bluuebunny/crossref_metadata_2025 huggingface dataset:
Decision support systems as supporters of clinical work: perspectives from physicians in Finland
Authors: Heponiemi T , Lääveri T , Kaipio J , Kainiemi E , Virtanen L , Kaihlanen A
Published: October 2024

Background

The digitalisation of healthcare has changed physicians’ clinical and administrative work. For example, decision support systems (DSSs) are expected to support physicians’ daily work. The present study examined physicians’ experiences of DSSs’ support for their work analysed by age, gender, employment sector and leadership position.

Methods

Altogether 4630 physicians (64% women) from Finland responded to the online survey. Logistic regression analyses were conducted to examine the associations of age, gender, employment sector, and leadership position with experiences of DSSs’ support for their work.

Results

Of the respondents, 21.3 % agreed that DSSs supported their work, whereas 43.5 % were neutral and 35.2 % disagreed with the statement. Age (Wald’s F = 15.5, p = 0.001), employment sector (Wald’s F = 84.6, p < 0.001), and leadership position (Wald’s F = 16.3, p < 0.001) were significantly associated with the assesment, whereas gender was not. Those aged between 45 and 54 (OR 0.65, 95% CI 0.51-0.81) and between 55 and 64 (OR 0.74, 95% CI 0.59-0.93) had lower odds for agreeing compared to those aged 35 or under. Compared to physicians in hospitals, primary care physicians had 2.18 times (95%CI=1.84-2.59) greater odds for agreeing that DSSs support their work. Those who were in leadership positions had 1.50 times (95%CI=1.23-1.82) greater odds for agreeing compared to those not in leadership positions.

Conclusions

Finnish physicians did not experience DSSs supporting their work. Especially older physicians, hospital physicians and those not in leadership positions gave negative assessments. DSSs should be better integrated to physician workflow, it is also possible that usability problems of DSSs such as alert fatigue affected user experiences. More attention should be paid to developing DSSs in a way that they support physicians work better.

Key messages

• Finnish physicians did not experience that decision support systems would actually support their work.

• Especially older physicians, hospital physicians and those not in leadership positions did not agree that decision support systems would support their work.
Machine-learning based prediction for high health care utilizers using a multi-institution registry
Authors: Tan J K , Quan L , Salim NNM , Tan J H , Goh S Y , Thumboo J , Bee Y M
Published: October 2024

Background

Rising healthcare costs worldwide have spurred interest in using machine learning to pinpoint major healthcare utilizers for population health efforts. Previous studies have focused on individuals who impose the highest financial burden, such as targeting high-need high-cost utilizers, a small group with limited potential for cost reduction. Therefore, we developed models to predict future healthcare utilization across various thresholds.

Methods

We leveraged data from a multi-institutional diabetes database to develop binary classification models capable of predicting healthcare utilization in the following year. The models predicted six different outcomes: patients with an annual total length of stay of ≥ 7, ≥14, and ≥30 days, and emergency department (ED) attendance of ≥ 3, ≥5, and ≥10 visits. To mitigate class imbalance, we applied random and synthetic minority oversampling techniques and compared against models trained without oversampling. Models were trained with 2019 data and tested on unseen data from 2020 and 2021.

Results

Models trained with random oversampling, including logistic regression, multivariate adaptive regression splines, boosted trees, and multilayer perceptron, consistently demonstrated high AUC (>0.80) and sensitivity (>0.60) across both training-validation and test datasets. Addressing class imbalance was found to be crucial, as models without oversampling displayed satisfactory AUC (>0.80) but significantly lower sensitivity (<0.10). Key predictors identified included age, number of ED visits in the present year, chronic kidney disease stage, inpatient bed days in the present year, and mean HbA1c levels.

Conclusions

Our machine learning models successfully predict high service level utilization with strong performance, offering valuable tools for policymakers and health planners to develop targeted health initiatives based on patient utilization patterns.

Key messages

• Machine learning models can be leveraged to predict future healthcare utilization and facilitate interventional program development.

• Annual total length of stay and total emergency department visits are useful service level indicators.
Social disconnectedness and the rate of medical conditions: a Danish population-based cohort study
Authors: Laustsen L M , Lasgaard M , Momen N C , Chen D , Gradus J L , Grønkjær M S , Jensen M M , Plana-Ripoll O
Published: October 2024

Background

Lack of social connections has a serious impact on health, increasing the risk of medical conditions such as depression, dementia, and coronary heart disease. However, evidence is limited by a disease-specific focus. We aimed to provide a comprehensive overview of differences in incidence rates of a broad range of medical conditions according to social disconnectedness (i.e., loneliness, social isolation, and low social support).

Methods

We conducted a cohort study using data on loneliness, social isolation, low social support, and a composite measure from the 2013 and 2017 Danish National Health Survey. Survey data was linked with register data on 11 categories of medical conditions through 2021. Poisson regression was applied to estimate incidence rate ratios (IRRs), incidence rate differences, and explore interaction with pre-existing mental disorders.

Results

Among 162,497 survey participants, 7.6%, 3.5%, and 14.8% were identified as lonely, socially isolated, and with low social support, respectively. Lonely individuals and individuals with low social support had a higher incidence rate of all 11 categories of medical conditions (interquartile range of IRRs, loneliness 1.22-1.49 and low social support 1.10-1.14), whereas this was the case for nine categories among socially isolated individuals (interquartile range of IRRs, 1.01-1.31). Applying the composite measure, the highest IRR was 2.61 (95% CI, 2.34-2.88) for a mental disorder and the lowest 1.03 (95% CI, 0.95-1.10) for cancer. We found neither major sex differences nor substantial interaction with pre-existing mental disorders.

Conclusions

Our study confirms and extends the available evidence on social disconnectedness and the risk of medical conditions. The attained knowledge may be of significance for mapping group-specific preventative needs and guiding interventions and health practitioners aiming to reduce the disease burden among socially disconnected individuals.

Key messages

• Based on survey and register data from 162,497 individuals, our study suggests that social disconnectedness, especially loneliness, is a determinant of a broad range of medical conditions.

• The findings may be of importance for identifying and targeting the disease burden among socially disconnected individuals.
Using EEA environment and health data to communicate with the public: the European Environment and Health Atlas
Authors: Sanchez Martinez Gerardo
Published: October 2024

The EEA European Environment and Health Atlas presents information on how pollution and other environmental risks affect the health and well-being of Europeans. It is almost exclusively built on the datasets that the EEA collects from its network, and it summarizes only environmental information of relevance to public health, as well as health impacts from key environmental risks like air pollution, noise and industrial emissions.
6.F. Scientific session: Understanding the impact of climate change on health: the latest reports from EEA and NPHIs
Authors:   Organised by: UK Health Security Agency, RIVM (Netherlands), Robert Koch Institute (Germany), European Environment Agency,   Chair persons: Lisbeth Hall (Netherlands), Svenja Matusall (Germany)
Published: October 2024

Climate change poses a significant threat to human life and wellbeing worldwide. Extreme weather events like heatwaves, storms or floods can have adverse impacts on health, as can many other factors influenced by climate change, such as allergens, UV radiation and vector-borne diseases. In order to support the action needed to protect and promote health and wellbeing, many National Public Health Institutes (NPHIs) aim to keep relevant stakeholders informed on the scientific evidence of the impacts of climate change on health. Reports that synthesise the evidence can help in the development of suitable and health-relevant climate change adaptation and mitigation measures. In this workshop, European Environment Agency assessments on climate and health are presented, including the European Climate Risk Assessment Report and recent outputs of the European Climate and Health Observatory. Next, three NPHIs introduce their recent national reports on the impact of climate change on health, sharing lessons learned and valuable insights into their content, process and reception, highlighting similarities and differences. The workshop will feature presentations by NPHIs from the United Kingdom (UK Health Security Agency), Germany (Robert Koch Institute), and the Netherlands (National Institute for Public Health and the Environment) as well as the European Climate and Health Observatory. The perspective of the European Climate and Health Observatory offers Europe-wide insights as a provider of tools and knowledge that support actions from NPHIs and other health actors. Our aim is to highlight the value of such reports, and inform and inspire NPHIs and other stakeholders that may be considering the publication of similar reports. The format of the workshop will be informative and interactive, with opportunity for Q&A, discussion, and engagement with the audience. By showcasing the recent reports, the workshop aims to increase awareness of climate change as a public health issue and establish NPHIs as key climate actors. Furthermore, it aims to highlight the importance of having a national, up-to-date evidence base to drive climate measures and enhance resilience.

Key messages

• National evidence-based reports on climate change and health are a useful tool for informing health-relevant climate change adaptation and mitigation measures.

• Through the public health functions of surveillance, monitoring, responding and evaluating, NPHIs play a crucial role in collating and assessing the evidence on the health effects of climate change.
Assessing the current health effects of climate change in the Netherlands
Authors: Hall L , Betgen C , Boekhold S
Published: October 2024

The National Institute for Public Health and the Environment (RIVM) has assessed the current effects of climate change on health as part of a national sector-wide process towards updating the Dutch National Adaptation Strategy. Besides health, this process includes assessing the risks of climate change for water management, agriculture, the built environment, nature and other sectors. It will provide a basis for policy, for prioritising the most urgent risks and for long-term risk monitoring. Six climate-related health topics were assessed for this update: heat, air quality, mental health, UV radiation, pollen allergies and infectious diseases. To allow comparison of the impact and likelihood of the climate-related risks across sectors, a format for factsheets on climate risks had been provided. Following this format, for each climate-related health topic we considered the climate threat, secondary effects, exposure, vulnerability, adaptive capacity, impact and cascading effects. The magnitude of the health impacts was categorised per topic as low (< 10,000 people affected; 0 - 10 seriously injured/dead), medium (10,000 - 100,000 people affected; 10 - 100 seriously injured/dead) or high (>100,000 people affected; >100 seriously injured/dead). The likelihood of these impacts was then described as well as possible black swan events or tipping points. Finally, the policy context was outlined, including possible maladaptation, lock-ins, and equity aspects, followed by quality assurance considerations. For all topics, negative health impacts are already occurring. However, the magnitude of the impacts cannot yet be accurately quantified. In this presentation, we will discuss the results of this assessment and explore the pros and cons of being part of a sector-wide process.
Establishing disease models for the Belgian national burden of disease study: challenges and perspectives
Authors: Nayani S , Devleesschauwer B , Claerman R , De Pauw R
Published: October 2024

The Belgian national burden of disease study (BeBOD) was launched in 2022, and currently provides disease burden estimates for 38 key diseases. The calculation of the non-fatal component of the disease burden, the Years Lived with Disability (YLD), follows a stepwise approach that aims to establish priority outcomes; quantify prevalence “best estimates”; establish disease models; and perform expert evaluation of methods and results. The disease models visualize the relationship between the different health states associated with a given outcome. Health states include the different acute and chronic stages of the outcome (including complications), which may be stratified in different severity levels (e.g., mild, moderate, severe). Disease models used in burden of disease studies primarily aim to document the considered health states, and do not aim at a representation of the complete clinical picture of the condition. The disease models instead help in understanding how the number of cases for each health state is calculated. Models typically start with one “parent node”, which contains all cases. This parent node then gives rise to multiple “child nodes”, with the terminal child nodes representing the individual health states. In BeBOD, disease models and severity distributions are adapted from the Global Burden of Disease (GBD) study, and complemented with local data where possible. This process ensures consistency with available disability weights, while still allowing for local data to feed into the calculations. In this presentation, we will demonstrate the BeBOD process for establishing disease models based on a number of archetypical examples, which represent varying challenges linked to disease model complexity, clarity and completeness of the GBD disease model documentation, and availability of local data. Future perspectives will be discussed, including the improved leveraging of local clinical data, and the implementation of tailored active data collection.
6.I. Round table: Strengthening preparedness for public health emergencies: lessons learned and future perspectives
Authors:   Organised by: ECDC,   Chair persons: Sara Mazzilli (France), Ebba Rosendal (Portugal)
Published: October 2024

In the face of intensifying global health threats, robust health security measures in Europe and worldwide have never been more pressing. The COVID-19 pandemic has underscored the critical need for coordinated action, adaptive strategies, and robust collaborative mechanisms to effectively respond to emerging infectious diseases and other public health emergencies. This workshop serves as a platform to examine the multifaceted landscape of health security actors, focusing on collaborative initiatives and lessons learned from recent crises. By convening experts and stakeholders from across Europe, the workshop aims to achieve several key objectives:

i) To provide an overview of collaborative initiatives established to strengthen European and international health security. By showcasing successful models of cooperation, participants will gain insights into effective strategies for fostering collaboration among diverse stakeholders.

ii) Emphasize the role of European and international institutions, such as the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO), in supporting states both in coordinating regional response efforts and in developing the necessary health workforce competencies and capabilities to respond to health emergencies.

iii) Drawing on experiences from recent health emergencies, including outbreaks of high-risk pathogens, such as Ebola, the workshop will facilitate a critical examination of lessons learned. Through interactive discussions, participants will identify challenges, best practices, and opportunities for enhancing preparedness and response capacity.

iv) By interactive presentations and panel discussions, the workshop will provide a platform for knowledge exchange and networking among participants. By sharing experiences, expertise, and innovative approaches, participants will contribute to a collective understanding of the challenges and opportunities in strengthening health security.

This workshop seeks to illuminate key strategies, capacity-building efforts, and real-world lessons learnt that contribute to enhancing response capabilities to public health emergencies. Participants will gain a deeper understanding of emergency participation mechanisms, essential skills required, and available training resources to enhance preparedness.

Key messages

• Collaboration and adaptive strategies are essential for strengthening international health security in the face of emerging infectious diseases and other public health emergencies.

• Lessons learned from recent crises provide valuable insights into effective response strategies and opportunities for enhancing preparedness and response capacity.
Enhance physical, mental and academic wellbeing of pupils in Germany through digital health literacy
Authors: Renninger D , Stauch L , Fischer L , Hartmann A , Rangnow P , Dadaczynski K , Okan O
Published: October 2024

Background

Digital health literacy (DHL) involves the ability to find, understand, appraise, and apply health information from digital sources. It serves as the foundation for informed decision-making about one’s health and well-being using digital technology and online health information sources and services. Despite its significance, the role of DHL in relation to schoolchildren’s wellbeing remains underexplored. Therefore, this study aims to investigate how schoolchildren’s DHL influences their physical, mental, and academic well-being.

Methods

The cross-sectional survey comprised a representative sample of N = 1448 school-aged children (9-18 years) living in Germany. DHL was assessed via a translated and adapted version of the DHL instrument. The assessment of physical, mental, and academic well-being relied on the KINDL questionnaire. Linear regression analyses were conducted, with the scale score of physical, mental, and academic well-being serving as dependent variables and DHL as predictor. Additionally, potential confounding variables such as sex, age, migration background, subjective family wealth, chronic illness, and subjective health status were included in the analyses.

Results

All three regression models were significant (physical: F(9,1325) = 34.99, p < .001; R2 = 0.19; mental: F(9,1320) = 27.43, p < .001; R2 = 0.16; academic: F(9,1336) = 15.19, p < .001; R2 = 0.09). DHL significantly predicted physical (B=.08, p=.01), mental (B=.17, p<.001), and academic (B=.21, p<.001) wellbeing.

Conclusions

This study provides the first evidence of the predictive power of DHL for schoolchildren’s physical, mental, and academic well-being. It emphasizes the importance of promoting DHL in schoolchildren to empower them to find, understand, appraise, and apply digital health information effectively.

Key messages

• Digital health literacy significantly predicts schoolchildren’s physical, mental, and academic well-being.

• Promoting digital health literacy can empower schoolchildren to make informed decisions about their well-being.
Limited critical and communicative health literacy is related to poorer health among older adults
Authors: Svensson P , Agerholm J , Wångdahl J
Published: October 2024

Background

Health literacy-related challenges are expected to increase with age due to a discrepancy between individual capacity and health care demands. Knowledge about associations between health literacy and age-related health outcomes among older adults is scarce. This is important to address and promote optimal health in older adults. The study aims to investigate the association between health literacy and health status among older adults and explore differences between the younger old and the oldest old adults.

Methods

Cross-sectional study using SWEOLD population-based data from 2022, a national representative sample of people 77+ years in Sweden. Univariate and multivariate logistic regression analysis assessed associations between communicative- and critical health literacy and health outcomes. Models were adjusted for age, sex, and socioeconomic status, and stratified by age.

Results

Significant adjusted associations were found between inadequate and problematic health literacy and less than good self-rated health (OR 2.64, 95%CI: 1.61-4.33; 2.11, 95%CI: 1.40.3.17), and requiring assistance with medicine management (OR 5.26, 95%CI: 2.67-10.38, 2.14, 95%CI 1.08-4.22). Among the younger old (77-84 years) inadequate and problematic HL was associated with having lifestyle-related conditions (OR 1.77, 95%CI: 1.07-2.93, 2.75, 95%CI: 1.33-2.71). Among the oldest old (85+), inadequate health literacy was associated with higher likelihood of poor activities of daily living (ADL) (OR 4.48, 95%CI: 1.99-10.07) and frailty (OR 3.51, 95%CI: 1.43-8.47). Level of frailty increases earlier in age for individuals with limited HL than among those with sufficient HL.

Conclusions

Limited health literacy is a prevalent issue in the older population and is associated with negative health-related outcomes. To mitigate development of poor health and frailty and to promote healthy ageing, care organisations need to meet the needs of this population in a health literacy friendly way.

Key messages

• Limited health literacy among the older population is associated with several negative health-related outcomes.

• Care organisations need to work actively to mitigate the development of poor health while promoting healthy aging among the older population in a health literacy-friendly and age sensitive manner.
Socioeconomic And Mental Health Challenges: Lessons From The COVID-19 Era
Authors: Melchior M , Hecker I , Roversi A
Published: October 2024

The relationship between work arrangements, financial difficulties, compliance with COVID-19 sanitary measures, and preexisting mental health issues amidst the ongoing pandemic is multifaceted. By merging data from the TEMPO cohort and other European cohort studies during the RESPOND European project, we seek to provide comprehensive about these dynamics for developing targeted interventions and policies aimed at mitigating the adverse impact of pandemics on mental well-being. Our analyses reveal significant associations between unemployment, financial strain, and elevated levels of symptoms of anxiety and depression during the COVID-19 pandemic. Even after controlling for pre-pandemic socioeconomic and mental health factors, individuals experiencing unemployment or financial difficulties were more likely to report heightened mental distress. Additionally, our findings highlight gender-specific patterns in compliance with COVID-19 sanitary measures, with women exhibiting increased compliance amidst mental health difficulties, while men, particularly those with lower educational attainment, demonstrated decreased compliance. These preliminary results underscore the complex interplay between socioeconomic factors, mental health, and public health behaviours during pandemics. In conclusion, our study underscores the urgent need for targeted interventions and strategies to address the intersecting challenges of mental health, employment, financial strain, and compliance with public health measures during the COVID-19 pandemic. The findings emphasize the importance of considering socioeconomic disparities in designing effective interventions aimed at promoting public well-being and resilience in the face of future pandemics. By leveraging these insights, public health practitioners and policymakers can develop evidence-based approaches to support individuals and communities experiencing heightened vulnerabilities during times of crisis.
The association between electronic media use and quality of life (QoL) in Norwegian adolescents
Authors: Kleppang A L , Stea T H , Bonsaksen T , Leonhardt M , Lien L , Steigen A M
Published: October 2024

Background

The use of screens, especially mobile devices like tablets and smartphones have increased over the last years and have become an integrated part of modern life. Adolescents today spend a lot of their time using screens both at school and outside school. Identifying how screen use are related to QoL is necessary to plan effective policies and interventions in adolescence since it is the period where different behaviours are adopted. The purpose of this study is to examine the association between electronic media use and quality of life (QoL) among adolescents.

Methods

This study was based on self-reported cross-sectional data from the Young-Hunt4 study, conducted in 2017-2019. The target group comprised 8066 13-19 years old adolescents. QoL was measured with the Norwegian version of the Inventory of Life Quality (ILC). The ILC scale consists of seven items with four response alternatives. Electronic media use was measured using the two variables Social media use and Gaming. Multiple linear regression was used to analyse the association between gaming, social media use and QoL.

Results

Preliminary results showed an inverse association between gaming (>3 hours per day) after school and quality of life (β: -.07, p < 0.001) and social media use (>3 hours per day) after school and quality of life (β = -.06, p < 0.001). Similar inverse associations were observed between gaming (>3 hours per day) in the weekend and quality of life (β: -.09, p < 0.001) and social media use (>3 hours per day) in the weekend and quality of life (β = -.04, p = 0.002). These associations remained significant after controlling for gender, age, family economy, psychological distress and having friends.

Conclusions

More than three hours on screens per day after school was negatively associated with QoL. Hence, public health policy and practice should pay attention to consequences of screen time use in adolescence. Additional research is needed to further explore these associations.

Key messages

• More frequent use of electronic media is negatively associated with QoL.

• Public health policy and practice should pay attention to screen time in adolescence and its association with QoL.
‘We do not include tests and treatment for those [STI] conditions’: the trouble in navigating access and care for STIs among gay, bisexual men and transgender and other MSM in Kenya and Rwanda
Authors: Igonya E , Muga W , Azubuike P , Stojanovski K
Published: October 2024

Background

Lesbian, gay, bisexual men, and transgender persons (LGBT) in Kenya and Rwanda have a hard time accessing healthcare, in particular sexual health screening. We used a social norms and values framework to examine determinants of access to healthcare, with specific attention to sexual healthcare.

Methods

We draw on cross-sectional mixed methods research in Kenya and Rwanda that examined the lived experiences of sexual and gender minorities in access to health services. A cross-sectional quantitative survey in Rwanda (n = 499) and Kenya (n = 1,550) was conducted with LGBT people. We conducted key informant interviews (n = 81), in-depth interviews (n = 48), digital storytelling (n = 3), and focus group discussions (n = 30). We used a mixed-methods thematic and content analysis to integrate quantitative and qualitative findings.

Findings

Accessibility and quality of care were the main barriers to healthcare services. The results indicate widespread discrimination and stigma toward LGBT people in service provision. Approximately half of the survey participants, 47%, reported challenges accessing health services, and 25% indicated they experienced discrimination in healthcare. Qualitative results link low quality of care to stigma and discrimination. “Mostly at the hospitals, there are times people take too much time discussing who we are instead of giving us the treatment we seek, and send us to mental health to first deal with our sexuality issues since they think it is a ‘sickness.’” (Focus group, Muhanga, Rwanda). Our study highlights challenges in navigating sexual healthcare in government, faith-based, and donor-funded health facilities.

Conclusions

Access to healthcare services, particularly sexual health screening and prevention, is a growing issue for LGBT people in Kenya and Rwanda. Stigma acts as a significant barrier to high-quality healthcare. Sensitivity training and educational opportunities for healthcare professionals are urgently needed to address stigma.
Informing healthy urban policy making through quantitative health impact appraisal – a co-designed approach
Authors: Hunt A , Eaton E
Published: October 2024

Quantitative health impact appraisal for land use development is currently challenging. We show how a co-designed process between urban decision makers and academics can help to improve ways of deriving evidence for creating healthier cities. The Health Appraisal of Urban Systems (HAUS) economic valuation model was developed with local partners to inform a strategic framework for a UK urban regeneration site. HAUS is a comparative risk assessment model which allows the user to understand mechanisms for change through applying an impact-pathway approach to quantify changes in health. It is informed by systematic reviews of epidemiology and societal costs of 85 individual health end-points. Scenarios combined a range of characteristics including air and noise pollution, green space, crime, walkability, food environment and transport. Health outcomes include morbidity and mortality impacts. Results show the value of a holistic approach to comparing health risks in designing urban living. By monetising outcomes, practitioners were able to understand the relative magnitude of risk within a specific area and compare alternate urban development scenarios. Compared to an unmanaged development, the Strategic Framework can mitigate health risks by improving safety and quality of the public realm and add health benefits by encouraging activity and active commuting. Flood risks are managed, and green infrastructure improved and extended. These benefits extend to communities outside the site boundaries. Over 25 years, the PV benefits are £60 - 80 million in averted health costs. Strategic planning for urban areas can unlock the potential of the public realm to tackle health inequalities and mitigate serious risks to public health. Timely access to quantitative information on health can help inform understanding of unhealthy environments, strengthen arguments for good design, reinforce capacity of planning teams and so improve the quality of urban developments.

Speakers/Panelists

Odile Mekel

NRW Centre for Health, Bochum, Germany
eHealth profile and care coordination of primary care physicians
Authors: Jendly M , Santschi V , Tancredi S , Chiolero A
Published: October 2024

Background

Digital health or eHealth is a vast field encompassing mobile health (mHealth), health information technology, wearable devices, telehealth, and telemedicine, and is changing the practice of medicine. While it holds promise for enhancing care coordination, its adoption is hindered by various barriers, including at the healthcare professional level. We assessed the eHealth profile of primary care physicians and its relationship with care coordination.

Methods

As part of the Commonwealth Fund 2022 IHP survey of primary care physicians, 1114 physicians in Switzerland completed a questionnaire on their digital health use, and care coordination practices. Based on their responses, we built a digital health score, summarizing physicians’ use of digital health tools, and a care coordination score. Associations between both scores were assessed using stratified analyses and multiple linear regression.

Results

Among 1114 participants (46% women, mean age 52), 83% used electronic patient records, 96% used teleconsultations for less than 5% of consultations, and 63% never used connected health tools for the monitoring of patients with chronic diseases. A total of 16% allowed for online appointments, 20% for online medical prescriptions, 52% for communicating electronically lists of medications with other healthcare professionals, and 89% the possibility of e-mail or web communications with the patient. The eHealth score was positively associated with the number of weekly working hours, being an internal medicine specialist or practicing physician, the number of full-time equivalents in the practice, and with being in a group practice setting. The higher the eHealth profile score, the higher was the care coordination score.

Conclusions

Physicians’ use of digital health tools was positively associated with care coordination. This could underscore the potential benefits of digital health in enhancing collaborative and interprofessional care practices.

Key messages

• In a large survey of primary care physicians, the use of digital health tools and care coordination were correlated.

• Digital health could enhance collaborative and interprofessional care practices.
Machine Learning powered Patient Records Analysis for Injury Monitoring in Children and Adolescents
Authors: Zysset A , Feer S , Saaro F M , Bächli M , Niemann S , Meier D , Seiler M , Bogojeska J , Dratva J
Published: October 2024

Background

Injuries to children and adolescents are common and are associated with individual suffering and costs. Switzerland lacks data of injuries in children and adolescents. This study investigates the feasibility of utilizing machine learning (ML) methodology to automatically extract relevant data from electronic pediatric patient records needed for monitoring and prevention purposes.

Methods

The feasibility study follows three steps. 1. Utility evaluation of text data from electronic pediatric patient records regarding ML, injury monitoring and prevention requirements in a test-sample. 2. The development of an ML-based approach to extract relevant information based on electronic pediatric patient records (N = 30’884) of children treated for injuries at the University Children’s Hospital Zurich emergency department between 2018-2022. 3. The performance of the ML methodology is evaluated.

Results

Qualitative and ML expert assessment of the sample showed that the desired data on injuries is contained in the test-sample and necessary requirements are met. Data records differ in detail with severe injuries providing especially rich information records. The international IDB code-tree was proved to be too elaborate and adult-orientated and was adapted. Preliminary data analyses indicate that the number of accidents is highest in the age group from 0 to 4 years (36%). More male (58%) children were treated. Majority of accidents were classified as less severe (73%), few (<1%) as very severe. Further lessons learned, along with more detailed prevalence data on injuries in children and adolescents, will be available by August 2024.

Conclusions

Extraction of injury information from electronic patient record by means of ML may provide valuable information for injury monitoring and prevention, so far missing in Switzerland. Prerequisites for the successful application of ML are digital record access, usable coding-tree, and detailed text input by the emergency departments.

Key messages

• An ML-based approach has the potential to improve the data basis by extracting valuable accidents information from existing texts of patient records.

• To successfully apply this method, digital record access and detailed text data are needed.
Noise inequalities and cardiovascular diseases in Bulgaria
Authors: Tsanova D , Vitkova T S , Bankova E M , Ivanova B , Dimitrov D
Published: October 2024

Background

Social determinants of health in the physical environment are among the social determinants that greatly impact population health. At very high levels, noise can cause permanent changes in a person’s psyche but, even at lower levels, it can cause stress and disorders. Global burden of diseases studies arrange noise on the second position among the environmental risk factors, related to sleep disturbance, cardiovascular effects etc. The study aims to analyse noise pollution in Bulgaria and measure its association with cardiovascular diseases.

Methods

National Statistical Institute and Eurostat data were used to analyse the noise pollution in Bulgaria. The 28 regions were compared according to the proportion of surveyed points above permissible limits and the death rates due to CVD, /2022/. Data were statistically processed with SPSS v.26. To establish the correlation, the Pearson coefficient was used.

Results

Data provided by Eurostat reveal that 9% of the total population suffers from noise but there is a very positive trend - from 17.7% /in 2005/ to 8.7% /in 2023/. The share of surveyed points above permissible limits shows a continuing trend of maintaining a high percentage - 71.80% /2011/ and 68.62%/2022/. The district comparison shows significant variations - Blagoevgrad -17.65% and Silistra, Kyustendil and Razgrad with shares above 80%. The study found that almost all districts with the highest share of surveyed points above permissible limits have higher levels of death rate due to CVD. The results of statistical data analysis show that there is a positive moderate linear correlation between the share of surveyed points above permissible limits and the death rate due to CVD - Pearson coefficient 0.423 (p = 0.025).

Conclusions

The study found a moderate correlation between noise pollution and the death rate due to cardiovascular disease. CVD have a multifactorial genesis, but reducing noise in urban areas would help prevent these diseases.

Key messages

• As a result of the performed analysis, it can be concluded that the investigated indicators determining the degree of discomfort during the daily period remained high in Bulgaria.

• The established health inequalities between regions and the increasing mortality from CVD are one of the factors for the deteriorating level of public health in Bulgaria.
Burden and economic impact of PM2.5 exposure on Acute Myocardial Infarction in Portugal, 2011-2021
Authors: Madeira F , Corda M , Martins C , Perelman J
Published: October 2024

Background

Air pollution, specifically particulate matter with a diameter of 2.5 micrometers (PM2.5), is the primary environmental health risk in Europe. Exposure to PM2.5 increases the risk of cardiovascular diseases, including AMI, resulting in high direct costs associated with in-patient treatment. This study aims to estimate the avoidable and attributable disease and economic burden of AMI due to ambient PM2.5 exposure in Portugal between 2011 and 2021.

Methods

National databases were used to assess the annual number of hospitalisations and deaths due to AMI between 2011 and 2021. The annual mean costs were calculated using a direct cost analysis (bottom-up micro-costing) to assess the direct economic burden of AMI. In turn, these cases and associated costs were multiplied by the respective morbidity and mortality population attributable fraction (PAF) to estimate the number of hospital admissions and deaths, and their associated costs attributable to ambient PM2.5 exposure. For 2019 and 2021, an alternative scenario of exposure was considered (2021 WHO Air Quality Guidelines), and the avoidable morbidity and mortality costs were determined using the potential impact fraction (PIF).

Results

Between 2011 and 2021, there were 130,447 hospitalisations and 47,968 deaths due to AMI, with 4.79% and 28.90%, respectively, attributable to ambient PM2.5 exposure. This translates to a direct economic burden of morbidity of more than 44 million euros and mortality of almost 195 million euros. If the proposed scenario guidelines were met, 279 cases and 448 deaths would have been avoided in 2019, resulting in a savings of almost 9.7 million euros. In 2021, 93 cases and 355 deaths would have been avoided, with approximately 4 million euros saved.

Conclusions

Exposure to ambient PM2.5 significantly contributes to AMI cases and deaths in Portugal, imposing a significant economic burden. These findings highlight the urgent need for measures to improve air quality.

Key messages

• PM2.5 pollution in Portugal drives AMI cases and fatalities, entailing significant economic costs.

• Adhering to WHO air quality guidelines promises substantial reductions in AMI incidence and save millions annually in healthcare expenditure.
Urban Exposome and Health
Authors: Jeong A , Kyriakou K , Kasdagli M I , Janc M , Vlaanderen J , Huss A , Katsouyanni K , Tonne C , Polanska K , Probst-Hensch N
Published: October 2024

Background

The environment in which we live is thought to explain 70% of the non-communicable disease burden. The aim of EXPANSE project (funded from the European Union Horizon 2020 research and innovation programme under grant agreement No 874627) is to evaluate the optimal strategies for maintaining health in the context of contemporary urban environments. As a component of the project, Urban Labs allow deep phenotyping of the urban exposome and assessing its use and perception. The Urban Labs aim to improve exposure assessment, identify mediating and modifying lifestyle factors, and link the urban exposome to intermediate endpoints relevant for cardiometabolic and pulmonary health.

Methods

By monitoring the activities of 4,000 individuals in five distinct urban areas, Urban Labs provide a comprehensive understanding of the urban exposome, which can be compared with residential address-based model estimates. The participants complete a baseline questionnaire, repeated bi-monthly questionnaires and exposure-specific questionnaires over a period of 2 years using mobile phone application (ExpanSeeker). Two-week personalized measurements including spatial-temporal activity patterns, sensor-based environmental and behavioral measurements, and minimally invasive biological sample collection are performed covering different seasons.

Results

The Baseline Questionnaire (BQ) and two-weeks measurement campaigns (MC) were completed in European cities as follows: Athens BQ = 379, MC = 232; Barcelona BQ = 1040, MC = 303; Basel BQ = 731, MC = 655; Lodz BQ = 634, MC = 100; The Netherlands (multicity) BQ = 1033, MC = 326. Data collection process is ongoing.

Conclusions

The collection of novel data on individuals activities and perceptions within temporal and geographical contexts in Urban Labs will contribute to a more comprehensive understanding of how the urban dwellers are exposed to and interact with their environment, thereby supporting healthier urban engineering and policy making.

Key messages

• Urban Labs will provide a more comprehensive understanding of the impact of the urban environment on individual’s behavior, their exposome, enabling more accurate prediction of non-communicable risk.

• Urban Labs will provide a base to support healthier urban engineering and policy making.
Dietary trajectory profiles of French adults over time: Multicriteria analysis of sustainability
Authors: Toujgani H , Berlivet J , Berthy F , Allès B , Fouillet H , Touvier M , Lairon D , Mariotti F , Baudry J , Kesse-Guyot E
Published: October 2024

Despite the urgent need for sustainable dietary transitions, few studies have examined current dietary trajectories using longitudinal data. This study aimed to identify dietary consumption trajectory profiles over an 8-year period (2014-2022) while assessing their sustainability in a multicriteria approach. Consumption data from NutriNet-Santé cohort participants were collected using FFQs in 2014, 2018 and 2022. Dietary trajectory profiles were modeled using group-based multi-trajectory based on factors from Principal Component Analysis on energy-adjusted consumption data (n = 17,187). Profiles were analyzed for sustainability (environmental and nutritional dimensions) using multi-adjusted mixed-effects models. Six trajectory profiles (P) were identified. P0 (considered as reference) had average consumption for all food groups, with increased plant-based intake over time. In comparison, P1 had the highest baseline alcohol (+301%) and offal intake, increasing processed meat (+74%) and decreasing offal over time. P2 had higher milk (+187%) and sweet drinks intake, increasing animal substitutes (+1737%) and whole-grain products. P3 had higher nuts (+680%) and legumes intake, increasing egg (+166%) and reducing fruit juice. P4 had high fish (+39%) and fruit intake, increasing butter (+53%) and reducing alcohol. P5 had higher pork (+143%) and red meat intake, increasing fish (+31%) and reducing dairy. Initially, P3 and P4 had the lowest GHG emissions (-18%, -49% vs. P0), best nutritional profiles, and higher organic food consumption. P5 had the greatest environmental impact (+51%) and the lowest nutritional scores. Over time, P0 reduced GHG emissions and improved nutritional scores. P3 and P4 showed minimal changes, while P5 had the greatest GHG emissions decrease (-14%) and nutritional quality improvements. Identifying ongoing dietary transition trajectories, our findings contribute to optimizing targeted actions aimed at promoting sustainable dietary consumption habits.

Key messages

• Regardless of initial dietary preferences, French adults exhibit an overall trend over time towards increased intake of plant-based foods and decreased intake of red meats, at varying scales.

• French adults exhibit varying degrees of transition towards more sustainable diets, with an overall decrease in GHG emissions from food consumption and an improvement in their nutritional profiles.
Scaling up joint efforts to tackle cardiovascular diseases and diabetes in Europe
Authors: Armocida B
Published: October 2024

JACARDI, a Joint Action on cardiovascular diseases (CVD) and diabetes (DM), aims to support EU countries in reducing the burden of CVD and DM and related risk factors, both at individual and societal levels, while ensuring health systems sustainability and equity. In particular, JACARDI aims to implement best practices and pilot testing of innovative practices throughout the entire patient journey. Commencing by improving health literacy and raising awareness among general and target populations, moving through primary prevention and screening of CVD and DM among high-risk populations, and then address people living with CVD and DM and their health service providers, through the improvement of service paths and (self) management, including through digital tools, and completing the path by supporting and encouraging the labour participation of people living with these diseases. With 21 European countries and 76 partners engaged, JACARDI undertakes 142 pilot projects, promising to advance CVD and DM care for millions across Europe. In particular, through an innovative Work Package on methodology, JACARDI will develop and implement a methodological framework to guide all the pilot projects in the design, preparation, implementation, monitoring, reporting, and assessment processes. This framework will encompass transversal and intersectional aspects, ensuring a harmonized and efficient approach for all JA activities. Through rigorous and multidimensional evaluation, JACARDI aims to uncover new approaches to enhance healthcare systems, grounded in evidence-based practices and current needs, while adopting the lens of equity and sustainability throughout the entire methodological and implementation process.