bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine Learning techniques for predicting inpatient probability and LOS from EU Injury Database
Authors: Pitidis A , Fondi G , Carannante A , Giustini M
Published: October 2024

Background

Unlike statistical inference Machine Learning (ML) makes repeatable predictions without prior assumptions about the underlying relationships among variables. The Full Data Set (FDS) of the EU-IDB (European Injury DataBase) consent to explore risk of hospitalization due to injuries using many predictors. The Length Of Stay of patients in hospital (LOS) is a relevant proxy of complexity of treatment and resources consumption.

Methods

The IDB-FDS provides more than 3.800.000 ED records, in years 2008-19 for 19 Countries. LASSO (Least Absolute Shrinkage and Selection Operator) cross-validated linearized regression technique (linear for LOS) was used for variable selection and parameter regularization. Inpatients are those admitted or transferred to hospital. Days of hospitalization were used for LOS. A cross-validated Generalized Linear Model was performed on 5 folds randomly sampled assigning 80% of records to training and 20% to testing samples.

Results

The strongest predictors of hospital admission risk, selected by the model were in order of importance: EUROCOST-39 diagnoses categories, Age Group, Intent, Mechanism Of Injury, Activity When Injured, Transport Injury Event, Sex Of Patient, Place Of Occurrence. EUROCOST-39 represents 61,9% of explained variability and age group 19,4%. The strongest predictors of LOS were substantially the same: EUROCOST-39 86,2% of explained variability and age group 8,6%.

Conclusions

The main part of variability in the ML model is explained by diagnoses reclassified according to a disability standardization method. For instance, in the maximum training sample risk of hospitalization ranges from odd 0,76% for hand/fingers sprain up to 154,02% for brain concussion. In the median sample LOS ranges from 0,45 days for strain of hand/fingers up to 11,65 for multi-trauma. A combination of more disabling injury, older age and mechanism of injury (i.e. threat to breathing) increases enormously the risk of hospitalization and LOS.

Key messages

• Machine Learning techniques applied on EU-IDB can provide identification of relevant risk factors of hospital admission from injuries for targeting preventive measures and organizing health care.

• Artificial Intelligence consents to analyse big amount of data as dimension or analytical detail of information for identifying patterns and predictors of specific indicators for injuries or diseases.
Predictive machine learning algorithms for metabolic syndrome among Tunisian adults
Authors: Zribi M , Zaier F , Zoghlami N , Elati J , Traissac P , Aounallah-Skhiri H
Published: October 2024

Background

Metabolic syndrome (MS), a cluster of interconnected risk factors for cardiovascular disease and type 2 diabetes, poses a significant health burden globally. In Tunisia, amidst an ongoing epidemiological transition, the prevalence of MS presents a growing concern. Our study aimed to identify the potential risk factors of MS and propose better machine learning (ML) based models for predicting MS among Tunisian adults.

Methods

Data was sourced from the Tunisian Health Examination Survey THES-2016, encompassing individuals aged 20 years and older. MS was defined based on the criteria set by the International Diabetes Federation. Logistic regression (LR) was employed to determine risk factors for MS. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. Five ML algorithms (Naïve Bayes, Support Vector Machine (SVM), Artificial Neural Network (ANN), AdaBoost, and Random Forest (RF)) were utilized to predict MS. Performance evaluation was conducted using accuracy, precision, recall, and area under the curve (AUC) metrics.

Results

Among the 8908 participants, the prevalence of MS was 32.8% (95% CI: 31.4% - 34.6%). LR identified age group 60-69 years (aOR: 18.5, 95% CI: 16.9-19.9, p < 0.001), female sex (aOR: 1.7, 95% CI: 1.2-1.9), sedentariness (aOR: 1.6, 95% CI: 1.5-1.8) and low education level (aOR: 1.2, 95% CI: 1.1-1.4) as significant factors associated with MS. Among ML models tested, AdaBoost had the highest accuracy (89.8%), followed by SVM (89.6%). Naïve Bayes had the highest Recall (98.1%) and the most performant AUC (91.4%), while RF had the highest Precision (70.8%). The ANN had an accuracy of 89%, a precision of 70.4%, a recall of 78.7% and an AUC of 85.1%.

Conclusions

Our study highlighted the effectiveness of ML algorithms like AdaBoost and SVM in predicting MS among Tunisian adults, offering potential as early detection tools. However, further validation with larger datasets is necessary to solidify their utility in healthcare settings.

Key messages

• Metabolic syndrome, a complex of cardiovascular risk factors, presents a substantial global public health challenge and is particularly pronounced in Tunisia.

• Machine learning algorithms, notably AdaBoost and Support Vector Machine, demonstrate promise in forecasting and addressing metabolic syndrome.in Tunisian adults.
Pandemic-related PTSD and associated risk factors in the general adult population in the Netherlands
Authors: van Duinkerken A , Bosmans M , Baliatsas C , Dückers M
Published: October 2024

Introduction

The COVID-19 pandemic introduced widespread stressors and shocking events, impacting mental well-being. Understanding posttraumatic stress disorder (PTSD) prevalence during the pandemic is crucial, yet existing studies on this topic vary widely in methodological quality. This study aims to fill this gap using a large-scale national survey study to examine PTSD prevalence during the pandemic and compare pandemic-related and traditional shocking events.

Methods

This study uses data from the Dutch Public Health Monitor Adults and Elderly 2022, consisting of 365,000 Dutch adults representative for the general adult population. Pandemic-related and traditional events were assessed and anchored to a screening instrument for PTSD: the Dutch version of the PCL-5.

Results

Two-thirds of participants reported experiencing a shocking event during the pandemic. Exposure to pandemic-related events was reported more frequently than traditional events. Overall probable PTSD prevalence due to these events was 2.4%, evenly split between pandemic-related and traditional events. Among exposed individuals, probable PTSD prevalence was 3.7%. This was higher for traditional than for pandemic-related events. Risk factors for developing probable PTSD after exposure to an event during the pandemic were younger age, financial difficulties, loneliness, low resilience and experiencing multiple events.

Discussion

Exposure to shocking events during the pandemic influenced the prevalence of probable PTSD. Despite the lower relative impact of pandemic-related shocking events compared to traditional events, exposure to pandemic-related shocking events accounted for the same amount of probable PTSD cases in the Dutch general population as 5 common traditional events. This emphasizes the need to address mental health consequences of prolonged crises and the demand for healthcare, and the importance of mitigation strategies based on risk and protective factors.

Key messages

• Exposure to pandemic-related events accounted for approximately the same amount of probable PTSD cases as 5 frequently occurring traditional events.

• Despite pandemic-related events being reported more frequently, traditional events were associated with a relatively higher prevalence of PTSD.
EVFAM-BR: Sharing experiences and closure
Authors: Eshriqui I , de Almeida L Y , de Souza E L , Nascimento V E , de Mendonça JMT , Neto FTP , Rebustini F , de Medeiros E B , de Sousa AAF , Bonfim D
Published: October 2024

This activity will last 20 minutes. After Role Play, participants will sit in large circle and the ones that assumed the observer role will share their experiences of using EVFAM-BR. Subsequently, other participants will be invited to share their experiences and impressions about EVFAM-BR. Based on the participants’ impressions and a review of the main points covered throughout the workshop, a final discussion and closure of the workshop will be facilitated.
Health Effects of Climate Change in the UK report 2023
Authors: Duarte-Davidson R , Gillingham E L , Phalkey R , Berrang-Ford L
Published: October 2024

The fourth Health Effects of Climate Change in the UK report (HECC) was published by the UK Health Security Agency in 2023. The report brings together 15 independent chapters written by 90 experts from UK and international academic and research institutions and UKHSA. It provides an authoritative summary of the scientific evidence on the health effects of climate change in the UK, potential implications for public health and gaps in evidence. Chapters include a combination of new empirical analyses (using the most updated climate data - UKCP18 projections) and synthesis of new evidence. Topics covered include future UK climate, temperature effects on mortality, flooding, outdoor and indoor air quality, aeroallergens, infectious diseases, vector-borne diseases, food supply, wildfires, drought, human exposure to chemicals, solar radiation, health impacts of net zero and indicators for climate change and public health tracking.
The German Status Report on Climate Change and Health 2023
Authors: Kelleher K , Mlinaric M , Niemann H , Ziese T
Published: October 2024

The German Status Report on Climate Change and Health was coordinated by the Robert Koch Institute, Germany’s public health institute, and published in 2023 through a collaboration of approximately 100 authors from 30 German institutions. It is an update of a similar report from 2010 and includes review articles and syntheses on the effects of climate change on human health through various influences such as heat, extreme weather, UV radiation, air pollutants and allergens, as well as the effect of climate change on infectious diseases through vector-borne, water-borne or food-borne pathogens. Literature reviews on the potential impact on antimicrobial resistance and mental health explore less well researched effects of climate change on health. The report discusses climate change communication and climate justice as cross-cutting issues and closes with an analysis of the options for action recommended throughout the preceding chapters. While the coordination of this report was funded by the German Federal Ministry of Health, the content was compiled by an advisory board of scientists and the authors recruited by them. The status report is published as 14 individual scientific papers in three issues of the peer-reviewed Journal of Health Monitoring and is available open access in English and in German in order to reach a large scientific audience. Besides the scientific audience, another target group are local authorities contributing towards adaptation and mitigation measures. Insights from the report are being communicated by diverse channels specifically to this latter group and are taken into consideration in the process of shaping the German Strategy for Adaptation to Climate Change.
Methodological insights into severity distribution of non-fatal cancer burden in Belgium using a microsimulation model (2004-2019)
Authors: De Pauw R , Gorasso V , Devleesschauwer B
Published: October 2024

This study leverages a registry-based microsimulation model to analyze the non-fatal burden of cancer in Belgium from 2004 to 2019, emphasizing the methodology for severity distribution. Utilizing incidence- and prevalence-based approaches, we estimated Years Lived with Disability (YLD) through detailed national cancer registry data coupled with tailored disease models. The microsimulation model employed enabled nuanced translation of cancer incidence into prevalence estimates, incorporating the longitudinal impacts of disease severity influenced by treatment. Methodologically, the model integrated expert elicitation to adjust for treatment-related disabilities, such as surgical aftereffects, enhancing the accuracy of disability weight assignment across different cancer stages. This approach allowed for a dynamic assessment of disease burden, reflecting real-world complexities of cancer prognosis and treatment pathways. Significant findings include a substantial increase in the age-standardized non-fatal burden for non-melanoma skin cancer, highlighting the model’s capability to detect shifts in disease impact over time. By focusing on the microsimulation’s capacity to delineate severity distributions within the cancer burden landscape, this analysis underscores the model’s utility in refining health policy decisions and resource allocation. Ultimately, this study presents a robust framework for national burden of disease studies, facilitating detailed evaluations of health interventions and their longitudinal effectiveness.
6.H. Round table: Harnessing Patient-Reported Data for Health Innovation: Insights from the OECD PaRIS Initiative
Authors:   Organised by: PaRIS Consortium, EUPHA-HSR,   Chair persons: Johan Hansen (EUPHA-HSR), Mieke Rijken (Netherlands)
Published: October 2024

This round table will disseminate knowledge and foster discussions on data reported by patients with a chronic disease in primary care settings in 20 countries for enhancing health system responsiveness and effectiveness. By delving into the OECD’s Patient-Reported Indicator Surveys (PaRIS) survey’s development, adaptation, and analytical strategies, participants will leave with a richer understanding of how patient-reported data can inform and transform health policy and practice in Europe and beyond.

Rationale

The round table aligns with the Conference theme by focusing on the transformative potential of patient-reported data in health systems. OECD PaRIS provide a unique lens through which to examine patient-centered care, showcasing innovative methods to capture and utilize data across diverse health system contexts. This round table will explore the development, adaptation, and analysis of this flagship survey, revealing its critical role in shaping health policies and practices that are attuned to patient needs and experiences.

Objectives

1. Understanding Development and Testing Processes: To gain insights into the systematic approaches used in developing patient-reported instruments that are both robust and sensitive across multiple healthcare settings; 2. Exploring Co-development and Adaptation: To discuss the challenges and strategies involved in adapting health surveys to various national contexts while ensuring stakeholder engagement and data relevancy; 3. Analyzing Data for Policy Making: To comprehend the analytical frameworks used in processing patient-reported data for crafting effective health policies and identifying factors that influence patient outcomes.

Key messages

• Patient reported data on experiences and outcomes provide essential information for health systems performance.

• Unique insights into the systematic collection of such information can be gathered through the proposed discussion on the experience of designing and implementing the PaRIS Survey.
Patient-Reported Indicator Surveys (PaRIS): making the case for co-development and adaptation to national contexts
Authors: Kendir Candan
Published: October 2024

In this presentation we discuss the early implementation of the OECD’s Patient-Reported Indicator Surveys (PaRIS) in primary care, highlighting the importance of co-development and national adaptation. The PaRIS initiative focuses on collecting patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) from individuals with chronic conditions and their primary care providers. This data collection is critical as populations age and the prevalence of chronic conditions increases, necessitating health systems that prioritize patient-centered care. The co-development process of the PaRIS survey involved extensive international collaboration, incorporating feedback from policymakers, healthcare providers, patients, and academics, thereby enhancing the relevance and ownership of the project. An example of successful stakeholder engagement is the creation of the PaRIS Patient Advisory Panel, which included representatives from various patient organizations who participated in all stages of the survey’s development. Challenges encountered during pilot implementations varied by country, influenced by factors like existing data infrastructures and regulatory environments. For instance, countries lacking robust data collection systems faced more significant hurdles in adapting the survey to their contexts. The article emphasizes that while rigorous standardization is essential for making international comparisons, adaptation to local contexts is crucial for addressing specific implementation challenges. The joint efforts of all stakeholders are vital for the success of international initiatives like the PaRIS survey. Such collaborative efforts not only facilitate the collection of meaningful data but also contribute to the enhancement of primary care quality through informed policymaking and improved patient care practices.
Health literacy in pregnant women facing prenatal screening: a short report from “SaperePer” project
Authors: Bellisario V , Squillacioti G , El Sherbiny S , Ghelli F , Mazzoli M , Sciarrone A , Carletto S , Marozio L , Bono R
Published: October 2024

Advancements in health promotion and prenatal medicine have made noninvasive prenatal testing (NIPT) a common practice during pregnancy, but understanding prenatal health information becomes crucial not only for the well-being of the mother but also for that of the unborn child. Analyze health-related information during pregnancy is fundamental, and this work fits perfectly with this topic, reporting preliminary results from the pilot study “SaperePer”. A health-related questionnaire was administered to 358 women in the first trimester of pregnancy, aiming to study different outcomes: 1.level of knowledge of NIPT; 2.number of screening tests undergone; 3.willingness to undergo a diagnostic test with a high outcome risk of screening test; 4.willingness to end the pregnancy following a diagnosis of pathology. The questionnaire was divided into 3 sections: personal characteristics and lifestyle habits, prenatal health behavior scale (PHBS), and knowledge of NIPT. Preliminary results showed that the level of knowledge of NIPT was higher in older, atheist, working, wealthy highly educated, and preliminary informed women, as well as the higher number of screening tests undergone and the propensity to undergo an invasive diagnostic test after a high-risk screening result (KS and MW tests p < 0.05). On the contrary, women with lower education, faithful and, even more, not preliminary and appropriately informed during prenatal counseling showed lower knowledge of NIPT, lower number of tests undergone, and meager chances to undergo an invasive diagnostic test or to end the pregnancy after a positive diagnosis of pathology (KS and MW tests p < 0.05). In conclusion, this study evaluated health-related information during the first but crucial stages of pregnancy, opening a new understanding of how health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women, particularly in those women with lower cultural tools.

Key messages

• Health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women.

• Understanding prenatal health information becomes crucial both for maternal and prenatal well-being.
Using PPI and UDL principles to design a gastrointestinal endoscopy patient information video series
Authors: Fennessy S , Mulcahy L , O’Donnell B , Mulcahy H , Spooner M , McDermott E
Published: October 2024

Introduction

Patients undergoing GI endoscopy often experience anxiety and due to limited health literacy. Traditional paper-based information leaflets are often not sufficient to accommodate for the diverse way in which people consume information. Public and patient involvement (PPI) and universal design for learning are two well-described pedagogical principles. We wanted to use these principles to design more effective patient education materials.

Objectives

Given the heterogeneity of resources available to patients, the authors wanted to develop a high-quality and trustable video resources for patients that would be available on our hospital website. These videos would be co-designed by patients and ancillary staff, through the formation of a key stakeholder panel.

Results

Using PPI principles, we were able to improve the relevance and quality of our content, through the use of storyboards and the expertise of the stakeholder panel. Through the three key UDL principles of multiple means of representation, engagement and action and expression, we were able to ensure that our videos were accessible and appropriate for all of our patients. Initial feedback from stakeholders and patients provided valuable insights, prompting necessary adjustments for accuracy and patient understanding. This comprehensive approach underscores the commitment to enhancing healthcare delivery. Our project is the first guide in combining both pedagogical principles in the development of patient information and education materials.

Conclusions

The meticulous steps taken, from stakeholder engagement to video production, reflect a commitment to inclusivity and patient-centred care. Ongoing evaluation and feedback mechanisms ensure continuous improvement, contributing to the overall success and sustainability of the digital service.

Key messages

• This is the first research/patient education piece designed using both PPI and UDL principles.

• The importance of patient-centred educational design is key to improving health literacy and education in our patients.
Does School Education Improve Children’s Health Literacy? Evidence from a Performance-Based Survey
Authors: Heiss R , Schamberger L , Leuprecht E , Schütze D , Überall M , Zoller C , Sahling F , Gell S , Griebler R
Published: October 2024

Background

Children begin using digital sources of health information at a young age and are quickly exposed to a variety of unmoderated health content. Health literacy helps children navigate, understand, evaluate, and act on this content. But is the educational system preparing young people for these tasks? This study develops a validated, performance-based measure of health literacy and applies it to a sample of 9- to 13-year-old children (grades 4 to 7).

Methods

A performance-based tool to measure children’s health literacy was developed through expert consultation and qualitative and quantitative pretesting. The tool uses vignettes and quizzes and captures three dimensions of health literacy: nutrition, physical activity, and psychosocial health. The validated tool was then used in a cross-sectional survey of Austrian children aged 9 to 13 years (n = 780): Diet, Physical Activity, and Psychosocial Health.

Results

Results show that the performance-based health literacy scores do not correlate with self-reported scores. Girls (vs. boys) and native speakers perform better on the performance-based literacy test, while boys and children reporting more robust financial backgrounds overestimate their literacy on self-reported questions. Most importantly, the data do not show meaningful increases in performance-based health literacy across grade levels. For nutrition literacy, the study even shows a slight negative trend across grade levels.

Conclusions

This study questions the heavy reliance on self-reported health literacy, which is often confounded with self-efficacy and social environment. Performance-based instruments are needed to measure health literacy as an educational outcome. This study presents one of the first validated instruments. Most importantly, the study shows that the current educational system may not produce meaningful increases in performance-based health literacy, calling for deeper educational reforms.

Key messages

• Performance-based health literacy is a distinct concept from the subjective health literacy measures that dominate current health literacy research.

• Performance-based health literacy did not increase with grade level, indicating a poor performance of the education system in strengthening health literacy.
Why is regulation of the online world urgently needed to protect children’s wellbeing?
Authors: Signal L , Smith M , Gurtner M , Gage R
Published: October 2024

Background

The online world affords children many benefits, such as connectivity and access to educational and cultural content. Simultaneously, it increases their likelihood of encountering harmful or distressing web-based content and behaviour, such as marketing for harmful products, violent or discriminatory material, and cyberbullying. Yet, there is a dearth of objective research globally on children’s real-time experiences, with current research relying on self-reports or observations made in experimental conditions. This paper reports on the nature and extent of children’s online world.

Methods

Kids Online Aotearoa is a cross-sectional observational study of children’s real-time experiences of the online world. A strategic sample of 180 12-year-olds from schools in the Wellington region of Aotearoa, New Zealand, used Zoom video conferencing software to record their online world for four days. Recordings were analysed manually and using AI.

Results

Children spend most of their time online on their phones, often using TikTok. Children spend 25 % of their online phone time gaming or watching games (game time). They encounter many gambling and gambling-like activities while doing so. Of game time, 16% of the time children are exposed to marketing. Preliminary analysis reveals that children are exposed to marketing for alcohol, junk food, tobacco, vapes and gambling. This is counter to national legislation prohibiting or restricting such marketing to children.

Conclusions

This novel methodology reveals the actual online experiences of children as they go about their daily lives. This includes engaging in harmful behaviours such as gambling and encountering harmful product marketing. While from New Zealand, this study is likely to be relevant for other countries given the global reach of the online world. The research indicates the urgent need for national and global government regulation of the online world to protect the rights of children and ensure their wellbeing.

Key messages

• Kids Online Aotearoa reveals the nature and extent of children’s online world, including their exposure to harmful product marketing.

• National and global regulation of the online world is urgently needed to protect child rights and wellbeing.
Effects of legal age change on adolescents’ perception of access to alcohol in Portugal
Authors: Lima D , Leão T
Published: October 2024

Background

Adolescents and young adults are a group particularly vulnerable to the effects of alcohol consumption. In Portugal, legislative changes in 2013 and 2015 prohibited the sale of alcoholic beverages to under-18s. This study aimed, first, to evaluate the impact of these policy shifts on the perceived access to alcohol among Portuguese adolescents, and second, to assess the different impacts across gender and socioeconomic strata.

Methods

Data from the ESPAD survey, spanning 1995-2019, was used. A quasi-experimental difference-in-differences study design was employed, using Finland, Norway, and Sweden as controls. The perceived access to beer, wine, and spirits among 16-year-old adolescents was used as outcomes, adjusted for gender and parental education. Results were also stratified by gender and by parental education status.

Results

After the increase in the minimum age for alcohol sales, there was a higher perceived easiness of access to beer (coef=0.018, p = 0.001) and a decline in spirits (coef=-0.088, p = 0.022), with no changes in wine. Male adolescents exhibited a decrease in the perception of access to spirits (coef=-0.100, p = 0.007) and wine (coef=-0.049, p = 0.049), while changes in the perception of access to beer were non-significant. Similar patterns were observed in female adolescents, yet non-significant for wine or spirits. These positive impacts on beer and negative impacts on spirits were observed in the different socioeconomic groups; wine was the exception, with only the highest-education group showing a decrease in the perception of access (coef=-0.056, p = 0.011).

Conclusions

In this study, the effect of raising the minimum age for alcohol sales in Portugal varied according to the alcoholic beverage, gender, and, for wine, according to the socioeconomic group. These findings suggest limitations in the policy’s effectiveness and equity. Future research should delve into the underlying causes to optimize health-promoting policies.

Key messages

• Portugal’s alcohol policy changes led to differential impacts on the perception of access to alcohol, with an impact in higher alcohol content beverages.

• The impact of alcohol policy changes also differed across gender and socioeconomic status, with a stronger effect on male adolescents and higher socioeconomic strata.
Psychological Distress Changes During COVID-19: A Belgian Cohort Study On Psychosocial Factors
Authors: Duveau C , Nicaise P , Smith P , Seeber K , Lorant V
Published: October 2024

Longitudinal studies have identified an increase in psychological distress across the general population during the COVID-19 pandemic. Nevertheless, the trajectories of mental health outcomes exhibit variations, suggesting potential associations with psychosocial individual factors. This paper identifies the factors of this individual trajectory of psychological distress during the COVID-19 pandemic. Five waves of a prospective cohort survey were conducted with a convenience sample of the general population in Belgium between March 2020 and November 2021 (n = 4,550). Psychological distress was measured using the GHQ-12. Individual covariates included socioeconomic factors (age, gender, level of education), psychological factors (loneliness, social support, and social activities), and factors related to the virus and the lockdown measures (exposure to COVID-19 and survey wave). Multilevel models were used for analysis. Women and young people experienced more pronounced fluctuations in their risk of psychological distress across study waves, experiencing both increases and decreases. We found that individual variance in psychological distress breaks down into two components, respectively 43% for psychosocial factors (time-invariant) and 57% for the survey waves (time-variant) variation. A significant share of the time-invariant difference in psychological distress over COVID-19 is associated with loneliness, social support, and social activities. Loneliness emerged as the most important interpersonal factor associated with psychological distress. The change in psychological distress was mainly associated with psychosocial factors rather than with pandemic-related dynamics (e.g. survey waves). These findings suggest that mitigation policies aiming at controlling the pandemic should focus more on addressing specific individual vulnerabilities rather than solely responding to the fluctuations within pandemic waves to decrease their detrimental impact on mental health.
SARS-CoV-2 Infection And COVID-19 Outcomes Among Mental Disorders: A Register-based Study in Catalonia
Authors: Haro J M , Giné-Vázquez I
Published: October 2024

This study aimed to study the risk of SARS-CoV-2 infection and severe COVID-19 outcomes across different mental diagnoses and to assess the role of sex in these associations. We used electronic health records from Catalonia to identify adults receiving inpatient/outpatient mental health care between 2017-2019 with diagnosis of non-affective psychosis (NAP), bipolar disorder (BD), depressive disorder (DEP), stress-related disorders, neurotic/somatoform disorders (NSD), and substance misuse (SUB) (exposed). Outcomes included SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19-related death. Adjusted logistic regression analyses were conducted. 785,378 adults were included (70.3% < 65 years old; 57.1% women). Compared to unexposed, those with NAP [OR (95%CI): 0.84 (0.80-0.88)], BD [0.80 (0.75-0.86)], DEP [0.97 (0.94-1.00)] and SUB [0.81 (0.78-0.84)] had a lower risk of SARS-CoV-2 infection, while people with NSD presented an increased risk [1.03 (1.01-1.06)]. Among those infected, people with DEP, NSD, and SUB had a lower risk of COVID-19 hospitalization, but higher risk of COVID-19-related death [1.23 (1.07-1.41); 1.26 (1.07-1.48); 1.48 (1.24-1.71), respectively]. A higher COVID-19-related death was also found in people with NAP and BD [1.68 (1.34-2.12); 2.02 (1.50-2.73)]. Sex-stratified analysis showed that women with NSD were especially vulnerable to infection [1.07 (1.03-1.11)], and women with DEP and NSD to COVID-19-related death [1.24 (1.05-1.47); 1.26 (1.02-1.54)]. These results suggest different vulnerabilities to infection and COVID-19 hospitalization and death across mental disorders. These findings have implications for pandemic preparedness, highlighting the need for specific public health strategies to mitigate the excess of mortality of people with certain mental disorders.
Tradition to Concern: Health Risks and Nicotine Dependence of Midwakh Use in Young Males in the UAE
Authors: Saddik B , AlHajjaj M , AlHouqani M , Halwani R , Mahboub B , Zeidan R , AlHammadi M , Shukla A , Seif A , Saheb Sharif-Askari F
Published: October 2024

Background

Midwakh smoking, a traditional practice, poses a growing public health concern in the Middle East region. Despite global efforts to curb tobacco use, smoking rates, particularly among young men, remain high. This study explores nicotine dependency, assesses acute health effects, and measures carbon monoxide levels among midwakh smokers.

Methods

A quasi-experimental before-and-after study involved 103 young male midwakh smokers in the UAE. Data collection included surveys featuring the Hooked-on Nicotine checklist (HONC), clinical measurements, and pre/post-smoking saliva samples. Statistical analyses, including descriptive, paired samples, correlation, and regression, assessed associations between midwakh smoking, dependency, and health outcomes.

Results

Preliminary findings found that 33% of midwakh smokers were under 21 years, 68% had below undergrad education, and household incomes over 15,000 AED monthly. Smoking initiation was as early as 10 years. Smoking habits revealed 37% exclusive midwakh, 54% midwakh with e-cigarettes, 21% with shisha, and 34% with cigarettes. Post-smoking clinical measurements showed significant increases in blood pressure, heart, pulse and respiratory rates, and carbon monoxide levels (p ≤ 0.05). Significant differences in pre- (134.6 ng/ml) and post-smoking (154.4 ng/ml) saliva cotinine levels (p ≤ 0.05) were observed. Regression analysis identified predictors of nicotine dependency: initiation age (β= -.315; -0.579,0.0512), household income (β = 1.221; 0.297,2.146), multiple tobacco use (β = 0.576; 0.129,1.024), quit attempts (β = 1.555; 0.519,2.590) and smoking risk perception (β = 3.420; 1.950,4.890)

Conclusions

Midwakh smoking adversely affects clinical measurements, with early start correlating with higher nicotine dependency, worsened by using multiple tobacco products. Urgent action is needed, including tailored prevention campaigns and support systems to aid youth cessation and raise awareness of midwakh smoking’s harmful effects.

Key messages

• Midwakh smoking is deeply ingrained in UAE tradition but poses significant adverse health outcomes and nicotine dependency.

• There is a need to establish specialized cessation programs offering support and resources to midwakh users, addressing both the health consequences and addictive nature of midwakh.
Early life social predictors of longitudinal relations between childhood BMI and overeating
Authors: Bartoskova Polcrova A , Ksinan Jiskrova G , Bobak M , Pikhart H , Ksinan A J
Published: October 2024

Introduction

The progression of obesity is a continuous process involving a complex system of genetic, environmental, and behavioural factors. Socioeconomic disadvantage as well as psychological distress may lead to overeating, subsequently associated with increased energy intake and weight gain. Recent evidence indicated that the association between childhood obesity and overeating might be bidirectional. Therefore, this study aimed to longitudinally investigate the directionality of the association between childhood BMI and overeating and to identify antecedent early childhood predictors.

Methods

The study sample included 5,777 children from the European Longitudinal Study of Parents and Children (ELSPAC), collected between 18 months and 11 years of child age. The outcomes were child BMI and overeating. Predictors included maternal BMI, maternal education, single-parent households, financial difficulties, and adverse childhood experiences (ACEs). The random intercept cross-lagged panel model (RI-CLPM) was applied.

Results

The results showed temporal stability in the development of overeating and BMI, with a bidirectional relationship that strengthened over time. The child’s BMI was predicted by maternal BMI (β = 0.37, p < 0.001). The child’s overeating was predicted by maternal BMI (β = 0.13, p < 0.001), but a stronger effect was found for ACEs (β = 0.24, p < 0.001). ACEs mediated the impact of maternal education, financial difficulties, and single parenthood on overeating with indirect effects of β = -0.01 (p = 0.005), β = 0.04, (p < 0.001), and β = 0.07 (p < 0.001), respectively.

Conclusions

We observed stable bidirectional longitudinal effects, with a stronger association from BMI to overeating. The results suggested two main pathways: one linked to maternal BMI and early childhood BMI increase followed by overeating, and the other associated with ACEs mediating the effect of early childhood socioeconomic factors on overeating, leading to gradual BMI gain. #NGEU

Key messages

• The study revealed a stable bidirectional association between childhood BMI and overeating, with a stronger association from BMI to overeating.

• There are two potential pathways in childhood obesity development, one involving maternal BMI, and the second associated with social disadvantage and ACEs.
Mental health symptoms and treatment for common mental disorders among sexual minority immigrants in Sweden – a national population-based study
Authors: Tinghög P , Bränström R , Malm A
Published: October 2024

Background

Although sexual minorities are at greater risk of poor mental health, less is known about mental health among dual minority statuses individuals based on sexual orientation and migration status. The current study investigated disparities in mental health symptoms and psychiatric treatment for common mental disorders among Swedish-born and immigrant heterosexuals and sexual minorities. It further explored the role played by interpersonal and social stress in explaining these disparities.

Methods

Participants (n = 104,652) were drawn from the Swedish Public Health Survey in 2018. Six groups were compared based on sexual orientation (heterosexual, sexual minority) and migration status (Swedish-born, European-born, non-European). The survey was complemented with information on psychiatric treatment from nationwide registries. Odds ratios were calculated using logistic regression.

Results

Compared to Swedish-born heterosexuals, Swedish-born and non-European sexual minorities had the greatest risk of mental health symptoms (odds ratios [OR]=2.20, 95% confidence intervals [CI]: 1.89-2.57, and OR = 2.10, 95% CI 1.34-3.29, respectively). Swedish-born sexual minorities had greater risk of psychiatric treatment (OR = 2.58, 95% CI 2.20-3.01), while non-European heterosexuals had lower risk (OR = 0.61, 95% CI 0.52-0.72). No differences in psychiatric treatment was found for non-European sexual minorities (OR = 0.82, 95% CI 0.46-1.48). Interpersonal and social stress factors mediated the associations between migration status and mental health symptoms and psychiatric treatment differently depending on sexual orientation.

Conclusions

No excess risk of mental health symptoms was found among sexual minority immigrants compared to their Swedish-born counterparts.

Key message

• Non-European sexual minority immigrants’ risk of mental health symptoms was equally high to the risk among Swedish-born sexual minorities, but they received less psychiatric treatment.
6.P. Scientific session: Economic evaluation of health impacts for better decision choices
Authors:   Organised by: EUPHA-HIA, -FS, -ECO, -PHPP, University of Bath (UK), RIVM (Netherlands),   Chair persons: Piedad Martin-Olmedo (EUPHA-HIA), Henk Hilderink (EUPHA-FS)
Published: October 2024

The strategy of Health in All Policies (HiAP) pursues to analyse the wider determinants of health affected by the decision-making process of traditionally non-health sectors, seeking to enhance population health benefits while avoiding health inequalities. This usually involves the use of health impact assessment (HIA) or health lens analysis to any policy, program, plan or project (PPPP), preferably prior to its implementation. On the other hand, decision-makers from a wide range of public and private sectors also demand a better insight of the meaning of the health impacts quantified under HIA. Assuming the (ubiquitous) situation of limited resources and budgets, decisions need to be based on cost effectiveness criteria and, whenever possible, direct and indirect health costs should be part of the impact assessment. Economic appraisal attempts to define whether a proposal makes a net contribution to social welfare, quantifying and valuing changes to individuals’ utility from the societal perspective, taking into account the impact of health on the individual, their family, employers, healthcare providers and the state. This approach can incorporate different components of the welfare costs of illness, including direct medical and paid care expenses, indirect lost opportunity costs such as productivity and the value of informal care time, as well as a value that monetises the disutility or pain and suffering associated with disease. The range of methods and estimated benefits can make it challenging to identify a best practice approach.

The present session aims to address certain methodological aspects related to the economic evaluation of health impacts, which still generate some controversy and debate, with particular emphasis on the following topics: • Approaches for synthesizing evidence on health impact pathways and economic evaluation of health impacts for a better decision choice; • Health metrics: influence on the conclusions of economic analysis within HIA; • Sources of metrics used for economic analysis; • Uncertainties inherent to economic valuation of health outcomes: how to deal with it.

Key messages

• The economic analysis of health impacts can help prioritizing aspects with the greatest impact on population health, facilitating a more effective use of human and economic resources.

• The economic analysis within HIA can improve decision-making but requires careful consideration of health metrics, sourcing of data, and management of uncertainties.
Cost-benefit analysis: just a step in the HIA process
Authors: Santos J
Published: October 2024

The economic analysis within Health Impact Assessments (HIA) is a critical component in informing public policy decisions by assessing the financial implications of health outcomes associated with the different intervention options. Health metrics play a role defining the cost-effectiveness and societal value associated with the interventions. These metrics, quantifying the health impacts, include quality-adjusted life years (QALYs), years of life lost (YLLs) or disability-adjusted life years (DALYs). On another level, such metrics need to be translated into cost-effectiveness and societal value in which other methods play a role, such as the value of statistical life (VSL) or the value of a life year (VOLY). While VSL quantifies the value individuals place on reducing mortality risk, VOLY evaluates the value attributed to extending life expectancy. On another hand, uncertainties related to economic valuation pose challenges to the accuracy and reliability of cost estimates within HIA. These come from several factors, including data quality, methodological differences across studies, and subjective judgments involved in valuing health states. In fact, estimating the economic value of a prevented death involves multifaceted considerations and important assumptions. Additionally, assigning monetary values to non-fatal health outcomes, such as disability or reduced quality of life, involves subjective assessments and value judgments. By selecting appropriate metrics, considering diverse data sources, and addressing methodological steps and uncertainties, HIA practitioners can improve the utility of economic assessments, facilitating evidence-based decision-making in public health policy and resource allocation. This work was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020).
Leveraging ChatGPT for systematic reviews: how accurate is it for screening by title and abstract?
Authors: Sciurti A , Migliara G , Isonne C , Siena L M , Marzuillo C , Villari P , Baccolini V
Published: October 2024

Background

Systematic reviews are at the top of the evidence pyramid, but the whole process can be labor-intensive, especially in the screening by title and abstract of retrieved records. Large language models (LLMs), such as ChatGPT, are proficient in natural language processing tasks and offer potential for accelerating this phase. The aim of this study is to assess ChatGPT’s performance in screening records for an already published systematic review (doi: 10.1080/21645515.2023.2300848).

Methods

1601 records with title and abstract were evaluated with ChatGPT 4, using two different prompts to instruct the model: one asking the model to classify each record as included or excluded (Prompt A), and one asking the model to rate each record from 1 to 5 based on inclusion confidence (Prompt B), to compute the model’s performance metrics.

Results

The review included 64 records after title and abstract screening, of which 18 after full text screening. Using records included by title and abstract as a reference, prompt B with a rating cut-off of 3 provided 82% sensitivity, 88% specificity and 99% negative predictive value (NPV). With articles included by full text as a reference, 100% sensitivity, 86% specificity, and 100% NPV. An 85% workload saving was reached. Prompts A showed higher workload savings (∼93%), high NPVs (∼100%) and specificity (∼96%), but lower sensitivity (62-72%).

Conclusions

Prompts with a rating cut-off of 3 achieved a better performance, and still relevant workload savings compared to binary classification prompts. These findings can inform prompt-engineering strategies to instruct LLMs and reach both high sensitivity and workload savings.

Key messages

• Systematic reviews provide evidence synthesis to guide policy and decision-making in healthcare and public health. Such process can be time-consuming, and need for timely evidence is often stringent.

• LLMs can help reduce workload and speed up the title and abstract screening phase of a systematic review, which is considered a major bottleneck in the review process.