (SHARE) as an early data version of the SHARE Corona survey conducted between June and August 2020. It features the data collected by telephone (CATI) on topics related to COVID-19 for a large sub-sample of SHARE panel respondents. This study examined a sample of 980 adults over 50 years old in Latvia. Bivariate analysis were performed utilizing the Pearson chi-square test for association to examine differences in symptoms of psychological distress by gender during the first six months of the COVID-19 pandemic. Level of significance was determined by the p-value test statistic. Alpha level was established at .05. A chi-square test for association shows that there were statistically relationships between gender and feeling nervous (X2 (2, N = 976) = 22.11, p < .001), feeling depressed (X2 (3, N = 976) = 10.95, p < .01), and trouble sleeping (X2 (2, N = 976) = 20.40, p < .001). This study rejects the null hypothesis that no differences exist between the genders, as women reported greater psychological distress during the first 6 months of the COVID-19 pandemic. Additional multi-method analysis is consistent with these findings and concludes that this is due to the greater concern women report for family, and the burden which placed limitations on meeting their children and grandchildren.

Key messages
Essential Medicines for Dental Caries: Cost-Effectiveness of ART and SDF
Authors: Gierth J , Coughlan J , Gkekas N , Hofbauer T , Listl S , Pattamatta M , Pold A
Published: October 2022

Background

Untreated tooth decay (caries) is the most common global health condition and one of the largest preventable disease burdens for society. It concerns both children and adults, particularly in low resource settings whereout of pocket expenditures for oral care often cause catastrophic health expenditures. The 2021 WHO Oral Health Resolution emphasized the relevance of developing so-called “Best Buys” for oral health. The purpose of this study was to identify the cost-effectiveness of Atraumatic Restorative Treatment (ART) and Silver Diamine Fluoride (SDF) as potential treatments to reduce the caries burden worldwide.

Methods

Leaning on WHO CHOICE methodology, evidence scoping and an expert consensus were facilitated to extract model input parameters which were then fed into cost-effectiveness-analyses (CEA) for ART and SDF. The cost-effectiveness of the interventions was expressed as Cost per DALY averted.

Results

The evidence scoping revealed relevant, information on the effectiveness and costs of ART and SDF. The CEA identified both ART and SDF to be potentially cost-efficient treatment strategies in settings with limited resources. SDF was found to provide a cost-efficient treatment alternative in settings where the comparably larger (human) resource requirements for ART cannot be met.

Conclusions

The findings suggest that ART and SDF represent potentially cost-efficient strategies to reduce the caries burden in settings with limited resources. While ART has previously been proposed as part of WHO’s essential package of oral care, SDF could provide a comparably inexpensive treatment alternative.

Key messages

• Untreated tooth decay (caries) is the most common global health condition and one of the largest preventable disease burdens for society.

• The CEA identified both ART and SDF to be potentially cost-efficient treatment strategies in settings with limited resources.
Women’s experiences of accessing vaccines during pregnancy and for their babies during COVID-19
Authors: Skirrow H , Barnett S , Bell S , Mounier-Jack S , Kampmann B , Holder B
Published: October 2022

Background

COVID-19 changed access to healthcare, including vaccinations, in the United Kingdom (UK). This study explored UK women’s experiences of accessing pertussis vaccination during pregnancy and infant vaccinations during COVID-19.

Methods

An online cross-sectional survey was completed, between 3rd August-11th October 2020, by 1404 women aged 16+ years who were pregnant at some point after the first UK lockdown from March 23rd 2020. Ten follow-up semi-structured interviews were conducted.

Results

Most women surveyed were pregnant (65.7%) and a third postnatal (34.3%). Almost all women (95.6%) were aware that pertussis vaccination is recommended in pregnancy. Most pregnant (72.1%) and postnatal women (84.0%) had received pertussis vaccination however, access issues were reported. Over a third (39.6%) of women had a pregnancy vaccination appointment changed. COVID-19 made it physically difficult to access pregnancy vaccinations for one fifth (21.5%) of women and physically difficult to access infant vaccinations for almost half of women (45.8%). Nearly half of women (45.2%) reported feeling less safe attending pregnancy vaccinations and over three quarters (76.3%) less safe attending infant vaccinations due to COVID-19. The majority (94.2%) felt it was important to get their baby vaccinated during COVID-19. Pregnant women from ethnic-minorities and lower-income households were less likely to have been vaccinated. Minority-ethnicity women were more likely to report access problems and feeling less safe attending vaccinations for both themselves and their babies. Qualitative analysis found women experienced difficulties accessing antenatal care and relied on knowledge from previous pregnancies to access vaccine appointments.

Conclusions

COVID-19 disrupted access to vaccinations in the UK. Vaccine services must ensure equitable access to vaccine appointments during ongoing and future pandemics including tailoring services for lower income and ethnic minority families.

Key messages

• Pregnancy and infant vaccines was disrupted by COVID-19 with women feeling less safe and having difficulties accessing vaccinations with ethnic minority women more likely to report access issues.

• Equitable access to routine pregnancy and infant vaccine appointments must be prioritised during future pandemics, including considering tailoring services for different population groups.
Decolonising global health in Africa: research agendas in public health, law, and human rights
Authors: Patterson D , Woldeyes M , Schuck N , Henricson E , Njuguna N , Oduor M
Published: October 2022

Background

In recent years the Groningen Centre for Health Law (‘GCHL’ - formerly the Global Health Law Groningen Research Centre), Netherlands, has held annual summer schools on global health, law, and human rights. Responding to calls to decolonise global health (Fofana, 2021), in February 2022 GCHL convened an online academic colloquium to explore the issues in Africa. Panellists and discussants comprised leading African academics and advocates for public health, law, and human rights.

Objectives

1. Identify priority current and emerging issues in global health, law, and human rights in the African region with, where possible, reference to the climate crisis.

2. Explore opportunities for identifying academic institutions, networks, and researchers working these issues across Africa.

3. Identify opportunities to support collaboration between institutions, networks and researchers and other actors to address the issues identified across the region

Results

Top public health issues identified for further research included: public health law frameworks in Africa; One Health and climate change; inequality in the distribution of the determinants of health and disease; international trade and public health; the right to benefit from scientific progress (e.g. in accessing vaccines for COVID-19); gender-based violence; public health and agri-food systems; noncommunicable diseases; healthy diets; poverty; mental health; social protection; and plastic pollution. The first meeting of the network on health, law and human rights in Africa was held in May 2022. The second academic colloquium was held in July 2022, co-hosted with Moi University and the University of Nairobi, Kenya.

Conclusions

Public health and legal academics in Africa are ready to engage systematically with European partners to address key health-related law and human rights issues of global interest. Research agendas should reflect African priorities, and collaboration should be led by African institutions.

Key messages

• Capacity must be built to understand the links between public health, law and human rights in Africa.

• Collaboration with European institutions to build capacity in public health, law and human rights is welcome, however priorities should be identified by - and responses led by - African academics.
SDG5 Gender Equality during the COVID-19 pandemic: an international comparative policy assessment
Authors: Kuhlmann E , Lotta G , Fernandez M , Herten-Crabb A , Maple J-M , MacFehr L , Paina L , Wenham C , Willis K
Published: October 2022

Background

The COVID-19 pandemic caused severe disruptions in healthcare systems and societies and exacerbated existing inequalities for women and girls across every sphere. Our study explores health systems responses to gender equality goals during the COVID-19 pandemic and which role these goals play in pandemic recovery policies.

Methods

We apply a qualitative comparative approach. Country case studies (expert information, secondary sources) were collected in March/April 2022. The sample comprised Australia, Brazil, Germany, United Kingdom and USA, reflecting conditions of high to upper-middle income countries with established public health systems, democratic political institutions and gender equality policies. Selected topics: maternity care/reproductive services, violence against women, and gender equality/female leadership.

Results

All countries tried to keep essential maternity and reproductive services open, but strong limitations applied especially for prevention and counselling services; at the same time, digitalisation/telemedicine supported service expansion. Violence against women and children strongly increased during the pandemic. Routine services were partly kept open and new helplines occasionally established, but no action was taken to scale-up mental health support and respond to new demand. A push-back of gender equality was observed across countries in all areas of health and social care, often coupled with strong increase in intersecting social inequalities; participation of women in decision-making bodies was generally weak and not monitored.

Conclusions

Across countries, gender equality policies cracked under the pressure of the COVID-19 pandemic; this is true for countries with male and female political leaders, and for different areas of SDG5 and health. There is an urgent need for more effective intersectional gender equality policies and improved participation of women in global health and in health system recovery plans.

Key messages

• Health systems failed to take action to protect SDG5 goals; gender and intersecting inequalities strongly increased during the pandemic.

• Building back better after COVID-19 will only be possible with an intersectional gender equality programme and feminist policy approaches.
Trends of hospital admissions and mortality of patients with dementia: descriptive study in Lombardy
Authors: Blandi L , Amorosi A , Bertuccio P , Odone A
Published: October 2022

Background

In 2017 the amount of people globally affected by dementia was estimated about 50 million and is predicted to increase to 132 million by 2050. Coping with dementia is one of the most important challenges of governmental organizations’ agenda. The objective of this study is to analyse the hospital admissions trends and monitor the overall mortality in a population of older patients with dementia over the last two decades in northern Italy.

Methods

This study is based on the healthcare utilization database of the Lombardy region (Italy), considering on hospital discharge records and death registry flows. Primary or secondary diagnosis at admission of dementia was coded according to the ICD9-CM. We carried out descriptive analyses of hospital admissions’ data from 1 Jan 1999 to 31 Dec 2020 of older patients aged 65 or more. We then conducted a temporal analysis of mortality rate over the study period.

Results

A total of 15,683,024 hospital admissions occurred during the study period. Over the last two decades, the prevalence of dementia among patients admitted to acute care hospitals remained around 1.1-1.3%. Considering the total of 183,268 patients with dementia over the study period, the average age at admission increased from 80.2 in 1999 to 83.3 years old in 2020, whereas annual mortality rate increased from about 1,950 to 3,230 deaths per 10,000 person-years. The mortality rate ratio of patients with versus without dementia fluctuated between 1.28 and 1.70.

Conclusions

Our findings suggest that there is an ever-greater appropriateness of hospitalizations over the last two decades, supported by out-of-hospital care that led patients to hospitalization in increasingly late and serious phases of the disease. The present study has a great future potential as well as limitations, due to the dependence on a correct coding of cases by clinicians according to the ICD9-CM system.

Key messages

• We observed an increased mortality among older people with dementia admitted to hospital over the last two decades.

• Our descriptive study, based on the Lombardy regional healthcare database, provides evidence of an increasing appropriateness of hospitalizations.
Short-term exposure to PM2.5 and hospital admissions for respiratory causes in the Czech Republic
Authors: Tomaskova H , Slachtova H , Tomasek I , Polaufova P , Hellebrandova L , Splichalova A
Published: October 2022

Background and Aims

The Regions Ostrava and Karvina are the most polluted areas in the Czech Republic. The aim of this study was the analysis of effect of ambient fine particles (PM2.5) on acute hospital admissions for respiratory causes.

Methods

In the period 2013-2019, a total of 20,490 cases of acute hospitalization from respiratory causes (J00-99 according to ICD-10) was registered. The daily PM2.5 concentrations were measured at 5 stations. The analyses were performed in two ways: i) including extreme values (max. 224 μg.m-3) and ii) for PM2.5<60 μg.m-3 (5% of the highest values were cut off). The generalized additive model (GAM) for Poisson distribution was used for the analyses; the „thin plate regression spline“ was applied to smooth the pressure, relative humidity and a temperature. The model was adjusted for meteorological conditions, incidence of acute respiratory infections, days off, the order of a day in a week and the area. The calculation was done for lag0 to lag3 days. The analyses were completed using the SW Stata v.14 and SW R v.3.6.1 with the use of mgcv package v.1.8-28.

Results

The median age of patients was 57 years (IQR 4-75 years), 56% were men. The annual PM2.5 values ranged from 18.5 to 31.0 μg.m-3. Based on the fully adjusted model, a10 μg.m-3 increase in PM2.5 was associated with an increase in hospital admission of 1.0% (95% CI: 0.2-1.8%) for lag0 and lag2, 1.2% (95% CI: 0.5-1.9%) for lag3. The percentage changes for models with values of PM2.5<60 μg.m-3 were higher - 1.8% (95% CI: 0.3-3.2%) for lag0 and 3.3% (95% CI: 2.0-4.7%) for lag1-lag3.

Conclusions

The analyses confirmed the effect of ambient fine particulates (PM2.5) on acute hospital admissions for respiratory causes in the regions Ostrava and Karvina.

This presentation was supported by the project TH03030195 of the Technology Agency of the Czech Republic and the project Healthy Aging in the Industrial Environment CZ.02.1.01/0.0/0.0/16_019/0000798 (HAIE).

Key messages

• A positive association was confirmed between short-term concentrations of PM2.5 and acute hospital admissions for respiratory causes (lag0-lag3).

• No statistically significant difference was found between the identified C-R functions and C-R functions published by the WHO for the relationship between respiratory hospitalizations and PM2.5.
Drivers of Energy Consumption in Portuguese Hospitals - a panel analysis
Authors: Chen-Xu J , Moutinho V
Published: October 2022

Background

Buildings represent about 40% of global energy consumed, playing an important role in sustainable transformation. Health institutions account for 10% of the energy consumed by the commercial sector, however public policies do not cover energy management in this setting. Energy poverty in hospitals, such as poor heating, affect patients’ and workers’ health and wellbeing. As such, this study aims to analyse drivers of electricity and natural gas consumption of Portuguese hospitals.

Methods

Data regarding 25 hospitals in Portugal’s National Health Service from 2015-2020 were analysed as logarithms in a panel of 18 trimesters, using Panel-corrected Standard Errors estimators. The PSAR model considers the presence of an autocorrelation within the panel, and the Hetonly modeling deals with heteroscedasticity and autocorrelation.

Results

There is an elastic elasticity and a statistical significance of electricity and natural gas consumption in relation to the number of beds occupied, with a greater variation of natural gas than electricity consumption. In turn, there is a predominance of an inelastic elasticity of electricity and natural gas consumption in relation to the number of workers and number of emergency episodes.

Conclusions

Energy consumption is highly influenced by the number of beds occupied, highlighting the need for a strategic management of energy and planning of hospital capacity. Overall, the positive absolute effects of the elasticities for energy consumption reveal that hospitals do not use effective measures aimed at rational and cleaner energy consumption, requiring a paradigm shift in the energy matrix. Increasing energy efficiency policies and environmental practices, such as autonomous energy production and renewable energies, might effectively contribute in reducing conventional energy consumption and associated energy poverty, which in turn improve patients’ and workers’ conditions within the hospital and their health and wellbeing.

Key messages

• Strategic energy management and capacity planning can contribute to lower energy poverty and a paradigm shift in the energy matrix.

• Hospital sustainability policies must include energy management, including autonomous energy production and investment in renewable energies.
Excess mortality during the coronavirus pandemic (COVID-19) in Poland
Authors: Pikala M , Burzyńska M
Published: October 2022

The COVID-19 pandemic, has begun a global changes in the mortality model, exceeding its predicted levels under standard conditions. The aim of the study was to assess the phenomenon of excess mortality in Poland in 2020 and in the first half of 2021 compared to 2016-2019 based on the data of the Central Statistical Office. The number of excess deaths was defined as the difference between the deaths in 2021 and the average number of deaths in the previous years. In accordance with the Eurostat methodology the 2016-2019 average was taken as the reference point. In 2020, the number of deaths in Poland amounted to 485,259 and was higher by 14.9% than expected on the basis of mortality in 2016-2019 (the absolute excess number of deaths amounted to 67,112). 43% of the excess deaths were deaths caused by Sars-Cov-2, 27% other deaths among infected people, and 30% deaths among those without confirmed infection. In this group, the highest increases were recorded for deaths due to cardiovascular diseases, neurological diseases and mental disorders. In the first half of 2021, 270,662 people died in Poland, i.e. 23.9% more than in the corresponding period in 2016-2019 and 22.9% more than in the first half of 2020, whereas 58,096 people died due to COVID-19 (22% of all deaths). The highest increases for non-viral deaths compared to 2016-2019 were recorded for blood diseases and immune mechanisms (121.53%), infectious and parasitic diseases (90.76%), mental disorders (34.93%) and cardiovascular diseases (11.65%). Excess mortality is a very serious problem of the public health. The increased mortality in 2020 and 2021 was closely related to the pandemic, as direct COVID-19 victims accounted for the majority of the observed increases in mortality. However, attention should be paid to the growth in mortality related to other causes, mainly mental disorders, for which mortality increases most rapidly, which requires immediate action.

Key messages

• The increased mortality in 2020 and 2021 was closely related to the pandemic, as direct COVID-19 victims accounted for approximately 90% of the observed increases in mortality in Poland.

• In the group of no-related with COVID-19 deaths the highest increases were recorded for mortality due to cardiovascular diseases, neurological diseases and mental disorders.