bluuebunny/crossref_metadata_2025 huggingface dataset:
Educational inequalities in cervical cancer mortality in the Baltic Sea region in 2008–2015
Authors: Nõmm O , Innos K , Leinsalu M
Published: October 2024

Background

Reducing inequalities in cervical cancer mortality is a public health priority. This study aims to assess the absolute and relative educational inequalities in cervical cancer mortality in the Baltic countries and Finland in 2008-2015.

Methods

Data for Estonia, Latvia and Lithuania were obtained from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, and data for Finland from the longitudinal register-based population data file of Statistics Finland. Cervical cancer deaths (ICD-10 code C53) were linked from national mortality registries. Educational level was census- or registry-based. Absolute and relative educational inequalities in cervical cancer mortality were assessed in 2008-2015 for women aged 30-49 and 50-64, using age-standardized mortality rates (ASMRs) per 100 000 person-years and mortality rate ratios (RRs) with 95% confidence interval (CI).

Results

This study included 1724 cervical cancer deaths and about 22 million person-years. Absolute and relative educational inequalities in cervical cancer mortality were considerably larger in the Baltic countries compared to Finland. Among 30-49-year-olds, ASMRs for high educated ranged from 0.6 (95% CI: 0.4-1.0) in Finland to 3.6 (95% CI: 2.5-5.0) in Lithuania, and for low educated from 2.2 (95% CI: 1.2-3.7) in Finland to 24.6 (95% CI: 18.2-32.4) in Lithuania. RRs for low educated compared to high educated ranged from 3.51 (95% CI: 1.57-7.68) in Finland to 9.11 (95% CI: 4.28-19.32) in Estonia. Among 50-64-year-olds, ASMRs for high educated ranged from 1.3 (95% CI: 0.8-2.0) in Finland to 9.8 (95% CI: 7.2-13.1) in Estonia and for low educated from 2.9 (95% CI: 1.9-4.1) in Finland to 43.9 (95% CI: 34.4-55.1) in Lithuania. RRs for low educated compared to high educated ranged from 2.18 (95% CI: 1.20-4.05) in Finland to 6.32 (95% CI: 4.30-9.36) in Lithuania.

Conclusions

Equitable prevention is a key to reducing cervical cancer mortality in the Baltic countries.

Key messages

• Lower-educated women largely drive high cervical cancer mortality in the Baltic countries.

• Equity-focused prevention is crucial for reducing cervical cancer mortality in the Baltic countries.
Characteristics of fatal COVID-19 among pregnant women admitted to hospitals in Kazakhstan
Authors: Nurgaliyeva Z , Semenova Y , Santric-Milicevic M , Nikolic D , Lackovic M , Glushkova N , Sarria-Santamera A
Published: October 2024

Background

The factors contributing to the fatal outcome of COVID-19 in pregnant women remain not entirely clear. We compared the prevalence rates of comorbidities and laboratory test results in pregnant survivors and non-survivors.

Methods

This retrospective study relied on clinical and laboratory data obtained from medical records of pregnant women with COVID-19 admitted to three hospitals of the Republic of Kazakhstan from 16.07.2021 to 31.01.2022. Overall, we obtained data on 157 pregnant women with COVID-19, of whom 95.9 % survived and 4.1 % died in the hospitals.

Results

Arterial hypertension was present in 50% of non-survivors vs. 7.9% of survivors (P = 0.001), diabetes mellitus was diagnosed in 16.7% of non-survivors vs. 2.3% of survivors (P = 0.044), and the rate of hyperglycemia was 40% and 7.2%, respectively (P = 0.009). Heart rhythm disturbance was present in 50% of non-survivors vs. 6.4% of survivors (P < 0.001), and already at the time of admission to the hospital, the non-survivors had significantly higher heart and respiratory rates. Laboratory tests showed that non-survivors had higher erythrocytes sedimentation rate, C-reactive protein, leukocyte count, and D-dimer levels (P = 0.001, P < 0.001, P = 0.038, P = 0.014, respectively). The creatinine level was within the normal range in both study groups, but it was relatively higher in the deceased pregnant women (71.3; IQR: 66-251.75) vs. 52; IQR: 43-63; P = 0.001). Finally, a higher proportion of those who died presented with abnormal chest CT as compared with the survivors (33.3% vs. 4.2%, P < 0.001).

Conclusions

The deceased had a higher rate of comorbidities. Given the vulnerability of pregnant women to COVID-19, it is essential to plan a prospective study to provide insights into the factors that contribute to severe COVID-19 outcomes in pregnant women.

Key messages

• Determining risk factors for fatal COVID-19 is crucial for effective medical care of pregnant women.

• Identifying potential risk factors of fatal COVID-19 among pregnant women could help inform public health policies and clinical guidelines.
Changes in overweight and overweight-related health behavior in higher education students in Finland
Authors: Parikka S , Ikonen J , Pohjola V , Sarttila K , Lundqvist A
Published: October 2024

Introduction

Covid-19 pandemic may have had negative effects on overweight and overweight-related health behavior in young adults. The aim was to examine the changes in overweight, physical activity, sedentary behavior and daytime tiredness in higher education students during and after the pandemic.

Methods

Two cross-sectional student representative surveys (aged 18-34 y) were conducted in 2021 (n = 6258, response rate 53 %) and 2024 (n = 3638, response rate 31 %). Overweight (BMI ≥25 kg/m2) was based on self-reported height and weight. Physical activity was dichotomized into those meeting physical activity recommendations and others. Sedentary behavior was dichotomized into sitting in front of TV, computer or smart device over three hours a day during leisure time and others. Daytime tiredness was dichotomized into those feeling tired 6-7 days a week and others.

Results

The preliminary results indicate that overweight in women increased from 34 % to 39 % whereas no increase was observed among men (47 % vs. 46 %) between 2021 and 2024. Meeting the physical activity recommendation increased from 46 % to 55 %, the change being similar for both sexes. Sitting over three hours in leisure time in front of TV, computer or smart device decreased from 54 % to 50 %. In men, the prevalence of sitting decreased (62% vs. 57 %) whereas in women no statistically significant change was observed (47% vs 45 %). No statistically significant change was observed in feeling tired almost every day (26 % vs 24 %).

Conclusions

Among higher education students, an increase in prevalence of overweight in women was observed for three years period. Favourable changes were observed in physical activity in both men and women, and sedentary behavior in men. Surveillance of the long-term health consequences of the pandemic in young adults is important for planning and targeting preventive activities.

Key messages

• Overweight increased among female higher education students after COVID-19 pandemic.

• Factors supporting favourable changes in health behaviour of young adults after pandemic should be examined in longitudinal setting.
Measles outbreak under the Leaning Tower of Pisa in Italy
Authors: Daole A , Giorgi S , Cruschelli G , Bonaldo L , Gallo A , Rizzo C
Published: October 2024

Background

Measles cases in Italy (58,9 mln population) were 8 in 2021, 15 in 2022 and 43 in 2023. Between January and April 2024 there were 213 cases in Italy, with higher incidence in children. Pisa Local Public Health Department (201073 population) experienced a measles outbreak in the same period.

Methods

Cases were classified according to Decision (EU) 2018/945. A bidirectional tracing (backward and forward) was conducted to identify transmission chain and contacts of cases. Immunization status was checked on Regional Vaccination Registry.

Results

33 suspected measles cases were notified in Pisa between 21st January and 17th April 2024: 16 by General Practitioners and 17 by Hospital Emergency Room. Additionally, 1 undiagnosed case was found during the epidemiological investigation. 2 notifications were withdrawn by General Practitioner because of lack of the diagnostic criteria. Laboratory analysis confirmed 24 cases. Last confirmed case occurred on 23rd February, while not confirmed cases occurred mostly in the last part of the period (6 in a row from 3rd March to 17th April), suggesting an infodemic effect. Women were more affected than men (17 vs. 7). Except for 2 babies (9 months and 1 year old age), the outbreak affected young adults with a mean age of 40 yo. Hospitalization rate was 37,5%. The first 5 unrelated cases occurred between 19th and 21st January. A second wave involved 13 people, 12 of them were related to a single case. Transmission occurred in Emergency Room (7), in a mall (1) and in the neighborhood (4). A third wave involved 4 cases (family contacts). 2 cases were imported from Sicily and Spain. All cases were unvaccinated, 2 were migrants. Around 950 contacts were traced.

Conclusions

In Pisa, high vaccination coverage of children < 2years of age (≥95%) protected school population and cases to spread, but there are pockets of unvaccinated adults which could allow measles circulation.

Key messages

• An effective public health response is required to contrast increasing measles cases in EU/EE countries.

• As recommended by ECDC, public health services need to close immunity gaps, addressing catch-up actions towards adults and vulnerable groups as migrants.
Revisiting COVID-19 Maps with Bayesian Hierarchical Modelling: Socioeconomic Insights from Istanbul
Authors: Küçükali H , Sezerol M A
Published: October 2024

Objectives

This study explores the spatial disparities in COVID-19 incidence across neighborhoods in Uskudar, Istanbul, and examines the relationship between these disparities and neighborhood-level socioeconomic status.

Methods

This ecological study analyzed cumulative COVID-19 case data for 33 neighborhoods in Uskudar, collected up to 31 December 2020. Socioeconomic status was assessed using the Socioeconomic Development Index (SEDI) scores from Istanbul Metropolitan Municipality. Spatial analysis included Moran’s I statistics and Local Indicators of Spatial Association (LISA) cluster analysis. Bayesian Hierarchical Modeling with the Besag-York-Mollie (BYM) model was employed to decompose spatially structured and unstructured variations, adjusting for SEDI scores and their sub-components. Model validation involved convergence diagnostics and Monte Carlo error assessments.

Results

A total of 29,834 COVID-19 cases were identified, with an incidence rate of 56.1 per 1000 residents. Spatial analysis revealed significant clustering of high incidence rates in peripheral and inner city neighborhoods. Moran’s I statistic for COVID-19 incidence was 0.331 (p = 0.003), indicating positive spatial autocorrelation. SEDI scores were also spatially autocorrelated (Moran’s I = 0.293; p = 0.005) and negatively correlated with COVID-19 incidence (r = -0.570; p = 0.001). Bayesian hierarchical models confirmed the association between lower socioeconomic status and higher COVID-19 incidence, even after adjusting for spatial autocorrelation.

Conclusions

The study highlights significant spatial and socioeconomic disparities in COVID-19 incidence in Uskudar, Istanbul. Lower socioeconomic status is associated with higher COVID-19 incidence, underscoring the need for region-specific public health strategies that consider socioeconomic factors. These findings can guide future interventions to mitigate the impact of the pandemic on vulnerable populations.

Key messages

• Study reveals COVID-19 incidence in Uskudar is significantly influenced by socioeconomic status, highlighting need for targeted health interventions.

• Positive spatial autocorrelation found in COVID-19 cases and socioeconomic index suggests clustering in specific Uskudar neighborhoods.
AI-driven ethical issues in the development of personalised therapy for pediatric SIRS patients
Authors: Yankulovska S , Stolte F , Thiemicke P , Orzechowski M , Steger F
Published: October 2024

Background

Systemic Inflammatory Response Syndrome (SIRS) is a rare disease often presenting emergency. While the aetiology varies, current diagnostic criteria do not allow differentiation. Hopes are placed on OMICs research and development of Artificial intelligence (AI) algorithms for personalised disease management. Our report aims at identification and analysis of AI-driven ethical issues within the bigger ERA PerMed funded project of development of tailored immunotherapy for paediatric SIRS patients (TIPS) coordinated by Prof. Catharina Schütz from Technic University Dresden.

Methods

Systematic literature review followed by qualitative research methodology. Ten experts with different backgrounds were interviewed. Subsequent thematic analysis was performed by two independent researchers.

Results

Experts were on the opinion that AI can lead to a depart from individual approach in the medicine, as the physician may be induced to only act based on algorithms that are more or less representative (N = 2). Interviewees were aware that AI can lead to changes in the assessment of reality, as it is dependent on data quality (N = 4). AI-aided decision-making might be useful for special therapeutic situations, although it may not always capture the subtleties of individual situations (N = 2). Positive implications of AI were significantly more emphasised, though current frameworks were perceived as more limiting than enabling.

Conclusions

Personalised therapy is making its first steps while the ethical apprehensions has already been there with a strong emphasis on precautionary principle and resulting limitations on the application of AI-algorithms. The multifaceted nature of the AI-driven ethical issues in personalised medicine research requires an interdisciplinary discourse, strengthened ethics training of all professionals involved in the technology development and more active involvement of physicians in the shaping of AI.

Key messages

• AI algorithms promise therapeutic benefits, not achievable by other means, for specific categories of vulnerable pediatrics patients.

• The multifaceted nature of the AI-driven ethical issues in personalised medicine research requires an interdisciplinary discourse and further ethics training of all stakeholders.
Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, 1990-2019
Authors: Carvalho Malta D , Saar Gomes C , Felisbino-Mendes M S , Malta dos Santos F , Augusto Veloso G , de Oliveira Cardoso L , Eloha Machado I , Constance Jaime P , Lucia de Couto Vasconcelos L , Naghavi M
Published: October 2024

Background

The double burden of malnutrition consists of the coexistence of nutritional deficiencies (malnutrition and overweight/obesity. Approximately 2.28 billion children and adults are overweight, and more than 150 million children are malnourished. The Decade of Action on UN Nutrition and SDGs that broaden the focus to both sides of malnutrition: overweight/obesity and nutritional deficiencies.

Objectives

To analyze the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019.

Methods: Study design

This is an epidemiological time-series study. This study analyzed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardized mortality rate, and disability-adjusted life years (DALYs). This study also analyzed the correlation between the percentage variation of mortality rates and SDI.

Results

A decrease in the number of deaths (75%), mortality rate (75.1%), and DALYS (72%) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6%); however, the mortality rate (9.7) and DALYs (6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI.

Conclusions

Our study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality.

Key messages

• Overcome the malnutrition public policies are necessary to guarantee the human right to healthy and sustainable food, such as encouraging the production and commercialization of fruits & vegetables.

• Overcoming undernutrition and excess weight requires public policies aimed at reducing social inequality and providing access to healthy food for all, and taxation of ultra-processed foods.
Evaluation of Label Compliance to Allergens in Imported Asian Food Sold in Northern Italy
Authors: Ragni L , Bertolassi R , Magagna G , Tilola M , Bertasi B , Pavoni E , Finazzi G , Losio M-N
Published: October 2024

Background

The import of Asian food is strongly increasing in the EU. In Italy, the Asian market has expanded over the last 3 decades. Unfortunately, the labelling of these products often implies errors, mainly due to linguistic differences. Consequently, it can become a consistent problem regarding food safety, in particular for allergens declaration. According to EU Reg. 1169/2011 (Annex II), allergens must be labelled in bold and translated in the current language of the Member State. Asian food non-compliant labelling could enhance the probability of allergic consumers to get adverse events; accordingly, it is important to increase controls on the imported products. The present work investigates the label compliance to allergens on Asiatic products imported in Northern Italy.

Methods

Totally, 39 foodstuffs were tested for gluten, 93 for white egg proteins and 118 for milk proteins by commercial ELISA kits according to manufacturers’ instructions. Samples were considered non-compliant when the results were above 20 mg/Kg, the law limit for gluten, or above the milk LOD (10 µg/Kg) and the egg LOD (0.4 mg/Kg).

Results

Data showed 18% (CI 95% 0.09-0.32) of non-compliant samples for gluten: 6 samples > 80 mg/Kg (snacks and ready to eat meal) and 1 sample containing 48 mg/Kg (snack). In addition, 19.4 % (CI 95% 0.13-0.28) showed presence of egg proteins (noodles, snacks, patties and pasty). Finally, 13.6% (CI 95% 0.08-0.21) samples were irregular for undeclared milk (noodles and snacks).

Conclusions

Products label report their content and represent an important element for food trading and tracing. The results obtained confirm a high percentage of non-compliant labels, underlining how the consumption of imported products can represent a health risk for allergic consumers. The present work highlights the importance of imported food monitoring to guarantee the consumers health, and of the implementation of standardized/international regulated labelling rules.

Key messages

• Many non-compliant labels about allergens was observed on Asiatic products.

• Correct labelling of allergens in imported food should be monitored to avoid adverse events.
Chrono-nutrition and post-bariatric weight loss: insights from the Portuguese ChronoWise cohort
Authors: Rodrigues J , Magalhães V , Santos M P , Reis C , Pichel F , Soares P , Santos J , Vilela S
Published: October 2024

Background

Post-bariatric weight loss varies substantially, and a large proportion of patients respond poorly. The literature highlights the importance of chrono-nutrition for weight regulation. This study aims to explore the chrono-related factors associated with poorer weight loss.

Methods

This study was conducted within the ChronoWise project, an ongoing prospective cohort study following patients undergoing bariatric surgery at the Santo António Local Health Unit, Porto. The sample included patients evaluated at both pre-surgery and 3 months post-surgery. Baseline information on meal timing was gathered through the Chrononutrition Profile-Questionnaire. The eating midpoint (midpoint between first and last meal) was calculated for work and free days. Chronotype was determined using the Munich Chronotype Questionnaire. Weight loss was expressed as the percent of total weight loss (%TWL = [(initial weight − current weight)/(initial weight)]×100). Chrono-related variables were compared according to %TWL (dichotomized by the median) using the Mann-Whitney test.

Results

Sixty patients were included (72% female; mean age 45±11.8). The mean baseline BMI was 44±5.6 kg/m2, which decreased to 35±5.3 kg/m2 at 3 months post-surgery, resulting in an average 20±3.9 %TWL. On free days, participants with lower %TWL tend to do the first meal later in the day (9h45 vs. 9h10, р=0.367), and later lunch on workdays (12h45 vs 12h30, р=0.531) compared with individuals with higher %TWL. Lower %TWL is typically observed in individuals having later eating midpoints (15h00 vs. 14h15 for workdays, р=0.011; 15h07 vs. 14h44 for free days, р=0.205). A later chronotype (3h37 vs 3h30, р=0.347) was also linked with poorer weight loss.

Conclusions

Eating later during the day and later chronotype may contribute to poorer post-bariatric weight loss. Funding: This work was supported by FCT - Fundação para a Ciência e Tecnologia [2021.01096.CEECIND, UIDB/04750/2020,LA/P/0064/2020&SGITR2023/EPIUnit].

Key messages

• Recognizing meal timing as a modifiable lifestyle factor may optimize current approaches by aligning food intake with circadian clock.

• A later chronotype, i.e. a behavioural expression of an individual’s internal circadian clock system as a preference for eveningness or later sleep timing, may negatively influence weight loss.
Accuracy of body weight perception: The Case of Türkiye
Authors: Baran Deniz E , Çelikay N , Kocadağ S
Published: October 2024

Background

Accuracy of body weight perception is defined as the extent to which an individual’s self-assessment of their body weight aligns with their actual body weight. Our study evaluates the accuracy of body weight perception, an important factor in preventing and managing obesity and overweight, according to sociodemographic factors.

Methods

This study utilizes data from the nationwide cross-sectional ‘Nutrition and Health Survey 2017’. The survey includes 12,266 participants who were interviewed face-to-face. Factors influencing the accuracy of body weight perception were evaluated using the chi-square test. Subsequently, the logistic regression models were constructed to assess factors that were statistically significant (p < 0.05).

Results

The prevalence of obesity and overweight was found to be 36.3% and 71.5%, respectively. The accuracy of body weight perception was 39.2%, underestimation was 57.0%, and overestimation was 3.8%. There was no significant difference in accuracy of body weight perception between sexes (p = 0.94). According to logistic regression analysis (n = 12.168), accuracy of body weight perception was higher among individuals who were not overweight compared to those who were overweight (p < 0.001, OR: 4.56, CI: 4.16-4.98), among those aged 15-44 compared to those aged 45 and over (p < 0.001, OR: 1.47, CI: 1.35-1.60), among those with high school and higher education compared to those with middle school education or less (p < 0.001, OR: 1.43, CI: 1.31-1.56), among unmarried individuals compared to married ones (p = 0.011, OR: 1.12, CI: 1.03-1.23), and in individuals with poor income status compared to good (p = 0.005, OR: 1.13, CI: 1.04-1.22).

Conclusions

In health promotion programs aiming to perceive body weight accurately, priority should be given to people with overweight, those with low education levels, married individuals, people aged 45 and over, and individuals with low income.

Key messages

• Accuracy of body weight perception is important in fighting obesity.

• Individuals with overweight, have a low level of education, are married, aged 45 and over, and have low income are misperceive their body weight to a greater extent.
Novel R package to quantify and monetize burden of disease attributable to air pollution and noise
Authors: Luyten A , Breitner S , Barbosa A , Kocbach Bølling A , Lepnurm M , Pauwels A , Rueda-López M J , Castro A
Published: October 2024

Background

Ambient air pollution and noise substantially impact public health and the economy. Different methods to quantify these impacts are described in the literature.

Objectives

Within the European project BEST-COST (Burden of disease-based methods for estimating the socio-economic cost of environmental stressors), we aim to develop an open-source R package to quantify and monetise the disease burden attributable to air pollution and noise, including the impact of social inequalities.

Methods

The developed code will allow for different calculation pathways including: single baseline health data vs. age-specific estimates from life tables; relative and absolute risk; scenario comparison based on the population attributable fraction vs. population impact fraction; single-pollutant vs. correlated exposures; and outdoor vs. indoor air pollution. Moreover, the package can digest a variety of input data formats for the exposure-response function (e.g. relative risk with fixed shape vs. user-defined function) and exposure data (e.g. population-weighted mean vs. categorical distribution, spatial data). Eligible impact metrics will include morbidity incidence and prevalence, number of deaths, years of life lost, and years lived with disability. Finally, the R package will enable quantifying social inequities (using a novel multiple deprivation index) and monetising the attributable disease burden (using a state-of-the-art approach).

Results

During development, the R package will be tested in BEST-COST case studies in 5 European countries (BE, EE, FR, NO, PT), compared with existing tools, and discussed with key users in a workshop. The final R package will be available on GitHub in 2026.

Conclusions

This tool will allow the quantification and monetisation of the health impact of air pollution and noise. The R package will be a flexible programming resource that can be used as a standalone or combined with existing tools to build a more solid basis for evidence-based policy making.

Key messages

• This open-source tool will allow the quantification and monetisation of the health impact of air pollution and noise, including the impact of social inequalities.

• The R package will be a flexible programming resource that can be used as a standalone or combined with existing tools to build a more solid basis for evidence-based policy making.
Impact of COVID-19 on cardiology and neurology services in a peripheral hospital in Northern Israel
Authors: Bernstine T , Spitzer S , Pleban R , Ron A , Armon-Omer A , Kains I , Hamudi J , Shahien R , Edelstein M
Published: October 2024

Background

The indirect impact of COVID-19 pandemic on clinical services remains incompletely described in secondary care hospitals outside major urban centers. We compared clinical outcomes before and during the pandemic in a disrupted service (Neurology) and a non-disrupted one (Cardiology) in a peripheral hospital in Israel, using Cerebral Vascular Accident (CVA) and ST-elevation myocardial infarction (STEMI) as clinical indicators, respectively.

Methods

We compared demographics, treatment and outcomes from CVA and STEMI patients who attended Ziv Medical Center, Israel, during the pandemic (15/3/2020-15/4/2022) and before (1/1/2018-14/3/2020), Using chi-square, t-test and Wilcoxon-Mann-Whitney tests.

Results

1029 CVA and 497 STEMI patients were included. Those who arrived during the pandemic were demographically comparable to those arriving before. Compared to pre-pandemic, intra-pandemic median time for CVA patients from arrival to imaging was longer (23 vs. 19 minutes, p = 0.001). However, timing from arrival to tissue Plasminogen Activator administration was similar (49 vs. 45 min, p = 0.61). The likelihood of transfer to another hospital was higher (20.3% vs. 14.4% p = 0.01) and median length of stay (LOS) was shorter (3 vs. 4 days, p < 0.05). Among STEMI patients, median time from arrival to percutaneous coronary intervention during the pandemic was shorter than before (45 vs. 50 minutes p = 0.02) and median ejection fraction at discharge was higher (50% vs. 45% p = 0.02). Mean LOS was shorter (3.86 vs. 4.48 p = 0.01), and unplanned re-admission to the ED was less frequent (7.8% vs. 14.6% p = 0.01). No significant changes in mortality were observed.

Conclusions

Our data shows no major negative impact of the COVID-19 pandemic on CVA and STEMI outcomes, and possibly improved care in the less disrupted department. Follow-up qualitative studies with neurology and cardiology staff already in action to comprehend how quality of care was maintained during the crises.

Key messages

• In peripheral setting, COVID-19 hadn’t negatively impact Neurology or Cardiology acute clinical outcomes.

• The consequences of maintaining clinical performance when working under adverse conditions requires further research.
TB Care in Ukraine: Understanding Access Barriers at the Primary Healthcare Level
Authors: Boiko A , Snidevych U , Odrynskyi V , Duda M , Pavlenko P , Hinchey B , Avaliani N , Polomoshnova E , Samko M , Tokar A
Published: October 2024

Background

In the WHO European Region, Ukraine is a high-priority country for TB control, being one of nine globally with high rates of multidrug-resistant TB. The WHO emphasizes patient-centered TB care, prioritizing patients as key figures in the care continuum. Thus, our aim was to explore barriers impacting the accessibility of TB services for patients at the primary healthcare level (PHC) in Ukraine.

Methods

During December 2022-June 2023, a qualitative study was conducted across eight PHC facilities in the Kyiv, Odesa, Mykolayiv, and Volyn regions. The study comprised: 4 focus groups involving 27 family doctors, 16 in-depth interviews with managers and health authorities from regional and national levels, as well as 25 interviews with TB patients. All data was transcribed, manually coded and deductively analyzed.

Results

All participants highlighted the benefits for patients of providing TB care continuum at the PHC level, yet the program lacks clear requirements for training of family doctors and nurses. Overall family doctors perceived positively various TB training they received; but despite this, they expressed doubts and reported a lack of practical skills, affecting the quality of care provided. Patients highlighted several barriers in interacting with healthcare providers, including stigma and cases of dismissive behavior of healthcare workers, communication challenges, and breaches of patientś data confidentiality. Patients also mentioned self-stigma, and perceptions of family doctors as poorly trained in TB. Still, patients who received healthcare services from the same family doctor “during long time” positively described their experience with TB services too.

Conclusions

Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine. To achieve this, a comprehensive TB training program tailored for PHC family doctors and nurses should be developed and implemented.

Key messages

• Expanding TB healthcare services to primary healthcare levels in Ukraine can be beneficial for patients. Training primary healthcare staff can enhance TB care quality.

• Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine.
An interdisciplinary approach: Exploring the five dimensions of the tools deployed by EUVABECO
Authors: Billuart M , Van Loenhout J , Nasiadka L
Published: October 2024

To effectively address the complexities of vaccination across the EU, EUVABECO’s 14 partners are implementing a comprehensive, interdisciplinary approach. Twelve pilot projects will be implemented from September 2024 to August 2025 in six MS (BE, DE, EL, LV, LU, PL, PT). These pilots will test innovative tools across five domains-medical, social, industrial, modelling and forecasting, and digital-to optimize vaccination outcomes:

Medical/Clinical Tool: A decision support system that aids patients and healthcare professionals by providing current, evidence-based information tailored to individuals, thereby facilitating informed vaccination decisions.

Social Tool: Data linkage on an individual level, to enhance the targeting and monitoring of vaccine campaigns, and ensuring equitable access to vaccines, especially for vulnerable populations.

Industrial Tool: An electronic vaccine leaflet that boosts the flexibility and responsiveness of vaccine distribution by offering dynamic, real-time information in local languages to both healthcare providers and patients - regardless of the source and point of use of the vaccine.

Modelling and Forecasting Tool: A disease simulator that models infection dynamics and evaluates the impact of public health interventions, crucial for strategic planning and resource allocation.

Digital Tool: A citizen-held digital vaccination card that enables individuals to maintain a comprehensive, accessible record of their own vaccination histories, enhancing continuity of care across borders.
Impact of COVID-19 on Management, Quality and Satisfaction of Health Organizations
Authors: Gaspar T , Salado V , Faia-Correia M
Published: October 2024

The hospital health care professionals are the frontline fighting COVID-19 considering they are responsible for all the care provided to patients during all the time they spend at the hospital for diagnosis, treatment or recovering of the COVID-19 disease and other diseases. The purpose of this study was to determine the impact of COViD-19 at the hospital management level and, also, to understand how psychosocial environment, and satisfaction of Health Professionals were affected. A case study was performed in a Portuguese Hospital. Data were collected at one hospital under study at two different occasions: the first before the pandemic (November 2019) and the second almost two years after the pandemic started (November 2021). Regarding data collection, 37.0% of participants responded in the occasion 1 (n = 296) and 63.0% responded in the occasion 2 (n = 503). The instrument for the Assessment of Global Management of Health Organizations (AGMHO) Comparing timings pre and during pandemic COVID-19, it was found that the participants in the pre- COVID-19 era showed stronger organizational culture, higher quality of life, better psychosocial environment regarding content/leadership and higher job satisfaction when compared to the participants during pandemic COVID-19. On the other hand, participants in the second occasion were found to have higher psychosocial risks related to mental health when compared to participants in the pre- COVID-19 phase. The results obtained allow us to identify priorities in terms of promoting well-being and satisfaction of professionals and overall wellbeing of the health organization, namely intervention in leadership relationships and psychosocial risks at work related to the physical and psychological demands of work, stress management and a more active and involved role for the professional.

Key messages

• This knowledge facilitates labelling and prioritizing the promotion of well-being and satisfaction of professionals and overall wellbeing of the health organization.

• The product is a comprehensive diagnostic model of the factors influencing the results in health organizations.
Making integration happen: managers’ views on multidisciplinary work in Finnish health system
Authors: Karreinen S , Paatela S , Huhtakangas M , Paananen H , Satokangas M , Tynkkynen L K
Published: October 2024

Background

In Finland, a large-scale health and social service reform was implemented in 2023. The structural reform centralised the organising of health and social services from some 200 organisations to 22 wellbeing services counties (WBSC). One goal of the reform was to promote service integration between and within health and social services. The reform offers a unique opportunity for investigating how such change unfolds. This study addresses the integration aspirations of those who are responsible for implementing the change, that is middle managers in WBSCs. We focus on micro and meso levels and explore how the aim of multidisciplinary collaboration is interpreted as part of advancing service integration by middle managers in one newly formed WBSC.

Methods

The data for this qualitative study were derived from 11 semi-structured interviews with senior and middle managers responsible for various fields of health and social care services in a single WBSC between October 2022 and June 2023. Inductive thematic analysis was applied.

Results

The managers framed multidisciplinary collaboration very positively and easier to achieve in the new organisation with health and social services united under the same management. The managers acknowledged the need to form collaborative structures (e.g. meetings) and processes at all levels of organisation. Leadership plays a crucial role in creating space for the professionals to form an experience of a shared every-day work. However, previous structures and patterns of work still seemed to limit these endeavours. Tensions between, for example, professional groups or units were left essentially untouched. Multidisciplinary collaboration will serve especially persons with complex and multiple needs and was framed key to cost savings.

Conclusions

While the structural reform opens a window of opportunity to new collaborative patterns, competing logics and interests as well as power imbalances may hamper the development if not addressed.

Key messages

• Middle managers had high hopes for multidisciplinary work after the health system reform, including effects on the difficult issues concerning costs and health workforce availability.

• While the managers were prepared to promote multidisciplinary work, the prior organisational boundaries and logics hindered integration. Different tensions between stakeholders need more attention.
Behavioral incentives on pay-for-performance schemes in primary health care: a scoping review
Authors: Alves J , Dias C V , Perelman J , Gonçalves I , Moiane I , Morgado V
Published: October 2024

Background

Incentivizing healthcare professionals through pay-for-performance (P4P) schemes has become an essential strategy to enhance healthcare quality and efficiency. In Portugal, a P4P framework was put in place in Primary Health Care (PHC). Understanding how these incentives influence healthcare delivery is crucial for optimizing P4P effectiveness.

Objectives

This scoping review aims to compare the impacts of intrinsic and extrinsic incentives of P4P schemes within PHC teams.

Methods

We are conducting a comprehensive scoping review following the PRISMA-ScR guidelines. The databases PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO are being searched to identify experimental and quasi-experimental studies. Eligible studies focused on PHC providers organized in teams, examining the role of intrinsic and extrinsic incentives under both public and private healthcare settings.

Results

Preliminary findings include a Dutch study demonstrating significant improvements in adherence to prescribing guidelines through electronic health records based P4P indicator. In Ethiopia, performance-based non-financial incentives led to enhanced data quality and evidence utilization among health workers. Conversely, a study from Burkina Faso highlighted mixed results in antenatal care quality improvement despite incentive implementation. In Scotland, studies on the removal of financial incentives indicated potential declines in certain quality care metrics, suggesting the complexities involved in the direct and indirect effects of incentive withdrawal.

Conclusions

The preliminary evidence indicates that both intrinsic and extrinsic incentives can significantly impact the effectiveness of P4P schemes, though the nature and magnitude of these impacts vary considerably. The findings underscore the necessity of a nuanced approach to designing and implementing incentive mechanisms in PHC to foster sustainable improvements in healthcare quality.

Key messages

• Intrinsic and extrinsic incentives significantly influence P4P scheme effectiveness in PHC.

• Designing P4P incentives requires nuanced consideration of varying impacts on healthcare quality.
The determinants of oral health in Turkish elderly: an analysis of Turkey Health Survey (THS) 2022
Authors: Şevik I , Davas A
Published: October 2024

Background

Oral health is an integral part of health and wellbeing; however, the use of dental care by the elderly is lower compared to other services. Considering the relationship between oral health and chronic diseases, along with healthcare use patterns, evaluating oral health in the elderly is crucial. This study aims to assess the oral health status and individual, socioeconomic and healthcare related factors in people aged 65 and over in Turkey.

Methods

This cross-sectional study was based on THS 2022 micro dataset. Participants aged 65 and over constituted the population of this study, with 3144 participants included. Data analysis was performed using SPSS 28.0 and included descriptive statistics, Pearson’s chi-square and logistic regression.

Results

The mean age of participants was 72.57 with 54% being women.Self-reported poor oral health was noted in 25.8%, and 75.2% did not receive dental care in the past year. Individual factors such as older age, obesity, and multimorbidity, as well as social factors like female gender, being single, and language barrier, were associated with worse oral health. Education and social support were also associated with oral health. Among economic factors, employment showed a significant association. Concerning healthcare-related factors, not using oral care in the past year, unmet dental care needs due to financial constraints, appointments, and transportation were associated with worse oral health. Logistic regression revealed significant associations between oral health and age, multimorbidity, gender, language, education, social support, employment, dental care use, unmet dental care needs due to financial constraints and transportation.

Conclusions

Addressing barriers and risk factors is needed to improve oral health among Turkey’s elderly. Efforts should focus on enhancing access to dental care and addressing socioeconomic determinants of oral health.

Key messages

• Identifying and addressing barriers and individual, socioeconomic and health-care related risk factors associated with poor oral health among the elderly in Turkey is important.

• It is needed to prioritize efforts aimed at enhancing access to oral care for the elderly in Turkey by both improving physical access and addressing social determinants to ensure better oral health.
Organization of Vaccination Sites in Quebec: Perception of Users, Employees and managers
Authors: Lanthier-Veilleux M , Pépin E M , Ezin Aloffan LND , Loslier J , Nour K , Guay M
Published: October 2024

Since late 2020, vaccination sites have emerged rapidly in order to protect the population against COVID-19. Health services in Montérégie (Québec) are provided by three organizations. Each adopted a different approach to immunization. The Regional Public Health Department took this opportunity to describe, compare, and explain these three approaches. A mixed methods design through a multiple case study was conducted. Users, employees and managers were interviewed at the end of 2021 on several performance-related topics. Individual interviews with employees and managers in mid-2022 further explored these topics. 38 managers, 360 employees, and 946 users participated in the survey. 9 managers and 10 employees were interviewed. Most participants were satisfied with vaccination organization regardless of the model used, mainly because of high geographic and temporal accessibility of the sites. Further signage to indicate directions could optimize accessibility. High adaptability was essential for managers and employees. Training strategies such as people to refer to and pairing allowed to better deal with frequent changes and staff rotation. The addition of ongoing training could be beneficial. Rapid changes in employee schedules were identified as a challenge. The use of technology-based scheduling tools, accessible to all, brought added flexibility, which was appreciated. Several ideas were used to communicate updates on a daily basis. However, timely implementation of new recommendations remained an ongoing challenge. Dedicated clinics for specific clienteles were successful. Community partnerships were generally beneficial, although establishing more of them could potentially reach other vulnerable communities. To improve accessibility and minimize health social inequities, a greater investment in local partnerships might reach more vulnerable clienteles. Regular communication and innovative employee support are key elements to improve fluidity of operations.

Key messages

• Reaching out for vulnerable clienteles is essential to minimize health social inequities.

• Rapid changes in services needs underlign fluidity communication importance.
Long-term Survival After Cancer: A Scoping Review of the Health Care Landscape in Germany
Authors: Messer S , Cryns N , Ernst M , Dirksen U , Gruenwald V , Skoetz N
Published: October 2024

Background

Cancer remains a global health concern, with a significant increase in new cases projected in the coming years. Although cancer treatment and diagnosis have advanced, leading to improved survival, survivors often face complex physical, emotional, and cognitive challenges. The objective of this scoping review is to provide an overview of the current landscape of specialized long-term survivorship care services in North Rhine-Westphalia (NRW) with a focus on vulnerable groups.

Methods

The scoping review involves two search approaches: a manual search performed by two review authors and a systematic search performed by an information specialist following Scoping Review guidance. The protocol was published on the OSF platform. The systematic search was conducted in databases such as LIVIVIO, MEDLINE and Scopus. The manual search involves identifying key categories of survivorship services and conducting online searches based on these categories in duplicate. Data extraction and synthesis is conducted using EPPI-Reviewer software, and focuses on services characteristics, patient demographics, program format, and accessibility.

Results

The study has identified more than 300 survivorship care services across North Rhine-Westphalia. According to preliminary results some services offer comprehensive care, while others have significant gaps, particularly in addressing the needs of vulnerable groups. One example of these gaps is the lack of tailored services specifically designed for people with a migration background. Most of the services are not available in multiple languages or gender-specific oriented. The results will be presented on the congress in detail.

Conclusions

This scoping review underscores the importance of tailored survivorship care, especially for vulnerable groups. Public health actions should focus on addressing disparities in access to survivorship services, enhancing existing programs, and developing new policies to support cancer survivors.

Key messages

• Effective survivorship care requires attention to vulnerable groups.

• The care of long-term cancer survivors should receive more attention in research.