bluuebunny/crossref_metadata_2025 huggingface dataset:
Welfare regimes and socioeconomic inequalities in edentulism: A multilevel analysis of 40 countries
Authors: Keller Celeste R , Guarnizo-Herreño C , Costa F , Ayo-Yusuf O , Barros A J , Fritzell J , Peres M A , Watt R G
Published: October 2024

Aim

To evaluate the association between welfare regimes with edentulism and to investigate if it modifies the magnitude of socioeconomic inequalities in edentulism.

Methods

We analysed data from 40 high-, middle- and low-income countries collected between 2007 and 2018, encompassing 117397 individuals 20 years or older. The main outcome was edentulism and welfare regimes were the main exposure and effect modifier. Individual level variables were sex, age and quintiles of the wealth score. Multilevel logistic regression was used to estimate the odds of being edentulous and cross-level interaction terms between individual wealth and country factors were tested.

Findings

Individuals at the lowest wealth quintile had a consistently higher prevalence of edentulism. The highest age-sex standardised prevalence of edentulism was found in Eastern European countries (9.9%) followed by Informal Security (9.4%), while the lowest was among the Insecurity regime (1.4%) followed by the Social Democratic regime (4.7%). Liberal countries presented the highest magnitude of absolute and relative inequalities, where the lowest quintile had OR = 16.7 (95%CI: 10.5-26.5) times more chances of being edentulous and 14.4 percentage points higher prevalence. Low-income countries in the Insecurity Regime in social and labour market presented the lowest level of inequalities. Among HIC and upper-middle income countries, Social Democratic regime had the lowest absolute inequalities (4.0 percentage points difference between highest and lowest quintiles) and the Informal Security regime had the lowest relative differences between the highest and lowest quintiles (OR = 3.21, 95%CI: 2.83-3.63).

Interpretation

Our findings suggest that policies in some welfare regimes might improve oral health while reducing inequalities. High and upper-middle-income countries presented a high level of edentulism and inequalities.

Key messages

• Larger socioeconomic inequalities in edentulism were found in high-income countries with liberal policies.

• A possible benefit of welfare policies on prevalence and inequalities in edentulism may be only evident among industrialised countries.
Children with disabilities and inclusive education in general schools: pricipals’ attitudes
Authors: Austys D , Bartkutė N
Published: October 2024

Background

As inclusive education is being implemented nationwide in Lithuania, various attitudes towards education of children with disabilities in general schools are observed. We aimed to assess the attitudes of heads of general schools towards the provision of education to children with disabilities in general education schools of Lithuania.

Methods

Heads of all schools in the Lithuanian capital and its surrounding municipalities implementing general education programmes were invited to take part in this study. 115 persons agreed to participate and completed the questionnaire in spring of 2024. The distribution of the respondents by their answers to the questions about the attitudes towards the provision of inclusive education was compared according to gender, age, education level, work experience, school location (municipality), language of education, type of school, subordination, number of pupils, teachers, teaching assistants and pupils with disabilities.

Results

The most frequently indicated barriers for inclusive education provision were the lack of specialists, compensatory measures, methodological tools, adaptation of the physical environment, and high number of pupils (87.8%, 84.3%, 78.8% and 76.6% respectively). Attitudes of the respondents were similar in most of the cases when compared according to socio-demographic factors (p more than 0.05). Negative attitudes towards the possibilities for provision of inclusive education were more common among respondents from schools with fewer pupils and higher relative number of teachers, positive attitudes - among those from schools located in municipalities with lower number of residents and schools with more teaching assistants (p less than 0.05).

Conclusions

While attitudes of heads of general schools towards the provision of inclusive education for children with disabilities are similar in most of the cases, negative attitudes are more common among those from schools with fewer pupils and more teachers.

Key messages

• While attitudes of heads of general schools towards the inclusive education are similar in most of the cases, negative attitudes are more common among those from smaller schools.

• Higher number of teaching assistants and smaller municipalities were associated with positive attitudes towards inclusive education of children with disabilies in general schools.
Decoding healthcare strategies: providing comprehensive care for type II diabetes in Ecuador
Authors: Bravo Díaz A , Pinto Delgado J , Barrera Guarderas F , Torres A , Peralta A , Blanes C , Parker L
Published: October 2024

Background

Diabetes is a major global health challenge, impacting millions and disproportionately affecting low- and middle-income countries (LMICs), where approximately three-quarters of affected individuals reside. Despite abundant guidance on diabetes management, most evidence is derived from high-resource settings, potentially impeding effective application in low-resource settings. This study explored issues related to the application of the current clinical practice guidelines (CPG) for diabetes management in Ecuador, from the perspective of local health professionals.

Methods

We developed 5 focus groups in Quito, the capital of Ecuador, in a low-income district. The groups included doctors, nurses, and health promoters; they discussed four sections of the CPG concerning their daily practice. Qualitative results are contrasted with quantitative research based on patient records.

Results

The Ecuadorian health system considers patients with diabetes a priority group, yet a patient may wait up to 4 months to receive their first appointments and once they receive their diagnosis several criteria set out in the CPG are not followed due to lack of time and resources, particularly the delivery of multidisciplinary attention. Access to specialized consultations, such as an ophthalmological assessment is severely restricted, and it can take up to a year to get an appointment. Clinicians expressed difficulties in adapting the nonpharmacological recommendations to different socioeconomic backgrounds, while at times, prescription choices are determined by medicine stock regardless of the patient’s actual needs.

Conclusions

Healthcare professionals have developed a series of ad-hoc strategies to ensure healthcare for their patients, pointing out the difficulties of applying CPG within a health system that lacks basic resources. Healthcare is intertwined with social inequalities among the Ecuadorian population that have worsened since the covid19 pandemic.

Key messages

• We identified significant challenges in applying the CPG in low resource settings. Clinicians adapt by introducing novel ways to overcome limitations at times to the detriment of the patient’s health.

• CPGs need to be tailored to the context considering socioeconomic realities of the population and limited resources in the health setting.
What Makes a Home.Evaluating a Novel Low Support Homeless Accommodation Model Using Co-design Methods
Authors: Frazer K , Darley A , Duffy C , Doyle O , Kroll T , Bhardwaj N
Published: October 2024

Background

Homelessness is a global challenge, with a prevalence of 4%; the problem is underestimated due to limitations in data collection. In Ireland, 1% of the population, including children, adults, and families, experience homelessness due to housing shortages and systemic complexities. Homeless accommodation is defined as emergency and temporary; the wording is used interchangeably. The ETHOS typology of homelessness comprises two dimensions - housing-focused and support-focused. Supports range from high to low levels. This study evaluated an emergency housing accommodation with low support to assess its feasibility and impact.

Methods

Previous residents of an urban residential area with low support [introduced in August 2021] and key stakeholders, including policymakers and health and social care professionals, were invited to collaborate in a half-day co-design workshop [February 2024]. The workshop modified Stanford D’s five-stage design thinking processes to consider ‘How might we harness strengths and abilities to create a home and beyond’. Qualitative data were captured on flip charts, post-its, and via photographs over three rounds of activities following initial reflection regarding 1) identifying emerging challenges, 2) exploring potential solutions, and 3) considering resources for advocacy and success.

Results

Data analyses from 16 participants highlight 1)Personal insights: silence, freedom in decision-making, feeling overwhelmed, valuing independence and understanding accommodation transitions; 2)Organisational insights: developing and promoting independent skills, managing resident preferences and personalities, balancing regulations within emergency accommodation, and staff training. Space was critical in fostering therapeutic well-being and a sense of home environment.

Conclusions

Effective organisational structures are required to facilitate coherent transfers and transitions. Using co-design methods enabled real-world partnerships and engagement.

Key messages

• Homelessness is a significant public health challenge, and a model of low support emergency accommodation has value in supporting transition through and out of services.

• Engaging with people with lived experience of homelessness is essential for developing supported accommodation models.
Nationwide trends in the suicide mortality among the disabled in Korea from 2006 to 2017
Authors: Yeob K E , Kim S Y , Park J H
Published: October 2024

Aims

The disabled are one of the priority populations at risk of suicide, but there has been no study of the factors influencing suicide mortality among the disabled in South Korea.

Methods

To analyze age-standardized suicide mortality (ICD-10 Codes, X60-84) for each year according to the presence, severity and type of disability, we linked three population datasets (National Health Insurance Claims Database, Disability Registry, and Deaths by Cause). Our dataset covers the entire population of South Korea, extended over a 12-year period from 2006 to 2017. The analyses were stratified by sex, and hazard ratios for suicide were determined by multivariate logistic regression after adjustment for socio-demographic and clinical variables.

Results

The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. The highest suicide rates were observed among intellectual or mental disabled, and severe disabled. In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.

Conclusions

Although the disabled people’s suicide is often seen as an individual problem, it actually affects their families, communities and society. Therefore, government must strive to emphasize the broad view of the disabled population - not just the health of individuals, and track suicide trends and identifying risk and protective factors for suicidal behavior. From this information, suicide prevention strategies for the disabled people should be evaluated to identify the most effective interventions. Financial support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (No. 2022R1I1A3070074, and 2022R1I1A1A01068449), and a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health & Welfare, Republic of Korea (No. HC23C016500).

Key messages

• The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017.

• In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.
Unmet needs and satisfaction with healthcare in patients with multimorbidity
Authors: Lopez Rodriguez F , Rodriguez-Blazquez C , Falcon M , de Tena-Davila M J , Romay-Barja M , Escobar C , Tortosa A , Carrascal P , Alvaro-Compostela P , Forjaz M J
Published: October 2024

Background

Health outcomes of patients with multimorbidity are associated with the satisfaction with the care received. The objective of this study is to describe and compare the needs, adequacy of and satisfaction with the received healthcare in patients with complex chronic diseases in Spain.

Methods

Data from a convenience sample of patients participating in the Access to Diagnosis and Treatment and Healthcare Survey (Spanish Patient Organizations Platform, 2022). The chronic conditions were grouped into osteoarticular, cardiovascular, neurological, respiratory, diabetes, rare diseases, digestive, vision diseases, cancer and others. The main variables included were satisfaction with the received care (0-10), perceived adequacy of care (1-5) and unmet needs (yes/no). Bivariate analyses (chi-squared and Mann-Whitney tests and correlation coefficients) were performed.

Results

1133 patients answered the survey: mean age 49.5 years (standard deviation, SD: 14.8), 55.1% women, mean of 2.9 chronic health conditions (SD: 1.7). Participants showed higher levels of satisfaction with routine follow-ups and control of diseases than with access to rehabilitation and specialized care. Satisfaction with healthcare was associated with perceived adequacy of follow-ups (r= -0.79, p < 0.01). Patients with osteoarticular pathologies reported a higher number of unmet needs (57%), rated the care received as less adequate (mean 3.4; SD: 0.9) and less satisfactory (mean 4.2; SD: 2.8). Patients with cancer reported fewer unmet needs (6%), considered the care adequate (mean 2.9; SD: 0.9) and satisfactory (mean 6.8; SD: 3.1). Similar figures were also seen in patients with cardiovascular diseases.

Conclusions

Knowledge on patients’ perceived unmet needs and demands may lead to improving satisfaction with the health system. Comprehensive care for people with multimorbidity, including assessing patients’ perception, is a challenge that must be addressed by healthcare systems.

Key messages

• The analysis of the differences between pathologies in their demands will better describe the reality of patients with multimorbidity in Spain.

• The perception of healthcare adequacy and satisfaction greatly varies across the type of chronic condition.
Adapting a cultural dance program to prevent cognitive decline: insights from experts and educators
Authors: Look M A , de Silva M , Hermosura A , Agard J K , Antonio JKW , Iseri D , Haumea S , Solatorio C , Yoshimura S , Kaholokula J K
Published: October 2024

Leveraging activities such as cultural dance shows promise as an effective basis for chronic disease prevention and management with at-risk populations. In fact, recent WHO reports and resolutions advocate utilizing cultural context to achieve health equality. Hula, the Native Hawaiian indigenous dance has been successfully utilized in interventions with statistically significant improvement in medication resistant hypertension management and heart disease prevention. In this study, Alzheimer’s Disease and Related Dementia (ADRD) experts and kumu hula (hula experts and educators) provide insights to developing a hula-based lifestyle program for prevention of cognitive decline. Informant interviews were used to collect information for developing a hula-based program for individuals with mild cognitive impairment from 4 ADRD experts and clinicians, and 4 kumu hula. The 60-90 minute semi-structured interviews were conducted, recorded, then transcribed. Separate thematic analysis allowed distinct themes for each group to emerge. Themes with greatest between group alignment informed the adaptation of an existing hula-based chronic disease intervention. The clinical and cultural experts were unanimous on multiple themes. First, a hula-based program was well positioned to promote social functioning. Second, hula facilitated integrated multi-dimensional benefits including physical, cognitive, social, and cultural. Third, facilitating learning included: repetition done in creative forms; utilization of aids such as dance notation and audio recordings; and educational approaches such as project-based learning. Cultural activities such as dance have been underutilized in health promotion initiatives. A significant challenge in health promotion programs is engagement and retention of participants. Cultural dance programs are popular and can be effective interventions, particularly when both clinical and cultural experts are engaged in program development.

Key messages

• Inclusion of clinical and cultural experts in health promotion program development leads to unique collaboration and impactful insights.

• ADRD clinicians and Hawaiian cultural dance educators identify social, cultural, physical, and cognitive benefits of hula as instrumental for individuals with mild cognitive impairment.
Measurements and medication data are indispensable for population blood pressure monitoring
Authors: Neuhauser H , Büschges J , Sarganas G , Gärtner B , Perlitz H , Fuchs J
Published: October 2024

Background

The National Study on Health of Older People in Germany “Gesundheit 65+” included blood pressure (BP) measurements at home by a study nurse and classification of all current medication.

Methods

Nationally representative examination survey of the population aged 65 years and older residing in Germany using two-stage population registry sampling from 128 sample points, with a standardized examination at home from June 2022 to April 2023. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above 140 mmHg, or mean diastolic BP (DBP) at or above 90 mmHg, or the use of antihypertensives (antihypertensives, diuretics, beta-blockers, calcium-channel blockers, ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities.

Results

The “Gesundheit 65+” examination part included 1,493 participants of whom 1,475 (98.8%) had successful BP measurements (763 men and 712 women, aged 66 to 101 years). Based on self-reported diagnoses alone, the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported diagnoses, standardized BP measurements and medication.

Conclusions

The prevalence of hypertension is greatly underestimated in the absence of examination survey data with standardized measurements and recording of medication use. In addition, measurement and medication data are needed for monitoring the hypertension cascade, i.e. awareness, treatment and control of hypertension.

Key messages

• Hypertension prevalence is underestimated in the absence of health examination surveys with measurements and medication data.

• The hypertension cascade, i.e. assessment of awareness, treatment and control of hypertension needs population surveys with measurements and medication assessment.
Advancing Dementia Care in Austria: developing a Dementia Registry using a multimethod approach
Authors: Cartaxo A , Herz T , Juraszovich B , Rappold E
Published: October 2024

Background

Austria faces an increasing demand for dementia care in an ageing population. However, a lack of representative data hampers evidence-based policy development and evaluation of care. To address this gap, the Austrian National Institute of Public Health is undertaking the task of developing the Austrian Dementia Quality Registry (ÖDQR).

Methods

Based on the AIHTA Good Practice Framework for Dementia Registries, the development and testing of the ÖDQR has unfolded in 4 distinct phases: 1) planning; 2) registry design (including definition of quality indicators and minimum data set, recruitment, and governance); 3) definition of data collection, sources, and management; 4) pilot testing. A steering committee of government representatives and dementia care experts was convened to oversee the project. A scientific committee provided oversight and ensured methodological rigor. Working groups of national and international dementia care experts focused on standards for diagnosis and therapy, activities of daily living and quality of life, legal aspects, and technical implementation, thus contributing to the content development of the ÖDQR.

Results

An initial systematic literature review informed the selection of quality indicators in the working groups. A conceptual framework of 15 descriptive and 30 quality indicators was developed. Preliminary results of pilot testing indicate feasibility and content validity. As a result, the ÖDQR will be established as a longitudinal survey-based registry, based on an instrument comprising 163 variables and emphasizing data collection across care settings. Legal and technical frameworks are being developed.

Conclusions

The öDQR holds the promise of informing evidence-based policy and improving the quality of dementia care in Austria. Careful planning and collaboration have laid the foundation for a data repository that will inform policy and improve care for people with dementia and their caregivers.

Key messages

• Dementia registries require a complex development to assure validity and adherence.

• The Austrian Dementia Registry aims to establish best practice by focusing on the life situation of those affected by this condition.
Implementing a chronic disease self-management program in Moldova: a roadmap for sustainability
Authors: Secula F , Berari D , Holm Faber N , Rimis C , Silitrari N , Curteanu A , Prytherch H
Published: October 2024

Chronic disease self-management programs are evidence-based interventions but achieving their sustainability can be challenging. We propose a roadmap to sustainability that examines the transferability of intervention components and fosters multi-level and multisectoral partnerships.

Since 2019, the Swiss Agency for Development and Cooperation’s Healthy Life project, in cooperation with the Ministry of Health of Moldova, has implemented a self-management program in rural communities. At pilot stage, we achieved a 53% increase in participants’ self-efficacy (Palmeirim et al, 2024). To date, the program has reached 1432 beneficiaries in 70 communities. The intervention cost per participant was approximately 74 Euros. Our evidence supported the inclusion of self-management in the national non-communicable disease program 2023-2027. We designed a roadmap to hand over this innovation to Moldovan public health institutions. Firstly, we unpacked the intervention into transferable resources, processes and roles. These included human resources (a network of 140 facilitators), pedagogical resources (culturally adapted facilitator training and self-management workshop content) and key operational processes (coordination, resource management, partnership building, monitoring and evaluation). Then, we convened a national workshop to discuss the transfer of these components to relevant institutions. We emphasized working in a coordinated partnership across institutions for intervention delivery. Finally, we launched a national working group that will work on the operational modalities of this multi-stakeholder partnership. Achieving an enabling policy environment for self-management created favorable conditions and accountability for institutional partnership building. A strategic reflection on our partner ecosystem was key to leverage local and national interests in continuing self-management approaches.

Key messages

• We have established priorities among transferable intervention components to match country stakeholders’ ability and readiness to sustain innovative approaches.

• We are building an institutional partnership across sectors based on complementarity of experience to sustain the delivery of a self-management intervention.
Type 2 diabetes risk is associated with poorer general health and mental health in women and men
Authors: Neuperdt L , Du Y , Nuebel J , Hapke U , Walther L , Mensink GBM , Richter A , Scheidt-Nave C , Baumert J , Heidemann C
Published: October 2024

Background

Increasing evidence points to a relation between cardiometabolic and mental health, but population-based data are scarce. We investigated the association of type 2 diabetes (T2D) risk to general and mental health with a focus on potential differences between women and men.

Methods

The study population comprised 5,192 adults (18+ years) without known diabetes based on data of the German Health Update (GEDA) 2022. T2D risk was assessed by the German Diabetes Risk Score (GDRS), that estimates the 5-year probability of developing T2D and was categorized into low, still low, elevated, and high risk. Sex-specific Poisson regression analyses were conducted including self-rated health (SRH), self-rated mental health (SRMH), depressive symptoms (PHQ-2) and anxiety symptoms (GAD-2) as dichotomous dependent variables and age, educational level, living alone, region of residence, and social support as covariables.

Results

Women had a higher prevalence of low T2D risk (66.1%) and a lower prevalence of high T2D risk (9.4 %) than men (55.3% vs. 16.3%). Compared to those with low T2D risk, women and men with a high T2D risk were less likely to report very good/good SRH (women: prevalence ratio: 0.63; 95% confidence interval: 0.51-0.79; men: 0.69; 0.57-0.84) or excellent/very good SRMH (women: 0.53, 0.39-0.73; men: 0.85, 0.63-1.15). Further, those with a high T2D risk had a higher risk of depressive symptoms (women: 1.71, 1.05-2.81; men: 2.23, 1.22-4.05) and anxiety symptoms (women: 1.84, 1.03-3.29; men: 2.73, 1.09-6.81). No statistically significant interactions between sex and T2D risk were observed regarding the included health outcomes.

Conclusions

A high T2D risk is associated with a lower probability of a favourable SRH and SRMH and a higher risk of depressive and anxiety symptoms in men and women. The underlying mechanisms need further identification, in order to design synergistically beneficial health promotion for cardiometabolic and mental health.

Key messages

• No sex-specific differences in general and mental health were found in people at high T2D risk.

• Further research is needed to identify the underlying mechanism to improve general and mental health.
The Association between Social Capital, Food Security, and Type 2 Diabetes Management
Authors: Berkovich E , Baron-Epel O
Published: October 2024

Background

Given nutrition’s key role in treating diabetes, food insecurity may seriously affect the standard management of the disease. A patient’s social environment or community plays an important role in managing the disease. This study explores how food security and social capital are associated with the management of type 2 diabetes.

Methods

A cross-sectional telephone survey of 381 Israelis Jewish and Arab with type 2 diabetes was conducted. Data was collected on food security, social capital, disease management factors, and socioeconomic status. Moreover, medical records provided information about HbA1c, age, and disease diagnosis date for each respondent.

Results

Blood glucose balance (HbA1c ≤7mmol/mol) was associated with employment, while unemployed respondents had a better balance. Food security is correlated with health perception - the better the food security, the better the health perception. Food security is related to social and family support, as well as to neighborhood help and connections. The social capital index increases as food security increases. A higher disease management index score, as well as a higher trust index score, indicates a more balanced patient. In light of the fact that food security is associated with social aspects of health, it may act as a mediator between social capital and perceived health.

Conclusions

Social factors directly affect the balance of the disease. Subjective health and gender were associated with food security. Social capital and support are linked to subjective health reporting through food security, so this variable is a mediator. It can be concluded that social factors and food security play a role in subjective health assessment in diabetics. Diabetes management and balancing depend not only on behavioral factors but also on environmental and social factors.

Key messages

• Food security is a necessary factor in balancing blood glucose levels, as well as a mediator factor between social capital and perceived health among diabetics.

• A balanced diabetes requires social support, such as a supportive social environment and must consider the individual’s character.
Lung cancer screening: Real screening site data, Vojvodina, Serbia
Authors: Djekić Malbaša J , Kovacevic T , Zaric B , Vujkovic B , Pajić Nikolić L J , Dragičević I , Dugandžija T , Srećković M
Published: October 2024

Background

Lung cancer (LC) is the top cause of cancer-related deaths globally and in Serbia, often diagnosed in advanced stage of disease with when 5-year survival is 10% to 20%. LC screening with low-dose CT (LDCT) can decrease LC mortality and overall mortality. The first pilot LC screening program in Serbia started in the Institute for Pulmonary Diseases of Vojvodina in September 2020. The main objective of this study was to analyze LC patient characteristics according to their screening status.

Methods

This retrospective study utilized LC hospital registry data from September 2020 to December 2023, including gender, age at diagnosis, settlement area, smoking habits, cancer histological type, TNM classification, disease stage (1-4), and data on participation in LC screening. Group differences were assessed using chi-square and Student’s t-tests, with analyses conducted in SPSS v24.0.

Results

During observed period from a total of 4649 LC cases 2948 (63.4%) were males, and 73 (1.6%) were included in LC screening. Average age of all LC patients was 66 years, without differences between groups (p = 0.778). Significant differences between groups by gender were find (p = 0.042). Non-screened LC patients were significantly common males compared to females (63.6% vs 36.4%), while among screened difference by gender were lower (52.1% vs 47.9%, respectively). Screened compared to non-screened LC patients have significantly lower percentage of SCLC (9.6% vs 19.1%), and higher percentage of NSCLC (90.4% vs 80.9%), (p = 0.040). According to LC stage, screened compared to non-screened patients were significantly common diagnosed in stage I of disease (45.8% vs 7.8%), and significantly less common in higher LC stages; stage IIIB (11.1% vs 22.5%), and in stage IV (22.2% vs 45.7%), (p < 0.001).

Conclusions

LC screening with LDCT is proven secondary preventive measure with significant influence on decreasing LC mortality by increasing number of LC patients in early stages of disease.

Key messages

• Lung cancer screening with low-dose CT significantly increases early-stage diagnoses, improving survival chances.

• Population strategies to prevent smoking and screening programs for high-risk groups are needed to reduce lung cancer incidence and mortality rates in Serbia.
Navigating the complexity of User Engagement: need for normative evaluations in digital interventions
Authors: Saleem M , Kühne L , De Santis K , Christianson L , Brand T , Busse H
Published: October 2024

Digital behavioral change interventions (DBCI), leveraging digital technology to promote cognitive behavioral therapy or positive psychology techniques, can potentially revolutionize health promotion. With applications across a spectrum of health behaviors-from managing common mental health disorders to enhancing physical activity, addressing smoking cessation, alcohol use, and weight management-these interventions offer promise for both healthy and clinical populations. However, their effectiveness hinges significantly on user engagement. Digital interventions are prone to attrition due to their self-help and unguided nature, which impedes their translation from research to real-life settings. This talk discusses the findings of a scoping review to shed light on these complexities. Firstly, we explore the various methodologies used to evaluate engagement across studies, hindering effective comparison and understanding. Secondly, we address the lack of systematic assessment of engagement strategies, advocating for experimental research to fill this gap. Lastly, we emphasize the need to establish an optimal level of engagement for desired outcomes, noting that continuous engagement may not always be conducive to behavioral change interventions, which aim to instill lasting changes in individuals. This underscores the importance of comprehensive assessment using both objective and subjective measures. In conclusion, engagement with digital interventions encompasses both quantitative usage metrics and qualitative subjective experiences, highlighting the need for comprehensive assessment beyond the mere evaluation of frequency or duration. Contrary to common belief, increased engagement does not always lead to better outcomes. Too much engagement can lead to exhaustion, while too little can result in inefficiency. Therefore, designing a DBCI that encourages optimal use is essential, fostering a balance that maximizes effectiveness while minimizing adverse effects.
Investigating socioeconomic disparities in prescribing new diabetes medication
Authors: Ardesch F H , Geurten R J , Struijs J N , Ruwaard D , Bilo HJG , Elissen AMJ
Published: October 2024

Background

There is a concern regarding socioeconomic disparities in prescription of new medications such as SGLT-2is or GLP-1RAs in type 2 diabetes mellitus (T2DM). This study aims to analyze prescription patterns of these medications and assess socioeconomic disparities in their initiation among individuals with T2DM with very high cardiovascular risk.

Methods

Individuals diagnosed with T2DM and very high cardiovascular risk were identified (N = 10,768) based on general practitioner’ electronic health record data. Socioeconomic status (SES) was based on standardized disposable household income in quintiles. The association between SES and the prescription of SGLT-2is and GLP-1RAs in 2022 was investigated by logistic regression analyses, adjusting for potential confounding factors. SGLT-2is and GLP-1RAs prescription patterns were examined over 2019-2022, stratified for age-groups and sex.

Results

We found a positive association between SES quintile 1 (referent) and quintile 4 in SGLT-2is prescription in all models (OR 1.29 95%CI:1.08-1.54 in the fully adjusted model). For prescriptions of GLP-1RAs, we found no significant differences in SES. Proportionally, men are more frequently prescribed SGLT-2is, while there are no sex disparities in GLP-1RAs prescription. Older individuals consistently receive fewer SGLT-2is and GLP-1RAs prescriptions compared to other age categories.

Conclusions

We observed sex and age disparities but no profound socioeconomic differences in initiation of SGLT-2is and GLP-1RAs in the Netherlands. The latter may be due to guidelines’ clear indication of the eligible population (T2DM and very high cardiovascular risk) and GP education. Future development and potential disparities in initiation and maintenance should be monitored.

Key messages

• We found no disparities in prescribing new Type 2 diabetes medication based on socioeconomic status.

• The adoption of prescribing new medication for Type 2 diabetes patients takes time.
The Rise in Glucagon-Like Peptide-1 Receptor Agonist Related Calls to United States Poison Centers
Authors: Farah R , Kerns A F , McDonald C T , Holstege C P
Published: October 2024

Background

In 2005, the United States (U.S.) Food and Drug Administration (FDA) approved the first Glucagon-Like Peptide-1 Receptor Agonist (GLP-1RA) as adjunctive therapy to improve glycemic control in type 2 diabetes. In 2021, the FDA approved semaglutide for chronic weight management. We aim to characterize GLP-1RAs related calls to all U.S poison centers (PCs).

Methods

We conducted a retrospective review of the U.S. National Poison Data System (NPDS) between 2005 and 2023 for all GLP-1RA exposures. All 55 PCs covering the entire U.S. population submit, in near real-time, de-identified case data to NPDS after providing poison exposure management to callers from the general public and health care providers.

Results

During the study period, U.S. PCs handled 13,692 GLP-1RAs related calls, of which 12,451 were a GLP-1RA single substance exposures. In 2023, PCs received 4,414 GLP-1RA related calls, compared to 234 in 2014 (a twenty-fold increase over 10 years). Seventy three percent of exposures involved females (n = 10,017). The main reasons for exposure were therapeutic errors (n = 10,213; 75%), adverse drug reactions (n = 1,222; 9%) and suspected suicide (n = 557; 4%). Gastrointestinal symptoms, such as nausea (n = 2,913; 23%), vomiting (n = 2,515; 20%), and abdominal pain (n = 593; 5%), and neurological symptoms, including central nervous system depression (n = 191; 1.5%), dizziness (n = 563; 5%) and headache (n = 495; 4%) were the most commonly reported clinical effects in single substance exposures. Hypoglycemia was reported in 431 cases (3.5%), Most single substance exposures were managed outside a healthcare facility (n = 8.573; 69%), and hospital admission was reported in 5% of exposures (n = 601).

Conclusions

PCs are well positioned to monitor trends in GLP-1RAs human exposures and associated adverse events and therapeutic errors. Based on available data, PCs can manage specific cases-types without referral to the hospital, preventing unnecessary healthcare utilization.

Key messages

• Poison centers are well positioned to monitor trends in GLP-1RAs adverse events.

• Poison centers can prevent unnecessary healthcare utilization.
Loneliness in the elderly and disease development in European welfare regions: a longitudinal study
Authors: Paiva Pessoa M , Girão Antunes F , Coelho B , Silva I , Perelman J , Perelman S
Published: October 2024

Healthy ageing research has brought a recent focus on the association between loneliness and disease. Regional differences on loneliness prevalence in the elderly across welfare systems, and its association with varying mortality rates, have recently been demonstrated. We hypothesise loneliness affects disease development in the elderly, impacted by socio-economic policies that characterise welfare systems in the EU. We use logistic regression models to assess the association between loneliness (R-UCLA scale) and onset of new chronic disease and disease events, in a European sample of people aged >50 (n = 40840), using the SHARE database, during 2013 - 22 (waves 5 to 9). Preliminary results from two subsequent waves (2015-17, n = 11870) show a statistically significant effect of persistent loneliness on disease onset (increase in new disease events), when adjusting for sex, age, previous illness, and other socio-economic covariates (AOR 1.22, 95%CI 1.08-1.39, p < 0.01). Notably, comparing to the Scandinavian welfare group, only Eastern European countries show higher odds of disease development (AOR 1.52, 95%CI 1.32-1.77, p < 0.001), while also having the highest incidence of new disease in our sample. Age and welfare group show the strongest association with the outcome of interest, followed by change in occupation (no longer employed). Our current analyses span a larger period (2013-22), and we are exploring additional mediators of this effect, such as behavioural and social activity-related variables. Additional analyses to control for unrelated disease (low biological plausibility) and a social isolation index, described in the literature, are added. Furthermore, we analyse the longitudinal association between loneliness and healthcare use, such as polypharmacy and consults. With this study, we aim to contribute decision-making in health in all policies, by increasing integration between health and social sectors, while considering different regional and welfare policies.

Key messages

• Understanding socio-economic and welfare mechanisms which impact health in the elderly allows for better cross-sector policy design, promoting healthier ageing.

• Persistent feelings of loneliness affect disease development in the elderly, which appear to be worsened in some EU welfare groups, independently of socio-economic status.
Bias in Evaluating Trends of Thyroid Cancer Incidence between Rural and Urban Populations
Authors: Magid A , Zolotov S , Mekel M
Published: October 2024

Background

Diagnosis of thyroid cancer is based on fine needle aspiration cytology of thyroid nodules, based on nodules’ sonographic appearance and size. The American Thyroid Association published new guidelines for management of thyroid nodules in 2009 and 2015, where in some cases, only follow-up of thyroid nodules without any other procedure is recommended. This may lead to a decrease in diagnosed thyroid cancer cases. We studied thyroid cancer trends in Israel between the Arab population who are more likely to be living in rural areas, and the Jewish population who predominantly living in urban areas, and assesses whether these guidelines were reflected in the trends.

Methods

Data on new thyroid cancer cases were retrieved for Jews and Arabs separately from the Israel National Cancer Registry. Trends in age standardized incidence rates between 1996-2019 were evaluated for the two population groups using joinpoint regression model. Population group was included in the regression models to compare the trends between the two groups. We also studied trends in treatment of thyroid cancer at Rambam Health Care Campus.

Results

In both populations, age standardized thyroid cancer incidence rate increased between 1996 and 2013. However, between 2013-2019, Annual Percentage Change continuously increased in Arabs, but decreased in Jews. In the hospital study, we found that the Arab patients were 30% more likely to have surgery for small tumors.

Conclusions

The decrease in thyroid cancer incidence in the Jewish population compared with the Arab population may be related to differences in implementing the 2009 guidelines, which do not recommend fine needle aspiration cytology for very small tumors. We have found evidence that these guidelines were not followed to the same extent among Arab community clinics. This may explain the persisting increasing trend among Arabs, and could be one of the possible explanations for the differences in trends between the two groups.

Key messages

• Updated Guidelines regarding thyroid cancer diagnosis may be differently implemented by rural and urban populations.

• Trends assessment may be biased due to differences in guidelines implementation.
Temporal trends, regional and socio-economic disparities of colorectal cancer burden in Cyprus
Authors: Assiotou A , Lamnisos D
Published: October 2024

Background

Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide and it is the third most common cancer in Cyprus. Previous studies have documented variations in CRC burden over time, across regions and area-based socio-economic deprivation. The aim of this study was to analyse the burden of CRC over time, across regions and area-based socio-economic deprivation in Cyprus for the time period 2000 to 2015.

Methods

A small area ecological study was performed, with census tracts as units of spatial analysis. The incidence and death date, sex and age of CRC were obtained from the population-based cancer registry of Cyprus. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed estimates of SIRs and SMRs were derived from the Spatiotemporal Bayesian Poisson log-linear model. To investigate temporal trends in the association between area-based socioeconomic deprivation and CRC burden, we have used the national socio-economic index.

Results

The burden of CRC was rising over time. The CRC cumulative incidence increase from 243.7 in the time period 2000-2007 to 347.3 per 100,000 persons in the time period 2008-2015.There was also a more pronounced geographical variation in SIR and SMR in the time period 2008-2015. Four areas out of 369 had smoothed SIR>1.15 while twenty-six areas had smoothed SMR>1.15, with most of those areas located at the east coast of the island and around the capital city. There was a temporal trend in the socio-economic inequalities of CRC burden. The areas in the third and fourth quartile of the socio-economic index had 23% and 45% lower rates of CRC incidence, and 33% and 47% lower rates of CRC mortality in the period 2008-2015.

Conclusions

These findings could shape national prevention policies, such as the national screening program of CRC starting in 2025 and protection strategies for CRC mortality.

Key messages

• Colorectal cancer screening should be geographically targeted for efficient resource allocation.

• Public health interventions to improve colorectal-specific mortality risk should be geographically targeted.
Regional variation in incidence and mortality due to hypertension in Sao Tome and Principe
Authors: Costa J , Anes E , Trovoada M J , Teixeira C
Published: October 2024

Background

The analysis of incidence and mortality due to hypertension (HT) provides statistical data for addressing public health programs, particularly in low-income countries where poor health systems impose constraints to address non-communicable diseases (NCDs). This study aims to assess the geographic pattern of incidence and mortality due to HT in Sao Tome and Principe (STP).

Methods

This is a descriptive ecological study. Aggregated data on new cases of and deaths due to HT by gender, age-group and district (2022-2023) were extracted from the Health National Database (STP Ministry of Health). Age-standardized incidence and mortality rates (ASIR and ASMR) and respective 95% confidence interval (95%CI) were obtained. Mortality-to-incidence ratio (MIR) was computed by district (lower values indicate better quality of care). Comparison between districts was done through standardized incidence ratios (SIR) and respective p-value. Analyses were stratified by gender.

Results

ASIR and ASMR per 100,000 were, respectively, 1168.9 (95%CI:1103.3-1237.6) and 76.8 (95%CI:62.0-96.2) among men and 2460.6 (95%CI:2365.0-2559.0) and 99.7 (95%CI:81.4-121.6) among women. Incidence of HT was significantly higher than expected (p < 0.001) in Agua Grande, Caue and Lemba with SIR varying from 122.8% (Agua Grande) to 201.1% (Caue) in men and from 125.1% (Lemba) to 224.1% (Caue) in women. Instead, Mé-Zochi presented much lower incidence than expected for both, men (SIR=43.1%;p<0.001) and women (SIR=38.4%;p<0.001). Large differences between districts were observed in MIR, varying from 0% (Caue and Lobata) to 84% (Mé-Zochi) in men and from 0% (Lobata) to 57% (Mé-Zochi) in women.

Conclusions

According to our findings there is, not only, a high incidence rate of HT, but also regional variation in this rate, deserving particular attention from policy-makers. Regional variation in hypertension incidence could be partially explained by differences in the quality of healthcare services.

Key messages

• Awareness should be given to the high incidence of hypertension demanding preventive strategies in the field of public health.

• Public health strategies should address the quality of care in regards to the prevention, diagnosis and monitoring of hypertension.