bluuebunny/crossref_metadata_2025 huggingface dataset:
Family-based sexual health intervention for adolescents; A systematic review and meta-analysis
Authors: Mataraarachchi D , Shepherd T , Ariyadasa G , Bajpai R , Corp N , Paudyal P
Published: October 2024

Background

Family-based interventions are important in promoting adolescent sexual health outcomes. However, the effectiveness of these interventions in promoting adolescent sexual and reproductive health (ASRH) in Lower and middle-income countries (LMIC) has not been empirically evaluated. This review aimed to summarise the effectiveness of family-based sexual and reproductive health interventions in promoting ASRH in LMIC.

Methods

We conducted a systematic search for studies published in English from 2000 to October 2023 using MEDLINE, PsyINFO, CINAHL, Web of Science, and EMBASE databases. Studies were included if they involved adolescents aged 10-19 years, included family members in a key intervention component, evaluated the effectiveness of the interventions using an experimental or quasi-experimental design, assessed ASRH outcomes reported by adolescents and were conducted in LMIC setting. Standardized mean difference (SMD) and 95% confidence intervals were computed and meta-analyses were conducted using random effect models.

Results

Ten articles involving 2,246 participants were included in the review. The studies were nostly conducted in Africa. Across studies, there was no significant impact of family-based interventions in improving adolescent sexual health knowledge (SMD=0.5, 95%CI: -1.98 to 2.98), attitudes (SMD= -0.05, 95%CI: -1.92 to 1.82), practices (SMD=0.53, 95%CI: -0.69 to 1.75), or sexual communication with their family (SMD= 0.14, 95%CI: -0.42 to 0.7). Although individual studies reported a mixed effect of family-based interventions in improving sexual health outcomes, the pooled results from the meta-analysis showed no significant impact of family-based interventions.

Conclusions

Our review did not find any significant impact of family-based interventions in improving ASRH in LMIC. We recommend interventions using innovative approaches and novel strategies to align with the socio-cultural and economic background of the study setting.

Key messages

• This study found no significant impact of family-based interventions in improving ASRH in LMIC.

• Additional studies, particularly from Asia, using culturally relevant interventions is required in this area.
Implementation Measures to Break the Gender Gap - a Scoping Review
Authors: Mollenhauer J , Sgraja S , Amelung V E , Kloepfer M , Seeland U , Kurscheid C
Published: October 2024

Background

For myocardial infarction, in-hospital lethality is still significantly higher in women than in men in Germany. Medical guidelines and nursing expert standards include recommendations for gender-sensitive care (GSC+), but it is unknown how these are implemented in health care practice. Research question: Which measures facilitate the implementation of GSC+?

Methods

Systematic literature research was conducted on Pubmed, web of science and CINAHL with adequate keywords connected with Boolean connectors.

Results

The initial literature search yielded a pool of 23,508 items. After removing irrelevant articles and duplicates 119 articles were included in the present scoping review. Among fifteen generated dimensions, which are summarized to six main dimensions (education, research & science, politics, LGBTQ+ care & education, institutions of care and career advancement), the included articles are related. Education is the dimension with the most identified articles. Key messages of main dimensions are that GSC+ • must be anchored in compulsory subjects of curricula; • must be considered in research. Researchers need to be aware and should follow a structured framework for generating sex-specific guidelines; • can get gain access to politics through purposeful lobby work; • in terms of LGBTQ+ care should be learnt from health care providers to LGBTQ+ people through case studies; • should be implemented strategical through change agents in institutions of care; • can be enhanced through aware women in leading positions, to implement GSC+ successfully.

Conclusions

The implementation of GSC+ has a positive impact on patient care and could reduce undesirable events or outcomes. To reach the implementation target the politics must set frame conditions and universities, science and health care providers have to integrate them. Moreover, the generation of evidence is important to promote GSC+ so that health care professionals have a defined work assignment for GSC+.

Key messages

• The research results provide a comprehensive overview of the existing literature on implementation measures of gender-sensitive care.

• Healthcare providers are sensitized to gender-sensitive care so that patient care can be further improved.
2.M. Scientific session: Economics of Mental Health in the interplay between health systems and public health
Authors:   Organised by: EUPHA-ECO,   Chair persons: João Vasco Santos (EUPHA-ECO), Vanessa Gorasso (EUPHA-ECO)
Published: October 2024

Mental health systems and services are essential components of the public health infrastructure, serving as frontline for prevention and intervention for health overall. Despite this, access to mental health services remains largely inadequate, with the OECD calculating that only about one in three people with mental health problems has access to quality treatment across 19 EU Member States. The economics of mental health play an important role in determining the allocation of resources, the accessibility of services and the overall effectiveness of interventions. Effective planning requires an understanding of population needs, service gaps and utilization patterns, in order to ensure equity and health improvement. In fact, the conceptualisation of the economic dimensions of mental health enables policymakers, practitioners, and stakeholders to make informed decisions that optimize resource utilization and maximize societal benefits. The proposed workshop will build on previous activities of the EUPHA Section on Public Health Economics at EPH, including the recent establishment of a working group on the economics of mental health. The aim of the meeting is to promote the adoption of best practices and methodologies in the conduct of economic studies on mental health. As such, the workshop will provide an opportunity to discuss the unique challenges of economic evaluation in this field and to present relevant ongoing activities by members of the Section and other invited experts.

Key messages

• Mental health, its distribution and at-risk populations influence resource allocation and policy decisions within mental health systems.

• Tackling inequalities in mental health is essential for promoting health equity and social justice, requiring evidence-based interventions and policy initiatives to empower marginalized communities.
What do we know about femicide in Italy? Data and insights from a repeated cross-sectional study
Authors: Gabrielli G , Porru F , Ricciardi W , Gualano M R
Published: October 2024

Background

Gender-based violence represents a huge public health issue, affecting mental, physical health and productivity. It is a significant obstacle to achieving gender equality and the empowerment of all women. While the overall homicide rate is decreasing in Italy, femicide, the intentional killing of women due to gender-related motivations, remains stable over time. This is the first study in Italy to evaluate potential risk factors of femicide, exploring the sociodemographic characteristics of victims and perpetrators of femicides, as well as the geographic distribution across Italy, with insights into differences between the size of municipalities and between geographic areas.

Methods

A repeated cross-sectional study was conducted to investigate femicides in Italy from 2020 to 2023 using data sources from Non Una Di Meno, an Italian NGO, and the Italian National Institute of Statistics.

Results

Our preliminary findings show that the majority (83%) of homicides of women were femicides. On a final sample of 403 femicides, in most cases (94,3%) the victims were more likely to be hit by their current or former partner or by a family member. In 97% of cases perpetrator was a man. In more than 50% of cases, both the victims and the perpetrators were under 55 years old (respectively, 51,8% and 57,9%). Femicide rates was 0.33 per 100,000 women. There appear to be no significant differences between the rates of femicide as the size of the municipality and the geographic macro-area vary, highlighting the extensive spread of the phenomenon throughout the territory.

Conclusions

Our findings show that femicide is a systematic and widespread phenomenon that occurs mostly within the home and needs interventions at the European level to prevent systemic violence against women. Moreover, this study provides methodological considerations to define femicide, suggests improvements to data collection methods and offer insights for future research in this field.

Key messages

• It is important to gather robust data on gender-based homicide, as it represents a public health issue.

• Femicide is a pervasive and systematic phenomenon that predominantly occurs within the home and requires intervention at the European level.
The role of health literacy in adherence to the Mediterranean diet
Authors: Duarte A , Martins J , Martins S , Augusto C , Silva M J , Magalhaes F , Lopes C , Rosario R
Published: October 2024

Background

Health literacy has emerged as a crucial concept in public health. It is considered a modifiable determinant influencing health-related decision. One such decision is the adoption of specific dietary patterns. The Mediterranean diet has garnered recognition as one of the healthiest diets. This study aims to explore the association between health literacy levels among adults in socially vulnerable contexts and their adherence to the Mediterranean diet.

Methods

This study is part of a cluster-randomized trial conducted in primary schools from socially vulnerable contexts. A total of 469 parents of school-aged children agreed to participate. Health literacy was assessed using the Health Literacy Survey Questionnaire. Adherence to the Mediterranean diet was evaluated using the MEDAS questionnaire. Anthropometric and sociodemographic variables were self-reported via questionnaire. Parental BMI was calculated using weight/height^2. Education level was categorized into two groups (less than higher education and higher education), while professional status was classified based on the occupational categories of collar color. Generalized linear models were utilized for the analysis.

Results

Individuals with higher levels of health literacy present a greater odd to adhere to the Mediterranean diet (B = 0.022, 95% CI 0.010-0.035), even after adjusting for potential confounders (B = 0.019, 95% CI 0.006-0.032).

Conclusions

Health literacy emerges as a crucial factor influencing individuals’ dietary choices, as evidenced by its association with higher adherence to the Mediterranean diet. These findings underscore the importance of implementing policies and initiatives aimed at promoting health literacy, particularly among individuals from socially vulnerable contexts. Enhancing public health interventions to bolster health literacy should be prioritized to foster better dietary decision-making.

Key messages

• Health literacy plays an important role in the adoption of Mediterranean diet among adults from socially vulnerable contexts.

• Implementing policies to aim the promotion of health literacy, particularly among individuals from socially vulnerable contexts are necessary.
Development of a risk-stratified shared decision-making tool for colorectal cancer screening
Authors: Herrera D J , van de Veerdonk W , Talboom S , Van Bos L , Veressen A , Seibert D M , Feyen K , Haesaert L , Van Hal G
Published: October 2024

European guidelines stress the importance of informed decision-making in colorectal cancer (CRC) screening. However, tailored tools that facilitate decision-making for underserved people and general practitioners (GPs) in Flanders are lacking. This study aimed to develop a tailored shared decision-making (SDM) tool for CRC screening, specifically a video decision aid, using a co-creative process. The development involved two rounds of focus group discussions with underserved people and five local quality group meetings with GPs in various parts of Flanders, Belgium. Qualitative data were analyzed using a Modified-Grounded Theory Analytical (M-GTA) approach to identify key themes. Findings revealed four core themes. The first theme, ‘Recognizing the Barriers to Screening’, identifies challenges such as a lack of time, staff, and tools for GPs, as well as language and literacy barriers for underserved people. The second theme, ‘Learning from Existing Tools’, highlights successful elements like visuals and simple language and limitations such as low accessibility and poor navigation. The third theme, ‘Determining the Content and Design,’ reveals that GPs seek user-friendly tools for at-home viewing, while underserved people value personalized and clear information about CRC risk factors and screening costs. The final theme, ‘Identifying Strategies for Integration,’ stresses the importance of a structured, collaborative care approach for the successful integration of the tool. The proposed modifications for the SDM tool include enhancing its accessibility with multiple language options, using simple and relatable visuals, and providing personalized risk discussions for underserved people and GPs. Nonetheless, further testing is needed to confirm the effectiveness of the SDM tool in supporting preventive talks and informed decision-making in CRC screening among these target groups.

Key messages

• A structured, collaborative care approach is needed for successful SDM tool integration during preventive talks with underserved people.

•  Further testing is needed to confirm the tool’s effectiveness in supporting informed decision-making in CRC screening for underserved people.
Scoping Review of Health Literacy Interventions among Migrant Communities in Europe
Authors: Seyfulayeva A , Dias S , Peruhype R , Marques M J
Published: October 2024

Background

The increase in migration trends in Europe has brought attention to the significant health disparities between migrant and native populations, which are largely rooted in social determinants of health such as economic difficulties, language barriers, and limited access to services. Tailored health literacy (HL) interventions can serve as an intermediate factor between social determinants of health and health outcome, thereby holding great potential for addressing these disparities. Despite a growing body of research on migrant health, there remains a gap in our understanding of effective HL interventions for this population.

Methods

A scoping review was conducted following the Joanna Briggs Institute (JBI) updated guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Electronic searches were carried out across five databases (PubMed, SCOPUS, Web of Science, PsychINFO, and CINHAL) and supplemented by a manual search. We included European studies on migrant HL interventions, conducted between 2011 and 2023, and published in English or Portuguese language.

Results

Out of 1018 records, 7 studies met eligibility criteria. Predominantly situated in Northern and Western Europe (85.5%), interventions primarily targeted female migrants (71.4%) through in-person courses (42.9%). Identified intervention strengths included culturally adapted content, migrant engagement, and access to written materials. Gaps included mental health interventions and community outreach.

Conclusions

This scoping review provides a comprehensive overview of HL interventions targeting migrant populations, highlighting their characteristics, strengths, and gaps. These findings serve as a foundational step towards developing guidelines for effective HL interventions within migrant communities.

Key messages

• Most European health literacy interventions for migrants target women and are conducted in North or West Europe.

• Cultural adaptation and community engagement are key strengths of migrant health literacy interventions, yet gaps remain in mental health support and community outreach efforts.
The economics of mental ill-health in the EU/EEA
Authors: Cecchini Michele
Published: October 2024

This presentation will provide an overview of the challenges and costs of mental ill health in 29 EU/EEA countries and an economic assessment of options to address current policy gaps. Nearly 20% of people in the EU/EEA experience mental ill health, with a particularly high prevalence among vulnerable groups such as people on low incomes or young people. However, in the majority of cases, and particularly for those with milder forms, these conditions go undiagnosed. Even when diagnosed, access to quality health services is sub-optimal, mainly due to financial issues or waiting times. The European Union and its Member States have identified mental ill health as a major public health threat, but there are still significant policy gaps and a lack of evidence on the most effective and cost-effective interventions to implementation. Building on its methodology for identifying and evaluating better public health policies for better lives, the OECD has recently extended the scope of its economic work to mental health. This presentation will start by providing an estimate of the health and economic burden of mental ill health in EU/EEA countries and will present evaluations of best practices in this field recently introduced by EU Member States. The talk will not only present the results of the analyses but will also use the identified case studies to discuss the approach used and some of the methodological issues involved in carrying out economic analysis for a set of diseases with high burden but relatively low mortality.
Is genomic testing properly evaluated? A systematic review of health technology assessment reports
Authors: Migliara G , Sciurti A , Baccolini V , Mussetto I , Kaminska A E , Pistollato A , Anniballo A , Leone I , Marzuillo C , Villari P
Published: October 2024

Background

The last decade has witnessed a steady embrace of Personalized Medicine. However, the evaluation of genetic/genomic tests is not straightforward. The purpose of this systematic review is to identify health technology assessment (HTA) reports assessing genetic and genomic tests, to summarize the methodologies used, the maturity level of the evidence included in it and the highlighted gaps in research.

Methods

PubMed, Scopus, and Web of Science were searched. Additionally, a desk research was performed on the main HTA reports repositories. HTA reports expressly created to assess genetic/genomic technologies including at least three core evaluation components (analytic validity, clinical validity, clinical utility, economic evaluation, organizational aspects, ethical, legal, and social implications) were included. This study was supported by the EC and MUR under PNRR - M4C2-I1.3 Project PE_00000019 ‘HEAL ITALIA’.

Results

Overall, 27331 unique records were retrieved, 55 of which were included in the systematic review. The reports were mainly from Australia (29%), Canada (27%) and UK (25%), regarded pharmacogenomics (36%) and oncology (35%), and analysed test use for treatment choice (29%) and diagnosis (13%). The most reported evaluation components were economic evaluation (87%), clinical utility (76%), and clinical validity (67%). Personal utility (7%), ethical (15%), legal (11%) and social (24%) implications and the patient’s perspective (27%) were poorly represented. Analytical validity, safety, and organizational aspects were included in about half of the reports.

Discussion

Although these are only preliminary results, the substantial lack of a shared standard in the evaluation of genetic/genomic applications appears clear, given the heterogeneity of the dimensions addressed between reports, as well as the need to strengthen the evaluation of the neglected dimensions, often of primary importance in the definition of the value and risks of personalized medicine.

Key messages

• The findings highlight the lack of a standard in evaluating genetic/genomic applications.

• A common methodology should be developed to comprehensively evaluate genetic/genomic applications.
Estimating the economic burden of mental and substance use disorders in Belgium
Authors: Schmidt Masja
Published: October 2024

Mental and substance use disorders are the leading cause of disease burden (disability-adjusted life years, DALYs) in Belgium. Strong mental health policies are needed to reduce the burden, taking into account effectiveness and cost-effectiveness of possible interventions. Next to providing an overview of the economic burden of mental health conditions (what is), routine cost-of-illness studies also serve as a source of information for modelling the cost-effectiveness of policies and interventions to improve the mental health of populations (what could be). In the context of an extension of the Belgian Health Status Report and the Belgian National Burden of Disease Study, we calculated the direct medical costs of a range of health conditions, including mental health conditions such as depression. We used self-reported diagnostic data from the Belgian health Interview Survey linked with claims data to calculate the incremental costs attributable to mental health disorders with g-computation. We correct for confounders such as age and sex, and also look at uncertainty brought about by the data source and modelling. This presentation aims to share the experience of calculating the economic burden of mental ill-health in the context of a routine cost-of-illness study. We will present the results of the study and discuss alternative ways in which the costs of common mental health conditions such as depression could be estimated, for example based entirely on claims data using pharmaceutical cost groups.
Environmentally sustainable health and social care – A proposal for goals and steering for Finland
Authors: Wulff P , Alanko L , Iivonen S , Nissinen A , Setälä L , Meriläinen P , Savolainen H , Alhola K , Suomalainen E , Pulkki J
Published: October 2024

Issue

Health and social services cause significant environmental impacts. In Finland, national steering towards environmentally sustainable health and social care has been lacking.

Description of the problem

A multidisciplinary research project (EKO SOTE 2022-2023) was designed to investigate aims and steering mechanisms for environmentally sustainable social and health care in Finland. The project aimed to propose national steering and monitoring mechanisms for stronger environmental sustainability within the sector. Data for the proposal was collected from literature, review of national legislation, interviews, surveys, and co-development events. The project also aimed to calculate the carbon footprint of Finnish health and social care with the EEIO model ENVIMAT.

Results

It was estimated that health and social care contributed to 6.5% of Finland’s national carbon footprint in 2019, of which the share of health care was 4.2%. The new goal ‘Social and health care is carbon neutral and minimizes the environmental burden by 2035’ was proposed to be incorporated in the national strategic steering. Wellbeing service counties (WSC) as public care providers were suggested to be included as responsible actors in the Finnish Climate Act. National networks and targeted project funding for WSCs were found important. Three sets of indicators were designed for monitoring environmental sustainability: minimum indicators for all WSCs for national monitoring, voluntary indicators for regional monitoring, and indicators for advanced regions to pioneer best practices.

Lessons

According to the informants, national steering for environmentally sustainable health and social care is urgently needed. The national goal should be ambitious, wide-ranging, and feasible, and cover environmental aspects broadly. The steering requires multiple mechanisms: normative, strategic, informational, and economic. WSCs should be empowered to develop suitable means to achieve the national goal.

Key messages

• The project provided an ambitious, feasible, and comprehensive national goal and steering model for reducing the environmental impact of health and social care in Finland.

• Collaborative efforts and joint steering model could advance environmental sustainability in health and social care.
Consumption of low-calorie sweetened products and intakes of free sugar and energy among UK adults
Authors: Seesen M , Chang K , Parnham J , Laverty A , Millett C , Rauber F , Levy R , Gregg E , Vamos E
Published: October 2024

Background

Policies to reduce free sugar intake in the population often suggest alternative low or no sugar products that may contain low-calorie sweeteners (LCS). However, the health effects of LCS are controversial and little is known about whether free sugar and energy intake differ between people with varying levels of LCS product consumption. This study examines the associations between LCS product consumption and free sugar and energy intake in UK adults from 2008 to 2019.

Methods

Repeat cross-sectional data from the UK’s National Diet and Nutrition Survey (2008/09 to 2018/19) involve 8304 adults aged ≥18 years (mean 48.7, SD 18.3) with 58.4% being women. Consumption of LCS products (grams/day) were obtained from 4-day diet diaries and participants were categorized into four groups (No-LCS, Low-LCS, Mid-LCS, High-LCS) based on LCS consumption tertiles in 2008/09. Linear regression analysed associations with LCS group, year, their interaction, and adjusted for sociodemographic factors.

Results

All four groups consumed free sugar (relative to total energy intake) above recommended levels (5% kcal/day) throughout the study period. In 2008/09, the mean free sugar intake for the No-LCS group was 58.1 grams/day, and the mean total energy intake was 1855.7 kcal/day, which were not significantly different from the High-LCS group. Over time, free sugar intake declined by -1.0 g/year (95%CI: -1.4, -0.6) whereas total energy intake declined by -6.0 kcal/year (95%CI: -11.4, -2.1) in the No-LCS group. The High-LCS group showed similar declines leading to no significant difference in mean free sugar and total energy intake between the No-LCS and High-LCS groups in 2018/19.

Conclusions

In this representative study of UK adults, similar levels of free sugars and total energy intake were observed among those with no LCS and those with the highest LCS product consumption from 2008 to 2019. Absence of LCS product consumption in diets were not associated with higher free sugar intake.

Key messages

• The high level of LCS product consumption was not associated with lower free sugar intake among UK adults. These finding challenges policies promoting LCS to reduce UK adults’ free sugar intake.

• The finding that UK adults consistently consumed free sugar above recommended levels highlights the ongoing need for policy interventions.
Supply of Alcohol in Early Childhood Leads to Higher Rates of Drinking in Adolescence
Authors: Ksinan A , Ksinanova G , Pikhart H , Bobak M
Published: October 2024

Background

Adolescents often experience their first encounter with alcohol at home, provided by parents who perceive it as a means of safeguarding their children against later alcohol-related issues. However, research shows that parental supply of alcohol is a risk factor for adolescent drinking. Notably, existing studies solely focused on parental supply during adolescence, neglecting the prospective evaluation of parental alcohol provision during early childhood on later alcohol use.

Methods

The data came from the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC), a longitudinal birth cohort study (N = 5,777). Mothers reported on the frequency of offering alcohol to children when children were 3, 5, 7, and 11 years old. The outcome was adolescent alcohol use at ages 15 and 18, reported by adolescents, mothers, and pediatricians. Control variables included sex, maternal education, family structure, and parental alcohol consumption.

Results

Three classes of children were identified based on parental alcohol supply: abstainers (75.5% of sample), infrequent sippers (16.2%), and frequent sippers (8.3%). Parental drinking increased the risk of both infrequent and frequent sipping. These classes were entered into two structural models (age 15 and age 18 alcohol use modeled as latent factors), alongside covariates. Compared to abstainer class, infrequent and frequent childhood sippers exhibited significantly higher alcohol consumption at age 15 (β = .21, p < .001; β = .25, p < .001, respectively) and age 18 (β = .11, p < .05; β = .24, p < .001, respectively).

Conclusions

This study represents the first prospective investigation quantifying early childhood alcohol exposure and its subsequent association with adolescent alcohol consumption. Findings emphasize the influence of family dynamics on alcohol behaviors, underscoring the necessity for targeted preventive measures, particularly within families with higher parental alcohol consumption.

Key messages

• Offering alcohol to children at ages 3-11, even infrequently, significantly increases the risk of more frequent drinking at ages 15 and 18, compared to those with no early exposure.

• Parents who drink are more likely to have children who sip alcohol early, leading to higher alcohol consumption in adolescence. Prevention efforts should focus on family habits and early education.
Maternal education and antenatal attendance in Georgia: A cohort study
Authors: Saad W , John M M , Adeboye E S , Haj M , Manjavidze T
Published: October 2024

Background

Antenatal care (ANC) and maternal education are important determinants for maternal and newborn health outcomes. Understanding the impact of maternal education on ANC is crucial.

Purpose

To examine the association between maternal education and ANC attendance.

Methods

A retrospective cohort study utilized nationwide electronic medical birth registry data (2020-2022) in Georgia. the study includes pregnant women and their newborns. A randomized sample was selected, and extracted variables included maternal age, parity, body mass index, education, year of delivery, gestational age, infant sex, Apgar score, birth weight, delivery type, and newborn status. Statistical analysis via IBM SPSS v23 involved chi-square, t-tests, and logistic regression.

Results

The sample size contains 4976 mothers after excluding cases with missing data (n = 25). The mean maternal age was 30.5 years (SD = 5.4), with a mean BMI of 28.0(SD = 4.8), and the mean gestational week was 38.4(SD = 2.0), with a mean birth weight of 3263.0 (SD = 568.0) grams. Highly educated women had more than 3 times higher odds (OR = 3.636,95%CI:2.575-5.134) of having at least one ANC visit compared to those with Unknown education. primiparous women had significantly higher odds of having at least one ANC visit compared to Multiparous women, OR = 1.519, (95%CI:1.081-2.135). The chi-square test showed significant difference between ANC visits and the number of liveborn/stillborn (χ² = 53.026, p < .001). Moreover, there was a significant association between birth weight categories and ANC visits (χ² = 167.095, p < .001).

Conclusions

Our study emphasizes the role of education in improving access to ANC among women with low education levels. We can increase ANC visits and improve maternal and newborn health outcomes by focusing educational efforts on pregnant women. Additionally, focusing on high-risk populations, and using tailored interventions can further improve ANC attendance along with maternal and neonatal health.

Key messages

• Boosting ANC access and improving maternal and neonatal health by tailored community programs.

• Conservative communities and underrepresented communities require additional resources to promote tailored healthcare. and extra effort in education about ANC.
Alcohol intake and patterns of multi-site musculoskeletal pain in the British Whitehall II study
Authors: Zhao Z , Lallukka T , Chandola T , Britton A
Published: October 2024

Background

Patterns of multi-site musculoskeletal (MSK) pain and its relationship with alcohol drinking among white-collar employees and retirees remain unclear compared to blue-collar workers. This study aimed to examine the relationship between alcohol drinking and MSK pain through latent class analysis (LCA) in current and retired white-collar employees.

Methods

We used the data from the 7th phase (2000-2002, n = 6,967, response rate 71.6%) of the British Whitehall II study, chosen for its availability of MSK items and approximately 1:1 ratio of employees to retirees, allowing for an evaluation of the relationship between alcohol drinking and MSK pain by employment status. LCA was used to distinguish patterns of multi-site MSK pain. A multinomial logistic regression model was used to examine the association between alcohol drinking and the identified pain patterns, with analyses conducted separately for employees and retirees.

Results

We identified five latent classes for pain (back/cervical: 7.1%, cervical: 28.9%, upper limb: 29.4%, combined LBP/upper limb/cervical: 13.2%, and LBP alone: 21.5%). Increased alcohol intake might be associated with elevated odds of upper limb pain in current drinkers, but this could not be statistically confirmed (OR: 1.04, 95% CI: 0.99-1.09). Employment status may modify the association with a significant interaction found between alcohol intake and retirement (p-value: 0.043). Every 7-unit increase in alcohol intake is associated with 18% and 12% higher odds of pain in LBP/UBP/cervical and upper limbs, respectively (95% CI: 1.02-1.37; 1.02-1.23).

Conclusions

Increased alcohol intake was associated with pain patterns only among retired white-collar employees but not the current ones. Interventions on alcohol consumption could help confirm if, reducing alcohol intake or avoiding hazardous drinking, for white-collar retirees prevents not only upper limb pain but also more complex pain patterns.

Key messages

• Musculoskeletal pain in white-collar employees and retirees contributes to the cervical and upper extremities, differing from low back/neck pain studies among general or blue-collar workers.

• The association between alcohol drinking and pain patterns may differ across employment status. Reducing alcohol intake might be advised to retired drinkers for preventing multi-site pain.
The relationship between mental health and employment: a systematic review of cohort studies
Authors: Bruggeman H , Héroufosse J , Van der Heyden J , Smith P
Published: October 2024

Background

Knowledge on the bi-directional association between employment status and mental health is important, as it affects multiple dimensions of our daily lives, both at the individual and societal level. Given that the mental health status and employment situation of individuals are likely to change over time, there is an important need for longitudinal data to better understand causality patterns in this association and the underlying mechanisms.

Methods

A systematic review was carried out based on the PRISMA guidelines in 3 electronic databases: PubMed, Embase, and PsycInfo. Studies eligible for inclusion were cohort studies, involving the general population, and assessing the relationship between employment status and mental health longitudinally.

Results

In total, 3,733 studies were identified and 36 met the inclusion criteria. The eleven studies focusing on the social causation hypothesis highlighted the negative long-term impact of unemployment and unstable employment on mental health. Four studies observed mental health improvements upon re-entering employment, although limited and in more specific contexts. The fourteen studies focusing on the health selection hypothesis found a lower probability for individuals with mental health problems in finding and maintaining employment. Finally, the eleven studies assessing the two hypothesis simultaneously found that mental health problems were both a consequence of and risk factor for poor employment status, although some important moderating factors, such as gender differences, influence the direction and strength of the association.

Conclusions

This review underscores the bi-directional association between the employment status and mental health of individuals, highlighting the need to develop targeted prevention (e.g. mental health support in the workplace) and interventions strategies (e.g. supported employment programs) in both the mental health and labor market systems.

Key messages

• The bidirectional link between employment and mental health highlights the need for concurrent responses to break the vicious cycle between poor mental health and social exclusion.

• To reduce the clinical and social burden of mental health problems, gender differences must be taken into account in mental health and employment support practices and policies.
Deployment of in-body wearable devices in healthcare and at work: closing the EU regulatory gap
Authors: Marassi S , Foldes M E
Published: October 2024

Background

In-body wearable devices can protect workers’ health and safety. Moreover, they might provide data that could be capitalized on in the context of the European Health Data Space (EHDS), which aims at fostering a single market for medical devices and high-risk AI systems. Yet, neither EU legislation nor national law regulates the use of in-body wearables at the workplace and the related data protection and safety issues. This regulatory gap impacts on workers’ rights.

Methods

The study explores whether the EU regulatory framework used in the healthcare sector for medical devices could fit the in-body wearables’ application in employment. The legal and policy analysis takes the perspective of workers’ rights and discusses the application of a key GDPR principle: lawfulness. The research discusses the potential transformations in the EU health data protection framework that could close the regulatory gap.

Results

The EU regulatory framework for medical devices (focused on product safety, performance, and quality) is not equipped to address the data protection challenges linked to the use of in-body wearables for occupational health and safety purposes. The GDPR’s principle of lawfulness and the related guidance by EU and national data protection authorities lack clarity on employers’ possibilities to apply in-body wearables for occupational health purposes. Filling the regulatory gap is conducive to appropriate qualification and risk-based classification of in-body wearables, which affect pre- and post-market requirements and impact on data protection.

Conclusions

a. The EU legislator could use its social policy competence to regulate the use of in-body wearables to protect workers’ health while safeguarding their data. b. EU authorities should clarify whether and how the data collected by in-body wearables at the workplace could be shared and (re)used within the EHDS. c. Further input by data protection authorities is needed to close the regulatory gap.

Key messages

• The EU should regulate the use of in-body wearables to protect workers’ health and safety.

• Health data gathered through the application of in-body wearables at the workplace may be an asset for the EHDS.
Predicting hospital readmission in multimorbid patients with the use of AI: A systematic review
Authors: Zain Y , Hassan N , Marley K , Slight R D , Bates D W , Slight S P
Published: October 2024

Background

Multimorbid patients are at higher risk of hospital readmission due to the complex nature of their conditions. Identifying those who may be at particularly high risk would allow us to intervene early and potentially delay or prevent such readmissions occurring, thus reducing healthcare costs. We conducted a systematic review investigating the use of machine learning models in predicting 30-days unplanned hospital readmission of multimorbid patients.

Methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines, and was registered with PROSPERO (CRD42022373937). We searched MEDLINE, Embase, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Included studies developed an AI model for prediction of 30-days hospital readmission for adult patients with two or more health conditions. The CHARM and PROBAST checklists for data extraction and bias assessment were used. The quality of included studies was assessed with the CASP checklist.

Results

Eighteen papers were eligible for inclusion. A total of 669 predictors were reported with an average of 37 used per model. Predictors were classified as modifiable and non-modifiable with the most common modifiable predictors being hospital length of stay, hypertension, anaemia and obesity. Average sensitivity and specificity of the models was reported to be 72% in 13 studies and 79.2 in 11 studies, respectively. Area under the curve (AUC) was reported in 13 studies, five of which were considered to have good discrimination power (AUC>0.8).

Conclusions

Machine learning models are capable of accurately predicting 30-days hospital readmission of multimorbid patients. Identifying modifiable predictors with highest weight allows for better planning and resource allocation to potentially reduce the risk of 30-days readmissions. An important area for future work would be the implementation of these high performance models in practice.

Key messages

• Hospital readmissions are preventable and identifying those at higher risk allows us to intervene early.

• Machine learning models are capable of predicting 30-days readmission of multimorbid patients.
Evolution of online health-related information seeking in France from 2010 to 2023
Authors: Quiviger A , Ducrot P , Richard J B
Published: October 2024

Background

Given the rapid ongoing progression of the internet and increase in health information available online since 2010, it is important to understand how these changes impact online health information-seeking behaviour of the population and the way of managing one’s health. This study aims to describe the evolution of the use of internet to seek health-related information as well as the characteristics of online health information seekers.

Methods

We used data from the French nationally representative surveys Health Barometers. It is a cross-sectional repeated survey of random representative samples of the French population conducted by the French national public health agency since 1992 using computer-assisted telephone interviewing. It serves to measure the evolution of key indicators regarding health-related behaviors, attitudes, and opinions in the general population and includes individuals aged 18-75 years old selected through randomly generated phone numbers. In the 2010, 2014, 2017 and 2023 editions, the same question was asked about the internet use as a source of health information. Evolutions over time were assessed using chi-square tests. Associations with sociodemographic characteristics and health status were evaluated using logistic regression models.

Results

Although internet access increased steadily during this period, from 72.8% in 2010 to 95.2% in 2023, the use of the internet as a source of health information rose between 2010 and 2014 (from 37.3% to 67.9%), decreased significantly in 2017 (60.3%) and rose again in 2023 at 65.3 %. The study describes the characteristics of the online health information-seekers trough time.

Conclusions

The past decade was marked by a breakthrough of the use of internet in the general population and the use of internet to seek health information. The analysis of the digital health information-seekers serves the public health authorities in their mission to provide accessible information on public health.

Key messages

• This study aims to describe the evolution of Online Health-Related Information Seeking in France from 2010 to 2023 and the characteristics of digital health information-seekers.

• The analysis of the digital health information-seekers serves the public health authorities in their mission to provide accessible information on public health.
Prediction of mental health risk in adolescents via a smartphone app: a feasibility pilot study
Authors: Bellido Bel T , Kadirvelu B , Freccero A , Di Simplicio M , Faisal A A , Nicholls D
Published: October 2024

Background

The prevalence of mental health problems in adolescents is a global public health concern. Machine learning (ML) can analyse multidimensional data collected by phone sensors (passive tracking) and symptom self-reporting (active tracking) to model and predict mental health states. However, research in adolescents is lacking. This study investigated the feasibility of using ML to predict mental health in a non-clinical population of adolescents from active and passive data collected through the Mindcraft mobile app.

Methods

We recruited 103 secondary students (aged 14-18) who first completed the Strengths and Difficulties Questionnaire (SDQ) and then used the Mindcraft app for two weeks. The app integrates sensor data (location, steps, noise, light, battery, app usage) and self-reports. We extracted 85 sensor-based features and 19 from questionnaires to develop a gradient-boosted ensemble ML model. This model identifies students with abnormal SDQ scores and was evaluated using leave-one-out cross-validation.

Results

All students completed the active questionnaires; 67 also provided passive sensor data. 31 had abnormal SDQ scores. Using passive data, the ML model reached a balanced accuracy of 0.64 and an AUC score of 0.57. Incorporating both data types improved accuracy to 0.67 and AUC to 0.70. Feature importance scores showed step count and questionnaire on racing thoughts and hopefulness as most significant.

Conclusions

Our findings affirm the potential of integrating passive and active data collection to monitor mental health in real-world settings. Our ML model demonstrated moderate accuracy in predicting adolescents’ mental health risk measured with a behavioural screening questionnaire. This study will guide the development of a ML-driven, personalised mobile intervention for early symptom detection and mental health self-management, which might constitute an innovative and scalable tool for mental health prevention and intervention in adolescents.

Key messages

• This study shows the feasibility of using active and passive data to predict mental health risk in adolescents.

• This study informs the development of a personalised machine learning-driven mobile intervention.