bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term outcomes in women diagnosed with heart failure in connection to delivery
Authors: Toska F , Thunstrom E , Schaufelberger M , Rosengren A , Pavdic A , Fu M , Basic C
Published: October 2024

Background

Heart failure (HF) among young patients may be from various causes, often triggered by heightened physical demands like pregnancy. Data regarding outcomes of women diagnosed with HF in conjunction to pregnancy and delivery are varied. There remains a notable gap in understanding the outcomes observed in women diagnosed with heart failure in conjunction with delivery. Also, long-term follow-up studies are crucial to elucidate the impact of pregnancy-associated HF on future cardiovascular.

Purpose

To study the interplay between pregnancy, HF, and subsequent cardiovascular risk.

Method

Using the personal identification numbers (PINs) that all individuals in Sweden have enables linkage of data between different registers. Data from the National Patient Register (NPR), Swedish Medical Birth Register (MBR) and the Cause of Death Register were also used. All women 18 to 50 years of age registered in the in MBR in the period 1st January 1997 to 31st December 2019 were included. Women with first-time HF in relation to delivery were identified using the international classification code for diseases (ICD-10) I50, I42, I43 and 090.3 together with co-morbidities. Every patient was compared with 5 controls without HF from the Total Population Register matched on age at delivery and calendar year of delivery. Outcomes: all-cause mortality, and any cardiovascular disease (CVD) diagnosed during the observation time.

Results

A total of 286 cases and 1,430 controls were included. The prevalence of comorbidities at baseline for both patients and controls was low; congenital heart disease (1.4%, vs. 0%), pulmonary hypertension (1.0% vs. 0%), valvular heart disease (5.9% vs. 0%), myocardial infarction 0.7% vs. 0%), arrhythmia (5.9% vs. 0%), hypertension (6.3 % vs. 0.1%), (all p<0.05). Preeclampsia prior to HF diagnosis had 31% of patients vs. 0.2% of controls (p<0.001). Patients exhibited higher mortality rates at 4.9% during median follow up 9.0 (IQR 5.6-13.0) years vs. 0.3%, median follow up 9.4 (6.2-13.5) years and hazard ratios (HR) for all-cause mortality HR (95% CI) of 18.20 (5.99 - 55.31) (p<0.001) compared to controls. During median follow up of 3.2 (0.0-9.2) years 60.1% of patients were diagnosed with CVD both at in-/out-patient settings compared with 4.1% in controls during 9.4 (5.8-13.5) years of follow up. Comparing patients with controls the HR (95% CI) was 22.24 (16.50 - 29.96) p<0.0001 for CVD diagnosis during follow-up, see Figure 1.

Conclusion

In conjunction with delivery, and in the years thereafter, women with heart failure diagnosis had more than eighteen times higher risk of mortality than women without heart failure. The risk of CVD event in the heart failure group is highest in conjunction with delivery.

Figure 1. Cumulative incidence functions for all-cause mortality, CVD in- or out-patient visit adjusted for death as competing risk, comparing cases with controls.
Resting heart rate and outcomes in patients with heart failure: impact of AF from the Thai-Heat Failure Registry (THFR - HRAF study)
Authors: Ariyachaipanich A , Chantrarat T , Chirakarnjanakorn S , Boonyaratavej-Songmuang S , Kanjanavanich R , Wongtheptien W , Thundee C , Chichareon P , Krittayaphong R
Published: October 2024

Introduction

Heart rate (HR) is a significant prognosis factor and target of the treatment in patients with heart failure (HF) but this relationship in heart failure patients with atrial fibrillation (AF) is uncertain.

Methods

A total of 2,996 patients with HF were enroll in the Thai-Heart Failure registry between 2023 to 2024, from 37 heart failure clinics in Thailand. Patients were classified by resting HR and whether having AF or not. The primary outcomes are all-cause death and/or HF. The continuous prognostic relationship and interaction were determined by Cubic-spline model.

Results

Total of 2,932 patients with available resting heart rate and AF status were analyzed (mean age 59.3±14.5 years, 67.9% male, mean LVEF 31.9%, 12.4% having AF). There were 273, 1,497, 895 and 267 patients have HR <60, 60-80, 80-100 and >100 bpm, respectively. From the lowest HR to the highest group, the all-cause death and/or HF were 16.5%, 10.4% 13.7% and 14.0%. Interestingly, the patients in the lowest, high and highest HR group were associated with poorer outcomes when compared to patients with normal HR (60-80 bpm). (p <0.001, 0.004 and 0.033, respectively). There were no statistic significances in patient with LVEF >40% (p= 0.37, 0.48 and 0.41, respectively). The hazard ratio is lowest between 64 to 91 bpm. The relationship is the same in patient with AF (p for interaction 0.071) but higher hazard ratio at any giving heart rate.

Conclusion

The normal heart rate (between 60-80 bpm) is associated with the best outcomes, not lower is better. HR is a significant prognosis factor whether having AF or not. The relationship is mainly in patient with HFrEF.Figure
Relationship between 3-dimensional aortic geometry and the risk of new-onset heart failure
Authors: Beeche C , Dib M J , Azzo J D , Maynard H , Salman O , Witschey W , Chirinos J
Published: October 2024

Introduction

Aortic geometric assessments to date have typically involved cross-sectional imaging of discrete aortic segments. However, the complex 3D geometry of the thoracic aorta, and its relationship to the risk of cardiovascular disease has not been assessed in large studies.

Methods

We segmented the thoracic aorta in SSFP axial MRI images from 49,282 UK Biobank participants using a deep convolutional neural network (U-Net). We then computed geometric measurements (centerline length, arch height, arch width, arch height-width ratio, arch unfolding index [inverse of tortuosity], curvature and mean, minimum and maximum diameters) in the overall thoracic aorta as well as in 6 subsegments. We quantified their relationship to the risk of cardiomyopathy and heart failure (HF) using multivariable Cox-proportional hazards models. All hazard ratios are standardized. Centerline length was allometrically indexed to body height.

Results

In models adjusted for age, sex, BMI kg/m2, low-density lipoprotein mg/dl, high-density lipoprotein mg/dl, triglycerides mg/dl, systolic blood pressure and diastolic blood pressure, the curvature of the aorta (HR=0.63; 95% CI=0.39, 0.99; P<0.05), particularly the aortic arch (HR=0.54; 95% CI= 0.35, 0.87; P<0.05) was strongly related to a lower risk of incident cardiomyopathy. A higher arch unfolding index (HR=1.46; 95% CI=1.03, 2.07; P<0.05), higher width-to-height ratio (HR=1.10; 95% CI= 1.02, 1.19; P<0.05) and lower aorta tortuosity (HR=1.20; 95% CI= 1.09, 1.32; P<0.05) were all associated with a higher risk of cardiomyopathy. This aortic geometric pattern was also associated with a greater risk of a new HF diagnosis (arch unfolding [HR=1.23; 95% CI= 1.07, 1.42; P<0.05], width to heigh ratio [HR=1.06; 95% CI= 1.01, 1.11; P0.05]).

Conclusion

We demonstrate that 3-D thoracic aortic geometric indices are strongly associated with incident cardiomyopathy and HF, independent of classic risk factors. This is likely related to abnormal afterload and ventricular-arterial interactions since adverse geometric remodeling affects left ventricular pulsatile load.Cardiomyopathy & Heart Failure Hazards
Electrocardiographic markers of depolarization and repolarization in lead V1 predict right ventricular dysfunction in patients with heart failure
Authors: Moldovan M P , Eotvos E A , Coseriu G , Burde A , Avram T , Lazar R D , Zehan I , Sarb A , Mocan L , Blendea E D , Tentea P , Gusetu G , Pop S , Blendea D
Published: October 2024

Background

Right ventricular (RV) dysfunction is an important predictor of survival in patients with heart failure (HF) with both preserved (HFpEF) and reduced ejection fraction (HFrEF). To date there is limited data on the value of the electrocardiogram in predicting RV function.

Purpose

Given these considerations the aim of our study was to assess the possible relationship between several electrocardiographic (ECG) parameters and right ventricular function evaluated by echocardiography.

Methods

We included 109 patients (age 61±14 years, 68men) of whom 89 had HF (HFpEF N=62 and HFrEF N=27) and 20 patients without HF. Twelve-lead ECG and echocardiograms were performed in all patients. We assessed echocardiographic parameters of global and regional RV function.

Results

Time to Intrinsicoid deflection in lead V1 (TID-V1) and the QTc interval measured in lead V1 (QTc-V1) were significantly more prolonged in patients with HF vs. patients with no HF (36±24ms vs. 23±15ms; p=0.03, and 450±40ms vs. 427±20ms; p=0.047 respectively).

TID-V1 correlated significantly with the tricuspid annulus systolic excursion (TAPSE) and RV fractional area change (FAC; r=-0.31; p=0.02, and r=-0.35; p=0.029 respectively). QTc-V1 correlated with parameters of global and regional RV function including FAC, RV apex longitudinal strain, RV free wall strain, and global RV strain (r=-0.42; p=0.0004, r=0.35; p=0.0032, r=0.21; p=0.045, and r=0.41; p=0.0005).

RV dysfunction as defined by RV-FAC<35% was predicted by TID-V1 > 30ms with a sensitivity of 61% and specificity of 75%; AUC=0.752 and by QTc-V1>440ms with a sensitivity of 80% and specificity of 57%; AUC=0.888, and by a multivariate logistic regression model that also included TID-V1 and QTcV1, age, TAPSE, and LV ejection fraction with an AUC=0.967 (Figure).

Conclusions

Lead V1 time to intrinsic deflection and QTc-V1 predict RV dysfunction independent of echocardiographic parameters of ventricular function in patients with HF.
2.H. Round table: Health system description and comparison: lessons from the WHO/Observatory Insights series
Authors:   Organised by: WHO/Europe, European Observatory on Health Systems and Policies,   Chair persons: Bernd Rechel (European Observatory), Natasha Azzopardi Muscat (WHO/Europe)
Published: October 2024

The European Observatory on Health Systems and Policies has been working for more than 25 years on the systematic description, analysis and comparison of health systems in Europe. This workshop explores experiences so far with a new series of health system profiles, the Health Systems in Action (HSiA) Insights, launched in 2021 in collaboration with the WHO Regional Office for Europe. The first round of the Insights in 2021 was a pilot series, covering just five countries (Georgia, Kyrgyzstan, North Macedonia, Ukraine, and Uzbekistan). Since then, the series has grown to 13 countries in 2022 and in 2024 is covering almost all WHO Member States that are outside of the European Union (EU). The Insights aim to provide short and easily accessible documents that provide core information on a country’s health system, its key strengths and challenges, how it compares to other health systems in Europe, and how it impacts on the health of its population. This roundtable provides a platform for sharing experiences with devising, writing and using the series so far, bringing in country and comparative perspectives and involving the audience. The objectives of the roundtable are to a) identify best practices for the comparative description and analysis of health systems in the form of a series of country profiles; b) explore the challenges of drawing up country profiles where comparative data are lacking, incomplete or politicized; c) identify ways of disseminating and using country profiles; d) establish an opportunity for cross-country learning and skills development for the writing of health system descriptions and analyses. The roundtable will consist of four speakers. It will start with three very brief country presentations on the Insights for Israel, North Macedonia and Kazakhstan, followed by a brief comparative perspective on how to capture, compare and analyse health workforce trends across a broad set of countries, which is the Spotlight section of the 2024 round of Insights. This will be followed by a broad discussion with audience interventions to bring in the experience of other experts and countries. The moderated discussion will emphasise key learning points on how to devise a comparative series, how to write health system profiles and how best to use them to inform health policy-making.

Key messages

• The regular monitoring of health systems and policies is challenging, but essential for improving them.

• Health system summaries require systematised approaches and up-to-date comparative data.

Speakers/Panelists

Ruth Waitzberg

Technische Universitat Berlin, Berlin, Germany

Yerbol Spatayev

WHO Country Office Kazakhstan, Astana, Kazakhstan

Simona Atanasova

WHO Country Office North Macedonia, Skopje, Republic of North Macedonia

Tomas Zapata

WHO/Europe, Copenhagen, Denmark
Seroprevalence and associated factors of toxoplasmosis in female children and adolescents in Germany
Authors: Giese L , Seeber F , Aebischer A , Kuhnert R , Schlaud M , Stark K , Wilking H
Published: October 2024

Background

Toxoplasmosis is a parasitic disease that causes a high burden of disease worldwide. Infections occur mainly through the consumption of undercooked meat or the ingestion of contaminated cat feces from the environment. In Germany, seroprevalence in adults is exceptionally high by international comparison (50%), which could be due to the frequent consumption of raw pork products. Comparable analyses for children and adolescents are missing but are needed to estimate the public health problem and to suggest countermeasures.

Methods

As part of the second wave of the representative German Health Interview and Examination Survey for Children and Adolescents (2014-2017), serum of 1,453 girls aged 3 to 17 years was tested for the presence of T. gondii IgG antibodies using enzyme linked fluorescence assay (ELFA). We calculated overall and stratified seroprevalence and used multivariable logistic regression models based on Directed Acyclic Graphs to identify associated factors. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) are being reported.

Results

Overall, 94 out of 1,453 girls tested positive for T. gondii resulting in a seroprevalence of 6.3% (95% CI: 4.7-8.0). With each year of life, the chance of being seropositive increased significantly by 1.2 (95% CI 1.1-1.3). A low social status (aOr 2.7; 95% CI 1.3-5.9) and living in rural (aOR 2.6; 95% CI 1.1-5.7) or urban (aOR 2.2; 95% CI 1.1-4.4) areas were found to be associated with seropositivity. No regional distribution patterns or differences between vegetarians and non-vegetarians were seen.

Conclusions

Six out of 100 girls become infected with T. gondii during the first 18 years of life. Independent risk factors identified in our study have also been associated with seropositivity in other countries. Meat consumption appears to have a reduced impact on the risk of infection in children and adolescents compared to adults, calling for different prevention strategies in this population.

Key messages

• Toxoplasmosis causes a high infection pressure for girls and young women in Germany.

• Transmission pathways might differ between age groups with more environmentally associated infections in children and adolescents.
Capacity mapping of comprehensive sexuality education in Gabon: A qualitative analysis
Authors: Koumba Maguena R J , Ngoungou E B , Van den Broucke S
Published: October 2024

Background

Access to comprehensive sexuality education (CSE) is crucial for adolescent health and well-being. Following UNESCO’s recommendations, Gabon revised its sex education policy in 2017 to better address adolescents’ sexual health needs. This study aims to map the capacities of the public health and education sector to implement Gabon’s CSE policy.

Methods

Semi-structured interviews were held with 15 professionals from ministries, NGOs, and development partners. Thematic analysis guided by Aluttis et al’s public health capacity model allowed to assess the existing capacities and gaps in leadership, organizational structures, partnerships, resources, and knowledge development for CSE.

Results

The implementation of CSE in Gabon is hindered by sociocultural and political factors, including the taboo on adolescent sexuality influencing perceptions of CSE content, natalist policies, and socio-economic disparities. Governmental involvement in CSE is limited to key ministries. Organizational structures for CSE lack cohesion due to changes in governance regimes and a lack of support for civil society organizations. Human resources are unevenly distributed, and financial constraints impede government initiatives, causing a strong reliance on external funding. An important role in supporting CSE is played by development partners and partnerships between stakeholders. While knowledge development for CSE is underway, monitoring and evaluation procedures are insufficient, and evidence mobilization by key professionals is insufficient.

Conclusions

Enhancing stakeholder collaboration, addressing structural constraints, and mobilizing human and financial resources are critical for effective CSE implementation in Gabon. Addressing these barriers requires coordinated efforts among stakeholders and addressing systemic challenges. This study provides insights for policymakers and practitioners to strengthen CSE programs and promote adolescent sexual health in Gabon.

Key messages

• CSE implementation is hindered by taboos on adolescent sexuality, natalist policies, and socio-economic gaps.

• Evaluation and evidence mobilization deficits limit effectiveness.
Visualizing science - the rise of graphical abstracts in public health journals
Authors: Vital Brito D
Published: October 2024

Background

As graphical abstracts (GA) gain popularity in scientific journals, they enhance visibility and engagement by summarizing research articles visually, while reaching both scientists and lay audiences more effectively. This study assesses the integration of GA in public health journals, focusing their role in enhancing scientific dissemination.

Methods

We conducted a descriptive quantitative analysis of 163 top-tier journals in Public Health, Environmental, and Occupational Health, using SCImago rankings. The analysis focused on factors such as mentions of GA and video abstracts (VA) in guidelines, mandatory use of GA, accessibility to GA, and adherence to GA’s best practices, which include graphical support, titles, and basic explanations.

Results

Of the journals analysed, 43 (26.4%) mention GA in their guidelines; only three (1.8%) require their mandatory use. Eight journals (4.9%) offer GA as part of paid promotional services, while 16 (9.8%) provide easy access to GA in their articles, and just six adhere to basic best practices. VA is mentioned in 25 journals (15.3%), with only nine (5.5%) featuring both GA and VA. Dedicated website sections for GA or VA are found in six journals (3.7%). Elsevier B.V. and Wiley-Blackwell are leaders in promoting GA usage, with 19 and nine mentions in guidelines, respectively.

Conclusions

The adoption of GA in public health journals is increasing, yet full adherence to best practices is not widespread. This trend points to a more visually engaging form of scientific communication, potentially influencing publication standards and research dissemination. The study underscores the need for further training in GA production and promotion among researchers and editors. Additionally, the emergence of GA as a paid promotional tool indicates a novel approach to broadening research outreach, with relevant implications for the standardization of scientific communication across Europe.

Key messages

• Only 26.4% of public health journals mention graphical abstracts, highlighting the need for wider adoption to enhance research visibility.

• Graphical abstracts boost engagement, but adherence to best practices remains low, underlining the need for better training in visual communication.
Communication of EU agricultural antibiotic use policies to farmers & implications for public health
Authors: Luke-Currier A , Moriarty E , Hodkinson T
Published: October 2024

Background

It is estimated that by 2050, ten million people will die each year from antimicrobial resistant infections. AMR is driven by the improper use of antimicrobials, particularly in agriculture. 73% of the antimicrobials sold globally are used in food-producing animals.

Problem

EU regulations 2019/6 and 2019/4 on veterinary medications and medicated feed require behavior change by farmers to reduce their antimicrobial use. While this is welcomed by public health professionals, the response of the farming community is more complicated, as these regulations exist within the complex context of the global food system and current political unrest between farmers and the EU. Given the influential role of agricultural media for farmers’ decision making, it is critical to understand how AMR and associated public health and EU policies are being communicated to farmers and how the views of specific stakeholders including farmer representative organizations, veterinary bodies and government regulators are being represented. To examine this problem, a case study content analysis of three major agricultural newspapers in Ireland is undertaken.

Results

Preliminary results suggest that AMR and AMU have been covered in the agricultural media with specific coverage on these EU policies. This includes negative coverage, with key terms such as “threatens”, “risk”, or “warns”, as well as potentially positive views (e.g. “hope”). Preliminary results also suggest that the agricultural media might be a useful source to identify the farming community’s concerns and reactions to EU policy, for example calls by farmer representative bodies for the national government to intervene.

Lessons

Public health professionals must recognize the important role of farmers in addressing AMR. Evaluating how EU policies on AMR are represented in the agricultural media can help to better understand how this public health issue and its solutions are being communicated to these important stakeholders.

Key messages

• Public health professionals must recognize the importance of animal health and the role of farmers in addressing the AMR problem.

• It is critical to evaluate how EU policies on AMR and associated One Health issues are communicated to non-public health professionals.
Global malaria vaccine research and community perception in Africa: a systematic review
Authors: Chutiyami M , Bello U M , Salihu D
Published: October 2024

Background

Malaria vaccine is one of the critical areas in tropical health research, considering the success recorded in other vaccine-preventable diseases. This review provides an overview of global malaria vaccine research and systematically reviews community perception of the vaccine in Africa.

Methods

A validated search was conducted to identify scientific literature on malaria vaccines in the Scopus database from 2005. Bibliometric indicators explored include publication/citation indices over time and the overall research themes using VOSviewer. A further in-depth search was undertaken in five databases to identify studies on community perception of malaria vaccine in Africa. Studies were screened, quality appraised, and narratively synthesized.

Results

6457 malaria-vaccine-related documents were found in 160 journals/sources from 189 countries/territories. There were 214,323 total citations, with 33.2 average citations per document and 167 documents’ h-index. The United States, United Kingdom and Australia combined produced more than 60% of the publication output. Six themes emerged from the global malaria vaccine research: Merozoite surface protein, characterization, trials, infant/children, traveler, and research/review. Twenty studies (n = 20) met the inclusion criteria for the systematic review. Overall perceptions of malaria vaccines varied in African communities (26.2-88.2%), in addition to higher willingness to accept the vaccines (32.3%-96.0%), poor knowledge/awareness (11%-60%) and misconceptions (19.2%-20.9%). Other issues identified include vaccine availability and logistics.

Conclusions

Malaria vaccine research and citations have increased considerably, mainly targeting vaccine development and safety/efficacy in Africa. African communities’ perceptions of the vaccine varied, with most of the population willing to accept the vaccine.

Key messages

• An increase in number of malaria vaccine research targeting vaccine development, and safety and efficacy in Africa.

• Varried malaria vaccine perception in Africa, including willingness to accept the vaccine, awareness, misconceptions, availability and logistics.
Health as predictor of unemployment. A population based study in Belgium
Authors: Van der Heyden J , Bruggeman H , Smith P
Published: October 2024

Background

Health and employment are interrelated, but this can be both the result of social causation and health selection. Insights in the association between health and employment should be explored in different settings and countries because contextual factors may differ. In this study we investigate if at the Belgian population level, ill health leads to a higher risk of unemployment.

Methods

We used data from the Belgian health interview survey 2018 linked with administrative data from the compulsory health insurance including information on employment status in 2018 and 2019. The sample for this study consisted of people with a paid job, aged 18-64 year, with no record of having being unemployed in 2018 (n = 3769). Multivariate logistic regression was used to assess if the risk of becoming unemployed in 2019 varied in function of the health status assessed in the 2018 survey.

Results

After adjustment for age, sex, education and social support, the risk of becoming unemployed was significantly higher for people with moderate to very bad self-rated health compared to those in good health (OR 2.76; 95% CI 1.34-5.67). Similarly, unemployment in the year following participation in the survey was significantly higher among people with activity limitations because of health problems (OR 2.32; 95% CI 1.14-4.72). The higher the number of chronic diseases and conditions, the higher the risk of unemployment (OR 1.37; 95% CI 1.13-1.53). Specific predictors of unemployment were a history of serious depression in the past 12 months (OR 4.47; 95% CI 1.85-10.80) and hypertension (OR 2.54; 95% CI 1.08-6.00).

Conclusions

In Belgium, health problems are a risk factor of getting unemployed. Especially people with a history of serious depression in the past year have a higher risk to lose their job. The findings confirm the health selection of unemployment and the need for the labour market to invest in interventions to support people with health problems to keep or find a job.

Key messages

• As employment is a fundamental right, also for people with health problems, further efforts are needed to create an inclusive labour market, with also job opportunities for more vulnerable people.

• To be able to understand better the link between health and unemployment at population level, longitudinal population data are needed including both dimensions.
Exploring Electronic Personal Health Record usage in Northern Italy: a cross-sectional study
Authors: Cataldo A , Scaioli G , Lo Moro G , Martella M , Scacchi A , Butnaru A M , Lodin M , Toffanin C , Bert F , Siliquini R
Published: October 2024

Background

The Electronic Personal Health Record (EPHR) is a patient-centered tool that enables citizens to manage their health information. The EPHR has been implemented worldwide, including in Italy, and holds immense potential, but it has shown a generalized underutilisation. Therefore, this paper aims to identify its fulfillment and the reasons behind its poor use, potentially uncovering the key to unlocking its benefits.

Methods

A survey was distributed on social media and in the waiting rooms of vaccination facilities in a Region of Italy. Multivariable regression models were conducted to detect a connection between the general population’s usage of the EPHR and specific independent variables.

Results

Of the 1634 respondents, 710 activated the EPHR, especially women, Italians, highly educated, unemployed, with good health but affected with chronic diseases. Amongst those who activated the EPHR, the multivariate analysis showed that the number of accesses to the platform was significantly associated with lower age (adjusted Odds Ratio (adjOR) 0.96 p = 0.015), higher level of education (adjOR 2.17 p = 0.029), unemployment (adjOR 5.61 p = 0.008) and considering the information on the EPHR complete (adjOR 3.83 p = 0.001). As age increases, the perceived ease of access to the EPHR decreases (adjOR=0.98 p = 0.049). Having a higher level of education (adjOR=0.41 p = 0.042), autonomy in reading health materials (adjOR=0.32 p = 0.043), and less self-confidence in filling out medical forms (adjOR=0.61 p = 0.033) were linked to a decrease in perceived ease of access.

Conclusions

The study showed that the EPHR is more utilised by specific categories of citizens, especially the young and those with higher education. More efforts should be made to increase access to the EPHR for the whole community by making it more intuitive and user-friendly. The present study provides valuable foundations to foster the implementation of a platform for sharing health data at a European level.

Key messages

• The Electronic Personal Health Record (EPHR) is underutilised despite its potential; it’s mainly accessed by young and highly educated individuals.

• Efforts to increase EPHR usage must focus on improving accessibility and ease of access, as well as enhancing user confidence and autonomy in managing health information.
Tracing applications for the control of virus dispersal - COVID-19 experience
Authors: Kalinowska-Beszczynska O , Wojtecka A , Tymosiewicz P
Published: October 2024

Tracing apps have been promoted as an effective tool for the monitoring and control of the spread of COVID-19. Although the correlation between the use of mobile tracking apps and reducing the spread of the virus has been demonstrated, the success of these apps depends on a number of factors, such as the number of app users, the rate at which new systems get adopted, as well as concerns related to anonymity and privacy. The aim of the research was to analyse the pattern of adaptation and use of a COVID-19 tracing app in the context of Polish society. The research used a qualitative approach, data were collected through focus group and individual interviews. The sample consisted of 34 respondents, aged 23-61, with different educational levels and backgrounds. The study followed two phases. First, a model with a set of questions was proposed on the basis of the unified theory of technology acceptance and use. Secondly, using the set of questions, interviews were conducted. In order to examine the data, thematic analysis was applied. To summarise the results of the survey, the respondents have clear expectations towards the app, which are not fulfilled. They are afraid of new technologies. However, they use them frequently and willingly without thinking about the security of their personal data. They expect applications to provide reliable information, but at the same time do not want to enter necessary data that they consider sensitive. They are negative about government actions without losing trust in government applications. It can also be speculated that a lack of information and understanding of the app may have contributed to some of the objections. In conclusion, we need to better understand users and be able to accommodate often conflicting characteristics in order to design more effective tracking applications in the future.

Key messages

• Technology offers ways to successfully prevent viruses from spreading.

• Getting the technology right, based on customer behaviour, is key to the effectiveness of tracking applications.
Physical activity and sedentarism among university students: an approach using a real-life survey
Authors: García-Lorenzo E , Visos-Varela I , Pintos-Rodríguez S , Salgado-Barreira A , Corral-Varela M , Figueiras-Guzmán A , Caamaño-Isorna F , Rico-Díaz J
Published: October 2024

Background

Evidence shows physical activity (PA) and sedentary behavior (SB) impact health-related outcomes. World Health Organization (WHO) provides PA guidelines for different life stages. A recent study revealed that engaging in SB > 6 hours/day increases all-cause mortality risk. Nevertheless many students spend a significant portion of their daily time on SB and PA levels are insufficient.

Methods

Students were selected by convenience sampling to complete a survey between October-November 2023. A validated PA questionnaire was included including PA Motivations and barriers. PA and SB were classified into 4 levels: Active but sedentary, extremely sedentary, physically active and discreetly active. Data were analyzed using Statistical Package for the Social Sciences (SPSS).

Results

Out of 2,216 surveys 1,648 were women, 568 men and 59.7% were in first university years. In our sample, 12.9% don’t do PA. Of those doing PA, 47.1% (n = 1043) don’t meet PA recommendations. Regarding SB, 84.7% spend >6 hours/day in SB. When grouped into PA/SB categories 40.5% were extremely sedentary in contrast to 8.8% physically active. Non-university facilities (41.1%) were preferred over university facilities (11.1%). Use of non-university and university facilities correlated with WHO compliance. Main barriers among inactive students were lack of time (48%) and lack of a workout partner (18.6%).

Conclusions

Most students don’t meet WHO guidelines. Less than 10% are considered active, while 40.5% are extremely sedentary. University sports facilities are underused even if linked to better compliance. To promote facilities as health-promoting spaces and investigate reasons for their underuse is necessary. Lack of company as a reason for not engaging in PA points out the need to strength university sports communities.

Key messages

• Although many students exercise, the majority do no meet World Health Organization recommendations.

• We must intensify university programs to promote physical activity and reduce sedentary behavior.
Traditional medicine use to manage hypercholesterolemia, hyperglycaemia and hypertension in Ecuador
Authors: Puig-García M , López-Herraiz C , Caicedo-Montaño C , Rivadeneira M F , Vásconez-Donoso J , Montalvo-Villacis G , Benazizi-Dahbi I , Parker L A
Published: October 2024

Background

Although the use of traditional medicine (TM) to manage health issues is frequently reported, clinical guidelines often overlook this practice. This study aimed to describe the frequency of TM use to control 3 cardiometabolic risk factors for non-communicable diseases (arterial hypertension, hypercholesterolemia, and hyperglycaemia, collectively referred to as CMRF here); and associated sociodemographic, economic, and clinical characteristics.

Methods

Descriptive cross-sectional study with a representative population of two health districts in Ecuador, one urban in southern Quito and one in a forested rural area with diverse ethnic groups in Esmeraldas. We included 602 individuals with at least one CMRF and calculated the proportion of those who reported regular use of TM (herbal or traditional remedies) to control their CMRF. We used a multivariable logistic regression model to calculate Odds Ratios for TM use according to sociodemographic, economic, and clinical characteristics.

Results

TM was commonly used to control CMRF in both sociocultural contexts (39.4% Esmeraldas, 31.1% Quito), often in combination with conventional medicine (CM). A notable percentage of people (33.9% Esmeraldas, 39.0% Quito) did not take any treatment for their CMRF, and the rest used CM alone. In both settings, education was significantly associated with TM use. While in Quito people with higher education were more likely to use TM (aOR 2.04, 95%CI 1.03-3.90), in Esmeraldas, it was more common among people without formal schooling (aOR 3.76; 95%CI 1.59-8.88) as well as those of younger age (aOR per year 0.97; 95%CI 0.95-0.99) and from Afro-Ecudorian ethnicity (aOR 2.13; 95%CI 1.02-4.45).

Conclusions

Traditional medicine is used by a significant portion of Ecuador’s population, highlighting the need for a more accessible and intercultural approach to healthcare.

Key messages

• The use of traditional medicine to address hypertension, hypercholesterolemia, and hyperglycaemia appears to be widespread in different sociocultural and economic contexts of Ecuador.

• To promote intercultural health, understanding the diverse sociocultural patterns associated with the use of traditional medicine, often combined with conventional medicine, is crucial.
Gut Microbiota and Parkinson’s disease - a prospective analysis of the FINRISK 2002 Study
Authors: Sääksjärvi K , Tynkkynen J , Salomaa V , Havulinna A , Jousilahti P , Kauko A , Palmu J , Niiranen T
Published: October 2024

Background

Parkinson’s disease (PD) is a neurodegenerative movement disorder with mainly unknown etiology. Constipation is a common symptom, and changes in gut microbiota may play role in PD pathogenesis. Previous studies exploring microbial associations to PD have been mostly cross-sectional, and the role of microorganisms in PD etiology remains unclear. Thus, we examined the association between microbiota features and incident PD in a prospective cohort design.

Methods

In the FINRISK 2002 Study, 7231 participants gave a stool sample that underwent shotgun metagenomic sequencing. Participants with missing stool sample, incomplete covariate data, pregnancy, antibiotic use, and prevalent cases were excluded (final n = 5562). Cox regression models, adjusted for age, sex, education, smoking, coffee consumption, diabetes, cardiovascular events, and constipation, were used to assess associations between incident PD and microbiota features, ie. alpha diversity (the number of different species present in a sample), beta diversity (the differences in microbial composition between individuals), and abundance of 381 core taxa (compositional detection rate of at least 0.1% and a prevalence of 1%). 120 incident cases of PD, identified through register linkage, occurred during a median follow-up of 17.8 years.

Results

In the multivariate models, PD incidence was not associated with the Shannon index, a measure on alpha diversity, (p-value 0.81), or with the ten first principal component axes in beta diversity analysis (p-values ranging between 0.49-0.91). In permutational analysis, PD did not explain differences in the composition of the gut microbiota (R2 <0.001, p-value 0.46)). None of the core species were associated with PD incidence (all FDR-corrected p-values > 0.05).

Conclusions

This prospective study showed no support for an association between gut microbiota features and incident PD.

Key messages

• Previous findings associating gut microbiota with PD may be due to the cross-sectional design, ie. PD affecting the gut microbiota.

• Suggestions to screen gut bacteria to identify people at high risk of Parkinson’s disease are vastly premature as the scientific evidence is inconclusive.
Mortality and causes of death in Serbia: redistribution of garbage codes to ischemic heart disease
Authors: Stamenkovic Z , Santric Milicevic M , Todorovic J , Rosic N , Brankovic B , Tamburkovski G , Jankovic Mladenovic S , Miltenovic S
Published: October 2024

Background

Cardiovascular diseases are ranked as the number one cause of death in Serbia, and one-fifth of them present ischemic heart disease (IHD). However, the physicians certifying the cause of death have either not been adequately involved in how to complete a death certificate according to the current International Statistical Classification of Diseases (ICD-10) or due to a high level of administrative tasks sometimes fail to complete the process of death certification. That is why we aimed to investigate the garbage codes (GCs) and the effects of their redistribution on underlying cause of death (CoD) estimates for IHD for 2015 and 2020.

Methods

Data from Belgrade mortality statistics in 2015 and 2020 were used to describe the occurrence and redistribution of garbage codes (GCs), defined as unspecified or impossible causes of death. In order to redistribute GCs we observed the underlying, antecedent, immediate causes and other conditions that contributed to deaths. Redistribution was done by consulting GBD methodology for GC proportional redistribution. The ICD-10 code range for IHD is I20-I25.

Results

In Belgrade, 17% (4022/23663) and 20.9% (5818/27775) of the deaths were coded with a garbage code in 2015 and 2020, respectively. In 2015, 2102 deaths (10.7% of all well-defined CoD) were attributed to IHD, while in 2020, 1806 (8,2% of all well-defined CoD) deaths were attributed to IHD. Finally, we redistributed a total of 452 deaths (GC type 1 203.9, GC type 2 122.1 and GC type 3 126.2 deaths) and 572 deaths (GC type 1 250.1, GC type 2 110.9, GC type 3 210.7 and GC type 4 22) due to IHD in 2015 and 2020, respectively. These calculations indicate a total number of 2554 and 2378 deaths due to IHD in 2015 and 2020, respectively.

Conclusions

A more detailed analysis of local practices, as well as continuing medical education in the field of death certification, could be a step forward in the future process of decreasing the number of GCs.

Key messages

• Since the huge number of deaths was added to ischemic heart disease in 2015 and 2020, it is crucial to focus on a more reliable disease surveillance system including better coding practices.

• A deep understanding of the garbage codes and their redistribution could significantly shape future decisions on factors contributing to ischemic heart diseases.
Climate change and gastroenteritis projections in Albanian children
Authors: Ylli A , Tomini E , Qirjako G , Bukli M , Burazeri G
Published: October 2024

Background

Human health can be affected by climate in direct and indirect ways. Increasing temperatures may affect ecosystems, water safety, and exposure to waterborne diseases. This is the first work in Albania aiming to demonstrate the link between gastroenteritis rate and climate in the country. This research was supported by UNICEF Albania through the WASH Global Thematic Fund, but it doesn’t necessarily represent UNICEF’s position.

Methods

Epidemiological surveillance reports of the period 2006-2022 were used for the yearly incidence of gastroenteritis in children 0-14 years old. Years 2020 and 2021 were not included because of pandemic confounding potential. Historic data for calculating the average summer temperatures were retrieved from timeanddate.com repository. Pearson coefficient is calculated to quantify the associations and linear regression is applied to project the increased rate in the future.

Results

There was a statistical association between gastroenteritis rate and summer temperatures during the study period (Pearson coefficient=0.78, p = 0.001). There was a tendency that in years with hotter summers higher incidence of gastroenteritis was reported by the health system. For each degree (Celsius) increase in the average summer day temperatures, the risk of gastroenteritis in children is expected to increase by 644/100 000 (CI 95%: 317 - 972). An excess rate of 966/100 000 is expected in the case of Intergovernmental Panel on Climate Change medium scenario projection of 1.5o C average temperature increase. That implies more than 4830 additional new cases every year in children 0-14 years old, attributed to climate change in the future in Albania.

Conclusions

The analysis demonstrated excess gastroenteritis risk may be related to higher summer temperatures observed in Albania. The expected gastroenteritis risk increase in a warmer future should be addressed by improvements in sanitation, education of parents and epidemiological intelligence.

Key messages

• A warmer climate is expected to affect the health by increasing the risk for diarrheic diseases.

• Children will be the most at-risk population category.
Association between number of hospitalizations of older adults and heatwaves in Slovenia 1999-2018
Authors: Percic S , Bitenc K , Pohar M , Cegnar T , Krosel M , Hrzenjak V V , Hojs A
Published: October 2024

Background

Heatwaves frequency, intensity, and duration increase with global climate change. The association between heat and mortality in older adults is well documented, but less is known about associations with hospitalizations. Knowing which diseases contribute to a higher number of hospitalizations during heatwaves is important for planning appropriate public health preventive measures.

Methods

We assessed short-term association between the number of hospitalizations for older adults (75+ years) and heatwaves in the years 1999 to 2018 in Slovenia. We estimated the relative risks (RR) with 95 % confidence interval for the number of hospitalizations for the observed diagnosis (all causes, circulatory, respiratory, endocrine and genitourinary diseases) and gender associated with heatwaves in Slovenia for each year, comparing the number of hospitalizations during heatwaves with reference days.

Results

We could not find an association between heatwaves and hospitalizations for all cause hospitalizations in all observed years. In some years the association was even negative. In cause specific analyses heatwaves were associated with increased hospitalizations for endocrine diseases in 2012 (32%; 95% CI: 1%, 73%), 2013 (23%; 95% CI: 5%, 33%), 2014 (48%; 95% CI: 4%, 110%) and 2015 (42%; 95% CI: 7%, 89%), but not for cardiovascular, respiratory and genitourinary diseases.

Conclusions

Older adults are most susceptible to the effects of extreme heat due to physiological changes that occur with aging, chronic diseases, certain medications, a sedentary lifestyle and social isolation. The results of our study will help in planning appropriate preventive public health measures to better protect older adults during the next heatwaves in Slovenia.

Key messages

• Heatwaves will become longer, more frequent and more intense in the near future.

• Endocrine diseases are the most important cause for hospitalization during heatwaves. Public health measures shoud adress these most vulnerable groups.